DAILY NEWS Nov 26, 2012 10:22 AM - 2 comments

Some anti-fraud task force recommendations need work: OTLA

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By: Harmeet Singh, Online Editor
2012-11-26

The Ontario Trial Lawyers Association (OTLA) has responded the recent final report from a task force on auto insurance fraud in the province, and while it says it’s supportive of most recommendations, some of them could use some work.

LawyerAmong the recommendations, The Ontario Automobile Insurance Anti-Fraud Task Force suggested the creation of an implementation group for tackling fraud, which would include two co-chairs - the Insurance Bureau of Canada (IBC) and the Financial Services Commission of Ontario (FSCO).  

Other representatives should include the Insurance Brokers Association of Ontario (IBAO), the provincial Ministry of Finance, the Canadian Association of Direct Relationship Insurers (CADRI) and a “consumer representative.”

But that group needs to be broader in its composition, the OTLA has argued. “It absolutely should include the legal community because we are one of the most significant stakeholders,” said Andrew Murray, a civil litigation lawyer based in London, Ont. and current president of OTLA.

Read more: Ontario anti-fraud task force calls for licensing clinics, greater power for FSCO in final report

While OTLA includes plaintiff personal injury lawyers, all lawyers should be represented in the implementation group, he said. The Advocates’ Society, for example, has several types of lawyers as its membership base and could also be included, he added.

Other organizations, such as those representing frontline treatment providers, should also be included, Murray said. “I’m a big believer that when you see a problem, you don’t always need to ask the CEO how to fix the problem; sometimes you can ask the guy who’s grilling the hamburgers.”

Another of the task force’s recommendations included implementing a $500 fee for missed medical examinations. The intent is likely to dissuade fraudsters who know their false claims would likely be caught in a defence exam, but there are already measures in place to penalize uncooperative claimants, Murray said.

“We say that the penalties are already adequate and that this would be an unnecessary punitive measure,” he said.

CollisionOTLA also said FSCO should “accelerate its current review of auto insurance profits and high premiums levels.” Following industry reforms in September 2010 aimed at reducing fraud, premium levels should logically have changed, Murray said.

Read more: Auditor general's report puts Ontario auto insurance in the political spotlight

The topic was also touched on by the Auditor General’s annual report for 2011, he noted. It’s important to look at the industry’s premiums and analyze what effect those 2010 reforms have had on premiums, he noted.

What’s critical for OTLA is that legitimate claimants aren’t negatively affected by efforts to target fraud.

“I think generally we all want fraud to be eliminated from the system,” Murray said.“What we certainly don’t want the public to take away as a message is that the whole system is filled with fraud and every claim needs to be eviscerated or scrutinized because that’s really, really doing a disservice.”



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Ona

FAIR (Fair Association of Victims for Automobile Accident Reform) main objectives are to educate consumers and actively advocate to improve the way claimants are treated under legislation. Fair treatment includes the issue of the quality of the independent medical exams that claimants are required to attend and the reports that stem from them. Substandard or biased IMEs are far too often used to disqualify legitimate claimants. Consumers expect that their legal representatives will scrutinize those IMEs and take action to stop this unfair and deceptive business practice so that all accident victims are fairly treated. These flawed reports often go unchallenged in our courts and the medical professional is allowed to continue to do the business of IMEs without sanction. The task force suggestion that the Colleges continue with oversight of their members who write third party reports is not going to be enough. Any implementation group is going to have a lot of work when College oversight is weak and not transparent. Consumer representation on any of these panels in the future is a must if anything is to improve. Profits for insurers go up and the quality of IMEs and access to treatment continue to fall. Things need to change and consumers need a louder voice.

Posted November 26, 2012 01:38 PM


Brian

Isn't there a newly formed consumer group (FAIR) in Ontario that made a submission to the Standing Committee Hearings on auto insurance matters as well as to the Task Force? Surely such a goup would be at least as "significant" as OTLA in terms of discussions around implementing recommendations intended to improve the quality of IMEs/IEs? After all - these people are the subjects of the assessments. So should't FAIR be the "consumer representative" at the implementation table? And yet Mr. Murray hasn't mentioned FAIR - leaving Ontarians to wonder if OTLA supports FAIR? Does Mr. Murray have some other "consumer representative" in mind?

Posted November 26, 2012 12:48 PM


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