Insurers must provide a Reason if they request an Examination Under Oath

In Aviva Insurance Company of Canada v. Frank McKeown (2016), Aviva brought an application to determine whether an insurer is obligated to state their reason for an examination under oath (EUO) in order to compel a person claiming statutory accident benefits (SABS) to attend an EUO, if requested by their insurer, pursuant to subsection 33 (2) of the SABS. Aviva was seeking a legal order to compel the named respondents to attend their respective EUOs.

Source/more:

http://www.personalinjurylawyerservice.ca/blog/insurers-must-provide-a-reason-if-they-request-an-examination-under-oath

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

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

Ont. Super. Ct. finds that the terms of a consent form for a s. 44 SABS assessment must be agreed to by the parties and cannot be imposed by the insurer

In Intact Insurance Company v. Beaudry, Ontario Superior Court Justice Beaudoin held that absent a prescribed form, or a standard form that may be devloped by the various stakeholders, the insurer and insured must agree on the consent form for assessments by healthcare practitioners under s. 44 of the SABS before they can be conducted.

More:

http://www.hughesamys.com/blawg/blawg-post/blog/2016/10/19/ont.-super.-ct.-finds-that-the-terms-of-a-consent-form-for-a-s.-44-sabs-assessment-must-be-agreed-to-by-the-parties-and-cannot-be-imposed-by-the-insurer

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

Fair Association Submission to Pre-budget consultation

Minister,

I am a motor vehicle accident survivor and I suffered with a severe brain injury.  The funding and resources available to me in the Statutory Accident Benefit Schedule (SABS) of 2008 assisted me in my recovery.  I worked for the government in the Ministry of Social Services and Ministry of Community Safety and Correctional Services, prior to the accident.  I am well aware of the social services programs.

I am appalled that the insurance industries are being allowed to download THEIR responsibilities of injured MVA victims to our already overloaded social services to save their profits.

The resources necessary to recover from a MVA, are readily available to the survivors through the rehabilitation services resources through the insurers.  The same resources and funding is NOT available through our social services.

With the legislation constantly being changed and benefits slashed by your government, you are assisting the insurers to bully, delay and deny the vulnerable persons who entered a contract to assist them when necessary.  Your government made insurance mandatory to operate a vehicle, but your government is deleting the mandatory responsibilities of the insurers and allowing them to breech the contracts we, the people, are made to sign.

The endless and expensive IME (independent medical examination) being used by the insurers to delay and deny victims is traumatizing some of the most vulnerable population.

The monies being taken out of the medical and rehabilitative benefits, is not being used to assist a victim to return to state of well being. It’s being used to abuse the victims and ultimately line the pockets of others to make money on the backs of a vulnerable population.

I truly believe OUR tax dollars and our government’s supports should be used to assist all Ontarians and NOT support wealthy insurance companies to escape their responsibilities to auto accident survivors!


Tammy Kirkwood
Vice Chair
www.fairassociation.ca



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