The wool over our eyes

Nov. 30, 2014

The online magazine, Canadian Underwriter.ca posted a Nov. 24th article wherein the insurer Aviva Canada extols the virtue of the passing of Bill 15 which will come into effect tomorrow. People think this bill will be beneficial to them but it will affect accident victims adversely.  In their article they say the following but you need to read on:

“We are pleased that the Ontario government passed Bill 15 without issue, it is a good first step,” Karin Ots, senior vice president of regulatory and government relations for Aviva Canada said in a statement.

“But to truly affect long-term change for the Ontario auto insurance system, we need to reduce claims costs to be in line with other provinces. The insurer says that for every $1 of premium it earns, $0.65 is paid out in claims costs.
“Claims costs need to come down in order to reduce premiums, especially when 92% of Aviva's policyholders in Ontario do not make a claim,” it said.
In Ontario, accident benefit claims have an average cost of $26,863 compared to $3,628 in Alberta, the insurer also noted, based on 2012 data from the General Insurance Statistical Agency (GISA).

Of those costs, 48% go to non-treatment expenses, such as legal fees and assessments, versus the 52% that go to actually treating of victims, based on Aviva’s own data." But figures quoted below on $ paid by insurers to accident victims  by FAIRAssociation,ca, (Rhona Desroches) are far different than the insurer's figures.

So I put to you, how is it that the insurer is complaining about its costs when it is in the business of collecting premiums to cover individuals when they have a car accident and are injured and 92% of policyholders do not in fact make a claim. 
So if only 8% are making a claim, (chances are  8% of people making claims are not all fraudulent) why did we need legislation to increase insurer's profits? Also, if average claims costs are $26,863 or 48% for non-treatment expenses such as legal fees and assessments, then a whole lot of money is spent by insurers to not pay claimants but to pay their legal representatives and their for hire-medico-experts in order to delay, deny, do surveillance, deny some more, cut off benefits if they were started, deny some more and ignore medical reports by physicians other than IME hires. Moreover, medical and rehabilitation benefits are limited to $3,500 in the minor injuries category, a category which people even with more serious injuries get stuck in unless they fight legally to access the $50,000 they are entitled to under their policies for serious injuries - and then the insurer has the right to deduct their assessment costs up to $2,200 out of this $3,500. One wonders why the insurers are complaining. They seem to have a pretty sweet deal.

Rona Desroches, Chair for FAIR Association of Victims for Accident Insurance Reform points out that "what is most shocking is the fact that any insurer (ie. Aviva) is paying out such substantial sums for defending against claims, 44 million dollars in just 2013 alone. This is just one insurance company paying an average of $7,719.30 in legal defence costs per claim - well above the average amount paid to claimants in 2013. See pg 24 of HCDB report where insurers paid out an average of $4745.00 ($3,934 - $5,557) to injured MVA victims in 2013. The amount paid to victims in the first 6 months of 2014 was a mere $1,790 per claim – meaning that the legal defence costs are now four times as much as the value of what a claimant gets from their insurer. http://www.ibc.ca/en/car_insurance/documents/facts/hcdb%20standard%20report%202014h1%20-%20final.pdf  See pages 58 and 59."

She also adds: "The premium paying public knows nothing of the machine that insurance has become – they all believe that they will be covered if they need it. They will continue to believe this even after the vote on Bill 15 because no one will advise them that on Monday they had certain coverage and on Tuesday the coverage has changed. The public puts its trust in our representatives. Even while coverage is tripped away, people believe that our government is acting in THEIR best interests and not the interest of insurance companies."

Inform yourselves about what you'll be put through if you file after being seriously injured and needing medical and rehabilitation benefits - see "So You Think You're Covered" The Insurance Industry Rip-Off" at www.deniedbenefitclaims.com

Source: http://deniedbenefitclaims.blogspot.ca/2014/11/the-wool-over-our-eyes.html

National News: Shameful backlog of cases at Social Security Tribunal

Nov 18, 2014 - 10:50 PM

Today, Social Security Tribunal Chairperson Murielle Brazeau confirmed that a significant backlog of cases was apparent from the day the Tribunal opened; that she was first in touch with Minister Kenney about insufficient staffing at the Tribunal over a year ago; that there are no performance measures or standards currently in place at the Tribunal, and that it is currently not possible to estimate when the backlog – now at more than 14, 677 cases – can be cleared.

“If we look at the section with the biggest backlog -- Income Security – and assume they’ll continue processing cases at the rate they’ve been going, it will take 11 years to clear it,” said NDP critic for Employment and Social Development Jinny Sims (Newton-North Delta). “Even if they double staff now, it will still take 5.5 years.”

The Conservative government did its best to limit the damning testimony by allowing the Official Opposition only five minutes to ask questions of Ms. Brazeau.

“Ms. Brazeau could not even provide an estimate on when we’ll see the backlog cleared,” said NDP deputy critic for Employment and Social Development Sadia Groguhé (Saint-Lambert).  “It’s been over a year and a half since the Tribunal’s inception, and the situation is worse than ever.”

Author: New Democratic Party of Canada

Source: http://www.northumberlandview.ca/index.php?module=news&type=user&func=display&sid=31642

7 years Victimized by the Insurance World

My first application for disability benefits was submitted to Service Canada in 2008 - one year after the crash. It was denied. Like so many I have been made to appeal. There are an estimated 10,000 appeals waiting to be heard at the Social Security Tribunal from injured disabled people. This is violation against humanity.

In 2007 I was hit head on by an 18 year old speeding and passing on a blind hill, solid double line, coming at me “at 102 km/hr at the end of his skid”. After he took off the front wheel of the car I was driving, the car rolled 8 times, and then hit a tree.

 

To protect my face I had my head sideways in the steering wheel at the time of impact and the airbag detonated on the side of my head at a force 2/3s more powerful than that of today cars. 

I was trapped upside down in the wreck. Permanently injured was my neck, spine, nerves, etc.. http://survivingacollision.blogspot.ca/2014/04/surviving-collision-full-story.html

You may be wondering at this point, how can I create this blog? At the time of this edit it is 3:31am. I have been writing this for months. I can't sleep because of the pain in my neck, back, head, etc.. I can't sleep because I can't stop grinding my teeth, and jaw pain, because I can't stop thinking about the crash, the insurance, the lawyers, the doctors, the therapists, the unjust Service Canada denials and lies that date back to 2007. As well as the Social Security Tribunal with my Appeal that is allowed to be unresolved in limbo.

So, with the help of a word processor, a thesaurus, and, many sleepless days and nights. I have put togeher – togehter together . Sorry I get letters mixed up, I was baqnged on the heaed. I have put together this letter.

I have mandatorily paid into CPP since the 1970's on the understanding that I would have something to fall back on if I could no longer work because of a disability. This understanding was clearly wrong.

CPP Disability Insurance is much like the auto insurance that we paid for, as it is riddled with unjust denials, delays, and unfair fraudulent behaviour. There is unaccountable adjudication. No supports are built into the process. Health and overall well-being are being jeopardized because of layers of complexity and a process designed to ensure failure. The current system is based on discriminatory and misguided assumptions. It is fundamentally flawed stemming from mistakes such as losing medical information, or simply just denying medical documentation exists. It is a prolonged drawn-out process.

Fair Association of Victims for Accident Insurance Reform has been an inspiration to me for they have published their findings of the insurance world schemes upon their website, and they advocate on behalf of the victims of insurance. Thank you to Fair for being there for the survivors and “supporting auto accident victims through advocacy and education”. Fair is a leading force for reform. They fight for justice not only for crash victims but for all Ontarians.  http://www.fairassociation.ca/ 

When I am able, and with the help of information I receive from sources like Fair Association of Victims for Accident Insurance Reform , I started blogging and Twittering about the Insurance world:

Surviving a Collision,http://survivingacollision.blogspot.ca/

https://twitter.com/Bears_world

Canadian Insurance News,http://cinsurancenews.blogspot.ca

https://twitter.com/Cinsurancenews

Social Security Tribunal Research Centre,http://sstrc.blogspot.ca/

 

I can only hope that my faxes, emails, blogs, web sites, and submissions to the government have not effected my appeal negatively. Insert link here after they deny appeal.

At the time of this writing I have spent 7 years in the insurance world dictatorship of deceit and at this point don’t give a shit anymore about the process. A process that is designed for the applicant to fail. The bogus denial letters written by bias Service Canada wordhirlings that make their living at the expense of innocent victims. 

I have learned how badly corrupt and backed up our justice system was during the FSCO backlog. How doctors that don't write their own reports will circumvent fee caps, and commit crimes to satisfy their employer, our insurer. 

I have learned that our private health information is allowed to be carried around on laptops by pay-for-hire therapists. Our private health information is also loose and run a muck in the hands of the HCAI data base where our information can be gained by anonymous users. 

I have learned how the insurance lobbyists work on twitter and how to expose them: Insurance Reform Investigation

 

I have learned that it's acceptable that an Insurer can dictate to a doctor how to treat a patient? This shouldn't be the case.

I have learned about the Ambulance chasers preying on the most vulnerable in our society- the injured crash victim. A private society that milks victims for as much as they can by overcharging made up fees and dragging things on and on for years so they can line their pockets with our money. An industry that preys on the weak, sick, and injured. Yeah I’m talking about the lawyers. The backroom deals. The slander. The ones that are letting it all go down.

I learned about the kickbacks from the drug cartel to the doctors and how the complaint process doesn't work at CPSO - the inmates run the prison. The self regulated insurance industry of the College of Physicians. 

I’ve learned that crash victims have very little voice, and so many victims are loosing so much, because of bad decision makers making one-sided legislation and allowing this conduct to continue to legitimate victims of MVAs.

Now I’m learning how to advocate for the injured crash victims. Victims of their own insurance systems. I'm learning to expose all of this to the public -while being injured, and having no income. That's how I choose to spend my time. That's my job now. If I am pissing you off by my writing, then I'm getting something back, some satisfaction at the very least. I’ve been threatened with legal action more than once because of my inability to pay lip service. I was told by the Tribunal that if I can blog I can work. Is there such a job for me? Can I expose the insurance world and be paid on a while I can basis?

As you know I tried to go back to work ( on my own) but was unable to because of injures I sustained in the crash ( that was not my fault) in 2007. Luckily I have been supported by my spouse all this time, she supports our family with her part time job. She pays for my medication, something she should not have to do.

The thing that is missing in the latest media coverage on this subject is; what about the spouses of the insurance victims? What about them? What about the families of these 10,000 people? It becomes much more that 10,000 victims. Kids that couldn't afford to go to school, bankruptcy, dying while they wait for benefits. How does that effect society and how many families have been destroyed by this relentless one sided process? 

In one year (2010/2011)  FSCO spent a total of $59 million of insurance dollars, while in the same time frame my case; “will take a year or more to get a hearing at FSCO”. Justice was delayed and lost to sign on the dotted line because we'll starve you out if you don't. Crash victim turned into insurance-justice-system-victim. 

IBC profits are in the billions every year with$146 billion in total assets. 

The Canada Pension Plan has assets over $180 billion and can't even meet my numerous requests for a copy of my file. 

Any reasonable person would question where the money is really going if it's not going to the disabled victims. The insurance dictatorship world of deceit is an industry built on smoke and mirrors and our dollars. Pay-for-hire Doctors, Lawyers, Therapists, Wordhirlings, assessment mills, etc.  prey on innocent victims and make lots of money from our misfortune. 

Where was my insurance when we needed it...? Where was my justice...? Where was my Government...? Where is the Social Security Tribunal and my appeal that Service Canada delayed and fraudulently denied for years and why are they still not sending my file to the Social Security Tribunal?

This delaying, denying, bullshit, has got to stop! Who will fix this before we are bankrupt and forced to rely on social assistance, or be forced to become a criminal and survive off rations from a cell?

For 36 years I have always paid my auto insurance, and on time. 

Since the 1970's my employers and I have paid CPP payouts to the Government. 

This money was not a gift!

Looking forward to hearing from you as soon as possible with an update to the status of my appeal, to the ruling by Service Canada, about my claim for disability benefits, since 2008.

Because of a crash in 2007.

Administrator,

Surviving a Collision
http://survivingacollision.blogspot.ca/

SOME NAMES HAVE BEEN REMOVED TO PROTECT THE INNOCENT

Minivans do poorly in new crash tests by the insurance industry

By: Dee-Ann Durbin, THE ASSOCIATED PRESS 2014-11-20

---

DETROIT - The Honda Odyssey was the only minivan to earn the highest safety rating in new crash tests by the insurance industry.


The Insurance Institute for Highway Safety said Thursday that the Nissan Quest, Chrysler Town and Country, and Dodge Caravan all garnered the lowest rating on the small overlap front crash test, which replicates what happens when a vehicle's front corner collides with another object at 40 miles per hour.

In each of those cases, the minivans' structure collapsed from the force of the crash. In the Quest, both of the dummy's legs were trapped and the air bag was shoved up into its face, the institute said. In the Town and Country, the dummy's head slid off the air bag and hit the instrument panel.

The Toyota Sienna earned the second highest rating of "acceptable.'' The institute said its structure was weak but the dummy was protected by its side air bags.

Only the Odyssey won a "good'' rating. Its structure was damaged, but the dummy was protected from serious injury, the group said.

The Arlington, Virginia-based institute introduced the small overlap test in 2012. This was the first time a group of minivans was tested, and the institute said it was surprised to see some of the worst outcomes possible for this type of severe crash.

Minivans are at a disadvantage because they are wider than the car platforms they're built on. That leaves large areas that are less able to absorb the force of a crash. Minivans are also heavier than cars, so the damage they inflict can be more severe.

One other minivan sold in the U.S., the Kia Sedona, has not yet been tested. Kia is making a change to the vehicle that should improve its performance, the institute said. It will be tested in a few weeks.

Source: http://www.canadianunderwriter.ca/news/minivans-do-poorly-in-new-crash-tests-by-the-insurance-industry/1003362599/xqyv5s0w2vW6x08yM2vx/?ref=enews_CU&utm_source=CU&utm_medium=email&utm_campaign=CU-EN11212014
 

Social Security Tribunal says more than 14,600 Canadians are now waiting for a hearing

Wednesday, November 19, 2014 

Social Development  

    [Table of Contents]

Mr. Robert Aubin (Trois-Rivières, NDP):  

    Mr. Speaker, on Tuesday the chair of the Social Security Tribunal confirmed that there are significant delays in the processing of cases: 14,677 cases are languishing on her desk.

    At this rate it will take 11 years to clear the backlog just for the income security section. That is shameful. For over a year, Ms. Brazeau has been in regular contact with the minister about the lack of staff at the tribunal, but the minister is asleep at the switch.

How can the minister allow such an administrative nightmare?

    [Table of Contents]

Hon. Jason Kenney (Minister of Employment and Social Development and Minister for Multiculturalism, CPC):  

    Mr. Speaker, thanks to my department's efficiency, we have seen a 90% decrease in employment insurance appeals. That means that almost 90% of cases are handled by public servants, without appeal. The service is quicker.

    In the case of Quebeckers, the Government of Quebec has its own appeal process for benefits paid by the Quebec pension plan, which does not fall under the Social Security Tribunal.

[English]

    [Table of Contents]

Ms. Jinny Jogindera Sims (Newton—North Delta, NDP):  

    Mr. Speaker, yesterday, the chair of the Social Security Tribunal told the human resources committee that she had been in continuous contact with the minister regarding the backlog. Yet, for 18 months now, that backlog has continued to grow, while the tribunal has been understaffed and working without performance standards. More than 14,600 Canadians are now waiting for a hearing.

    Why did the minister not take action sooner to address the enormous mess at the Social Security Tribunal?

    [Table of Contents]

Hon. Jason Kenney (Minister of Employment and Social Development and Minister for Multiculturalism, CPC):  

    Mr. Speaker, again, in fact our ministry did take action by introducing a new approach toward reconsideration of EI refusals. That now happens quickly, by a public servant who, remarkably, actually picks up a phone and calls the person who has asked for a reconsideration, and sorts it out, often getting additional documentation.

    This means that we are now resolving about 90% of those refusals at a reconsideration stage in a matter of weeks, without having to go through a lengthy multi-month quasi-judicial process.

    In terms of the CPP cases before the tribunal, we are adding additional decision makers and taking other administrative measures to speed up the process.

    [Table of Contents]

Mr. Mike Sullivan (York South—Weston, NDP):  

    Mr. Speaker, behind every one of those numbers is a person who needs to put food on the table and pay the bills.

    People cannot wait years for the government to get its act together. Nearly 10,000 Canadians still waiting for an appeal are living with a disability. In many cases the uncertainty and stress of financial insecurity makes their medical conditions worse.

    Will the minister commit to eliminate the backlog and finally give these Canadians the justice they need and deserve?

    [Table of Contents]

Hon. Jason Kenney (Minister of Employment and Social Development and Minister for Multiculturalism, CPC):  

    Yes, I will, Mr. Speaker. That is, in part, why we have legislation before the House in the budget implementation act, which we hope the NDP will support. This would allow us to hire up to an additional 22 decision makers at the tribunal. 

    I am very pleased to highlight that the faster informal reconsideration process for refused EI applications means a 90% reduction in the caseload for EI, meaning we can reallocate those decision makers over to the income security division. This means we will get at that backlog of cases so we can provide the kind of service that Canadians expect and deserve.

Source: http://www.parl.gc.ca/HousePublications/Publication.aspx?Language=E&Mode=1&Parl=41&Ses=2&DocId=6781650#Int-8510994

Committee Transcripts: Standing Committee on General Government - 2014-Nov-05 - Bill 15, Fighting Fraud and Reducing Automobile Insurance Rates Act, 2014

05-NOV-2014_G004.htm  

 

STANDING COMMITTEE ON GENERAL GOVERNMENT

Wednesday 5 November 2014 Mercredi 5 novembre 2014

Fighting Fraud and Reducing Automobile Insurance Rates Act, 2014 Loi de 2014 de lutte contre la fraude et de réduction des taux d’assurance-automobile
Ontario Trial Lawyers Association
Insurance Bureau of Canada
Aviva Canada
The Advocates’ Society
FAIR, Association of Victims for Accident Insurance Reform
CAA South Central Ontario
North American Auto Accident Pictures, Towing Division
Associated Towers Guild of Ontario
Fair Value Committee
Ontario Rehab Alliance
Associated Canadian Car Rental Operators
Ontario Safety League
Towing and Recovery Professionals of Ontario
Canadian Finance and Leasing Association
Code Yellow Towing

Bill 15: New Auto Insurance Legislation Inhibits Access to Justice, Requires Amendment

With Bill 15, introduced in July 2014, the government has brought forward amendments that were initially introduced earlier this year. OTLA welcomes the new legislation which would bring forward Justice Douglas Cunningham’s much-needed reforms to the auto insurance dispute resolution system.

While we welcome the majority of the recommendations, there are two outstanding issues that we ask MPPs to address through amendments at committee:

1. ensuring accident victims have access to the Courts and,
2. setting a fair prejudgment interest rate to ensure timely access to justice.

The Right to Sue

Currently, accident victims have the right to go to Court or to arbitration to dispute decisions made by their own insurance companies that deny them necessary benefits, including income replacement benefits and medical and rehabilitation treatments. But under the proposed Legislation, claimants will only be able to advance claims to the Licence Appeal Tribunal. The removal of access to the court is going to lead to huge amounts of wasted dollars and duplicated efforts.

If a person is injured and it was someone else’s fault, and that person also has a dispute with his or her insurance company about benefits, the injured person will now have to pay a lawyer to handle two different legal claims, in two entirely different systems: a lawsuit in Court against the person who caused the injury, and a totally separate dispute through the Licence Appeal Tribunal for benefits that were wrongfully refused. This dual system is going to add tremendous unnecessary costs to the system. Doesn’t it make sense to allow accident victims the right (that they currently have) to bring the two claims together before the court and to vastly reduce the costs they have to incur? The province will also benefit by allowing victims to use one process instead of paying for the cost of two hearings and two decision makers.

Our complex system of benefits already makes it extremely difficult for people to access the benefits to which they are reasonably entitled. This proposed change that takes away the right to sue and will result in more victims just giving up because they can’t afford the fight. Maybe that’s why the insurance sector wants to push this change through.

Prejudgment Interest for Innocent Victims

Bill 15 also proposes to change a 30-year-old rule that has been so important to those who have suffered injuries in Ontario. “Prejudgment interest” on pain and suffering damages is intended to compensate an innocent victim when the negligent person’s insurance company delays paying those damages. Basically, it ensures timely payment for damages by insurance companies to innocent victims. No one can argue with the fact that timely resolutions are in the best interest of both sides of any dispute, and the Court system.

Currently, insurance companies are required to pay 5% interest on whatever sum injured people are owed for pain and suffering. For example, if an injured person has a serious injury and his or her injury is ultimately assessed at $50,000, but the insurance company delays paying the claim for 3 years, the insurer would have to pay $7,500 in interest. That’s not a lot, but at least it is something to compensate for the delay, and it serves as an important incentive for insurers not to purposely delay settlement of claims!

The Ontario Trial Lawyers Association is urging MPPs to consider changes to this section of the legislation because, as it stands now, the bill would give insurers an economic incentive to delay providing compensation to innocent victims.

Insurers invest their money and, according to the federal regulator, they made about 4% on these investments in 2012, and 3% in 2013. Under the proposed legislation, prejudgment interest would be slashed to 1.3%. The insurance companies would therefore stand to earn 1.7% profit on the innocent victim’s money for every year that they put off settling with that victim. It’s really just simple math! Don’t forget – that money belongs to the injured person. If the prejudgment interest rate is reduced to 1.3%, insurance companies will directly profit from NOT paying injured people the money they are entitled to for years. With the proposed reduction in prejudgment interest, there is no incentive whatsoever for insurance companies to settle cases on a timely basis. If the government wants to look more closely at this issue, it should simply determine how much money insurers have been making on their investments, and set the prejudgment interest rate at a level that doesn’t create any incentive to delay. In comparison, injured people who can’t work and have to borrow money to get by are certainly paying interest at a rate much higher than 5%!

The insurance companies would stand to earn 1.7% profit on the innocent victim’s money for every year that they put off settling with that victim.

It Denies Justice To Innocent Accident Victims!

In addition to continuing to line the pockets of profitable insurance companies, the reduction of the prejudgment interest rate will delay the cases in the system. If you have heard how backlogged some of our Courts are now, imagine what will happen if insurers can delay payments for years with no financial penalty! It means that fewer cases will settle at an early stage, more cases will have to be set for trial, more judges will be needed to conduct extra pre-trial conferences, and this will lead to even longer backlogs in the courts. All of this, of course, will come at a significant cost to our justice system.

We urge MPPs to consider minor amendments to address these outstanding issues in Bill 15. We look forward to bringing these concerns forward again when the bill is referred to committee.

Source: http://otlablog.com/bill-15-new-auto-insurance-legislation-inhibits-access-to-justice-requires-amendment/
 

New auto insurance legislation restricts right to sue, critics say

The Ontario Trial Lawyers Association says the devil is in the details of legislation designed to reduce auto insurance premiums and tackle fraud.

Victor Biro / Toronto star file photo 

The Fighting Fraud and Reducing Automobile Rates Act passed Thursday but the Ontario Trial Lawyers Association says the legislation removes a motorist’s right to sue an insurance company for denying their claims. 

 

By: Richard J. Brennan Provincial Politics, Published on Thu Nov 20 2014

 

 

The Ontario Trial Lawyers Association says the devil is in the details of legislation designed to reduce auto insurance premiums and tackle fraud.

The Fighting Fraud and Reducing Automobile Rates Act passed Thursday but Steve Rastin, president of the OTLA, noted there’s a clause buried in the legislation that removes a motorist’s right to sue an insurance company for denying their claims.

Bill 15 doesn’t actually mention an earlier 15 per cent reduction that was spelled out in the 2013 budget.

“We are profoundly disappointed in the government for what they did today,” Rastin said, noting the government has replaced the right to sue for denied claims with a convoluted arbitration system that, he claims, will be both costly and time consuming.

Rastin said while the association supports most of what is included in the bill, it finds the removal of the right to sue, and reducing the interest rates that injured claimants get on their money from insurance companies — which is kept in a reserve account — from 5 per cent to 1.3 per cent as completely unacceptable.

“The legislation says it’s all about fraud and fighting costs. There is a lot more in there than that that’s been added to it. The legislation ends the right of an accident victim to sue the insurance company in the courts for not paying for benefits,” Rastin said.

Finance Minister Charles Sousa first promised the 15 per cent reduction in August 2013 when the New Democrats made that a condition of supporting the then-minority Liberal government’s budget earlier that year.

As it turned out the NDP voted against the bill Thursday for many of the reasons cited by the trail lawyers, including the fact the reduction in premiums is taking too long. From August 2013 to this August the premiums dropped by an average of only 6 per cent.

Ralph Palumbo, vice-president, Ontario, Insurance Bureau of Canada, welcomed the legislation.

“Everyone — including the insurance industry — is in agreement on one thing: auto insurance in Ontario is far too expensive. We realize the financial hardship it can create for vehicle owners, particularly young people and those in northern and remote communities . . . now we have an opportunity to begin fixing the system once and for all,” Palumbo said.

Source: http://www.thestar.com/news/queenspark/2014/11/20/new_auto_insurance_legislation_restricts_right_to_sue_critics.html

Auto insurance bill passes in Ontario Legislature

The Ontario legislature passed a bill Thursday aimed at reducing car insurance premiums an average of 15 per cent by next August from where they were in the summer of 2013.

The government said rates have fallen about six per cent since it first introduced the bill, which is aimed at tackling fraud to lower costs for insurance companies and "is expected to help lower insurance rates" for Ontario drivers.

"We want to make sure people with clean records get the benefit of the cost reductions that are going to be imposed now by this piece of legislation," said Finance Minister Charles Sousa. "And they should be seeing, on average, a rate reduction of 15 per cent because that's what we're trying to fight for."
Sousa said 21 of the 120 auto insurance companies in Ontario have already lowered their premiums an average of 10 per cent in just over a year.

NDP voted against legislation

The New Democrats forced the then-minority Liberal government to agree to legislate a 15-per-cent cut in car insurance premiums over two years in exchange for allowing the 2013 budget to pass.

But the NDP voted against the insurance bill Thursday, insisting it was a bad deal for motorists because it takes away their right to sue if accident benefits are denied.

"Removing more protections for people is not the right way to go," said NDP critic Jagmeet Singh. "It's a significant loss of our rights, and this is not a good bill."

MPPs are voting Thursday on the third and final reading of a bill that is aimed at reducing the cost of auto insurance for consumers. (Geoff Nixon/CBC)

The NDP said insurance companies saved $2 billion when the Liberals changed regulations in 2010 to cut the cap on payouts for routine accident claims in half, and can afford to pass the savings on to drivers in the form of lower premiums.
"These benefit reductions are ongoing, not a one-time thing, and are going to continue forever," said Singh. "So the insurance industry has more than enough profits, more than enough room to provide the 15 per cent reduction."

The Progressive Conservatives supported the legislation, but doubted the Liberals would be able to achieve 15-per-cent cuts in premiums by next August after they failed to meet the eight-per-cent reduction goal set for this past year.
"They're not on target, and admitted today they are at six per cent," said PC finance critic Vic Fedeli. "Much like missing their revenue targets, they've already missed this insurance rate-reduction target, but it is a step forward and that's why we voted in favour of it."

More:
Source: http://www.cbc.ca/news/canada/toronto/auto-insurance-bill-passes-in-ontario-legislature-1.2841928
 

NDP-inspired Bill 15 passes – without NDP support

by Donald Horne | 20 Nov 2014

Bill 15 was passed in the legislature this morning at Queen’s Park, ironically without the support of the party that had put it forward as a condition for the passage of the 2013 then-minority Liberal budget.

The legislation is primarily aimed at reducing car insurance premiums an average of 15 per cent by next August, and has been welcomed by the Insurance Bureau of Canada as the first step to reducing the cost of auto insurance in Ontario.

“It’s a great step and strikes a blow at those in the car accident business who have wrongly profited from the current auto insurance product,” said Ralph Palumbo, Vice-President, Ontario, IBC. “Everyone – including the insurance industry – is in agreement on one thing: auto insurance in Ontario is far too expensive. We realize the financial hardship it can create for vehicle owners, particularly young people and those in northern and remote communities.”

The Liberals say the bill will help tackle fraud to lower costs for insurance companies, which “is expected to help lower insurance rates for Ontario drivers.”

Premier Kathleen Wynne’s government says the Fighting Fraud and Reducing Automobile Insurance Rates Act is designed to help those injured in collisions settle disputed claims faster.

However, groups like FAIR (fair association of victims for accident insurance reform) have been arguing that the opposite will happen, pointing to the provision for reducing the Prejudgment Interest to 1.3 per cent, which FAIR feels will only encourage insurers to dispute more claims.

“There needs to be more accountability, not less,” says FAIR’s board chair Rhona DesRoches. “Without anything to discourage them, insurers will be incentivized to systematically deny claims through the use of partisan medical reports prepared by their preferred medico-legal ‘expert’ assessors to deflate a claim.

“All because, for some unknown reason, it’s generally believed that honest and unbiased medical assessments of accident victims is a bad thing.”

Bill 15 had its birth back in 2013, when the NDP forced the then-minority Liberal government to agree to legislate a 15 per cent cut in car insurance rates in exchange for allowing the 2013 budget to pass.

And that 15 per cent mandated cut has been a tough pill to swallow for insurers.

George Kalopsis, president and chief operating officer at Echelon Insurance, has said that the holy grail of 15 per cent won’t come from a single silver bullet – especially fraud.

“Fighting fraud is important, but I don’t think it gets us to the 15 per cent,” Kalopsis told Insurance Business. “You can reduce costs for insurers by streamlining the filing process, and develop a clear and sustainable definition of catastrophic impairment. There is no one silver bullet. They are all important, but unfortunately, we’re missing some of those bullets in our gun right now.”

Bill 15 provides the basis for:

• Establishing a more efficient and effective dispute-resolution system;
• Continuing the right of claimants and insurers to appeal decisions to the courts;
• Continuing the right of claimants to pursue tort claims in court;
• Reducing  the prejudgment interest that can be awarded for non-economic losses to reflect current interest rates; and
• Reducing fraud and abuse in the towing and vehicle storage industries.

With Bill 15 only awaiting royal assent, the insurance industry is now better positioned to rectifying some of the issues facing Ontario auto insurance, says the IBC’s Palumbo.

“Now we have an opportunity to begin fixing the system once and for all,” said Palumbo.

Fitbit Data Now Being Used In The Courtroom

The Fitbit 'Force' band; its data coming to a court room near you? (Image via Fitbit)

Personal injury cases are prime targets for manipulation and conjecture. How do you show that someone who’s been in a car accident can’t do their job properly, and deserves thousands of dollars in compensation? Till now lawyers have relied on doctors to observe someone for half an hour or so and give their, sometimes-biased opinion. Soon, they might also tap the wealth of quantifiable data provided by fitness trackers. A law firm in Calgary is working on the first known personal injury case that will use activity data from a Fitbit to help show the effects of an accident on their client.

The young woman in question was injured in an accident four years ago. Back then, Fitbits weren’t even on the market, but given that she was a personal trainer, her lawyers at McLeod Law believe they can say with confidence that she led an active lifestyle. A week from now, they will start processing data from her Fitbit to show that her activity levels are now under a baseline for someone of her age and profession.

It will “back up what she’s been saying,” says her lawyer, Simon Muller of McLeod Law.

The lawyers aren’t using Fitbit’s data directly, but pumping it through analytics platform Vivametrica, which uses public research to compare a person’s activity data with that of the general population.

Muller says the case is “unique,” and does appear to be the first known case where data from a wearable is used in court. (If other earlier cases come to light I will update this post.)

“Till now we’ve always had to rely on clinical interpretation,” Muller says from his office in Calgary. “Now we’re looking at longer periods of time though the course of a day, and we have hard data.” His plaintiff will share her Fitbit data with Vivametrica for several months as part of an assessment period.

“We’re expecting the results to show that her activity level is less and compromised as a result of her injury.”

What’s intriguing (and a little creepy) is that cases like Muller’s could open the door to wearable device data being used not just in personal injury claims but in prosecutions. “Insurers will want it as much as plaintiffs will,” says Muller, for assessing sketchy claims.

Insurers wouldn’t be able to force claimants to wear Fitbits as part of an “assessment period,” like Muller’s client, but they could request a formal court order from whoever holds the data to release it to them, says Dr. Rick Hu, co-founder and CEO of Vivametrica. “We would not release the information,” he adds. Insurers could instead request it from a law firm or even from Fitbit directly.

“It’s always evolving with technology,” says Muller. “A number of years ago we saw courts requisition Facebook [for] information. If you’ve been wearing the Fitbit monitors it’s likely you’ll see court applications to compel disclosure of that data.”

Data from wearables is poised to become even more insightful for courts as their sensors become ever more sophisticated: tracking not only steps, but continuous heart beat and temperature data.

Legal experts have already speculated about the idea of forcing the disclosure of wearable data on various law blogs. Says Neda Shakoori at McManis and Faulkner (emphasis mine):

Wearables are yet another example of how technology may be a gold mine of potentially relevant [electronically stored information] for use in litigation. Take, for example, a personal injury case where a plaintiff is claiming the injuries he sustained in an automobile accident prevent him from participating in physical activities, such as running. Suppose further that the plaintiff has worn a fitness tracking device which has been recording every one of his five-mile runs during the past three months. The data generated by the plaintiff’s wearable device may be discovered in litigation and, as a result, completely discredit plaintiff’s case for damages resulting from the accident.

Wearable devices could become a “black box” for the human body, adds Matthew Pearn on Claims Canada, who says several previous court cases have already paved the way for more invasive disclosure of digital information in the court room.

At Muller’s law firm, using Fitbit data for his personal injury claim isn’t a one off.

“I’m already lining up more clients with a variety of circumstances to use this data,” he says. “You can’t rely on just one piece of data. You have to get all the pieces lined up.”

Insurance model 'scandalously dishonest,' says FAIR

As debate over Bill 15 continues at Queen’s Park, one accident victims’ group is advocating that the Colorado Model of Assessors be adopted.

“The Colorado Model of Assessors just might move Ontario’s insurance industry from a scandalously dishonest and bullying business model to a more functioning system,” says Rhona DesRoches, the board chair for the fair association of victims for accident insurance reform (FAIR). “If you reward Ontario’s insurers existing bad behaviour by making it less costly to behave badly we will not be further ahead and the life of accident victims will be even more stressful and harmful.”

Describing the Colorado model as a “highly successful and cost saving program,” DesRoches has been at the sharp edge of the sword slamming Bill 15 for what her association describes as the first step towards insurers becoming less accountable and less willing to honour contracts with auto accident victims.

“While we are sure that is not the legislator’s intent, it certainly will be the result of passing Bill 15,” says DesRoches. “Insurers will be less likely to stand behind their contracts and victims will be further victimized and marginalized without fair access to our courts – everything Ontario’s insurers need to increase profits.”

DesRoches specifically took aim at testimony from an Aviva representative who recently spoke at the Bill 15 hearings.

“Legislators heard from the Aviva representative at the hearings on Bill 15. Most shocking is the fact that any insurer is paying out such substantial sums for defending against claims, 44 million dollars in just 2013 alone,” says DesRoches. “This is just one insurance company paying an average of $7,719.30 in legal defence costs per claim - well above the average amount paid to claimants in 2013.

“So is there a cure for this dysfunctional and bullying insurance system we have? We don’t know but we think that holding insurers accountable when claims are wrongfully denied and cleaning up the medical opinions (on which the denial is based) would be a positive first step.”

DesRoches cited an HCDB (Health Claims Data Base) report where insurers paid out an average of $4,745 ($3,934 - $5,557) to injured MVA victims in 2013.

“The amount paid to victims in the first 6 months of 2014 was a mere $1,790 per claim,” she says, “meaning that the legal defence costs are now four times as much as the value of what a claimant gets from their insurer.”

The Colorado Model

The Colorado model was created in 1996 in response to what that state saw as a perception that the claims process was biased.

The new program – under Colorado’s no fault law – provides the exclusive mechanism for resolving disputes over the reasonableness, necessity and relatedness of treatment following MVAs. The program (the Personal Injury Protection [PIP] Examination Program) makes available a group of licensed health care providers, experienced in the treatment of MVA issues and actively engaged in clinical practice, who have not earned more than half their income or spent more than half their professional time performing IMEs, to examine patients when a dispute with the insurance company arises.

When a dispute arises and an examination is requested, a list of five qualified practitioners in the same specialty as the treating doctor whose opinion or bills are disputed is prepared and within five days of the request sent to the party disputing the claim (usually the insurance company, but maybe the patient in the case that there was a dispute over an earlier IME). If neither side can agree on one person from the list to conduct the examination, the insurer and the patient each strike two names and the remaining practitioner performs the examination.

The examiner is required to address in a written report the issues in dispute, and the insurer is required to pay the benefits if the examiner agrees with the previous treatment rendered or with the medical conclusions of the treating doctor. If either party is dissatisfied with the findings, that party may request and pay for a second IME under the same procedures of selection.

In this case, the conclusions of two of the three practitioners (the two examiners and the treating provider) are binding, and the examiner must physically examine the patient and review the records, which must be supplied by the insurance company; and the patient may augment the records as necessary.

The requesting party is obligated to pay the examiner’s fees, DesRoches points out. 

The whole process is designed to be completed within 45 days of when the insurer initially disputes the claim.

The problem with Bill 15 – and will only encourage insurers to dispute more claims, says Desroches – is that the Prejudgment Interest will be reduced to 1.3 per cent.

“There needs to be more accountability, not less,” she says. “Without anything to discourage them, insurers will be incentivized to systematically deny claims through the use of partisan medical reports prepared by their preferred medico-legal ‘expert’ assessors to deflate a claim.

“All because, for some unknown reason, it’s generally believed that honest and unbiased medical assessments of accident victims is a bad thing,” says DesRoches.




Source: http://www.insurancebusiness.ca/news/insurance-model-scandalously-dishonest-says-fair-185489.aspx?p=3

Addiction and Pain Management Programs Not Mandatory ICBC Benefits

November 19th, 2014 

Reasons for judgement were released today by the BC Supreme Court, Vancouver Registry, finding that an addiction program and a multi-disciplinary pain management program are not mandatory ICBC No Fault benefits.

In today’s case (MacDonald v. ICBC) the Plaintiff was inured in three separate motor vehicle collisions.  She was insured with ICBC.  She suffered a variety of injuries which resulted in chronic pain and addiction issues.  Among the recommended treatments for the Plaintiff were an inpatient residential addiction treatment program along with a multi-disciplinary pain management program.

ICBC refused to fund these under the Plaintiff’s policy of insurance arguing that neither of these programs were ‘mandatory’ benefits covered under section 88(1) of the Insurance (Vehicle) Regulation.  Madam Justice Fitzpatrick agreed finding components of the programs (such as physiotherapy) may be covered individually and further that the programs may be covered as ‘permissive’ ICBC benefits, they could not be compelled under section 88.  In reaching this conclusion the Court reasoned as follows:

[83]         The mandatory provisions in s. 88(1) stand in contrast to those in s. 88(2) where ICBC may provide funds to an insured at its discretion and where ICBC’s medical advisor advises that funded benefits under this section are likely to promote the rehabilitation of the insured who was injured in an accident…

[95]         I am reluctantly driven to the conclusion that Ms. MacDonald’s position is not supportable. As ICBC argues, I think correctly, the Raguin decision has confirmed that the proper interpretation of the section is a more restrictive one in the sense that it is driven by the specific enumerated services that are described in s. 88(1). In accordance with that approach, I see no basis upon which services could be seen to be included as long as they are overseen or supervised by a medical doctor. Services provided by others do not become “medical services” simply because a medical doctor directs them or oversees or supervises them.

[96]         From a public policy perspective, this strict interpretation of the enumerated services presents some difficulties. It is unlikely that the Legislature intended to adopt a rehabilitation-in-pieces approach to legislation that exists to promote reasonable and necessary benefit coverage to injured persons. However, in the absence of clear guidance in the Regulation that s. 88(1) is capable of supporting multi-disciplinary programs, these programs cannot be read-in to include other services not specifically enumerated, such as the court did in Raguin.

[97]         Even accepting Ms. MacDonald’s proposition regarding medical supervision, there is no evidence that in fact, the services at Heartwood and the “other services” at Orion Health either were or would be under the supervision of a medical doctor (although I appreciate that Dr. Mead continued to treat Ms. MacDonald for pain and addiction issues throughout her stay at Heartwood).

[98]         The difficulty is that the argument for both Heartwood and Orion Health is an all or nothing proposition. Both are, as described above, multi-disciplinary treatment programs that bring in various disciplines in order to offer a team approach to dealing with a host of problems, such as Ms. MacDonald has. I have no hesitation in finding that some of the services, such as provided by a medical doctor, were or would be covered under s. 88(1) but it is equally apparent that some are not. In my view, this leads to the conclusion that the treatment programs, as a whole, are not covered under s. 88(1).

Source: http://bc-injury-law.com/blog/

 

Growth slows and Revenues Fall: Liberals’ Economic Statement

Tuesday, 18 November 2014 05:02

Catherine Fife, Ontario NDP Finance Critic (MPP, Kitchener-Waterloo), says that Liberals’ fall economic statement shows that Ontario’s slow growth and falling revenues will result in deeper cuts, more privatization and sale of public assets.

“Liberal mismanagement means Ontario is going to miss four years’ worth of growth targets. It only took five months for the Liberals to admit they wouldn’t be keeping their rosy election promises,” said NDP Fife. “This update shows Liberals aren’t meeting their revenue targets, but are on track to make the deepest cuts since Mike Harris. With revenues down $509 million from just four months ago, how much deeper will the Liberals cut, and what other public assets are they going to sell or privatize just to make up for their losses?”

For the first time, the Liberals admitted publicly that they had not met their first year target for reducing auto insurance rates. The fall economic statement also cast serious doubts on the willingness of the Liberals to keep their promise to reduce auto insurance rates by 15 per cent.

“The Liberals made a lot of promises during the election, but open up the fall economic statement and they are nowhere to be found: Remember the Liberal promise for a 320 km/h bullet train in 10 years that would only cost $10? It’s nowhere to be found. Remember the promise that the Liberals would pay for transit with a Trillium Trust? It doesn’t even get mentioned,” continued Fife. “The Liberals talk up how quickly will create Stephen Harper-approved PRPP private pensions, complete with loopholes that will allow high-cost private pensions to completely undercut a proposed Ontario public pension,  but the update doesn’t give any comfort to US Steel retirees wondering what will happen to the pensions they already have.”

Source: http://www.wawa-news.com/index.php?option=com_content&view=article&id=21521:growth-slows-and-revenues-fall-liberals-economic-statement&catid=122:editorials&Itemid=157
 

College won’t explain restrictions put on pediatrician convicted of sex assault

A doctor previously convicted of sexual assault had a gender-based restriction placed on him for reasons the College won’t make public. 

 

Ken Faught / Toronto Star file photo 

Dr. Kunwar Raj Singh, pictured in 1991, the year he was convicted of 16 counts of sexual assault and indecent assault, is still allowed to practise, albeit with restrictions. 

By: Jacques Gallant Staff Reporter, Sadiya Ansari Staff Reporters, Published on Sat Nov 15 2014

 

 

A pediatrician who has worked in Mississauga and Sarnia is still practising after being convicted of sexually assaulting women related to his work.

Dr. Kunwar Raj Singh also has unrelated gender- and age-based restrictions placed on his practice, but the College of Physicians and Surgeons won’t say why.

His case raises questions about why a doctor who has been convicted of sexual assault linked to his work is able to practise at all.

Roz Roach, a psychotherapist who sat on a provincial task force on sexual abuse of patients, says given Singh’s criminal conviction, it’s “scary” that he’s still treating patients.

“He shouldn’t be practising and his licence should have been revoked,” said Roach, who runs a centre for women and children who are victims of domestic violence in Scarborough.

Singh did not respond to multiple requests for comment.

An office manager at a Mississauga walk-in clinic linked to Singh said he hadn’t worked there in years. The clinic is still listed as one of Singh’s practice locations on the college registry.

There are 21 physicians in Ontario who have gender-based restrictions on practising, a Star investigation recently found. Twenty are male doctors restricted from treating female patients. One is a male doctor restricted from seeing male patients.

Ontario Health Minister Eric Hoskins recently ordered a review of the decades-old legislation that governs all 23 of the province’s regulatory colleges.

Singh was convicted of 16 counts of sexual assault and indecent assault in 1991, for which he received two years’ probation.

The college’s disciplinary committee found Singh guilty of professional misconduct over the same incidents related to his criminal convictions, college spokeswoman Kathryn Clarke said. According to the committee’s 1991 decision, the committee dealt with 13 specific incidents involving eight hospital employees and two mothers of Singh’s patients between 1976 and 1990.

The college found Singh made “inappropriate personal and suggestive comments, touched or squeezed the breasts of the victims or kissed the person against her will or grabbed or rubbed their buttocks or legs.”

The committee suspended Singh’s licence for six months, though the college asked that it be revoked. Clarke said the law only calls for mandatory revocation of a licence when “sexual abuse of a current patient is proven.”

In Singh’s case, the victims were hospital employees and patients’ mothers.

In its decision, which was sent to the Star by the college but is not included on Singh’s page in the online registry, the committee wrote: “Although his actions are a clear violation of ordinary social conduct as well as professional behaviour, this case does not fit into the category of sexual violation or exploitation of a patient/doctor relationship and this weighed significantly in the Committee’s decision not to revoke Dr. Singh’s licence as requested by the College.”

Medical malpractice lawyer Paul Harte says Singh’s case is particularly “troubling” not only because of his sexual assault convictions, but because three years later he was found to have falsified a document to register with the Medical Board of Trinidad and Tobago, according to a disciplinary panel decision document. His licence was then suspended for three months.

“Those are two very significant breaches,” said Harte.

A decade after Singh’s criminal convictions, he entered into a secret agreement with the college forcing him to have a female health professional with him if he is interacting with female patients or female caregivers of patients.

The 2003 restriction, unrelated to his criminal convictions, came after allegations were referred to the college’s discipline committee, said Clarke.

The allegations, which Clarke said were related to patients but did not include sexual touching, were withdrawn in October 2003 “as there was no reasonable prospect of a finding.”

She did not respond to followup questions on the nature of the allegations.

The voluntary agreement was updated in 2013, restricting Singh from treating anyone over the age of 18. It is not clear why. Clarke said there were no new allegations, but “the college may conduct investigations based on a variety of information about the physician’s clinical practice.”

A prospective patient searching for Singh on the college’s public registry will only see the two conditions from the updated 2013 agreement.

Singh’s registry history under 2003 simply says: “Transfer of class of certificate to: Restricted certificate.”

There are no other details.

Clarke said keeping the reasons behind the agreement “unavailable to the public” is mandated by law, noting the terms and conditions on a doctor’s certification must be made public, but that the law does not provide for a “summary of details” to be made public.

Roach said having a female health professional supervise doesn’t necessarily make the environment any safer.

“They themselves — they can become victims,” said Roach, who started her career as a nurse.

Clarke said Singh’s chaperones have “voluntarily agreed” to act in the role and are fully aware of Singh’s discipline history.

“It is desirable to have a regulated health professional act in this role as they are aware of the expected standards of practice, and are capable of fulfilling this function appropriately and completely,” she said.

When Singh tried to get back hospital privileges in Sarnia in 1992, nurses successfully rallied to get Singh banned from St. Joseph’s Health Centre, collecting 2,600 signatures on a petition arguing their workplace should be free of harassment.

With files from Paul Moloney, Colin Graf and The Canadian Press


Source: http://www.thestar.com/life/health_wellness/2014/11/15/college_wont_explain_restrictions_put_on_pediatrician_convicted_of_sex_assault.html