For-profit welfare scheme draws concerns
“Where I get worried about it, is thinking around, really, what are the goals? What are the incentive structures put in place and who will be administering this?” asked the researcher and family physician with St. Michael’s Hospital’s City Health Associates. “We know there will be private companies bidding to help administer this system. That, to me, is extremely concerning.”
DOUG FORD OPENS WELFARE FOR BUSINESS
A recent article in the Catholic Register informs us that the Ford government will run ‘a three-year pilot program in for-profit welfare in Hamilton-Niagara, Peel and Muskoka-Kawartha.’ The paper goes on to say that, “These three regions will be the forerunners of a province-wide system the government has already mapped out. Eventually, Ontario will be carved into 15 regions. In each region, municipalities, non-profits and for-profit corporations will be invited to bid through a “Request for Proposals” process to manage the caseload of clients on Ontario Works (OW) and the Ontario Disability Support Program (ODSP) in each region.”
Ontario Adopting Process to Better Connect Job Seekers in Hamilton-Niagara With Good Jobs
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EDITORIAL: Auto insurance needs an overhaul
The consumer group FAIR (Fair Association of Victims for Accident Insurance Reform) say this means victims have to hire their own lawyers and medical experts to counter their insurer’s lawyers and medical experts to get benefits for which they’ve paid.
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New report shows Ontario auto insurance rates jumped by 20 per cent over three years
“When you add up all the profit that [the insurance companies] are making on home insurance, commercial insurance and auto insurance in the other provinces, it still does not equal what they’re making in profit just on auto insurance in Ontario,” he explained.
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Two Recent LAT Cases See Special Awards Against Insurers Who Unreasonably Withheld Payment to Applicants
When an applicant has to dispute an unreasonably denied benefit in front of the Licence Appeal Tribunal (LAT), the adjudicator is able to award a special award in addition to the amount in dispute in the form of a lump sum payment of up to 50% of the amount to which the person was entitled. This power comes from section 10 of Ontario Regulation 664, R.R.O. 1990. An unreasonable denial has been interpreted by the courts to mean one that is “excessive, imprudent, stubborn, inflexible, unyielding or immoderate.”[1]
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Most Canadian P&C professionals would prefer a single auto insurance model nation-wide: CU poll
Most property and casualty insurance professionals across the country would like to see a single business model for auto insurance across Canada – as long as it’s the one in their home province, it seems.
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Self-represented litigants struggle to be heard at the Supreme Court of Canada
Supreme Court statistics show there is only a 0.23 per cent chance a self-represented litigant will be granted leave to appeal to the country’s top court, which takes on cases it considers to be of public importance.
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Government looking into reports new Ontario licence plates are unreadable at night
“We have been made aware that some Ontarians are reporting concerns with readability to the naked-eye under certain light conditions,” the office of Minister of Government and Consumer Services Lisa Thompson said in an email Monday.
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Webinar Registration- Financial Assistance Programs
Special guests Melissa Vigar and Laura Bellon from the Brain Injury Society of Toronto will be joining Ken to discuss various financial assistance programs, along with their application processes and best practices for best results. If you would like your family’s situation addressed or have a particular question, we may be able to answer it at the webinar.
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S.R. v. Aviva Insurance Canada, 2019 CanLII 126104 (ON LAT), <http://canlii.ca/t/j4ggf
[6] Through the November Notices, the respondent scheduled the following IEs: an orthopaedic assessment, a functional abilities evaluation, and a job site evaluation. The Tribunal found, that although the November Notices included a valid medical reason for each examination, the respondent failed to provide the applicant with sufficient notice for the functional abilities evaluation and the jobsite evaluation because they did not fully comply with s. 44(5). Specifically, they lacked details regarding the professions of the individuals conducting the examinations.
9] I agree that the Tribunal erred. In short, the Orthopaedic Notice did not comply with s. 44(5)(c) of the Schedule. Finding that it did was a significant error. Thus, I grant this reconsideration request and, therefore, will not deal with the applicant’s second basis for the reconsideration request, that is the allegation of a lack of medical reasons in the Orthopaedic Notice.
[10] In accordance with s. 55(1)2 of the Schedule, an insured person shall not apply to the Tribunal if the insurer has provided the insured person notice “in accordance with this Regulation” that it requires an examination under s. 44 but has not complied.
[14] Although this may be a technical oversight, not all individuals with a “Dr.” prefix before their names are medical doctors and/or qualified to conduct an orthopaedic assessment.
[15] While I agree with the Tribunal that one could reasonably ascertain by his title and designation the type of assessment being scheduled, I do not agree that one could reasonably ascertain the regulated health profession to which Dr. Yee belongs. However, even if the applicant could have reasonably ascertained the information, this is not the applicant’s obligation. Instead, that is information that, according to the Schedule, an insurer must provide the applicant.
[16] Without referencing another source, the applicant could not have known Dr. Yee’s regulated health profession. It is not up to the applicant to find out the information that the insurer was to provide. I agree with the applicant that it was entirely in the insurer’s hands to ensure that the notice was in accordance with the Schedule.[2] In this case, it was not, and the Tribunal’s focus on the applicant’s ability to reasonably ascertain the missing information was a significant error.
[17] The Tribunal should not assume that an applicant would be able to ascertain information that was missing. It is worth repeating that one of the main objectives of insurance law, including the Schedule, is consumer protection.[3] The information that the insurer was required to provide the applicant was to be provided in “straightforward and clear language, directed toward an unsophisticated person.”[4]
20] In accordance with s. 37 of the Schedule, the respondent was not entitled to discontinue paying the IRB on the basis that the applicant failed to attend the s. 44 IE given that the Orthopaedic Notice was non-compliant with the Schedule.
[21] The applicant indicated in his reconsideration submissions that the respondent never took issue with the applicant’s entitlement to IRBs and based its entire reason for not paying the IRBs on the s. 55(1)2 exclusion clause. The respondent did not refute this submission.
[22] Therefore, I order that the IRB is payable to the applicant for the period that it was withheld, specifically from December 3, 2015 to October 11, 2016.
[23] The applicant has requested a ruling on an award pursuant to s. 10 of Ontario Regulation 664 regarding the withheld IRB for the period of December 3, 2015 to October 11, 2016.
[24] In accordance with s.10 of Ontario Regulation 664, in addition to awarding benefits, the Tribunal may order an award if it finds that the insurer unreasonably withheld a benefit.
[25] Merely because an insurer failed to comply with the Schedule does not mean that the applicant is entitled to an award. An insurer may fail to comply with the Schedule without acting unreasonably. In this case, even though the insurer did not fully comply with the Schedule, I do not find that the errors in the Orthopaedic Notice reach the threshold of unreasonably withholding or delaying a benefit contemplated in s.10 of Ontario Regulation 664.
[26] Accordingly, I find that the applicant is not entitled to an award on the IRBs payable for the period of December 3, 2015 to October 11, 2016.