‘FAIR – supporting auto accident victims through advocacy and education’
FAIR (Fair Association of Victims for Accident Insurance Reform) is a grassroots not-for-profit organization of MVA (Motor Vehicle Accident) victims who have been injured in motor vehicle collisions and who have struggled with the current auto insurance system in Ontario. Read more »
OR support FAIR and the website through a donation (could sure use the support!) here.
New Auto Insurance Dispute Resolution System Takes Effect April 1 2016
Independent Administrative Tribunal Process to settle cases quickly and efficiently
April 1, 2016 – Ontario’s new Automobile Accident Benefits Service (AABS) today starts to accept applications from individuals hurt in a motor vehicle accident who have had their claim denied by their automobile insurance company.
The AABS is a streamlined dispute resolution process at the Licence Appeal Tribunal, part of the Safety, Licensing Appeals and Standards Tribunals Ontario (SLASTO), and is independent from the government and insurance companies.
“SLASTO is committed to delivering a fair, independent and effective dispute resolution system for automobile accident benefits,” says Executive Chair Linda Lamoureux. “Our staff and adjudicators are trained to help parties simplify disputes and get faster decisions on access to benefit entitlements.”
Disputes are first discussed at a case conference, and if that doesn’t result in a settlement, then there is a hearing led by an independent adjudicator, who will make a decision that must be followed. Forms and details about the new process can be found on the AABS website.
Modernizing the auto insurance dispute resolution model is part of the Ontario government’s auto insurance cost and rate reduction strategy. The AABS is the first phase of a two-year implementation plan of dispute resolution changes based on the 2014 Auto Insurance Dispute Resolution System Review Final Report conducted by the Honourable J. Douglas Cunningham.
Previously, motor vehicle accident insurance disputes were brought to the Financial Services Commission of Ontario (FSCO). If you currently have a file in the mediation stage at FSCO, your next step would be to file an application at AABS, if mediation fails. If you currently have a file in the arbitration stage at FSCO, it will remain at FSCO. All new claims must be filed at AABS.
OUR LATEST PRESS RELEASE
Job One for newly appointed auto insurance Czar David Marshall: Public Inquiry into auto insurance claims medical evidence http://bit.ly/1UCMUn2
Earlier FAIR Press releases:
Ontario’s Auto Accident Victims in Crisis April 16/2015/CNW/
Ontario Government Abandons Auto Accident Victims May 28/2015/CNW/
Do we need a Public Inquiry into the quality of the medical evidence? We think so and here’s why
Job One for newly appointed auto insurance Czar David Marshall: Public Inquiry into auto insurance claims medical evidence http://bit.ly/1UCMUn2
Ontario Auto Insurance in Crisis: OTLA calls on Wynne Government to call a public inquiry into medical assessments of accident victims http://bit.ly/1RVIJ7P
OFL, Injured Workers and Medical Professionals File Official Request for Ombuds Ontario Investigation into the WSIB http://ofl.ca/index.php/ombuds2016/
WSIB and auto insurance: Birds of a feather At the same time that the WSIB is under fire, the Ontario Trial Lawyers Association has called on the Ontario government to conduct a public inquiry into the state of independent medical examinations of injured auto accident victims. The OTLA refers to medical experts who “distort evidence … in a bid to satisfy insurance company clients” which causes “unconscionable delays and unfair denial of coverage.” http://www.torontosun.com/2016/02/13/wsib-and-auto-insurance-birds-of-a-feather
Cuts to benefits, ‘hired guns’ faulted http://www.brantfordexpositor.ca/2016/02/01/cuts-to-benefits-hired-guns-faulted
Social Justice: Expert witnesses and access to justice http://www.lawtimesnews.com/201602085208/commentary/social-justice-expert-witnesses-and-access-to-justice
Third party assessment reports need strict code http://www.lawyersweekly-digital.com/lawyersweekly/3531?folio=18&pg=19#pg19
Bruff-Murphy v Gunawardena, 2016 ONSC 7 (CanLII), http://canlii.ca/t/gmr5x – see para 53-125
Trial Lawyers Association calls for inquiry http://www.lawtimesnews.com/201602085211/headline-news/trial-lawyers-association-calls-for-inquiry
Fair auto insurance? That’s a stretch Premiums are too high, benefits are being slashed and insurers are denying valid accident claims http://www.torontosun.com/2016/01/30/fair-auto-insurance-thats-a-stretch
1310 News – Ed Hand Show on auto insurance http://www.fairassociation.ca/2016/02/ed-hand-show-on-auto-insurance/
OTLA Presentation at the 2016 OLA Pre-Budget Hearings https://youtu.be/zQi-ibT_1bk
Latest Number of MVA victims waiting for hearings at the Financial Services Commission of Ontario FSCO Med-Arb-Timelines 2007-Jan 2016
StatCan numbers on auto insurance related cases on the docket in Ontario Civil Courts (you’ll have to manipulate the data to get the Ontario numbers)
Read about how much we are overpaying: The Truth about Auto Insurance
The Canadian Society of Medical Evaluators 2011 President’s Message:
Dear Members & Colleagues,
We have all to realize that times are changing-amateurism, bias and fraud in the domain of IMEs will be tolerated less and less in the future.
In September 2011, at IAFS2011, the International Association of Forensic Sciences, the topic arrogance and lack of formal training of self-declared medical experts in the UK and Canada was covered in detail. At the same meeting, a recent UK Supreme Court decision (Jones v Kaney, UKSC 13, 2011) was discussed: at least in the UK, immunity for medical experts sems to be past history.
The basic body of knowledge to be mastered by medical experts has been defined, is in constant revision and is being offered in Europe and Canada through web-based University Programs.
CSME’s effort to promote excellence in medicolegal activities will be proposed to the Royal College, in 2012, a portofolio to be recognized as an Area of Focused Competence diploma: a new medicolegal expertise diploma; CSME also wants to be positioned as a key player in the Maintenance Of Competence program for all future College-certified medicolegal experts.
For those of you doing IMEs for years, it is time to notice this approaching shift: the cost of litigation, cost of automobile insurance and lack of quality control of IMES, leading to public scandals, might soon lead the parties requesting IMES to be more critical when the appraising medicolegal credentials of an expert before hiring his/her services.
CSME wants to be an active partner with the Canadian stakeholders interested in the medicolegal field, to promote and maintain excellence for all medicolegal opinions given by its members.
Dr. Francois Sestier, MD, PhD, FRCPc
See: Muzzling Criticism
ALERT to injured claimants sent for insurer assessments – Claimants/members being sent for IMEs to these firms may want to bring these articles and/or the decisions below to the attention of their lawyer.
We need to care about our coverage BEFORE we get in a car accident
1310 News interview August 10, 2015
- Survey for claimants: https://www.surveymonkey.com/s/AutoInsurer
- Please share this survey with others you know who have gone through the claims experience!
Here’s what stakeholders had to say
We’ve already overpaid for coverage!!! Lazar Prisman report 033115 FINAL
Government slashes benefits to seriously injured MVA victims and calls it “Promoting consumer protection”
It’s a sad day for Ontario consumers when our government puts the interests of big business insurance companies ahead of the health and well-being of Ontario’s injured auto accident victims. The slashes to auto insurance coverage in the 2015 budget can only be seen as a step closer to public auto insurance when with every cost saving solution the IBC comes up with in order to curtail claims means the unsuspecting tax-payer will pay more of the costs for victims through our publicly funded programs.
Ontario already has an auto insurance claims disaster: FAIR reaction to Budget April 28 2015
We’ve been overpaying for years: Returns on Equity for Automobile Insurance Companies in Ontario
What are auto accident victims losing so Insurers can gain greater profit on the backs of the injured?
|The definition of catastrophic is set to be severely restricted to make the definition consistent with the latest medical evidence. That will likely mean that combining physical and psychological impairments will no longer be permitted. This will see many severely accident victims without adequate coverage. Coverage available for catastrophically impaired victims will be cut in half. The limit of $1 million each ($2 million right now for both) for med/rehab and attendant care will be limited to $1 million total for both med/rehab AND attendant care combined. There will be optional coverage available at an added cost. The standard duration for med/rehab benefits will be reduced to 5 years instead of the previous 10-year maximum, except for children. Costs for care will then fall on Ontario’s taxpayers through OHIP and various public supports. Non-catastrophic coverage will be reduced. If the budget is passed, med/rehab and attendant care coverage will be $65,000, down from the current combined total of $86,000. Consumers will have an option to increase this coverage up to $1 million at an added cost. The six month waiting period for non-earner benefits will be eliminated the duration of non-earner benefits will be limited to two years after the accident. The government will be introducing amendments to the Insurance Act to adjust the deductible and the disappearing deductible amount to reflect inflation since 2003 and link it to future changes in inflation. The deductible or the amount you insurer is ‘allowed’ to keep when a claimant takes the insurer to court is presently $30,000 for cases in civil court that are worth less than $100,000. This is already a deterrent to victims’ ability to hold insurers accountable. There will be further changes to allow for the effect of the tort deductible to be taken into account when determining a party’s entitlement to costs. Call or write to your MPP and tell them you expect better at: http://www.ontla.on.ca/web/members/member_addresses.do?locale=en|
What’s in YOUR Legal Bill???
You may not be paying what you think you are for your legal representation. By the time the costs of holding our insurer accountable come due and payable many auto accident victims are on their second or even third lawyer. Often the invoices for legal services are without detail and we are simply told what we are supposed to pay without adequate explanation.
According to the most recent data available 78% of Ontario’s legal bills are reduced at an assessment hearing. It’s a clear indication that something is very wrong when better than half of all legal bills (not just auto accident claims) are found to be excessive. Over 25% of these fees-for service accounts are reviewed and then reduced by 50% or more at a hearing so if you don’t understand what’s in your legal bill it may be worth the trip to court to find out.
It might come as a surprise to most people that it’s legal and accepted by our courts to increase the hourly rate without advising you, or to round up hours to a higher amount, or add on a ‘premium’ for a lawyer’s success in court to a client’s bill.
A recent assessment of costs case, Wilson v Edward, with no written retainer or contingency agreement documents “a $100,000 premium for significant success” for a plaintiff’s legal representative. The judge also allowed the lawyer to increase his hourly wage from $300/hr to $500/hr without informing the client saying “it would be patently unreasonable to find any client so naïve as to believe that an applicable hourly rate would not escalate over the passage of 149 months”. The lawyer was also able to round up his hours and add on an additional $2000 in legal fees to the client which the court also found “satisfactory”. more….
Additional information at: http://www.fairassociation.ca/choosing-a-lawyer/How Do I Get a Lawyer’s Bill Reviewed Getting a lawyer’s bill reviewed is called a Solicitor-and-Client Assessment. This is a court procedure where a client and/or a lawyer may have his or her legal bill reviewed at an assessment hearing in the Ontario Superior Court of Justice. https://www.lawhelpontario.org/lawsuits-disputes/superior-court/how-to-guides-superior/get-lawyers-bill-reviewed/
What’s in YOUR medical file???
There is increasing evidence that Ontario’s auto accident victim’s medical files are being routinely changed to suit the needs of Ontario’s insurers to save money by deflating an MVA victim’s injuries. Portions of reports have been removed, manipulated or even changed entirely without the author’s knowledge or consent. Signatures have been forged or used without permission in many cases. Victims and their legal representatives should be viewing reports and evidence with a critical eye to insurer fraud whether it be an adjuster, an assessor, assessment centers, treatment facility or even your own lawyer’s staff. This abuse of evidence is widespread and should be a major factor in the fight on fraud and yet it isn’t. Accident victims are often re-victimized and defrauded out of the coverage they paid for by the fraudulent acts of others.FAIR Policy question regarding evidence used at FSCO DRS hearings FAIR response from FSCO JR Richards
A leaked document from a discussion forum
I am involved in an Arbitration on the issue of catastrophic impairment where Sibley aka SLR Assessments did the multi-disciplinary assessments for TD Insurance. Last Thursday, under cross-examination the IE neurologist, Dr. King, testified that large and critically important sections of the report he submitted to Sibley had been removed without his knowledge or consent. The sections were very favourable to our client. He never saw the final version of his report which was sent to us and he never signed off on it. more…
Ansari and State Farm [+] Arbitration, 2014-12-24, Reg 403/96. Final Decision
Medical Rehabilitation Benefits/Cost of Examinations
10. The Respondent submits that given the Treatment Plan of November 5, 2010, was not signed by a health practitioner and part 4 was admittedly “forged”, the Treatment Plan should not be considered in the context of this arbitration hearing. Additionally, it was also withdrawn; therefore it is not properly in dispute in this proceeding and is not payable .
For the purposes of this Hearing, I find the Treatment Plan, as completed and signed by Ms. Lipka, a registered nurse, is valid. After the report left the hands of Ms. Lipka, the report was altered, for reasons unclear, by others as to her designation. No evidence was introduced at the Hearing to show the assessment was withdrawn.
Burwash v. Williams, 2014 ONSC 6828 (CanLII) 2014-11-25 http://canlii.ca/t/gfdrp
 The Plaintiffs assert that they had no reason to suspect that Cira was involved in the review, revision and editing of draft expert reports until the examination for discovery of Dr. St. Pierre when answers and subsequent productions indicated that Cira may be using third parties to review and revise the Defendants’ expert reports.
 The Plaintiffs provided documents that indicate that there may have been third party manipulation and alteration of the expert reports that the Defendants will rely upon at trial. Relevancy is established since this issue goes straight to the heart of the Plaintiffs’ case and the medical evidence they intend to lead to prove damages. more…
MC v KE, 2013 CanLII 55435 (ON HPARB), 2013-09-04 http://canlii.ca/t/g0c3g
10. However, the Committee did express concern about the information uncovered during the course of the investigation related to Riverfront having altered the Respondent’s report. The Committee noted the “egregious” impact that these changes could have had on the Applicant’s entitlement to benefits. In the result, the Committee decided to offer advice to the Respondent about the importance of ensuring that she personally reviews and approves any assessment report she completes prior to the report being issued. more…
Macdonald v. Sun Life Assurance Company of Canada, 2006 CanLII 41669 (ON SC) — 2006-12-13 http://canlii.ca/t/1q596
 In the course of this jury trial I ruled that Dr. Frank Lipson, who had conducted a defence medical of the plaintiff, not be permitted to testify as an expert witness on behalf of the defence. Dr. Lipson had testified that a medical report purportedly signed by him had not been signed by him. He stated that his signature stamp had been affixed to the report without his authority by an individual at Riverfront Medical Evaluations Limited (Riverfront) thecompany who had retained him to conduct the defence medical. I made my ruling based on the evidence before me at the time. The case proceeded and the jury ultimately delivered a verdict awarding the plaintiff damages and that verdict has not been appealed. However, in view of the serious allegations that had been made against Riverfront I felt that Riverfront should be given an opportunity to respond before I delivered the full reasons for my ruling. more…
FSCO Minutes – March 25, 2011 – 5. “Doctored” Reports:
Senior Arbitrator Nastasi reported that a recent unit meeting arbitrators reported two separate hearings in which in the middle of testimony by a doctor or assessor, it became clear that the report issued / produced by the Clinic or assessor was not the same report created by the doctor / assessor on the witness stand. more…
So You Think You’re Covered! The Insurance Industry Rip-Off by Jokelee Vanderkop http://www.deniedbenefitclaims.com/index.html
pg 144-146 – ‘Preparing for Court’ – Only with his prodding did I take a closer look and was shocked to see that the signature was not mine although the typed name under it was. I was now more alert. I had never seen this letter despite my name being on it. The content of the letter had, most likely, been innocuously presented by the car insurer’s claims advisor to Mr. K.’s legal clerk to type up and sign in my name, possibly under the guise of saving me a trip to their office to sign it and speed up my getting the funds. The insurer dealt with her for this transaction, rather than her boss, probably counting on her not being up to speed on the legalities. more…
2011 Ontario Auditor General Report on Auto Insurance: http://www.auditor.on.ca/en/reports_en/en11/301en11.pdf
Ontario’s insurers are looking to save money by reducing the interest penalty on overdue amounts owed to legitimate injured MVA victims with Bill 15
Before you pass Bill 15 our letter to legislators
Ontario’s insurers and the IBC are lobbying to reduce pre-judgment interest rates on overdue payments to Ontario’s injured accident victims. We feel that this is an incentive to delay and deny even more claims going forward. After all, it is only those insurers who are incompetent at claims handling or who purposely deny legitimate claims who will benefit from the proposed reduced 1.3%/year interest they will have to pay on overdue amounts – it is an incentive to deny.
Take the time to comment on the reduced pre-judgment interest rate on overdue payments by Ontario’s insurance companies that is part of Bill 15. Review the 3 days of discussion about Bill 15 and auto insurance in the legislature – see links below – as you can see our legislators appear to believe that the interest rate reduction will affect only pain and suffering. The truth is it will affect ALL overdue amounts from insurers including income replacement, costs of treatment, attendant care etc. We cannot borrow money at 1.3% so it will mean that not everyone will be able to cover their own cost of care during a delayed and denied claim. Call your MPP and them them to stop giving away our benefits! Insurance companies in Ontario need to be held accountable, not given incentives to abuse victims through Bill 15.
What do our legislators have to say?
‘So You Think You’re Covered! The Insurance Industry Rip-Off – Surviving the Fight for Long-Term Disability Benefits’
by Jokelee Vanderkop http://www.deniedbenefitclaims.com/index.html_____________________________________________________________________________________________________
IMPORTANT – WARNING
Last year Ontario’s motor vehicle accident (MVA) victims made over 89,000 visits to private medical clinics, assessment centers and private offices for treatment and medical assessments. There is a serious lack of oversight or standards at these facilities. MVA victims are legislated by our government to attend these facilities for third party medical opinion examinations arranged by Ontario’s insurers. We are always at risk and we are without adequate protection from often very shady business operators and a system suffering from a lack of oversight, poor regulations and no enforcement. Did you attend the Rothbart Pain Clinic for treatment? If so, you may want to read the IMPORTANT WARNING private medical care facilities and clinics.
Raising the Bar of Accountability: College Council Votes for Greater Transparency, Stronger Patient Protection – News Release June 1 2015 http://www.cpso.on.ca/Whatsnew/News-Releases/2015/Raising-the-Bar-of-Accountability-College-Council
The IME – the public has their say about how they feel about the quality of Ontario`s expert medical reports
- FAIR statement to CPSO consultation on Dec 2 2014
- See: http://www.fairassociation.ca/the-independent-medical-examination-imeie/
Fed up? Abused? Take the time to tell the Minister of Health about your concerns and how you feel about the treatment of innocent and vulnerable MVA victims at the hands of Ontario’s third party for-hire medical practitioners at: email@example.com
Not happy about our coverage for most injuries being capped at $3500.00 for rehabilitation? Think you are paying too much (you are) for the low coverage or have you been injured and can’t get the promised benefits? Do you think the process for making claims is abusive? Do you think coverage for the most catastrophically injured should be slashed so insurers can make more money? Write to your MPP at Queen’s Park and let them know that you are aware and watching and tired of being ripped off and abused. http://www.ontla.on.ca/web/members/member_addresses.do?locale=en
NOTICE – FAIR has been advised that at least one insurer is sending out notices to their assessors that they are not to share IME reports without approval from the adjuster – even with a signed consent form from the claimant. Assessors are told, “under no circumstances should any assessor be speaking/writing/communicating with claimants/plaintiff counsel.” If this adversarial policy is affecting your access to information about your IME or claim, we’d like to hear from you.