DAILY NEWS May 28, 2012 5:35 PM - 10 comments

Claims costs for Ontario auto insurers "still out of control": IBC

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2012-05-28

Claims costs for Ontario auto insurers remain high despite the gains realized as a result of the provincial reforms in 2010, notes the Insurance Bureau of Canada’s (IBC) submission to the Ontario Committee Hearings on Auto Insurance on May 28.

“While the September 2010 reforms were a needed first step in reducing the pressure on no fault injury costs, claims costs are still out of control,” IBC’s vice president for Ontario Ralph Palumbo told the hearings.

The Standing Committee on General Government passed a motion Apr. 16 to strike the select committee, which is holding public hearings to propose recommendations to the minority government.

Palumbo listed four reasons why claims costs remain high, namely mediation backlogs, an increase in catastrophic injury claims, an increase in bodily injury costs and the persistence of auto insurance fraud.

“First, there is an excess of 30,000 unresolved claims cases awaiting dispute resolution at [Financial Services Commission of Ontario, FSCO] and these have undetermined costs,” Palumbo said. “Depending on how these cases are decided, it could re-ignite the accident benefits costs spiral.

“I cannot stress strongly enough how this backlog is a major risk to insurance premium stability. Claimants don’t know what their benefits will be and insurers don’t know how much their claims are going to cost.”

Second, Palumbo said, the number of catastrophic injury claims is rising faster than other claims. Between 2004 and 2010, the number of no-fault injury claims rose 28%, while the count for large claims has more than doubled.

Hospitalizations from motor vehicle accidents are down 12% and yet auto insurers are being presented with many more catastrophic injury claims, Palumbo said. “This is a mystery.”

Third, bodily injury (BI) claims costs on the tort side are increasing rapidly. Palumbo said latest available figures show that the frequency of these claims has been rising, as has the average claims cost. BI claims represent more than $2 billion in annual costs.

“It is very concerning that the volume and average cost of these types of claims appear to be rising so rapidly, Palumbo said. “BI is on the same track accident benefits were before the 2010 reforms and more needs to be done to assess the causes and what can be done to alter this concerning trend.”

Finally, fraud persists in the Ontario auto insurance system.

“Many [insurers] are currently in the process of preparing responses to a FSCO [Statutory Accident Benefits Schedule] questionnaire about their internal practices to address fraudulent and abusive claims,” Palumbo said. “Companies have taken significant steps to enhance their claims management process — for some companies this has meant wholesale restructuring of their claims departments. As well, consumers are becoming more educated.

“We want to continue this momentum because society as a whole will benefit from fighting this crime.”



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Reader Comments

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Susan

Strange that Mr. Paulumbo claims that costs are "out of control" but if you read the minutes of the actual presentation, he provides no data post-September 2010 regarding costs per claims. In fact when pressed by the committee, he seemed fairly evasive in terms of presenting any acutual numbers to back up this claim. Still more spin and no substance by one of the most powerful lobbyists in the province. At least they have finally dropped the 1.3 billion number as it relates to fraud now that the task force has come out saying that there is no actual evidence for that figure. How long did IBC spout that number as justification for giving legitimatly injured accident vicitms a hard time?

Once again, more spin. Hospitalizations down 12%? What is their definition of hospitalization? Does this mean rehab? Why does IBC and FSCO insist on using hospitals as a filter for benefit entitlement. Why do they want to exploit the gaps in public resources for injured persons who can not get into rehab beds due to wait lists and regional access issues?

I have seen several clients on my caseload who were not cat at first but, due to lack of early intervention, denials of treatment, bad IE's from "hired guns", they just got worse over time and then apply for cat. Increased depression, anxiety and chronic pain. It is the overly adversarial system that makes these people sicker and IBC needs to start looking in their own backyard before pointing fingers.

Posted June 7, 2012 04:33 PM


Ona

The industry needs to clean up it's own backyard before pointing fingers randomly at others, the fraud begins with those numbers of claimants at FSCO and asking how they ALL were disqualified by their insurer. Can they all be fraudsters? If not then how did they all end up in that line, bad adjusting? Or is it tainted medical reports by preferred vendors? Either way, the insurance industry must clean up their adjusting practices and treat policy-holders fairly, ultimately its costing everyone when claimants must fight for every dime for treatment or benefits, it prolongs recovery and it increases costs.

Posted June 3, 2012 07:12 PM


Ibrahim Abaza

Perhaps nothing is getting resolved because our judiciary system did not get on board with the changes needed in the insurance legislation.

Until today judges and arbitrators seem to find a way of stretching definitions of threshold, and they often pressure litigation adjusters to settle non threshold claims.

Until the courts agree to hold the line, they will defeat any new legislation that is introduced or will create loopholes that will render new legislations useless.

Posted June 1, 2012 11:32 PM


peter

Government doing the insuring? Think OLG, E-health and the ongoing increases in our electrical costs due to political stupidity. I don't think I need to say more!

Posted May 30, 2012 03:52 PM


Frank Cain

Your posted readers take delight in trashing the insurance industry rather than coming up with suggestions to make the system better. They obviously are unaware that the auto insurance system in Ontario is under the thumb of FSCO and the watchful eye of the critics who in their own way can deliver verbal abuse without positive ideas that might make a difference.

In truth, with the reform of Accident Benefits now nearly two years old and with no ideal settlement of the former difficulties abated, there is only one recourse for auto insurance in Ontario and that is the transfer of liability and Accident Benefits to the Government with a maximum assigned limit of $200,000. The balance of coverage would be the role of private carriers.

As a 61-year career insurance guy (that's not my age!), my observation has been without interruption that auto insurance in Ontario has never worked. That is not a concession to defeatism but simply a statement born of the difficulties auto insurance has represented to the insurance companies and in a less consequential way, to insurance buyers, whose unfortunate handicap about any insurance is that they simply do not understand how the transfer of a financial loss works. That is not meant to pander sympathy. Insurance, as opposed to the mystery surrounding electricity that confounds the most intelligent mind, and notwithsatnding that it grew from its root first planted in Babalonia, is as basic a business proposition is as possible to attain. Yet, it is in a no small way that the lack of understanding of the insurance principal has infected the industry because of the hatred, if not only abuse, to which it has become a victim.

It is now crucial that auto insurance in Ontario be made a utility of the Government (as above) as it can now be clearly seen that any attempt to alter the onus of liability away from the wrongdoer is antagonistic to the private enterprise system. Added to this can be the futile attempt by a reduction in coverage to address realistic consequences of a motor vehicle accident. In essence, there are far too many factors at work to return auto insurance in Ontario to a program of tort liability, maintained by private carriers, any more than there is viability in the control of claims for injuries under the present system.

The right to drive an automobile in Ontario is a function santioned by the provincial Government. The licensee is granted a privilege. It is not god-given, nor is it earned under the misconception of a civil right.
The laws governing the operation of a motor vehicle are contained in Acts imposed by Government and any infration of those laws will be brought to bear upon the miscreant. The right to be licensed as a driver can be rescinded by the same Government by virtue of contolling laws. Reinstatement of that license can be restored provided the Government deems so. It is the same Government that controls the workings of auto insurance in Ontario through its various agencies, with the provision of insurance transferred to private industry and therein lies the difficulty.

Auto insurance as exisitng in Ontario, is anathema to any business under private control. In its present form, it would be laughable as a tradable commodity. It's shareholders, looking for profit on investment, being less concerned about reduced premiums than expecting to grow wealth on their money. Pure underwriting results creating a loss spiral only rescued by wise and stealth-led investment. Profit depending on the cutting through of high loss experience by increased premiums thwarting any dependence on client continuity to offset dollar output.

To any mind of a normal business nature, even a casual one, it should be obvious that the mix of governmental rule and private enterprise is a bad one indeed for the successful operation of an auto insurance system. Any argument against the initial involvement of government would have to present irrefutable processes to prove the point. In view of the announcement that the reforms to Accident Benefits are in question and that the industry would appear to be in peril, I can not see that happening.

If my 61 years in the insurance business (company, then brokerage) has proved anything at all, is it that auto insurance has metamorphosed into a system attempting to satisfy all obligations against all possible odds, that has failed.

Good luck!

Frank Cain

30

Posted May 30, 2012 11:13 AM


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