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Meehan v Good, 2016 ONSC 2110 (CanLII)
[3] The MVA resulted in catastrophic injuries to the plaintiffs, particularly to Anne Meehan. The evidence in this proceeding supports their position that their former solicitor, Donald Good may have been negligent in his handling of the actions related to one or more of their claims stemming from the MVA. Unfortunately for the plaintiffs, they did not pursue their claims in negligence prior to the expiration of the two year limitation period. They now seek to recover as against Cardill for failing to advise them of their rights in negligence and the running of the limitation period.
Licence Appeal Tribunal (LAT) Rules of Practice and Procedure, Version 1 (April 1, 2016)
LAT adjudicates matters in a variety of diverse areas such as alcohol and gaming regulation, motor vehicle impoundments and driver’s licences, new home warranties, consumer protection, regulation of various occupations and businesses, and starting on April 1, 2016, in relation to automobile insurance Statutory Accident Benefits Schedule (SABS) disputes.
Information about LAT’s Automobile Accident Benefits Service (AABS) is available here: www.slasto.gov.on.ca/en/AABS
2.3 “AUTOMOBILE ACCIDENT BENEFITS SERVICE (AABS) CLAIM” “Automobile Accident Benefits Service (AABS) Claim” means an application to the Tribunal pursuant to s. 280(2) of the Insurance Act seeking resolution of a dispute involving statutory accident benefits.
2.23 “STATUTORY ACCIDENT BENEFITS SCHEDULE (SABS)” “SABS” means the Statutory Accident Benefits Schedule, Ontario Regulation 34/10 (Statutory Accident Benefits Schedule—Effective September 1, 2010), made under the Insurance Act, as revised from time to time, or a previous version of the SABS.
INFO: http://ow.ly/103AM9
Illogic of jury awards – Celebrities often get millions of dollars, car crash victims a pittance
How is it that two high-profile people can be awarded tens of millions of dollars for invasions of privacy while two private citizens are awarded a pittance for substantial physical injuries?…
My theory, and it is only a theory, is that the insurance lobby’s campaign publicizing insurance fraud has been so successful that many jurors have become poisoned in how they view run-of-the-mill motor vehicle accidents.
In other words, they too easily view plaintiffs as fakers.
Howell v Jatheeskumar, 2016 ONSC 1381 (CanLII)
[27] The failure of Plaintiffs’ counsel to proceed with this matter in a timely way is of great concern to the Court. If the test for granting the relief that the Plaintiff is seeking in this case was whether their counsel had moved promptly to take the appropriate and necessary steps, I would have no hesitation in dismissing these motions. Although these concerns are not relevant to my disposition of this motion, I have detailed them because it was clear to me that the lawyers involved did not believe that there was any issue with the way that they had handled the claim.
[28] The failures of Plaintiff’s counsel are not, however, the test to be applied. The tests to be applied relate to the prejudice that would be suffered by the Defendants. In addition, the Court must ensure that meritorious disputes are resolved on their merits, rather than on preliminary motions or preliminary issues. (See Mader v. Hunter (2004 CanLII 17834 (ON CA), 2004 Can LII 17834, 183 O.A.C. 294 (C.A.)). As a result, the fact that it is clear that it is the Plaintiff’s lawyers who have been dilatory in pursuing this claim is actually a factor that assists the Plaintiff, as he should not be held responsible for the conduct of his counsel. I now turn to the merits of the two motions.
Putting the pieces together – what Ont auto insurers don’t pay and how it is creating a crisis
Insurers are pocketing the health care costs of treating MVA victims – funds that should be repaid to taxpayers (not to mention OW and ODSP costs that the taxpayer is unknowingly picking up along with prescription costs) and this has created a health care $ deficit problem for Ontario taxpayers. A problem the Financial Services Commission has known about for years – the Auditor General told the FSCO it needed fixing in 2011 but nothing was done so the taxpayer has continually paid some of the medical costs of MVA victims. To ‘cure’ the problem it is now suggested by the Ontario Chamber of Commerce to privatize some services. Which means more people would have to increase their private insurer coverage if they are lucky enough to have this extra coverage. Who benefits? Not the taxpayer and not victims. Insurers who will now sell consumers the coverage they can no longer get from OHIP. Simultaneously auto insurance coverage (as of June 1, 2016) is decreased by over $1 million for the most catastrophically injured among us, thereby saving insurers about $6-800 million a year in payouts. Rehabilitation/medical rehab access is also cut by 5 years for all but children who are injured. https://truthaboutinsurance.ca/ . So just as MVA victims are about to be increasingly shunted onto the OHIP system, the proposal is to increase the privatization of that system.
From the 2011 Annual Report of the Office of the Auditor General of Ontario http://www.auditor.on.ca/en/content/annualreports/arreports/en11/301en11.pdf – see page 65 In 2005, our audit of the recovery of health costs resulting from accidents led us to conclude that the Ministries of Health and Finance did not have satisfactory policies and procedures in place to monitor the adequacy of the initial $80-million annual assessment. Subsequently, the government increased the annual assessment in September 2006 to about $142 million. () We compared Ontario’s assessment of healthsystem costs to those of other jurisdictions and found that Ontario’s is among the lowest in Canada when measured on a per-registered-vehicle basis, as illustrated in Figure 9. If Ontario’s assessment per registered vehicle were raised to the average of other provinces, the assessment would increase by 50%, or about $70 million, to $214 million. Assuming that the insurance industry was successful in passing this cost on to vehicle owners, this change would likely add almost $10 to the insurance premium for each vehicle in Ontario.
From the HSPRN report: Conclusion We employed a robust and rigorous approach to estimating total health system costs associated with treatment in the Ontario health care system for motor vehicle accidents. The estimated attributable cost per MVA individual in the first year following a motor vehicle accident in 2011/12 was $3,134 and averaged $2,958 over seven years from 2007-2012 (expressed in 2013 CAD currency terms). Costs in subsequent years were considerably lower from the second year onwards and declined slowly over time. The present value of all estimated MVA attributable costs was $5,495. With a total of 69,724 incidents in 2013/14 this amounts to a total present value (net actuarial liability) of $383,099,805 for MVAs that occurred in 2013/14. HSPRN Report, “Cost of Public Health Services for Ontario Residents Injured as a Result of a Motor Vehicle Accident”
From the ONTARIO SOCIAL ASSISTANCE STATISTICS: Ontario Disability Support Program 325,351 cases and 449,861 recipients. “Cases” refer to the individuals and families who receive social assistance benefits. “Recipients” are the total number of people – cases and dependent family members – who benefit as a result of receiving social assistance. Canada Social Report Social Assistance Summaries, Ontario, 2015
Updated Canada Social Assistance Summaries, Ontario 2020
From the Release/Analysis Chamber of Commerce Privatization Report Poorly Researched, Not in Public Interest: Health Coalition: The Ontario Chamber of Commerce report adheres to what has become the predictable formula of “create a crisis then privatize” used by the pro-privatization forces in Canada, virtually all of whom come from for-profit health care industry that wants more privatization to expand its own market share and profits. http://www.ontariohealthcoalition.ca/index.php/release-chamber-of-commerce-privatization-report-poorly-researched-not-in-public-interest-health-coalition/
Transformation Through Value and Innovation: Revitalizing Health Care in Ontario Report http://occ.ca/wp-content/uploads/HTI_March15.pdf
And who will profit? Insurers whose profits are already billions of dollars richer from overcharging consumers. Insurers will profit an additional $6-800 million/year from the reduction of coverage for catastrophic injuries in policies sold after June 1, 2016.
From the Ontario Trial Lawyers: Dr. Fred Lazar and Dr. Eli Prisman, from the York University Schulich School of Business, conclude in a recent study that for the period of 2001 to 2013, consumers in Ontario have likely overpaid for auto insurance between $3 billion and $4 billion. This money has not gone to accident victims or to lower premiums for consumers – instead this money has gone straight to the insurance companies’ coffers. In 2010, deep cuts were made to auto insurance benefits payable to those injured in auto collisions. Those cuts resulted in $2 billion in costs savings for the auto insurers. A large percentage of this windfall to the insurers was the reduction of medical and rehabilitation benefits payable to injured auto accident in victims. The standard coverage was reduced from $100,000 to $50,000. But equally troubling was the introduction of the Minor Injury Guideline that in practice has seen medical and rehabilitation benefits slashed for almost 80% of injured victims from $100,000 to $3,500.
From the Lazar Prisman Report: Auto insurance companies in Ontario have had a relatively free ride during the past 20 years. Since the ROEs permitted by FSCO since 2001 exceeded the ROEs we estimated for the auto insurance industry, it is conceivable that premiums have been too high and as a result, consumers in Ontario have paid too much for auto insurance. The possible over-payments range as high as $685 million, with total over-payments of approximately $3.1 billion between 2001 and 2013. http://www.fairassociation.ca/wp-content/uploads/2015/06/Lazar-Prisman-report-033115-FINAL.pdf
HSPRN Report, “Cost of Public Health Services for Ontario Residents Injured as a Result of a Motor Vehicle Accident”
Conclusion
We employed a robust and rigorous approach to estimating total health system costs associated with treatment in the Ontario health care system for motor vehicle accidents. The estimated attributable cost per MVA individual in the first year following a motor vehicle accident in 2011/12 was $3,134 and averaged $2,958 over seven years from 2007-2012 (expressed in 2013 CAD currency terms). Costs in subsequent years were considerably lower from the second year onwards and declined slowly over time. The present value of all estimated MVA attributable costs was $5,495. With a total of 69,724 incidents in 2013/14 this amounts to a total present value (net actuarial liability) of $383,099,805 for MVAs that occurred in 2013/14.
See: 2011 Annual Report of the Office of the Auditor General of Ontario http://www.auditor.on.ca/en/content/annualreports/arreports/en11/301en11.pdf – see page 65 In 2005, our audit of the recovery of health costs resulting from accidents led us to conclude that the Ministries of Health and Finance did not have satisfactory policies and procedures in place to monitor the adequacy of the initial $80-million annual assessment. Subsequently, the government increased the annual assessment in September 2006 to about $142 million.
Our letter to W5 – The Claims Game
March 17, 2016
Re: W5 The Claim Game show aired on March 12, 2016
Dear Mr. Malarek
Fraud is a big problem everywhere and especially when it comes to Ontario’s auto insurance industry. Your show touched on fraud perpetrated against insurers. Many of Ontario’s MVA victims face some type of fraud in the course of making a claim. Much of this fraud is ignored by our government and the public remains unaware that insurers are participating in deceptive claims handling practices.
According to the Auditor General about half of all MVA claims end up in our courts. That’s an unreasonably high number of denials unless one is willing to believe that one out of every two MVA victims is trying to scam the system. If the insurance industry’s estimate of fraud is 10-15% of claims – why are so many claims denied and victims treated with suspicion?
A comment was made by Lloyd Robertson that “claims are paid out quickly” in Ontario. This can’t be farther from the truth when 80% of the cases being heard at the Dispute Resolution System at the Financial Services Commission (FSCO) in the past month are 6 or more years post accident. That’s not timely and since many of these individuals are unable to fund their own treatments while in the claims process this means we have a system that harms victims through an empty promise of coverage.
How are all these claims denied and postponed? Through the use of biased or even unqualified medical examinations that, in many cases, even FSCO’s arbitrators call “inaccurate, failed, misleading, defective, incomplete, deficient, not correct and flawed”. These questionable medical examinations contribute to the cost of claims because insurers consistently spend more money on assessing injuries than they do actually treating victims and assisting recovery. It is not the claimants that contribute to the higher costs; it is the insurers who commission these bogus reports and then deny benefits that adds to the higher volume and costs through disputed claims that end up in our courts. There are plenty of cases on our website of useless medical evidence, forged assessor signatures and medical reports that have been tampered with in order to favour insurance companies.
Many victims end up on OW, ODSP and CPP disability and often must frequent food banks when insurers shirk their responsibilities. Many victims simply lose the timely window for recovery when needed treatment isn’t available through public supports.
In the past weeks we have heard from two elderly MVA victims (over 90 yrs old) who can’t get what they need for recovery. One elderly MVA victim who suffered catastrophic brain damage and whose insurer failed to approve necessary care has since died.
The bottom line is that Ontario has auto insurance on which legitimate claimants cannot count on. In 2015 there were over 80,000 auto insurance related cases in our courts, a clear signal that auto insurance is broken and victims are not being paid. Working closely with the Insurance Bureau of Canada, our government, like insurers, has focused only on fraud perpetrated against insurers and has failed to do anything to protect victims. Meanwhile, seriously injured victims are paying a very high personal price when they do not receive the accident benefits they deserve.
We hope that any follow-up show will include the story of those whose lives are forever changed because they’ve made a claim with an insurer who fails to live up to the promise of coverage.
Sincerely,
Rhona DesRoches, FAIR, Board Chair, fairautoinsurance@gmail.com
Job One for newly appointed auto insurance Czar David Marshall: Public Inquiry into auto insurance claims medical evidence http://bit.ly/1UCMUn2
Ontario Auto Insurance in Crisis: OTLA calls on Wynne Government to call a public inquiry into medical assessments of accident victims http://bit.ly/1RVIJ7P
WSIB and auto insurance: Birds of a feather http://www.torontosun.com/2016/02/13/wsib-and-auto-insurance-birds-of-a-feather
OFL, Injured Workers and Medical Professionals File Official Request for Ombuds Ontario Investigation into the WSIB http://ofl.ca/index.php/ombuds2016/
WSIB and auto insurance: Birds of a feather http://www.torontosun.com/2016/02/13/wsib-and-auto-insurance-birds-of-a-feather
Third party assessment reports need strict code http://www.lawyersweekly-digital.com/lawyersweekly/3531?folio=18&pg=19#pg19
http://www.fairassociation.ca/wp-content/uploads/2015/02/HCDB-standard-report-2014h1-final.pdf pgs 56 – 59
Local author doubles efforts to raise wrongful benefit denial awareness
PALMERSTON – Jokelee Vanderkop knows first-hand the turmoil and upheaval one can experience battling for legitimate insurance benefits. She’s made it her mission to share that experience and information with others, because “Having a legitimate claim, medically backed by one’s doctors, is no guarantee that an insurer will pay the benefits for which an individual has paid,” she said.
Is the WSIB ignoring medical advice?
The Workplace Safety and Insurance Board is being accused of cutting off benefits to injured workers against the advice of medical professionals. The Ontario Federation of Labour is asking the provincial Ombudsman to investigate. The new president of the WSIB, Tom Teahen, talks with the Rita Celli about the allegations.
Podcast found here: http://www.cbc.ca/ontariotoday/episodes/#