“Ontario’s crowded hospitals don’t need even more exams” – WILLIE HANDLER

We are delighted to see Ontario auto insurance policy expert and consultant Willie Handler’s recent piece. His views on the Marshall Report line up beautifully with those we expressed in our submission. Fingers crossed that government will take heed.

Click Here to View the Article 

Cost Reductions are a Good News Story for Ontario Drivers & Auto Insurers

The Ontario Rehab Alliance (ORA) congratulates the Ontario government on reducing auto insurance premiums and claims costs.

The recently released annual report from GISA (the General Insurance Statistical Agency) shows two remarkable trends in 2016:

Despite a 10% increase in the number of insured vehicles to a record of 7.5 million, total net
Accident Benefits premiums dipped for the fifth straight year in a row to total $3.047 billion,
representing a 19.4% reduction from 2012 ($3.782 billion).

The reduction in net Accident Benefits premiums is a direct result of the decrease in average
cost per claim which dipped to $34,047, the lowest in last 5 years. The most recent average
claim cost represents a 12% reduction over the previous year.

The ORA notes that these trends are all the more remarkable because the GISA data does not reflect the
additional reductions in Accident Benefits claim costs that are expected from subsequent changes to the
Catastrophic Injury definition, reduction in Catastrophic and Non-Catastrophic benefits and the
transition to the Licensing Appeals Tribunal (LAT), which is expected to improve dispute resolution in the sector.

“Such dramatic reductions in both premiums and claim costs indicate that the government’s previous
strategy is now bearing fruit” says Ms. Laurie Davis, Executive Director of the ORA. “Rushing in with new recommendations based on dated data risks undoing everything the government has accomplished to date and may introduce new unpredictable costs to the system”, she adds. Ms. Davis is referring here to the recently published “Fair Benefits, Fairly Delivered” report by Mr. David Marshall which calls for a
broad system overhaul, with many of its recommendations based on 2013 financial data which
preceded many of government initiatives which led to the recent reductions.

“We congratulate Minister Sousa on his success to date and urge him to press pause on consideration of
any further reform until the last wave of changes works itself through the system and benefits are
realized. Victims of Ontario’s motor vehicle crashes have been through enough changes in the past
decade and deserve some respite”, says Ms. Davis

Please Click Here for the Full Release: Cost Reductions a Good News Story

 

 

Last Call for October 18th Event in Stoney Creek

Car Insurance Reforms Bad for Taxpayers

Original Article by Dary Merkur, August 12, 2017 (visit original post Here)

Anyone want to save $100 per year on automobile insurance?

What’s the catch you ask?

Well, you will get less insurance protection than you need.

Oh, and did I mention your taxes will go up significantly because people without adequate insurance protection will now tap into the public purse?

In other words, paying less for automobile insurance gets you less in insurance coverage and results in increased government spending (also known as higher taxes).

Wouldn’t you expect the Ontario government to quantify and evaluate the impacts of a reduced mandatory automobile insurance product before making massive reductions to mandatory automobile insurance coverage?

Not so. The Ontario government, through its June, 2016 automobile insurance reductions, adopted this “cutting corners” philosophy as its ill-conceived solution to reducing automobile insurance premiums.

Now, the Ontario government has gone a step further by considering additional automobile insurance “cost cutting” measures recommended by their advisor, David Marshall.

The recommendations by Marshall will be up for public consultation later this month.

Surely, no one will be surprised when the Ontario government announces more changes and claims victory on this issue just in time to sweep this issue under the rug before the next election.

Let me be the first to congratulate the Ontario government for reducing automobile insurance premiums by increasing taxes.

What’s next? Reducing hydro bills by increasing taxes, or has that already happened, too?

Actually, there is one even easier way to immediately reduce auto insurance premiums — enforcing a restriction on insurers’ true profit to reasonable profit expectations.

(See the comprehensive study conducted by York University Schulich School of Business Professors Fred Lazar and Eli Prisman outlining excessive profits by insurers).

Unfortunately, the Ontario government appears completely unwilling to challenge insurers’ profit reporting despite compelling reasons to do so.

Injured motorists have significant care needs.

If those needs are not covered by insurers then the costs are absorbed in large part by various government-funded agencies.

No consideration has been given by the Ontario government to the financial and practical impacts of the June, 2016 automobile insurance changes, nor to Marshall’s recommendations, on government agencies paid for by the taxpaying public.

For example, one of the June, 2016 changes was a major reduction in non-earner benefits paid to injured persons such as students, who have suffered a “complete inability to carry on a normal life”.

Obviously, these accident victims have been severely disabled in order to qualify for that benefit.

But the June, 2016 changes limit non-earner benefits to less than a total of $20,000 when previously non-earner benefits for an injured student could have been worth roughly $500,000.

Now, the injured student, who is severely disabled and permanently unable to work, ends up on Ontario Disability, which ends up covering the same $500,000 in benefits over his or her lifetime.

Another June, 2016 change that was mean-spirited and unnecessary was halving the benefits available to the most seriously injured persons in car accidents, referred to as “catastrophically impaired” persons within the legislation.

With significantly less benefits available, the catastrophically impaired accident victim’s care, housing, transportation and treatment needs are all absorbed by the taxpaying public through government assistance such as CCAC, subsidized housing, Wheeltrans, ODSP and increased reliance on OHIP (leading to longer wait times at hospitals and reduced access to physicians).

The care needs of car accident victims are real.

The goal of the automobile insurance system should be to provide a product that gives accident victims a legitimate chance to maximize their recovery and to live with dignity and independence, without having to feel like a drain on the public purse.

Reducing automobile insurance premiums by ignoring the costs transferred onto the public system is a shell game, much like the shell game associated with insurer profitability.

Have Your Say Today!

The ORA invites all FSCO licensed auto sector healthcare providers to share their experience. Click Here to complete the survey and have your say!

 

Ontario Needs to be More Transparent About Auto Insurance Changes

Written by Ken Rubin, published by The Windsor Star on June 9th 2017. See the original post Here.

 

For two and a half years, Ontario’s Ministry of Finance and its rate regulator — the Financial Services Commission of Ontario — refused to release records of the Insurance Bureau of Canada’s efforts to influence and encourage government moves to reduce auto insurance coverage.

After denying my (Ken Rubin) requests under the province’s Freedom of Information and Protection of Privacy Act, the ministry made submissions to the Information and Privacy Commissioner of Ontario claiming that the IBC was one of its confidential “consultant policy advisers” retained as a kind of an “expert panel.” Therefore IBC lobbying records and even its 2012 pre-budget consultation submissions should be considered policy advice and not released, it argued. The ministry made this claim despite the fact that it is supposed to regulate the IBC’s members.

The ministry also claimed in a sworn affidavit that IBC records were cabinet confidences. Since influential IBC positions were discussed at numerous identified Ontario cabinet meetings, IBC records must be subject to cabinet confidence and not made public, it said.

In May 2016, as part of my appeal of the ministry’s decision not to release the information, I argued that widening the cabinet exemption to include the IBC — an independent third-party stakeholder — would set a dangerous, unwarranted precedent.

Had the Finance Ministry and its Financial Services Commission succeeded, lobbying groups’ submissions and meetings could have been hidden and freedom of information legislation severely compromised.

But thanks to the Information and Privacy Commissioner’s benchmark decisions in April, those outlandish claims were dismissed.

As a result, the records from 2012 to 2014 that I requested were released in May. They show the IBC pressing Finance Ministry and Financial Services Commission officials through frequent communications, meetings and briefings.

In November 2013, the IBC urged the government to remain firm on a $3,500 cap for minor injury claims it felt were “vulnerable to disputes,” documents show. The bureau offered ways to tighten the cap, so that mediation and medical claims would be confined and protected from “being tested, attacked, expanded and dissected by numerous challenges.”

The IBC insisted government officials keep it informed about the development of regulations and legislation, for which it conveniently supplied drafts for the government’s consideration. For example, in August 2014, the IBC asked which measures “are ready to be presented to Cabinet” and “which recommended reforms contained in IBC’s submission of July 4 have been reviewed and are ready for constructive discussions with a view of finalizing proposed regulatory and legislative language.”

The day before a February 2014 cabinet meeting, the IBC asked – given pre-election “political uncertainty”— to be put on the agenda to discuss the government holding firm to bringing in alternate dispute resolution reform, licensing of rehabilitation clinics and reviewing costly towing practices.

Due to the government’s subsequent cuts to basic auto insurance, Ontario consumers now have to pay extra premiums for better accident coverage. In a market dominated by several large insurance companies, Ontario’s more than 9.5 million car owners still pay high auto insurance fees despite successive governments promising lower premiums.

Ontario’s auto insurance regulation system is far from independent and transparent. Other North American jurisdictions, like California, set auto insurance rates with truly independent regulators in charge after open hearings where consumers can challenge proposed rates. Data submitted by stakeholders like the IBC is subject to public scrutiny and the process is more transparent. The rates set and premiums established are fairer and lower than those in Ontario.

It’s time to end the secretive industry-government relationship that keeps the Ontario public in the dark and auto insurance premium rates high, with shrinking coverage and low benefits.

 

Budget Confirms No Cuts to Accident Benefits

There’s no really big news (as in new information) about auto insurance in today’s budget. And maybe that’s good news.

The government says that it is “committed to finding ways to lower auto insurance rates and improve health outcomes for victims of auto accidents without reducing benefits”; it’s good to see that in writing after years of benefit cuts.

The budget  references the Marshall report, highlighting recommendations re programs of care and the establishment of Independent Medical Examination Centres. However, the budget does make clear the report has yet to be consulted on in the coming months.

The budget also referenced the establishment of the Financial Services Regulatory Authority (FSRA), legislated in December 2016. The FRSA will be assuming responsibility for regulating auto insurance, and presumably providers. The budget says the FSRA Board should be in place this spring and will then begin to develop its mandate.

So chances are there may not be many developments that will concern us, other than consultation for a number of months.

I was amused to read maybe the only specific innovation made in the budget for auto insurance consumers: drivers will now be able to use their phones to show electronic/digital proof of insurance. It is the government’s expectation that insurers will pass along to consumers the savings they realize from not having to send these pink pages. Seriously?

Car insurers and lawyers brawl in public

Two sides point to each other as reason for high insurance premiums. The truth is, they’re both responsible

By Alan Shanoff, Toronto Sun

A slugging match recently erupted between car insurance companies and Ontario personal injury lawyers.

The Insurance Bureau of Canada (IBC) opened by claiming the public needs regulatory oversight of contingency fees charged by personal injury lawyers.

The IBC feels a change is necessary to protect consumers and allow the government to evaluate the impact of lawyers’ fees on the auto insurance system.

The Ontario Trial Lawyers Association (OTLA) countered by releasing a study it commissioned concerning auto insurance premiums.

According to the study, prepared by two professors at York University’s Schulich School of Business, “consumers in Ontario may have overpaid for auto insurance by between $3 and $4 billion over the period 2001 to 2013.”

The OTLA urged an independent “thorough and truly transparent” review of auto insurance by Ontario’s Auditor General.

Reacting quickly, the IBC fired back through a press release, pointing the finger back at personal injury lawyers claiming, “lawyers’ fees are simply too high and have a significant impact on the cost of auto insurance.”

The IBC supported its conclusion by claiming some lawyers charge 40%, while others between 25% and 33% of any settlement or judgment.

I doubt many lawyers would dare charge a 40% contingency fee, although even a 25% to 33% fee may be too high in some cases.

But, the IBC forgot to mention clients don’t pay the entire contingency fee as a good part of the fee is paid by the insurance company.

To rub it in further, the IBC stated, “In 2013, lawyers received an estimated $500 million from injury claimants out of their insurance settlements for bodily injury claims. These are real dollars that never make it to the claimant. IBC will continue to fight for increased transparency so that consumers can actually see where their insurance dollars go.”

But I don’t think insurers want to open the transparency can of worms.

If they want to talk about “real dollars” that don’t make it to claimants, check out the vast sums paid by insurers for their so-called independent medical examinations (IMEs), used to belittle or deny claims.

According to the most recent Ontario Health Claims Database, insurance companies paid approximately $372 million for IMEs for accidents taking place in the last four years.

In some years, insurance companies forced almost half of all claimants to attend IMEs and in each year the average amount paid per assessed claimant for these exams exceeded the average amount paid per claimant for all medical and rehabilitation expenses.

Sending claimants for multiple and expensive assessments to pro-insurer experts is a major contributor to insurers’ costs and takes “real dollars” out of the pockets of claimants.

That’s not to say lawyers are free of blame.

There’s a long history of lawyers neglecting to act diligently to expose insurer experts who file partisan reports, sometimes outside their sphere of expertise, used by insurers to delay and deny claims.

As well, quality control at some law firms is substandard.

The FAIR Association of Victims for Accident Insurance Reform has recently posted an announcement stating, “ALERT – we are hearing about more and more cases where time limitations for filing have lapsed due to plaintiff’s legal representatives failing to meet limitation period deadlines.”

Then again, motor vehicle litigation and accident benefits claims are highly complex and insurance company tactics often lead to increased fees.

And if the insurance industry wants to point fingers at personal injury lawyers, perhaps they ought to make complete disclosure of the money they spend on defence lawyers and adjusters to deny, delay and defend claims.

Furthermore, how much do insurers pay to fund their massive public relations campaigns — including political contributions to those in power — which they effectively use to portray accident victims as opportunistic, malingering or just plain fraudulent?

It seems there is a lot of mud that can be thrown at each side in this messy debate.

But while the debate drags on, insurers continue to exact high premiums and lawyers receive handsome payments for their work.

And accident victims? They’re stuck in the middle.

Car crash victims deserve better deal

Ontario’s car insurance system seems to work well except for consumers who need it and accident victims who make legitimate claims under it.

After all, the insurance industry is making good money.

Lawyers are amply rewarded acting for plaintiffs and insurance firms.

Doctors earn significant sums preparing insurer-requested medical reports.

Treatment providers receive good compensation for treating the injured.

Premier Kathleen Wynne received generous financial support from the car insurance industry when she ran for the Liberal leadership.

The Liberal party receives significant campaign donations from it.

But here’s the problem. Two problems, actually.

The first is fraud by people trying to rip off insurance companies with phony claims. We agree it happens and it’s a serious problem.

But what we don’t understand is why the amount of fraud — to hear it from the insurance companies — never, ever, seems to decrease.

Fraud, we’re told, is the main reason auto insurance premiums in Ontario remain stubbornly high, no matter how many times the government cuts back benefits to all accident victims at the behest of the insurance industry, as it did again in its latest budget passed last week.

We also think there’s another kind of fraud in the insurance industry that needs to be addressed by government.

That fraud happens when people who have faithfully paid their auto insurance premiums year after year are hurt in serious accidents and, when they make legitimate claims for the benefits promised in their policies, are denied them.

It happens when car insurers fight against paying genuine claims from accident victims, falsely making them out to be the enemy and going to absurd lengths in and out of court to deny them the benefits to which they are entitled.

Last week, hundreds of demonstrators at Queen’s Park protested this kind of fraud as the Liberals passed yet another piece of legislation favoured by the insurance industry that will cut in half benefits for people who sustain catastrophic, life-changing injuries in car accidents.

Prior to the passage of the budget, Finance Minister Charles Sousa boasted, “Ontario is the most generous in Canada when it comes to providing coverage for auto insurance.”

Last week, Sun legal affairs analyst Alan Shanoff, demonstrated conclusively in his column how this statement was inaccurate.

In fact, Ontario doesn’t provide the most generous benefits for either catastrophic injuries or for so-called “minor” ones, which can include dislocation of joints, partial tears of tendons and ligaments and whiplash not exhibiting neurological symptoms.

As the FAIR Association of Victims for Accident Insurance Reform put it: “The budget does nothing to ensure that insurer claims management practices are fair and there has been no action (to deal with) … the biased and corrupt insurer medical examination reports that are disqualifying innocent and legitimate accident victims.”

We agree. It’s time to end this type of insurance fraud, as well.

Ontario Minor Injury Guideline a limit but not exclusion to Statutory Accident Benefits Schedule: Court

Jun 9, 2015 1:10 PM –

Nothing in Ontario's Statutory Accident Benefits Schedule “expressly incorporates by reference the entirety” of the province's Minor Injury Guideline (MIG) for auto insurance claims, but the “burden of proof” is on claimants “to establish entitlement to the appropriate level” of auto accident benefits, the province's Divisional Court suggested in a recent ruling.

Ontario’s Divisional Court has ruled on how to apply the minor injury guideline in auto insurance, in a dispute between Lenworth Scarlett and Belair Insurance Company Inc.The Divisional Court ruled Friday largely against Lenworth Scarlett, who was injured in September, 2010 when the vehicle in which he was a passenger was rear-ended. The vehicle's insurer, Belair Insurance Company Inc., is essentially disputing Scarlett's contention that his injuries fall outside the MIG, which puts a $3,500 limit on auto insurance claims for a minor injury, which could include a “sprain, strain, whiplash associated disorder, contusion, abrasion, laceration or subluxation and any clinically associated sequelae.”

In March, 2013, an arbitrator with the Financial Services Commission of Ontario (FSCO), John Wilson, ruled that Scarlett was “not precluded” from claiming housekeeping, attendant care and medical and rehabilitation expenses beyond the $3,500 limit of the MIG.

But the following November, FSCO appeals officer David Evans, a director's delegate, determined that Wilson's analysis had several legal errors that “required the matter be returned for a new arbitration hearing,” wrote Mr. Justice Robbie D. Gordon, of the Divisional Court, in its June 5 decision. That was on a judicial review requested by Scarlett, who asked the court to set aside Evans' decision and to reinstate the order that Scarlett is not precluded from claiming benefits above $3,500.

Related: New arbitration hearing ordered in Ontario minor injury guideline dispute

Rather than reinstate Wilson’s decision, the Divisional Court remitted Scarlett's case for a new preliminary issue hearing.

Evans, in 2013, “decided that rather than having only the preliminary issue addressed at the new arbitration, it would be most just and expedient to have all of Mr. Scarlett's issues addressed in one arbitration hearing before a new arbitrator,” Justice Gordon wrote on behalf of himself, Madam Justice Ann Molloy and Mr. Justice David L. Corbett.

The Divisional Court found that most of Evans' findings were reasonable. The court agreed with Evans' finding that Belair was denied procedural fairness when Wilson “raised arguments of his own for the first time, conducted research of his own, and inappropriately applied section 233 of the Insurance Act, all without first raising the matters with counsel and allowing an opportunity for submissions to be made.”

But the court disagreed with Evans’ finding that the MIG is “as binding” as SABS.

The MIG “remains a non-binding interpretative aid in deciding whether Mr. Scarlett comes within the MIG,” Wilson wrote in 2013. “In the absence of clear legislative direction that would override the existing jurisprudence as to burden of proof, it remains the insurer's burden to prove any exception to or limitation of coverage on the civil balance of probabilities. In this case, that burden has not been met.”

At the time, Wilson found it was “not at all clear that (Scarlett) also did not suffer from any other conditions that were neither soft tissue injuries nor the sequelae therefore, or that the sum of his injuries from the accident was minor in nature.”

Justice Gordon noted that there is “no provision in the SABS which expressly incorporates by reference the entirety of the MIG.”

Therefore, “it is necessary to examine each reference to the MIG to determine if it is an express reference thereto, and if so, what part of the MIG is required for the proper interpretation of the SABS provision in question,” the Divisional Court found.

“Although it is fundamental to insurance law that the burden of proof rests on the insured to establish a right to recover under the terms of the policy, so too is it fundamental that when an insurer relies upon an exclusion in the policy to avoid payment, the onus of proving that the loss falls within the exclusion generally lies upon the insurer,” Justice Gordon added. But the court ruled that neither Section 14 or Section 18 of SABS creates such as exclusion.

Related: MIG Schmig

Court records indicate that in his request for judicial review, Scarlett argued that Evans had “erred in finding that the $3,500 limit on medical and rehabilitation expenses,” in section 18 (1) of SABS “was not an exclusion of benefits.”

That section stipulates that “the sum of the medical and rehabilitation benefits payable in respect of an insured person who sustains an impairment that is predominantly a minor injury shall not exceed $3,500 for any one accident, less the sum of all amounts paid in respect of the insured person in accordance with the Minor Injury Guideline.”

Section 18 (1) creates limits but not exclusions on an auto insurer's liability under SABS, the Divisional Court ruled.

Therefore, it “reasonable” for Evans “to find that the effect of sections 14 and 18 is to create three tiers of benefits relating to medical and rehabilitation benefits,” Justice Gordon wrote.

Those tiers are:

-A maximum of $3,500 for an impairment that is predominantly a minor injury;

-A maximum of $50,000 if the impairment is not a minor injury and is not catastrophic; and

-A maximum of $1,000,000 for an impairment that is catastrophic.

“There being no exception, the Director Delegate reasonably and correctly held that the burden remains on the insured throughout to establish entitlement to the appropriate level of benefits,” the Divisional Court found.

The June 5 Divisional Court decision “is helpful in some ways, but not in others,” law firm Dutton Brock LLP commented in a bulletin. “There is no judicial review of whether chronic pain or (temporal madibular joint) impairments can be considered ‘clinically associated sequelae.’ The finding that the Guideline is only binding on the limited basis of ‘specific reference’ in the Regulation makes interpretation more challenging.”