Ottawa's unjust approach to disability insurance

Creation of a new, inadequate Social Security Tribunal was a cut to federal disability insurance by stealth, at the expense of the most vulnerable.

Dreamstime

People with permanent disabilities who cannot return to work already struggle with very low payments from the government, write Jackie Esmonde and Marie Chen. And a new tribunal system has only made matters worse. 

By: Jackie Esmonde Marie Chen Published on Fri Sep 12 2014

 

Imagine you have a car accident. You file a claim with your insurance company for the damage to your car. Three months later your claim is denied with little explanation. You appeal the decision, but the bureaucratic process takes years because the insurance company does not hire enough adjusters to handle claims. After raiding your savings to cover the repairs and going through three different levels of appeal, your claim is finally granted — but they only give you a fraction of the actual cost of the damage.

No doubt this process would leave you questioning the worth of buying the insurance and the fairness and good faith of the company. You might conclude the entire process was set up to prevent you from getting paid in the first place.

Recent actions by the federal government mean people who apply to Canada’s long-term disability insurance program face precisely this process. But unlike car insurance, CPP-Disability is social insurance. It provides income support to people with significant disabilities who have paid into the system through their and their employer’s contributions. It’s an important source of income for many Canadians with disabilities who are no longer able to work.

The Canada Pension Plan is well-funded, with net assets over $180 billion from contributions and returns on investments. None of CPP’s funding comes from taxes. Yet government has made accessing CPP-Disability harder, not by changing the already-stringent rules of eligibility but by creating a new and more onerous administrative process for appeals. Appeals are important because they catch mistakes. Under the old process, almost half of appeals were ultimately granted.

But the federal government has created a new body to deal with appeals. The Social Security Tribunal now hears all employment insurance, CPP and Old Age Security appeals, taking on the work of four previous tribunals. After opening its doors just over a year ago, the tribunal already has a backlog of almost 10,000 cases.

The government’s legislation actually prevents the tribunal from employing more than the equivalent of 85 full-time decision-makers to hear appeals from all of these programs for the entire country. This is a severe reduction from the number of adjudicators in the previous system. And even this limited number of positions has not been filled.

If cases continue to be heard at the current rate, it will take almost 30 years to clear the backlog. Even if the tribunal picks up the pace, it will take many years. Undoubtedly there are people who will die before their appeal is ever heard.

But lengthy delays and the cumbersome process are not the only problems. The federal government has also changed the rules so that people making claims no longer have the right to a hearing. An adjudicator can deny your case without ever seeing or talking to you. Some lucky enough to get a hearing have been told to travel hundreds of kilometres just to be heard by video conference.

People with permanent disabilities who cannot return to work already struggle with very low CPP-D payments — a maximum $1,200 monthly and $850 on average. The new tribunal system has only created more barriers for people with serious and prolonged disabilities.

And the federal government introduced these changes without warning or consultation. The creation of the tribunal was buried in the 2012 omnibus budget and the rules governing hearings were made public during Christmas holidays.

As legal clinic lawyers, we’ve seen the devastating impact of these changes.
After two accidents, one of our clients suffers from extreme pain and has a brain injury. He applied for CPP-D in 2012 when he could no longer work and is still waiting for his appeal hearing. Meanwhile, he has spent almost all his savings. The tribunal has told him he cannot count on a hearing within a year.

Many others have been waiting even longer. Without an income, some will lose their homes, go bankrupt or be forced to rely on social assistance. They all paid into CPP-D with the expectation they would have something to fall back on if they could no longer work because of disability. Sadly, they were mistaken.

The creation of the Social Security Tribunal was a cut to CPP-D by stealth, at the expense of the most vulnerable in our society. If this was private insurance, would you buy it?

Jackie Esmonde and Marie Chen are lawyers with the Income Security Advocacy Centre, a legal clinic that engages in litigation, community organizing and advocacy to fight poverty and improve income security in Ontario.


Source: http://www.thestar.com/opinion/commentary/2014/09/12/ottawas_unjust_approach_to_disability_insurance.html

CPP Disability Benefits - realm of dishonesty

February 24, 2014

Via Facsimile: 1-855-814-4117

Social Security Tribunal

Attention: General Division (IS)

PO BOX 9812, STN T CSC

Ottawa ON K1G 6S3

Re: January 15, 2014 Client Identification Number - xxxxxxxx

SIN #xxxxxxxxx

Dear Social Security Tribunal:

I acknowledge receipt of a decision by Service Canada dated January 15, 2014 denying my CPP Disability benefits. Please accept this letter as my formal appeal to that decision.

My first application for disability benefits was in 2008. I was told I would not receive disability benefits because my case would have to be resolved first. My Doctor did not fill in the first medical report in my claim for Disability Benefits in 2008. (My doctor has since filled them as you know.)

My conversation with Service Canada further verified at that time, that my application did not have to be filed at that time “ we will look into your entire file when we make a decision” , “funds would be retroactive to 2008” “when I reapplied at a later time”.

Both our lawsuits were unable to receive justice from the justice system in 2010. To be clear, the crash was not my fault and we were not justly compensated, we were burned by the insurance system and the justice system. Our lawsuits were concluded by a forced settlement due to the FSCO backlog and fraudulent pay for hire doctors, and much of the same conduct that Service Canada has been providing and supposing.

Service Canada is fraudulent in their letter of January 15, 2014. The excuses for denial of benefits fail to provide any reasonable valid reasons.

Health Canada Says: “According to your doctor you received a sprain to your neck and back and receive pain”. Why is Service Canada downplaying my injuries?

Many disability certificates and doctors reports as you know from 2007 – 2010 say different.

“WAD III” , “Associated ICD-10-CA code for injuries and sequelae that are the direct result of the automobile accident Code numbers: F39, F41, G44, R51, S034, G47, M545, S33, M546, M6261, S49, R41, S19, Z56, Z723, Z733, Z736, M501, S234, S8340, F067, S9351”.

The Diagnostic imaging Report in 1999 states: “Early degenerative disc desease at C6-7”

In the March 28, 2012 Psychological Legal Assessment Report by xxxx and xxxx states: “Moderate Major Depressive Disorder, PTSD in partial remisssion”, “we are of the opinion that this man suffers permanent and serious impairment with respect to overall psychological functioning”.

Page 1 of 22

Health Canada Says: “I have the ability to do sedimentary work”.

Report dated March 12, 2012 by xxxx Occupational Therapist / Director states the following: “Mr. xxxx is completely disabled for any occupation to which he is suited by way of his education, training or experience”.

Even for the healthy and uninjured finding work in our area- is very difficult, if not impossible.

The Niagara area reports highest unemployment rate in Ontario.

According to Niagara this weeks newspaper article January 16, 2014

“NIAGARAS UNEMPLOYMENT RATE HIGHEST IN ONTARIO.”

Add to the resume that you are a 53 year old 3^rd generation truck driver with nerve damage in my spine and can’t drive much because of the pain, etc., then add to the resume you have limited education from 12 grade schools, reaching a level of only grade 9. What is suitable, available, work for me?

The imaginary laptop that Service Canada mentions in their denial letter January 15, 2014 was never provided by my insurer.

Service Canada comments about work are unfounded and as you know I have been thoroughly investigated by doctors, therapists, lawyers, and insurance investigators at a great cost.

As you know I was in the Insurance fiasco for 6 years and cooperated with all interrogations (eg; rehabilitation, work hardening, multi disciplinary assessments, situational assessment etc.). I tried to go back to work after the crash, on my own, and was unsuccessful. The issue of work has been answered at great physical, mental, and financial lengths.

In the Service Canada Denial letter of January 15, 2014 it states the following to establish denial of benefits:

(1)- “in 2011 you were provided with a utility tractor for you outdoor maintenance.”

(2)-“This tractor included a backhoe and a loader.”

(3)-“This work activity would be indicative of capacity for suitable work”

I WAS NEVER PROVIDED WITH A TRACTOR WITH A BACKHOE FROM MY INSURER

Service Canada is fraudulent in writing that I did. According to E. Chase- Medical Adjudicator, Service Canada letter of January 15, 2014 she writes:

“According to the occupational therapist in 2011 you were provided with a utility tractor for you outdoor maintenance. This tractor included a backhoe and a loader.”

How could a medical adjudicator have written such an uneducated sentence?

If E. Chase- Medical Adjudicator had given my application the attention it deserves than he/she would know of the attached copy of the file management log by Vista Disability (the assessment mill).

The log will prove the assessment mill getting instructions from my Insurance adjuster (xxxx -xxxx Insurance) to deny this device. His instructions to the Occupational Therapist were Pryor to his examination (interrogation) at our home.

My adjuster xxxx says in the log: “he would like the OT to go to the home and address the OCF -18 regarding a tractor for approx $25000.00. Advised OCF -18 would be denied next week so Ax in week of Nov 14^th”.

The Occupational Therapist xxxx then came to our house to write the denial report as he was instructed and agreed upon (“xxxx called and confirmed Ax”).

Page 2 of 22

The following will provide even more evidence to prove that I WAS NEVER PROVIDED WITH A TRACTOR WITH A BACKHOE FROM MY INSURER:

The assessment mill excerpt below, and email attached, will show that even after my insurer received the paid for hire doctor report it still wasn’t good enough for my insurance adjuster xxxx of xxxx Insurance.

Email #1states the following:

From: xxxx

Sent: November 28-2011 3:08 PM

To: xxxx

Cc: 'xxxx'

Subject: xx – OT OCF-18 In-Person – (Kaine) – due ASAP

“Green highlights are revisions for xxxx. Due to the adjuster – ASAP. xxxx mentioned xxxx would like to see this report, so I have copied her.”

Email #2 states the following:

From: xxxx

Sent: December -02-11 9:03 AM

To: 'xxxx'

Subject: RE: xx – OT OCF-18 In-Person – (Kaine) – due ASAP

Follow Up Flag: Follow up

Flag Status: Red

“Hi xxx, xxxx has reviewed and approved the revisions. The final is saved to the claimants folder.”

As you know the tractor that is mentioned above and in the Service Canada denial letter of January 15, 2014 was explained in the xxxx OT submitted treatment plan of May 4, 2012.

As the report states the tractor was to enable me to:

(1)- “to maintain his 1.5 acre property.”

(2)- “The recommended tractor is anticipated to minimize the effects of Mr. xxxx functional losses.”

(3)- “the client would be able to pace himself”

(4)- “is best suited to meet his property maintenance needs”

If the purpose of the tractor was for work (it wasn't according to the treatment plan above), and if I had received this assistive device from my insurer (I didn’t as proved above), I would still need funds to buy equipment to haul the tractor. A truck and trailer etc. would be necessary. Then even if the money fell from the sky to provide these funds then I would need to get training, and licences, and insurance, to operate the tractor/backhoe as a business.

Then I would need to find work in an area that has “the highest unemployment rate in Ontario.”

Most of all I would then need the health and stamina that I do not have because of the injuries I sustained in the fatal crash of 2007.

Page 3 of 22

How can a Medical adjudicator have concluded that I can work driving something?

If Service Canada had completely read my medical file then they know I am limited in driving because of my injury’s sustained in the crash.

The Psychological Legal Assessment Report dated March 28, 2012 states the following:

“He is incapable for psychological reasons of returning to any work that involves driving, and clearly is incapable of returning to his lifelong profession as a driver.” “This also poses a barrier to work in general, as he is avoidant of leaving home due to fearfulness in the car.”

Why would Service Canada deny my claim for a benefit I am clearly entitled too?

If I had to make some guesses why a Service Canada Medical Adjudicator would act unreasonable I would guess that it’s because they know I am an outspoken critic of the track record to receive CPP Disability benefits and write a blog about Service Canada and the Insurance industry.

Could the reason why Phyllis Brodie, Medical Adjudicator- Service Canada denied my Disability benefits was because Service Canada did not like my fax letters?

Would a Medical Adjudicator act unreasonable toward me because I filed a complaint to the Collage of Physicians and Surgeons of Ontario about a doctor pay for hire interrogation?

Would an insurance decision maker be biased as to my claim for benefits because I have written letters to FSCO on what I have learned about Insurance industry practices?

Maybe why a Medical Adjudicator would act unreasonable is because as they know I am an active member of Fair Association of Victims for Accident Insurance Reform, and publicly disputed an IBC advocates remarks.

I don't know why I have been denied Disability benefits but there is enough evidence to establish that Service Canada did not read my health file prior to making a decision to deny my CPP Disability Benefits, or they did read my health file and are committing a crime.

In the case of the latter we are enquiring an investigation into the following individuals that work for Service Canada:

(1)- E. Chase Reg. N, Medical Adjudicator, Service Canada.

(2)- L. Cuthbert, Benefits Officer - Service Canada.

(3)- Phyllis Brodie, Medical Adjudicator- Service Canada.

The quality of health care is in crisis. The white coat black art podcast at CBC radio episode December 27, 2013 states: “We have to make partners out of patients because I will help keep you from making catastrophic medical errors if you just let me be on my own care team. The hazards would be far fewer if we were like pilots. We're passengers in our own plane.”

“This means I am let in on the conversation so I may be informed and I may help correct the human mistakes Doctors are so destined to make”.

My insurer has deleted files in my file at HCAI. There have been assessment mill errors writing the records for the doctors, errors by doctors, and even anonymous access to my medical file at the HCAI online database. Now Service Canada has altered my health file to provide false representation.

Page 4 of 22

Phyllis Brodie, Medical Adjudicator- Service Canada has admitted that “we know you cannot work” in her denial letter of July 16, 2013.

Again, how can Service Canada write “we know you cannot work”, and at the same time deny my disability?

Service Canada and the Insurance industry have made me feel that I have entered a world of unicorns leprechauns and magic beans. There should be legislation to protect the most vulnerable in our society.

Obviously there is something wrong if a crash victim must be put threw a process that is designed to fail. It’s very disturbing that Service Canada can deny a claim without even speaking to a claimant. Saying in denial letters “we tried to contact you” without even a phone message - is not trying.

Injured victims deserve better treatment.

Service Canada does a lot of imagining in denial letters. But as you know the 18 year old boy that was speeding, and passing on a solid double line, and blind hill, that hit me head on, at 102 km per hour,

taking off the front wheel, and making me roll 8 times, with the airbag going off in the side of my head at a force twice as powerful of that of today’s cars, and hit a tree, and was trapped upside/down in the twisted seat, has left me with severe and prolonged injury’s.

Doctor Report date Feb 10^th 2012 states:

“Cervical Spine (July 17^th , 2007) –C6-C7 and C7-T1 disc spaces can not be commented on secondary to obstructed view.”

“MRI (September 2008) 1 year post MVA and C-Spine x-ray:

Degenerative Disc Disease worse at C5-C6

-Moderate spinal canal stenosis c4 c5

-Bilateral neuroforaminal narrowing C3-C4

\-C6-C7moderate to severe right rear frontal narrowing and moderate left rear frontal narrowing”

“suffered significant LONG-TERM and PERMINANT disability secondary to the motor vehicle crash on July 17^th 2007:

1. Chronic Myofascial Pain Syndrome of the Neck.
2. Chronic Myofascial Pain Syndrome of the Trapezium.
3. Chronic Mofascial Pain Syndrome of his shoulders Bilaterally.
4. Biceps Tendonosis in his left shoulder.
5. WADS lll of his neck
6. Occipital Neuralgia;
7. Cervical Degenerative Disc Disease and Canal Stenosis”,

“obvious degeneration and disease in Mr. xxxx spine”,

“at least 60- 70 % of his pre-accident function”,

“it is medically sound to conclude that Mr. xxxx suffers form Degenerative Disc Disease in his Cervical Spine, as well as debilitating MyoFascial pain syndromes in his cervical spine trapezium and Bilateral shoulders”.

Page 5 of 22

The reality is that I suffer in constant pain, and I wonder what it would be like, to not have to fight for years in a realm of dishonesty, for the rights and security I paid for all of my adult life.

I do not belong in your world please conclude this conflict as it is detrimental to my recovery.

Please accept this Notice of Appeal to the tribunal as instructed by the Service Canada letter of January 15, 2014. I kindly ask that CPP Disability Benefits be granted without further delay, denials, and fraudulent conduct.

Please acknowledge receipt of this correspondence.

I look forward to hearing from you in this regard, as soon as possible. Thank you.

Sincerely,

Mr. xxxx

* I would like to thank my wife for making this letter intelligible and supporting me emotionally, physically, and financially,

with her part time job since the crash in 2007.

Attachments First Mailings:

-File management log xxxx Disability February 8, 2012

-xxx - xxxxxxx December 12, 2011

-Cpp Decision -July 16, 2013

-Cpp Decision -January 15, 2014

-Cpp Decision -February 5, 2014

-pictures of crash

First mailings March 2014:

Cc: Dr. xxxxx

Cc: Rhona DesRoches, Board Chair - Fair Association of Victims for Accident Insurance Reform

Cc: Phyllis Brodie, Medical Adjudicator- Service Canada

Cc: E. Chase Reg. N. Medical Adjudicator – Service Canada

Cc: A. Trudell, Benefit Officer - Service Canada

Cc: Surviving a Collision Blog

Page 6 of 22



REMOVED PAGES 7- 22



 











File management log blow proves claim above that adjuster sent OT to home of claimant to deny tractor.

 

ADD YOUR COMMENT

Reconsideration of the decision to deny Canada Pension Plan Disability

Dear Service Canada:

We have not had any correspondence from you in regards to my reconsideration of August 13, 2013 that you acknowledged in your letter of September 27, 2013.

You have been ignoring my letters to Service Canada as well.

My request for an appeal in my letter of January 21, 2013 was ignored.

There was no Acknowledgement letter of the appeal for my application of May 21, 2008.

If you continue to deny and delay your office will be subject to further public scrutiny’s that are being duplicated and broadcasted to online sources.

Please act according to the regulations and take my case more seriously.

I will take a louder voice if you continue to deny my application for a benefit I am clearly entitled to. What is it going to take to be fairly treated? Will I have to Cc everyone in the house of commons and get on the news!

The most important inquiry to you was four months ago when I asked you to please explain how you can write “we realize that you cannot work now.” and at the same time deny my application.

I kindly ask that you respond to my inquiries relating to my application so I can get on with my recovery and have the funds to pay for my medication at $435.05/ month.

Be advised we do not answer the phone because of persistent calls from collection agencies. You will need to leave a message and I will return your call.

Page 1 of 2

Please acknowledge in writing:

1. Answer my inquiry letters sent to you in 2013
2. The status of the appeal of my application of May 21, 2008
3. The latest reconsideration status

Looking forward to hearing from you as soon as possible in this regard.

Thank you.

Sincerely,

xxxx

Page 2 of 2

HCAI Security Breach

The definition for the HCAI has been defined in the 2013 Annual Report of the Office of the Auditor General of Ontario. HCAI is an online database and billing portal to which health-care providers are required to submit billings for injury claims before they are forwarded to insurers for payment.

According to the Privacy statement on the HCAI website ( http://www.hcaiinfo.ca/Media_Public/Privacy.asp ) health Claims for Auto Insurance Processing (HCAIP) is responsible for the operation of the electronic processing system (HCAI) for automobile insurance claims. This system allows health care facilities and insurers to communicate with each other by facilitating the transmission of Ontario claim forms (OCFs).

The HCAI system contains sensitive personal health information. Protecting this information is the job of HCAIP. In order to protect the confidentiality of personally identifiable information (PII) HCAIP commits to maintain appropriate technical and administrative safeguards to protect the data in the HCAI system and any third parties that HCAI contracts to take prompt action in the instance of a privacy breach and protect PII from unauthorized disclosure in paper, electronic or verbal format.

So after reading about the HCAI you would think our personal information is protected, right?

The following document shows that there was in fact a breach of security at the HCAI online database on November 14, 2011.

Clearly the Access to a claimants file in the database by the “Anonymous Web User” logged in to the SecureDox HCAI online database justifies an explanation by its administrators at the HCAI system, and the IBC.

How has an Anonymous user logged into the HCAI online database been allowed to download personal health information?

It doesn't surprise me that our personal health information is at risk by the powers that be.

Insurance Doctors ( wordhirlings) interrogating victims of crashes using their personal computers. Using unsecured email to transfer our personal health information to unsecured servers.

Why is there no legislation to force our personal information be deleted from all the Laptops filled with claimants personal files that wordhirlings bring to the interrogation rooms. And all those emails sent back and forth between the assessment mills and interrogators.

Who monitors our personal health information,  transferred so freely and unsecured, from so many different sources?

Administrator,

Surviving a Collision.

Surviving a Collision

07/17/2007 7pm @ 7th street

I was coming home from work in my boss’s car. 
The truck I have been driving was in for service so he let me use his car to get home.

I was doing the speed limit traveling on a narrow country road I used often. 
When I was about 60 feet from the crest of a blind hill, suddenly there were two cars traveling towards me, side by side. One car was in my lane.

There was no where for me to go!...

http://survivingacollision.blogspot.com/2014/04/surviving-collision-full-story.html