In search of an advocate; Someone has to step up for car accident victims and insurance consumers

 By Alan Shanoff ,Toronto Sun, First posted: Saturday, March 17

This is Fraud Prevention Month. There are many scammers ready to pounce on the unwary and we need to be vigilant to avoid becoming victims of fraud.

The RCMP, the OPP, Canada Revenue Agency, the Competition Bureau and other government agencies implore us to protect ourselves, to avoid being taken in by fraudsters.

The Insurance Bureau of Canada is also reminding us of Fraud Prevention Month, telling us to be on the lookout for insurance fraud.

And that’s got me thinking.

Sure, there’s plenty of insurance fraud. Sure, we need to stamp out crime rings that engage in staged accidents.

This includes the fraudulent body shops, towing companies and medical and rehabilitation clinics that participate in such scams.

But why isn’t there a month where we advocate for car insurance consumers and car accident victims?

There’s little doubt both are under sustained attack by the insurance industry.

Ontario accident benefits were drastically reduced in 2010.

Many were eliminated while others were cut in half.

The majority of claims are now dealt with under a so-called minor injury guideline in which benefits, including the costs of assessments, are capped at $3,500.

Proposals have been made to limit the number of catastrophic impairment designations, thereby reducing the number of victims who qualify for the broadest range of benefits.

Treatment plans and requests for treatment for accident victims are being denied at increasing rates.

Insurance adjusters have and use the power to deny assessments and treatment, without obtaining a supporting medical opinion.

Adjusters deny, delay or remove benefit payments with little or no notice, without providing any reasons.

Victims aren’t given the benefit of the doubt and are often treated as adversaries.

Mediation requests face delays of about one year.

Arbitration requests face similar delays, meaning accident benefits claims in dispute and related medical treatments can be delayed for a minimum of two years before a decision is released.

That decision can then be appealed, creating more delay.

Insurers are resisting efforts to streamline dispute resolution by insisting on mediation prior to arbitration, even if it means an additional year of delay.

Insurers retain preferred, expert physicians to deny claims, many of whom earn the bulk of their income from insurer reviews.

Many of these “hired gun” reports from assessment mills are prepared by physicians who perform “paper reviews”, without examining the victim.

Clinic administrators are writing portions of insurer medical expert reports, with the doctors writing only a small portion, because the cap on fees for reports, a mere $2,000, doesn’t allow for adequate compensation for doctors.

Legitimate accident victims are easily labelled malingerers or opportunistic fraudsters by insurers.

Decisions, including arbitration decisions, denying benefits have been based on reports by so-called experts who lack expert qualifications or proper credentials.

Victims can be buried under requests for multiple assessments.

Claimants who sue the other driver face a $30,000 deductible for claims under $100,000 and must also satisfy a stringent threshold to recover any award.

I could go on but I’ll end with this concern: In spite of the decrease in benefits, premiums keep increasing.

For example, my car insurance premium is going up a whopping 16.4% next month.

Apparently my postal zone in North York has seen a large increase in claims that trumps my accident-free record of 44 years.

So who is going to speak up for accident victims and car insurance consumers?

Even the Consumers’ Association of Canada, which used to be active in covering the insurance beat for consumers, appears to have lost interest in the subject, having issued only one press release or study on the topic since 2004, with their last release four years ago.

So who is going to declare a month in favour of accident victims and insurance consumers? Who is going to step up?

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