Fair Response to: Consultation on Modernizing Disciplinary Hearings for Insurance

Response to: Consultation on Modernizing Disciplinary Hearings for Insurance
Agents and Adjusters in Ontario
Submitted by:
FAIR
Fair Association of Victims for Accident Insurance Reform
579A Lakeshore Rd. E, P.O. Box 39522
Mississauga, ON, L5G 4S6
http://www.fairassociation.ca/
September 30,

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FAIR Association of Victims for Accident Insurance Reform is a not-for-profit consumer
organization whose members are accident victims, their supporters and consumers who have
an interest in Ontario‟s insurance system. Our perspective is one of an end user of Ontario‟s
insurance product and we represent those most affected by ongoing changes to coverage,
Ontario‟s accident victims. We appreciate the opportunity to bring the concerns of Ontario‟s
consumers and auto accident victims to your attention.
We have reviewed the proposed changes in the document „Modernizing Disciplinary Hearings
for Insurance Agents and Adjusters in Ontario‟ posted on the FSCO website. FAIR supports
changes that look to protecting the rights of accident victims through promoting transparency of
those who work in Ontario‟s auto insurance industry.
FAIR often hears from our members about their experiences with Ontario‟s insurance adjusters
and the problems that accident victims encounter when attempting to complain about an
adjuster.
It is odd to consider changing the disciplinary process for adjusters when there is no adequate
process in place for hearing those complaints in the first place. In fact, we were unable to find
any record on the Financial Services website that documents any complaints at any time about
any adjuster. Could this lack of openness about complaints have resulted in no complaints
being heard officially by the Advisory Board (AB)?
Consumers have developed some well-founded suspicion about some sectors of the insurance
industry that are self-regulated - which is to say that these sectors are basically unregulated
wild-west sectors who are never held to account. It looks like oversight of Ontario‟s adjusters
falls into that category – otherwise – where are the records of the complaints?
Accident victims will tell you that there is no place to complain – they can‟t find one.
We are aware of the General Insurance Ombudsman (GIO) and the services they provide in
respect to claimant complaints about adjusters. Claimants are particularly unhappy with the
complaints system as it now stands and have little trust in an Ombudsman who works within the
very company that employs the adjuster who they have an issue with. We are told that their
complaints are sloughed off as unimportant and the Financial Services Commission response to
this is that they are not able to hear of the complaint while a case is open. This is very unfair to
the accident victim whose access to rehabilitation and benefits is dependent on an adjuster
being competent to do their job.
Our members complain of a lack of objectivity and feel they are likely prejudiced against by
having brought the complaint forward to the Insurance Ombudsman. This hardly promotes trust
in the system, in fact, the close relationship between these Ombudsmans and their companies
has contributed to a mistrust of the insurance system overall.
Adjusters have taken on a quasi-medical role in adjusting claims since the Minor Injury
Guidelines MIG have come into effect in 2010. What was proposed as a minor injury guideline
has captured 80% of accident victim claims, many of whom are seriously injured or cognitively
impaired. Adjusters now have the power to essentially practice medicine by rejecting the

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diagnosis and treatment plans of attending physicians. This has harmed thousands of claimants
who have been unable to access timely treatment and whose lives are irreparably damaged by
their insurer‟s denial or delay of their claim by deflating or minimizing their injuries. Accident
victims who are abused in this process of wrongful denial believe that Adjusters should be held
accountable for their actions with Administrative Monetary Penalties (AMPs) when they fail to
comply with rules and regulations. Again, how will the public know that adjusters are
accountable when complaints are shuffled under the carpet because the system isn‟t structured
to hear them?
The proposed changes do nothing to address the consumer right to prompt and fair handling of
claims when it comes to some adjusters. The Ontario Insurance Adjusters Association states
that, “The adjusters shall so act as to promote public confidence in insurance companies through
fair and conscientious dealing, and shall refrain from any fraud, deceit, misrepresentation,
dishonest non-disclosure, undue influence or other mischievous practice. The relationship of the
adjuster to the company is one of trust and confidence calling for the highest degree of good faith
in all transactions.”
Adjusters acting in bad faith have been documented in the media
http://www.torontosun.com/comment/columnists/alan_shanoff/2011/03/18/17672156.html ,
http://www.torontosun.com/2011/11/04/adjusters-forgetting-ethics and in our courts
http://www.fairassociation.ca/the-adjusters/.
Improving and streamlining hearings for oversight that doesn‟t exist in a meaningful way is
misleading to Ontario‟s accident victims and to consumers who expect that adjusters ought to
act in good faith. In other words - the somewhat more transparent system of the Financial
Services Tribunal (FST) hearings with the power to carry through on recommendations or
discipline would be a good thing if the cart were not before the horse so to speak.
The balance of protection must always tilt toward the accident claimant who is the most
vulnerable of consumers. It would be appropriate that the Superintendent consider on an
individual basis whether his/her actions strike the appropriate balance between protecting
consumers, and providing access to justice for agents and adjusters.
Thank you for the opportunity to contribute to this process.
FAIR Association of Victims for Accident Insurance Reform
http://www.fairassociation.ca/
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_{Source: http://www.fairassociation.ca/}