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/

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/

I’ve come to the conclusion that the question is no longer, “What’s wrong with ICBC?”

The question is, “Is there anything right?”

I wrote two previous columns on ICBC’s financial woes — one on a seniors discount that costs an estimated $100 million annually, another on the climbing cost of litigation. Those were but two contributors to the corporation’s financial woes. There are many strands that one can pull to explain ICBC’s unravelling.
Readers responded. Some, no surprise, were civilians complaining about what they felt was ICBC’s unfair tactics. But several were from insiders to the process — lawyers, doctors and claim adjusters. They identified a problem affecting ICBC’s bottom line the public never hears about.
It was the high cost of medical reports.

Wrote one senior ICBC injury adjuster, whose job is to settle lawyer-represented claims:

“Lawyers routinely hire experts (doctors) to produce reports to support how badly injured the individual is/was from the accident. It is quite common to have two to five different experts report on a single file. These experts charge between $4,000-$6,000 to examine the patient and write a report. ICBC will have to hire their own experts, typically one to two per file for the same costs as above.

“We often settle a claim, for example, between $50,000 to $100,000 and then pay on top of that between $30,000 and $40,000 for costs and disbursements. So not only are the lawyers making tidy sums, but the medical experts make a fair chunk off the litigation process as well.”.....

........There is a large number of medical professionals in B.C. that are making well in excess of $1 million per year from writing medical reports now.......

Source/more: http://vancouversun.com/opinion/columnists/pete-mcmartin-medical-reports-make-up-major-chunk-of-icbc-expenditure-insiders-reveal?utm_medium=Social&utm_campaign=Echobox&utm_source=Twitter&utm_term=Autofeed#link_time=1481157840

Regulation changes deny accident victim adequate benefits, family says

That injury classification — the criteria for which changed the same day of Adam Bari's accident — means he is eligible for only a fraction of the compensation they feel will be needed to finance his recovery.

Source/more:

http://www.thespec.com/news-story/6910240-regulation-changes-deny-accident-victim-adequate-benefits-family-says/

If He Crashed 12 Hours Earlier, He Wouldn't Face Bankruptcy

They say timing is everything. That seems to be distinctly, horribly true in the case of Adam Bari. The 34-year-old Canadian man was riding his motorcycle June 1 when he was T-boned by a car, CBC reports. Bari's family is now facing the possibility of bankruptcy, but that wouldn't be if the crash had happened just 12 hours earlier.

http://www.newser.com/story/232407/crash-hours-after-insurance-change-leaves-family-reeling.html

Insurance industry uses Trump tactics to pump up fraud

If juries have become cynical it is because the insurance industry spends inordinate amounts of money, and uses Trump tactics, to launch ad campaigns to tell the public about so-called rampant insurance fraud.

The public has come to believe that nearly everyone is fraudulent without hearing the perspective of accident victims

Most injured parties have to take on their insurer via a legal battle to receive the income replacement and rehab benefits they require and are obliged to sign "privacy" or confidentiality agreements so they can't divulge the settlement or how they were treated at mediation or in an examination for discovery.

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

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

Accident Benefit Coalition Victim Survey

Take the Victim Survey:

http://ow.ly/UaTq3042ADh

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

LAT hearings held in writing 'fundamental denial of justice'

“These people are not being given the opportunity to come before the tribunal and have their credibility assessed, have their doctors testify and have their lawyers cross-examine the insurance company’s doctors,” Singer tells AdvocateDaily.com. “Instead, it’s all done in writing.

Source/more:

http://www.advocatedaily.com/darryl-singer-lat-hearings-held-in-writing-fundamental-denial-of-justice.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

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/ …

Canadian Insurance News encrypted connection

All visitors are now able to view Canadian Insurance News over an encrypted connection by visiting https://cinsurancenews.blogspot.com.

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

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Canadian Insurance News

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

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

Hard road for car crash victims

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....

More:
http://www.torontosun.com/2015/09/12/hard-road-for-car-crash-victims

 

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