FAIR Association of Victims for Accident Insurance
Reform
579A Lakeshore Rd. E
PO Box 39522
Mississauga, ON, L5G 4S6
November 14, 2014
Before you pass Bill 15, some things to consider
What do claimants want?
From a claimants perspective much of what is wrong with the
system starts with the Insurance Act and that it is virtually impossible to
decipher what you are or are not covered for. The present Statutory Accident
Benefits Schedule (SABS) is over 60 pages long. Imagine reading that after a
car accident while trying to recover.
The constant changes to the legislation make it a necessity
to have legal representation to even fill out the forms correctly. Accident
victims rely on the Insurance adjuster to provide them with correct information
and this is problematic. Many insurers have no information on-line to assist
their clients to make a claim and we note that the IBC also has no information
to assist the consumer to understand the process. We asked at the DRS review that FSCO consider
putting together a help line or process to assist MVA victims but it did not
materialize. The message that we get from this lack of action is that no one
understands the insurance product anymore and don’t want to get involved in any
process other than making profit.
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.
Imagine how many claims will be turned down by Ontario’s
insurers going forward if insurers are off the hook for interest on overdue and
unpaid SABS benefits like income replacement and rehabilitation or attendant
care costs. This will inevitably lead to more cases in front of adjudicators,
no matter what system is in place. Justice delayed is justice denied and with
each change to Ontario’s auto insurance legislation that causes delays
(historically this is a fact) accident victims’ rights to fairness are
sacrificed for efficiency and cost savings that benefits only Ontario’s
insurers.
There are systemic problems that must be corrected or the dysfunction
will simply be passed on and into a new system.
FAIR has appeared in front of the Anti-Fraud Task Force, the
DRS Review, and in front of our legislators with the same suggestion to correct
the delays in the system and the unjust
treatment and bullying of legitimate claimants that has led to the backlog in
our courts. At every level there has been an acknowledgement of the problem but
there has been no will to stop the abuse of victims.
For clarity in respect to our testimony at Queen’s Park last
week, I am attaching information on the Colorado Model of assessor selection.
This is a system that the State of Colorado found so effective that, despite
having long since disposed of their No-Fault auto insurance and having moved
back into a Tort style of coverage, they have kept the roster system of
assessor selection.
The Colorado Model relies on a roster of qualified medical
practitioner assessors. When an accident victim requires a medical assessment
for injuries an application is sent to the IME Program Administrator in charge
of the roster. Both plaintiff and defence lawyers are sent a short list of only
5 names of approved and qualified assessors and from this list the two sides
must agree on one single assessor to perform the assessment.
Inclusion on the roster is subject to qualification and
adherence to the stringent time lines and rules and failure to comply will
result in a name being taken off the roster. This system would go a long way to
weeding out the bad apples and the fraudulent medical reports in the Ontario
system.
This is not a resurrection of the Designated Assessment
Centers (DACs) but it does hold assessors accountable and limit the amount of
IMEs that accident victims will have to attend. This will promote interaction
between the two opposing legal representatives and expedite claims when
triers-of-fact don’t have to sift through volumes of highly partisan
‘independent’ medical opinions. Ontario’s biased medical opinions are at the
core of the backlog and the expense of claims handling. Let’s face it, without
bona fide and reliable medical opinions about injuries – how can any accident
victim expect justice? Or for that matter, how can insurers, who are also
victims of this partisanship, be expected to handle claims fairly?
As it is now, the bulk of the reports in the system are
slapped together piecemeal as there are no protocols in place, no template
available and there is no regulatory oversight. In other words there is a complete
lack of standards while the whole system in Ontario, from qualifying for the
benefits to deciding the cases heard in court, relies on medical opinions and
reports.
Oversight of assessors relies on the Colleges in Ontario.
That too is not working and the media is full of negative coverage about CPSO
and CPO college inaction when it comes to harming patients. What do you think
is happening to vulnerable MVA victims who were seen at or received treatment
at over 89,000 private offices and clinics just last year alone.
Wondering why you don’t hear about many complaints about the
bullying and abuse and why so many claims are turned down based on these medical
reports. It’s simple. The Colleges, on
which the entire system is relying on to regulate the health professionals that
work in the insurance industry, is a complete failure at protecting the public.
There is no meaningful oversight of the assessors and it is a wild west of
incompetence and bias. When accident victims complain, as they often do, the
complaints are ignored, sloughed off or kept secret from the public. This isn't
right and it benefits Ontario’s insurers who often knowingly use these
practitioners to rid themselves of legitimate claims. As our government do you
not have a duty to protect the public? Surely someone does.
It’s already a done deal that half of all claims are turned
down as a tactic to save the insurers money. Reducing the Prejudgment Interest
to 1.3% will only add fuel to the fire. There needs to be more accountability,
not less. 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.
There will be cries of fraud and malingering by insurers to
prop up the denials, more victims will be unpaid and without treatment, more
legal cases in our courts, more strain on our public systems, and ultimately
more money for insurers.
All because, for some unknown reason, it’s generally
believed that honest and unbiased medical assessments of accident victims is a
bad thing. The entire system would fall apart if victims were to know the
extent of their injuries and seek treatment for them. Scamming accident victims
by denying claims is really harming and intimidating victims until they go away
and stop making claims. This costs victims valuable timely recovery and quite
often their home and any savings they may have, it is an exercise in
humiliation. And what does it cost insurers?
Last week 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. 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_
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.
Below is information on the Colorado Model of Assessors, a
highly successful and cost saving program that just might move Ontario’s
insurance industry from a scandalously dishonest and bullying business model to
a more functioning system.
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. While we are sure
that is not the legislator’s intent, it certainly will be the result of passing
Bill 15. 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.
Thank you for your time and we hope you’ll take a moment to
remember that the purpose of insurance is to provide coverage and not just
profit for insurance companies.
Rhona DesRoches,FAIR, Board Chair
http://www.fairassociation.ca/
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