Auto accident victim group slams insurance sector

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Ontario’s newly appointed auto insurance advisor, David Marshall, is being pressed to launch a full public inquiry into the quality of medical evidence used in auto insurance claims.

On Monday, his first day in the chair, Marshall received a call from the FAIR Association of Victims for Accident Insurance Reform, which claims that Ontario's auto insurance system is “troubled and dysfunctional”.

Rhona DesRoches, chair of FAIR said: "It is not an exaggeration to say that we are in a crisis when it comes to medical evidence in auto insurance claims. Ontario's auto accident victim's medical files are routinely manipulated by Ontario's auto insurers to delay and deny claims," she said.

FAIR wants a public inquiry into what it believes is systemic abuse of Ontario's vulnerable and injured car crash victims by Ontario's insurers and courts system.

While it’s well reported that fraud is rife in the auto insurance sector, according to the FAIR organization, about half of all claims are initially denied by auto insurers, and the court system is allegedly abused by insurers to delay payments to legitimate claimants.

The group claims that this results in the improper and wasteful expenditure by insurers of hundreds of millions of insurance premium dollars on medical reports to legitimate claims and a cost to Ontario taxpayers for financial and medical support for victims whose claims have been denied.

DesRoches said there was a failure of Ontario's courts and judges to ensure that medical expert witnesses are in compliance with the Rules of Civil Procedure.

"The use of bogus medical reports and testimony has profound negative outcomes for MVA victims who are left behind by their auto insurer," DesRoches said.
  • Ingrid Marroquin on 2016-02-02 10:29:16 AM

    unless clinics, doctors, lawyers, tow trucks, auto shops, contractors, insureds, etc. are heavily fined or their licenses taken away or get jail time - this is not going to change. Do you know how much these people overcharge insurance companies? specially if client is with a company like Chubb - they just see $$$ signs. the whole system needs to be changed.

  • Brian on 2016-02-02 10:46:02 AM

    @ Ms. Marroquin

    You say unless doctors "get jail time" nothing will change. You appear to be talking about the doctors who treat auto accident victims. But what about the doctors who sell bogus accusations of malingering to auto insurers which are then used to bilk seriously injured auto accident victims out of their policy benefits? Do you think they need some jail time too - or is this flip side of auto insurance fraud ok with you? If it is fraud to exaggerate an injury for opportunistic gain - it is also fraud to deliberately and wrongfully minimize and trivialize serious injuries so that auto insurers can avoid paying legitimate claims. What about that form of fraud? Should we be looking to lock up the auto insurers' preferred vendors of bogus accusations of malingering?

  • Ingrid Marroquin on 2016-02-02 10:58:35 AM

    All of them-insurance companies included if they are found to be denying or short changing insureds on legitimate claims. It will not get better if everyone is not treated the same.

  • Brian on 2016-02-02 11:12:54 AM

    RE: "All of them... It will not get better if everyone is not treated the same. "
    Ms. Marroquin,
    I agree with you. Too bad the IBAO doesn't. It has never been willing to talk about this flip side of fraud. Instead the IBAO has always chosen to only parrot the IBC's accusations of widespread malingering - the "proof" of which is the bogus accusations of malingering the auto insurers buy from their "hired gun" medical assessors. Fraud is a two-way street in the Ontario auto accident injury context - but you would never know that from having listened to the IBAO's insurer-friendly spin-doctors.

  • Brian on 2016-02-02 11:21:41 AM

    The similarity is remarkable! The point made in this column entitled "Auto Accident Victim Group Slams Insurance Sector" was well illustrated yesterday in a Lawyers Weekly column:
    "Arbitrator slams insurer for acting in bad faith ..............20"

  • Ingrid Marroquin on 2016-02-02 11:32:43 AM

    Thanks for article Brian - so it is basically the same except that they are blaming insurance companies and the insurance companies blame everyone else. You would think that with all the evidence against State Farm we would have heard that they got heavily fined or something but I doubt that was the case. Nobody wins in this situation and now with the new auto reform less coverage for insureds - unbelievable

  • Brian on 2016-02-02 11:51:30 AM

    RE: "You would think that with all the evidence against State Farm we would have heard that they got heavily fined or something "
    Ms. Marroquin,
    The arbitrator ruled that the medical report the insurer used to deny benefits to this catastrophically injured claimant was "seriously flawed" and that this "should have been obvious " to the insurer. The arbitrator punished the insurer with a $108k special award. But for purposes of your earlier comment about jail time for rogue doctors - the question is whether in a just world the doctor who provided the insurer with this flawed assessment used to deny treatment benefits and attendant care to a catastrophically injured claimant ought to be prosecuted for fraud (and sent to jail). Especially given the IBC is forever pushing for zero-tolerance and swift prosecution of rogue treatment providers. Alas, when it is the insurer doctors who are up to no good - the IBAO and IBC look the other way. It has been ever thus.

  • Jokelee Vanderkop on 2016-02-02 12:03:29 PM

    Hopefully Mr. Marshall won't be wearing the same hat as at the WSIB where he lost sight of claimants in an effort to straighten out the organization's dismal finances, much due to years of managerial incompetence. Claimants weren't getting paid but he was plus a $400,000 bonus. The fraudster claimant versus the non fraudster claimant is more likely 1 to 100 yet the whole organizational structure at the WSIB and in the auto insurance industry treats almost all claimants as fraudsters. Marshall is lauded for lowering the debt but on the backs of workers. Auto insurers are most likely very happy with his appointment. He'll become one of them. If the hat he wears this time is not simply business oriented but truly client focused, he should welcome a public inquiry. There's plenty of evidence of biased, incompetent and shoddy insurer medical assessments both in the auto insurance industry and at the WSIB. They employ the same second opinion medical vendors. It is these guys who stay on the insurer payrolls making a much better living than just getting paid by OHIP.
    Fraud by organized crime, which insurers have a hard time getting a handle on, shouldn't be fought to the detriment of legitimate claimants. The industry has done a great job of making the public think that if you're not receiving your benefits, it's because your claim is fraudulent. What is fraudulent is the insurers' denial tactics of people who need the accident benefits they've paid for. And the whole system, like at the WSIB is supported by an industry of insurance doctors who become wealthy working for insurers and even more so by owning the very assessment centres that are primarily focused on writing medical reports favourable to insurers while discounting the medical opinions of treating physicians. We need a public inquiry not only into the auto insurance industry, but into FSCO and the CPSO.
    The public should be concerned because each one of us could be in an auto or work accident from one minute to the next. Better to find out how broken the system is and what you'll be up against before it happens. Inform yourself at deniedbenefitclaims

  • Devils Trumpet on 2016-02-02 5:36:53 PM

    I see no reason whatsoever why this government will call for an inquiry into auto insurance,why would they?Their relationship with the industry benefits both parties at the exclusion of the accident victims,exposing such collusion will never happen on their own volition and there's nothing to force an investigation let alone an objective one.
    Money talks,the industry has it,the lawyers have it and the doctors have it,accident victims don't and everyone knows it.
    Inquiries regularly turn into a government dog and pony show wasting tax dollars on a report full of recommendations that routinely never see the light of day.
    Mr.Marshall's record at WSIB of cutting benefits of legitimately injured workers and the WSIB's history of using bogus medical exams to do so require an inquiry themselves.He certainly earns his 400,000 dollars plus dollars yearly.Any thought that Marhsall's recommendations will somehow benefit injured accident victims is delusional at best.

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