FAIR Association of Victims for Accident Insurance Reform
579A Lakeshore Rd. E. P.O. Box 39522
Mississauga, ON L5G 4S6
Response
to: FSCO’s 2014 Statement of Priorities
May 30, 2014
Dear Mr.
Howell,
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 the end users of Ontario‘s insurance product and we represent those
most affected by changes to coverage, Ontario‘s accident victims.
Thank you
for the opportunity to respond to the FSCO 2014 Draft Statement of Priorities.
We would
like to think that the well-being and recovery of Ontario’s accident victims is
priority one for Ontario’s government. The constant erosion of coverage, the
abuse of Ontario’s vulnerable accident victims by insurers and their experts
tells us that this isn’t so.
The reality
of making an auto accident claim in Ontario versus the “open and transparent
system that protects the public” that is described on the FSCO website and in
this draft statement are two totally different realities.
The draft
report speaks of enhancing consumer confidence in FSCO when it is clear that
the system isn’t working and the overpriced coverage we purchase isn’t there
when we need it. Congratulating yourselves on a great job done is disingenuous
when it isn’t an accurate reflection of what is really going on in respect to
Ontario’s auto insurance coverage. We have a system that is at best described
as dysfunctional and at worst as causing harm to innocent accident victims.
This isn’t a system that is effective, timely or fair.
It is a
false promise that FSCO has an open and transparent system - the public should
know that many of the recent changes to coverage were done without adequate
consultation with the public or accident victims. In fact, accident victims
were closed out of any hearings in respect to Bill 171 - as if the 9 million
drivers in Ontario just didn’t matter.
This week
we find out that accident victims’ treatment providers will have to pay
additional fees for using HCAI when they assist MVA victims to access care and
treatment. How is this fighting fraud in the system? How does that fix
anything? It surely won’t be far down the road that the IBC will be saying
(again) that claims costs have risen and that benefits need to be cut again.
Over and
over the changes to our coverage read like a Christmas wish list for the
Insurance Bureau of Canada. Many of our concerns are in the FAIR submission to
the 3 year review http://www.fairassociation.ca/
Why is FSCO
still not taking any action to protect vulnerable accident victims from
predatory assessors? FAIR has asked this question many times – we’ve asked the
Anti-Fraud Task Force, Justice Cunningham at the DRS review, and our
legislators. FSCO is aware that some of Ontario’s regulatory colleges are
failing in their duty and yet you are quite willing to rely on this broken
system of flawed medical assessments rather than fix this fundamental problem.
Accident
victims do not feel protected or that they are being assisted in a “fair and
open system” that is looking after their best interests. Half of those who make
a claim are unable to access medical rehab and other needed benefits and yet
the “FSCO aims to improve the ways in which it regulates and delivers services
to foster consumer protection in the financial services sectors.”
Where is
the protection talked about in this statement? Why are tens of thousands of
Ontario’s accident victims lining up for hearings when they’ve been wrongfully
denied the benefits they paid for in a time of need?
Why are
accident victims still being subjected to poor quality or bogus medical
examinations that are virtually without oversight? Why are MVA victims still
being abused by some individuals in the medical community whose incomes are
dependent on the insurer that hires them to do these poor quality reports? We
ask the question but we already know the answer – benefits are paid out (or not)
based on these medical reports and all an insurer needs is one medical
professional to say an MVA victim doesn’t need the treatment prescribed by
another professional and the claim is denied.
We’d ask
the question why there are so many accident victims lined up for hearings at
FSCO but we already know the answer to that too. See paragraph above.
We’d ask
why cases are still taking so long and why legal costs are so high but we
already know that the line-up and the costs are the direct result of improper
or incompetent denials - see the paragraph above.
Victims
only have one real question that needs answering – when are you going to fix
this dysfunctional system?
We know
there is some fraud everywhere in any system and legitimate accident victims
support fraud awareness. But they don’t support insurer incompetence or fraudulent
deflating of their injuries so insurers can save more money.
Why are
insurers not subjected to the same scrutiny as are claimants and rehabilitation
and support workers? Why are Ontario’s insurer physician assessors not held
accountable for their actions when they produce biased or unqualified reports –
the whole system is based on whether or not an accident victim is injured so
why isn’t there any quality or regulatory action on assuring these reports have
value? Isn’t that lack of oversight the how and why there are so many claims
turned down in Ontario and why our courts are clogged up with cases?
Will the new
prosecution office take legal action on the for-hire medico-legal experts who
falsely deflate injuries and treat it as the insurer fraud it is? If “FSCO
supports that fraudsters should be vigorously pursued and prosecuted where
evidence warrants” it would clean up some of the insurer fraud– or will
insurers be given a free pass again by investigators and prosecutors who turn a
blind eye to the fraudulent practice of unqualified accusations of malingering
by pro-insurer assessors?
The
Statement of Priorities mentions nothing about ensuring adequate coverage for
Ontario’s accident victims but plenty about mitigating risks. We’d like to
point out that the risk of promoting such poor coverage for Ontario’s citizens
and failing to ensure that Ontario’s insurers stand behind their contracts
leads to a significant cost download to the taxpayers. An insurance product
that only covers half of those individuals who are injured is hardly a bargain.
FSCO knows
full well that the Minor Injury Treatment Protocol report is some years away
and since 2010 too many claimants have fallen through the cracks and are left
without care or resources. This study should have been done before such radical
slashing of coverage for Ontario consumers. It is hardly a strategy to do such
a study after making these changes that have benefited Ontario’s insurers while
impoverishing Ontario’s accident victims.
If FSCO aims to improve the ways in which
it regulates and delivers services to foster consumer protection in the
financial services sectors then why are you not holding insurers accountable
when they wrongfully deny a legitimate claim? Why is it that through Bill 171
accident victims will have the interest on money owed to them on overdue
payments reduced to such an extreme low level that it will encourage Ontario’s
insurers to deny even more claims?
And why support less access to justice for
accident victims? Is it so insurers can make even higher profits or is it to
just keep the number of people who are denied access to treatment and benefits
under wraps and out of sight – if they can’t access the courts, they don’t
exist as unsatisfied customers.
Victims of Ontario’s deplorable auto
accident insurance coverage have their own list of Highlights from 2014 and
they can be found on the FAIR web-page at: http://www.fairassociation.ca/
We continue to write and to voice our
concerns to the government but it appears that our concerns are falling on deaf
ears. So in fairness to our members we think that you should read what accident
victims really think about what a great job the Financial Services Commission
of Ontario is doing with the auto insurance sector below.
FAIR Association of Victims for Accident
Insurance Reform
“How can a
blameless victim of insurance crime obtain substantive legal advocacy, when the
criminals are employed by insurance companies whose policies and practices are employed in
predatory ways to deny claim services, intimidate, threaten and injure vulnerable
claimants in a flawed system endorsed by disinterested law enforcement and
bureaucratic enablers?”
“Forcing everyone to purchase car insurance without adequate
coverage and more roadblocks than a obstacle course, is a disservice to all
motorists. Can you imagine becoming permanently disabled and having to settle
for significantly less than the cap applied to your condition? Now you are
being expected to live out the rest of your life on a shoestring budget and
significant physical obstacles. The younger the accident victim is only makes
the situation worse.”
“ My Adjusters denied, delayed my legitimate accident
benefits off and on for 5 years with the use of bogus reports. My case file was
manipulated to provide false representation of a matter of fact by deleting
parts of the file and duplicating others.”
“I have been watching the benefits
of legitimate survivors benefits being slashed over and over to help the
insurers profit margins. Mr. Palumbo, how do you and the IBC sleep at night?
God forbid, you or yours are very seriously injured in a MVA and ASSUME the
benefits are available. For the amount of money being spent by the insurers to
paint a survivor as a fraudster in a claim, with the IBC lining the pockets of
the people willing to accept the your word without actual PROOF, also the
insane amounts being spent on advertising to get the public to buy into the
fraud, thousands of victims could be making maximum in their recoveries with
the funds and resources that the IBC and INSURERS squander!”
“For a few bucks, this government has made it clear
that they have sold out not only accident victims and their families, but every
rate payer who is under the illusion that, should they become injured in an
auto accident, the insurer,who has received thousands upon thousands of dollars
from the rate payer, will actually provide the benefits the insurer is obliged
to provide. This is a government with no compunction as to remove the rights of
Ontario residents and accident victims for the appeasement of an industry.”
“What about bill 59 and then the 2003 changes to
coverage? What about the fact that we only have $3,500 coverage less the cost
of a insurance medical assessment since the 2010 reforms? Where does it end?
High premiums, virtually no coverage and an abusive system that requires a
lawyer to even figure out. It's fake coverage with big business just siphoning
off their profits - no money left for accident victims. What a scam. With the
removal of the punitive value of pre-judgement it's an open season on victims.
Just take our money and run when there's no reason to stand behind the policy
thanks to our government's mishandling of this file.”
“Last year their profit was 4.4 BILLION, yet, they keep using
the old unproven complaint that their are millions of malingerers (liars) out
their costing insurance premium to go up! BULL!! Please do not forget that the
4.4 Billion is from the millions of citizens across Canada that are paying
through the nose for car insurance and the worse treated in this country and in
fact in the whole of North America is right here in Ontario!!!”
“If they state the reason for
their actions is to counter fraud, why are they spending more money to avoid
making payments than would take to simply make the payments as originally promised?”
“The Financial Services Commission of Ontario
and the Insurance Bureau of Canada are one and the same with our government
bending to their every wish.”
“The Insurance Companies are using the smoke
screen of "fraud" to further attack seriously injured victims, and
all the Parties are playing right along. I realize there is fraud in the
system, but it is getting blown "way" out of proportion. Accident
victims are being labelled a fraud until proven innocent and with Bill 171,
they will have fewer resources to fight this injustice. Somehow the biggest
fraud never gets “seriously” put on the table and that would be the for-hire
Independent Medical Examination (IME) Doctors. They treat accident victims with
contempt or worse and deny or delay legitimate claims and benefits. Does this
sound like a system that is trying to help people recover? In my opinion, this
is a Human Rights abuse story.”
“We’ve known for a very long time that the insurance companies and
governments have been in bed together for decades while innocent victims suffer
and are robbed blind due to so much corruption in this Ontario of ours.It is so shocking that the Ontario Governments of the day are willing to abuse the rights of accident victims for the generous political contributions paid by Insurance Companies and the Insurance Bureau of Canada, IF their desires are met.
(IN FACT IT'S THE GENERAL PUBLIC'S
MONEY BEING MANIPULATED TO SEE TO IT THAT INSURANCE COMPANIES AND YOUR
GOVERNMENT ARE TOTALLY IN CONTROL AND FOR PROFIT/POWER WHILE
TRUE VICTIMS ARE DOING WITHOUT AND ARE LEFT IN PAIN).
How many times has the Insurance
Industry, over many years, state that billions are wasted on fraudulent claims
and yet they refuse to produce their evidence?”
“Is this not a human rights issue
when the abuse of the injured is so wide-spread?”
“Since
2003, accident victims have been treated with contempt by the insurance
industry and it’s regulator. Injured persons and their families are receiving
less and less in benefits and even more are being outright denied any benefits.
Regulatory and legislative changes to auto insurance have greatly reduced
financial and medical benefits while industry profits have exponentially risen
within the same time frame. The argument for such changes has been the effort
to combat fraud but does little to do so. How is punitively fining accident
victims $500 for missing an assessment reduce fraud? With the exception of
accident victims, the industry, government and other stakeholders have
persevered in side stepping the issue of IME’s. Assessments that I have filling
up an entire file cabinet all favour the insurance company, a typical outcome
when doctors are paid by the insurer. These documents are sometimes not even
authored by the examining doctor. These assessments are used to delay and deny
benefits, sometimes by a medically untrained adjuster deciding on an accident
victim’s medical needs such as medications and therapies. These medications and
therapies are critical to an accident victim’s recovery in the first two years
following an accident. IME’s are the most critical part of a claim to assess
the severity of an accident victim’s injuries, incorrect or fraudulent reports
guarantee an unfair and unjust outcome. Misrepresentation of the truth by any
party involved denies justice to be seen as being done.”“Why is our government even agreeing to a tax on justice in the first place? Another reason for insurance companies to fight their own customers when the law helps them beat up the defenseless victims. Our government is helping big business cheat their own customers - welcome to Ontario.”
“Scam on top of scam - it's as if the government has never heard of 'protect the public interest' when it comes to insurers - too busy counting donations.”
“The absurdity of a government who mandates that
every driver has insurance and yet stays silent about the coverage we get,
cooks secret deals, takes 'contributions', and abuses their power by changing
coverage without consultation has no business saying they are acting in the
best interests or protecting the rights of their citizens.”
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