Veteran Affairs Canada, WSIB and Insurance companies in general

Nov. 26, 2014

No matter who the payor is, it appears that legitimate claimants requiring health benefits from Veterans Affairs Canada, WSIB, CPP Disability or any car insurer or extended health provider for (LTD) long-term disability benefits will have to fight to get what is owed.

As recently pointed out by auditor general Michael Ferguson  and reported in a Waterloo Record article today by Murray Brewster (p.A3), veterans payouts are delayed for months and they face dizzying paperwork. These claimants often suffer from PTSD and need treatment quickly as their families also suffer. CBC's Ontario Today did a program a few weeks ago on paramedics, fire fighters and police who suffer from PTSD because of what they experience on the job. WSIB doesn't even cover them for this very serious disorder and works harder at denying benefits to legitimate claimants for other injuries than offering those benefits. Extended health carriers and car insurers likewise will put legitimate claimants through a nightmarish process of for hire-medico-experts who run Insurance Medical Examinations (IMEs) more often than not in favour of the insurer despite independent physicians reporting on the legitimacy of an individual's health problem or injury.

Ferguson points out that "The department doesn't really seem to have spent time looking at the process from the point of view of the veteran. And we think the department needs to put themselves in the shoes of the veterans who are trying to access these services in order so they can understand the experience of trying to navigate through that whole process just to get an answer" (ibid. Waterloo Record, Nov. 26, 2014, p A3). The IBC (Insurance Board of Canada), insurers and the government of Ontario have neither put themselves in the shoes of all those other legitimate claimants.

The focus steadfastly remains on fraud against insurers to the extent that anyone filing a claim for more serious injuries or illnesses is made to feel like a scammer. Ontario's Bill 15 which comes into effect on December 1 and will have adverse consequences for anyone with a serious injury from a motor vehicle accident (mva) is seen as the bill to end all fraud but does not so much as look or consider the fraudulent behavior of car insurers when presented with legitimate claims. And when you read it, it sounds like fraud will be defeated and we all applaud with our thoughts going to the story we heard about some person or the neighbour we saw who is wearing a neck brace as a result of some accident yet looks fine to us but is doing some outdoor task, so we presume she or he must be scamming. We are the experts after all! For sure there are scammers and the 2012 Automobile Anti-Fraud Task Force estimates that organized crime is responsible annually for over a billion dollars of fraudulent claims. And yes, there are individual scammers who have their car disappear and say it is stolen or who have additional  body work done than that caused by a fender bender. And there are those who use whiplash or back pain when it might only be a short-term problem after a fender bender and try to collect long-term income replacement.  But these individuals are in the minority and we should all remember that fraud exists everywhere, in all walks of life, in every company by bosses, employees and so forth. Even taking pens or other office equipment home from work for our personal use is theft.

So why are we so quick to say yeah for these insurers, or government bodies and equally as quick to think that any one filing a claim is scamming. We pay premiums in hopes of never having to make use of our policies but when a claim is legitimate, the payor should pay up and not force claimants through months even years of waiting, denials, medical testing and more medical testing when their own family physicians and specialists will back up the seriousness of their illness or injury, and all this in hopes they will drop their claim. If you had any idea how much money was spent to deny legitimate claimants their benefits you'd be horrified. Between the IMEs, private investigators, lawyers, much more is spent than the claim is usually worth but the hope is that the claimant will drop out sooner as opposed to later. And most do drop their claim out of frustration, emotional turmoil, a worsening of their health issue because of the stress and decide they no longer have the energy to fight. The payor wins again.


Source: http://www.deniedbenefitclaims.com/blog.html