‘FAIR – supporting auto accident victims through advocacy and education’
Here’s what Ellen Roseman, Toronto Star columnist had to say about media coverage of accident victim issues in her speech The Big Con Job Apr 20 2012 “Insurance fraud is a good story. The goal is to create a package so complete that the reporter or producer never has to leave his or her desk…As journalists, let’s try to tell the story of the suffering accident victims. Let’s not focus on unsubstantiated but flashy insurance crime sagas….We’re all just a distracted driver away from being an accident victim.”
FAIR Media releases and Open Letters
Positive News for Ontario’s Injured Car Accident Survivors
TORONTO, April 15, 2019 PRESS RELEASE – Last week Ontario’s drivers received the first positive news they’ve heard in over a decade.
FAIR is pleased to see that coverage for the most injured of accident victims will be increased to the pre-June 2016 level of $2 million in med/rehab benefits for catastrophically injured Ontarians.
The concerns of motor vehicle accident (MVA) survivors under the previous government had been ignored and the erosion of coverage had allowed insurers to download a significant number of victims onto taxpayers who were already paying some of the highest premiums in Canada.
Auto insurance has been dysfunctional and broken for many years and this has left injured Ontarians to fend for themselves to find treatments when insurers ignored their responsibilities. The changes in the 2019 Budget are the first indication that this government was listening to consumers and they have a taken a good first step to improve things for this vulnerable population.
Car accident victims in Ontario have faced many barriers to recovery, both in the medical file manipulations by insurers who have been dodging the responsibility owed to their injured customers and in the increased legal costs of holding their insurers accountable.
According to Tammy Kirkwood, Vice Chair of FAIR “This government listened and heard the need for positive changes for the victims of MVA. It will be a good thing to see that insurance is going to start working to be the safety net we need after the traumatic event of an auto accident.” Ms. Kirkwood is herself a survivor of a horrific car accident with a dump truck some years ago and has dedicated much of her time to ensure that others have the same recovery options and resources as she did post accident. “We all deserve to be the best we can be and insurers should be on board with that as a promise to their injured customers.”
FAIR looks forward to working with stakeholders in a new era of “Putting Drivers First” in Ontario and toward protecting the rights of injured consumers to access the treatments they need in order to reach maximum recovery.
‘FAIR – supporting auto accident victims through advocacy and education’
SOURCE: FAIR Association of Victims for Accident Insurance Reform
Press Release – Regulatory failure leaves Ontario’s injured car accident survivors paying while insurance companies dodge responsibility
TORONTO, November 2, 2018 / It should concern all Ontarians that auto insurers are failing to pay the HST on goods and services required by injured MVA victims in recovery. Traumatically injured auto accident survivors are among the most vulnerable of patients and they should not have to fight their insurance company to get what they paid for.
The Ontario government has a duty to protect vulnerable citizens from predatory insurers and to ensure that we have the quality coverage we need if we are injured. FAIR has long been aware of the many oversight failures that have led to this class action and the continuing struggle of accident victims to access adequate resources for maximum recovery.
The IBC and their auto insurer members were known to be among the highest donors to the Liberal government in recent years. That relationship undermined the recovery of tens of thousands of injured car crash survivors who depended on the government to do their job and protect them and not insurer profits. The sum and total of the previous governments failure to regulate has led us to where we are today with a fundamentally broken system since the previous Liberal government “fixes” were heavily tilted in favor of protecting the financial health of Ontario’s private auto insurers at the expense of the physical health of injured claimants.
According to Rhona DesRoches, Chair of FAIR, “Effectively we have ended up with a blended public/private auto insurance. Private insurer profits soar when they deliberately fail to live up to their promised coverage and download recovery costs to accident victims and unsuspecting taxpayers. It is only once in the system that one can see how hard insurers fight to put profits ahead of their customers recovery and how little meaningful regulation there is to protect them from predatory practices.”
“We aren’t buying policies with a ‘user fee’ of 13% in Ontario. While this does not sound like a large amount for a person to pay, spread over many claims over a number of years it means insurers are pocketing big dollars while downloading significant costs to those most injured. In order to recover these ill-gotten HST fees an injured accident survivor would have to take their insurer to the Licensed Appeal Tribunal (LAT) for a hearing where the victim has to pay a fee and even if successful at recovering these expenses from an insurer, they will not be reimbursed for their legal costs for having done so.”
FAIR supports the class action suit and the effort to hold insurers and their regulators to account. We look to the new Conservative government to do the right thing and protect Ontario’s vulnerable car accident survivors in recovery while holding insurers to account for their fraudulent acts.
OPEN LETTER – sent to MPPs and media
September 8, 2017
They say you reap what you sow but in the case of Ontario’s vulnerable and injured car accident survivors – they are reaping the sorrow for poorly conceived auto insurance legislation and a harmful lack of oversight for medical ‘experts’ examinations/reports and that means there’s a long line-up to have their cases heard in court.
The Insurer Medical Examinations (IMEs) are out of control and the recent media coverage in the Toronto Star and the National Post has exposed this seamy underbelly of medicine. Insurer ‘experts’ are making hundreds of thousands of dollars a year, some at $77,000 a month, and the medical evidence is so poorly crafted, so partisan and unacceptable that Ontario judges are at a loss on how to stem the dishonest testimony. It’s widespread, it’s shameful and it isn’t going to stop until the government steps up and speaks out for the ill and injured and forces Colleges to do their duty.
Please see FAIR’s letter to the Ontario Civil Rules Committee http://www.fairassociation.ca/wp-content/uploads/2017/09/Letter-to-Civil-Rules-Committee-September-5-2017.pdf for more information.
To read the rest of our letter to MPPs and the media OPEN LETTER sent to MPPs and media Sept 8 2017
Job One for newly appointed auto insurance Czar David Marshall: Public Inquiry into auto insurance claims medical evidence http://bit.ly/1UCMUn2
TORONTO, Feb. 1, 2016 /CNW/ – Today The FAIR Association of Victims for Accident Insurance Reform calls on newly appointed auto insurance advisor David Marshall to recommend a full public inquiry into the quality of medical evidence used in auto insurance claims.
“It is not an exaggeration to say that we are in a crisis when it comes to medical evidence in auto insurance claims,” said Rhona DesRoches, Chair, FAIR. “Ontario’s auto accident victim’s medical files are routinely manipulated by Ontario’s auto insurers to delay and deny claims,” she added.
Mr. Marshall, the former head of the Workplace Safety and Insurance Board (WSIB), is tasked with identifying opportunities for reform in Ontario’s troubled and dysfunctional auto insurance system.
“The use of bogus medical reports and testimony has profound negative outcomes for MVA victims who are left behind by their auto insurer,” DesRoches said.
“A public inquiry is necessary to uncover the systemic abuse of Ontario’s vulnerable and injured car crash victims by Ontario’sinsurers and our courts system, and recommend ways to address the harm,” she added. “We hope Mr. Marshall will get behind the proposal to clean up this unsavoury aspect of auto insurance.”
FAIR calls on our MPPs and the public at large to support an inquiry into:
- The failure of Ontario’s courts and judges to ensure that medical expert witnesses are in compliance with the Rules of Civil Procedure. Too many experts act as hired guns for insurers.
- The overuse and abuse of our courts by Ontario’s auto insurers to delay payments to legitimate claimants. Currently about half of all claims are initially denied by auto insurers.
- The improper and wasteful expenditure by insurers of hundreds of millions of insurance premium dollars on medical reports to fight their own clients’ legitimate claims.
- The role of Ontario’s regulatory colleges in failing to meet their obligations to the public through the lax application of standards.
- The cost to the Ontario taxpayers for financial and medical support for MVA victims whose claims have been fraudulently denied by Ontario’s insurers who commission poor quality or partisan medico-legal reports.
‘FAIR – supporting auto accident victims through advocacy and education’
SOURCE FAIR Association of Victims for Accident Insurance Reform
For further information: Rhona DesRoches, FAIR, Board Chair, email@example.com, fairassociation.ca
Ontario Auto Insurance – is No-Fault coverage really worth it anymore?
TORONTO, June 1, 2016 / – Today is Auto Insurance Awareness Day and it is the day that Ontario drivers lose $1 million in auto insurance coverage.
Ontario’s wealthy insurance companies continue to see high profit levels while drivers, who pay the highest premiums in Canada, continue to see their coverage eroded to the lowest level in 25 years.
“It isn’t just Ontario’s most injured auto accident survivors that are being asked to pay the price for higher insurer profits” says Rhona DesRoches, Chair of FAIR, “the length of time that an injured person can collect from their insurer has a much shorter time frame and this will affect the public supports systems we have in the province.”
Insurers will be reducing the duration limit of medical and rehabilitation benefits from 10 years to 5 years for all claimants (except children) and stripping millions out of coverage.
“For those that are not working, such as students at the time of an accident, the cuts are really going to hurt if you are seriously injured” says DesRoches. “These individuals will now only receive $185.00 a week for 2 years instead of $320 a week over a lifetime if they suffer a complete inability to carry on a normal life. This represents hundreds of thousands of dollars those victims won’t be able to access and these costs will be passed on to the unsuspecting taxpayer.”
Ontario’s social nets and healthcare coverage are already under significant stress with the number of individuals dependent on Ontario Disability Support Program (ODSP) considerably higher since the last round of auto insurance cuts in 2010.
The Minister of Finance’s recent report on the healthcare costs of treating accident victims revealed that taxpayers are paying the lion’s share of victim’s medical costs with a shortfall in 2013/14 of almost a quarter of a billion dollars that year.
“We have to ask ourselves, do we already have publicly funded auto insurance when the taxpayer is already subsidizing so much of the costs?” asked DesRoches.
The Ontario government recently stripped away the Charter right of victims to access our civil courts to hold their insurer accountable by setting up a new hearings system to handle the tens of thousands of unpaid claims each year. So far this year there has been over 18,000 claims filed by victims who have been denied the benefits they’ve paid for.
Auto insurance in Ontario is changing and resources for victims will have to come from the taxpayers in the future. Ontario needs to make a plan and commit to deciding whether No-Fault insurance is still working for consumers.
‘FAIR – supporting auto accident victims through advocacy and education’
SOURCE: FAIR Association of Victims for Accident Insurance Reform. For further information: firstname.lastname@example.org
Ontario’s Shame and Scandal – how the injured and disabled are punished by government policy
Victim’s group calls for the Auditor General and the Ontario Ombudsman to investigate what is happening to Ontario’s injured and disabled citizens
TORONTO, November 17, 2015 PRESS RELEASE – Ontario auto insurers are poised to make higher profits on the backs of Ontario’s disabled and injured MVA victims in 2016 while continuing to build up the provincial deficit by downloading the expense of victims to the taxpayers. Recently passed legislation means that coverage for the most injured MVA victims will be cut in half.
In October Ontario’s over 9 million drivers learned through the Lazar Prisman Report that they had been overcharged for auto insurance and likely overpaid by $1.5 billion in the last two years alone.
In recent weeks we learned just how challenging recovery is and how poorly the WSIB injured workers are treated in the Prescription Over-Ruled: Report on How Ontario’s Workplace Safety and Insurance Board Systematically Ignores the Advice of Medical Professionals.
How are these two stories related? Both systems are focused on their bottom line profits and their investments and not on recovery or the best interests of their clients. Both systems are based on medical evidence to support or deny claims; access to treatments and benefits relies on it. So what happens if those medical examinations aren’t reliable?
Ontario’s auto insurance companies have been delaying and denying their customer’s claims by way of poor quality or biased medical opinion reports in much the same way as is happening at the WSIB. Many of the same experts are employed under the two systems and those assessors who are auto insurers’ “preferred vendors” of these “independent” assessments are often beholden to the company that pays them. Similar to the WSIB assessment model where expectations are to be met or there are consequences. more…
Ontario Government Abandons Auto Accident Victims
TORONTO, May 28, 2015 /CNW/ – Last week the Standing Committee on Finance and Economic Affairs met with the public and industry stakeholders to consult on Bill 91, Building Ontario Up Act.
Our legislators chose not to invite auto accident victims to the consultation process and instead opted to look at empty chairs rather than look auto accident victims in the eye and listen to their concerns.
Ontario already has the highest premiums in Canada and the lowest coverage with 80% of claims capped at $3500for med/rehab. As pointed out by the Ontario Auditor General in 2011, about half of all claims are turned down by insurers and this means that our benefits are also too difficult to access.
Our government is proposing to cut $1 million dollars in coverage from catastrophically injured auto accident victims who currently have $2 million in coverage. Seriously injured victims will see their coverage drop from $86,000 to $65,000.
It appears that our government hasn’t considered the recent study that revealed that Ontario drivers were overcharged by their insurance companies by $840 million in 2013 and that we have overpaid insurers by $3-4 billion dollars since 2001.
It is unacceptable to be giving away money to wealthy insurance companies who are already using some very shady business practices to deny a record number of claims.
Victims are downloaded to OHIP, Ontario Works (OW), Ontario Disability Support Program (ODSP) and CPP disability. These programs are already overburdened and don’t offer the specialized treatments that many victims require so they will simply be left to fend for themselves.
Our government is giving insurers a financial gift by allowing insurers to pay injured victims less and simultaneously download the cost of victims to the unsuspecting taxpayers who are also the same drivers looking for a break on insurance premiums.
So what are we going to do about it?
We invite the public and Ontario’s auto accident victims to join FAIR and the Accident Benefit Coalition on Wednesday June 3rd, 2015 from 12 pm- 1:30 pm at Queen’s Park at the #Rally4AccidentVictims.
We hope you will sign the petition asking the Government to Stop Reducing Accident Benefits.
FAIR Association of Victims for Accident Insurance Reform is a not-for-profit organization of MVA victims and their supporters. http://www.fairassociation.ca/
SOURCE FAIR Association of Victims for Accident Insurance Reform
For further information: Media Contact: Rhona DesRoches, email@example.com
Government slashes benefits to MVA victims and calls it “Promoting consumer protection”
FAIR calls for a moratorium on the proposed auto insurance changes in the 2015 budget
Media Release April 28 2015 The 2015 budget is an absolute windfall for Ontario’s insurers who are the beneficiaries of Building Ontario Up by building up their already substantial profits on the backs of Ontario’s seriously injured auto accident victims.
Did our legislators or Mr. Sousa even read the recent Schulich School of Business report on Ontario’s insurance industry profits? Ontario’s wealthy insurance companies have had an “easy ride for over 20 years” and insurers have overcharged Ontario drivers by billions of dollars over the years according to that report. If Mr. Sousa had read the report there should have been some second thoughts about this latest billion dollar gift to insurers. Victims don’t just disappear when insurers fail to live up to the promise of coverage; they just end up on our public support systems at the tax-payers’ expense.
Our government, under the guise of protecting victims, is proposing to cut over a $1 million dollars in coverage for the most seriously injured among us while pretending that they are fiscally responsible. You don’t have to be an accountant to see that the government is doing the industry a big financial favour and doing it on the backs of some of the most disabled individuals in Ontario. It’s a disgusting and unacceptable way to treat these vulnerable individuals.
This latest slash to benefits, buried in a budget bill, is certainly deceptive but it is also bad economics to be giving away money to wealthy insurance companies while calling it balancing the needs of injured claimants to recover. It is an illusion to say that we are ensuring affordable insurance by allowing insurers to pay injured victims less and simultaneously be downloading the cost of victims to the taxpayers who are also the same drivers looking for a break on insurance premiums.
The Budget does nothing to ensure that insurer claims management practices are fair and there has been no action on FAIR’s concerns about the biased and corrupt insurer medical examination (IME) reports that are disqualifying innocent and legitimate accident victims. The auto insurance landscape should be cleaned up but instead we are seeing Ontario’s auto insurers being rewarded handsomely for disqualifying as many claims as they manage to handle.
Our legislators must be under significant pressure to be willing to support the abuses and dysfunction in our insurance system. We have to remember that to bring in the LAT system it requires that our MPPs ignore the Charter rights of all accident victims to access to our courts and that our elected officials are willing to create a third class citizen by denying that right. It is no small thing to denigrate the most vulnerable members of our society so an elite industry can profit.
We have no doubt that the new Tribunal hearings system will benefit Ontario’s insurers who are still doing nothing about their poor claims handling practices. Our government is not fixing the problem of the unprecedented volume of cases in the court system and the 61,063 unpaid and untreated accident victims waiting for justice. The new LAT system will be faster but will still punish victims and be based on Ontario’s insurers’ dependence on their deceptive and dishonest medical reports.
Ontario insurance is an adversarial delay and deny business model and profits depend on the turn down of claims. But who is paying for that? Well, first the victims who endure the endless bogus medical examinations required by our insurers in order for them to deny to access benefits. There are now so many thresholds and quantifiers of injury because insurers and the IBC work very hard to keep injured Ontarians at the lowest level of coverage and the more levels of coverage there are, the more opportunity there is for an insurer to deny the claim. All of these coverage issues are worked out in our courts at a cost to the taxpayer and not our insurers.
Even small changes such as the “require goods and services not explicitly listed in the Statutory Accident Benefits Schedule (SABS) to be “essential” and agreed on by the insurer” will become a point of contention and lead to even more cases in our courts if these changes pass into law.
There were over 42,000 Ontario Disability Support Program (ODSP) applications last year, many of them auto accident claimants who are forced to wait many years for their benefits. There are 61,063 auto insurance cases on the docket in Ontario courts, there are over 25,000 cases at the Financial Services Commission DRS unit, and many of our members are on ODSP and CPP disability so Ontario’s insurers are already well on the road to paying less than their fair share of MVA expenses and we already have a distorted form of public auto insurance.
The Ontario government is willing to allow insurers to shave more than a million dollars of coverage from our policies and they’ve demonstrated a willingness to punish victims in a way we haven’t seen before. There are about 600 or so catastrophically injured MVA victims every year and so this is an immediate saving of $600 million in just the first year. Victims will be downloaded to the public systems that are not set up to service their disabilities and unlike the fantasy world of protecting claimants in Building Ontario Up, victims will be sacrificed to build up insurer profits. So now these injured individuals face a lifetime of now increased physical, emotional and financial challenges.
We are very concerned about the changes to the Catastrophic Impairment designation. The direction and the insurer presence on the CAT Panel haven’t inspired confidence that the industry will do the right thing here. At one point only 75% of that Panel agreed that paraplegia or quadriplegia was a catastrophic injury. Now the potential that the industry will separate mental and physical injuries as if they were unrelated is another danger for injured victims and this too will lead to increased court challenges.
Why is our government indexing the court deductible of $30,000 for tort claims but not considering indexing the inadequate $400/wk income replacement for victims that has also stayed the same for well over a decade now? Here is a clear demonstration of the imbalance in how our government views auto insurance when the insurer’s income from the deductible (and it is the insurer who gets to hang on to that $30,000) is indexed to inflation and yet MVA victims are expected to survive on an amount that is lower than our minimum wage and far below the poverty line.
Ontario’s drivers are at a greater risk than ever before with falling coverage, high premiums and with a government that clearly could care less about them.
FAIR Association of Victims for Accident Insurance Reform is a grass roots not-for-profit that advocates for Ontario’s auto accident victims.
Media contact: Rhona DesRoches at firstname.lastname@example.org
Ontario’s Auto Accident Victims in Crisis
Victim’s Group Calls for Ontario Auditor General to investigate and report on the Auto Insurance Sector
TORONTO, April 16, 2015 /CNW/ – A recent StatsCan Civil Court Survey revealed that there are now 61,063 auto insurance related cases waiting for hearings in Ontario’s Superior Court.
According to the 2013 Minister of Finance DRS Report there were over 30,000 unresolved claim disputes at the Financial Services Commission of Ontario.
This is an unprecedented number of innocent and injured victims who have not had their claims properly handled by the insurer whom they paid to assist them in a time of need. Many of these seriously injured victims are without timely access to treatment and rehabilitation and they face a wait of up to 10 years or more to hold their insurer accountable.
Ontario drivers pay the highest prices in Canada for insurance, almost double what some other Provinces are paying for similar coverage. With so many unresolved claims in the system it is time to take a hard look at whether our government should be legislating Ontarians to buy this inferior product.
According to the Auditor General’s 2011 Report on auto insurance about half of all claims are turned down by Ontarioinsurers. What the AG report doesn’t talk about is how these claims are turned down. Victims are forced to attend multiple and excessive medical examinations by their insurer in course of a claim. Insurers spend more on assessing a victim than they do on treatment and rehabilitation according to the Insurance Bureau of Canada’s own statistics in the HCDB Standard Report.
Insurer medical examinations (IME) are virtually without oversight and are often performed by biased and even unqualified medical ‘experts’ who are beholden to the insurer who hires them. These bogus medical opinions are the tool used to deny claims and are at the core of the court backlog.
Victims are being downloaded at an alarming rate onto OHIP and our public system of Welfare, Ontario Disability and CPP Disability programs that are underfunded and unable to provide adequate care for victims.
Not only do victims face a personal crisis but they are faced with hiring a legal representative in a province where the cost for legal representation is the highest in Canada. Many victims hire more than one lawyer during the course of a claim and there is plenty of evidence that the quality of the services and the billing practices of that sector are also harming MVA victims.
We pay our premiums and we should be able to access the coverage we paid so handsomely for. What we have is legislators who are listening only to the Insurance Bureau of Canada’s incessant calls to slash benefits and our government is now on-board with blocking victim’s access to fair and balanced hearings in court through Bill 15.
When insurers don’t pay we all will. We are paying for private insurers who, according to the OTLA’s recent report, are making unprecedented and excessive profits on the backs of victims they refuse to pay.
We invite the public to join FAIR and we ask our elected MPPs to join in the call to the Auditor General to review and report on the auto insurance sector.
About FAIR Association of Victims for Accident Insurance Reform – FAIR is a grassroots not-for-profit organization of auto accident victims and their supporters who have struggled with the current auto insurance system in Ontario. http://www.fairassociation.ca/
SOURCE FAIR Association of Victims for Accident Insurance Reform
For further information: Rhona DesRoches, FAIR, Board Chair, email@example.com
TORONTO – September 25, 2014 – FAIR, the Association of Victims For Accident Insurance Reform, urges the Ontario government to fix the province’s broken auto insurance system and provide better oversight to protect vulnerable auto accident victims.
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.
FAIR is concerned that the victims and survivors of car accidents are exposed to significant risk when attending medical assessments and treatment clinics when regulatory oversight and enforcement is virtually non-existent.
According to the Health Claims for Auto Insurance Processing report released last month Ontario’s auto insurers spent over $242 million dollars for 89,826 visits by MVA victims at private clinics, assessment facilities and medical offices for medical opinions or treatment in 2013….
BILL 171 – CHRISTMAS COMES EARLY FOR THE INSURANCE COMPANIES ACT
Ensuring that Ontario has a working insurance system that provides good coverage and an honest system of justice for accident victims is part of the bargain and the responsibility of the government. There is also a responsibility that accident victims are not harmed by the process itself by way of the lack of regulations and the harmful practices of some of Ontario’s medico-legal assessors during the course of a claim. We look forward to that issue becoming part of the debate.
….Accident victims see Bill 171, not as a fraud fighting measure but as a template for reducing benefits paid to injured drivers by way of legislation geared toward enhancing insurer profits.
…Please stop trading accident victims’ rights to fair hearings, and the benefits they need for recovery, for insurer dollars.
…Please stop capitulating to Ontario’s insurers and discriminating against those whose insurers have failed to stand behind their contracts by taking away their right to have their case heard. Stop letting assessors harm accident victims and start making regulation and enforcement work.
Please stop taking action that has made Ontario’s accident victims third class citizens and in the bargain allowed Ontario’s insurers to walk away from their responsibilities by downloading these costs to the taxpayer.
…..Years of FSCO inertia (specifically referred to in the Final Report) in respect to a litigation landscape littered with bogus and partisan medical reports have led us to a justice system that no longer functions. Avoiding the issue does not make the improvements we need to fix this broken system.
If we could remove all of the legitimately injured accident victims in the system whose claims have been wrongfully denied on the basis of a poor quality medical report – the preposterous wait times and high costs would be greatly reduced. The DRS Review’s failure to address the core issue of bogus medical evidence will only speed up the flow of wrongful denials of legitimate injury claims thus increasing the backlog.
…. It is a disservice to injured accident victims that rely on this system to say we don’t care if it’s a qualified or partisan report but keep it short and under a certain amount of pages. And don’t worry, if the report is flawed, an Arbitrator will make sure the assessor won’t get paid. How does that improve the system?
Responses to our Open Letter:
FAIR response to the AIAC : FAIR response to AIAC Oct 3 letter – sent October 22 2013
Our Letter: Several months ago FAIR Association of Victims for Accident Insurance reform wrote to you in respect to the inadequate oversight of Ontario’s ‘independent’ medical assessors.
Several letters were sent out that proposed what we feel might be viable solutions to the problem of patient safety and the integrity of the professions when it comes to the Independent Medical Examinations (IME) performed by Ontario’s medical professionals.
The credibility of the auto insurers’ preferred IME/IE vendors, whose assessments are often used to deny and delay seriously injured claimants’ access to policy benefits is not only affecting access to treatment, it is affecting our justice system.
Accident victims are lined up by the thousands at the Financial Services Commission of Ontario looking for hearings to access the treatment they were promised and then denied on the basis of an often flawed or unqualified ‘expert’ medical opinion. Innocent legitimate accident victims, some cognitively impaired, are treated like criminals, often threatened and intimidated during an IME and the reports that are generated often of poor quality and of little use except to disqualify that patient for treatment recommended by other health professionals.
Those in Ontario’s auto insurance industry have made comments that cry out for better regulatory oversight and governance and that too is being ignored.
The President of the Canadian Society of Medical Evaluators (CSME) recently wrote that Ontario’s auto insurance IME domain is at risk of “public scandal” due to the inferior quality of “amateurish, biased and fraudulent” medico-legal assessments.
The President of the Association of Independent Assessment Centres (AIAC) said “The value of these independent assessments is directly proportionate to the independence and quality that courts and arbitrators attach to them.”
Ontario’s Arbitrators, who must decide whether or not an injured driver is deserving of treatment or benefits have called some of these medical reports on which they must rely “‘inaccurate, failed, misleading, defective, incomplete, deficient, not correct and flawed”.
A discussion at a FSCO Dispute Resolution Services Counsel meeting included the comment “100% of ALL assessments are “doctored” – in that the actual doctors and assessors are not able to do MOST of the report…” adding a suggestion that “FSCO needs to look at this in a more systemic way”.
We’ve put some suggestions out there to various governing bodies and have not received an answer to a question of public safety. We’ve proposed several possible solutions to those whose duty it is to protect the interests and safety of Ontarians.
FAIR would ask that you consider and respond to our suggestions that the annual public disclosure of fees paid by auto insurers to their medico-legal assessors (as is done in British Columbia) would improve transparency and accountability. FAIR would like to see an end to regulators’ ‘secret cautions’ that keep vulnerable accident victims in the dark about their medical examiners. More importantly, we feel assessors with prior adverse comments by judges and arbitrators regarding a poor quality IME should be subject to a ‘three strikes rule’ that would purge those who repeatedly abuse accident victims from plying their trade in our court systems.
Public safety should not be sacrificed so that a few rogue assessors can get rich by harming innocent auto accident victims. Surely the most vulnerable citizens who find themselves injured on our roadways deserve better treatment and more respect than that.
We look forward to hearing back from you on the issue of transparency, adverse comments and decisions, and on the ways that might be of use to clean up what has become a harmful medical system for Ontario’s accident victims.
Rhona DesRoches, FAIR, Board Chair
Reducing Fraud with Transparency in Ontario’s Independent Medical Examinations – Open letter to Stakeholders March 19 2013
On February 19 and March 4, 2013 FAIR wrote open letters to the stakeholders in the oversight communities that govern Ontario’s Independent Medical Examination practitioners.
Today we write to each of the stakeholders with a third suggestion to promote transparency in a system that everyone agrees is ‘broken’ – we must now move to the question of how we can fix it.
On Feb. 26, 2013 Heather Mack, the IBC’s Toronto Regional Director of Government Relations, wrote a letter to the Windsor Star praising Ontario’s private auto insurance system. On the ‘transparency’ issue Ms. Mack says there is a need to put the public auto insurance systems “under the microscope” and states that: “private companies in Ontario provide more information to the government than the Manitoba Public Insurance (MPI) Corporation provides to its government”.
The credibility of the auto insurers’ preferred IME/IE vendors, whose assessments are often used to deny and delay seriously injured claimants’ access to policy benefits and onto taxpayer paid systems such as welfare and OHIP, is in tatters…so much so that the President of the Canadian Society of Medical Evaluators (CSME) recently wrote that Ontario’s auto insurance IME domain is at risk of “public scandal” due to the inferior quality of “amateurish, biased and fraudulent” medico-legal assessments.
One way to shine a light on auto insurer fee-for-service assessment ‘mills’ would be for the Ontario auto insurers to annually disclose to the public the total amount each assessor has been paid. By making this information transparent the public would be alerted to the potential for bias when medico-legal assessors become completely beholden to the private auto insurers for the lion’s share of their annual income. Currently in Ontario, this information is not disclosed to the public. The bias inherent in this secretive system is obvious. British Columbia’s public system has disclosed this information for years. Why aren’t Ontario’s private insurers doing the same?
FAIR is asking that the same disclosure of information practice be adopted here in Ontario. The benefits of greater transparency to Ontario’s injured auto insurer claimants who are forced to submit to these often shoddy insurer assessments are obvious.
Far too much of the ongoing auto insurance talk consists of little more than unsubstantiated statements in which the competing stakeholders shout at one another over the heads of seriously injured auto accident victims – leaving them caught in the cross-fire. With the exception of columns in the Toronto Sun there has been virtually no dialogue about injured claimants and how to improve the quality of these insurer assessments.
It is within these questionable assessments that the perpetual accusations of opportunistic malingering and fraud are made by pro-insurer assessors looking to hold on to their steady stream of IME/IE insurer referrals. Those who attend the legislated medical examinations know that the wrongful denials of legitimate injury claims are justified on the basis of shoddy insurer commissioned medico-legal opinions and that this abuse is rampant.
Of late the discussion centers around simplistic insurer fixes like the continuation of the IBC/Liberal war on the alleged opportunistic fraud versus the NDP’s equally simplistic demands for a 15% premium reduction. It seems to be entirely lost on the NDP that a significant chunk of the increased auto insurer profits it wants to claw back from the insurers is the result of wrongful denials of policy benefits to some of Ontario’s most seriously – sometimes catastrophically – injured claimants. What about them? Don’t any of the stakeholders or politicians care about injured auto accident victims? So far it doesn’t look that way.
The suggestion for the annual disclosure of fees paid by auto insurers to their medico-legal assessors represents our third concrete, practical suggestion toward improving Ontario’s auto injury IME/IE system together with a ‘three strikes’ rule regarding adverse judicial comments and the mandatory disclosure of ‘secret cautions’ issued to IME/IE vendors.
FAIR would like to hear from all stakeholders in the Ontario auto insurance system as to whether they agree or disagree that, in the interests of transparency and accountability, such a disclosure requirement would represent a tangible step toward improving Ontario’s auto insurer assessment system.
Board Chair, FAIR Association of Victims for Accident Insurance Reform email: firstname.lastname@example.org
This letter is to apologize for our oversight in not copying you our “Open Letter” (scroll down) on the subject of “secret cautions” in the context of Ontario’s auto insurance ‘independent’ medical examinations (IME/IE). FAIR believes this is a matter affecting many of Ontario’s health regulatory Colleges. We believe that both the OMA and the OPA have an important role to play in the matter since their respective positions on the issue of “secret cautions” of IME/IE preferred vendors of auto insurer commissioned assessments would carry significant weight. Both the OPA and OMA can influence Ontario health policy and practices in a way that FAIR cannot.
In the context of the recent back and forth between the Toronto Star and the Ontario government on the subject of “secret cautions” the Minister of Health stated that there is nothing in the legislation to prevent the Colleges from disclosing these secret cautions to the public.
The CPSO and the Minister of Health have taken the position that, in the interests of public safety, the CPSO needs to disclose the names of the private clinics that have failed inspections. FAIR’s position is a simple one: that if willing consumers of other health service commodities offered at these clinics deserve this sort of transparency and disclosure – then why are seriously injured Ontario auto accident victims being denied the same? Unlike the willing consumers of these private clinics’ services; injured auto accident victims have no choice but to attend medico-legal assessments (IMEs/IEs).
Seriously injured and highly vulnerable auto accident victims are captive consumers of these medico-legal assessors – some of whom are recipients of multiple “secret cautions” for previous substandard auto insurer assessments. It isn’t the injured and sometimes cognitively impaired accident victims shopping for these assessments – it is the auto insurers. It’s been said by some of the stakeholders that the IME/IE marketplace is like any other – a “buyer beware” market. But to use this reasoning as a defence for keeping the track record of the Ontario auto insurers’ preferred vendors a secret from the subjects of their assessments requires a failure to remember that it is the insurer – not the injured claimant – who is the buyer. And if injured auto accident victims fail to submit to these scheduled assessments with assessors that their insurers have chosen – their policy benefits (income replacement and treatment benefits, etc.) are immediately suspended. In fact, the Premier is currently considering adopting a regulatory change that will soon allow insurers to fine injured auto accident victims $500 if they fail to submit to scheduled insurer commissioned medico-legal assessments.
So shouldn’t these assessors come as advertised by the auto insurers – highly qualified, completely impartial and well-respected by their licensing body? Is it fair for auto insurers, FSCO, the Colleges and the preferred insurer medico-legal assessors to continue to hide “secret cautions” related to previous flawed insurer assessments from the vulnerable accident victims who are forced to submit to these assessments?
FAIR would appreciate feedback from the OPA and OMA on this issue as well as any Colleges that care to provide their views.
Sincerely, Rhona DesRoches Board Chair, FAIR Association of Victims for Accident Insurance Reform email: email@example.com
FAIR Treatment for Ontario Accident Victims – MVA Victims at Risk Due to Secret Cautions – An Open Letter to Ontario’s Auto Insurance Stakeholders March 4 2013
To: Kathleen Wynne, Premier; Andrea Howarth, Leader NDP; Tim Hudak, Leader Conservative Party; C. Sousa, Minister of Finance; Financial Services Commission of Ontario; Insurance Bureau of Canada; College of Physicians and Surgeons of Ontario; Health Professions Appeal and Review Board; Alliance of Community & Medical Rehab Providers; Ontario Trial Lawyers Association; Canadian Society of Medical Examiners; Association of Independent Assessment Centers; Deb Mathews, Minister of Health; J. Singh, MPP, NDP; Alan Shanoff, Toronto Sun; Theresa Boyle, Toronto Star: Kenyon Wallace, Toronto Star
Two weeks ago (Feb. 19, 2013) FAIR sent an open letter to several Ontario auto insurance stakeholders asking each to articulate its position with respect to a “three strikes rule” that would help reduce the number of shoddy assessments used to decide whether injured accident victims are entitled to treatment and benefits. We have not heard back from these stakeholders.
Today we write to ask each of the same stakeholders to state whether or not they agree with the proposition that Ontario health professionals providing medico-legal assessments and/or proffering expert opinions in auto accident injury cases should be required to disclose any and all College reprimands or censures related to previous assessments.
Recently the Toronto Star carried a series of investigative reports on the topic of “secret cautions” issued by the the College of Physicians and Surgeons of Ontario. Some, including the opposition parties, are already saying that “Health Minister Deb Matthews must take “immediate” action to ensure that Ontario’s health regulatory colleges publish cautions issued to doctors, dentists and others for mistakes or improper behaviour“.
FAIR believes that it is unfair to require injured claimants to submit to insurer commissioned medico-legal assessments conducted by assessors who have been “secretly cautioned” for previous substandard assessments. Some health professionals doing these assessments in the Ontario auto insurance sector have been cautioned by their licensing body (College) more than once – but are not required to disclose these cautions to the subjects of their assessments. To make the matter even worse – the Ontario Auto Insurance Anti-Fraud Task has recommended to FSCO – and through FSCO to the Finance Minister – a regulatory change allowing a $500 fine to be levied against any injured claimant who fails to submit to a scheduled insurer assessment (IME/IE). If injured claimants are to be coerced into submitting to insurer commissioned IME/IEs in this way – then the insurers’ preferred assessors shouldn’t be hiding “secret cautions” from the now captive subjects of these ‘independent’ assessments.
It is upon the outcome of these assessments that insurance adjusters base their decisions as to whether or not to provide treatment benefits (and/or other policy benefits) as spelled out in the accident victim’s policy. So it is important that the examinations be done by highly qualified health professionals who are completely impartial and are truly “in good standing” with their regulatory College. These assessments should not be done by health professionals whose assessment work product has been repeatedly found wanting by our courts and certainly not by an IME/IE vendor who has been the recipient of undisclosed “secret cautions” issued by her/his College as a result of previous substandard assessments.
Improving the quality of these medico-legal assessments with a “three-strike rule” and with a requirement that “secret cautions” be disclosed to the subjects of the assessment will help improve our Ontario auto insurance injury assessment system. Surely all the stakeholders will agree? But if not – surely those stakeholders who don’t agree will say so – and will say why they don’t?
Rhona DesRoches is the Chair of FAIR Association of Victims For Accident Insurance Reform http://www.fairassociation.ca/ (firstname.lastname@example.org)
Health minister urged to tell colleges to publicize cautions Wed Jan 16 2013 Health Minister Deb Matthews must take “immediate” action to ensure that Ontario’s health regulatory colleges publish cautions issued to doctors, dentists and others for mistakes or improper behaviour, say opposition parties.
Professional colleges and self-regulation Tue Jan 15 2013
Health colleges given go-ahead to make cautions public Mon Jan 14 2013 The colleges that regulate the province’s health workers argue they are not permitted to publish the warnings they issue to doctors, dentists, nurses and others for mistakes or improper behaviour. The province says otherwise.
Doctors, dentists, pharmacists: The mistakes you can’t know about Fri Jan 11 2013 STAR INVESTIGATION: Want to find out if your health-care provider has a caution-free record? You’re out of luck. The warnings given to them are being kept secret by their regulatory colleges because they aren’t required to tell you about them
An Open Letter to Ontario’s Auto Insurance Stakeholders Feb 19 2013
Sent to: Kathleen Wynne, Premier; Andrea Howarth, Leader NDP; Tim Hudak, Leader Conservative Party; C. Sousa, Minister of Finance; Financial Services Commission of Ontario; Insurance Bureau of Canada; College of Physicians and Surgeons of Ontario; Health Professions Appeal and Review Board; Alliance of Community & Medical Rehab Providers; Ontario Trial Lawyers Association; Canadian Society of Medical Examiners; Association of Independent Assessment Centers; Deb Mathews, Minister of Health; J. Singh, MPP, NDP; Alan Shanoff, Toronto Sun
February 19, 2013
Too often the Ontario auto insurance system treats seriously injured claimants unfairly and yet this issue still isn’t getting consideration from legislators or regulators at Queen’s Park. Current “fixes” are heavily tilted in favour of protecting the financial health of Ontario’s private auto insurers at the expense of the health of injured claimants.
“Independent” Medical Examinations (IMEs) are essential in adjusting the injury claims of Ontario’s auto accident victims. The Ontario Auto Insurance Anti-Fraud Task Force has acknowledged that there are problems in terms of the quality of these assessments and ongoing mainstream press coverage continues to chronicle examples of how shoddy insurer medico-legal assessments hurt legitimately injured claimants.
A ‘three strikes’ method of purging the insurance system of biased, unqualified or substandard IMEs was proposed by Alan Shanoff: “If a judge or arbitrator has made critical or adverse comments concerning a health professional make the comments public rather than leave them buried in decisions that few read. Allow adverse comments made about a health professional to be used against the health professional in subsequent cases and disallow the use of any professional who has been the subject of three adverse comments. We can get rid of shoddy, biased independent medical examinations — but only if we want to.” http://www.torontosun.com/2012/11/30/concern-for-professional-reps
So far, none of the stakeholders have responded to that suggestion. And yet insurer assessors themselves acknowledge that the worth of the assessors is inextricably tied to the value the Trier of Fact attaches to their work product: “The value of these independent assessments is directly proportionate to the independence and quality that courts and arbitrators attach to them.” http://www.canadianunderwriter.ca/news/letter-to-the-editor-independent-medical-examinations-provide-necessary-check-and-balance/1001950950/
FAIR would like to know what each of the stakeholders think of this “three strikes” rule as a first step toward purging the rogue assessors from the Ontario auto insurance system. This rule would apply evenly to insurer assessors and treatment provider assessors alike. Do you support this idea – or do you oppose it? If you oppose a three strikes rule – why? What alternative solution for the substandard assessment problem do you have to offer?
Seriously injured Ontario auto accident victims deserve fair assessments performed by well qualified assessors. Sadly, they can’t count on getting such an assessment. They have been waiting long enough for action. So FAIR would appreciate a timely reply in order that we, together with the other stakeholders, can all move forward in a collaborative effort to clean up the Ontario IME system and make sure that auto accident victims are treated fairly and with dignity.
Rhona DesRoches Board Chair, FAIR Association of Victims for Accident Insurance Reform email: email@example.com
(…)Consumers have noticed the large advertising placed around the Minister of Finance’s buildings by the Insurance Bureau of Canada. Clearly there are abundant funds for advertising, while catastrophically injured accident victims have had their claims delayed and denied by their insurer….
February 1, 2013
Ontario’s accident victims support the fight on fraud – after all they are very often the unknowing victims of fraud during the course of a claim. The Anti-Fraud Task Force recognized this while specifying “Our recommendations should not make things worse for legitimate claimants.” The changes to regulations on January 21, 2013 are not a reflection of the intent of the Task Force and have changed substantially from the proposals put before the public and consumers in their final report.
The new regulatory changes, specifically those at 46.3 (1): the Duty of insured person to provide information, now see the Minister of Finance placing additional stress on accident victims with burdensome questions that many accident victims would be unable to answer. Consumers who are injured, often in pain and sometimes cognitively challenged know nothing of the intricacies of a rehabilitation workers file, management time or costs, nor do they have receipts for items purchased on their behalf. Yet they will be subject to questioning on “what, when and by whom the goods and services were provided” and asked to make sworn statements on those points. Claimants who are unable to swear to the details of their goods and services will now have payments stalled under “(3) For the purpose of section 51, the amount payable by an insurer under an invoice is not overdue and no interest accrues on it during any period during which an insured person fails to comply with subsection (2).” This will disadvantage claimants in a way not intended by the Task Force. The Minister of Finance has left an open door for some unscrupulous insurers to potentially abuse vulnerable accident victims. There is no defined limitation on the amount of times insurers might request under oath testimony from innocent accident victims for goods and services. Why is that? Why would the Minister not follow the Task Force recommendation that those who provide the goods and services should also make available the signed forms confirming that the goods and services were provided? Providers of goods and services are better equipped to track expenses and will be audited on a regular basis – so why put the responsibility on the accident victim?
The implementation of these new regulations, as they read now, not only fail to “not make things worse” but the wording now has the potential to punish innocent and vulnerable accident victims even while making them soldiers in the war on fraud. FAIR feels that the language of these regulatory changes should better reflect the intent of the Anti-Fraud Task Force and that all accident victims should be treated fairly and with respect by their insurers and their government.
Fair is a not-for-profit consumer advocacy group dedicated to ensuring all accident victims are treated fairly under current automobile insurance legislation.Rhona DesRoches FAIR, Board Chair
FAIR – Time to Fix Ontario’s Broken Auto Insurance System Jan 16 2013
Whoever wins the Ontario Liberal leadership race should pay closer attention to making our broken auto insurance system fair for injured accident victims and their families.
Too often the Ontario auto insurance system treats seriously injured claimants unfairly and yet this issue still isn’t getting consideration from legislators or regulators at Queen’s Park. Current “fixes” are heavily tilted in favor of protecting the financial health of Ontario’s private auto insurers at the expense of the physical health of injured claimants.
The perception that our government takes Ontario’s insurance industry interests more seriously than public health has been heightened by the news that at least three of the Liberal leadership candidates have accepted sizable donations from the Insurance Bureau of Canada. The question will be asked, is the insurance industry using donations to get the legislation they want passed before an election?
FAIR, the Association of Victims for Accident Insurance Reform is a consumer group. We are accident victims, their families and supporters who think we need to fix our insurance system.
What’s wrong with auto insurance in Ontario? A lot, if you ask FAIR’s members, or anyone of the more than 60,000 people in Ontario who are injured in motor vehicles accidents annually.
Here are just some of the problems:
* In 2010, the provincial government arbitrarily put a $50,000 limit on the amount anyone can claim for basic coverage — cutting in half the upper limit of funds for non- catastrophic injury that people previously could receive from insurers after a debilitating accident. Perhaps worse, a more insurer-friendly method of calculating what counts as “catastrophic injury” has been recommended by a panel of insurer-friendly medical “experts.”
* In 2010 Ontario allowed insurers to limit victims’ claims for so-called “minor injuries” to $3,500, down from the previous level of $100,000. While this may sound reasonable, $3,500 is not enough to cover even basic rehabilitation after an auto accident. Worse, an overly aggressive use of the Minor Injury Guideline has contributed to wrongful inclusion of serious injury cases within the guideline benefit limits.
* Many Ontarians run out of treatment funds within six months, which can compel them to settle for less than what is fair given the insurance premiums they paid and what they’ll need for recovery. Hardball insurer assessors often exacerbate this problem.
* There’s still a sizable backlog of claims in Ontario — some 20,000 claims in the province are reportedly in dispute, with most waiting more than a year for resolution. The Ontario government has put immense resources into cutting hospital waiting times — why is it standing by idly while insurance claim waiting times remain intolerable?
* The wrongful denial of policy benefits to injured claimants based on shoddy insurer assessments through Independent Medical Exams (IMEs) is a central problem in the Ontario auto insurance system. These questionable ‘independent’ opinions often deny or delay victims getting the help they need and drive up costs to both the injured victim and the taxpayer who must shoulder the burden when insurers fail to do so.
*The quality of Ontario’s IMEs has frequently come into question and has become the cause of widespread consumer mistrust of auto insurers. College sanctions of their members, out of sight of public scrutiny, have allowed the ‘independent’ for-hire assessors to ignore the College regulations while pursuing profits from insurers.
*The government is poised to implement a key recommendation of the recent Anti-Fraud Task Force which would impose a $500 fee on victims who miss one of the dubious insurer-ordered examinations. Frankly, there are other measures currently available to deal with people who repeatedly miss appointments. But it must be said that there is a real imbalance of power between insurers and their preferred assessors versus cognitively vulnerable and seriously injured claimants. Imposing a $500 fee for a missed appointment amounts to extortion for not submitting to what often turn out to be substandard assessments performed by “hired guns” masquerading as impartial assessors.
Insurers justify this harsh treatment of victims of serious accidents by saying it’s necessary in order to prevent fraud and keep premiums reasonable for the millions of Ontarians who pay insurance every year and don’t make claims. The result could not be more different: all we get is ever-higher premiums, lower benefits and skyrocketing profits for insurers.
FAIR is neither advocating for or against public auto insurance as a replacement to the current private sector system we now have in Ontario. Consumers should consider the poor performance of private auto insurers – Ontario faces the highest premiums and the lowest benefits in Canada. FAIR believes all options for better coverage ought to remain on the table.
The majority of us will never be in an accident but all of us take our chances on our roads and highways. It needs to be asked —in a province where consumer goods and services are constantly getting better, why is auto insurance one of the only products that seems to perpetually get worse?
It’s something the next premier, our new government — and everyone in Ontario — ought to be asking and our auto insurers need to answer.
Rhona DesRoches is the Chair of FAIR Association of Victims For Accident Insurance Reform http://www.fairassociation.ca/ (firstname.lastname@example.org)
FAIR Media Release Dec 11 2012
For immediate release
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