Sunday, June 14, 2015

Car insurers and lawyers brawl in public

Two sides point to each other as reason for high insurance premiums. The truth is, they’re both responsible

By , Toronto Sun
First posted: | Updated: First posted: | Updated:

auto insurance cuts
Hundreds protest the Ontario government’s proposed auto insurance cuts outside Queen's Park in Toronto on June 3, 2015. (Dave Abel/Toronto Sun)
A slugging match recently erupted between car insurance companies and Ontario personal injury lawyers.

The Insurance Bureau of Canada (IBC) opened by claiming the public needs regulatory oversight of contingency fees charged by personal injury lawyers.

The IBC feels a change is necessary to protect consumers and allow the government to evaluate the impact of lawyers’ fees on the auto insurance system.

The Ontario Trial Lawyers Association (OTLA) countered by releasing a study it commissioned concerning auto insurance premiums.

According to the study, prepared by two professors at York University’s Schulich School of Business, “consumers in Ontario may have overpaid for auto insurance by between $3 and $4 billion over the period 2001 to 2013.”
The OTLA urged an independent “thorough and truly transparent” review of auto insurance by Ontario’s Auditor General.

Reacting quickly, the IBC fired back through a press release, pointing the finger back at personal injury lawyers claiming, “lawyers’ fees are simply too high and have a significant impact on the cost of auto insurance.”

The IBC supported its conclusion by claiming some lawyers charge 40%, while others between 25% and 33% of any settlement or judgment.

I doubt many lawyers would dare charge a 40% contingency fee, although even a 25% to 33% fee may be too high in some cases.

But, the IBC forgot to mention clients don’t pay the entire contingency fee as a good part of the fee is paid by the insurance company.

To rub it in further, the IBC stated, “In 2013, lawyers received an estimated $500 million from injury claimants out of their insurance settlements for bodily injury claims. These are real dollars that never make it to the claimant. IBC will continue to fight for increased transparency so that consumers can actually see where their insurance dollars go.”

But I don’t think insurers want to open the transparency can of worms.
If they want to talk about “real dollars” that don’t make it to claimants, check out the vast sums paid by insurers for their so-called independent medical examinations (IMEs), used to belittle or deny claims.

According to the most recent Ontario Health Claims Database, insurance companies paid approximately $372 million for IMEs for accidents taking place in the last four years.

In some years, insurance companies forced almost half of all claimants to attend IMEs and in each year the average amount paid per assessed claimant for these exams exceeded the average amount paid per claimant for all medical and rehabilitation expenses.

Sending claimants for multiple and expensive assessments to pro-insurer experts is a major contributor to insurers’ costs and takes “real dollars” out of the pockets of claimants.

That’s not to say lawyers are free of blame.

There’s a long history of lawyers neglecting to act diligently to expose insurer experts who file partisan reports, sometimes outside their sphere of expertise, used by insurers to delay and deny claims.

As well, quality control at some law firms is substandard.

The FAIR Association of Victims for Accident Insurance Reform has recently posted an announcement stating, “ALERT – we are hearing about more and more cases where time limitations for filing have lapsed due to plaintiff’s legal representatives failing to meet limitation period deadlines.”
Then again, motor vehicle litigation and accident benefits claims are highly complex and insurance company tactics often lead to increased fees.

And if the insurance industry wants to point fingers at personal injury lawyers, perhaps they ought to make complete disclosure of the money they spend on defence lawyers and adjusters to deny, delay and defend claims.

Furthermore, how much do insurers pay to fund their massive public relations campaigns -- including political contributions to those in power -- which they effectively use to portray accident victims as opportunistic, malingering or just plain fraudulent?

It seems there is a lot of mud that can be thrown at each side in this messy debate.

But while the debate drags on, insurers continue to exact high premiums and lawyers receive handsome payments for their work.
And accident victims? They’re stuck in the middle.


Wondering what Insurance Company CEOs make in a year?

It's a heck of a lot more than the $400/wk accident victims are expected to live on!

56 year old Executive Profile Donald A. Guloien- Chief Executive Officer, President and Director, ManulifeFinancial Corporation

 C$14,484,208 As of Fiscal Year 2014


Name Position/
Thomas J. Wilson II Chairman of The Board, Chief Executive Officer, Chairman of Allstate Insurance Company, Chief Executive Officer of Allstate Insurance Company, Director of Allstate Insurance Company and Chairman of Executive Committee
The Allstate Corporation
Jay S. Fishman Chairman, Chief Executive Officer, Chairman of Executive Committee and Member of Operating Committee
The Travelers Companies, Inc.
Paul A. Mahon Chief Executive Officer, President, Director and Member of Executive Committee
Great-West Lifeco Inc.
Mark Andrew Wilson Group Chief Executive Officer and Executive Director
Aviva plc
2.3M GBP
John Robert Strangfeld Jr. Chairman, Chief Executive Officer and President
Prudential Financial, Inc.
Compensation as of Fiscal Year 2014.
Source/ more:

FAIR comment on FSCO Draft Statement of Priorities 2015

Why is it that there is so little mention of the priorities/concerns of the injured victims the system purports to serve?

If it is truly the mandate of the FSCO and the “measurement of providing regulatory services that protect the public interest and enhance public confidence in the regulated sectors” then shouldn’t the quality of the coverage and access to that coverage be of utmost importance?

If people had confidence in the quality of the coverage and access to benefits as promised, would over 20,000 people be signing a petition?

When hundreds of people rally at Queen’s Park to protest the cuts to benefits to the most catastrophically injured of Ontario’s auto accident victims; is that not a clear signal that consumers (in this case people who have used the product) have lost confidence in our coverage?

Read more at: FAIR submission to FSCO Statement of Priorities 2015

Car crash victims deserve better deal

First posted: | Updated:
Kathleen Wynne
Ontario Premier Kathleen Wynne. (QMI files)
Ontario’s car insurance system seems to work well except for consumers who need it and accident victims who make legitimate claims under it.

After all, the insurance industry is making good money.

Lawyers are amply rewarded acting for plaintiffs and insurance firms.

Doctors earn significant sums preparing insurer-requested medical reports.

Treatment providers receive good compensation for treating the injured.

Premier Kathleen Wynne received generous financial support from the car insurance industry when she ran for the Liberal leadership.

The Liberal party receives significant campaign donations from it.

But here’s the problem. Two problems, actually.

The first is fraud by people trying to rip off insurance companies with phony claims. We agree it happens and it’s a serious problem.

But what we don’t understand is why the amount of fraud -- to hear it from the insurance companies -- never, ever, seems to decrease.

Fraud, we’re told, is the main reason auto insurance premiums in Ontario remain stubbornly high, no matter how many times the government cuts back benefits to all accident victims at the behest of the insurance industry, as it did again in its latest budget passed last week.

We also think there’s another kind of fraud in the insurance industry that needs to be addressed by government.

That fraud happens when people who have faithfully paid their auto insurance premiums year after year are hurt in serious accidents and, when they make legitimate claims for the benefits promised in their policies, are denied them.

It happens when car insurers fight against paying genuine claims from accident victims, falsely making them out to be the enemy and going to absurd lengths in and out of court to deny them the benefits to which they are entitled.

Last week, hundreds of demonstrators at Queen’s Park protested this kind of fraud as the Liberals passed yet another piece of legislation favoured by the insurance industry that will cut in half benefits for people who sustain catastrophic, life-changing injuries in car accidents.

Prior to the passage of the budget, Finance Minister Charles Sousa boasted, “Ontario is the most generous in Canada when it comes to providing coverage for auto insurance.”

Last week, Sun legal affairs analyst Alan Shanoff, demonstrated conclusively in his column how this statement was inaccurate.

In fact, Ontario doesn’t provide the most generous benefits for either catastrophic injuries or for so-called “minor” ones, which can include dislocation of joints, partial tears of tendons and ligaments and whiplash not exhibiting neurological symptoms.

As the FAIR Association of Victims for Accident Insurance Reform put it: “The budget does nothing to ensure that insurer claims management practices are fair and there has been no action (to deal with) ... the biased and corrupt insurer medical examination reports that are disqualifying innocent and legitimate accident victims.”

We agree. It’s time to end this type of insurance fraud, as well.


Update: rally against insurers deemed “a great success”

by |

  • Brian on 2015-06-07 9:58:11 AM
    When will the dubious "preferred vendors" of the Ontario auto insurers' "proof" of massive opportunistic fraud be put under scrutiny? Systemic, bogus accusations of malingering churned out by pro-insurer medico-legal
    'experts' are first used (on a case by case basis) to deny benefits and then, in turn, trotted out by the Liberals as proof, on a policy level, that quad/paraplegics and brain inured accident victims are being treated "over-generously" and getting money "that needs to go to the people who really need it". We need to look at the long trail of sketchy "medical authorities" that Ontario governments have used to attack the credibility of the injured and the honesty of all Ontario motorists - a trail reaching all the way back to Dr. James N. Sears (aka Dimitri the Lover) - the insurer's "medical authority"
    behind the Harris "Rate Stability Act". And here we are: deja vue all over again!!!
  • Brian on 2015-06-07 10:28:09 AM
    In terms of cause - one can draw a straight line between these latest cuts to the catastrophically injured back to the Liberal/IBC cherry-picked Panel of Experts on Catastrophic Injury which concluded that what counts as "catastrophic" injury is too generous and that the criteria needs to be made tougher for the most seriously injured to "thread" the catastrophic injury definition "needle". The Liberals have decided to double-down on that insurer-friendly report and use at not just to come up with a more narrow definition of catastrophic injury - but also to justify cutting in half the treatment and attendant care benefits of the handful of injured claimants who will ever be able meet the upcoming stricter/tougher/revised catastrophic injury definition. All this thanks to a Panel of "preferred" insurer IME vendors and a couple of epidemiologists who never have and never will meet (much less treat) a catastrophically injured auto accident victim.
  • Rick on 2015-06-07 7:31:56 PM
    So coverage will be cut in half. I guess there's a refund on its way to everyone. Fat chance of that ever happening. Good on this group of concerned citizens for getting out there and making some noise about the evaporating coverage Ontario has. They've forgotten that they are selling, we are buying so we expect something for all those $billions we pay for coverage besides converting our policy dollars to Liberal campaign contributions.
  • Brian on 2015-06-07 11:38:10 PM
    Ironically, the editorial position in today's Sunday Sun has some choice words to say about the Ontario auto insurers' "shady practices":

    Prior to the passage of the budget, Finance Minister Charles Sousa boasted, “Ontario is the most generous in Canada when it comes to providing coverage for auto insurance.”

    Last week, Sun legal affairs analyst Alan Shanoff, demonstrated conclusively in his column how this statement was inaccurate.

    In fact, Ontario doesn’t provide the most generous benefits for either catastrophic injuries or for so-called “minor” ones, which can include dislocation of joints, partial tears of tendons and ligaments and whiplash not exhibiting neurological symptoms.

    As the FAIR Association of Victims for Accident Insurance Reform put it: “The budget does nothing to ensure that insurer claims management practices are fair and there has been no action (to deal with) ... the biased and corrupt insurer medical examination reports that are disqualifying innocent and legitimate accident victims.”

    We agree. It’s time to end this type of insurance fraud, as well.

  • Brian on 2015-06-08 1:34:55 PM
    The insurers say they won’t tolerate auto insurance fraud. Nor should they. So was this National Claims Manager (below) prosecuted – or not? If not – why the double standard? Is insider fraud tolerable?

    A Toronto lawyer has had his licence revoked for his part in a $1.5-million insurance fraud.

    Pradeep Bridglal Pachai admitted to taking part in a scheme that saw a senior employee at an insurance company client authorize higher payments to settle litigation than was needed and the two men pocketing the difference.

    Pachai claimed he was pressured into the scheme by Vinti Sansanwal, national claims director at HB Group Insurance Management Ltd., fearing he would cut him off from legal work defending the company, which had become his largest client.

    Initially, Pachai said he thought the arrangement was for one time only, but between 2005 and 2007, the scam snowballed, netting the pair $1.5 million from 11 files with the lawyer keeping $675,000 of the spoils for his role.

    The scheme came crashing down after an anonymous tip led to an investigation and Sansanwal’s dismissal. The insurance company then launched a civil action to recover the funds that named Pachai as a defendant. After he made restitution, the claim against him was dismissed.

    Close family and four lawyer colleagues acted as character witnesses for Pachai during the hearing. They labelled his actions as being out of character.

    In the meantime, Pachai asked the Law Society of Upper Canada to impose a lengthy ban, but the panel disagreed, noting the mitigating circumstances weren’t sufficient “to justify a second chance.”

    “There is no satisfactory explanation for his misconduct; it was a self-interested, economic choice which was not forced upon him, even if it was devised and initiated by Mr. Sansanwal.

    Nor was it unavoidable, in the sense that it was out of character because it was caused by a disability, addiction or any similar factor,” wrote Bencher Raj Anand on behalf of the three-person panel.

    The panel awarded no costs, noting Pachai had co-operated fully and wouldn’t be able to pay since having voluntarily ceased practice in 2008.
  • Claire Laforest on 2015-06-08 5:18:59 PM
    The proposed reductions in auto insurance coverage are outrageous!! Unless you have walked a day with Sara and the family during the last 19 months, you have no idea what catastrophic injuries stemming from a brain injury caused by the MVA can do to someone emotionally, physically and financially. You may think that the proposed $500,000 for each of nursing care and medical/rehab therapy over a lifetime is a lot of money but it's not! We have so far spent close to $150,000 to $200,000 on Sary Buckley's injuries with nursing care and rehab and were not even at the 2 year anniversary yet. Home health care agencies charge between $25-$55/hr for PSW and RPN care while the current insurance coverage allows for $15/hr for 400 hours/mth or 150 hours/mth at the industry rate. Therapists charge between $100 and $150/hr plus mileage and report writing. Sara requires a physiotherapist 3X/week, a speech therapist once to twice a week, a rehab therapist every day and an occupational therapist every week. You think that's a lot? Well, it's not when someone like Sara requires 24/7 care; she cannot walk, talk, feed, bathe or dress herself nor maintain continence. All this at 18!! And then add to that the expenses related to the drugs and tube feed not covered by extended health private insurance and the cost of accommodating the accessibility to her home. The proposed changes will reduce the current $2M in total allowance by half. And this total $2M is not even what a survivor receives upon settlement because of lawyer fees. These changes must be protested. Proposed changes are going to be devastating. On behalf of all future MVA victims, the proposed changes have to be stopped. Please sign petitions!! Please participate in protests!! Contact your MPPs!! And the Ontario Government should be ashamed of what they are putting forward, in effect Sept. 2015!!
  • Griswald G on 2015-06-08 9:30:24 PM
    The public has no concept of what rehabilitation and recovery can cost. Very few of us could afford what we might need if we were brain-injured or catastrophically impaired. The sense of urgency in Claire's posting is what most people feel when faced with coping with injured loved ones. Our government has failed us on many fronts when it comes to auto insurance and has allowed the IBC to misinform us of the coverage we have with their constant propaganda that everything is fine here, nothing to see, move along, we just need a few more dollars to keep us going and hey look - we can just get it from the victims - especially the worst off ones because they are least likely to be able to complain about it. Maybe there is something to see, and it all played out at the Rally last week when severely injured people showed up to help others they don't even know. And that's a darned sight more than our insurance companies do when we get injured in a crash. What do we get - shipped off to some assessment mill and a denial letter in the mail. Time to consider other possibilities like public auto insurance in Ontario.
  • Brian on 2015-06-08 11:06:52 PM
    Who to believe? That is the question. We can believe the picture being painted by the IBC lobbyists. They would have us believe the insurers money is spent on people who only pretend to be catastrophically injured - and who - even if they are catastrophically injured - are getting to much treatment and too much attendant care. Twice as much in fact. Or, we can listen to the decisions of triers of fact (the judges and arbitrators) who scrutinize the way in which the insurers too often "treat" their most vulnerable claimants. You be the judge. Here (excerpts below) is a case. Who would you trust - the IBC's version of the story or this Arbitrator's decision. The Ontario auto insurance litigation landscape is littered with cases like this one chronicling all manner of insurer abuses. This case manager ought to be ashamed for her implausible (falsified?) reports submitted time and again and used to justify denial of care. Isn't falsifying reports in this way a crime? If not - it ought to be.
    Michalski and Wawanesa [+] Arbitration, 2005-12-13, Reg 403/96.
    Final Decision

    Each of the case manager's subsequent reports to Wawanesa, in March, April, May, June and July, 2002 state in the body of the report that Dr. Dobrowolski continues to report further improvement. I find each of those comments at significant odds with the contents of Dr. Dobrowolski's notes, records, reports to third parties, and an implausible summary of his opinion....

    ...I do not know why Wawanesa preferred the opinions of the occupational therapists and the case manager, flawed and deficient as they were, to the opinions of its own psychiatrist and psychologist, whose greater expertise in assessing Mrs. Michalski's cognitive function Wawanesa sought. I find Wawanesa failed to act with sound and moderate judgment in reassessing evidence from its own assessors. I find Wawanesa's actions and defaults overlap and compound each other.

    ...I believe the sanction should reflect that Wawanesa failed to meet its contractual obligations, and is entirely to blame for the manner in which this claim unfolded. I agree with the submission of counsel for the Applicant that it is difficult to find a more vulnerable Applicant than Mrs. Michalski, who, as a result of her injuries, functions like a two year old, was unrepresented by counsel and whose primary language was not English. She could not be safely left alone. Wawanesa repeatedly put her at risk. Fortunately, her husband and children provided her with care. I believe the award should also reflect that Wawanesa took advantage of Mrs. Michalski's children, and should encompass the need to deter Wawanesa and other insurers from engaging in similar conduct. Nothing indicates that Wawanesa is likely to be subjected to any additional penalty as a result of its misconduct. I agree with the view that interest is remedial C not a penalty.
  • R DeKramer on 2015-06-09 7:09:40 PM
    Here's what a well-known insurer medical assessment doctor told his college when called to task for his poor quality medical report:
    There are three types of patients:
    1.Patients with nothing wrong with them who are “pulling the wool over everyone’s eyes”
    2. Patients with no problem who think they have a problem. These patients actually believe that there is something wrong with them, even though there is not.
    3. Patients with minor problem who have exaggerated this problem into something much bigger than it is.

    Do mva victims even have a chance? Not if there's no room to even consider an injury. A blindness caused by the insurers handpicking and handsomely paying their medical experts so they deny injuries even exist. This is the system and what victims face every day. 


Drastic Cuts to Accident Benefits Ahead

The provincial government is quietly pushing forward a bill that slashes the insurance coverage available for people injured in Ontario car accidents....

More / source: 

Whats on the Public Register at CPSO?

Wondering about that assessor you are going to see?

What is on the Public Register (

You have the right to contact HPARB and ask whether or not the insurer assessor to whom they are being sent has any CPSO censures that were appealed to them. HPARB decisions are publicly accessible. http://www.hparb.

The Health Professions Appeal and Review Board is an independent adjudicative agency.
On request, it:
  • Reviews decisions made by the Inquiries, Complaints and Reports Committees of the self-regulating health professions Colleges in Ontario;
  • Conducts reviews and hearings of orders of the Registration Committees of the Colleges; and
  • Holds hearings concerning physicians' hospital privileges under the Public Hospitals Act.

Medical-Rehabilitation & Attendant Care - Summary of Cuts to Accident Benefits

Click here to email your MPP today about these cuts!

  • Rehabilitation (“rehab”) benefits cover a range of medically necessary goods and services that aren’t funded in the public system such as physiotherapy, speech therapy, psychology, medications, accessibility renovations, nursing, wheelchairs, artificial limbs, etc.
  • Attendant care (“AC”) benefits cover the services of personal support workers to assist with bathing, dressing, toileting, etc.
  • All goods and services are always subject to the insurer’s determination of what is “reasonable and necessary”, so insurers can deny any request for rehab or AC services even if funds are available
  • There are approximately 65,000 people injured in motor vehicle accidents in Ontario each year: minor injuries account for about 80% of all injuries, serious injuries account for about 19%, and catastrophic injuries account for just 1%; insurers have strong controls over which individuals get classified into which severity category
Budget 2015
Rehab for Minor and Serious Injuries:
$100,000 plus the cost of assessments; minor injuries were subject to care pathways
AC for Serious Injuries:
Rehab for Catastrophic Injuries:
$1,000,000 plus the cost of assessments
Attendant Care for Catastrophic Injuries:
Rehab for Minor Injuries:
$2,200 with an option for an additional $1,300; in-home assessments eliminated
Rehab for Serious Injuries*:
$50,000 including the cost of assessments (approximately a 65% cut in benefits)
AC for Serious Injuries:
$36,000 (a 50% cut)
Rehab for Catastrophic Injuries:
$1,000,000 including the cost of assessments (approximately a 20% cut in benefits)
Attendant Care for Catastrophic Injuries:
Rehab for Minor Injuries:
No further changes to limits but additional documentation required
Rehab for Serious Injuries*:
No further change to limits
AC for Serious Injuries:
$36,000 for outside caregivers; family member caregivers must demonstrate direct economic loss
Rehab for Catastrophic Injuries:
No further change to limits
Attendant Care for Catastrophic Injuries:
$1,000,000 for outside caregivers; family member caregivers must demonstrate direct economic loss
Rehab for Minor Injuries:
Awaiting a report with recommendations
Rehab and AC for Serious Injuries**:
$65,000 combined (a $21,000 or additional 25% cut)
Rehab and AC for Catastrophic Injuries**:
$1,000,000 combined (a $1,000,000 or additional 50% cut)
Budget also suggests changing the criteria for “catastrophic”
* Optional Benefits
In 2010, the government introduced “optional benefits” to allow buyers of auto insurance to buy better coverage.  Our members’ experience with agents and brokers is that this is rarely discussed when policy renewals come up and most brokers are unable to speak to what med-rehab and attendant care benefits cover.  Data from FSCO released a couple years ago confirmed that less than 2% of policy holders bought optional coverage.  This is in stark contrast to optional liability coverage which agents and brokers always encourage policy holders to increase from the mandated $200,000 to $1,000,000 or $2,000,000 (liability coverage pays for the rehabilitation and expenses of someone a policy holder injures in an accident, whereas accident benefits pay for one’s own rehabilitation and expenses when injured).  It is unconscionable that drivers in Ontario are encouraged to ensure they cover someone else’s health care needs to the tune of $2,000,000 in coverage, yet are told that they need less than $50,000 to cover their own health care needs.
** Combining Rehab and AC Benefits
The 2015 budget suggests combining rehabilitation and attendant care benefits into one fund, meaning the most seriously of injured people (e.g., those who are paralyzed, people with amputated legs or arms, individuals with severe brain damage, etc.) will be required to choose between getting help to maintain their personal hygiene (bathing, toileting, dressing, etc.) or getting rehabilitation to improve their functional abilities.  This represents one of the most distasteful slashes to the dignity of those with disabilities in the province of Ontario, and because of the small percentage of people who fall into these categories, the savings to insurance companies will be negligible.
Prior to the 2015 Budget announcement, Ontario had already devolved to having the worst rehab insurance coverage in the country on a weighted average basis (80% of injuries access up to $3,500, 19% access up to $50,000 and 1% up to $1,000,000 = weighted average of up to $22,300 in available rehab benefits, if the insurer approves the funding).  With the 2015 Budget announcement, this figure drops to an appalling $15,400.  In 6 years, the Ontario government has reduced rehab funding in the auto sector from a weighted average of $50,000 to $15,000 – and this in the context of publicly funded outpatient and home care rehab services being drastically reduced or eliminated in most jurisdictions across the province.

Numerous other changes have been made to the Accident Benefits package in the past 6 years, all designed to constantly boost insurers’ profitability and all on the backs of injured and vulnerable Ontarians.  The important balance between insurer profitability, premium levels and consumer protection was pushed to the brink in 2010 and will be completely destroyed with the 2015 Budget announcement.  Our government passes seatbelt, helmet and smoking laws to keep people safe.   And one of our most deeply held Canadian values is to provide a safety net for the most vulnerable among us.  The Ontario government needs to show that it cares as much about its citizens as it does about insurer profitability.  Disabled Ontarians and their families are too busy trying to get through basic daily activities with some dignity and hope; they can’t lobby the way the insurance industry can.  You, our MPP, need to be their voice. 

Please stop these proposed changes, review insurer profitability, and let the impact of all the other cuts take place before enacting any new regulations that further disadvantage injured Ontarians.



The Accident Benefit Coalition (ABC) consists of a membership of Ontarians concerned with issues surrounding the provinces' mandatory Accident Benefits. It  was founded by NeuroConnect and FAIR Association and is committed to advocating for Accident Victims in Ontario.

The Accident Benefit Coalition (ABC) is comprised of organizations concerned about the proposed reduction to Ontario's Accident Benefits.

Please click here to sign the Petition asking the Government to Stop Reducing Accident Benefits.

Thank you to everyone who attended the #rally4accidentvictims on June 3rd.

Please click here for pictures of the event.

Hundreds rally against cuts to auto insurance benefits

By , Toronto Sun
First posted: | Updated:  

TORONTO - Changes to auto insurance benefits for motor vehicle accident victims passed in the Ontario legislature Wednesday as part of the provincial budget.

“God help us all,” Tammy Kirkwood said upon hearing the news. “We’re getting a lot less coverage for a lot more money and I’m not sure why.”

Kirkwood was one of hundreds of protesters at Queen’s Park rallying against reductions in auto insurance benefits which they say will have the most effect on victims with catastrophic injuries.

The 47-year-old Orillia woman said protesters were “flabbergasted” that the provincial government “was trying to disable our resources and our funding to recover.”

Part of the changes to auto insurance rules under the new budget mean that combined coverage for medical, rehabilitation and attendant care benefits for the catastrophically injured will be cut in half from its current cap of $2 million to $1 million.

Kirkwood survived a 2008 collision when a dump truck hit her car. She had to be pried free from her vehicle by firefighters, and was deemed catastrophically injured.

She says she was only able to move forward because she had access to the services she needed.

Unable to return to work, Kirkwood now volunteers as an advocate with FAIR Association of Victims for Accident Insurance Reform.

New Democratic Party MPP Jagmeet Singh spoke at the rally in support of their cause.

The cuts affect “the most vulnerable people,” such as people with brain and spinal cord injuries, he said.

“They need benefit coverage ... to live an at least somewhat decent life,” Singh pointed out.

A spokesman for Finance Minister Charles Sousa said the government is “working hard to create a fair and affordable insurance system” for the province’s 9.4 million drivers.

Ontario is “the only province in Canada to offer exclusive catastrophic coverage,” Kelsey Ingram said in an e-mail.

“Catastrophically impaired claimants will also continue to be able to sue an at-fault party to recover damages for health-care expenses and potentially other claims,” she added.

The provincial government is also committed to making sure any savings from these changes do not result in “excess profits” for insurance companies, Ingram said.

“This is about lowering premiums while providing support and protection for all Ontario drivers,” she said.

MD watchdog becoming less secretive

The College of Physicians and Surgeons will post on its website whether MDs have been "orally cautioned" for mistakes...

More/ source:


Simplify ODSP process

Re: Ontario rethinks complex disability reviews, May 17 

Ontario rethinks complex disability reviews, May 17
In her interview with Laurie Monsebraaten, Mary Marrone of the Income Security Advocacy Centre gives us pause when she describes the process of Ontario Disability Support Program (ODSP) medical reviews as flawed, wasteful, and “careless with people’s lives.” 

As a physician and a member of the Select Committee on Mental Health and Addictions, being careless with people’s lives is the last thing Helena Jaczek, the Minister of Community and Social Services, would want.

That’s why Ontario’s registered nurses, nurse practitioners, and nursing students urge her to simplify the ODSP application process. Right now, it is so complicated that more than half of community legal clinic cases involve ODSP appeals. 

With more than half of these appeals being eventually approved by the Social Benefits Tribunal, this is not accountability but “denial by design.” We can and must be ever careful with the lives of every Ontarian, especially those most in danger due to health and disability challenges.

Doris Grinspun, CEO, Registered Nurses’ Association of Ontario, Toronto


Ontario's 25-Year No-Fault Journey

Ontario's auto insurance system is unrecognizable, and it is time to stop tinkering. The concept of using an insurance system to provide a social safety net is flawed, perhaps requiring in its place a system where private insurance companies provide both third-party liability and physical damage coverage while a Crown corporation delivers accident benefits.....


More/ source: By: Willie Handler, Consultant, Willie Handler and Associates 2015-05-01

Injured worker on hunger strike for compensation hearing

After 18 days with only water and broth to drink, Jimmy Velgakis says he just wants a chance to tell his side of the story.

 Former city worker Jimmy Velgakis holds vigil outside Queen's Park, where he's holding a hunger strike to make his case for workers compensation.
Former city worker Jimmy Velgakis holds vigil outside Queen's Park, where he's holding a hunger strike to make his case for workers compensation. 

After more than 20 years, Jimmy Velgakis is still angry.

With a sign around his neck, he’s been standing in front of Queen’s Park for the past 18 days on a hunger strike. The former city ice rink worker injured his back lifting a piece of plywood on the job in 1991 and has never received the workers’ compensation benefits he says he’s due.

When he tells his story, Velgakis’ voice grows louder and his deep tan takes on a reddish hue.

“I have the injury. I prove that and they refuse to pay me,” he says in a thick Greek accent. “When I get to a second tribunal, they kick me out of the room. They don’t allow me to talk. They play with me.”

As he reaches his crescendo, the 74-year-old mustachioed man stops and stumbles backward. After nearly three weeks with only water and broth to sustain him, he says, these flashes of weakness hit with increasing frequency.
It’s Velgakis’ third hunger strike in the past four years. The last two ended with promises that he would get a new hearing and be given an opportunity to tell his side of the story. Both times, a full hearing didn’t materialize.

“At every turn this poor man has just been shut down. He really is literally at the end of his tether right now. We tried everything to convince him not to do this, but he insisted,” said NDP MPP Cheri DiNovo, who went on a 10-day hunger strike with Velgakis in 2013.

DiNovo, who plans to highlight Velgakis’ case in a statement to the House on Monday in honour of injured worker’s day, has tried to get the premier, minister of labour and Toronto city hall involved, but says she has been rebuffed at every turn.

“It’s a matter of justice. He’s been fighting for years. It’s very indicative of what injured workers have to go through with (the Workplace Safety and Insurance Board). He’s just not letting it go. Why should he?” she said.

The WSIB declined to comment and referred the Star to the Workplace Safety Insurance Appeals Tribunal. The WSIAT doesn’t normally comment about individual worker’s cases, said acting general counsel Michelle Alton.
“We are aware of Mr. Velgakis’ hunger strike. The tribunal hopes he takes care of himself and he stays healthy,” she said.

After his injury, Velgakis continued to work for three years in a role that had been adapted for his bad back. When the city laid him off in 1994, he was given a one-time payout and signed away — unwittingly, he says — his right to pursue further claims.

In 1996, Velgakis won a decision recognizing his injury and granting him benefits, but he only got a few days of payments before they were cut off.
At the next hearing, his temper got the best of him and he was asked to leave while his future was decided without him. His claim was rejected.

Velgakis rented out his basement and asked his brother in England for some help to make ends meet, but soon the pressure became too much. He says his marriage fell apart and he grew estranged from his two daughters. He now lives off a half-pension from the city and CPP.

Marion Endicott, of Injured Workers’ Consultants, represents Velgakis free of charge. While acknowledging that he’s exhausted his legal avenues for recourse, she argues that he should be given a new hearing on humanitarian grounds.
“Jimmy has been the victim of an insidious transformation of our workers’ compensation system from an inquiry-based one to an adversarial one,” Endicott said. “Jimmy’s fighting not only for himself, he’s fighting for all injured workers — the only difference is that he’s not giving up.”

Hospitals still use flawed secrecy law to review medical errors

As the government drags its heels over amending the health secrecy act, hundreds of critical care incidents are still being investigated under the flawed legislation, the Star has learned.

Hospitals continue to invoke a controversial health secrecy law when they investigate critical medical errors, despite a government report that in March highlighted serious flaws in the legislation.

In the past week, the Star has surveyed 15 hospitals in the GTA and found more than 200 critical or severe incidents had been handled under the act since April 2014 — most of those while the legislation was under active review by the province. This includes at least 11 patient deaths...



"House of horrors" dentist leaves practice

This ones not a canadian story but deserves our attention:

by |

Bad news for crash victims

Finance Minister Charles Sousa’s claim Ontario has the most generous auto insurance benefits is nonsense

By , Toronto Sun
First posted:

Ontario Finance Minister Charles Sousa announces at Queen's Park on Tuesday that he will introduce the Fighting Fraud and Reducing Insurance Rates Act. (ANTONELLA ARTUSO/Toronto Sun)
Ontario Finance Minister Charles Sousa. (ANTONELLA ARTUSO/Toronto Sun)
TORONTO - Last month’s Ontario budget continued the erosion of accident benefits for victims in motor vehicle accidents.

The reductions are most significant for those suffering from catastrophic injuries.

Since 1996, these victims were entitled to reasonable and necessary medical and rehabilitation services up to $1 million, in addition to up to $1 million in attendant care benefits.

That combined coverage of $2 million will now be cut by 50% to a combined $1 million.

It’s puzzling why the government would want to cut back benefits to those who need it most, especially since only 1% of accident victims suffer catastrophic injuries.

Ontario Finance Minister Charles Sousa stated, “Ontario is the most generous in Canada when it comes to providing coverage for auto insurance.”
I guess he isn’t aware Manitoba, Saskatchewan and Quebec provide medical rehabilitation benefits in excess of Ontario’s $1 million, when medically warranted, for any motor vehicle accident victim.
At the other end of the spectrum, dealing with so-called minor injuries suffered by approximately 80% of accident victims, Ontario’s “generous” limit for medically necessary treatment is $3,500, including the cost of assessments, examinations and reports.

No other province mandates a cap on minor injuries.

Don’t think these “minor” injuries are insignificant.
They include dislocation of joints, partial tears of tendons, ligaments and muscles, contusions, abrasions, lacerations and whiplash not exhibiting neurological symptoms.

For serious injuries — neither minor nor catastrophic — medical and rehabilitation benefits are capped at $50,000 in Ontario. That compares favourably to Nova Scotia, PEI, Nunavut and the NWT, which each have a limit of $25,000, and equals the limit in Alberta and New Brunswick.
But it falls short of the limits in British Columbia, Manitoba and Saskatchewan.

So, the most generous benefits in Canada? Hardly.
The lowering of benefits for catastrophic injuries is only one of many prejudicial changes to auto insurance coverage announced in the budget.
There’s also enhanced barriers imposed on plaintiffs suing for negligence arising out of auto accidents.

Most people are unaware of two barriers on the right to sue for damages resulting from harm suffered in an at fault auto accident.

First, there is a threshold test that must be satisfied before anyone can succeed in winning a lawsuit.

This law, introduced in 1996 and made more stringent in 2003, bars successful lawsuits unless plaintiffs can establish they suffer “from permanent serious impairment of an important physical, mental or psychological function.”

To meet this test, various stringent conditions must be satisfied.

The threshold often prevents injured people from recovering damages for serious injuries that fail to meet its definition.

Second, there is a deductible that applies only to lawsuits against negligent auto drivers. It was increased from $15,000 to $30,000 in 2003 and applies to damages for pain and suffering of $100,000 or less.

The budget would index the deductible to inflation as of 2003.

According to personal injury lawyer Darcy Merkur, that would impose a deductible of about $37,000 on damage awards of about $123,000 or less. As an example, a damage award of $100,000 would be reduced to $63,000!

Having both a threshold and a deductible is redundant and only benefits insurance companies.
And why would the government choose to index amounts that favour insurance companies, while not indexing amounts that favour accident victims?
I didn’t see any proposal to index the minor injury cap of $3,500 or the medical/rehab cap of $50,000.

As FAIR Association of Victims for Accident Insurance Reform says, “The budget does nothing to ensure that insurer claims management practices are fair and there has been no action (to deal with) ... the biased and corrupt insurer medical examination reports that are disqualifying innocent and legitimate accident victims.”

The government also announced it intends to amend the catastrophic impairment definition.
Does anyone doubt that these amendments will only serve to benefit insurance companies by restricting the number of victims who would otherwise qualify for the enhanced benefits applicable to the catastrophically impaired?


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