Wednesday, March, 18, 2015 - 4:04:33 PM
Local voice against wrongful benefit denials not staying silent
BY SHANNON DUFF EXPRESS MANAGING EDITOR
Editor’s note: The following is the final installment of a three-part
series about local insurance advocate Jokelee Vanderkop and her efforts
to help legitimate claimants ensure they receive their rightful
benefits.
PALMERSTON – Ontario’s Bill 15, the Fighting Fraud and Reducing
Automobile Insurance Act, is being touted as a good thing but could
prove to be anything but, says Palmerston resident and insurance
advocate Jokelee Vanderkop.
“Many people sing its praises because they’ve been told it’s good – but
don’t really understand why — other than it fights fraud and will save
the insurance industry a lot of money,” Vanderkop said. “The true
implication of this bill on accident victims is anything but good.”
After a life-altering motor vehicle collision and more than a decade of
battling to receive the insurance benefits she paid for, Vanderkop said
she refocused her anger into an energetic effort to expose “what goes on
for the majority of motor vehicle accident claimants.”
Those efforts resulted in her book — So You Think You’re Covered! The
Insurance Industry Rip-off. She said her book exposes the great lengths
to which insurers will go to deny legitimate claimants. Now, speaking
out on Bill 15 is one of Vanderkop’s endeavours in her efforts to raise
awareness on what claimants may endure in the journey to receiving the
benefits to which they’re entitled.
For instance, Bill 15, Vanderkop explains, has made the arbitration
process worse for claimants by removing the right to take their insurer
to court when they have been denied benefits.
“Insurers rarely pay benefits unless the claimant hires a lawyer,” she
said in December 2014, shortly after the bill was passed. “The question I
ask is why one even needs to hire a lawyer when you pay for insurance
coverage for benefits you will need when seriously injured in a car
accident?”
Pete Karageorgos, director for consumer and industry relations for the
Insurance Bureau of Canada, explained that those involved in a collision
have seven days to report the incident. A package of paperwork,
including applications and forms for the individual involved or a
physician, then goes out to be completed.
The forms are reviewed by an adjudicator, who will “work with you for
that process, find out what sort of injuries you may have, answer any
questions, and move forward,” he said in an interview with The Express.
Insurance companies are subjected to a health-care levy, to the tune of
about $142 million annually, imposed by the provincial government to
help cover health-care costs.
“As an industry, we pay into OHIP for those services provided in hospital,” he said.
Bill 15 is meant to help combat insurance fraud, which Karageorgos said is alive and well indeed.
Insurance fraud takes place when someone attempts to take advantage of
an auto insurance claim, or a physical damage claim — anything from
making a fraudulent claim for injuries that don’t exist or for enhanced
abuse, which means exaggerating the situation. He cited an example of a
police officer in the Peel region who was convicted of fraud for
falsifying a claim, or people staging collisions to take advantage of
benefits.
In the province of Ontario, the annual cost of estimated fraud in 2010
ranged from $768 million to $1.56 billion, said Karageorgos.
“When insurance fraud is committed, we all pay,” he said.
But for legitimate claimants?
“If someone has a legitimate claim, they’re not going to have a problem,” said Karageorgos.
But for Vanderkop and the many legitimate claimants like her, that is simply not the case.
“One woman . . . said the insurer’s lawyer told her that he was paid
over $500,000 per year to deny [claims.] Most [insurance] fraud is
perpetrated by organized crime groups,” she said. “There is no real way
to quantify fraud. Meanwhile, claimants get lumped in too as fraudsters .
. .with no consideration of insurers’ fraudulent behavior towards
legitimate claimants.”
She said she doesn’t deny that fraud happens, but the other side of the
story is how insurers fight to try and deny claimants who have
legitimate, medically verifiable claims of their rightful medical,
income and disability benefits.
“Inform yourself. This could be you,” she said. “These people are
silenced because they are too injured to speak up. When they are at
their weakest, they will have to fight their hardest.”
She said she hopes So You Think You’re Covered! The Insurance Industry
Rip-off will help raise awareness and educate legitimate claimants on
how to successfully navigate the process.
“People need to have their stories heard, and there are plenty of them,”
she said. “Do you want to hear the inside story, read about what
insurers don’t want you to know, and learn about their misguided process
and how you can fight back?”
Vanderkop’s book is available online, at the Book Shelf in Guelph, and
Words Worth Books in Waterloo. She is available for public speaking
engagements, and more information on Vanderkop and her book is available
at www.deniedbenefitclaims.com.
Source: http://www.southwesternontario.ca/news/local-voice-against-wrongful-benefit-denials-not-staying-silent-3/
Historically,
whenever the Ontario government was considering major changes to
automobile insurance legislation, there was widespread consultation with
stakeholders. That consultation process consistently revealed it was
common ground among all stakeholders that it was sacrosanct to reduce
the benefits available to the most seriously injured persons. As a
result, prior changes focused on changes other than reductions in the
benefits available to the catastrophically impaired.
