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
