About The Book
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Fraud by Auto Insurers under the Media Radar
Every day, we hear news of serious accidents involving fatalities and those of accident victims who have non life-threatening injuries. Listeners or readers breathe a sigh of relief when there isn’t a fatality. However, unless someone has been in a serious auto accident with non-life threatening injuries, or knows someone who has, the public doesn’t realize that many of these accident victims have life-changing circumstances that include loss of careers, due to such injuries as traumatic brain injuries, severe soft tissue injuries, chronic pain, that are not visible but real, which alter their former active lifestyles to permanently dealing with health issues. Too often there is an inability to return to work, or if they can, to undertake work that enables them to make a viable living. Most accident victims become burdened with financial problems. To add insult to injury, they will find themselves in the fight of their lives with their auto insurer to receive the rehab, medical and income replacement benefits they’ve paid for in their policies. This is a fight that can’t be won without hiring a personal injury lawyer, which of itself can be fraught with problems. Even when an accident victim wins, that person will continue to deal with a severely altered lifestyle and have to make due financially with a fraction of what they used to earn.
Meanwhile, the media provides us with plenty of stories about insurance fraud, but little investigative time and resources are put into reporting and following up with what most seriously injured auto accident victims experience firsthand: fraud by auto insurance companies against legitimate claimants. Somehow, this fraud, which is rampant, flies under the media radar, yet thousands upon thousands of legitimate claimants are defrauded by their auto insurance companies on a regular basis.
The Insurance Board of Canada, the industry lobby group (IBC) spends millions of dollars on advertising campaigns to talk about insurance fraud, with figures cited that are as exaggerated as statements made by the current President of the U.S.A. Insurers spend inordinate amounts of money on for-hire medical assessors who, at insurer medical examinations, frequently downplay, ignore or change diagnoses provided by a claimant’s own team of medical practitioners. Deny, delay, defend is the industry mantra meaning that the seriously injured have to focus on fighting their insurer for benefits rather than focus on getting better, or at least be able to focus on reaching an optimal level of improvement.
Insurers know that seriously injured accident victims, all too often, are not in a position to endure the years of fighting to have their policies honoured. Most give up or settle for far less than what they are owed and deserve. The auditor general has acknowledged that nearly one out of two claimants are denied. On average, it takes an injured party 8 years to reach a settlement if they persevered. Meanwhile, they have been denied or had delayed appropriate treatment. OHIP doesn’t cover the type of treatment and rehab that most accident victims require. While in this insurance fight for owed benefits, accident victims have to live off their savings or credit lines or end up on the Ontario Disability Support Program (ODSP). The latter has a high threshold to be accepted, yet these same people are still denied by their auto insurers.
The book “So You Think You’re Covered! The Insurance Industry Rip-Off” describes this reality in detail. It provides definitive proof of what claimants undergo, how insurers treat them, and how the Ontario government, with IBC input, is complicit in insurance fraud through its 2016 legislative changes. The general public, claimants and yes, personal injury lawyers would be well-served to read it. In the case of the latter, most think they don’t need to because they know it all already. Not true. If they were really interested in their clients as opposed to the money to be made, they would look at what is much more than a claimant’s perspective . They don’t know it all, and don’t really understand what claimants endure.
Auto insurers’ blame game continues
Insurers want the public to think that “Contingency fees are one of the key drivers of claims costs and, as a result, increase insurance premiums that all Ontario drivers pay,” according to Irene Bianchi, executive vice president of claims, Aviva Canada. But this is not true. Contingency fees are what claimants often pay personal injury lawyers to defend wrongful denial of claims for accident benefits such as treatment, rehab, income replacement benefits and to fight for tort settlements.
Insurers pay multi millions of dollars annually to insurer-hired second opinion medical assessors working out of assessment centres whose primary clients are insurer-sent claimants. Injured parties are sent, not to help them get better, but primarily to discount, downplay or dismiss diagnoses by treating physicians so that insurers can deny claims. A lot of money is spent to deny legitimate claims, forcing accident victims to hire lawyers to have their policy honoured. As few have the money to be able to afford a lawyer, thankfully contingency fee agreements provide a means for them to access legal representation, without which they would be completely dismissed by their insurer. There are problems to be sure with CFAs but that is nothing compared to the problem of insurer-hired second opinion medical experts who retain their lucrative status as insurer assessors thanks to the number of claimants they deny, point to as fraudsters or as malingerers. For auto insurers, it is not about the claimant, but about dollars and cents to the detriment of the health and recovery of accident victims. Insurers know they can wear down seriously injured claimants by sending them to dozens of insurer examinations extended over years. Struggling to deal with their injuries, most of these claimants don’t have the physical, emotional or financial means to continue to fight their insurer. Not being able to work at all or not enough hours to make a sustainable living, they can’t handle the additional pressure of a claims process geared to deny them. Many give up, a few settle for far less than is owed, and the odd person fights on to the bitter end.
In addition to the expense of paying their assessors, insurers have their own stable of costly lawyers to defeat a claimant if that person continues the fight. Add to that the multi-million dollar salaries the insurance industry’s senior management pays itself, it is the industry and only the industry itself that is responsible for high claim costs. “So You Think You’re Covered! The Insurance Industry Rip-Off” outlines exactly what is happening in this industry and it is not a pretty picture.
Insurers blame contingency fees for high insurance costs – but ..
Why focus just on contingency fees, thus laying, in fact, the brunt of the blame on personal injury lawyers for high insurance costs. Insurers need to also accept responsibility for high costs. Claimants don’t want to have to hire a lawyer to get the accident benefits they’re owed but no injured party gets through the auto insurance dispute resolution system successfully unless they hire a lawyer.
Insurers retain high-priced defence lawyers to too often back up unscrupulous, dishonest, or downplayed IME assessments of injuries by equally high paid insurer-hired medical experts. It costs a lot to keep these IME rogue experts in the stable to benefit the insurer outcome rather than claimants. What about an automatic $36,700 deductible for insurers on tort settlements. That’s no small change and it benefits the insurer.
The March and October 2015 Schulich Reports by Professors Fred Lazar and Eli Prisman show that the auto insurance industry has been very profitable for a long time and that policyholders have been over-paying on average $100-$120 per year. The companies that weren’t profitable were so not profitable, due to bad management, that they should not have been allowed to stay in business. And now, accident benefits have been further reduced in June 2016 from already dramatic benefit cuts in 2010.
It’s time the auto insurance industry cleaned up its act, cleaned out its IME assessor stables and paid policyholders who are injured what they promised to pay in their policies. Insurers and the IBC need to stop pointing the finger elsewhere for high premium and insurance costs, and stop putting shareholders and the corporate bottom line, despite their government-approved 6% Return on Premium benchmark which works out to a 12% annual return on equity, ahead of injured accident victims.
Bad client – what about bad lawyers!
In the article “Why It’s Good Business to Fire a Client”posted January 24th in SLAW online legal magazine http://www.slaw.ca/2017/01/24/why-its-good-business-to-fire-a-client/comment-page-1/#comment-948459 outlines all that is wrong with “bad” clients for the lawyer and why they need to be fired. Let’s not forget the “bad” lawyers and why some clients have to go from one to another.
In response to my book, “So You Think You’re Covered! The Insurance Industry Rip-Off” at deniedbenefitclaims.com, I can provide a long list of claimants who could give testament to bad lawyers. I have my own examples. It’s not easy finding a good lawyer. There are enough lawyers out there who take on personal injury cases with no experience just because it contributes to their billing.
The first one I met told me to say I had such and such injuries when I didn’t. I didn’t stay long in that meeting. The first one I hired, who told me I had a good case and that he had the time, expertise and willingness to take it on was too busy making senior partner to care about it. The next one divulged in mediation to another lawyer that he had never done this type of case (pi). This man lost a case at mediation that had already been won and was to be transferred to my primary health carrier. Go figure! The debacle of his incompetence is outlined in the book. Later, a judge acknowledged his “ill-advice”. It was lawyer number #3 who was brilliant and had integrity. I wish there were more like him. He couldn’t believe the errors that had been made in my case by both my previous lawyers, including the new senior partner whom he knew to be a good lawyer.
Finding a pi lawyer who has solid litigation experience is not easy, or one who can stand up to insurer defence lawyers and their underhanded tactics. I’m sure we all have lots of stories that can cancel each other out but many bad clients become bad clients because the lawyers weren’t upfront in their contingency agreements, hidden clauses and premium success fees, not keeping their client informed, ill-preparing them for mediation and examination for discoveries, increasing their hourly rate without having to tell the client, charging at the rate of the lawyer for work that should be charged at a clerical rate, Diamond-like practices – and on and on. It would be interesting to keep statistics on the bad clients and the bad lawyers and compare.
IBC commissions the wrong question
Financial Post January 18, 2017 “Law professor questions whether contingency fees benefit clients” by Drew Hasselback
Conclusion by Allan Hutchinson of York University is that cfs are a better deal for lawyers than their clients. Study financed by the IBC.
The question that the Insurance Bureau of Canada (IBC), the insurance industry lobby group, has put to Professor Hutchinson of York University about whether contingency fee arrangements are a better deal for lawyers, particularly personal injury (pi) lawyers, than their clients is the wrong question. The right question is “Why do auto accident victims, whose lives have been irreparably changed for the worse, have to fight an insurance battle which necessitates the need for a lawyer?”
Legal billing has always been a sore point for everyone involved. There are problems to be sure with some contingency fee agreements as there can be with hourly billing. The problem is not so much with the payment modality as it is with the integrity or lack of integrity of some lawyers. It is ‘buyers beware’. Clients need to read all agreements carefully. That said, whether we speak of contingency fees or an hourly rate, the reality is that lawyers need to be paid. Contingency fees might be somewhat higher when it comes to settlement of costs than an hourly rate, but few motor vehicle accident (MVA) victims can afford to pay a lawyer outright. Without contingency fees, many accident victims would have to forego legal representation and without a pi lawyer, many would have to give up their fight for benefits. Unfortunately, the fight will rarely be won without the assistance of a pi lawyer. With contingency agreements, legal costs accumulate over the course of years for the firm while claimants fight their auto insurer for accident benefits. Yes years! Auto insurers put up all kinds of roadblocks through delays, denials, insurer-hired medical experts and defence lawyers to renege on paying what is owed. The auditor general has acknowledged that nearly one out of two claimants is denied.
What is at the bottom of the IBC’s question in this study is that the IBC would like to eliminate personal injury lawyers entirely. The insurance industry would rather point a finger at others – personal injury lawyers and so-called fraudulent claimants for a long-drawn out insurance process, not the insurance industry’s own bad practices in paying as few claimants as possible. But, pi lawyers will never be irrelevant as long as insurers use their own army of medical and legal experts to wrongfully deny legitimate claimants.
To reach this goal, the IBC has used its considerable influence, financial and otherwise, with the Ontario government to bring in legislation, (introduced April 1, 2016) that eliminates the right of MVA victims to take their auto insurer to court for denied benefits. The purpose was not only to streamline disputes or lower costs by making the new Licence Appeal Tribunal (LAT) the sole arbiter of auto insurance disputes. The latent purpose, I would argue, was to have more control over a system that regularly obliges claimants to fight for their benefits. Eliminating the court option and the relevance of personal injury lawyers ensures that claimants are even less able to fight back.
However, insurance law and the Statutoy Accident Benefits Schedule (SABS) are far too complex for lay persons to have a chance of winning against an insurer and their lawyers without their own legal representation. Whether claimants pay a little more via a contingency fee agreement as opposed to an hourly rate is a moot point when they’re fighting an insurance company. Few claimants have the money for the latter, and they need representation.
If the IBC were really concerned about plaintiff or pi lawyer clients, that is, accident victims, they’d clean up the for hire-insurer medical experts and expert witnesses who are known to be biased, take a close look at the business of insurance assessment centres and oblige individual insurers to honour their policy commitments to those in need. Or at the very least, pay for a study that looks at why so many claimants need lawyers in the first place. Maybe the IBC should carry the contingency costs for claimants. I’m sure there would be fewer denials.
Breakthrough article in the National Post
This National Post article outlines what FAIR and my book have been saying for a long time.
Hired gun in a lab coat: How medical experts help car insurers fight accident claims
National Post columnist Tom Blackwell has written an excellent article about how insurer-hired medical experts are too often biased in favour of the insurer that is paying them rather than the claimant they are examining. He spoke at length with Rhona Desroches of FAIR, the not-for profit advocacy group for accident victims and with me after receiving a copy of my book, “So You Think You’re Covered! The Insurance Industry Rip-Off”.
Claimants need to know that they are not alone and learn how to fight back. Insurers want to isolate them, and if they endure the years it takes to fight their insurer to get a settlement, they are saddled with a “gag” order not to divulge what they’ve been put through.
Any one of us could be in a serious car crash and end up having to fight years to get auto insurance accident benefits. The wealthy think an insurer will pay out. However, in this number’s game, social status is meaningless. It doesn’t matter if you are one of the economically privileged. Nearly one out of two claimants is denied, no matter one’s social or economic status.
The Legal Conundrum for Seriously Injured Auto Accident Victims
Recently the media has been full of news about a particular insurance assessor who was caught altering medical reports so that the victim would not qualify for deserved catastrophic (CAT) accident benefits: http://news.nationalpost.com/news/ontario-doctor-misrepresented-views-on-catastrophic-injuries-to-benefit-insurer-judge-rules
This incident is not a rarity in the attempt by insurers to pay claimants as little as possible or nothing at all. Unfortunately, this is not the only problem accident victims face when they undertake the claims process for accident benefits. Another obstacle for motor vehicle accident (MVA) victims is good legal representation, a must if seriously injured claimants are ever to be paid by their auto insurer.
Unless a client is injured enough to be potentially eligible for an insurance CAT designation, too many lawyers aren’t interested in taking on lesser degrees of seriously injured claimants, particularly the larger firms, because the financial rewards are not nearly as high for them. However, it is the larger firms that have more litigation experience and thus more experience in dealing with the well-paid legal sharks insurers hire. Non catastrophic claimants often struggle to find legal representation and could end up with lawyers, who may be well-intentioned, but lack experience and the financial resources to carry the client for the years it takes to settle auto insurer accident cases. The larger firms, which can afford to carry these costs more readily, obviously want to ensure a big financial return at the end. This means primarily taking on clients who are seriously injured enough to qualify for the CAT designation, along with a possible malpractice or bad faith suit to further increase the payout.
However, claimants cannot go through the process of accessing benefits from their insurer without a lawyer, though the government thinks otherwise with its elimination of the right to take an insurer to court as of April 1, 2016. This is a policy that is only beneficial to insurers despite insurer and government claims that it is meant to streamline the process and move away from costly litigation. But what is not said is that claimants need to undertake litigation because insurers do not willing pay legitimate claimants what is owed.
The difficulty for non-catastrophically injured claimants is not only to find a lawyer who will take on their case, but to find one who is competent, a successful litigator and who can afford to take them on as clients. This is where claimants are often left in a black hole, without proper legal representation.
Claimants who unknowingly hire an inexperienced or worse, incompetent lawyer, who is unprepared or not forceful enough to stand up to defence lawyer tactics even at mediations, let alone in court, find themselves in an even worse bind: that of needing to fire their lawyer or being possibly dropped by the lawyer if they speak out and ask questions. In Ontario’s insurance system, even a bad lawyer is better than no lawyer. However, claimants are still saddled with disbursement costs despite any contingency fee – money that most claimants don’t have.
Complicating the financial scenario, claimants are left to find a more competent lawyer, but if the client only has a standard policy, which many policyholders unfortunately have, their rehab benefits may be partially used up if the insurer has paid up on any rehab, and the tort potential may only be a few thousand dollars. Thus, there is little incentive for another lawyer to take on the case. If another legal firm takes on the case, they have to make arrangements to pay off the first lawyer when the case is settled, with possibly a certain sum paid upfront, then the new firm’s own disbursements and contingency fees, plus the loss of a $37,000 deductible that goes back to the insurer for any tort settlement. The overall accident benefits and tort settlements are often not high enough to cover expenses all these expenses and lastly, still include a payout to the client.
Many cases end up financially nonviable with the claimant unable to find legal representation, thus effectively leaving them in insurance limbo where nothing can proceed. The last step, and one the insurer awaits, is to have claimants drop out of the process and salvage what is left of their life, with the final solution: applying for the Ontario Disability Support Program (ODSP). It pays a little over $1000 per month for a single person and about $1,500 per month for a single person with a child. The insurer is off the hook, knowing full well that the claimant doesn’t have the resources to continue the fight and that likely, no other lawyer will take them on to get justice, let alone any money. And all this because a person was seriously injured, but not seriously enough in an auto accident.
Consequently, the way insurers, their insurance medical evaluators and their lawyers operate put the seriously injured but non catastrophic in the worst possible position. CAT clients are readily taken on by large legal firms because there is money to be made. Minor injuries, because the maximum rehab costs are only $3,500, are more likely to be paid by the insurer, and don’t require legal representation, although a fight is still probable. The rest are in for the fight of their lives.
Many seriously injured but not seriously enough injured claimants can’t return to work, and if they can do some work, they are frequently only able to undertake a few hours a week, not enough to earn sufficiently for a sustainable living. Their workplaces accommodate them only for so long and if they can’t work up to regular hours within a determined time frame, they are let go. The accident and their subsequent injuries cost them their quality of life and livelihood. Many become so desperate that they actually wish they were catastrophically injured so that their case would be taken on by a good law firm.
Insurers and the government do not acknowledge that this nightmare goes on because the two have a “good working relationship”. Insurance is big business and government tows the line. Insurers are political contributors and provide a lot of jobs. Plus, enough statements of fraud against insurers are released to have the public believe that most claimants are fraudulent. Yes, there is fraud but most of it is by organized crime groups. Yet it is the seriously injured who are being treated by their insurers as fraudsters as a means of lowering payouts. Insurers know full well that many crash victims can’t endure a long-drawn out fight, if they fight, and will often settle for a fraction of what they are owed. The battle is worth enough dollars to insurers to pay the big bucks to their own lawyers and insurance-hired medical assessors to turn it into a colossal fight against claimants.
Despite the legal conundrum, claimants can’t go through this process without a lawyer. Even if a claimant adjudicates through the government’s new dispute resolution system, the Licence Appeal Tribunal (LAT), which took over in April 2016 from the more experienced but inundated FSCO dispute resolution system (a new system designed to serve insurers, not claimants) a lawyer – a really good lawyer remains a necessity. The problem is finding a lawyer who has a social justice conscience, is competent, has the financial means and the desire to help non-catastrophic claimants get back as much of their lives as possible, and as such, is willing to forego the big financial rewards of primarily taking on the catastrophically injured.
So You Think You’re Covered! The Insurance Industry Rip-Off
What boxes not to check in IME forms
One of FAIR’s members (FAIRAssociation.ca – Accident victims for insurance reform) brought an issue forward regarding signing the forms you are presented with when attending an insurance medical examination (IME). There are 2-3 forms handed to you – one or two on arrival and one following the assessment.
Professional Consent Form – It is necessary that insurers and the assessor have your consent – after reading the form and approving the content as there are variations unique to each assessor.
Assessment Verification Form – Check the information for accuracy and when you sign you are verifying who you are and who the assessor is.
Assessment Quality Form – Here’s where the trouble can start and I have no idea if all forms are the same. The member attended a couple of IMEs with a family member a couple of weeks ago so there are recent forms in this person’s files. The person didn’t check any of the ‘boxes’ in this section “because who knows how that IME report will ultimately look when it is received” (pertaining to the high risk of reports being altered). Of course the assessors were not happy about not checking those boxes although the family member did sign them all and had them photocopied so things could not be changed without knowledge/consent afterward.
You do not have to check these boxes – after all, if there is a problem with the report which you haven’t yet seen, you’ve already agreed, when checking the boxes that the assessor was “thorough and careful with obtaining your history and assessing your impairments”. FAIR points out that since their survey indicates that only 9% of victims felt that the IME reports they received was an accurate reflection of their injuries, both those scenarios can’t be true. Essentially you are being asked to agree in advance about the quality of the IME and should you decide later to complain to the College about the assessor or when your case goes to a hearing, that document can be used against you.
Chair, Rhona Desroches, of FAIR pointed out that she had made a complaint to the CPSO about an assessor many years ago and it was one of the first things the investigator said to me – well you signed that you thought the examination was adequate didn’t you?
Altered medical reports
Altered medical reports are no surprise to those who have been injured. The media is finally latching on because a judge ruled against Dr. Platnick but FAIR, an advocacy group for accident victims, and others, have tried to get their attention on many occasions, but to little avail. What the public and media need to understand is that this is just the tip of the iceberg.
Even when reports aren’t altered, far too many assessors downplay the seriousness of a claimant’s injuries. Minor injuries are settled quite quickly under the Minor Injury Guideline (MIG) because there is only $3,500 worth of treatment costs on the line for insurers but the injury really has to be very minor. However, far too many accident victims who are more seriously injured are up against insurer examiners who frequently refuse to acknowledge that they need more rehab than allowed by the MIG. To add insult to injury, many are treated condescendingly by examiners. I could show a list a mile long of comments that many claimants get by some pro-insurer assessors when they present at an IME. The most seriously injured, who should be deemed catastrophic, cost insurers the most, so many of them are also forced to fight for benefits in the CAT category. Even here, examiners may downplay their injuries so that they fall in the moderate to serious rather than qualify for the CAT category – thwarted again by insurer-hired doctors who want to stay in the good graces of the insurers who hire them. Almost one out of two claimants, acknowledged even by the auditor general,is denied outright.
Platnick’s lawyer argues that medical reports written for plaintiffs by their medical experts are often exaggerated. I presume he means claimants’ treating physicians. Well, treating physicians have nothing to gain. They are paid by OHIP. Insurance doctors have lots of $$$ to gain as do insurers by making sure their medical vendors do their job to suit the insurer.
Platnick’s first complaint is about his reputation and his loss of income because many insurers have now dropped him. He deserves what has happened to him in that regard. His behavior is not only unethical but it has far-reaching consequences for the accident victims involved. The unfortunate part is that he was dropped not because he altered medical reports but because he was caught. And this impacts the insurance industry.
Insurance industry uses Trump tactics to pump up fraud
Re Law Times article see http://bit.ly/2faogP5 – If juries have become cynical it is because the insurance industry spends inordinate amounts of money, and uses Trump tactics, to launch ad campaigns to tell the public about so-called rampant insurance fraud. The public has come to believe that nearly everyone is fraudulent without hearing the perspective of accident victims. Most injured parties have to take on their insurer via a legal battle to receive the income replacement and rehab benefits they require and are obliged to sign “privacy” or confidentiality agreements so they can’t divulge the settlement or how they were treated at mediation or in an examination for discovery. Pro-insurer-hired doctors, many of them orthopedic surgeons, who know little about chronic pain, tell the courts that it is subjective. It is not. Chronic pain is not only a reality but is debilitating, requiring accident victims to dramatically change their lifestyle, which frequently means no longer being able to carry out their former job. Doctors specialising in chronic pain, whose opinions insurers tend to avoid, know the health implications of chronic pain. Traumatic brain injury frequently accompanies chronic pain. Both are downplayed by insurers. And as insurers are so adept at playing the game, forcing accident victims to fight for years in hopes that they give up, they know the correlation of their ad campaigns to jury outlooks, and will of course, opt for a jury trial. These “other factors” have become “inherent flaws”, as it is a flaw that juries don’t even know that there is an almost $37,000 deductible, making their meager awards, a travesty of justice. When it comes to auto insurance and accident victims, our court system is being played by insurers. The sad thing is that this industry has been playing our government for years and now too the public.
Judge sees his recommendations cherry-picked re auto insurance
Justice Cunningham is himself now wary of his February 2014 recommendation that the province appoint a “public sector administrative tribunal” for SABS disputes and get rid of the court option for MVA victims. He now acknowledges that few of the LAT adjudicators actually have experience resolving AB disputes, saying “Clearly many of my recommendations were not adopted.” “There was a lot of cherry picking that went on here.” WHY IS HE SURPRISED? As an accident victim I certainly am not. And herein lies the problem. Even the experts have misjudged or don’t truly understand what accident victims face to receive auto insurance benefits. The injured have to hire a lawyer and fight years to get what they’ve paid for. The delays in treatment or inadequate treatment don’t enable them to return to optimal health. Not receiving income replacement benefits means many go broke while fighting their insurer and insurer medical examinations are far too often set up to discount what treating physicians have determined.
The sad thing is that between the government, their hired consultants, the IBC and even opposition critics, the latter who are supposed to understand the auto insurance file and stand up for claimants, beyond their focus on insurance premiums, none appear to truly understand because none are willing to sit down and listen to injured accident victims and hear about the horrendous experiences that about 50% undergo when they try to access their benefits. Few of the experts are standing up for claimants or willing to expose what really goes on behind the scenes in the close working relationship that the government has with the IBC, which Premier Wynne sees as such a positive, without any understanding of what people will face when injured in a MVA. It’s all about saving or making money.
Meanwhile insurers play the fraud card, with even W5 (CTV – owned by Bell) playing the same insurance fraud show twice within a few months about a chiropractor and a paralegal scamming the system but ignoring the fraud perpetrated against claimants. (Even Aviva’s president stated in the show that this type of fraud is rare). How about a balanced view?
Let’s hope Campisi Law prevails in their February challenge and that Justice Cunningham now lends support to claimants rather than to the government and the IBC.
“So You Think You’re Covered! The Insurance Industry Rip-Off”
Juries swayed by big $ spent on IBC fraud campaigns
It would seem that David Cheifetz, a now retired defence lawyer, can be as insulting to auto insurance claimants via his incredibly ignorant statements to the Chair of FAIRAssociation.ca (not-for-profit motor vehicle accident victim group seeking insurance reform) as so many of the rogue IME assessors are to claimants they assess, whom they deny in order to keep their lucrative insurer-paid jobs. No wonder so many seriously injured claimants don’t stand a chance of getting the benefits for which they’ve paid when you have these entitled insurer cronies earning their high salaries at the expense of policyholders, not to mention the substantial sums that insurers spend to tell the public that fraud is rampant but not telling the public that they deny almost one out of two claimants as a matter of course. Juries are made up of this public. So really, one out two claimants is fraudulent? What is fraudulent is how seriously injured claimants are treated by insurers. For these insurer-hired guns, it’s a job that pays well. As one B.C. defence lawyer who could no longer take beating down claimants in court for pennies on the dollar and quit said, “my well-paid hell but hell nonetheless job” where “The overarching rule was this: Insurance companies hate to pay out on the policies they’ve written” and many insurance lawyers help them achieve this goal.
For accident victims, it’s their life, dramatically altered, denigrated, disbelieved and denied by insurers who know that most will give up or settle for far less than what is owed. Enjoy your retirement Mr. Cheifetz.
Bill reeks of IBC influence
Hudak is now leaving politics and has never shown any interest or knowledge in the topic of auto accident victims or pi lawyers before – so why now that he is leaving? If he is pushing through the Protection for Motor Vehicle Accidents Bill to get the government to scrutinize personal injury lawyers, it is highly likely that the Insurance Bureau of Canada (IBC) is behind it. This bill is being advanced under the guise of protecting claimants, while the IBC has been happy to influence the government to cut benefits and eliminate the right of claimants to take their insurer to court for denied benefits, the latter in effect since April 1, 2016 and the former since June 1st. What Hudak and the IBC don’t make public is that nearly one out of two injured motor vehicle accident victims are denied their benefits by insurers. These people have to battle their insurer for years to get them and will no longer have court as an option. Taking your insurer to court was too often the only way to get your insurer to pay what they owed. Yes, not all pi lawyers are reputable but few insurers are reputable. If Hudak is going to talk about pi lawyers, there needs to be an equal airing of wrongful denials and the insurer-hired doctors who too often, and shamelessly deny benefits to injured accident victims because they want to keep their lucrative job as a medical assessor for the insurance industy. The government can’t have it both ways and Hudak should apprise himself of what is really going on beyond the pi lawyers. Let’s call it equal billing.
Author: “So You Think You’re Covered! The Insurance Industry Rip-Off”
Public Inquiry into Auto Insurance Medical Assessments which Favour Insurers
Please print, sign, share petition ow.ly/HyDs3011waJ Too often auto insurer-hired medical assessors deny legitimately injured claimants because they don’t want to lose favour with the insurance company that has hired them and which provides them with their well-paid positions – positions that pay far more than OHIP pays doctors. Justice Douglas Cunningham even made a pronouncement to that fact. Far too many claimants, nearly one out of two according to the auditor general, are being refused their accident benefits by these hired medical rogues who perform the insurance medical examinations. Injured accident victims have to fight for benefits which we all presume will be there when we need them. Instead, people find that an eight-year insurance battle is not uncommon.
By printing and filling in the sheet which is calling for the government to hold a public inquiry into these underhanded practices, you will be helping yourself and all of Ontario’s drivers. You can go well beyond the 9 name spaces – add names and put the total count on the top sheet.
Mail in as many sheets and Ontario signatures as possible to the address at the bottom of the form. The Legislative Assembly will be presented with forms from all over Ontario in September. So please, help push for this inquiry. Your benefits were already dramatically reduced June 1st and you lost the right to take your auto insurer to court for denied benefits on April 1st of this year.
If Ontario drivers mobilize and sign this petition asking for the Premier to conduct an independent inquiry into the for-hire medical assessors that the auto insurance industry (the WSIB uses the same assessors) employs, we have an opportunity to hold auto insurers and the Insurance Bureau of Canada (IBC) accountable and you will be protecting yourself from being wrongfully denied accident benefits when you need them.
Your name, town and postal code and a signature is all that is required. You don’t have to fill out the phone number and email address.
Author “So You Think You’re Covered! The Insurance Industry Rip-Off”
Getting media coverage exposing fraudulent insurer behavior
3 radio interviews on my book, “So You Think You’re Covered! The Insurance Industry Rip-Off” tomorrow, June 21. First one in Edmonton, CHED, Bruce Bowie at 8:55 am for 5 minutes; one in Ottawa CFRA with Carol Meeken at 2:15 or 2:30 for 7 minutes; and one in Hanover, Joseph Clark, Bluewater Radio 91.3 for 50 minutes.
Thursday the 23rd, a half hour interview in Vancouver with rockhousestyle.com
The book is available at http://www.deniedbenefitclaims.com or at Words Worth Books in Waterloo, The Bookshelf in Guelph, Roxanne’s book store in Fergus and at Millenia in Hanover.
Those insurer-hired medical expert witnesses with whom claimants don’t stand a chance
Shanoff’s article outlines how the judicial process with its biased insurer examiners work against legitimate claimants. Comments by Vanderkop at the end.
Social Justice: Expert witness cross-examination conundrum
There are various strategies available to counsel in attempting to impeach an expert’s credibility. Cross-examination on the basis of prior inconsistent statements is a well-known strategy. As seen in the recent Jian Ghomeshi acquittal, this technique is a powerful weapon in attacking the credibility of any witness. Another strategy is cross-examination to establish bias, attempting to establish the witness’ partisanship.
Libby Znaimer “Fight Back” Radio program at Zoomer radio with Jokelee Vanderkop
Fight Back –
MICHAEL BRATTMAN & JOKELEE VANDEKOP – June 1
June 1 and the hefty cuts to auto insurance benefits plus a redefinition of what is catastrophic, working against someone who is catastrophically injured, came into effect. We are told that our premiums are going down. The catch is that they are only going down for some (7%) max so far, but benefits are also down. Nice way to finance the premium reduction for those with perfect driving records. Libby Znaimer of Zoomerradio, with her program, “Fight Back”, had me on her show yesterday to give an opinion other than what an insurance broker would represent.
MICHAEL BRATTMAN & JOKELEE VANDEKOP – June 1 – Zoomer Radio AM740
There are new changes to the law when it comes to your auto insurance today, and it has a lot of…
I’ll also be interviewed on Tuesday, June 7th at 7:52-&.57 am. Interview with Mike Stubbs of News Talk 1290, London
Another interview on the same day at 10:30 am with the foremost English language station in Montreal. Interview with Tommy Schnurmacher, CJAD Radio Montreal http://www.cjad.com/Shows/TommySchnurmacherShow.aspx
Fraud Upon the Public Not Limited to the WSIB – Check it Out
The Workplace Safety and Insurance Board (WSIB) put pressure on an assessment centre in 2015 to get one of its doctors, Dr. Brenda Steinnagel to change her diagnosis of an injured client so the WSIB wouldn’t have to pay benefits. When she refused, her position was terminated. Steinnagel had the courage to file a lawsuit. She would be the first doctor to take a legal stand but this is certainly not the first time that an insurer-hired doctor has been pressured to downplay an injury or change a diagnosis to benefit the WSIB. Of course, the WSIB wants the lawsuit dismissed.
Injured workers have already called for a public enquiry by the Ontario Ombudsman because of wrongful denials so more negative publicity for this workplace insurer is the last thing it wants. However, the issue needs to be made public because wrongful denials are commonplace as are altered diagnoses.
A judge ruled this past week that the lawsuit may proceed. Steinnagel’s statement of claim alleges that “The defendants WSIB and WHCS [assessment centre] tried to force [her] to participate in a fraud upon the public.” What a great term because that is precisely what it is. Insurers have been getting away with it for years but it is becoming worse according to many treating physicians and rehab providers. If doctors want to keep their lucratively paid insurer-assessment positions, they’d better be siding more often than not with the powers that be.
But unfortunately, “fraud upon the public” isn’t limited to the WSIB. Every driver who is injured in an accident is also affected. Auto insurers perpetuate “fraud against the public” against many motor vehicle accident (MVA) victims who are sent to insurer hired assessment centres. To my knowledge, no doctors assessing MVA victims have had the courage to report let alone take legal action regarding what really goes on. If they can’t handle these corrupt practices, they quit and quietly slip away. Yet ask any number of doctors, and they’ll tell you the system is corrupt and that many of these assessment doctors are intellectually dishonest.
My book, “So You Think You’re Covered! The Insurance Industry Rip-Off” provides details around this issue.
So it’s a fact, the CBC proves that the IBC is but one to grease the palms of politicians
Mike Crawley, CBC Provincial Affairs reporter, April 19, 2016. “Ontario’s Biggest Political Donors Revealed.” Insurance Bureau of Canada (IBC) contributions to PC party and to the Liberals over $315,000. To this my comment is:
With political parties opening their door to these kinds of donations, of course the political wheels get greased. When it comes to the IBC, $315,310, split almost evenly between the Liberal and PC parties, they have in return got the party in power to save insurers a lot of money to the detriment of claimants.
Wynne’s government tells us we have the best auto insurance in the country (not true actually) but in the meantime, these IBC donations have the government and the IBC working closely together. This has resulted in the elimination of the right of claimants to take their insurers to court (as of April 1) so a wrongfully denied claimant no longer has legal recourse to fight back when they’ve been wrongfully denied. These donations have also bought cuts to accident benefits, providing less pay outs and higher profits for insurers, and has also introduced a higher injury threshold for what is deemed catastrophic. So brain injured, loss of limb(s), blinded, paraplegic and the list goes on isn’t enough to qualify for the CAT category?
This is not a free market economy but a monied economy where only the corporations, politicians and the financial elite benefit. Denied benefit claims are the norm. “So You Think You’re Covered! The Insurance Industry Rip-Off” – Claimants aren’t and they’re ripped off for sure.
Read Mike Crawley’s article: http://www.cbc.ca/news/canada/toronto/ontario-political-party-fundraising-largest-donors-1.3540674
What About the Claimant!
Gail J. Cohen writes in her April 4 article, “The Great Divide”published in Canadian Lawyer: “What has been going on in [Ontario] for years now has been a system that increasingly doesn’t work for individuals seeking accident benefits, and it is tipped in favour of insurance companies looking to reduce payouts whenever they can. According to this month’s personal injury legal report, there are numerous decisions showing medical experts are not acting as impartially as they should.”
Thank you, thank you. Finally a lawyer who is willing to begin to tell it as it is.The playing field between claimants and the system is so uneven it is laughable. The seriously injured are too often treated as scammers, with insurer medico-legal reports as a means to this end. The public is kept in the dark about what really goes on–the denial of benefits to people who need them. The injured are forced to spend years fighting for what they’re owed while their health deteriorates even further. They become the “walking wounded”. Every delay, denial, altered or bogus insurer medical report, bought expert witness or missed filing date by lawyers is proof that all these experts have lost sight of what is important–injured claimants. The system is more geared to ensure the lucrative livelihood of many in “the accident business” and to keep shareholders happy.
Consequently, many of these experts don’t want to even know what a legitimate claimant undergoes physically, emotionally and financially in their fight for benefits. Nor do they want claimants to have enough information to be truly informed of what they’re up against. “So You Think You’re Covered! The Insurance Industry Rip-Off” gives that perspective. Claimants are thrilled to have a voice but many experts don’t want the public to know what really goes on because the status quo works fine for them. Those in the “accident business” who delay, deny, miss crucial filing dates, forcing legitimate claimants to fight years for their benefits, have lost sight of what is important — injured claimants. Claimants who have paid premiums on a contract they now need to kick in, and had expected would be honoured, have become pawns in a system that too frequently only benefits the experts and nothing more.
Why is the public not aware of this, because claimants are so stressed by the process, insurer intimidation tactics and gag orders to keep them from speaking out, that it is neatly kept under wraps. Otherwise, policyholders would revolt if they really knew what to expect.
Would you not want your pi lawyer/treatment provider to have read and tell you about this book?
Why are so many lawyers and treatment providers who have heard about the book “So You Think You’re Covered! The Insurance Industry Rip-Off ignoring it? Comments like “good luck with the information” with no more interest than that are puzzling. Is it because “lawyers know best” and can’t concede that an accident victim has something worthwhile to say? The ones who truly have their clients or patients’ well-being at heart have come back to order more copies to hand out to their clients. This is not a push to sell books but a questioning about the lack of curiosity when enough already know about the book. Claimants, on the other hand, are extremely grateful to find this book, to know they are not alone and very thankful for the information “So You Think You’re Covered! The Insurance Industry Rip-Off provides. And they include the ones who have hired lawyers.
For the curious, more information on the book and how to acquire it can be found at http://www.deniedbenefitclaims.com
Corporate Greased Political Wheels a Slap in the Face to the Electorate
Politics, money and lobbying all add up to corporate interests superseding the interests of the electorate and specifically, Ontario drivers. Wynne’s self-proclaimed “working closely with the insurance industry” has guaranteed that the Insurance Bureau of Canada has its interests protected through further auto insurance benefit cuts on June 1 (presented as providing drivers choice – yes the choice of less, lesser and least benefits), as well as claimants losing the right to take their auto insurer to court as of April 1. Another win for the IBC. Also in 2015, 26 insurance companies applied for and received premium rate increases despite the promised 15% premium reduction. Wynne tells Ontario drivers that they have the best auto insurance in Canada. Her talking head points are very wrong. If the public were apprised of what really goes on, they could help un-grease the wheels of government by throwing this party out of office in the next elections. And to think I voted Liberal.
The only winners in the insurance industry are insurers, not policyholders
Mark Tweedle’s April 15th letter to the editor of Peterborough’s online newspaper, My Kawartha.com:”Car crash victim feels everyone wins except for him and his family” (link below) is more than just the frustration of one person mishandled by his or her insurer. His wife was fortunately not injured but of the 65,000 motor vehicle accident victims who are injured each year in Ontario alone, the auditor general acknowledges that nearly one out of two is denied.
As an accident victim myself, who lost her career as a secondary school teacher and had to fight a twelve-year insurance battle, which I won, the wrongful denial of seriously injured claimants is commonplace and needs to be exposed. The not-for profit advocacy group, FAIRAssociation.ca, which I was very happy to discover, is fighting a lonely battle for insurance reform and can tell you what insurers and the government of Ontario don’t want you to know: we’re not covered without a fight and most accident victims give up because the delay, denial, insurer-medical assessment system and the appeal process is meant to wear down claimants.
Giving a helping hand to insurers to help them reach the ever stretched goal of 15% premium reductions, the government has eliminated the right to take an insurer to court, effective April 1, followed by a redefinition of catastrophic injuries and a massive reduction in benefits under the banner of more choice for drivers.
Under the guise of insurance fraud, millions are spent by the Insurance Bureau of Canada (IBC) to highlight what is supposedly $1.56 billion fraud. The figure $1.3 billion was cited throughout the 90s and early 2000s. If fraud in this amount really exists, what corporation can afford not to reign it in without going bankrupt. Yes, there is fraud but most of it is by organized crime groups and coordinated individuals, not by the seriously injured. Our higher than ever premiums are a never-ending supply of funds and we get increasingly less for them.
The public would do well to inform themselves and the media would do well to take on this story and inform the public.
Read article: http://www.mykawartha.com/opinion-story/6500003-car-crash-victim-feels-everyone-wins-except-for-him-and-his-family/
To inform yourself check out: http://www.fairassociation.ca and http://www.deniedbenefitclaims.com
Insurers spend fortunes to pay out little
Michael Erdle says in his April 7th article, “The Problem with Experts” in SLAW, an online legal magazine, is that “litigation and arbitration are teeming with experts and they never agree”. That’s for sure. Because of the adversarial component, experts say what they are paid to say. Money, greed and A-type personalities don’t bode well for legitimate claimants.
By the time all the experts get called in one knows that this is not a minor injury that will resolve itself quickly. Insurers bring in the big guns to ensure that the claimant gets as little as possible. It is not the injuries that are so much in question but the category of benefits that needs to be paid. If we can get someone who is catastrophically injured placed in the moderate to serious category and someone who is moderately to seriously injured in the MIG category where $3,500 is the maximum for treatment and the insurer can still take out $2,000 worth of assessment costs against that amount, or better still, fight claimants long enough that they become so frustrated and worn down that they drop the claim or apply for ODSP instead (the government disability welfare program), insurers can save fortunes. However, this is money on the backs of those who deserve benefits. But what gets put out to the public is that these people just want to live off the system and not work. Well, for what is paid even in the best case scenario, is a fraction of what a claimant was earning or will earn over the years. Seeing most claimants have a standard policy, IRBS of $400 per week is no bonanza, even the upper end of $1,000 at 70% of someone’s salary is not rich compared to what that person was earning and could still earn if he or she had not been injured. Let’s all stay home and live off the system!
Could we look at what the experts are earning for which policyholders pay. And for the odd ones who do work the system – with fingers pointed incorrectly at anyone on welfare or ODSP, we are talking about that small percentage that exists in every single society, who often have a history of family dysfunction, addiction or mental health problems with the odd really lazy person. But to be that lazy is some sort of dysfunction in itself. Yet it is the odd malingerer that becomes the example cited by insurers for just about all claimants. Meanwhile, money is freely spent to deny, delay, defend. We have lost sight of the human element and let experts, like hedgefund managers determine the outcome of their own livelihoods to the detriment of their clients.
New edition of “Denied Benefits” book now available
The updated “So You Think You’re Covered! The Insurance Industry Rip-Off” is now available.
This 360-page edition has been completely revamped to include a researched exposé of 120 extra pages that expose how auto insurers, the WSIB and disability insurers deny medical, rehab and income replacement benefits to legitimate claimants. Nearly one out of two claimants is denied. It doesn’t matter if a person is seriously injured or not. The catastrophically injured also need to fight to receive the CAT benefits available in their policies – benefits that the Wynne government has cut in half commencing June 1.
This informational resource, with my own insurance fight as a backdrop, takes a close look at the insurer examination process, so often used as the tool to wrongfully deny benefits. The book still helps claimants through the process and provides a lot of advice from how to file a claim, prepare for mediations, examination for discoveries, how to find a good lawyer, how to cope and stand up for yourself against your insurer and much more.
Under the guise of fighting fraud, insurers are denying rightful benefits, often treating the seriously injured as fraudsters. There is fraud but what insurers fail to mention is that most of it is by organized crime or coordinated individuals, yet legitimate claimants take the hit.
Some who have read the book have commented that it is “highly interesting, insightful and gutsy”.
Become informed because every driver across the country is vulnerable to these underhanded denial practices. Insurers’ business practices are the same whether you are in Ontario or in other parts of the country. The difference in denial practices between public and private insurers is very little. Their goal is to pay out as little as possible or not at all. Insurers frequently spend more to deny legitimate claimants than to return them to optimal health.
To purchase: please go to http://www.deniedbenefitclaims.com.