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
CIN is a non-profit Advocate for Insurance and Health Care Reform. Postings are cut/paste from other sources. @Cinsurancenews #rally4accidentvictims #ABPetition #CPPbacklog
Showing posts with label medical opinion. Show all posts
Showing posts with label medical opinion. Show all posts
Wednesday, December 14, 2016
Monday, December 12, 2016
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
[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
Tuesday, December 22, 2015
Doctor suing WSIB and former employer over fraud claims
(Canadian OH&S
News) — A Hamilton, Ont. doctor has filed a lawsuit against the
Workplace Safety and Insurance Board (WSIB) and her former employer,
Workplace Health & Cost Solutions (WHCS) in Vaughan, for wrongful
dismissal from the latter — claiming that the former tried to force
her to change her medical opinion about an injured worker, before
pressuring the latter to fire her....
More:
Sunday, December 6, 2015
WSIB lawsuit: Fired hospital worker details struggles after losing his claim
An injured hospital worker who says his claim was denied by the Workplace Safety and Insurance Board — despite backup from a doctor who allegedly provided a medical opinion in his favour — is going public with how he struggled to earn a living after losing his job......
More:
http://www.thestar.com/news/
More:
http://www.thestar.com/news/
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