Author Archives: Admin2

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

http://www.fairassociation.ca/wp-content/uploads/2014/01/FAIR-letter-to-the-DRS-Panel-January-15-2014.pdf

PALMERSTON – Jokelee Vanderkop knows first-hand the turmoil and upheaval one can experience battling for legitimate insurance benefits. She’s made it her mission to share that experience and information with others, because “Having a legitimate claim, medically backed by one’s doctors, is no guarantee that an insurer will pay the benefits for which an individual has paid,” she said.

Jokelee Vanderkop Mintos article

The Workplace Safety and Insurance Board is being accused of cutting off benefits to injured workers against the advice of medical professionals. The Ontario Federation of Labour is asking the provincial Ombudsman to investigate. The new president of the WSIB, Tom Teahen, talks with the Rita Celli about the allegations.

Podcast found here:  http://www.cbc.ca/ontariotoday/episodes/#

Canadians off work due to a disability are facing a perfect storm – they need time to recover, but instead of focusing on their health, they’re often dealing with the financial stress of trying to make ends meet and the emotional stress of being away from work.

http://www.ilstv.com/disabled-workers-face-perfect-storm/

One of the safeguards in place for those who have suffered personal injuries in car accidents and who have been wrongly denied a benefit is the ability to file a claim in the Ontario courts against their insurance company. It is an important right to have – although there are other methods of disputing an insurance company’s denial of a benefit in a personal injury claim (such as through the dispute resolution procedure at the Financial Services Commission of Ontario, or FSCO.)

http://lernerspersonalinjury.ca/the-license-appeal-tribunal-and-the-future-of-car-insurance-disputes/?utm_source=Mondaq&utm_medium=syndication&utm_campaign=View-Original

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

According to the Financial Services Commission there were over 3,000 applications for mediation and arbitration hearings every month or 136 applications for hearings every business day in 2015 (Jan-Sept). This is an extremely high number of unresolved disputes and denied claims and likely more than a newly created system would be able to accommodate efficiently. According to these numbers Ontario’s auto insurance disputes are on the same trajectory as discussed in the Ontario Ombudsman 2011 report with half of all claims denied and a system bogged down and bottlenecked.

FAIR comment on Proposed amendments to Insurance Act regulations regarding the Ontario AIDRS Feb 12 2016

It has been and continues to be OTLA’s position that public protection and safety are the cornerstones for transparency and accountability.

It was this belief in transparency and accountability that lead OTLA to call for a public inquiry into the quality of medical evidence used in court. Too many motor vehicle accident victims find that they are victims as well of a system of medical assessments that are tailored for partisan purposes and permitted to flourish in a climate of secrecy and a lack of accountability.

OTLA Submission to CPSO Transparency Phase 2 Feb 12 2016