Changes in Ontario Insurance Act: How Insurance Dispute Lawyers Can Assist

Accidents happen without warning. All it takes is a split second for a disaster to happen, but its effects can last for a life-time. A serious accident related injury impacts not just the injured person, but often the entire family and support system.

Such devastating events impose huge physical, financial and emotional burdens on all those connected with it. The recovery process could be extremely long-drawn-out, painful, frustrating and expensive. There could be a need for a dedicated caregiver, costly and complicated treatments and medication, lengthy rehabilitation procedures etc.

Emotionally, victims and those dear to them are thrown into a psychological maelstrom. Confusion, anxiety, fear, grief and panic attacks, post-traumatic stress syndrome, sleep disturbances, breakdown of relationships, depression, suicidal thoughts, addiction to alcohol or drugs etc are some of the hazards that patients and families have to face.

The economic aspect can be hugely traumatic too. If the injured person was the sole income-earner or contributed significantly to the family income, being unable to work for extended periods can result in income-loss. If there are permanent disabilities, this means there is a loss of earning-capacity. Treatment, home-maintenance, living expenses, debts etc can all pile up and create devastating consequences.

Accidents are usually preventable and avoidable. Most of them are caused by someone else’s fault or negligence.

Meeting Expenses

Most injured victims and families trust their insurer to compensate them for their injuries, based on the type of coverage they’ve purchased. Additionally, all injured victims of motor-vehicle accidents in Ontario are entitled to statutory benefits (SABS) regardless of fault, from their own insurers.

However, injured victims may face several issues and challenges in collecting settlement from insurance-companies. They may dispute the claims on technical grounds, deny or dismiss the nature/extent of defendant liability or minimize your injuries. They may also adopt various strategies to compel victims to accept swift and meager settlements.

Dispute Resolution

At present, disputes between clients and insurers are regulated by the Financial Services Commission of Ontario (FSCO) but if no resolution is reached, there are other avenues available to plaintiffs. Arbitration and a personal injury trial are some options.

Changes To Act

In 2015, sweeping changes to the Insurance Act were made. Insurance dispute lawyers are concerned about:

  • Disputes under SABS now under the jurisdiction of the License Appellate Tribunal instead of under FSCO, effective April 1, 2016.
  • Catastrophic and non-catastrophic funding was slashed.
  • Revisions to definition of “catastrophic.”
  • Mediation fee introduced.
  • Parties are encouraged to settle dispute.
  • LAT not bound by FSCO case-laws and precedents.
  • LAT adjudicators may not have specialization in accident benefits legislation.
  • Ambiguity on statute of limitations period under LAT.

How We Can Assist

It’s difficult to challenge the rulings of insurance companies and government agencies without specialized knowledge and training. An experienced personal injury lawyer who regularly handles such cases can help you get the settlement that you are contractually entitled to.

In many cases, permanent disabilities require a Life Plan to be presented. We work with a multi-disciplinary team to ensure that a robust claim is presented during all communications/arbitration with the at-fault party.

Call for Inquiry into Ontario’s Automobile Insurance Industry: Motor-vehicle Accident Victims’ Advocates

A new, scathing report released by the Ontario Trial Lawyers’ Association (OTLA) focuses on the need for drastic reforms in the auto-insurance industry. Conducted by two independent American experts from the York University Schulich School Of Business, the study reveals several insights that far-reaching implications for this sector.

The primary areas of concern expressed by OTLA included impending cuts to victims’ benefits and biases in medical evidence used to assess injuries/disabilities etc suffered by motor-vehicle accident victims.

President of OTLA, Maia Bent, opines, “After years of changes designed to placate the insurance industry, the government needs to turn its attention to the plight of victims.”

She further remarked that Ontario’s insurance system was in crisis, coverage was being steadily eroded, premiums remained stubbornly high and insurer profitability was allowed to continue without limits. Injured accident victims and their families usually bear the brunt of the punitive changes that have been recently instituted in insurance regulations.

OTLA has called upon the government of Ontario to set up “a commission to conduct a public inquiry to examine the current state of independent medical assessments of injured auto accident victims.”

Additionally, David Marshall, the newly-appointed auto insurance advisor has opined that his task will be “identifying additional opportunities for auto insurance reform…. leading to better health outcomes, lower costs and more affordable insurance premiums.”

Reforms Needed

FAIR, the organization that advocates for insurance reforms for victims of accidents, has welcomed this move. FAIR has deemed that the auto insurance industry urgently needs reforms. Some of the important areas require detailed inquiry into:

  • Lack of diligence by Ontario court system and judges to make sure that medical experts are not “hired guns.”
  • Failure to ensure that medical experts are in compliance with the Rules of Procedure
  • Delay of payments to legitimate applicants – more than 50% claims are routinely denied by insurers
  • Wasteful and exorbitant rates paid by insurers on creating medical reports to counter the claims of legitimate applicants
  • Lax application of standards
  • Ontario regulatory colleges failure to meet their public obligations
  • Ontario taxpayers bearing the burden of motor-vehicle accident victims
  • Ontario insurers commissioning poor quality or partisan medico-legal reports

Medical Evaluations Under Scrutiny 

Rhona DesRoches of FAIR refers to the troubling use of “bogus medical reports and testimony….. the unsavory aspect of auto insurance.”

Currently there is a backlog of more than 60,000 insurance claims in the courts in Ontario, while another 20,000 are held up in arbitration. Studies reveal that insurers pay nearly 70 cents to every dollar they pay victims on gathering evidence to counter the claim.

Unlike other patients, accident victims have no choice regarding the physician who conducts their Independent Medical Examination (IME). In many cases, it is found that the physician provides unqualified, shoddy or biased report. This becomes part of the victim’s medical file and the basis for all further action. Rehabilitation benefits are often denied based on such faulty reports.

Victims and their representatives have no access to the IME physician’s previous history, track record, professional qualities, complaints regarding conduct etc. Another issue is the intended $500 fine for failure to appear at the IME.

If you have been injured in a motor-vehicle accident, consult our experienced, knowledgeable car accident lawyer for a genuine, swift and comprehensive assessment of your claim.