CIN is a non-profit Advocate for Insurance and Health Care Reform.
Postings are cut/paste from other sources. @Cinsurancenews #rally4accidentvictims #ABPetition #CPPbacklog
Why is the Ontario government taking away money they deserve and transferring it to the insurance industry?
How nice for the insurance industry. Take money from deserving accident victims and give it to insurance companies.
Instead of increasing the deductible the government ought to abolish it.
There’s no principled reason to apply a deductible....
Hundreds
protest the Ontario government’s proposed auto insurance cuts outside
Queen's Park in Toronto on June 3, 2015. (Dave Abel/Toronto Sun)
A slugging match recently erupted between car insurance companies and Ontario personal injury lawyers.
The Insurance Bureau of Canada (IBC) opened by claiming the public
needs regulatory oversight of contingency fees charged by personal
injury lawyers.
The IBC feels a change is necessary to protect consumers and allow
the government to evaluate the impact of lawyers’ fees on the auto
insurance system.
The Ontario Trial Lawyers Association (OTLA) countered by releasing a study it commissioned concerning auto insurance premiums.
According to the study, prepared by two professors at York
University’s Schulich School of Business, “consumers in Ontario may have
overpaid for auto insurance by between $3 and $4 billion over the
period 2001 to 2013.”
The OTLA urged an independent “thorough and truly transparent” review of auto insurance by Ontario’s Auditor General.
Reacting quickly, the IBC fired back through a press release,
pointing the finger back at personal injury lawyers claiming, “lawyers’
fees are simply too high and have a significant impact on the cost of
auto insurance.”
The IBC supported its conclusion by claiming some lawyers charge 40%,
while others between 25% and 33% of any settlement or judgment.
I doubt many lawyers would dare charge a 40% contingency fee, although even a 25% to 33% fee may be too high in some cases.
But, the IBC forgot to mention clients don’t pay the entire
contingency fee as a good part of the fee is paid by the insurance
company.
To rub it in further, the IBC stated, “In 2013, lawyers received an
estimated $500 million from injury claimants out of their insurance
settlements for bodily injury claims. These are real dollars that never
make it to the claimant. IBC will continue to fight for increased
transparency so that consumers can actually see where their insurance
dollars go.”
But I don’t think insurers want to open the transparency can of worms.
If they want to talk about “real dollars” that don’t make it to
claimants, check out the vast sums paid by insurers for their so-called
independent medical examinations (IMEs), used to belittle or deny
claims.
According to the most recent Ontario Health Claims Database,
insurance companies paid approximately $372 million for IMEs for
accidents taking place in the last four years.
In some years, insurance companies forced almost half of all
claimants to attend IMEs and in each year the average amount paid per
assessed claimant for these exams exceeded the average amount paid per
claimant for all medical and rehabilitation expenses.
Sending claimants for multiple and expensive assessments to
pro-insurer experts is a major contributor to insurers’ costs and takes
“real dollars” out of the pockets of claimants.
That’s not to say lawyers are free of blame.
There’s a long history of lawyers neglecting to act diligently to
expose insurer experts who file partisan reports, sometimes outside
their sphere of expertise, used by insurers to delay and deny claims.
As well, quality control at some law firms is substandard.
The FAIR Association of Victims for Accident Insurance Reform has
recently posted an announcement stating, “ALERT – we are hearing about
more and more cases where time limitations for filing have lapsed due to
plaintiff’s legal representatives failing to meet limitation period
deadlines.”
Then again, motor vehicle litigation and accident benefits claims are
highly complex and insurance company tactics often lead to increased
fees.
And if the insurance industry wants to point fingers at personal
injury lawyers, perhaps they ought to make complete disclosure of the
money they spend on defence lawyers and adjusters to deny, delay and
defend claims.
Furthermore, how much do insurers pay to fund their massive public
relations campaigns -- including political contributions to those in
power -- which they effectively use to portray accident victims as
opportunistic, malingering or just plain fraudulent?
It seems there is a lot of mud that can be thrown at each side in this messy debate.
But while the debate drags on, insurers continue to exact high premiums and lawyers receive handsome payments for their work.
And accident victims? They’re stuck in the middle.
Ontario’s car insurance system seems to work well except for
consumers who need it and accident victims who make legitimate claims
under it.
After all, the insurance industry is making good money.
Lawyers are amply rewarded acting for plaintiffs and insurance firms.
Doctors earn significant sums preparing insurer-requested medical reports.
Treatment providers receive good compensation for treating the injured.
Premier Kathleen Wynne received generous financial support from the
car insurance industry when she ran for the Liberal leadership.
The Liberal party receives significant campaign donations from it.
But here’s the problem. Two problems, actually.
The first is fraud by people trying to rip off insurance companies
with phony claims. We agree it happens and it’s a serious problem.
But what we don’t understand is why the amount of fraud -- to hear it
from the insurance companies -- never, ever, seems to decrease.
Fraud, we’re told, is the main reason auto insurance premiums in
Ontario remain stubbornly high, no matter how many times the government
cuts back benefits to all accident victims at the behest of the
insurance industry, as it did again in its latest budget passed last
week.
We also think there’s another kind of fraud in the insurance industry that needs to be addressed by government.
That fraud happens when people who have faithfully paid their auto
insurance premiums year after year are hurt in serious accidents and,
when they make legitimate claims for the benefits promised in their
policies, are denied them.
It happens when car insurers fight against paying genuine claims from
accident victims, falsely making them out to be the enemy and going to
absurd lengths in and out of court to deny them the benefits to which
they are entitled.
Last week, hundreds of demonstrators at Queen’s Park protested this
kind of fraud as the Liberals passed yet another piece of legislation
favoured by the insurance industry that will cut in half benefits for
people who sustain catastrophic, life-changing injuries in car
accidents.
Prior to the passage of the budget, Finance Minister Charles Sousa
boasted, “Ontario is the most generous in Canada when it comes to
providing coverage for auto insurance.”
Last week, Sun legal affairs analyst Alan Shanoff, demonstrated conclusively in his column how this statement was inaccurate.
In fact, Ontario doesn’t provide the most generous benefits for
either catastrophic injuries or for so-called “minor” ones, which can
include dislocation of joints, partial tears of tendons and ligaments
and whiplash not exhibiting neurological symptoms.
As the FAIR Association of Victims for Accident Insurance Reform put
it: “The budget does nothing to ensure that insurer claims management
practices are fair and there has been no action (to deal with) ... the
biased and corrupt insurer medical examination reports that are
disqualifying innocent and legitimate accident victims.”
We agree. It’s time to end this type of insurance fraud, as well.
Ontario Finance Minister Charles Sousa. (ANTONELLA ARTUSO/Toronto Sun)TORONTO - Last month’s Ontario budget continued the erosion of accident benefits for victims in motor vehicle accidents.
The reductions are most significant for those suffering from catastrophic injuries.
Since 1996, these victims were entitled to reasonable and necessary
medical and rehabilitation services up to $1 million, in addition to up
to $1 million in attendant care benefits.
That combined coverage of $2 million will now be cut by 50% to a combined $1 million.
It’s puzzling why the government would want to cut back benefits to
those who need it most, especially since only 1% of accident victims
suffer catastrophic injuries.
Ontario Finance Minister Charles Sousa stated, “Ontario is the most
generous in Canada when it comes to providing coverage for auto
insurance.”
I guess he isn’t aware Manitoba, Saskatchewan and Quebec provide
medical rehabilitation benefits in excess of Ontario’s $1 million, when
medically warranted, for any motor vehicle accident victim.
At the other end of the spectrum, dealing with so-called minor
injuries suffered by approximately 80% of accident victims, Ontario’s
“generous” limit for medically necessary treatment is $3,500, including
the cost of assessments, examinations and reports.
No other province mandates a cap on minor injuries.
Don’t think these “minor” injuries are insignificant.
They include dislocation of joints, partial tears of tendons,
ligaments and muscles, contusions, abrasions, lacerations and whiplash
not exhibiting neurological symptoms.
For serious injuries — neither minor nor catastrophic — medical and
rehabilitation benefits are capped at $50,000 in Ontario. That compares
favourably to Nova Scotia, PEI, Nunavut and the NWT, which each have a
limit of $25,000, and equals the limit in Alberta and New Brunswick.
But it falls short of the limits in British Columbia, Manitoba and Saskatchewan.
So, the most generous benefits in Canada? Hardly.
The lowering of benefits for catastrophic injuries is only one of
many prejudicial changes to auto insurance coverage announced in the
budget.
There’s also enhanced barriers imposed on plaintiffs suing for negligence arising out of auto accidents.
Most people are unaware of two barriers on the right to sue for
damages resulting from harm suffered in an at fault auto accident.
First, there is a threshold test that must be satisfied before anyone can succeed in winning a lawsuit.
This law, introduced in 1996 and made more stringent in 2003, bars
successful lawsuits unless plaintiffs can establish they suffer “from
permanent serious impairment of an important physical, mental or
psychological function.”
To meet this test, various stringent conditions must be satisfied.
The threshold often prevents injured people from recovering damages for serious injuries that fail to meet its definition.
Second, there is a deductible that applies only to lawsuits against
negligent auto drivers. It was increased from $15,000 to $30,000 in 2003
and applies to damages for pain and suffering of $100,000 or less.
The budget would index the deductible to inflation as of 2003.
According to personal injury lawyer Darcy Merkur, that would impose a
deductible of about $37,000 on damage awards of about $123,000 or less.
As an example, a damage award of $100,000 would be reduced to $63,000!
Having both a threshold and a deductible is redundant and only benefits insurance companies.
And why would the government choose to index amounts that favour
insurance companies, while not indexing amounts that favour accident
victims?
I didn’t see any proposal to index the minor injury cap of $3,500 or the medical/rehab cap of $50,000.
As FAIR Association of Victims for Accident Insurance Reform says,
“The budget does nothing to ensure that insurer claims management
practices are fair and there has been no action (to deal with) ... the
biased and corrupt insurer medical examination reports that are
disqualifying innocent and legitimate accident victims.”
The government also announced it intends to amend the catastrophic impairment definition.
Does anyone doubt that these amendments will only serve to benefit
insurance companies by restricting the number of victims who would
otherwise qualify for the enhanced benefits applicable to the
catastrophically impaired?
In
late 2014, the Liberal Ontario government passed Bill 15, the “Fighting
Fraud and Reducing Automobile Insurance Rates Act, 2014”. The new law
only benefits multi-billion dollar insurance companies while giving auto
collision victims in Ontario the shaft when in need of accident
benefits. Here are some of the new lows coming from the Bill:
all accident benefits disputes in Ontario will be heard by the Licence Appeal Tribunal (LAT)
the right to go to court for accident benefits disputes has been taken away from auto accident victims
interest payable by an insurance company on benefits that should
have been paid only starts when the injured victim files for mediation
and not from when the insurer unfairly denied paying the benefits
the interest rate payable on damages for injuries to a person
innocently injured has been reduced from 5 percent, which is the
standard for all personal injury damages owing in all cases in Ontario
to 1.2 percent for motor vehicle cases
The most egregious change is the removal of the right for auto
accident victims to access the civil courts if an insurance company
refuses to pay auto accident benefits. The right to access our courts to
settle disputes is a fundamental right for all Canadians. The deck has
been stacked against auto accident victims for years and this is another
Ace for the insurers.
Why are Ontarians being denied the right to have disputes over
accident benefits heard by an impartial and independent decision maker?
The reason is simple, insurance companies who give lots of money to the
Ontario Liberal government wanted to take away the right to ensure that
they don’t have to pay as much for claims.
Alan Shanoff recently wrote a column in the Toronto Sun exposing the
danger to all auto accident victims from having their disputes with
their insurers now being heard by the LAT. From what he says in his
column we can expect the following.
more delays in getting disputes heard
disputes heard by individuals without experience or training in the complex auto accident benefits regime
majority of claims being denied
Currently, the LAT hears disputes for liquor licence appeals, reviews
of medical suspensions of drivers’ licences, motor vehicle impoundments
and claims under the Ontario New Home Warranties Plan. Mr. Shanoff
refers to a study that was conducted by the Canadians for Properly Built
Homes (CFPH), a national, non-profit consumer protection organization
that analyzed the 2006-2013 LAT decisions pertaining to homeowner
appeals of Tarion decisions concerning new home warranties. During the
eight-year period of the study, LAT (the tribunal that will be hearing
auto accident disputes) refused 96 percent of homeowners’ claims. That
is an outstanding failure rate. I can understand why the automobile
insurers wanted to have the LAT decide auto accident benefits disputes.
You can read Mr. Shanoff’s column by clicking here.
Since September 2010, auto accident benefits have continued to be
reduced. These are accident benefits that every person in Ontario
contracts for with a private auto insurance company to pay in the event
that the person is injured in a motor vehicle collision. These are not
“free” benefits or granted by the goodwill of the automobile insurance
companies — these are benefits paid for with our premium dollars.
In response to the argument that the accident benefits paid need to
be slashed because of fraud, I say show me the proof. The insurance
companies have never been able to produce any solid evidence that there
is any substantial fraud in auto insurance. What have we received in
return for our auto insurance benefits being slashed? A mere 6.1 percent
reduction in average auto insurance rates since August 2013. Hardly
worth the cost of what we have lost.
TORONTO - With last year’s passage of
Bill 15, the “Fighting Fraud and Reducing Automobile Insurance Rates
Act, 2014”, the handling of accident benefits disputes in Ontario is to
be passed from the Financial Services Commission of Ontario (FSCO) to
the Licence Appeal Tribunal (LAT).
There are obvious reasons for the public to fear this transition.
FSCO handles about 10,000 applications each year, compared to LAT’s 700.
FSCO arbitrators and mediators have a wealth of experience in a
highly specialized area, while LAT members have no experience in
accident benefits disputes.
Instead, LAT members have expertise in liquor licence appeals,
reviews of medical suspension of drivers’ licences, motor vehicle
impoundments and claims under the Ontario New Home Warranties Plan.
Courtesy of Canadians for Properly Built Homes (CFPBH), a national,
non-profit consumer protection organization, we have a report analyzing
2006-2013 LAT decisions pertaining to homeowner appeals of Tarion
decisions concerning new home warranties.
Tarion is the private corporation created by the Ontario government
to protect new homebuyers and administer new home warranties, although
its board of directors is controlled by builders.
CFPBH has concluded LAT’s “operations and performance need
improvement both in relation to the adjudicators themselves
(specifically in relation to self-represented parties) and the LAT’s
management and administrative processes.”
The numbers in the CFPBH study present a dire picture for homeowners who dare to enter the LAT’s chambers.
During the eight-year period of the study, LAT gave homeowners a 96% failure rate in relation to major deficiency claims.
The annual failure rate for total issues presented by homeowners in the last three years of the study is 82%, 83% and 94%.
The number of appeals brought before LAT dropped from 119 in the first four years of the study to 69 in the last four.
It’s impossible to know why the numbers have dropped off but CFPBH
believes many homeowners have given up and made repairs themselves while
some have resorted to what they call “patch and run” tactics.
That is, homeowners patch up the deficiencies and place their homes
on the market for resale without disclosing the builders’ defects.
Still others bypass LAT completely and pursue remedies through the courts.
Yet this very avenue has been taken away from those seeking accident benefits arising from vehicle crashes.
Bill 15 removes this option and forces all accident benefit claims to be resolved without recourse to courts.
Karen Somerville, President of CFPBH, believes LAT has “serious
shortcomings” and purchasers of new homes urgently need — and deserve — a
fair and appropriate appeal process for the largest purchase most
consumers make: a home.
LAT’s numbers seem to support Somerville’s contention. Certainly
there doesn’t appear to be a level playing field between homeowners and
Tarion.
All of which begs the question, why was LAT chosen to administer the automobile insurance dispute resolution system?
Hopefully many current FSCO arbitrators will be moved over to LAT so their expertise won’t be lost.
But that doesn’t change the fact LAT members are part-time (other
than the Associate Chair), appointed for temporary terms, receive per
diem rates (other than the Associate Chair), and are government
appointees.
Reappointment is at the pleasure of the Ontario cabinet, so they cannot be seen as independent.
Current FSCO arbitrators are full-time, unionized, public sector employees.
It is difficult to see how the transfer of jurisdiction from FSCO to
LAT will serve to either fight auto insurance fraud or reduce rates,
although it is easy to see how the transfer will result in massive new
expenditures and may result in injustices.
But shouldn’t we first be fixing LAT and providing purchasers of new
homes with meaningful remedies, before we throw 10,000 new auto
insurance disputes at it?
Sitting in a hospital emergency room waiting for a doctor is one of life’s frustrating events.
Wait times are measured in hours, not minutes, for most.
But we wait and wait, believing the professionals who will treat us
or our loved ones are doing heroic work, attempting to save the lives of
people in dire need of their expertise.
But, according to Dr. Brian Goldman, a Toronto emergency room physician, that belief may be far from the truth.
Goldman’s recent book, The Secret Language of Doctors, provides the
inside scoop on what some doctors are actually up to while we wait for
treatment.
They’re playing games, treating patients as the enemy and doing everything possible to avoid looking after them.
The slang word for this game is “blocking”.
They also engage in “turfing”, having a patient punted from one department to another to avoid a difficult one.
Worse is a “patient dump”.
According to a study cited by Goldman, nearly 8% of doctors
practising in hospitals have participated in blocking a patient from
being admitted.
More than 9% have engaged in turfing.
Worse, some doctors actually celebrate successful blocks and turfs as if they had scored a touchdown.
Our health and the health of our loved ones is just a game to them.
As Goldman critically remarks, “While you or a loved one wait to be
admitted to hospital, just a few metres away from your cubicle, yet well
outside of earshot, physicians may be verbally duking it out over your
immediate future. The aim is not so much to care for you as to find a
clever way to jettison that responsibility by finding someone else to do
it.”
Doctors sometimes lie or omit crucial information as part of the turfing process.
This unseemly practice has doctors shopping patients around trying to
make a sale, doing whatever it takes to turf or dump the patient.
According to a doctor quoted by Goldman, the time spent blocking patients almost always causes patient suffering.
Many health professionals “can’t stand” what they call GOMERS, “get
out of my emergency room patients”, usually the “old, demented sick with
half a dozen or more illnesses”.
They look at GOMERS as people taking up valuable beds and wonder why they aren’t dead.
GOMERS are viewed as “bed blockers”, blocking beds for more entitled, often younger, patients.
But it isn’t just GOMERS that doctors can’t stand.
According to Goldman, many doctors hold the view, “If you are old,
demented, frail, mentally ill, overly anxious about your health,
morbidly obese, addicted, in police custody or if you just call on us
too often, we’re not keen on having you as a patient.”
This point of view is expressed in the rich vein of slang used by doctors to describe undesirable patients.
A “toad” is a troublesome and demanding patient.
A “whale” is an obese patient, as is a beemer.
A “cockroach” is a patient who keeps coming back.
“FTDs” are patients who fail to die when expected to do so.
“FLKs” are funny looking kids.
A patient with a “horrendoma” has a horrible or awful condition.
“Closing the deal” refers to convincing a patient or next of kin to sign, or agree to, a “do not resuscitate” order (DNR).
But even if there’s no DNR order doctors may engage in the deceptive
practice labelled as a “Slow Code” or a “Hollywood Code” of even a
“Light Blue”.
While every profession uses its own slang, and there’s nothing wrong
with black humour, it’s obvious this disrespectful language expresses a
disrespectful attitude towards the public which must surely have an
impact on the care provided.
If these doctors don’t want to treat the old and frail, those
suffering from dementia, the obese, the addicted, or people who are
overly anxious about their health, then maybe they shouldn’t be doctors.
And maybe we need different health care professionals to look after these patients.
Check out Goldman’s book. His honesty is refreshing.
The Report analyzes data collected through the Health Claims for Auto
Insurance (HCAI) system. Since February 2011, HCAI has been the
mandatory system that Ontario health care facilities are required to use
when submitting auto insurance claim forms to insurance companies. The
insurers respond to the claims through the HCAI system as well. As the
Report states, data is collected to “…better understand the medical and
rehabilitation costs involved in Ontario automobile insurance health
claims and the recovery process.”
While the HCDB Report offers an abundance of statistical information
from 2011 through to June 2014, some numbers are particularly
concerning, namely, the cost of Insurer Medical Examinations (IMEs).
As Alan Shanoff highlights in his article for the Toronto Sun,
insurers spent $64,945,218 on IMEs in 2013. Although the total amounts
paid for health claims expenses appear to have declined since 2011, we
can expect those numbers to rise as claims-related expenses for 2012 and
2013 develop more fully. Despite these apparent reductions, insurers
continued to order IMEs on roughly one-third of their claims and IME
costs remained high; accounting for roughly 25% of total health claims
expenses.
Adding to this cost is the expense for missed or cancelled
appointments where insurers were found to pay their experts in excess of
$1,000 per occurrence. From my experience, many IMEs are scheduled
without notice and / or proper compliance with the SABS. When claimants
do not attend, this adds unnecessarily to the total claim expense.
This is not the first time the value of IMEs have been scrutinized.
They were a live topic earlier this year with the review of the Dispute
Resolution System (DRS) for Ontario automobile claims. The DRS was
reviewed with the intent of discovering ways to reduce claim costs and
make the process more efficient and assessable. The DRS Review Final Reportwas released in February and proposed a number of changes.
With respect to IMEs, the Honourable J. Douglas Cunningham wrote in the DRS Review Final Report that, “…today’s
insurer examination (IE) reports appear to have little credibility with
claimants and only serve to trigger disputes.” He goes on to write
that, “…IE assessors are not accountable to FSCO, have no standard
assessment protocols, report formats or timelines and are not insulated
from outside influence.”
In their written submissions on the Interim Report,
OTLA also called for greater transparency and accountability on
medicals experts who were found to be biased or lacked qualification.
The DRS Final Report recommends that experts should be
required to certify their duty to provide fair, objective and
non-partisan evidence. In addition, Arbitrators should ignore evidence
that is biased, and in such instances, the expert should not receive
compensation for appearing as a witness.
With the questionable value of IMEs to the dispute process and with
IBC’s intense focus on reducing claim costs, why do insurers continue to
spend such significant amounts on IMEs?
Mr. Cunningham may have indirectly answered this question when he
explained in his Final Report, that “…their reports and testimony are
often used by insurers in the DRS to support benefit denials… [and] the
IE assessor is selected because he or she might support the insurer’s
position.”
Without doubt, medical experts find a substantial source of revenue
in conducting medical assessments for insurance companies. However, is
the expense justified? Are IMEs a valuable resource for insurers to
effectively evaluate claims or are IMEs biased, over-utilized, and
simply cause delay at the expense of accident victims? Certainly, there
is a need for ongoing reform with these questions in mind.
Transparency is always a good start. Mr. Shanoff concludes his
article by suggesting that Ontario implement similar disclosure
requirements to British Columbia where experts are listed in an annual
report along with the amount paid to that expert in that year.
Considering the DRS Review recommendations, there appears to be a call
for further disclosure and accountability in the use of IMEs and the
medical experts involved.
The cost of automobile insurance should reflect the risk to insurers,
the underlying claims and adjustment expenses, as well as the
profitability of insurers. Ontario has the highest premiums for auto
insurance in the country. The reason for this seems to depend on who you
ask. In May of 2012, Ralph Palumbo, Vice-President of the IBC, stated
that despite the September 2010 reforms, the benefits package continued
to be “rich”, claims costs were still “out of control”, and insurers
could not depend on investment returns to cancel out underwriting
losses. He further attributed increasing premiums to the prominence of
insurance fraud. The press release can be found here.
Conversely, data released by the General Insurance Statistical Agencysuggests
a dramatic reduction in AB claims from $3.8 billion in 2009 to a low of
$1.9 billion in 2012. While claims over the past year are projected to
rise to $2.2 billion they are still down overall. In addition, the data
revealed an overall loss ratio decline from 94% in 2009 to 69% last year
and average earned premiums on the rise from $1,344 in 2009 to $1,545
in 2013. These numbers indicate that insurer profits have actually
increased since 2010.
Clearly, the industry’s own numbers show that claims costs, which
have dropped over the last four years, are not driving higher premiums.
That said, insurers should be prudent with expenses that are directly
within their discretion on behalf of all policyholders who ultimately
pay the price.
This blog post was contributed by Michael Giordano, OTLA Blog Committee member and lawyer practicing with Sal Guzzo LLB.
NDP Leader Andrea Horwath claims people who live in more modest
neighbourhoods pay higher premiums for auto insurance.(SUN FILE PHOTO)
TORONTO - The Ontario Health Claims Database, August 2014 Report, was issued earlier this month.
It discloses data for auto insurance health claims expenses for
six-month reporting periods, beginning January 1, 2011 and ending June
30, 2014.
It will be interesting to see how the insurance industry explains the
inconvenient numbers and statistics disclosed in the Report.
Perhaps the most alarming statistic relates to the number and cost of insurer-initiated medical examinations (IMEs).
These are the so-called independent examinations insurance companies force accident victims to take.
Victims have long complained about the number of examinations they
are required to attend as well as the quality of the examinations and
examiners.
In 2011, insurers spent $132,950,124 on these IMEs.
They spent $453,923,425 on all health claims expenses, meaning
insurers gave their medical experts 29.3 cents out of every dollar they
spent on health claims expenses.
They ordered IMEs for 26,957 of 59,080 claimants, almost one out of of every two claimants.
They paid an average of $4,930 per claimant examined to their medical experts.
Yet the total average amount paid per claimant, including payment for treatment, was $7,683.
The numbers dipped in 2012 when insurers only spent $99,060,443 on IMEs.
But there were fewer claimants, only 54,440, and the total amount
paid on all health claims expenses dipped to $364,621,262 so insurers
still gave their medical experts 27.1 cents out of every dollar they
spent on health claims expenses.
They ordered IMEs for 21,529 out of 54,440 claimants, paying an
average of $4,601 per claimant examined to their medical experts. Yet
the total average amount paid per claimant was only $6,697.
In 2013, insurers spent $64,945,218 on IMEs for 55,799 claimants.
The total amount paid for health claims expenses plummeted to
$262,089,955 so insurers gave their medical experts 24.8 cents out of
every dollar spent on health claim expenses.
They ordered IMEs for 17,465 out of 55,799 claimants paying an
average of $3,718 per claimant examined to their medical experts. Yet
the average amount paid per claimant dropped to $4,697.
These numbers tell us a shocking story.
The average amount of health claims paid per claimant has dropped a significant amount from $7,683 in 2011, to $4,697 in 2013.
Insurers spend a disproportionate amount of money on medical experts.
While the gross numbers are dropping, they still take up almost 25% of all health claims expenses.
Again, while the numbers are dropping, insurers order examinations
for huge numbers of claimants, about 46% in 2011, 40% in 2012 and 31% in
2013.
Insurers are also paying huge amounts to their experts for missed or
canceled appointments, about $16.6 million in 2011, $10.6 million in
2012 and $7.8 million in 2013.
The average amount paid for missed or canceled appointments was
$1,308 per claimant in 2011, $1,193 per claimant in 2012 and $1,120 per
claimant in 2013. Paying over $1,000 for a canceled appointment is
ridiculous.
While the Report highlights aggregate amounts paid to insurer medical
experts, it also highlights diminishing average amounts paid per
claimant in every six-month period from January 1, 2011 to June 30,
2014: $7,901 to $7,472 to $6,858 to $6,554 to $5,557 to $3,934 to
$1,790.
Because of on-going treatment for injuries, these numbers will increase with the passage of time but the trend is very clear.
Of course, insurance fraud has a large impact on insurance expenses,
but perhaps insurers should focus more on what they are paying their
medical experts.
Clearly, many physicians are getting rich by providing insurance assessments.
It’s no wonder some physicians appear to be beholden to the insurance companies.
Perhaps it’s time we initiated the same disclosure that British
Columbia mandates, whereby each physician and expert who provides
services to an auto insurer is listed in an annual report, along with
the aggregate amount paid during the year.
Driving without insurance can lead to fines, licence suspension and vehicle impoundment.
It’s also financially risky.
Uninsured drivers are personally responsible for any accidents they cause.
But what isn’t so obvious is that they also forfeit the right to sue other car owners or drivers.
The purpose of this law is simple.
We don’t just want to keep uninsured drivers off the road.
We also want to prevent those who haven’t paid into the pool of
insurance premiums from suing or obtaining money from insurance
companies and drivers who have paid into that pool.
This law makes sense.
What doesn’t make sense occurs when an insurance company tries to use
the law to retroactively void an insurance policy, to take away an
injured driver’s right to sue.
That’s what happened to Wayne Radwan Alof.
Alof obtained car insurance in Nova Scotia, where his car was registered.
He moved to Ontario and had his car registered in Ontario in February, 2010.
He had a discussion with his insurance company after moving to
Ontario, advising it he didn’t know if the move was going to be
permanent.
Alof had the misfortune of being in an accident in Mississauga in July, 2010.
He apparently suffered serious injuries and sued the other driver.
One month after reporting the accident his insurer, TD Insurance,
notified Alof his insurance had been retroactively voided as of the
previous February, due to a failure to advise the insurance company that
his car had been registered in Ontario.
So, Alof had insurance as of the date of the accident, but his
insurance company retroactively withdrew the insurance after the
accident, leaving Alof in a precarious position.
Could this “now you see it, now you don’t” insurance policy result in
a retroactive forfeiture of his right to sue to recover compensation
for the injuries he suffered in the July accident?
That’s precisely what the other driver’s insurance company argued in a court motion to dismiss Alof’s lawsuit.
The motion was argued in January with a decision released in April.
Superior Court Justice Wendy Matheson ruled the lawsuit could proceed.
She applied some common sense, ruling that regardless of TD
Insurance’s attempt to retroactively void Alof’s policy, the fact
remained that at the time of the accident Alof did have insurance
coverage, so he did have the right to sue.
I can’t help but think insurance companies and their lawyers stay up
all night trying to dream up ways of defeating valid claims.
Fortunately, we have many good judges who stand ready to protect our rights.
But there are some lessons to be learned in this case.
Any move, from one province to another, to a different city or town,
or even within the same city or town, can trigger a change in risk for
your auto insurance.
Changes in the use of a vehicle and vehicle modifications, even some cosmetic ones, can also lead to a change in risk.
Changes in ownership and the addition of a new driver also trigger changes in risk.
It’s important that any potential changes in risk be reported to your insurance company.
Ask for an email address so you can send an email and obtain a record of your disclosure.
Your insurance company may decide to modify the premium — up or down —
but you will have the peace of mind of knowing your coverage is intact,
as is your ability to sue others for your losses.
Failure to report a change in risk can lead to the cancellation or voiding of your policy.
If you are in an accident your insurer may deny coverage.
Do the right thing. Even if in doubt, report all changes.
Isn’t it odd that when we read or talk about auto insurance, we focus on premiums or fraud?
We rarely read or talk about the interests of accident victims.
Maybe that’s because it would be politically embarrassing to discuss their interests.
If we did, we’d have to mention that in 2010, the $100,000 maximum
for medical/rehabilitation benefits was reduced to $3,500 for minor
injuries (even though many so-called minor injuries are quite
significant) and $50,000 for non-catastrophic injuries.
We’d have to mention these benefits are even lower than they appear
since the costs of assessments and examinations are now deducted from
these reduced benefits, thereby reducing them further.
Prior to 2010, there were additional benefits to pay for necessary
assessments to determine entitlement to benefits, or to determine the
medical/rehabilitation services required.
We’d have to mention that in 2010 the $72,000 maximum attendant care
benefit for non-catastrophic injuries was reduced to zero for minor
injuries and $36,000 for non-catastrophic injuries.
We’d have to mention that in 2010 the $100 per week maximum for
housekeeping benefits was eliminated, save for the 1% of accident
victims who have suffered catastrophic injuries.
We’d have to mention that in 2010 the maximum caregiver benefit of
$250 per week plus $50 per week for additional dependents was
eliminated, save for those suffering from catastrophic injuries.
While some accident benefits can be topped up via optional coverage
for extra premiums, consumers have been ill-served by insurers and
government and, accordingly, only about 1% of those who buy insurance
purchase additional coverage.
As the Fair Association of Victims for Accident Insurance Reform
(FAIR) has pointed out, “consumers remain unaware of the low level of
coverage they’ve purchased until it is too late and they need to use
it.”
Oddly, even though some accident benefits can be topped up, insured
persons aren’t allowed to opt out of any benefits to save premiums.
Many retirees, for example, complain about the mandatory purchase of income replacement benefits.
FAIR is absolutely right when it concludes, “the 2010 reforms were
intended to control insurer costs without regard to the outcome for
Ontario’s accident victims.”
But it isn’t just the lower benefits that prejudice the rights of accident victims.
It’s the behaviour of many insurance companies in denying payment of accident benefits.
Almost one in every two Ontario accident victims has a dispute with an insurance company.
In 2013, 25,329 injured accident victims applied for mediation to contest accident benefits denied by their insurer.
About 45% of those cases dealt with the denial of medical/rehabilitation benefits.
That means that last year alone, we had 11,399 people claiming wrongful denial of medical/rehabilitation benefits.
A major cause of the large scale denial of benefits rests with the medical assessments purchased by insurance companies.
In many cases, more money is spent assessing a victim’s injuries than the cost of the treatment being sought.
Yet, according to a recent review of auto insurance, there are “no
standards or qualifications for assessors in the auto insurance system.”
Then again, why would we need such standards or qualifications? That would just benefit accident victims.
Making matters worse is the 2010 “reform” eliminating an injured
person’s right to obtain a rebuttal assessment to counter a denial of
benefits brought about by an insurer’s medical assessment.
At one time I was optimistic some in the Ontario government cared about the plight of accident victims.
The Standing Committee on General Government and the Standing
Committee on Finance and Economic Affairs held public hearings and heard
from groups representing accident victims, as well as individual
accident victims.
But here we are more than two years later and we have heard nothing but silence concerning accident victims.
But not to worry. Politicians of all stripes remain interested in auto insurance premiums.
Apparently, the product is of little importance; only the price matters.
Monday, 07 July 2014 08:00 | Written By Alan Shanoff
It seems odd that we continue to debate the recording of
litigation-related medical assessments while video and audiotaping
become a staple of society.
The latest skirmish in this debate arises in Alladina v. Calvo,
a May 6 decision of Superior Court Master Benjamin Glustein allowing a
defence motion to compel the plaintiff to attend a medical assessment
before a psychiatrist and dismissing the plaintiff’s motion to conduct
the assessment by a different practitioner or, alternatively, to record
it.
In doing so, Glustein followed pre-2010 decisions holding
that recording defence medical assessments shouldn’t be routine and is
only warranted on the basis of “substantial and compelling reasons.”
More significantly, he refused to follow the more modern approach
exhibited by Master Donald Short in Bakalenikov v. Semkiw.
Short
considered the amendment to Rule 53.03 that says experts must not be
advocates for either side. He noted a Superior Court judge had
previously criticized the psychiatrist chosen by the defence to conduct
an assessment of the plaintiff for providing his evidence as “an
advocate for the party calling him as a witness” and who had his
opinions “disregarded by the court for bias and advocacy for the
defence” on at least three occasions.
Short took those judicial
findings seriously when he stated: “If a judge of the court has made a
finding with respect of an individual expert in the past, that is the
finding of the Superior Court. How can the court abdicate any
responsibility to audit the performance of such experts in light of the
expressed intent of the amendments made to Rule 53?”
Accordingly,
Short concluded the psychiatrist’s “objectivity needs to be
demonstrated” and ordered that the examination be audiotaped.
Glustein
had before him similar evidence concerning the doctor proposed by the
defence. Evidence disclosed that the plaintiff had found 66 cases in a
Westlaw search that considered psychiatrist’s evidence. In 11 of these
cases, courts or tribunals didn’t accept parts or all of the doctor’s
evidence. In doing so, they made comments that the doctor’s “evidence
had a flavour of advocacy,” “smacks of partiality” or wasn’t “balanced.”
Of
course, that isn’t evidence of bias or that the doctor is incompetent.
But with 11 negative remarks in 66 cases, shouldn’t we require proof of
the doctor’s objectivity? Glustein didn’t think so, concluding there
were no “substantial or compelling reasons to require videotaping or
audiotaping to ensure fairness.”
Glustein found that any taping
of the defence examination would provide an unfair advantage to the
plaintiff since there was no recording of the plaintiff’s examination.
The reasoning appears to run through other cases denying similar
motions. But what would the harm be in allowing a recording of the
defence examination given that the introduction of the tape would be at
the discretion of the judge?
The reluctance of defence lawyers
and experts to allow taping of assessments has always puzzled me. The
tape protects the doctor from allegations of wrongdoing by the patient.
Why wouldn’t an expert want irrefutable evidence of what was said and
the examinations conducted during an assessment? Further, as stated in Moroz v. Jenkins,
“The ability to review the defence examination and compare it to the
report should in most instances promote settlement by demonstrating to
both sides the correlation between what the psychiatrist saw and heard
and his or her conclusions.”
Yet doctors resist recording their
examinations. Their arguments ring hollow, however. For example, we hear
patients may perform in front of the camera. But if doctors can’t
adequately deal with performing patients, surely we can leave that to
the judge or jury to sort out.
Patients may not be forthcoming
knowing there will be a recording. Yet it’s the patient who has
requested the recording, so how can that be a valid consideration? Could
it be that defence experts don’t want an accurate record of their
examination so as to make it more difficult for plaintiffs to dispute
their findings?
Common sense dictates recording defence examinations when plaintiffs reasonably ask for it.
The use of so-called “black boxes” to document surgical procedures is long overdue.
A 2012 study estimated about 40,000 Canadians die each year due to medical errors.
The actual number of medical-error induced deaths is likely much higher due to a lack of adequate reporting.
Almost 50% of all hospital adverse events take place during surgery, according to a 2007 study.
So it is comforting to see Toronto’s St. Michael’s Hospital has
installed and is using video and audio recording equipment to document
surgical procedures.
Other hospitals should follow suit.
This will allow analysis of surgical techniques and permit hospitals to take steps to avoid errors.
Clearly, this has great potential provided hospitals are willing to
take the time to analyze the recordings and educate surgical teams on
best practices.
Doctors are concerned the recordings may be used as evidence in malpractice lawsuits.
The doctor who introduced the recording system to St. Mike’s has been
quoted as saying, “If we choose to use it as a tool to place blame and
to point fingers at surgeons for litigation, I think this will never
take off.”
That is a misguided view.
If there’s an adverse event during a surgical procedure why shouldn’t we use the best possible evidence to assess liability?
Why should we force courts to rely on notes and recollections, often
faulty and incomplete, to determine what took place when we have an
accurate recording?
Using a recording as evidence should simplify matters and make it easier to determine fault, thereby reducing trial duration.
Better yet, if the recording makes it clear someone made an obvious
error there’s no reason why the hospital shouldn’t enter into an early
settlement, thereby saving everyone a great deal of money.
It seems our laws are set up in an effort to insulate hospitals and doctors from adverse publicity and lawsuits
While we pass laws superficially intended to enhance patient safety,
the reality is the laws protect hospitals and health care professionals
from litigation and shield them from having to disclose embarrassing
information.
The best example of this is the Quality of Care Information Protection Act.
This legislation places restrictions on the release of any
information collected by or prepared for a hospital’s quality of care
committee.
This is the legislation that allowed Humber River Regional Hospital
to keep secret information on how a baby was wrongly declared dead in
February, 2013.
It is also being used to throw a cloak of secrecy over the June
suicide of Prashant Tiwari, while under 24-hour surveillance at Brampton
Civic Hospital.
Quality of care information is not available under freedom of
information legislation and even if disclosed is not admissible in any
court proceeding.
Hospital administrators attempt to justify such secrecy legislation,
arguing that without assurances of confidentiality candid reviews would
not take place.
But what does that say about hospitals and doctors?
That they are more interested in protecting themselves and their colleagues and would compromise on honesty and patient safety?
We also have section 36(3) of the Regulated Health Professions Act,
which bars the use of any information obtained as a result of a
complaint to the College of Physicians and Surgeons.
Even findings of wrongdoing are inadmissible in court proceedings,
making it difficult for victims of malpractice to pursue civil claims.
These laws portray hospitals and health professionals in the worst possible light.
They send the message it is more important to hush up malpractice
than to provide justice or improve patient safety. We have a fault-based
system of civil liability for medical errors.
We hold hospitals and health care professionals accountable for their
negligence, believing such accountability will lead to behaviour
modification to improve patient safety.
Yet we have created laws to shield hospitals and health care professionals from being held accountable.
These shield laws must be eliminated.
All hospitals should be forced to use black boxes to record surgical procedures, regardless of how the recordings are used.
Ontario has made significant changes to the auto
insurance system - capping benefits and streamlining the process - but
it’s not yet clear what impact that’s had on limiting fraudulent claims.Ontario’s Bill 15 has a strange title.
The title, Fighting Fraud and Reducing Automobile Insurance Rates
Act, 2014, is strange because this proposed legislation doesn’t refer to
fraud anywhere in the body of the bill save in references to the title
of the proposed legislation.
Then again why pass up the opportunity to propagandize?
Upon introduction of the bill earlier this month the Ministry of
Finance announced, “Ontario is moving forward with its plan to help
reduce auto insurance rates, by introducing legislation that would, if
passed, protect the province’s nine million drivers and fight fraud in
the auto insurance system.”
But there’s nothing in the bill that fights fraud in the insurance system.
Worse, there’s little in the bill that would protect drivers.
Indeed, there’s much in the bill that would harm drivers, especially those injured in auto accidents.
Let’s start with the manner in which no-fault accident benefits disputes are handled.
Currently such disputes may be dealt with via arbitration or through court action.
Bill 171 will remove the option of court action.
It’s hard to see how removing the right to pursue claims before a judge will help drivers.
Paradoxically, this move will cause legal costs to increase as claimants are forced to pursue two separate claims.
Ontario drivers are subject to a hybrid or dual auto insurance system.
Those injured in auto accidents may pursue a tort or negligence claim
(although that right has been curtailed as a result of previous
legislation), as well as a claim for no-fault accident benefits.
Currently, lawyers often combine both in one lawsuit.
But following passage of Bill 15 lawyers will be forced to pursue two
different proceedings, a court proceeding for the negligence claim and
an arbitration proceeding for the accident benefits claim, thereby
resulting in higher costs.
At the same time accident benefits claim disputes will no longer be
handled by the expert arbitration staff at the Financial Services
Commission Ontario.
Bill 15 would see the elimination of all mediators and arbitrators employed by FSCO.
Disputes will be handled by Ontario’s Licence Appeal Tribunal, a body
that currently decides cases with no relation to the complex accident
benefits issues seen daily by FSCO arbitrators.
FSCO arbitrators have many years of experience handling accident benefit disputes.
They are full-time, unionized public sector employees who are seen to be independent and are highly respected.
LAT members are part-time (other than the Associate Chair), appointed
for temporary terms, receive per diem rates (other than the Associate
Chair), and are government appointees.
Reappointment is at the pleasure of the Ontario cabinet, so they cannot be seen as independent.
While there’s nothing to stop cabinet from appointing some former
FSCO arbitrators to the LAT roster, there’s also nothing to stop cabinet
from cherry-picking from among the FSCO arbitrators to eliminate
arbitrators whose decisions have displeased the insurance lobby.
Prejudice
Bill 15 contains two other provisions that will prejudice those injured in auto accidents.
Currently arbitrators have the power to penalize insurers who act unreasonably in withholding or delaying benefits.
They can award a lump sum of up to 50% of the amount withheld or
delayed along with interest at the rate of 2% compounded monthly.
Bill 15 eliminates that power.
In addition, Bill 15 would reduce the amount of interest insurers are required to pay on money owed to accident victims.
That surely won’t serve to speed up settlements, with insurers given an incentive to delay payments.
Let’s not kid anybody.
Bill 15 is mainly about saving money for insurance companies to help
them reduce premiums, so as to assist them in achieving the government’s
promised 15% rate reduction.
But even if we achieve this 15% savings in auto insurance rates
there’s nothing to stop insurers from increasing premiums on their other
products, including property insurance, which is not subject to
government regulation.
If you don’t believe me, just take a look at your next property insurance bill.
Regular readers will know I have locked horns with the Insurance Bureau of Canada on many occasions.
That’s why I’m pleased to say I agree with the statements on the IBC
website that “Ontarians deserve affordable, effective insurance and the
current system is simply not working in Ontario” along with, “Too much
of the money doesn’t actually go to accident victims.”
But the IBC website then goes on to say, “Instead, it pays for other
costs like legal fees, fraud and assessments by for-profit medical
facilities”, which implies that more money would go to accident victims
if these costs decreased.
And with that, I disagree.
The recently reported case of Pamela Mayer (and her husband and
daughter) versus Anwar Gewargis Shemon offers a glimpse into the
exorbitant world of legal and experts’ fees.
The plaintiffs sued over a motor vehicle accident. Liability was
admitted. The only issue for resolution was the financial award.
The plaintiffs initially sought $1.1 million plus interest and legal
costs but increased the claim to $2 million plus costs during the trial.
The jury saw things differently and awarded damages of only $140,600 following a four-week trial.
Having won the case, albeit with a minor victory, the plaintiffs sought compensation for part of their legal costs.
The partial legal costs being sought were an astounding $265,393.21, plus $156,662.20 for disbursements.
That’s $422,055.41 in respect of a case the jury assessed as worth only $140,600.
None of these figures include the legal fees charged by the insurance company’s lawyers, or fees paid to the defence experts.
While those fees aren’t fully disclosed in the court decision it’s
safe to assume the fees paid to the insurance company’s lawyers and
defence experts exceeded $250,000.
Ontario Superior Court Justice Ian F. Leach labelled the legal fees
sought by the plaintiffs’ lawyers as being “extremely excessive” and
“outlandish”, pointing out the total clerk time of 580.49 hours claimed
“is the equivalent of someone working solidly on nothing but this
matter, 40 hours per week, ... for approximately 14.5 weeks”.
That, according to Justice Leach, was “quite unreasonable”.
The disbursements included $26,398.27 to an expert epidemiologist
witness whom the court said had a “relatively brief appearance” in
court, $20,556.93 to another expert witness doctor, $18,851.17 to two
occupational therapist witnesses and $30,722.25 to an expert witness who
testified on economic losses suffered by the plaintiffs.
Those are just the experts retained by the plaintiffs and the figures demonstrate how lucrative being an expert witness can be.
But not if Justice Leach has his way, as he remarked, “an expert
cannot simply charge what he or she considers appropriate and then
expect ... that such fee will be deemed acceptable by the court.”
Clearly the plaintiffs’ lawyers did not have a realistic assessment
of the realities of the case as determined by the jury and devoted time
and resources to the case that were disproportionate to its true worth.
Further, the plaintiffs made no effort to settle the case until the eve of trial, when they sought $1.5 million plus costs.
Based on these and other factors Justice Leach decided to award no
costs to the plaintiffs in spite of their victory in the lawsuit. That
should present a sobering lesson to plaintiffs’ lawyers who conduct
litigation in a similar fashion.
The revelations in this case reinforce the IBC lament of too much money being incurred on costs like legal fees.
But here is where I part company with the IBC.
The IBC implies if less money went to other costs like legal fees, there’d be more money for accident victims.
But based on past history and particularly the reduced money going to
lawyers and experts and medical facilities due to the 2010 cap of
$3,500 on minor injuries, there’s little reason to believe if less money
went to lawyers and experts that more money would flow to accident
victims.
If you drive a vehicle in Ontario, the law requires that you insure
your vehicle. Every auto insurance policy includes mandatory no-fault
benefits. We pay for these benefits with our premium dollars. While
premiums have continued to climb year after year, the no-fault accident
benefits for injured victims continue to erode. While benefits have been
steadily declining for many years, the changes that were imposed in
September 2010 were the most drastic and punitive to date.
The highlight for the insurers and the low point for injured victims
was the introduction of the Minor Injury Guideline, commonly referred to
as the MIG. Before September 1, 2010, the standard auto insurance
policy in Ontario included a limit of $100,000 to pay for reasonable and
necessary medical and rehabilitation treatment. This did not mean that
every person injured in a car crash in Ontario was entitled to $100,000;
however this did mean that provided the injured person needed medical
and rehabilitation treatment, those treatments would be covered up to a
maximum of $100,000. The insurer still had to approve the treatment, but
at least if the treatment was approved there was money to pay for that
treatment. The introduction of the MIG in September 2010 dramatically
changed the landscape for almost all Ontarians injured in motor vehicle
collisions. The MIG caps the payment for all medical and rehabilitation
treatments at $3,500. This means that if an insurer puts a person
injured in a motor vehicle collision in the MIG, that person can only
receive treatment up to a maximum cost of $3,500. This might not be so
bad if the MIG only truly captured “minor” injuries. Sadly, insurers in
Ontario are classifying up to 75 percent of all auto crash victims in
Ontario as MIG injuries and capping all medical and rehabilitation
treatments at $3,500. Even if you are in the lucky 25 percent that
insurers are not putting into the MIG and capping coverage,
your coverage for medical and rehabilitation benefits have been reduced
from $100,000 to $50,000.
There can be no question that the insurers are the big winners from
the September 2010 auto insurance changes. When premiums remain
unchanged or go up and claim costs go down, the insurer’s profits
skyrocket. Here’s what one insurance CEO commented after the September
2010 changes to auto insurance benefits:
“We are starting to see the benefits
of the 2010 auto insurance reforms in Ontario, which is combining with
our recent focus on proactive broker management and underwriting
discipline to generate stronger results.”
In two short years since the September 2010 auto insurance changes,
auto insurance claims in Ontario were down more than 20 percent or a
reduction of $4 billion. In that same two year period, auto insurers
have reported more than $3 billion in profits. It should come as no
surprise to anyone that insurers will profit when benefits for insured
victims are reduced and in many cases eliminated.
In wake of these changes, Ontario now has, in practical terms, the
lowest level of no-fault coverage for medical and rehabilitation
benefits in the country. Ontario is also the only jurisdiction in the
country with a special category of auto insurance for so called “minor”
injuries.
These changes not only affect those injured in car crashes but the
impact can and will be felt by all Ontarians. As the insurers limit
medical and rehabilitation benefits, those injured individuals will have
no choice but to seek treatment from the publicly funded OHIP system.
The lack of treatment will also lead to more people not being able to
recover and return to work and need to look to the publicly funded
social security net. Meanwhile insurers continue to report record
profits.
These changes are only the latest and most drastic erosion of auto insurance benefits in Ontario. Toronto Sun columnist Alan Shanoff has documented the steady decline in coverage over the years in Ontario. Read his comments here.
He ends his article as follows:
“One thing is certain. The current
system can’t get much worse for accident victims. Victims need timely,
adequate accident benefits even more than they need premium cuts.”
Contributed by Kris Bonn, an OTLA Director and a lawyer practising with Bonn Law Office in Trenton, Ont.
The latest skirmish in this debate arises in Alladina v. Calvo,
a May 6 decision of Superior Court Master Benjamin Glustein allowing a
defence motion to compel the plaintiff to attend a medical assessment
before a psychiatrist and dismissing the plaintiff’s motion to conduct
the assessment by a different practitioner or, alternatively, to record
it.
The use of so-called “black boxes” to document surgical procedures is long overdue.
