Sadly, it is with ongoing regularity that we see
people with mild traumatic brain injuries (mTBI) being trapped within
minor injury claim limits following motor vehicle accidents. The problem
that we see time and again is that the mTBI is dismissed by the insurer
in the absence of immediately available objective findings...
MORE-Source:
http://oatleyvigmond.com/from-mig-to-cat-the-difficulties-of-a-claim-for-mild-traumatic-brain-injury/#.VQxtWY4ynLk
Jokelee Vanderkop wrote a book about how to
fight your insurance company to get benefits. Now she’s preparing for
another fight about her benefits.
In 2008, she won a lawsuit against the
Personal Insurance Co. after a car accident left her unable to continue
working as a high school teacher. When the company appealed in 2009, she
won again.
She was 44 when injured in 1997. Now 62, she lives on income replacement benefits paid by her insurer.
Hoping to share her experiences of a court battle that lasted more than a decade, she put out a self-published book, So You Think You’re Covered? The Insurance Industry Ripoff, in 2013.
Most of the 200 copies were given away to
friends or dumped, she says. When told the writing was weak, she
published a revised edition last fall and sold 84 copies (at $25
apiece).
As part of her publicity campaign, she was a guest on an hour-long CBC radio phone-in program on Jan. 21, Ontario Today. It didn’t take long for her insurance company to follow up.
“I received a letter, dated Jan. 31, saying I
now had earnings that could be deducted from my benefits entitlement,”
she says. “They said they could not consider any further payments until I
submitted my earnings statements and my tax returns for the last five
years.
“The insurance company has a right to request
information, but normally they tell you it’s required in order to
continue benefits. In my case, they cut me off first. This is pure
intimidation.”
Desjardins General Insurance Co., which owns The Personal, said there was a misunderstanding about her benefits being cut off.
“When we learned that Ms. Vanderkop published
and is promoting a book, we sent her a standard form asking for copies
of her tax returns,” explained spokesperson Joe Daly.
“Under the legislation, a portion of any
income she earns from the book, or any other source, could be deducted
from the weekly income replacement benefits we send her. We naturally
assume that she wrote the book to earn income.
“Please note that we have not cut off her
benefits and have no intention of doing so. If her tax returns indicate
that she has little or no income from the book or other sources, then
her weekly entitlement payments will not be affected.
“We didn’t send the note to intimidate Ms.
Vanderkop. We were just curious if she was now working as a writer,
which is a difficult and demanding job, and earning income.
“In retrospect, the claims adviser who decided
to send the form obviously didn’t understand the realities of
publishing in Canada. It’s tough to make any money writing a book.”
Rhona Desroches is chair of a non-profit advocacy group called FAIR, the Association of Victims for Accident Insurance Reform. She was a guest on the CBC radio show with Vanderkop.
“We heard from six to eight callers, who all
had benefit claims that were about seven years old,” she says. “The
people were injured and not in the best shape. I found it very moving.”
Desroches has heard from many frustrated
insurance customers. She finds Vanderkop’s story a bit more complicated
than most because there were two insurers battling it out at her
expense.
She was insured by Personal under a motor
vehicle policy and by Manulife under her employer’s group policy. When
Manulife denied her application for long-term disability benefits in
1997, she ended up settling for a $57,500 lump sum during a private
mediation in 2002.
After the mediation, Personal refused to pay
income replacement benefits to Vanderkop, even though she met the test
for entitlement, because of the settlement she made with Manulife.
Personal argued that it could deduct any long-term disability benefits
that might have been payable had Vanderkop been successful in her
litigation.
The Ontario Court of Appeal said income
replacement benefits could be reduced by long-term disability benefits
resulting from an accident. But Personal could not set off hypothetical
benefits applied for, but refused.
The long legal fight has led to other health
problems for Vanderkop. But she’s keen to give tips to accident victims,
such as not keeping a journal during a hearing (since it may be
confiscated and used as evidence).
Desroches draws a lesson from the author’s tussle with her insurer about potential book earnings.
“I think it is outrageous that a person’s
benefits are always at risk,” she says. “Settling a case with an insurer
is no guarantee that the negative experience of making a claim with
auto insurance benefits is really over.”
Ellen Roseman writes about personal finance and consumer issues. You can reach her at eroseman@thestar.ca or www.ellenroseman.com
Source: http://www.thestar.com/business/personal_finance/2015/02/10/writing-a-book-can-lead-to-repercussions-roseman.html
That being said,the insurance industry is looking for new opportunities to squeeze more money into their pockets with the lawyers being their next target to lobby(pay)the government for legislation that sets financial limits on what personal injury lawyers can earn from representing a client.
Nothing will change until changes occur at Queen's Park first.
This dysfunctional system helps all the hands in the victims pockets grease their own palms.
"IBC's recommendation that injured auto accident victims be provided an easily understandable (consumer friendly) fee-structure outline" Sounds good, but is it more bullshit?
"Nothing will change until changes occur at Queen's Park first." Indeed! Look at the cuts to benefits the gov't as been making to social services themselves.