This is a provocative question to anyone who conducts business that involves vehicle insurance claims. But troubling accusations were published in a January issue of Canadian Underwriter, and we believe they’re worth noting.
The freelance writer, a former lawyer who turned to the investigation of suspicious accident benefits for the insurance industry until 2006, contends that Ontario’s no-fault system “has been hijacked and looted by some assessment companies, legal representatives, health practitioners and rehab clinics.” She notes that when Ontario’s mandatory, five-year auto insurance review winds up, the credibility of the system will be an issue.
Since its implementation in 1990, the system has undergone so much expansion and amendment, the writer says, that it is far too complex for anyone outside the insurance industry to understand. She contends that her professional background has taught her keen insight into abuses in the no-fault system. Among the abuses cited are:
- Primary care providers who are regulated health professionals are employed by unregulated business people. The primary care provider is typically paid an hourly rate far below the rate billed to an insurer
- Clinic owners are forging names and registration numbers of regulated health professionals unbeknownst to targeted health care providers, using banked practitioner electronic signatures, rubber stamp signatures and cut-and-paste
- The number and cost of assessments is a problem because personal injury lawyers use the assessments, paid for by the first-party insurer, in both their no-fault and tort files. Apparently, this encourages spurious tort litigation in minor cases despite the fact that there’s a threshold in tort for non-pecuniary claims
- In some minor accident claims, after certain legal representatives and rehab clinics/assessment companies get involved, the insurer is deluged with 10-15 applications for approval, covering in-home needs, psychological assessments, functional abilities evaluations, driving assessments, orthopaedics, neurology, etc. etc. The writer contends that all of these get submitted regardless of age, injury or the severity of the accident.
The article goes on to cite unscrupulous dealings by legal representatives and clinics, but we noted that none of the claims are substantiated.
We urge you to read the full article and make your thoughts known. The current insurance system may well be subject to abuse and in need of reform but we believe it is dangerous as well as injurious to the accused in this article to make such statements without properly documented, supporting case material.
Send us your thoughts on your own experiences and we’ll be pleased to present a follow-up in a future newsletter.