Ontario budget 2015: the divisive industry reactions

The liberal Ontario government has published its 2015-16 budget, and several elements of the plan impact the insurance industry and its client base.
 
For one, the government has renewed its commitment to lowering auto insurance premiums by 15%, which it intends do accomplish by raising deductibles from $300 to $500, as well as lowering maximum interest rates and forbidding increases on premiums because of “minor, at-fault” accidents.
 
In addition, Finance Minister Charles Sousa announced that insurance companies will be required to offer discounts for drivers who install snow tires on their vehicles.
 
Because of these measures, the Insurance Bureau of Canada (IBC) feels that the budget is a step in the right direction for the province’s drivers.
 
“It's clear that the government recognized that the auto insurance product needed reforms to work better for consumers,” Ralph Palumbo, Vice-President, Ontario, IBC, said in a statement. “These reforms will remove excessive costs and this will result ultimately in lower premiums for Ontario's 9.4 million drivers. This shows, once again, the Ontario government's leadership and commitment to consumers.”
 
At least one insurance company echoes this positive sentiment. Unica Insurance Inc. applauded the Government of Ontario for its efforts to help keeps motorists safe during the winter months.
 
“We strongly believe in providing Canadians with products that will not only provide them with the protection they require, but at a price that delivers good value,” said Martin Delage, President and COO of Unica Insurance. “The Government of Ontario's budget announcement related to an insurance discount on winter tires directly aligns with this.”
 
Unica currently offers a 10% discount for consumers who make use snow tires on their vehicles, but it is unclear what price reduction will be mandated by the budget.
 
Finally, the 2015 budget makes dramatic changes to what is included in auto coverage. Whereas medical and rehabilitation benefits used to exceed $80,000, it now rests at $65,000. In addition, catastrophic incident benefits now face a limit of $1 million, reduced from $2 million.
 
Some advocacy groups have expressed outrage over these cuts.
 
“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,” said Rhona Desroches, FAIR Board Chair. “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.”
 
In addition, FAIR disagrees with the impending changes to what constitutes a “catastrophic impairment,” and feels that this will further exacerbate the conflicts of interest that exist with the CAT panel.
 
“At one point only 75% of that Panel agreed that paraplegia or quadriplegia was a catastrophic injury,” Desroches said. “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.”
 
FAIR is not the only critic of Sousa’s budget. NDP Leader Andrea Horwath has also been vocal about her opposition, and she similarly argues that the Liberals’ supposed reforms will only serve to benefit insurance companies, not consumers.
 
“It never trickles down to the drivers,” she told the CBC.

From http://www.insurancebusiness.ca

Ontario to reduce mandatory auto accident benefits, update catastrophic impairment definition

By: Greg Meckbach, Associate Editor
2015-04-23

The Ontario government does not plan to mandate further cuts in private passenger auto premiums, but the ruling Liberals do plan to change the Insurance Act to reduce the total mandatory coverage, in the standard auto policy, for medical and rehabilitation benefits and to change the definition of catastrophic impairment.

The government will change the standard benefit level under the province’s mandatory auto coverage to $65,000

Finance Minister Charles Sousa released Thursday the budget for the 2015-16 fiscal year, announcing the government will “change the standard benefit level” under the province's mandatory auto coverage, to $65,000 and to “include attendant care services under this benefit limit.”

Since 2010, Ontario's standard auto policy has provided for $50,000 for medical and rehab benefits and $36,000 for attendant care. Those amounts are half the mandatory coverage required prior to 2010.

In Thursday's budget documents, the government announced that for catastrophic injuries, the mandatory coverage of $1 million will in the future include attendant care and medical and rehabilitation benefits. Currently, claimants with catastrophic injuries have $1 million in attendant care benefits and $1 million in medical and rehab benefits.

Read more – Ontario to create administrative bodies for mandatory workplace pension plan, condo manager licensing

“Ontario is certainly one of the highest cost jurisdictions in North America for auto insurance claims,” Sousa said in a press conference before he tabled the budget. “In fact, we are the only province that provides catastrophic coverage, which is expensive so we are going to continue doing that. We are modifying it somewhat.”

The government “will amend Insurance Act to update the catastrophic impairment definition consistent with more up to date medical information and knowledge,” the Liberals say in their budget document, adding they will “continue to ensure, where possible, that insurance coverages reflect the most relevant scientific and medical knowledge on identifying and treating injuries from automobile accidents.

In August, 2013, the province passed the Ontario Automobile Insurance Rate Stabilization Act (AIRSA), establishing an “industry-wide target reduction,” by 15% over two years, of the average private passenger auto premium. Since then, Ontario insurers have been required to “propose rates and a risk classification system that contribute adequately to the achievement of” that 15% target.

“We have now reduced them by over 7%,” Sousa said Thursday. “We are halfway there.”

Sousa made his remarks in a press conference near Queen's Park, where reporters were given copies of the budget in the morning and locked up until he started his speech in the legislature. Sousa told reporters the measures announced in the budget are “part of our strategy to reduce rates to get to the 15%.”

Another measure announced Thursday is a plan to mandate discounts for winter tires, but he did not say what that discount would be.

Ontario Finance Minister Charles Sousa

“We are looking for the insurance companies to give at least 15% discounts right across and that's the goal we are trying to achieve,” Sousa (pictured right) said in reply to a reporter asking what the mandated winter tire discount would be. “Winter tires will help supplement that as will the telematics boxes if they wish to proceed with that.”

The announcements got no praise from opposition leaders who addressed reporters.

Vic Fedeli, the Progressive Conservative finance critic, alluded to the fact that in 2013, the Liberals – who then had a minority government – promised to mandate a 15% auto rate reduction in return for the NDP voting in favour of the 2013-14 budget. Had neither the NDP nor the PCs supported the 2013-14 budget, the minority government would have fallen.

The NDP “were bought off essentially,” Fedeli said during his press conference Thursday before Sousa tabled the budget. “There was no business plan. There was no go-forward plan so you start off with a bad premise like that and it's no surprise that, come August, we won't see insurance rates reduced 15%.”

NDP leader Andrea Horwath suggested consumers will not benefit from the Liberals' efforts to cut claims costs.

“If you are talking to the insurance industry, they are going to try to paint it in a way that looks like they are really struggling,” she told reporters in the media lockup. “I don't think anybody in this room believes that for a minute and I certainly don't.”

She did acknowledge that some individual insurers lose money on Ontario auto.

“Is there the odd insurance company that doesn't do a good business? Absolutely, that happens in every type of business that we have,” Horwath said during the press conference. “Some are good at what they do and some are not. But overall, as a whole, Ontarians are paying far too much for their insurance.”

In 2010 – in addition to reducing mandatory coverage for medical, rehab and attendant care coverage – the Ontario government also reduced mandatory income replacement coverage and introduced a $3,500 cap for injuries that fall under the minor injury guideline. The Insurance Bureau of Canada reported earlier the industry lost $1.7 billion on Ontario auto in 2010.

“In 2010 the government made changes to the policies around insurance and all that did, instead of creating an opportunity for reductions, is it created an opportunity for insurance companies to pocket more money,” Horwath told reporters Thursday. “The government talks about anti-fraud measures, they talk about winter tires and they talk about all of these other initiatives and the issue that we have is that no matter what initiative the Liberals tend to put in place, the first people to get their fingers into that savings opportunity is the insurance industry. It never trickles down to the drivers, yet that's the theory as to why these changes are being made.”

From The http://www.canadianunderwriter.ca

Ontario’s 2015 Budget Injures the Injured

The 2015 Budget is very bad news for those injured in auto accidents. The Ontario Rehab Alliance is profoundly disappointed and worried by the proposed changes to standard Auto Insurance Benefits.

While we understand the pressure this government faces to reduce premiums, we worry about the future wellbeing of the 65,000 fellow Ontarians who are injured in motor vehicle crashes every year.  We regretfully believe that the latest policy direction will have a devastating effect on the most severely injured and their families.  Based on the budget announcement, we will undoubtedly see fellow Ontarians whose horrific crashes resulted in quadriplegia, severe brain injuries and amputations live the rest of their lives with little to no dignity.  The future of their children, wives, husbands or parents will be forever changed as they have to rededicate their lives to becoming full time caregivers in light of deep cuts to the benefits.

Whose money is saved by these cuts?

Not drivers. Even if (and that’s a big ‘if’) the cuts lead to slightly lower premiums, seriously injured drivers and their passengers will find themselves unable to get the help they need to recover and return to work and earn an income. They will have to use their own money – if they have any – to pay for rehab services over and above what their insurance covers to try to get their lives back as best as possible.

Not taxpayers. We will all pay the price of the increased burden on health and social services.

Insurers’ will benefit. Their profits from auto insurance will increase in proportion to the savings made at the expense of those they are meant to be insuring. 

Ontario drivers overcharged $3 billion on insurance: Study

InsuranceBusiness.ca, by IBO 

Drivers in Ontario overpaid on their auto insurance by about $3 billion over the past decade – even as accident benefits have been cut.

That’s the crux of a new study conducted by two York University professors for the Ontario Trial Lawyers Association, and reported on in the Toronto Star. According to professors Fred Lazar and Eli Prisman, the average Ontario family should have paid $100 to $120 less for auto insurance in 2013, adding up to a total of $840 million in overcharges that year.

Additionally, individual auto insurance companies have earned significantly more than the 11 per cent return on equity allowed by the Ontario government, despite cuts to accident benefits.

“Families in the province are paying more and getting less,” Steve Rastin, president of the Ontario Trial Lawyers Association, said at a press conference last week.

The association, whose members specialize in personal injury law, is hoping the Ontario auditor general will investigate.

The insurance industry rejects the study’s claims, pointing out that the auto insurance industry as a whole reports very thin profit margins: -1.1$ in 2001 through 2011, 4.2% in 2012 and 2.4% in 2013.

Meanwhile, claims costs continue to rise while the government regulates premiums, said Insurance Bureau of Canada Vice President Ralph Palumbo. The IBC also asserts that lawyers themselves are adding to the problem by billing excess contingency fees that cost consumers an estimated $500 million in 2013.

 “Real reforms to the auto insurance product have been ongoing and continue and are reducing the cost of auto insurance in Ontario,” Palumbo said. “If the lobbyists and well-heeled lawyers want to know who is driving up insurance costs, they need to take a look in the mirror.”

Palumbo added that the IBC is continuing to work toward less expensive insurance premiums for Ontario drivers.

“This, of course, is not easy, but it can be done,” he said. “The insurance industry is working successfully with the Ontario government so that the auto insurance product works for consumers.”

Inspection powers under Ontario Bill 15 take effect April 1

DAILY NEWS, Canadian Underwriter Mar 19, 2015

Sections of an Ontario law aimed at reducing auto insurance claims costs, which would give inspectors power to enter premises without a search warrant and remove records for review, take effect in less than two weeks.

Bill 15, the Fighting Fraud and Reducing Automobile Insurance Rates Act, is an omnibus bill that was passed into law Nov. 20. Not all provisions have taken effect, but a section of Bill 15 – that changes to the Consumer Protection Act to provide for the appointment of inspectors and inspection powers – comes into force April 1, the province announced March 14 in the Ontario Gazette.

Bill 15 will “provide new enforcement tools, such as allowing inspectors to issue orders where violations are found,” said Laura Albanese (pictured below), parliamentary assistant to Ontario Finance Minister Charles Sousa, when Bill 15 was tabled for second reading last October. She was commenting on the parts of Bill 15 that impose additional requirements on towing and storage providers.

Bill 15 will change the Consumer Protection Act to require tow and storage providers to publish their rates, accept credit card payments and provide itemized invoices before receiving payment. It “would require tow and storage providers to get authorization from the consumer, or someone acting on behalf of the consumer, before charging for towing and storage services,” Albanese said during the debates last fall.

It also reduces, from 60, the number of days that a vehicle can be stored after an accident without giving notice to the owner and other persons.

“Currently, when a vehicle has been damaged in an accident, it may be brought to a storage facility after the collision by someone other than the owner, or without the owner's authority,” said Albanese, Liberal MPP for York South-Weston, of Bill 15 last October. “Those who store vehicles after accidents can begin charging for storage services right away, even though the owner of the vehicle may be unaware of where their car is located and that it is accumulating charges every day. Storers can hold a vehicle and accumulate storage charges for up to 60 days without giving any notice and then still claim a lien for the storage costs.”

One change to the Consumer Protection Act – that takes effect April 1 as a result of Bill 15 – stipulates that a provincial inspector “may, without a warrant, enter and inspect any place in order to perform an inspection to ensure this Act is being complied with.”

An inspector may also “require the production of a record or other thing that the inspector thinks may be relevant to the inspection” and “remove for review and copying a record or other thing that the inspector thinks may be relevant to the inspection.”

Bill 15 includes a number of measures affecting tow truck operators.

The Highway Traffic Act will be changed such that tow truck operators will require a Commercial Vehicle Operator's Registration (CVOR) certificate. The CVOR “is the best tool available, in our opinion, to deal with commercial vehicles on public roadways,” said Brian Patterson, president and chief executive officer of the Ontario Safety League, during a hearing last November before the Standing Committee on General Government. But other witnesses during the same hearing suggested there could be “unintentional consequences” if the hours of service requirement under CVOR applies to tow trucks.

“Tow operators do a lot of short tows, with a lot of time in between,” said Aris Marinos, a director of North American Auto Accident Pictures Towing Division, an association of independent tow truck operators, during the committee hearing. “There are no scheduled calls, so it's all emergency towing, which will not leave enough time off consistently or consecutively to satisfy the requirements of the program.”

Bill 15 includes a number of other measures intended to help reduce auto insurers' costs. For example, it reduces the prejudgment interest rate for non-pecuniary loss for auto accident victims. As of October, the prejudgment interest rate on damages for non-pecuniary loss in a personal injury action was 5% per year, while the rate “for most other damages is based on Bank of Canada interest rates and calculated quarterly,” Albanese said at the time.

“The 5%-per-year prejudgment interest rate for damages for non-pecuniary loss in a personal injury action increases the cost of bodily injury claims in the auto insurance system, which drives up costs for all consumers,” Albanese reported.

Bill 15 will also move the auto insurance claim dispute resolution system from the Financial Services Commission of Ontario (FSCO to the Ministry of the Attorney General's licence appeal tribunal. The Liberals said last year that move “would help cut down on consumer frustration as well as curb financial and administrative stress on the system, which can increase costs and cause rates to go up.”

So under Bill 15, a new section of the Insurance Act will allow insured persons and insurers to apply to the Licence Appeal Tribunal in order to resolve disputes “in respect of an insured person's entitlement to statutory accident benefits or in respect of the amount of statutory accident benefits to which an insured person is entitled.”

The Insurance Act will also prohibit parties from bringing such proceedings into court, “other than an appeal from a decision of the Licence Appeal Tribunal or an application for judicial review.”

Bill 15 will also give FSCO the authority to “revoke or immediately suspend the licences of agents and adjusters who act improperly and put the public at risk,” Albanese said last year. “Bill 15 would also align the process for these disciplinary hearings with modern principles of procedural fairness, including replacing the 90-year-old advisory board system with the existing Financial Services Tribunal.

Writing a book can lead to repercussions: Roseman

Business / Personal Finance

Jokelee Vanderkop fought two insurance companies to get benefits after a car accident. Now she’s fighting to keep her benefits after writing a book.

 By: Ellen Roseman On Your Side, Tue Feb 10 2015

Jokelee Vanderkop wrote a book about how to fight your insurance company to get benefits. Now she’s preparing for another fight about her benefits.

In 2008, she won a lawsuit against the Personal Insurance Co. after a car accident left her unable to continue working as a high school teacher. When the company appealed in 2009, she won again.

She was 44 when injured in 1997. Now 62, she lives on income replacement benefits paid by her insurer.

Hoping to share her experiences of a court battle that lasted more than a decade, she put out a self-published book, So You Think You’re Covered? The Insurance Industry Ripoff, in 2013.

Most of the 200 copies were given away to friends or dumped, she says. When told the writing was weak, she published a revised edition last fall and sold 84 copies (at $25 apiece).

As part of her publicity campaign, she was a guest on an hour-long CBC radio phone-in program on Jan. 21, Ontario Today. It didn’t take long for her insurance company to follow up.

“I received a letter, dated Jan. 31, saying I now had earnings that could be deducted from my benefits entitlement,” she says. “They said they could not consider any further payments until I submitted my earnings statements and my tax returns for the last five years.

“The insurance company has a right to request information, but normally they tell you it’s required in order to continue benefits. In my case, they cut me off first. This is pure intimidation.”

Desjardins General Insurance Co., which owns The Personal, said there was a misunderstanding about her benefits being cut off.

“When we learned that Ms. Vanderkop published and is promoting a book, we sent her a standard form asking for copies of her tax returns,” explained spokesperson Joe Daly.

“Under the legislation, a portion of any income she earns from the book, or any other source, could be deducted from the weekly income replacement benefits we send her. We naturally assume that she wrote the book to earn income.

“Please note that we have not cut off her benefits and have no intention of doing so. If her tax returns indicate that she has little or no income from the book or other sources, then her weekly entitlement payments will not be affected.

“We didn’t send the note to intimidate Ms. Vanderkop. We were just curious if she was now working as a writer, which is a difficult and demanding job, and earning income.

“In retrospect, the claims adviser who decided to send the form obviously didn’t understand the realities of publishing in Canada. It’s tough to make any money writing a book.”

Rhona Desroches is chair of a non-profit advocacy group called FAIR, the Association of Victims for Accident Insurance Reform. She was a guest on the CBC radio show with Vanderkop.

“We heard from six to eight callers, who all had benefit claims that were about seven years old,” she says. “The people were injured and not in the best shape. I found it very moving.”

Desroches has heard from many frustrated insurance customers. She finds Vanderkop’s story a bit more complicated than most because there were two insurers battling it out at her expense.

She was insured by Personal under a motor vehicle policy and by Manulife under her employer’s group policy. When Manulife denied her application for long-term disability benefits in 1997, she ended up settling for a $57,500 lump sum during a private mediation in 2002.

After the mediation, Personal refused to pay income replacement benefits to Vanderkop, even though she met the test for entitlement, because of the settlement she made with Manulife. Personal argued that it could deduct any long-term disability benefits that might have been payable had Vanderkop been successful in her litigation.

The Ontario Court of Appeal said income replacement benefits could be reduced by long-term disability benefits resulting from an accident. But Personal could not set off hypothetical benefits applied for, but refused.

The long legal fight has led to other health problems for Vanderkop. But she’s keen to give tips to accident victims, such as not keeping a journal during a hearing (since it may be confiscated and used as evidence).

Desroches draws a lesson from the author’s tussle with her insurer about potential book earnings.

“I think it is outrageous that a person’s benefits are always at risk,” she says. “Settling a case with an insurer is no guarantee that the negative experience of making a claim with auto insurance benefits is really over.”

Local voice against wrongful benefit denials still speaking out

Thursday, March, 12, 2015

BY SHANNON DUFF

EXPRESS MANAGING EDITOR (SouthwesternOntario.ca)

Editor’s note: The following is the second installment of a story featuring local insurance advocate Jokelee Vanderkop and her efforts to help legitimate claimants ensure they receive their rightful benefits.

Palmerston – After a life-altering motor vehicle collision and more than a decade of battling to receive the insurance benefits she paid for, Palmerston resident Jokelee Vanderkop said she refocused her anger into an energetic effort to expose “what goes on for the majority of motor vehicle accident claimants.”

Those efforts resulted in not only her book — So You Think You’re Covered! The Insurance Industry Rip-off — but also the opportunity to speak on CBC’s Ontario Today radio show in January.

“The host said she had never seen the [call-in] board light up so completely before a show had even started,” Vanderkop said. “The accident victims who spoke of their negative experiences with their insurers were very moving. One woman said she had spent six months in intensive care after an accident and was denied benefits. Another said the insurer’s lawyer told her that he was paid over $500,000 per year to deny her.”

Ten days after the show, Vanderkop received an explanation of benefits from her insurer, stating that since she now had earnings, the company could not consider further payments until it received copies of her earning statements.

Vanderkop said the letter left her shaking her head.

“What earnings?” she asked. “No mention was made of how [I] was supposedly making these earnings.”

In a February interview with finance and consumer journalist Ellen Roseman, Vanderkop stated the insurance company does have a right to request information, but “normally they tell you it’s required in order to continue benefits. In my case, they cut me off first.”

Joe Daly of Desjardins General Insurance Co. said the situation was a misunderstanding and indicated questions arose once the company learned of Vanderkop’s book.

“When we learned that Ms. Vanderkop published and is promoting a book, we sent her a standard form asking for copies of her tax returns,” he explained to Roseman. “Under the legislation, a portion of any income she earns from the book, or any other source, could be deducted from the weekly income replacement benefits we send her. We naturally assume she wrote the book to earn income.”

“If her tax returns indicate she has little or no income from the book or other sources, then her weekly entitlement payments will not be affected.”

Daly continued, “In retrospect, the claims advisor who decided to send the form obviously didn’t understand the realities of publishing in Canada. It’s tough to make any money writing a book.”

Indeed, the book has been more of an expense than anything, said Vanderkop.

Rhona DesRoches, chairperson of FAIR Association of Victims for Accident Insurance Reform [FAIRAssociation.ca], a not-for-profit advocacy group for motor-vehicle accident victims and insurance reform, also appeared on the CBC radio show with Vanderkop.

Vanderkop’s and others’ experiences, said DesRoches, indicates that benefits aren’t a sure thing.

“I think it is outrageous that a person’s benefits are always at risk,” she said in an interview with Roseman. “Settling a case with an insurer is no guarantee that the negative experience of making a claim with auto insurance benefits is really over.”

Vanderkop and DesRoches have since kept in contact, joined in their efforts to help legitimate claimants receive their benefits.

FAIR treatment

FAIR is predominately made up of accident victims, their family members and supporters, DesRoches explained.

“We’re a voice for those victims who really can’t speak out for themselves. Accident victims tend not to speak very loudly,” DesRoches said in an interview with The Minto  Express.

“Jokelee is an unusual person in that she speaks up and speaks out. Predominately accident victims are very quiet about what’s happened to them,” she said.

FAIR members advocate for change and education. “We find a lot of accident victims don’t know what they’re entitled to or why this is happening to them. People are very isolated, and they’re not sure why,” said DesRoches.

The association was founded in 2011, and DesRoches, a member since 2012, said motor accident victims finally have a voice at the table.

“Prior to FAIR, there was always complications,” she said. “But, there really wasn’t anyone at the table to give the accident victims’ perspective on how difficult the system is, and why it isn’t working.”

“Auto insurance isn’t just unaffordable, it’s also problematic in the quality of service it delivers,” DesRoches continued. “We’ve made ourselves a voice. A lot of what we do is directed towards our legislators and various other stakeholders in the auto insurance field. We do consult and submit on various issues that come up.”

Vanderkop, whose book is available at www.deniedbenefitclaims.com and who is available for speaking engagements, says she is now concerned about the recent passing of Bill 15. The Fighting Fraud and Reducing Automobile Insurance Rates Act is being touted as a good thing, she said, but could only make things more difficult for accident victims making claims.

Editor’s note: Please see next week’s Minto Express for the next installment of this story.

Hamilton Spectator: Auto insurance must improve

Mileage No Longer a ‘Reasonable’ Expense?

Arbitrarily changing a practice of more than 20 years’ standing, insurers are no longer reimbursing service providers for mileage when they must travel to treat seriously injured clients. 

This change will have serious and significant consequences for providing treatment to persons with serious and catastrophic injuries who must receive services in their homes, community settings or workplaces in order to get better. This is the single most dramatically negative change impacting claimants that we’ve experienced since the 2010 cuts

The change makes clear to how little understanding FSCO and the Ministry of Finance have about the needs of seriously injured persons and the importance of community-based treatment. Insurers have claimed that mileage is merely ‘a cost of doing business’ – or overhead.

Really? In what world?

Mileage is an incurred cost directly related to providing treatment. Overhead expenses are not attributable to a specific client. Just as insurance companies pay mileage or provide gas cards or rented vehicles to staff so that they needn’t absorb the cost of doing their jobs, the same is true for rehab providers. When mileage is incurred it is because the client’s condition requires that our services be delivered in the home, community setting or workplace, in order for the rehabilitation goals to be achieved. 

This change hurts the injured as well as the service providers. Many providers may not be able to provide service under these conditions – particularly in rural and remote regions – and this will have a profound impact – creating significant ‘down river’ costs of injured persons unable to return to work or school or look after their children, more serious injuries becoming catastrophic due to lack of treatment, increased numbers of disputes and more costly tort settlements. 

We also question the fairness and optics of a stance that leads to lack of treatment and services for claimants while the system continues to pay significantly, without quibble or question, for mileage and incurred travel costs for investigators and insurer-ordered IE exams to support denial of treatment.

Writing a book can lead to repercussions: Roseman

Jokelee Vanderkop fought two insurance companies to get benefits after a car accident. Now she’s fighting to keep her benefits after writing a book.

By: Ellen Roseman On Your Side, Published on Tue Feb 10 2015

Jokelee Vanderkop wrote a book about how to fight your insurance company to get benefits. Now she’s preparing for another fight about her benefits.

In 2008, she won a lawsuit against the Personal Insurance Co. after a car accident left her unable to continue working as a high school teacher. When the company appealed in 2009, she won again.

She was 44 when injured in 1997. Now 62, she lives on income replacement benefits paid by her insurer.

Hoping to share her experiences of a court battle that lasted more than a decade, she put out a self-published book, So You Think You’re Covered? The Insurance Industry Ripoff, in 2013.

Most of the 200 copies were given away to friends or dumped, she says. When told the writing was weak, she published a revised edition last fall and sold 84 copies (at $25 apiece).

As part of her publicity campaign, she was a guest on an hour-long CBC radio phone-in program on Jan. 21, Ontario Today. It didn’t take long for her insurance company to follow up.

“I received a letter, dated Jan. 31, saying I now had earnings that could be deducted from my benefits entitlement,” she says. “They said they could not consider any further payments until I submitted my earnings statements and my tax returns for the last five years.

“The insurance company has a right to request information, but normally they tell you it’s required in order to continue benefits. In my case, they cut me off first. This is pure intimidation.”

Desjardins General Insurance Co., which owns The Personal, said there was a misunderstanding about her benefits being cut off.

“When we learned that Ms. Vanderkop published and is promoting a book, we sent her a standard form asking for copies of her tax returns,” explained spokesperson Joe Daly.

“Under the legislation, a portion of any income she earns from the book, or any other source, could be deducted from the weekly income replacement benefits we send her. We naturally assume that she wrote the book to earn income.

“Please note that we have not cut off her benefits and have no intention of doing so. If her tax returns indicate that she has little or no income from the book or other sources, then her weekly entitlement payments will not be affected.

“We didn’t send the note to intimidate Ms. Vanderkop. We were just curious if she was now working as a writer, which is a difficult and demanding job, and earning income.

“In retrospect, the claims adviser who decided to send the form obviously didn’t understand the realities of publishing in Canada. It’s tough to make any money writing a book.”

Rhona Desroches is chair of a non-profit advocacy group called FAIR, the Association of Victims for Accident Insurance Reform. She was a guest on the CBC radio show with Vanderkop.

“We heard from six to eight callers, who all had benefit claims that were about seven years old,” she says. “The people were injured and not in the best shape. I found it very moving.”

Desroches has heard from many frustrated insurance customers. She finds Vanderkop’s story a bit more complicated than most because there were two insurers battling it out at her expense.

She was insured by Personal under a motor vehicle policy and by Manulife under her employer’s group policy. When Manulife denied her application for long-term disability benefits in 1997, she ended up settling for a $57,500 lump sum during a private mediation in 2002.

After the mediation, Personal refused to pay income replacement benefits to Vanderkop, even though she met the test for entitlement, because of the settlement she made with Manulife. Personal argued that it could deduct any long-term disability benefits that might have been payable had Vanderkop been successful in her litigation.

The Ontario Court of Appeal said income replacement benefits could be reduced by long-term disability benefits resulting from an accident. But Personal could not set off hypothetical benefits applied for, but refused.

The long legal fight has led to other health problems for Vanderkop. But she’s keen to give tips to accident victims, such as not keeping a journal during a hearing (since it may be confiscated and used as evidence).

Desroches draws a lesson from the author’s tussle with her insurer about potential book earnings.

“I think it is outrageous that a person’s benefits are always at risk,” she says. “Settling a case with an insurer is no guarantee that the negative experience of making a claim with auto insurance benefits is really over.”

Ellen Roseman writes about personal finance and consumer issues. You can reach her at [email protected] or www.ellenroseman.com