Sunday, June 14, 2015

Update: rally against insurers deemed “a great success”

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  • 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. 


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