Today Ontario Finance Minister Charles Sousa announced that the government intends to introduce legislation that if passed with lower average annual premiums by 15% or $225 per vehicle for safe drivers.
It appears that FSCO will be authorized by legislation to compel insurers to refile rates to achieve the 15% average roll-back. Although not mentioned, I expect FSCO will be able to make exceptions where a full roll-back could create solvency issues for an insurer.
The Minister said there should be an immediate impact but did not say exactly when drivers would see the savings. Based on past roll-backs, it may not be until a driver renews their insurance.
The Minister appeared to link rate roll-backs with fraud prevention initiatives and road safety improvements. FSCO will be provided with expanded powers to investigate fraud and enforce compliance.
FSCO will also be authorized to license and oversea health clinics and practitioners that invoice auto insurers. When asked about regulating the towing industry, the Minister was non-committal.
Finally, the Insurance Act is to be amended to make Superintendent's Guidelines, incorporated by reference in the SABS, to be binding. This proposed amendment appears to specifically address a view expressed by the arbitrator in the Scarlett and Belair decision.
Tuesday, 30 April 2013
Insurance News - Tuesday, April 30, 2013
Here are the leading auto insurance headlines from ONTARIO AUTO INSURANCE TOPICS ON TWITTER for Tuesday, April 30, 2013:
- Self-driving cars are going to save lives by removing human error which makes up about 99% of auto fatalities.
- Matheson v. Lewis decision could have an impact on cases where insurers try to deny coverage to occupants of uninsured vehicles. In this case although the ATV in question was a “self-propelled implement of husbandry” under the CAIA,which would not have been required to be insured under an automobile policy, the judge still ruled in favour of the plaintiff,
- An interesting human interests story. An affluent insurance broker by day and blogger by night offers Toronto’s homeless something more meaningful than spare change.
- According to the Toronto Star, Ontario Finance Minister Charles Sousa will announce this morning the government's plan to lower auto insurance premiums by 15% but also to lower the ROE benchmark for insurers when filing for rate changes. So part of the rate reduction is to be in the form of lower profits.
- Another polls also has Ontario Liberals and Progressive Conservatives in a close race. With the NDP falling behind it only reinforces my view that Andrea Horwath will not be forcing an election this spring.
Monday, 29 April 2013
Insurance News - Monday, April 29, 2013
Here are the leading auto insurance headlines from ONTARIO AUTO INSURANCE TOPICS ON TWITTER for Monday, April 29, 2013:
- Guarantee CEO, Alister Campbell, suggests that Ontario auto insurance regulations and OSFI's capital requirements are contributing to a decline in foreign P&C carriers in Canada.
- The Scarlett and Belair decision is beginning to gain media attention: Accident victim wins challenge to Ontario’s $3,500 minor injury cap.
- Conflicting FSCO arbitration decisions have made the interpretation of what is an "accident" about as clear as mud.
- A number of no-fault auto insurance states are exploring reforms to address fraudulent claims.
- An RSA executive indicates that brokers are still losing market share to direct writers as customers want more web and mobile services but the decline will begin to slow down.
- Ontario polling numbers all over the map. Now a Forum Research poll is indicating that Wynne’s Liberals have jumped into a first-place tie with Tories.
Thursday, 25 April 2013
Insurance News - Thursday, April 25, 2013
Here are the leading auto insurance headlines from ONTARIO AUTO INSURANCE TOPICS ON TWITTER for Thursday, April 25, 2013:
- Driverless vehicles would be a windfall for households and businesses that acquire them but would probably increase traffic and nationwide fuel usage.
- The U.S. government is urging car makers to curb web apps and electronic gadgets to reduce distracted driving.
- HowU.S. government Distracted-Driving Guidelines will shape your next smartphone.
- Proposed Texas law would bar uninsured drivers from collecting non-economic damages when they are injured in a crash.
- Why are Ontario Conservatives eager for an election? It's because they have a near-10% lead over the Liberals and NDP. So don't be surprised when the NDP decide to support the Liberal budget next week, their supporters fear a majority Conservative government.
- Is auto insurance an election-worthy issue outside of Brampton?
Implementing a 15% Reduction In Auto Insurance Premiums
The NDP put forward their motion on March 27th calling upon the government “to direct FSCO (the Financial Services Commission of Ontario) to gradually reduce average, industry-wide, private passenger auto insurance premiums by 15%.” Just what Ms. Wynne subsequently agreed to do is still a bit vague, and although the motion is non-binding, it does seem certain that some form of autom insurance premium roll-back will be enforced, either legislatively or through FSCO policy over the coming months.
- The government could introduce legislation requiring all insurers to re-file their rates with FSCO with a 15% reduction within a specific timeframe. However, this would require some escape clause for the regulator so that a company doesn't become insolvent.
- The government could introduce legislation requiring all insurers to re-file their rates with FSCO again within a specific timeframe. The Minister would then direct the Superintendent, perhaps through a policy statement, to reduce rates by 15% (similar to Bill 5 process in 2003). Again, some insolvency protection would likely be included.
- A gradual reduction in rates as the government identifies savings in the system (introducing new catastrophic impairment definition, implementing Automobile Insurance Anti-Fraud Task Force recommendations, reforming the dispute resolution system, tort reforms).
Wednesday, 24 April 2013
Standing Committee on General Government - April 17, 2013 - Automobile insurance review
I've provided some highlight of the first day of hearings last week on
auto insurance by the Standing Committee on General Government. Full transcripts are available here.
Collision Industry
Information Assistance
John Norris
- Repair shops who become preferred providers of insurance companies are expected to provide labour cost discounts and purchase parts from suppliers selected by insurers and who pay the insurer a fee. Local suppliers are often not used which delays repairs.
- Shops often have no choice but to become preferred providers because of the volume of business that comes from insurance companies.
- Companies that rent repair estimating systems to shop sell the data collected to insurers who use it to identify policyholders who have not reported accidents. The policyholder is rebilled to reflect a higher risk.
- Cash settlements for physical damage claims are not always used to repair vehicles which means unsafe vehicles are on the road.
- Supports self-regulation of the towing industry.
- Repair shops can also identify fraudulent claims if there was an entity to which they could be reported.
FAIR, the Association of Victims for Accident Insurance Reform
Rhona DesRoches
Tammy Kirkwood
Greg Smith
- Believe that dishonest or corrupt vendors of auto insurer medico-legal assessments or IMEs ought to suffer the same fate as dishonest treatment providers.
- Do not see any difference between opportunistic fraud in the form of falsely inflating the value of a claim by exaggerating injuries and impairments, and the opportunism of falsely deflating the value of a claim by dishonestly trivializing and minimizing serious injuries.
- Propose a three-strikes rule, where if an IME provider has three negative comments about the quality of their reports from arbitrators or judges, they would be denied the ability to continue to provide reports.
Insurance News - Wednesday, April 24, 2013
Here are the leading auto insurance headlines from ONTARIO AUTO INSURANCE TOPICS ON TWITTER for Wednesday, April 24, 2013:
- Survey shows a prospective customer's age is not always a good way of predicting whether they want to get insurance quotes online.
- Some courts are now applying a higher level of judicial scrutiny to the role of expert witnesses, particularly in cases involving medical diagnoses. Claims examiners and insurers need to be cautious when retaining experts and make sure that their processes will stand up to review.
- Property and casualty insurers looking to maintain and enhance profitability in 2013 and beyond are advised to adopt a more consumer-centric business model.
- Sentry Insurance announces the release of a mobile version of its risk management solution, Sentry Insight Mobile, which provides a customer-focused way for businesses to receive claims information on any smart phone.
- A new study from researchers at the Texas Transportation Institute at Texas A&M University found that sending text messages via voice while driving is just as dangerous as texting with fingers.
Tuesday, 23 April 2013
Standing Committee on General Government - April 15, 2013 - Automobile insurance review
I've provided some highlight of the first day of hearings last week on auto insurance by the Standing Committee on General Government. Full transcripts are available here.
Financial Services
Commission of Ontario
Philip Howell
Tom Golfetto
- With respect to the mediation backlog, all files will be assigned to a mediator by year-end which will eliminate the backlog
- The average accident benefit claim costs are higher in Ontario because maximum benefit levels for comparable accident benefit coverages in other provinces are less generous or unavailable.
- There’s absolutely no question that there is some rate reduction room in the system. It varies quite a lot by company.
- If every company had to cut rates by 15% next year without any corresponding reduction in costs, there would be many companies that would be effectively put out of business or would at least have to go to their investors and ask for a significant infusion of capital in order to remain in business.
- Clarified that the 2010 reforms produced $2 billion in reduced claims cost but not $2 billion in additional profits.
Insurance Bureau of Canada
Ralph Palumbo
Barb Taylor
Joe Cheng
Neil Parkinson
Pete Karageorgos
- Two actuarial reports commissioned by the IBC show that the proposed 15% premium reduction would basically exceed any profits the industry had made and put the industry in a loss situation.
- Claim costs were lower fully by $1.6 billion just on a straightforward calendar-year-to-calendar-year basis between full year 2010 to 2012.
- Underwriting losses were substantially reduced, but not eliminated, to $655 million in 2012 and when you allocate investment income to it, the industry has achieved a small and positive return for 2012: about 3.3%. Effectively, it was break even in 2011 according to KPMG.
- GISA data cannot be used to measure profitability.
- There is an explanation for the difference in claims costs from 2011 and 2012. JSCP indicates and increase of $300 million and KPMG indicates of drop of $198 million. JSCP’s calculation is principally driven off premiums and KPMG is driven off capital and claims reserves. So there is a difference in investment income; there are some other differences in allocation and estimates.
Independent Brokers Association
of Ontario
Rick Orr
Randy Carroll
- Concerned that a 15% rate reduction would make the industry unprofitable and impact on availability similar to what was going on prior to 2010. Drivers would be forced into the Facility Association.
- Rates have not been coming down because of uncertainty in the market due to lack of progress around changes to the definition of catastrophic impairment and the mediation backlog. Uncertainty has now increased because of the proposed 15% rate reduction.
- There is a growing risk if the insurance companies continue to buy brokerages and remove the independents from the market.
Ontario Trial Lawyers Association
Andrew Murray
John Karapita
- Should consider using profits to provide better protection to accident victims. The minor injury cap should be increased from $3,500 but if the money in the system is used to reducing premiums then it won’t happen.
- Dispute resolution can be sped up if you improve the ability to fail those mediations where it’s clearly obvious that the dispute is so large or the gap is so wide that it’s not amenable to a mediated resolution.
- Should consider hiring some of the outsourced mediators if they’re working well, to clear through the backlog, and then, having tackled the backlog, keep them on to stay ahead of the wave.
- Provide greater flexibility for those cases where the mediation is not well suited to actually resolving the file with a lump-sum settlement.
Canadian Automobile
Association
Elliott Silverstein
Matthew Turack
- From an auto insurance perspective, regulation of the towing industry will not only help further the industry’s image; it will help prevent the tow truck industry from being used by other industries where fraud is already prevalent. Through regulation, the industry would also include a code of conduct, safety standards, training and proper oversight, not to mention consumer protection as well.
- CAA has conducted a pilot of a telematics product and surveyed its participants with an overwhelmingly positive response. The results showed that of those surveyed, 43% would consider enrolling in a telematics-driven product if they received a discount on their auto insurance. Also important to highlight is that 11% of those surveyed would enrol in a telematics program without any incentives or discounts whatsoever.
- We have seen an impact since the reforms in 2010 on the accident benefits side of the business, as well, we’ve also seen a shift, and continue to reserve as such, to the bodily injury side, from accident benefits claims to bodily injury claims.
- If we took a 15% rate reduction in a one-year period of time, it would put us into a negative underwriting profit position and it would mean that we would have very small, if any, returns from the insurance company.
Ontario Rehab Alliance
Laurie Davis
Patricia Howell
Nick Gurevich
Justine Hamilton
- The quantum of benefits seems to be too low. At $3,500, our current system offers the lowest level of protection in Canada to about 80% of all victims who, since the 2010 reforms, are deemed to have sustained a minor injury.
- Would like to see a licensing process for health care facilities that focuses on owns the business that provides the service, because the providers are largely regulated.
- Would like a person to be designated as a clinical director within a practice, and that has to be a regulated provider.
- The $2,000 assessment cap creates a situation where low cost assessments are overcompensated and complex assessments are undercompensated.
- Concerned that when the Task Force recommendations get implemented, additional barriers to access treatment are created because the early recommendations that have been implemented seem to be headed in that direction.
Monday, 22 April 2013
Insurance News - Monday, April 22, 2013
Here are the leading auto insurance headlines from ONTARIO AUTO INSURANCE TOPICS ON TWITTER for Monday, April 22, 2013:
- A British report has come out suggesting that the UK is the ‘Whiplash Capital of Europe’ with over twice the average of France, Spain and the Netherlands.
- The Texas House gave preliminary approval to levelling a $100 fine to drivers caught texting behind the wheel. However, Gov. Rick Perry, who vetoed a similar bill in 2011.
- The California Department of Motor Vehicles will be seeking public input on possible regulations of the driverless cars.
- Statistics suggest that younger Americans are driving less because they're biking and taking public transit.
- Finance Minister Charles Sousa announces budget to be presented on May 2nd. He said the budget will not announce any new tax hikes will include funding to expand public transit in Toronto and Hamilton and will move ahead this year with 60 per cent of Drummond Commission's recommendations. No mention of auto insurance rate reductions but I expect they will be included in the budget.
Sunday, 21 April 2013
Insurance News - Sunday, April 21, 2013
Here are the leading auto insurance headlines from ONTARIO AUTO INSURANCE TOPICS ON TWITTER for Sunday, April 21, 2013:
- Debate is underway in Florida regarding the elimination of no-fault. No-fault was originally introduced to address fraud so will eliminating it only shift fraud back from 1st party payer to 3rd party payer?
- Ontario Superior Court of Justice rules against the Motor Vehicle Accident Claims Fund after attempt to suspend an uninsured driver's licence for failing to repay the fund. The judge ruled that when a provincial agency denies a driver's licence to someone who has been through the bankruptcy process and who has "not fulfilled a judgment debt incurred as a result of an automobile accident," this is debt collection and is therefore in violation of the federal Bankruptcy and Insolvency Act.
- Gov. Rick Snyder and Republican leaders want to dump Michigan's unlimited coverage for severe vehicle crash injuries and replace it with a plan limiting auto insurance-funded coverage to $1 million. The governor promised that the average Michigan family would save $250 a year on auto insurance coverage.
- It seems that everyone agrees that Ontario drivers pay more for auto insurance than anywhere else in Canada. But that all they agree on as no one agrees on why we pay more.
Thursday, 18 April 2013
Insurance News - Thursday, April 18, 2013
Here are the leading auto insurance headlines from ONTARIO AUTO INSURANCE TOPICS ON TWITTER for Thursday, April 18, 2013:
- This Globe article on abuses by towing companies makes a case for regulating the towing industry which happens to be a recommendation of the Auto Insurance Anti-Fraud Task Force.
- Credit score insurance screening under review in New Brunswick where the consumer advocates wants a ban on using credit scores to set insurance premiums.
- Hudak's Progressive Conservatives insist they have a specific and tested four-point plan for lowering Ontario auto insurance rates: eliminating red tape for insurance providers, reforming the industry’s dispute resolution process, fighting insurance fraud and increasing accountability of insurance companies.
- Legislation to overhaul North Carolina's auto insurance rate approval system was rejected by a House committee as the insurance industry was divided on the proposal to allow for individual company rate approval submissions instead of a combined industry submission to the North Carolina Rate Bureau.
- A driving study conducted by the Virginia Tech Transportation Institute says that fatigue is a cause of 20 percent of car crashes, rather than the two or three percent previously estimated based on surveys, simulator studies and test tracks.
Read more here: http://www.charlotteobserver.com/2013/04/16/3985815/nc-auto-insurance-overhaul-proposal.html#storylink=cpy
Tuesday, 16 April 2013
Insurance News - Tuesday, April 16, 2013
Here are the leading auto insurance headlines from ONTARIO AUTO INSURANCE TOPICS ON TWITTER for Tuesday, April 16, 2013:
- In the U.S. texting while driving penalties harshest in Alaska (maximum penalty for a first offense is a $10,000 fine and a one-year prison sentence) and weakest in Virginia ($20).
- How big of a problem is distracted driving? The OPP says distracted driving is a factor in more fatalities than impaired driving.
- What impact with Google Inc (GOOG)’s robotic car have on auto insurance?
- Allstate in the U.S. introduces an iPhone and Android app for usage-based insurance.
- The Canadian Underwriter has an article on over-inflated charges for assistive devices costing industry a lot of money. Except the problem was addressed by Anti-Fraud Task Force and FSCO in 2012 with the Cost of Goods Guideline.
- AAA study on what it costs to drive a car in the U.S. suggests that the average cost for sedans is $9,122 yearly or 60.8 cents/mile.
Saturday, 13 April 2013
Insurance News - Saturday, April 13, 2013
Here are the leading auto insurance headlines from ONTARIO AUTO INSURANCE TOPICS ON TWITTER for Saturday, April 13, 2013:
- The Ontario legislature's Standing Committee on General Government returns to auto insurance hearings on Monday and Wednesday. I had erred on a previous that the hearings were in May.
- Presentations for Monday are found here and presentation for Wednesday can be found here.
- In advance of the committee hearings, the IBC has released two industry audits it had commissioned which shows that return on equity for Ontario private passenger auto insurance was between 3.3% and 4.9% last year.
Thursday, 11 April 2013
Insurance News - Thursday, April 11, 2013
Here are the leading auto insurance headlines from ONTARIO AUTO INSURANCE TOPICS ON TWITTER for Thursday, April 11, 2013:
- New facial recognition technology promises to reduce insurance fraud but will insurers invest in the technology?
- Something to think about when the FSCO DR system is reviewed, British Columbia’s Minister of Justice has committed to investing in Canada’s first online Civil Dispute Resolution tribunal.
- Consumers' Association of Canada in British Columbia has released a report that makes 15 recommendations to fix Insurance Corporation of British Columbia and lower auto insurance rates in BC.
- The Arkansas Senate has approved legislation to allow charging drowsy drivers with negligent homicide when they cause fatal crashes.
- Many insurers say big data promise is "overblown": according to a survey by Celent and contained in a reported titled How Big is Big Data?
- Here we go again, Standing Committee on General Government is holding public hearings on auto insurance May 28 and 30.
Tuesday, 9 April 2013
Insurance News - Tuesday, April 9, 2013
Here are the leading auto insurance headlines from ONTARIO AUTO INSURANCE TOPICS ON TWITTER for Tuesday, April 9, 2013:
- I think we all know this but here is a survey by Progressive in the U.S. that indicates most drivers are unaware they subsidize bad drivers.
- Volvo promises an injury-proof car by 2020 that use radar, sonar and other technology to prevent and mitigate crashes. That's only 7 years away.
- U.S. insurer offering technology for teens that blocks phone calls, texts, email, and other smartphone applications while the car is in motion. So will the technology actually be used?
- It shouldn't come as a shock to learn that a National Highway Traffic Safety Administration study in the U.S. shows that distracted driving deaths are on the rise.
- Oregon House of Representatives considers removing exemption for insurers from being sued under the Fraud Act which will open the door for third-party claims that insurers have negotiated in bad faith or have a “private right of action” for claims payments they believe are still owing.
- Saskatchewan General Insurance is forming a Motorcycle Review Committee after its proposal to uncap motorcycle insurance rates mes stiff resistance.
- Finance Minister Charles Sousa signals that the next Ontario budget will include provisions for auto insurance rate reductions.
- As an election approaches, Elections Ontario calls for cap on third party spending during elections as well as other reforms.
Monday, 8 April 2013
FSCO Releases A Draft Statement Of Priorities For 2013
Section 11 of the FSCO Act requires FSCO to deliver to the Minister
of Finance and publish in The Ontario Gazette by June 30th of each year,
a statement setting out the proposed priorities of the Commission for
the fiscal year in connection with the administration of this Act and
all other Acts that confer powers on or assign duties to the Commission
or the Superintendent.
FSCO has released a draft Statement of Priorities for 2013 and
invites stakeholders to submit comments on the proposed priorities and
initiatives by June 2, 2013. The draft is loaded with auto insurance initiatives which reflects the high level of activity on this file by the government over the past few years. Here is a summary of the auto insurance initiatives:
Design and implement an information
technology Enterprise Development Program
- FSCO will develop a web-based information technology system offering integrated services to stakeholders by giving them one-window access for all of their dealings with FSCO.
Respond to the recommendations
of the Auto Insurance Anti-Fraud Task Force
- FSCO is addressing several recommendations. It is working with stakeholders to develop a consumer engagement and education strategy, developing an anti-fraud hotline, and will continue to work with the Ministry of Finance to implement recommendations from the Task Force, as directed by the government.
Respond to Auditor General’s
2011 Value-for- Money follow-up audit
- The 2012 Ontario Budget included two initiatives that address the auditor’s recommendations.
- In 2013, FSCO will begin the next five-year review of the auto insurance system which will include a review of cost containment strategies and benefit levels in other provinces.
- FSCO considers several factors, including ROE, in reviewing the reasonableness of auto insurance rates filed by insurers.
- FSCO is expanding its auto insurance attestation.
Enhance auto insurance information
and analysis
- FSCO will conduct a closed claims study on third-party liability bodily injury claims in Ontario.
- FSCO will review the data available through the Health Claims for Auto Insurance (HCAI) system.
Review and implement requirements
for usage based auto insurance
- FSCO is examining key regulatory issues and working with the auto insurance sector to ensure consumers are fairly treated when implementing voluntary usage-based auto insurance rating programs.
Work with Ministry of Finance
on statutory and system reviews
- FSCO will lead a mandated five-year review of the auto insurance system and a three-year review of the auto insurance risk classification and rate determination regulations.
Develop Minor Injury Treatment
Protocol
- FSCO has retained medical and scientific experts to develop an evidence-based Minor Injury Treatment Protocol.
Work with the Ministry of Finance
to develop and implement changes to the definition of Catastrophic Impairment
Work with the Ministry of Finance
to complete a review of insurance company solvency regulation leading to recommendations
for changes to the Insurance Act
Develop proposals to modernize
disciplinary hearings for insurance agents and adjusters
- FSCO will consult on proposals to create a model that aligns with the modern disciplinary, licensing, and enforcement processes and standards used in the other sectors FSCO regulates.
Implement fraud awareness
stakeholder engagement strategy
- FSCO will expand its fraud awareness social media outreach across all its regulated sectors.
- FSCO will partner with law enforcement, the Ministry of Finance, the Ministry of Consumer Services, and industry associations in joint fraud awareness activities.
Work with other auto insurance
rate regulators on common rate filing issues and requirements
Saturday, 6 April 2013
Scarlett and Belair: The First MIG Arbitration Decision
Stakeholders and interest groups in the auto insurance
sector have been anxiously waiting for over 2 years for a ruling on what types
of impairments fall within and outside the SABS definition of “minor injury.” That finally happened with week when FSCO
posted a recent arbitration decision on a preliminary issue in Scarlett
and Belair.
Lenworth Scarlett was injured in a motor vehicle accident several
weeks after the 2010 reforms became effective in September of that year. Shortly after the accident Mr. Scarlett
submitted a disability certificate that described his injuries as various
sprains and strains to joints and ligaments of the lumbar spine as well as headaches
and acute stress reaction. The
disability certificate describes an injury that falls under the minor injury
definition.
Subsequently, a dentist reported that Mr. Scarlett also suffered
from temporal mandibular joint (TMJ) syndrome.
Later there were additional diagnoses of chronic pain and psychological impairments. Belair stuck to the original diagnosis and
insisted that Mr. Scarlett’s injuries were subject to the Minor Injury Guideline (MIG) and the $3,500 cap on treatment and assessment expenses set out
in the SABS.
The arbitrator agreed with the claimant that his injuries
were not minor and not subject to the $3,500 cap. Some of his rationale will likely make some people
unhappy.
The arbitrator noted that the SABS provided the
Superintendent with authority to issue the MIG since it is incorporated by
reference. However, he determined that
it was a non-binding interpretive aid.
As a result, he challenged the use of “compelling evidence” in
determining whether a pre-existing condition would bring a claimant out of the
MIG and not subject to the $3,500 cap.
However, this language has been pulled from the SABS in subsection 18(2)
and was not created by the Superintendent. In addition, it wasn't clear why there was pages of analysis regarding the use of compelling evidence since the test only relates to pre-existing conditions and none were discussed in the decision.
The arbitrator also suggests that without "clear legislative direction that would override" existing rules on the burden of proof, the onus is on the insurance carrier "to prove any exception to or limitation of coverage" based on a balance of probabilities. So it is up to the insurer to prove that the claimant falls under the MIG and not the other way around.
The arbitrator also suggests that without "clear legislative direction that would override" existing rules on the burden of proof, the onus is on the insurance carrier "to prove any exception to or limitation of coverage" based on a balance of probabilities. So it is up to the insurer to prove that the claimant falls under the MIG and not the other way around.
The outcome of this case was something I have been
predicting and has been a topic of some of my past presentations and
articles. I have always said that there
will be claims which begin as soft tissue injuries and become more complex over
time. Specifically, in cases such as
this one where chronic pain and psychological impairments develop. These cases should be treated initially in
the MIG but may eventually fall outside as other problems manifest themselves.
The arbitrator is correct that a “cookie cutter” approach to
adjudicating these cases is problematic.
Not all soft tissue injuries follow the same pattern or resolve
themselves in the same period of time. That was reflected in the 234-page
report of the Neck Pain Task Force in 2008 and published in the Spine journal.
The problem with the existing MIG is that it only covers the
acute phase of an injury and does not consider a possible chronic phase. The SABS does not specifically address it
either but it also does not prohibit someone who is initially diagnosed with a
minor injury subsequently being diagnosed with additional impairments at a
later date.
FSCO currently is overseeing a project to conduct research
on the treatment of minor injuries and hopefully some of these gaps will be
addressed by the project team lead by Dr. Pierre Côté.
Finally, many of the assessments conducted by the insurer were paper reviews and it appears the arbitrator did not give them much weight. This claim occurred shortly after the 2010 reforms became effective and the insurer may have had a large volume of claims to refer for a third party medical assessment as part of the process of trying to determine what injuries fell under the minor injury definition. To accomodate the volume of assessments needed the insurer may have requested a large number of paper reviews.
Finally, many of the assessments conducted by the insurer were paper reviews and it appears the arbitrator did not give them much weight. This claim occurred shortly after the 2010 reforms became effective and the insurer may have had a large volume of claims to refer for a third party medical assessment as part of the process of trying to determine what injuries fell under the minor injury definition. To accomodate the volume of assessments needed the insurer may have requested a large number of paper reviews.
Friday, 5 April 2013
Insurance News - Friday, April 5, 2013
Here are the leading auto insurance headlines from ONTARIO AUTO INSURANCE TOPICS ON TWITTER for Friday, April 5, 2013:
- FSCO's has a draft 2013 Statement of Priorities out for consultation and it is loaded with auto insurance initiatives.
- ISO has filed its first vehicle telematics-based rating rule in 33 states and received approvals in 19 states. The optional rating rule to award discounts for vehicles operated in areas safer than where they are garaged.
- Florida Senate Committee has begun looking at the possibility of replacing the no-fault auto insurance system. This is in response to a recent court decision sided with the claim by chiropractors and massage therapists that the law illegally prevents accident victims from using PIP claims to pay for their treatment.
- Did you know that being overweight may be an unexpected benefit for pedestrians and cyclists hurt in traffic accidents?
- P&C insurers still concerned about loss ratios in Ontario. Is this related to related to the Ontario product or other factors?
- The first arbitration decision is out dealing with minor injuries and it provides some direction on what injuries are covered the definition and $3,500 cap.
- The aftermath of the Florida international driving permit fiasco: newspaper ads welcoming Canadians.
Tuesday, 2 April 2013
Insurance News - Tuesday, April 2, 2013
Here are the leading auto insurance headlines from ONTARIO AUTO INSURANCE TOPICS ON TWITTER for Tuesday, April 2, 2013:
- According to CAA-Quebec the Florida law that requires that Canadians carry an International Driving Permit (IDP) has been repealed.
- Fair Isaac buys fraud detection service Infoglide Software as part of an effort to help banks and insurers uncover criminal activity.
- Another state goes to electronic proof of car insurance - Kentucky.
- Metrolinx proposes road tolls, fuel and other taxes, vehicle kilometres travelled fees and transit fare increases to pay for GTA transit expansion. Premier Kathleen Wynne says she is prepared to go to an election anytime to fight for transit infrastructure. A sure fired vote winner in the GTA.
- Ontario's doctors are calling on the government to expand alcohol harm reduction programming in the province.
Peter Kormos: 1952 - 2013
I had a lot of respect for Peter Kormos although he was extremely frustrating to work with, He was truly a maverick and uncompromising who at times was a thorn in the side of his own party. He was a socialist, populist and a excellent advocate for his many causes and beliefs - one of which was a government-run auto insurance in Ontario.
I enjoyed listening to him debate in the legislature and he had some colourful quotes which he used to describe the insurance sector. Here are some that I remember.
"Insurance companies have the proverbial short arms and deep pockets."
"The fact is that the insurance industry is an untameable beast, an uncageable monster, an unleashable mad dog."
"The governmnt has been so deep in the back pockets of the auto insurance industry that they're spitting out lint."
I enjoyed listening to him debate in the legislature and he had some colourful quotes which he used to describe the insurance sector. Here are some that I remember.
"Insurance companies have the proverbial short arms and deep pockets."
"The fact is that the insurance industry is an untameable beast, an uncageable monster, an unleashable mad dog."
"The governmnt has been so deep in the back pockets of the auto insurance industry that they're spitting out lint."
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