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/

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/

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

MDs legal insurer should be made accountable

the Canadian Medical Protective Association, which has $3.2 billion in funds heavily subsidized by the province through Ontario doctors, should be subject to regular audits by the Auditor General and be required to make public how much it pays out to injured patients and how much it is spending on legal costs to defend doctors..........


More:
http://www.thestar.com/news/canada/2015/10/01/mds-legal-insurer-should-be-made-accountable.html

Ontario Government Abandons Auto Accident Victims

TORONTO, May 28, 2015 /CNW/ - Last week the Standing Committee on Finance and Economic Affairs met with the public and industry stakeholders to consult on Bill 91, Building Ontario Up Act.

Our legislators chose not to invite auto accident victims to the consultation process and instead opted to look at empty chairs rather than look auto accident victims in the eye and listen to their concerns.

Ontario already has the highest premiums in Canada and the lowest coverage with 80% of claims capped at $3500 for med/rehab. As pointed out by the Ontario Auditor General in 2011, about half of all claims are turned down by insurers and this means that our benefits are also too difficult to access.

Our government is proposing to cut $1 million dollars in coverage from catastrophically injured auto accident victims who currently have $2 million in coverage. Seriously injured victims will see their coverage drop from $86,000 to $65,000.

It appears that our government hasn't considered the recent study that revealed that Ontario drivers were overcharged by their insurance companies by $840 million in 2013 and that we have overpaid insurers by $3-4 billion dollars since 2001.

It is unacceptable to be giving away money to wealthy insurance companies who are already using some very shady business practices to deny a record number of claims.

Victims are downloaded to OHIP, Ontario Works (OW), Ontario Disability Support Program (ODSP) and CPP disability. These programs are already overburdened and don't offer the specialized treatments that many victims require so they will simply be left to fend for themselves.

Our government is giving insurers a financial gift by allowing insurers to pay injured victims less and simultaneously download the cost of victims to the unsuspecting taxpayers who are also the same drivers looking for a break on insurance premiums.

So what are we going to do about it?

We invite the public and Ontario's auto accident victims to join FAIR and the Accident Benefit Coalition on Wednesday June 3rd, 2015 from 12 pm- 1:30 pm at Queen's Park at the #Rally4AccidentVictims.

We hope you will sign the petition asking the Government to Stop Reducing Accident Benefits.

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

SOURCE FAIR Association of Victims for Accident Insurance Reform

For further information:

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

Ontario’s Auto Accident Victims in Crisis

Victim’s Group Calls for Ontario Auditor General to investigate and report on the Auto Insurance Sector

A recent StatsCan Civil Court Survey revealed that there are now 61,063 auto insurance related cases waiting for hearings in Ontario’s Superior Court.

According to the 2013 Minister of Finance DRS Report there were over 30,000 unresolved claim disputes at the Financial Services Commission of Ontario.

This is an unprecedented number of innocent and injured victims who have not had their claims properly handled by the insurer whom they paid to assist them in a time of need. Many of these seriously injured victims are without timely access to treatment and rehabilitation and they face a wait of up to 10 years or more to hold their insurer accountable.

Ontario drivers pay the highest prices in Canada for insurance, almost double what some other Provinces are paying for similar coverage. With so many unresolved claims in the system it is time to take a hard look at whether our government should be legislating Ontarians to buy this inferior product.

According to the Auditor General’s 2011 Report on auto insurance about half of all claims are turned down by Ontario insurers. What the AG report doesn’t talk about is how these claims are turned down. Victims are forced to attend multiple and excessive medical examinations by their insurer in course of a claim. Insurers spend more on assessing a victim than they do on treatment and rehabilitation according to the Insurance Bureau of Canada’s own statistics in the HCDB Standard Report.

Insurer medical examinations (IME) are often performed by biased and even unqualified medical ‘experts’ whose incomes rely on the insurer who hires them and these assessors operate with virtually no regulatory oversight. These bogus medical opinions are the tool used to deny claims and are at the core of the court backlog.

Victims are being downloaded at an alarming rate onto OHIP and our public system of Welfare, Ontario Disability and CPP Disability programs that are underfunded and unable to provide adequate care for victims.

Not only do victims face a personal crisis but they are faced with hiring a legal representative in a province where the cost for legal representation is the highest in Canada. Many victims hire more than one lawyer during the course of a claim and there is plenty of evidence that the quality of the services and the billing practices of that sector are also harming MVA victims.

We pay our premiums and we should be able to access the coverage we paid so handsomely for. What we have is legislators who are listening only to the Insurance Bureau of Canada’s incessant calls to slash benefits and our government is now onboard with blocking victim’s access to fair and balanced hearings in court through Bill 15.

When insurers don’t pay we all will. We are paying for private insurers who, according to the OTLA’s recent report, are making unprecedented and excessive profits on the backs of victims they refuse to pay.

We invite the public to join FAIR and we ask our elected MPPs to join in the call to the Auditor General to review and report on the auto insurance sector.

About FAIR Association of Victims for Accident Insurance Reform – FAIR is a grassroots not-for-profit organization of auto accident victims and their supporters who have struggled with the current auto insurance system in Ontario. http://www.fairassociation.ca/

For further information contact: Rhona DesRoches, FAIR, Board Chair, fairautoinsurance@gmail.com, Tel: 705 543-0574

Ontario’s auditor general should investigate auto insurance rates: Editorial

It’s no secret that Ontario residents are forced to pay a lot for auto insurance — we face rates that are 45 per cent higher than in Alberta, and about double what they are in the Maritimes. Hard-pressed consumers deserve more assurance that they aren’t being gouged.

More/source:
http://www.thestar.com/opinion/editorials/2015/04/13/ontarios-auditor-general-should-investigate-auto-insurance-rates-editorial.html

Toronto Star's View: Ontario’s auditor general should investigate auto insurance rates

Ontario’s auditor general should investigate auto insurance rates after a new study found that Ontarians are being grossly over-charged

OurWindsor.Ca

A new study showing Ontarians were likely over-charged for auto insurance by $840 million, in one year alone, is sufficient cause for a fresh investigation by the province’s auditor general. 

More/source:

http://www.ourwindsor.ca/opinion-story/5553990-toronto-star-s-view-ontario-s-auditor-general-should-investigate-auto-insurance-rates/

 

Ontario Drivers Pay Excessive Auto Insurance Rates while Company Profits Soar

Trial Lawyers Call for Immediate Rate Reductions with No Cuts in Coverage, Full Review

 

TORONTO, April 10, 2015 /CNW/ - A major study released today shows the need for immediate reductions in Ontario motorists' high auto insurance premiums, the Ontario Trial Lawyers Association says.

The study, conducted by York University Schulich School of Business Professors Fred Lazar and Eli Prisman, reveals in 2013 alone, consumers likely overpaid by $840 million.

"Auto insurance companies in Ontario have had a relatively free ride during the past 20 years. It is conceivable that premiums have been too high and as a result, consumers in Ontario have paid too much for auto insurance," the professors' report says.

"We estimate that consumers in Ontario may have overpaid for auto insurance by between $3 and $4 billion over the period 2001 to 2013."

The report says that the profit benchmark set by Ontario's insurance regulator at 11 per cent return on equity, should be no more than 5.5 per cent given today's low interest rate environment. Ontario's insurance regulator recently changed the profit cap, allowing insurers to earn even higher profits. 
A copy of the study is available here
 
The Ontario Trial Lawyers Association (OTLA), which commissioned the new study, calls on government to roll back the high rates that Ontario motorists pay, while halting any further reductions to auto insurance benefits. Insurers reduced coverage in 2010, while profits soared even higher.

"It is now up to the government to do the right thing and implement an immediate, orderly reduction in the profit cap and ensure that savings are passed along to consumers," said Steve Rastin, President of OTLA. "We must also ensure that coverage is not cut further for the thousands of injured car accident victims in Ontario," he added.

OTLA also recommends that Ontario's Auditor General conduct a fully independent review of auto insurance in Ontario.

"It's time for the Auditor General to step in to examine every aspect of auto insurance. For too long, we have not had all the facts and we simply cannot leave it to big insurance and their consulting actuaries," Rastin said.

"We need a thorough and truly transparent review that gets to the heart of costs in the insurance business. For example, we know that insurers spend millions on assessments just to deny legitimate claimants – about 50 cents for every dollar of treatment. Insurers should not be able to count those assessments as part of the overall claims cost. We need to put an end to that practice and also curb the abuse of accident victims who must endure endless intrusive assessments," added Maia Bent, President-Elect, OTLA.

More/source:
http://www.newswire.ca/en/story/1515829/ontario-drivers-pay-excessive-auto-insurance-rates-while-company-profits-soar