‘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 injured MVA (Motor Vehicle Accident) survivors who have struggled with the current auto insurance system in Ontario. Read more »
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What to do if you have a claim: FSRA page on Understanding the Claims process
If you were in a car accident and no one had auto insurance, you may be eligible for compensation. Apply to the motor vehicle accident claims fund
The LAT (Licence Appeal Tribunal) Automobile Accident Benefits Service (AABS)
Tribunals Ontario 2022-23 Annual Report shows 13,983 injured claimants applied to the LAT for a hearing in 2022-2023 https://tribunalsontario.ca/documents/TO/Tribunals_Ontario_2022-2023_Annual_Report.html#lat
Ontario Trial Lawyers call for immediate review of the Licence Appeal Tribunal
Eight years of concerning trends, lack of transparency and procedural fairness indicate systemic flaws with the LAT – read the stats
OTLA pushes for urgent Licence Appeal Tribunal review
The LAT AABS – why isn’t it working for consumers?
Is this a system ‘under the influence’ of insurance companies who are paying for the costs of hearings that too often sides with insurers?
According to an anonymous letter, the adjudicator first decided to approve Mary Shuttleworth’s benefits, only to have the adjudicator’s boss order a denial
Which companies have more than their market share of claims in the LAT AABS system? All part of these Stats. The summary tells us that average # of days between application and decision has reached an epic 589 days in 2021-2022 Q4 – far more than promised with a new streamlined hearings system!
READ: 2021: Another Year of the LAT (and it isn’t getting faster)
READ: LAT Stats: Market Share vs. LAT Applications and Decisions
READ: Tribunal Watch: Access to Justice in Crisis: Tribunals Ontario in 2022 Statement of Concern
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What’s New?
CBC · GO PUBLIC: Insurers fighting injury claims hire doctors slammed for shoddy work as key medical experts
By Rosa Marchitelli & Jenn Blair/ A CBC Go Public investigation reveals insurance companies looking to block or minimize compensation for people hurt in crashes are hiring doctors called out for giving shoddy testimony. Advocates say doctors with histories of reprimands shouldn’t be allowed to work as experts.
https://www.cbc.ca/news/health/insurance-medical-legal-experts-injury-1.7382872
WATCH | Medical experts criticized for testimony in insurance cases:
Related: (LAW TIMES) Judge awards $2.4 million to plaintiff involved in car crash, calls for medical expert objectivity
Graul v. Kansal, 2022 ONSC 1958 (CanLII), https://canlii.ca/t/jnn5r
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FSRA Consultation on auto reforms
NEW: Read the submissions to the FSRA review: https://www.fsrao.ca/engagement-and-consultations/consultation-auto-reforms
The consultation will close on November 29, 2024
Ontario’s Financial Services Regulator (FSRA) is conducting a review of the health service provider guidelines and frameworks. This will help make the auto insurance system more modern, efficient, and ensure consumers injured in auto accidents continue to get the care they need. As part of this review, FSRA is now consulting on three papers that set out options, which fall within FSRA’s statutory authority, to support government auto insurance reforms.
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Upcoming changes to Statutory Accident Benefits (SABs) Will it be Opt-in or Opt-out of income replacement (IRB) – either way, care must be taken to protect Ontario consumers
Sent to: Hon. Peter Bethlenfalvy, Ministry of Finance on July 5, 2024
…We know that many Ontarians are currently paying for income replacement they can never collect because it requires an individual to have an income to base a replacement amount on. The over 2 million over 65 drivers (3) who are paying for insurance likely don’t know they don’t qualify for this benefit. Anyone already on disability (ODSP) or social support (OW) cannot collect this benefit either. Students, home-makers, and anyone not employed cannot collect on a benefit they have been paying for every year.
In order to make informed choices consumers need to know what they are being charged for and then make the decision about what they do and don’t need. This requires an opt-out process, not an opt-in. The opt-out is aligned with the Regulator’s promise to consumers to ensure they are treated fairly. In the FSRA Automobile Insurance Supervision Plan 2023-2025 Policy (6)
Can your office confirm:
- the Income Replacement Benefit (IRB) will be an opt-out and not an opt-in benefit;
- consumers must prove alternate disability coverage or an ineligible status to collect IRBs in order to opt-out;
- there will be some discussion with stakeholders around the effect of optional coverage and what that means to vehicle passengers;
- that making IRBs optional (or any other proposed optional benefits) will reduce premiums for Ontario drivers;
- there will be public consultation on the changes to basic auto insurance coverage prior to introducing legislation
Read the full letter: FAIR Letter to Hon. Peter Bethlenfalvy July 5 2024 on opt-in/opt-out
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FAIR Statement on 2024 Ontario Budget: Building a Better Ontario
Ontario drivers and those who assist them after a car crash injury are further ahead today
March 27, 2024
There’s some big misses in this 2024 Building a Better Ontario budget but there’s some cost relief for some Ontario drivers and some improvement in the delivery of care for claimants.
The biggest miss is the failure to live up to the 2019 promise in the 2019 Blueprint for Putting Drivers First budget where the promise was to increase Catastrophic coverage from $1 million for med/rehabilitation to $2 million in coverage as it had been reduced by the Wynne government in 2016. This has left the most injured claimants with inadequate coverage and we had hoped to see that change.
There is no increase to the Unfair and Deceptive Acts and Practices (UDAP) Administrative Monetary Penalty (AMP) that would enable FSRA to hold insurers and their associates to account in a meaningful way for unacceptable behavior. This is a big miss and consumers will continue to be at risk during the claims process because accountability needs to have teeth and FSRA could have used more clout.
As people who have made a claim can tell you, it’s a complicated system that has had insurers as payors of the last resort so many Ontarians have been paying for coverage they’ll never get to use. Or they have to exhaust their private plan to pay for MVA expenses – and that might rob them of healthcare they are depending on for medical reasons outside of a car crash injury. That is coming to an end and it lines up with FSRA’s recently announced Automobile Insurance Supervision Plan 2023-2025 to ensure the fair treatment of customers while promoting public trust and a robust insurance sector in Ontario.
Read more:
FAIR statement on 2024 Budget Mar 27 2024
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UPDATE April 19/24 FAIR Statement on 2024 Budget and Canadian Disability Benefit CDB April 19 24
Bill C-22 update:
Canada disability benefit bill passes but the amendment to block insurer claw-back has been removed
How does this matter to Ontario drivers?
If you are seriously injured you will likely end up on Ontario Works (OW), Ontario Disability Support Program (ODSP) and Canada Pension Plan Disability (CPP-D).
Though consumers are led to believe their insurance company will cover the costs of a car accident including income replacement, that isn’t the whole story. Insurers are payors of last resort which translates to the injured person must exhaust all other sources of income, including Employment Insurance (EI), workplace Long Term Disability (LTD), ODSP, and CPP-D and then your private auto insurer tops up those funds. They pay last and often pay the least.
Private insurers use public dollars to cover accident costs, its as simple as that when they keep the money they ought to be paying out. Every year our premiums go up while insurers pay less and taxpayers pay more for accident costs. Provinces appear to have made deals with private insurers and each of these agreements will have to be addressed individually before the Canada Disability Benefit (CBD) will be a reality. It’s unlikely auto insurers won’t try to take advantage of taxpayer dollars so removing the amendment to block the insurer claw-backs was important to taxpayers in general who could see their hard-earned dollars flow directly into insurer coffers.
FAIR submission to: Senate Standing Committee on Social Affairs, Science and Technology (SOCI) on Bill C-22, and how the current legislated poverty is affecting our members here.
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FAIR is pleased to share with you our latest project to promote safe driving. It is printable and we hope you’ll share it with your family and friends and commit to safe driving practices.
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Check out the new Blog post from Ninette Ibanez Silverio Pereira about Section 44 of the SABs and insurer compliance with legislation here.
The highest court in Canada, the SCC, should acknowledge and recognize the public importance of the following two main issues raised in Silverio Pereira v Aviva:
[i] the insurers’ notice obligations in the SABS (question of law) and
[ii] the Tribunal’s inconsistent or lack of correct examinations of insurers’ duty of notice and its process breaching the rules of procedural fairness.
This is a timely piece since FAIR recently brought forward an Unfair or Deceptive Acts or Practices (UDAP) complaint to the Financial Services Regulatory Authority of Ontario (FSRA) on this very issue. Current decisions at the Licence Appeal Tribunal (LAT) show a significant number of cases where regulations were ignored and improper notices for coverage denials and for medical examinations fall far short of legislative requirements.
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CLOSED:
The College of Physicians and Surgeons of Ontario want to know what YOU think about their draft Conflicts of Interest and Industry Relationships policy before it’s finalized. https://policyconsult.cpso.on.ca/?page_id=14433
The draft policy retains the core expectations of the current Physicians’ Relationships with Industry: Practice, Education and Research policy and includes a new section related to conflicts of interest under the Medicine Act, 1991, General regulation.
The draft Conflicts of Interest and Industry Relationships: Advice to the Profession document has been updated to clarify and further explain the draft policy content.
View the draft policy and Advice to the Profession document
Post your comments on our online discussion page
Referenced from: https://ontariohealthregulators.ca/public-consultations/
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From the Office of the Auditor General of Ontario November 30, 2022
Even though Ontario has one of the lowest accident rates in Canada, it has the highest private passenger automobile insurance rates in Canada. Auditor General Bonnie Lysyk’s 2022 Annual Report says the regulator, the Financial Services Regulatory Authority of Ontario (FSRA) could evaluate several initiatives for applicability in Ontario, that are in effect in other provinces, that may reduce rates. https://www.auditor.on.ca/en/content/news/22_newsreleases/2022_news_AR_FSRA.pdf
The FSRA, which reports to the Minister of Finance, is the primary regulator of several financial services in the province, including about 310 insurance companies, 67,000 insurance agents, 60 credit unions and 4,600 pension plans.
18 recommendations, with 60 action items, to address audit findings
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College of Physicians and Surgeons of Ontario Consultation
Read what was said about IMEs (Third Party Insurer Medical Examinations aka IEs, DMEs) during recent consultations.
http://policyconsult.cpso.on.ca/?page_id=12720
http://policyconsult.cpso.on.ca/?page_id=12720
http://policyconsult.cpso.on.ca/?page_id=12360
The College recently reviewed its Third Party Reports and Medical Expert: Reports and Testimony policies. These policies set out expectations for physicians who: complete or prepare third party reports, conduct independent medical examinations, and provide medical expert reports and testimony. The reports, examinations and testimony are for purposes other than the provision of health care (e.g. for insurance benefits, or in respect of workplace issues, attendance in educational programs, legal proceedings, or other third party process).
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Do we need a Public Inquiry into the quality of the medical evidence? We think so and here’s why
Licence to bill – Globe and Mail
Doctors are taking in millions of dollars a year by putting their names to accident injury reports for the insurance industry. Some of these reports unfairly discredit injury claims, leaving victims intimidated and exhausted. But because the majority settle out of court, the practice is hidden from public scrutiny. Kathy Tomlinson investigates
Globe investigation finds billion-dollar companies that are paid by auto insurers hire doctors to assess accident victims in a process called independent medical evaluations, and then edit and package those medical reports. In some cases, arbitrators and judges have rejected the assessment reports because the companies altered the medical professionals’ opinions in the insurer’s favour. Kathy Tomlinson reports
Hired gun in a lab coat: How medical experts help car insurers fight accident claims – National Post
The car accident victims, the doctors who testified against her and the judges who aren’t accepting their expertise-for-hire — how insurance companies try to sway claims at trial
Experts disqualified for history of bias? – Law Times
Rhona DesRoches, chairwoman of the Association of Victims for Accident Insurance Reform, calls the decision a “game-changer” for personal-injury claimants, an indication that the courts have “had enough of the manipulations of insurers to delay and deny claimants through the use of biased medical evidence.”
WSIB and auto insurance: Birds of a feather – Toronto Sun 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.”
Cuts to benefits, ‘hired guns’ faulted
Social Justice: Expert witnesses and access to justice
Daggitt v Campbell, 2016 ONSC 2742 (CanLII), <http://canlii.ca/t/gpqm3 – see para 26-32
Bruff-Murphy v Gunawardena, 2016 ONSC 7 (CanLII), http://canlii.ca/t/gmr5x – see para 53-125
Trial Lawyers Association calls for inquiry
OTLA Presentation at the 2016 OLA Pre-Budget Hearings
Proper Use of Experts in Civil Trials – Rastin and Mahony (1)
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
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Fixing Auto Insurance -The Agenda with Steve Paikin Feb 7 2019
Will the Ontario government’s decision to launch a public review of the province’s auto insurance system lead to positive changes for drivers across the province?
https://twitter.com/i/status/1093613873435951105
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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. more….
Additional information at: http://www.fairassociation.ca/choosing-a-lawyer/
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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. more…