Accident victims still waiting
Being able to obtain insurance benefits on a timely basis is no easy task
If justice delayed is justice denied, then Ontario car accident victims are certainly getting the short end of the stick.
Under Ontario’s no-fault car insurance system, those injured in car accidents are entitled to certain statutory accident benefits for things like partial income replacement, attendant care, and rehabilitation services.
The extent of the benefits is dependent on the extent of the injuries suffered, defined as minor, non-catastrophic and catastrophic.
But being able to obtain accident benefits on a timely basis is no easy task.
If an insurer denies a request for accident benefits, or declines to approve a treatment plan, the injured person is forced to turn to the Financial Services Commission of Ontario (FSCO) for mediation.
The FSCO, which regulates insurance companies, is an agency of Ontario’s ministry of finance.
Now, there’s nothing wrong with mediation in principle.
But it’s non-binding and, worse, the waiting list for a hearing is about one year.
According to FSCO statistics earlier this year, there were 23,336 open pending mediation files. From March 2010 to February 2011, FSCO received 28,043 applications for mediation and closed 18,515 files.
That means the backlog is growing and will continue to do so until either insurance companies and their adjusters change their policies on benefits denial, or FSCO, that is, the provincial government, hires more mediators.
According to an executive director with FSCO, there has been an “unprecedented increase in the number of mediation applications received”.
I’d suggest the chief reason for the growing backlog is the increasing practice of the insurance industry to refuse treatment plans and benefits.
According to Nick Gurevick’s experience — he’s President of the Alliance of Community Medical & Rehabilitation Providers — the decline rate for treatment plans has more than doubled to about 30% in the past year.
If mediation fails — and the failure rate is about 30% — the injured person must file for arbitration and wait another year or so for a hearing.
That means injured people can easily wait a minimum of two years before obtaining a decision on their benefits.
The “lucky” ones, those whose claims are resolved at mediation, only wait about one year.
Imagine the hardship caused by denial of income replacement and therapy for one or two years.
By that time, small injuries can turn into larger ones, or become chronic and rehabilitation less effective.
With zero or reduced income and a lack of therapy, it’s no wonder many accident victims become depressed.
According to Paula Stamp, owner of a firm focusing on accident benefits “insurers deny benefits on a regular and on-going basis,” which has created the huge backlog in mediation and arbitrations.
She believes “the system’s built-in delays encourage insurers to deny payment of benefits they rightfully should pay.”
Why pay for something today when you can delay it for one or two years?
I wonder if some insurance companies aren’t trying to beef up their bottom lines and mitigate investment losses by delaying or denying benefits.
But Kevin Anstee, a case manager with Progressive Case Management Inc., advises me of another related problem: Insurance companies that regularly delay payments by 6-12 months for approved treatment plans.
This places financial pressure on rehabilitation service providers and may eventually push the smaller ones out of business, leaving the field open for high volume businesses or even large U.S. cookie cutter type firms.
Justice delayed is justice denied? That’s nothing new for Ontario’s car accident victims.
Source: Alan Shanoff ,Toronto Sun First posted: Saturday, September 17, 2011 10:00 PM EDT | Updated: Friday, September 16, 2011 08:04 PM EDT
Being able to obtain insurance benefits on a timely basis is no easy task
If justice delayed is justice denied, then Ontario car accident victims are certainly getting the short end of the stick.
Under Ontario’s no-fault car insurance system, those injured in car accidents are entitled to certain statutory accident benefits for things like partial income replacement, attendant care, and rehabilitation services.
The extent of the benefits is dependent on the extent of the injuries suffered, defined as minor, non-catastrophic and catastrophic.
But being able to obtain accident benefits on a timely basis is no easy task.
If an insurer denies a request for accident benefits, or declines to approve a treatment plan, the injured person is forced to turn to the Financial Services Commission of Ontario (FSCO) for mediation.
The FSCO, which regulates insurance companies, is an agency of Ontario’s ministry of finance.
Now, there’s nothing wrong with mediation in principle.
But it’s non-binding and, worse, the waiting list for a hearing is about one year.
According to FSCO statistics earlier this year, there were 23,336 open pending mediation files. From March 2010 to February 2011, FSCO received 28,043 applications for mediation and closed 18,515 files.
That means the backlog is growing and will continue to do so until either insurance companies and their adjusters change their policies on benefits denial, or FSCO, that is, the provincial government, hires more mediators.
According to an executive director with FSCO, there has been an “unprecedented increase in the number of mediation applications received”.
I’d suggest the chief reason for the growing backlog is the increasing practice of the insurance industry to refuse treatment plans and benefits.
According to Nick Gurevick’s experience — he’s President of the Alliance of Community Medical & Rehabilitation Providers — the decline rate for treatment plans has more than doubled to about 30% in the past year.
If mediation fails — and the failure rate is about 30% — the injured person must file for arbitration and wait another year or so for a hearing.
That means injured people can easily wait a minimum of two years before obtaining a decision on their benefits.
The “lucky” ones, those whose claims are resolved at mediation, only wait about one year.
Imagine the hardship caused by denial of income replacement and therapy for one or two years.
By that time, small injuries can turn into larger ones, or become chronic and rehabilitation less effective.
With zero or reduced income and a lack of therapy, it’s no wonder many accident victims become depressed.
According to Paula Stamp, owner of a firm focusing on accident benefits “insurers deny benefits on a regular and on-going basis,” which has created the huge backlog in mediation and arbitrations.
She believes “the system’s built-in delays encourage insurers to deny payment of benefits they rightfully should pay.”
Why pay for something today when you can delay it for one or two years?
I wonder if some insurance companies aren’t trying to beef up their bottom lines and mitigate investment losses by delaying or denying benefits.
But Kevin Anstee, a case manager with Progressive Case Management Inc., advises me of another related problem: Insurance companies that regularly delay payments by 6-12 months for approved treatment plans.
This places financial pressure on rehabilitation service providers and may eventually push the smaller ones out of business, leaving the field open for high volume businesses or even large U.S. cookie cutter type firms.
Justice delayed is justice denied? That’s nothing new for Ontario’s car accident victims.
Source: Alan Shanoff ,Toronto Sun First posted: Saturday, September 17, 2011 10:00 PM EDT | Updated: Friday, September 16, 2011 08:04 PM EDT
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