Hired gun in a lab coat: How medical experts help car insurers fight accident claims

.... years after being rear-ended in a car accident, Liese Bruff-McArthur saw a small army of medical professionals. Most agreed the crash had left her with chronic pain, depression, PTSD and other troubles, making a return to work untenable.

Then she met Dr. Monte Bail.

Hired by the insurance company she was suing, the psychiatrist spent an hour and a quarter with the Ottawa-area woman — the kind of work that earned Bail as much as $77,000 a month — and concluded Bruff-McArthur was essentially faking it..........

And such cases are likely just the tip of the iceberg, say lawyers representing accident victims, the plaintiffs. Judicial criticisms arise only in the five per cent or so of cases that get to trial, they note, so most instances of bias stay under wraps as lawsuits are settled out of court.

“It’s clear from the (reported) cases that it is far too prevalent,” says Adam Wagman, a plaintiff lawyer and president of the Ontario Trial Lawyers Association. “That attacks the very foundation of our system of justice.”.....

Source/more:
http://news.nationalpost.com/news/hired-gun-in-a-lab-coat-how-medical-experts-help-car-insurers-fight-accident-claims

Putting the pieces together - what Ont auto insurers don't pay and how it is creating a crisis

Insurers are pocketing the health care costs of treating MVA victims – funds that should be repaid to taxpayers (not to mention OW and ODSP costs that the taxpayer is unknowingly picking up along with prescription costs) and this has created a health care $ deficit problem for Ontario taxpayers. A problem the Financial Services Commission has known about for years – the Auditor General told the FSCO it needed fixing in 2011 but nothing was done so the taxpayer has continually paid some of the medical costs of MVA victims. To ‘cure’ the problem it is now suggested by the Ontario Chamber of Commerce to privatize some services. Which means more people would have to increase their private insurer coverage if they are lucky enough to have this extra coverage. Who benefits? Not the taxpayer and not victims. Insurers who will now sell consumers the coverage they can no longer get from OHIP. Simultaneously auto insurance coverage (as of June 1, 2016) is decreased by over $1 million for the most catastrophically injured among us, thereby saving insurers about $6-800 million a year in payouts. Rehabilitation/medical rehab access is also cut by 5 years for all but children who are injured. http://truthaboutinsurance.ca/benefits-recently-cut-further/ . So just as MVA victims are about to be increasingly shunted onto the OHIP system, the proposal is to increase the privatization of that system.

Source/more: http://www.fairassociation.ca/2016/03/putting-the-pieces-together-what-ont-auto-insurers-dont-pay-and-how-it-is-creating-a-crisis/

Constitutional Challenge Launched Against Flawed Ontario Liberal Government Automobile Insurance Legislation- Discriminatory and Unconstitutional

Joseph Campisi, lawyer and advocate, is launching a constitutional challenge in the Ontario Superior Courts.  Mr. Campisi is seeking a declaration from the courts that parts of the legislation that were recently passed by the Liberal Government are discriminatory and unconstitutional and should be inoperative.

"The right to access the Superior Courts is a fundamental right for Canadians.  I am concerned that the recently proclaimed legislation will deny this right to individuals who have been severely disabled." said applicant and noted Personal Injury Lawyer Joseph Campisi.  "Historically, the deck has been stacked against collision victims.  The recent amendments to the legislation have turned a bad situation into a worse one for these vulnerable individuals.  No longer will these individuals be allowed to have the assurance of impartiality and independence that is a cornerstone of our justice system when litigating a claim against their own insurance company.  I could not stand idly by and let this happen."...........

Sources/more:

http://www.newswire.ca/news-releases/constitutional-challenge-launched-against-flawed-ontario-liberal-government-automobile-insurance-legislation--discriminatory-and-unconstitutional-516506531.html

Bill reeks of IBC influence

Hudak is now leaving politics and has never shown any interest or knowledge in the topic of auto accident victims or pi lawyers before - so why now that he is leaving? If he is pushing through the Protection for Motor Vehicle Accidents Bill to get the government to scrutinize personal injury lawyers, it is highly likely that the Insurance Bureau of Canada (IBC) is behind it.

Source:

http://deniedbenefitclaims.com/blog.html

This is a Xmas Wish that We hope everyone will RETWEET

Being delayed the help you need..is a crime! 

Wish list 4 Santa. Suffer financially everyday waiting for insurance approvals. We are here 4 U.

Sources: https://t.co/j86f6glLeW

https://twitter.com/busted_bucket/status/808302759535669248

So we ask - why is the Ontario government gifting auto insurers with our healthcare dollars?

For 11 years the Ontario government has known that the taxpayers are paying too much for the healthcare of MVA victims post accident. The Auditor General has told them so in more than one report. The Minister of Finance recently put out the HSPRN report that acknowledges that the actual cost to OHIP was $383 million in 2013/14. This is a shortfall of $241 million in just one year. The loss to the taxpayer, who is paying while insurers aren't, is well over $1 billion in just the last 5 years alone.

Source: http://www.fairassociation.ca/2016/10/ontario-government-gifting-auto-insurers/

Broker Negligence Claims: Are You Adequately Covered?

Is your insurance broker adequately inquiring about your insurance needs? With the substantial decline of available medical, rehabilitation and attendant care benefits from $2 million to $1 million for catastrophically injured individuals, this is a question that will be asked more often in the realm of motor vehicle insurance. The recent cutbacks to the accident benefits regime in Ontario are expected to have profound effects on those seriously injured in accidents.

Source/more:

http://www.mondaq.com/article.asp?articleid=544044

Judge sees his recommendations cherry-picked re auto insurance

Justice Cunningham is himself now wary of his February 2014 recommendation that the province appoint a “public sector administrative tribunal” for SABS disputes and get rid of the court option for MVA victims.
He now acknowledges that few of the LAT adjudicators actually have experience resolving AB disputes, saying “Clearly many of my recommendations were not adopted.” “There was a lot of cherry picking that went on here.” WHY IS HE SURPRISED? As an accident victim I certainly am not. And herein lies the problem.

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

Rhona DesRoches, FAIR: 59,000 cases on docket in Ontario

Ending the use of jury trials in personal injury cases doesn’t have much to do with restricting freedom of speech for insurers who will undoubtedly continue with their fight to reduce claims costs under the guise of a fight on fraud. 

The constant maligning of MVA victims over decades by the IBC/insurers in advertising has had the intended consequence of negatively influencing the public and that has included potential jurors. This is not just one case.

In Bruff-Murphy v Gunawardena, 2016 http://canlii.ca/t/gmr5x there’s an acknowledgement that the expert evidence that the Judge found questionable may not have been viewed in the same way by the jury. Juries are made up of ordinary people with the ordinary expectation that the evidence they are presented with is honest. Anyone working in the personal injury field knows that this is often not the case when it comes to Ontario’s ‘experts’ whose medical opinions are relied on by insurers to delay and deny legitimate claims

Auto insurance is a dirty game played out in our courts and if the flawed evidence is going to be allowed in the door you can’t expect the ordinary jurors to filter out the junk medicine replete with biased or flawed opinions and come to a just decision. 

According to StatsCan there are over 59,000 (2015) auto insurance related cases on the docket in Ontario; aside from pointing out that this is indicative of an unaddressed problem with Ontario’s auto insurance, it’s a massive amount of money being laid out by taxpayers when 50% of claims are denied and end up in hearings.



Source/more:
http://www.slaw.ca/2016/10/26/wednesday-whats-hot-on-canlii-188/comment-page-1/#comment-948175

Van Galder v. Economical Mutual Insurance Company

[11] There is no issue that the respondent was seriously injured in a motor vehicle accident on January 20, 2004. She suffered significant physical injuries to both legs. Since the date of the accident, she has been unable to walk unaided and is now wheelchair-bound. Subsequent complications and surgeries that followed over the next several years resulted in the amputation of her lower right leg and left her with chronic pain.

[93] The appellant submits that the application judge’s order has the opposite effect: it “incentivizes” an insured person to delay his or her catastrophic application as long as possible in order to accrue tremendous amounts of interest in the interim. According to the appellant, this would also create difficulty for insurers in properly establishing reserves for claims files open beyond the 104 (or 260)-week period.

[94] These arguments were submitted to and rejected by the application judge. I also would not give effect to them.

[95] First and foremost, it defies common sense that a catastrophically impaired insured person would delay making an application that would open the door to desperately needed enhanced catastrophic benefits. I agree with the application judge’s observations in this regard:

A catastrophic injury is a serious one; catastrophically injured people require assistance to perform their activities of everyday living and to cover medical expenses. The nature of these expenses are such that they cannot be forgone by a victim or denied by an insurer, with the aim of accruing or avoiding costs.

[96] There is no question that the SABS requires an insured person to make the necessary applications and provide the required information to an insurer. However, these obligations must be understood in the context of a catastrophic impairment. The nature of many catastrophic impairments may necessarily render a catastrophically impaired insured person incapable of navigating and completing the complicated and detailed application process for a catastrophic impairment determination. As the application judge found, this is clearly what happened in the present case.

Source/more: 2016  ONCA 804 (CanLII), < http://canlii.ca/t/gvd47

Inquiry into Medical Evidence petition

Link to: Inquiry into Medical Evidence petition

FAIR has put together a paper version of the petition calling for a Public Inquiry into the medical evidence used in our courts and administrative tribunals. It is the same as the one we have asked you to sign online.

The Ontario Legislature ONLY accepts ORIGINAL petitions, on paper, with ‘hand signed’ signatures. There are strict rules for petitions so NDP MPP Jagmeet Singh’s office has generously agreed to receive the paper petition in his office and present it at Queen’s Park.

If you or a loved one were injured in an auto accident, at work or elsewhere wouldn’t you want an honest, unbiased and qualified medical opinion/report of your injuries? That’s just not happening in Ontario for injured and disabled individuals who make a claim for benefits through their private or public insurers. What if it was your fault that something happens to someone else? You’d want them to have the best chance at recovery wouldn’t you?

Please print, sign and circulate the petition because quality and qualified medical evidence shouldn’t be something we need – it should be something we already have because there is no real justice without it.

Make a copy and mail the ORIGINAL copies to: MPP Jagmeet Singh, Room 172 Main Legislative Building, Queen’s Park 111 Wellesley St. Toronto, ON M7A 1A5

Thanks for being part of the collective voice needed for change!

Other On-line petition: https://www.change.org/p/the-legislative-assembly-of-ontario-support-a-public-inquiry-into-medical-evidence-in-ontario-s-courts-and-tribunals (these signatures are also important to make our point elsewhere and it gives those on-line the power and opportunity to use their voice)

Source: http://www.fairassociation.ca/

Auto insurance changes

Auto insurance changes with @IBAOntario and Jokelee Vanderkop http://www.zoomerradio.ca/show/fight-back-on-zoomer-radio/michael-brattman-jokelee-vandekop-june-1/ …

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Existing links and bookmarks to Canadian Insurance News will continue to work.

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Ontario’s Shame and Scandal – how the injured and disabled are punished by government policy

Victim’s group calls for the Auditor General and the Ontario Ombudsman to investigate what is happening to Ontario’s injured and disabled citizens

TORONTO, November 17, 2015 PRESS RELEASE - Ontario auto insurers are poised to make higher profits on the backs of Ontario’s disabled and injured MVA victims in 2016 while continuing to build up the provincial deficit by downloading the expense of victims to the taxpayers. Recently passed legislation means that coverage for the most injured MVA victims will be cut in half.

In October Ontario’s over 9 million drivers learned through the Lazar Prisman Report that they had been overcharged for auto insurance and likely overpaid by $1.5 billion in the last two years alone.

In recent weeks we learned just how challenging recovery is and how poorly the WSIB injured workers are treated in the Prescription Over-Ruled: Report on How Ontario’s Workplace Safety and Insurance Board Systematically Ignores the Advice of Medical Professionals.

How are these two stories related? Both systems are focused on their bottom line profits and their investments and not on recovery or the best interests of their clients. Both systems are based on medical evidence to support or deny claims; access to treatments and benefits relies on it. So what happens if those medical examinations aren’t reliable?

Ontario’s auto insurance companies have been delaying and denying their customer’s claims by way of poor quality or biased medical opinion reports in much the same way as is happening at the WSIB. Many of the same experts are employed under the two systems and those assessors who are auto insurers’ “preferred vendors” of these “independent” assessments are often beholden to the company that pays them. Similar to the WSIB assessment model where expectations are to be met or there are consequences.

Providing auto insurers’ with “favourable” medico-legal opinions by minimizing/trivializing legitimate injuries is unethical and it should be treated as a form of fraud. It is after all the mirror image of the type of fraud the FSCO, the Insurance Bureau of Canada and the WSIB say they won’t tolerate.

The insurers’ assessment is the only component of our broken Ontario auto insurance regime that has escaped regulatory scrutiny. It is the corrupted insurer medico-legal (IME/IE) assessment system that stands between injured claimants and their access to the Statutory Accident Benefits (SABs).

The current legislation allows auto insurers to deny policy benefits (including treatment, income replacement, attendant care, etc.) to seriously injured auto victims solely on the basis of the opinions of these second opinion insurer assessments commissioned to question the validity of the diagnosis and prognosis of attending physicians and treatment providers.

No matter how many attending physicians attest to the legitimacy of an injury ultimately the insurer assessor’s opinion (even if unqualified or biased) trumps those of the attending physicians’ in terms of the injured claimant’s eligibility for treatment and benefits.

The legislative changes and cuts to coverage will find many untreated and injured MVA victims dumped onto our OHIP and public supports systems. Insurers have been taking advantage of the taxpayer who ends up paying the costs of car crash survivors through Ontario Works (OW) and Ontario Disability Support Program (ODSP). Insurers’ profits and WSIB books get balanced while victims end up impoverished and at the food bank.

Ontario’s injured and disabled individuals deserve better treatment at the hands of our government be they car crash survivors or WSIB claimants. They have the right to expect to have their medical conditions addressed through the recommendations of their treating physicians and providers who shouldn’t be second-guessed by “hired gun” insurer ‘experts’.

We ask that the Ontario Ombudsman look into the systemic abuse of Ontario’s victims and why the Financial Services Commission of Ontario and the Minister of Finance have failed to protect the interests and well-being of injured Ontarians with meaningful regulation and enforcement.

We ask the Auditor General to look into the reasons why the Minister of Finance (MOF) has not taken action on the Auditor General’s 2011 report recommendation that an update on the assessment of health system costs be done. These are the costs to the taxpayer through our medical systems that should be paid by Ontario’s insurers through a transfer of funds. Health care costs and the volume of MVA victims dependent on our social supports have increased substantially since the inception of No-Fault insurance. Yet the transfer of funds from Ontario's insurers to the province has not increased since 2006 before the majority of MVA victims have had their med/rehab claims capped at $3500.00 in 2010, down from $100,000.00 in previous years.

We would ask the Auditor General to go further and assess the cost of the public supports to unpaid MVA victims and WSIB claimants when they are downloaded to OW, ODSP and ultimately CPP Disability. Ontario’s insurers will slash benefits in half to $1 million for med/rehab/attendant care for the most catastrophically injured MVA victims in June of 2016. This will have far reaching costs to taxpayers who not only pay the highest auto insurance premiums in Canada but who are also going to have to pick up the majority of the costs of seriously injured MVA victims and provide additional services through OHIP.

Our auto insurance system is surely broken when insurers are so routinely using our courts as a tool to deny claims. According to StatCan there are over 61,000 auto insurance related cases waiting for hearings in Ontario civil court and over 19,000 more MVA victims at the Financial Services waiting for hearings. All of these delays and denials have a cost and insurers don’t seem to be the ones paying for it.

SOURCE FAIR Association of Victims for Accident Insurance Reform is a not-for-profit organization of MVA victims and their supporters. http://www.fairassociation.ca/

For further information: Media Contact: Rhona DesRoches, 705 543-0574, fairautoinsurance@gmail.com

Accident Benefit Coalition Victim Survey

Accident Benefit Coalition Victim Survey is for Accident Victims who were injured in Ontario Motor Vehicle Collisions (MVCs). The purpose is to collect information regarding victims’ experience in regards to obtaining Ontario Accident Benefits from insurers. Absolutely no personal information is collected or shared.

The Accident Benefit Coalition (ABC) consists of a membership of Ontarians concerned with issues surrounding the provinces’ mandatory Accident Benefits. It was founded by NeuroConnect and FAIR Association and is committed to advocating for Accident Victims in Ontario.

Survey for claimants: https://www.surveymonkey.com/s/AutoInsurer

Please share this survey with others you know who have gone through the claims experience!

The petition is still going https://www.change.org/p/ontario-mpps-finance-minister-charles-sousa-stop-reducing-ontario-accident-benefits

The deck is stacked against injured MVA victims if they choose litigation

Unlike other types of litigation in Ontario, personal injury actions arising from motor vehicle accidents are stacked against plaintiffs from the beginning....


MORE:
http://www.lawyersweekly.ca/articles/2509

Social Security Tribunal OUT OF SERVICE Backlog

The rush to relieve the backlog of thousands is on at the Social Security Tribunal of Canada.

Minister Jason Kenny said the backlog of thousands would be gone by this summer.

The New Minister Pierre Poilievre Responsible for taking care of the backlog (that this blogger has contacted, but had no response from) has not gotten rid of the backlog of Appeals.

Someone called. We could not make it out. Someone called again, it was the Social Security Tribunal of Canada, her message said “if your matter has already been completed then you can disregard this call” “otherwise you can call us” and left an OUT OF SERVICE NUMBER 1-877-277-8577.

I emailed the Social Security Tribunal and was informed that I had been given the wrong number by them and it should have been 1-877-227-8577.

To make matters worse the email he replied back to me with quoted someone else s case number! Not mine!

Am I in the twilight zone?

I was a MVA victim in 2007 after a fatal 3 car crash. My application for CPP Disability Benefits was launched in 2008. I still have not received a complete copy of my file, and a lot of what they have sent me so far, is unreadable to any human. At least they didn't leave my medical-legal file on a bench in front of our house unattended this time.

The latest opinion from xxxx the Medical Adjudicator at Service Canada in August was that I have not established a Disability that is “Severe and Prolonged”.The (hired gun) Adjudicator out of the Chatham office goes on to say that I did not provide any medical documentation to support my Disability. 

They have however acknowledged receipt of my 105 page fax to them with the case file number GD37-1. The fax included the Ontario Superior Court of Justice Mediation Brief that included medical documentation to support a finding of a “severe disability”. 

My submitted Doctors findings should not be taken lightly as they come from respectable sources. 

One submission in the Brief is from a Doctor with a 25 year career in the hospital sector focusing on neurological disorders, schizophrenia, and pediatric brain injury and pediatric oncology including consultation to the hospital MS Clinic an acute psychotic disorders clinic. He has a long career in psychological research and scientific publication and presentation. He has published in the areas of chronic insomnia, neurohorrnoes in schizuphrenia, metabolic brain imaging in schizophrenia (positron emission tomography), and neuropsychology of schizophrenia. He carries out psychological asssessment and treatment, supervises clinicians, and carries out psycho legal and multidisiplinary-legal assessments and testifies at Arbitrations and Court. He was the Director of the Hamilton Medical-Legal Society and past President. He has been co-chairman of the Ontario Psychological Association Task Force on Auto Insurance. He was appointed by the Minister of Finance to the Accident Benefits Advisory Committee for Bill 164. He was appointed by the Minister of Finance to be a member of the Ministers Committee on the Designated Assessment Center System for Bill 59 and held the position for a year. He was appointed to the Expert Panel reviewing the Catastrophic Impairment SABS. He was a founding member of the Canadian Academy of Psychologists in Disability Assessment (CAPDA). He received the Karl Heiser Presidential Award from the American Psychological Association and the Ontario Psychological Association Award for his advocacy efforts on behalf of professional psychology. He received the OPA Lifetime Achievment Award. 

Other medical-legal documentation provided to the Social Security Tribunal was from a doctor whos is a registered psychologist with areas of competence in rehabilitation and clinical psychology. He is a partner at a psychology clinic and assessment centre. His doctoral degree is in Clinical Psychology, with a minor in Health Psychology. He has a post graduate diploma program (DESS) through the University of Montreal Faculty of Medicine in Insurance Medicine and Medicolegal Expertise. He has a Master of Science in Community Counselling with specialized training in vocational assessment and counselling. His doctoral training included assessment, diagnosis and treatment of severe mental and behaviour disorders in private and public psychiatric inpatient hospital settings, as well as sheltered workshops. He has also performed disability assessments for patients with severe mental disorders applying for Social Security Disability. As a clinical psychologist, he worked in several chronic care facilities, assessing, diagnosing and treating patients with severe psychological disorders, including psychotic and severe mood disorders. Upon immigrating to Canada he has re specialized in rehabilitation psychology. He since has performed hundreds of psychological disability assessments in relation to M.V.A, WSIB, and other personal injury contexts. He was on the FSCO roster for Post 104 and Catastrophic disability assessors, and has performed hundreds of Catastrophic, Post-I 04 disability and psycho-vocational assessments. He has published scholarly works with respect to catastrophic impairment, and created educational modules addressing catastrophic impairment evaluation for psychological disability assessors. disability and psycho-vocational assessments. He delivered the 2010 Keynote Address to the British Psychological Societys Division of Counselling Psychology on the intersection of psychological assessment and the law. He has also edited two books on the application of humanistic theory to psychological treatment and has also published book chapters and articles in this area. He was the President of the Canadian Academy of Psychologists in Disability Assessment (CAPDA). He has been accepted as an expert witness in Ontario courts. GD37-52

Their medical documentation in the Brief supports a finding of a “chronic pain” , “severe disability” , “severe depression” , “PTSD” , “suffers permanent and serious impairment” , I am “neither exaggerating nor feigning” , “tends to minimize his complaints” , “suffers a complete inability to engage in any employment for which he is reasonably suited by education, training or experience”, “is at a competitive disadvantage in the workforce”. GD37-33 / GD37-34 / GD37-35 / GD37-37 /GD37-38

Also included was a Chronic Pain Assessment from yet another doctor that states: “his neck disability” , “suffered a significant functional, financial and emotional loss” , “suffers from Degenerative Disc Disease in his Cervical Spine, as well as debilitating Myofascial pain syndromes in his cervical spine.” , “severe disability”, and “complete disability” , “WADS III of the neck”. GD37 – 105 / GD37-23 / GD37-25 / GD37-105.

Also included in the Brief was yet another doctor report that states: “completely disabled from any occupation to which he is suited by way of his education, training or experience.” GD37-43

Another Doctors report included in the Brief states: Overall, I am “not employable”. GD37-32.

Rather that go long winded in this post I submit that I have provided enough medical documentation to establish my disability just from the above doctors. You have the other reports and blog postings I will not duplicate them here.

Today I finally received a date for my Appeal Hearing. The date on the notice was 39 days ago. The notice says that my hearing is not going to be until 2016, next year!

In this effort to get rid of the backlog of thousands how many are getting run over. What happened to the pledge to wipe out the backlog by this past summer? How many Appellants are still backlogged at the Social Security Tribunal of Canada?

If my Medical-legal experts are good enough for the Ontario Superior Court, a mediator, numerous doctors and lawyers, and 4 insurance companies they should be good enough for Service Canada and the Social Security Tribunal. I hope that the Tribunal Member that decides my appeal takes into account my medical-legal evidence submitted here in from real Medical experts, that write the rules, and not Service Canada employees with an agenda.

Sincerely,

name removed

CPP Disability Applicant since 2008,

MVA-Insurance-Victim since 2007.

Thank you to all those who help me with my writing and blogging and to those who follow my blog. Unfortunately I have been diagnosed with astigmatism and cataracts in my eyes recently. Advocating for MVA victims will have to be less frequent. Seeing (reading and writing) has now been added to my list of Medical problems.

NO NAMES ARE POSTED ON THIS PAGE AT THIS TIME

THIS POSTING WAS SENT TO THE SOCIAL SECURITY TRIBUNAL OF CANADA NAME INCLUDED 

Cc: undisclosed

Car insurers and lawyers brawl in public

Two sides point to each other as reason for high insurance premiums. The truth is, they’re both responsible

By Alan Shanoff, Toronto Sun

First posted: Saturday, June 13, 2015 07:00 PM EDT | Updated: Saturday, June 13, 2015 08:20 PM EDT First posted: Saturday, June 13, 2015 07:00 PM EDT | Updated: Saturday, June 13, 2015 08:20 PM EDT

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.

Source: http://www.torontosun.com/2015/06/13/car-insurers-and-lawyers-brawl-in-public

 

Update: rally against insurers deemed “a great success”

by Jill Gregorie | 07 Jun 2015

Last week, Insurance Business reported on a rally that was being planned in protest of “shady” industry practices and the liberal government’s call for reduced MVA benefits as part of the provincial budget.

A spokesperson for reports with one of the rally’s organizers, FAIR Association of Victims for Accident Insurance Reform, reports that the event was “a great success with hundreds of people attending, either victims or their supporters.”

New Democratic Party MPP Jagmeet Singh addressed the crowd to lambaste the cuts as well, arguing that they hurt society’s “most vulnerable people.”

“It was a lively and vocal crowd who came out,” FAIR Board Chair Rhona Desroches said. “Many of the participants and certainly the auto accident victims who gave speeches were in various stages of recovery and I'm especially grateful that they came to speak for future victims who won't have the level of coverage that they themselves did post-accident.”

Desroches is referring to a little known provision where MVAs who sustained injuries prior to 2010 coverage reductions receive a greater share of benefits than MVAs injured recently, further exacerbated by the fact that “insurers made some benefits more difficult to access last year, i.e. qualifying for attendant care costs.”

The group hopes that this rally will incite a more vocal public outcry against Ontario’s treatment of MVA victims, who they believe are neglected in favor of insurance companies.

“The message is that MVA victims are not worth their time or the effort of the legislators who continue to assist Ontario's wealthy insurers profit margins rather than ensuring that Ontarians have coverage enough to recover. It's shameful,” Desroches said.

COMMENTS

• Brian on 2015-06-07 9:58:11 AM
  When will the dubious "preferred vendors" of the Ontario auto insurers' "proof" of massive opportunistic fraud be put under scrutiny? Systemic, bogus accusations of malingering churned out by pro-insurer medico-legal
  'experts' are first used (on a case by case basis) to deny benefits and then, in turn, trotted out by the Liberals as proof, on a policy level, that quad/paraplegics and brain inured accident victims are being treated "over-generously" and getting money "that needs to go to the people who really need it". We need to look at the long trail of sketchy "medical authorities" that Ontario governments have used to attack the credibility of the injured and the honesty of all Ontario motorists - a trail reaching all the way back to Dr. James N. Sears (aka Dimitri the Lover) - the insurer's "medical authority"
  behind the Harris "Rate Stability Act". And here we are: deja vue all over again!!!
• Brian on 2015-06-07 10:28:09 AM
  In terms of cause - one can draw a straight line between these latest cuts to the catastrophically injured back to the Liberal/IBC cherry-picked Panel of Experts on Catastrophic Injury which concluded that what counts as "catastrophic" injury is too generous and that the criteria needs to be made tougher for the most seriously injured to "thread" the catastrophic injury definition "needle". The Liberals have decided to double-down on that insurer-friendly report and use at not just to come up with a more narrow definition of catastrophic injury - but also to justify cutting in half the treatment and attendant care benefits of the handful of injured claimants who will ever be able meet the upcoming stricter/tougher/revised catastrophic injury definition. All this thanks to a Panel of "preferred" insurer IME vendors and a couple of epidemiologists who never have and never will meet (much less treat) a catastrophically injured auto accident victim.
• Rick on 2015-06-07 7:31:56 PM
  So coverage will be cut in half. I guess there's a refund on its way to everyone. Fat chance of that ever happening. Good on this group of concerned citizens for getting out there and making some noise about the evaporating coverage Ontario has. They've forgotten that they are selling, we are buying so we expect something for all those $billions we pay for coverage besides converting our policy dollars to Liberal campaign contributions.
• Brian on 2015-06-07 11:38:10 PM
  Ironically, the editorial position in today's Sunday Sun has some choice words to say about the Ontario auto insurers' "shady practices":
  http://www.torontosun.com/2015/06/06/car-crash-victims-deserve-better-deal
  
  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.
  
  
• Brian on 2015-06-08 1:34:55 PM
  The insurers say they won’t tolerate auto insurance fraud. Nor should they. So was this National Claims Manager (below) prosecuted – or not? If not – why the double standard? Is insider fraud tolerable?
  
  http://www.lawtimesnews.com/201012062960/inside-story/monday-december-6-2010
  Share
  
  
  LAWYER HELPED IN $1.5M FRAUD
  A Toronto lawyer has had his licence revoked for his part in a $1.5-million insurance fraud.
  
  Pradeep Bridglal Pachai admitted to taking part in a scheme that saw a senior employee at an insurance company client authorize higher payments to settle litigation than was needed and the two men pocketing the difference.
  
  Pachai claimed he was pressured into the scheme by Vinti Sansanwal, national claims director at HB Group Insurance Management Ltd., fearing he would cut him off from legal work defending the company, which had become his largest client.
  
  Initially, Pachai said he thought the arrangement was for one time only, but between 2005 and 2007, the scam snowballed, netting the pair $1.5 million from 11 files with the lawyer keeping $675,000 of the spoils for his role.
  
  The scheme came crashing down after an anonymous tip led to an investigation and Sansanwal’s dismissal. The insurance company then launched a civil action to recover the funds that named Pachai as a defendant. After he made restitution, the claim against him was dismissed.
  
  Close family and four lawyer colleagues acted as character witnesses for Pachai during the hearing. They labelled his actions as being out of character.
  
  In the meantime, Pachai asked the Law Society of Upper Canada to impose a lengthy ban, but the panel disagreed, noting the mitigating circumstances weren’t sufficient “to justify a second chance.”
  
  “There is no satisfactory explanation for his misconduct; it was a self-interested, economic choice which was not forced upon him, even if it was devised and initiated by Mr. Sansanwal.
  
  Nor was it unavoidable, in the sense that it was out of character because it was caused by a disability, addiction or any similar factor,” wrote Bencher Raj Anand on behalf of the three-person panel.
  
  The panel awarded no costs, noting Pachai had co-operated fully and wouldn’t be able to pay since having voluntarily ceased practice in 2008.
• Claire Laforest on 2015-06-08 5:18:59 PM
  The proposed reductions in auto insurance coverage are outrageous!! Unless you have walked a day with Sara and the family during the last 19 months, you have no idea what catastrophic injuries stemming from a brain injury caused by the MVA can do to someone emotionally, physically and financially. You may think that the proposed $500,000 for each of nursing care and medical/rehab therapy over a lifetime is a lot of money but it's not! We have so far spent close to $150,000 to $200,000 on Sary Buckley's injuries with nursing care and rehab and were not even at the 2 year anniversary yet. Home health care agencies charge between $25-$55/hr for PSW and RPN care while the current insurance coverage allows for $15/hr for 400 hours/mth or 150 hours/mth at the industry rate. Therapists charge between $100 and $150/hr plus mileage and report writing. Sara requires a physiotherapist 3X/week, a speech therapist once to twice a week, a rehab therapist every day and an occupational therapist every week. You think that's a lot? Well, it's not when someone like Sara requires 24/7 care; she cannot walk, talk, feed, bathe or dress herself nor maintain continence. All this at 18!! And then add to that the expenses related to the drugs and tube feed not covered by extended health private insurance and the cost of accommodating the accessibility to her home. The proposed changes will reduce the current $2M in total allowance by half. And this total $2M is not even what a survivor receives upon settlement because of lawyer fees. These changes must be protested. Proposed changes are going to be devastating. On behalf of all future MVA victims, the proposed changes have to be stopped. Please sign petitions!! Please participate in protests!! Contact your MPPs!! And the Ontario Government should be ashamed of what they are putting forward, in effect Sept. 2015!!
• Griswald G on 2015-06-08 9:30:24 PM
  The public has no concept of what rehabilitation and recovery can cost. Very few of us could afford what we might need if we were brain-injured or catastrophically impaired. The sense of urgency in Claire's posting is what most people feel when faced with coping with injured loved ones. Our government has failed us on many fronts when it comes to auto insurance and has allowed the IBC to misinform us of the coverage we have with their constant propaganda that everything is fine here, nothing to see, move along, we just need a few more dollars to keep us going and hey look - we can just get it from the victims - especially the worst off ones because they are least likely to be able to complain about it. Maybe there is something to see, and it all played out at the Rally last week when severely injured people showed up to help others they don't even know. And that's a darned sight more than our insurance companies do when we get injured in a crash. What do we get - shipped off to some assessment mill and a denial letter in the mail. Time to consider other possibilities like public auto insurance in Ontario.
• Brian on 2015-06-08 11:06:52 PM
  Who to believe? That is the question. We can believe the picture being painted by the IBC lobbyists. They would have us believe the insurers money is spent on people who only pretend to be catastrophically injured - and who - even if they are catastrophically injured - are getting to much treatment and too much attendant care. Twice as much in fact. Or, we can listen to the decisions of triers of fact (the judges and arbitrators) who scrutinize the way in which the insurers too often "treat" their most vulnerable claimants. You be the judge. Here (excerpts below) is a case. Who would you trust - the IBC's version of the story or this Arbitrator's decision. The Ontario auto insurance litigation landscape is littered with cases like this one chronicling all manner of insurer abuses. This case manager ought to be ashamed for her implausible (falsified?) reports submitted time and again and used to justify denial of care. Isn't falsifying reports in this way a crime? If not - it ought to be.
  Michalski and Wawanesa [+] Arbitration, 2005-12-13, Reg 403/96.
  Final Decision
  
  
  Each of the case manager's subsequent reports to Wawanesa, in March, April, May, June and July, 2002 state in the body of the report that Dr. Dobrowolski continues to report further improvement. I find each of those comments at significant odds with the contents of Dr. Dobrowolski's notes, records, reports to third parties, and an implausible summary of his opinion....
  
  ...I do not know why Wawanesa preferred the opinions of the occupational therapists and the case manager, flawed and deficient as they were, to the opinions of its own psychiatrist and psychologist, whose greater expertise in assessing Mrs. Michalski's cognitive function Wawanesa sought. I find Wawanesa failed to act with sound and moderate judgment in reassessing evidence from its own assessors. I find Wawanesa's actions and defaults overlap and compound each other.
  
  ...I believe the sanction should reflect that Wawanesa failed to meet its contractual obligations, and is entirely to blame for the manner in which this claim unfolded. I agree with the submission of counsel for the Applicant that it is difficult to find a more vulnerable Applicant than Mrs. Michalski, who, as a result of her injuries, functions like a two year old, was unrepresented by counsel and whose primary language was not English. She could not be safely left alone. Wawanesa repeatedly put her at risk. Fortunately, her husband and children provided her with care. I believe the award should also reflect that Wawanesa took advantage of Mrs. Michalski's children, and should encompass the need to deter Wawanesa and other insurers from engaging in similar conduct. Nothing indicates that Wawanesa is likely to be subjected to any additional penalty as a result of its misconduct. I agree with the view that interest is remedial C not a penalty.
• R DeKramer on 2015-06-09 7:09:40 PM
  Here's what a well-known insurer medical assessment doctor told his college when called to task for his poor quality medical report:
  There are three types of patients:
  1.Patients with nothing wrong with them who are “pulling the wool over everyone’s eyes”
  2. Patients with no problem who think they have a problem. These patients actually believe that there is something wrong with them, even though there is not.
  3. Patients with minor problem who have exaggerated this problem into something much bigger than it is.
  
  Do mva victims even have a chance? Not if there's no room to even consider an injury. A blindness caused by the insurers handpicking and handsomely paying their medical experts so they deny injuries even exist. This is the system and what victims face every day. 
  
  
  Source: http://www.insurancebusiness.ca/news/update-rally-against-insurers-deemed-a-great-success-192073.aspx
   

Hundreds rally against cuts to auto insurance benefits

By Maryam Shah, Toronto Sun

First posted: Wednesday, June 03, 2015 08:22 PM EDT | Updated: Wednesday, June 03, 2015 08:27 PM EDT  

TORONTO - Changes to auto insurance benefits for motor vehicle accident victims passed in the Ontario legislature Wednesday as part of the provincial budget.

“God help us all,” Tammy Kirkwood said upon hearing the news. “We’re getting a lot less coverage for a lot more money and I’m not sure why.”

Kirkwood was one of hundreds of protesters at Queen’s Park rallying against reductions in auto insurance benefits which they say will have the most effect on victims with catastrophic injuries.

The 47-year-old Orillia woman said protesters were “flabbergasted” that the provincial government “was trying to disable our resources and our funding to recover.”

Part of the changes to auto insurance rules under the new budget mean that combined coverage for medical, rehabilitation and attendant care benefits for the catastrophically injured will be cut in half from its current cap of $2 million to $1 million.

Kirkwood survived a 2008 collision when a dump truck hit her car. She had to be pried free from her vehicle by firefighters, and was deemed catastrophically injured.

She says she was only able to move forward because she had access to the services she needed.

Unable to return to work, Kirkwood now volunteers as an advocate with FAIR Association of Victims for Accident Insurance Reform.

New Democratic Party MPP Jagmeet Singh spoke at the rally in support of their cause.

The cuts affect “the most vulnerable people,” such as people with brain and spinal cord injuries, he said.

“They need benefit coverage ... to live an at least somewhat decent life,” Singh pointed out.

A spokesman for Finance Minister Charles Sousa said the government is “working hard to create a fair and affordable insurance system” for the province’s 9.4 million drivers.

Ontario is “the only province in Canada to offer exclusive catastrophic coverage,” Kelsey Ingram said in an e-mail.

“Catastrophically impaired claimants will also continue to be able to sue an at-fault party to recover damages for health-care expenses and potentially other claims,” she added.

The provincial government is also committed to making sure any savings from these changes do not result in “excess profits” for insurance companies, Ingram said.

“This is about lowering premiums while providing support and protection for all Ontario drivers,” she said.

maryam.shah@sunmedia.ca