March 17, 2016
Re: W5 The Claim Game show aired on March 12, 2016
Dear Mr. Malarek
Fraud is a big problem everywhere and especially when it comes to Ontario’s auto insurance industry. Your show touched on fraud perpetrated against insurers. Many of Ontario’s MVA victims face some type of fraud in the course of making a claim. Much of this fraud is ignored by our government and the public remains unaware that insurers are participating in deceptive claims handling practices.
According to the Auditor General about half of all MVA claims end up in our courts. That’s an unreasonably high number of denials unless one is willing to believe that one out of every two MVA victims is trying to scam the system. If the insurance industry’s estimate of fraud is 10-15% of claims – why are so many claims denied and victims treated with suspicion?
A comment was made by Lloyd Robertson that “claims are paid out quickly” in Ontario. This can’t be farther from the truth when 80% of the cases being heard at the Dispute Resolution System at the Financial Services Commission (FSCO) in the past month are 6 or more years post accident. That’s not timely and since many of these individuals are unable to fund their own treatments while in the claims process this means we have a system that harms victims through an empty promise of coverage.
How are all these claims denied and postponed? Through the use of biased or even unqualified medical examinations that, in many cases, even FSCO’s arbitrators call “inaccurate, failed, misleading, defective, incomplete, deficient, not correct and flawed”. These questionable medical examinations contribute to the cost of claims because insurers consistently spend more money on assessing injuries than they do actually treating victims and assisting recovery. It is not the claimants that contribute to the higher costs; it is the insurers who commission these bogus reports and then deny benefits that adds to the higher volume and costs through disputed claims that end up in our courts. There are plenty of cases on our website of useless medical evidence, forged assessor signatures and medical reports that have been tampered with in order to favour insurance companies.
Many victims end up on OW, ODSP and CPP disability and often must frequent food banks when insurers shirk their responsibilities. Many victims simply lose the timely window for recovery when needed treatment isn’t available through public supports.
In the past weeks we have heard from two elderly MVA victims (over 90 yrs old) who can’t get what they need for recovery. One elderly MVA victim who suffered catastrophic brain damage and whose insurer failed to approve necessary care has since died.
The bottom line is that Ontario has auto insurance on which legitimate claimants cannot count on. In 2015 there were over 80,000 auto insurance related cases in our courts, a clear signal that auto insurance is broken and victims are not being paid. Working closely with the Insurance Bureau of Canada, our government, like insurers, has focused only on fraud perpetrated against insurers and has failed to do anything to protect victims. Meanwhile, seriously injured victims are paying a very high personal price when they do not receive the accident benefits they deserve.
We hope that any follow-up show will include the story of those whose lives are forever changed because they’ve made a claim with an insurer who fails to live up to the promise of coverage.
Sincerely,
Rhona DesRoches, FAIR, Board Chair, fairautoinsurance@gmail.com
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
WSIB and auto insurance: Birds of a feather http://www.torontosun.com/2016/02/13/wsib-and-auto-insurance-birds-of-a-feather
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 http://www.torontosun.com/2016/02/13/wsib-and-auto-insurance-birds-of-a-feather
Third party assessment reports need strict code http://www.lawyersweekly-digital.com/lawyersweekly/3531?folio=18&pg=19#pg19
http://www.fairassociation.ca/wp-content/uploads/2015/02/HCDB-standard-report-2014h1-final.pdf pgs 56 – 59