Social Security Tribunal says more than 14,600 Canadians are now waiting for a hearing

Social Development

Mr. Robert Aubin (Trois-Rivières, NDP):  

    Mr. Speaker, on Tuesday the chair of the Social Security Tribunal confirmed that there are significant delays in the processing of cases: 14,677 cases are languishing on her desk.

    At this rate it will take 11 years to clear the backlog just for the income security section. That is shameful. For over a year, Ms. Brazeau has been in regular contact with the minister about the lack of staff at the tribunal, but the minister is asleep at the switch.

How can the minister allow such an administrative nightmare?

Hon. Jason Kenney (Minister of Employment and Social Development and Minister for Multiculturalism, CPC):  

    Mr. Speaker, thanks to my department's efficiency, we have seen a 90% decrease in employment insurance appeals. That means that almost 90% of cases are handled by public servants, without appeal. The service is quicker.

    In the case of Quebeckers, the Government of Quebec has its own appeal process for benefits paid by the Quebec pension plan, which does not fall under the Social Security Tribunal.

[English]

Ms. Jinny Jogindera Sims (Newton—North Delta, NDP):  

    Mr. Speaker, yesterday, the chair of the Social Security Tribunal told the human resources committee that she had been in continuous contact with the minister regarding the backlog. Yet, for 18 months now, that backlog has continued to grow, while the tribunal has been understaffed and working without performance standards. More than 14,600 Canadians are now waiting for a hearing.

    Why did the minister not take action sooner to address the enormous mess at the Social Security Tribunal?

Hon. Jason Kenney (Minister of Employment and Social Development and Minister for Multiculturalism, CPC):  

    Mr. Speaker, again, in fact our ministry did take action by introducing a new approach toward reconsideration of EI refusals. That now happens quickly, by a public servant who, remarkably, actually picks up a phone and calls the person who has asked for a reconsideration, and sorts it out, often getting additional documentation.

    This means that we are now resolving about 90% of those refusals at a reconsideration stage in a matter of weeks, without having to go through a lengthy multi-month quasi-judicial process.

    In terms of the CPP cases before the tribunal, we are adding additional decision makers and taking other administrative measures to speed up the process.

Mr. Mike Sullivan (York South—Weston, NDP):  

    Mr. Speaker, behind every one of those numbers is a person who needs to put food on the table and pay the bills.

    People cannot wait years for the government to get its act together. Nearly 10,000 Canadians still waiting for an appeal are living with a disability. In many cases the uncertainty and stress of financial insecurity makes their medical conditions worse.

    Will the minister commit to eliminate the backlog and finally give these Canadians the justice they need and deserve?

Hon. Jason Kenney (Minister of Employment and Social Development and Minister for Multiculturalism, CPC):  

    Yes, I will, Mr. Speaker. That is, in part, why we have legislation before the House in the budget implementation act, which we hope the NDP will support. This would allow us to hire up to an additional 22 decision makers at the tribunal. 

    I am very pleased to highlight that the faster informal reconsideration process for refused EI applications means a 90% reduction in the caseload for EI, meaning we can reallocate those decision makers over to the income security division. This means we will get at that backlog of cases so we can provide the kind of service that Canadians expect and deserve.

Source: http://www.parl.gc.ca/HousePublications/Publication.aspx?Language=E&Mode=1&Parl=41&Ses=2&DocId=6781650#Int-8510994

Insurance model 'scandalously dishonest,' says FAIR

Insurance model 'scandalously dishonest,' says FAIR

As debate over Bill 15 continues at Queen’s Park, one accident victims’ group is advocating that the Colorado Model of Assessors be adopted.

“The Colorado Model of Assessors just might move Ontario’s insurance industry from a scandalously dishonest and bullying business model to a more functioning system,” says Rhona DesRoches, the board chair for the fair association of victims for accident insurance reform (FAIR). “If you reward Ontario’s insurers existing bad behaviour by making it less costly to behave badly we will not be further ahead and the life of accident victims will be even more stressful and harmful.”

Describing the Colorado model as a “highly successful and cost saving program,” DesRoches has been at the sharp edge of the sword slamming Bill 15 for what her association describes as the first step towards insurers becoming less accountable and less willing to honour contracts with auto accident victims.

“While we are sure that is not the legislator’s intent, it certainly will be the result of passing Bill 15,” says DesRoches. “Insurers will be less likely to stand behind their contracts and victims will be further victimized and marginalized without fair access to our courts – everything Ontario’s insurers need to increase profits.”

DesRoches specifically took aim at testimony from an Aviva representative who recently spoke at the Bill 15 hearings.

“Legislators heard from the Aviva representative at the hearings on Bill 15. Most shocking is the fact that any insurer is paying out such substantial sums for defending against claims, 44 million dollars in just 2013 alone,” says DesRoches. “This is just one insurance company paying an average of $7,719.30 in legal defence costs per claim - well above the average amount paid to claimants in 2013.

“So is there a cure for this dysfunctional and bullying insurance system we have? We don’t know but we think that holding insurers accountable when claims are wrongfully denied and cleaning up the medical opinions (on which the denial is based) would be a positive first step.”

DesRoches cited an HCDB (Health Claims Data Base) report where insurers paid out an average of $4,745 ($3,934 - $5,557) to injured MVA victims in 2013.

“The amount paid to victims in the first 6 months of 2014 was a mere $1,790 per claim,” she says, “meaning that the legal defence costs are now four times as much as the value of what a claimant gets from their insurer.”

The Colorado Model

The Colorado model was created in 1996 in response to what that state saw as a perception that the claims process was biased.

The new program – under Colorado’s no fault law – provides the exclusive mechanism for resolving disputes over the reasonableness, necessity and relatedness of treatment following MVAs. The program (the Personal Injury Protection [PIP] Examination Program) makes available a group of licensed health care providers, experienced in the treatment of MVA issues and actively engaged in clinical practice, who have not earned more than half their income or spent more than half their professional time performing IMEs, to examine patients when a dispute with the insurance company arises.

When a dispute arises and an examination is requested, a list of five qualified practitioners in the same specialty as the treating doctor whose opinion or bills are disputed is prepared and within five days of the request sent to the party disputing the claim (usually the insurance company, but maybe the patient in the case that there was a dispute over an earlier IME). If neither side can agree on one person from the list to conduct the examination, the insurer and the patient each strike two names and the remaining practitioner performs the examination.

The examiner is required to address in a written report the issues in dispute, and the insurer is required to pay the benefits if the examiner agrees with the previous treatment rendered or with the medical conclusions of the treating doctor. If either party is dissatisfied with the findings, that party may request and pay for a second IME under the same procedures of selection.

In this case, the conclusions of two of the three practitioners (the two examiners and the treating provider) are binding, and the examiner must physically examine the patient and review the records, which must be supplied by the insurance company; and the patient may augment the records as necessary.

The requesting party is obligated to pay the examiner’s fees, DesRoches points out.

The whole process is designed to be completed within 45 days of when the insurer initially disputes the claim.

The problem with Bill 15 – and will only encourage insurers to dispute more claims, says Desroches – is that the Prejudgment Interest will be reduced to 1.3 per cent.

“There needs to be more accountability, not less,” she says. “Without anything to discourage them, insurers will be incentivized to systematically deny claims through the use of partisan medical reports prepared by their preferred medico-legal ‘expert’ assessors to deflate a claim.

“All because, for some unknown reason, it’s generally believed that honest and unbiased medical assessments of accident victims is a bad thing,” says DesRoches.




Source: http://www.insurancebusiness.ca/news/insurance-model-scandalously-dishonest-says-fair-185489.aspx?p=3

FAIR Submission on Bill 15

FAIR Submission on Bill 15

FAIR Submission on Bill 15, an Act to Amend Various Statutes in the Interest of Ontario’s Wealthy Insurers and Ignoring Accident Victims

Submitted by: FAIR

Fair Association of Victims for Accident Insurance Reform
579A Lakeshore Rd. E, P.O. Box 39522
Mississauga, ON, L5G 4S6
http://www.fairassociation.ca/
fairautoinsurance@gmail.com
November 2014

FAIR – supporting auto accident victims through advocacy and education

Page 1

FAIR Association of Victims for Accident Insurance Reform is a not-for-
profit consumer organization whose membership is comprised of motor
vehicle accident victims and their supporters.

Its customary to say thank you for allowing us the time to input but that
would grant legitimacy to hearings that have given Ontario‟s 9 million
drivers a mere 15 minutes of consultation. Why aren‟t you listening to the
people who actually use the insurance product under discussion?

MVA victims invariably have the same question – “Why is my insurance
company doing this to me?” Only half of the claims in Ontario are being
properly handled every year – the other half end up in our courts.
What they really should be asking is “Why is the MPP that I voted for and
who is supposed to represent the best interests of their constituents and
Ontario, striving so hard to hurt MVA victims?”

Bill 15, as it is written here, is virtually without any details about the
changes to auto insurance coverage and stands as a fine example of how
the auto insurance file is handled by the government of the day. Ramming
changes through without clarity or any real consideration of how badly it will
harm the already injured and damaged MVA victims has become a habit.

Insurers in Ontario are like junkies addicted to high profits by providing poor
service to their clients who are in need. And like the proverbial addict they
are always looking for another easy „fix‟ to make themselves richer. This
has translated into a bloated and incompetent industry that appears to be
ready to do just about anything to enhance already obscene profits. Profits
made on the backs of some of the most injured and impaired people in the
Province. And the shocker is that our government is on board with it.

So, like dealers ready to make a sale without consideration for the
outcome, many of Ontario‟s legislators enable the junkie to get their „fix‟
regularly with pro-insurer legislation and without regard to victims.
In an effort to afford some legitimacy to the act of bullying and beating up
on injured people this is done under the guise of „fighting fraud‟.

FAIR – supporting auto accident victims through advocacy and education

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The MPP who called these changes “disgusting” was being far too kind.
Victims, who are already exposed to all manner of underhanded claims
handling tactics by their own insurance company, call what is being done to
them on a daily basis fraud, intimidation, harassment and criminal and the
lack of action on the part of our government to protect the MVA victim,
unethical.

What does it take for our legislators to care more about the people that put
them in their chair than the insurers who court their favour?
How are accident victims going to be impacted by Bill 15 and how much
time was allotted to their interests?

What do our legislators have against MVA victims anyway?

What‟s wrong with a system built on honest, accurate medical evaluations,
insurers that stand behind their contracts, and court cases heard by
experienced arbitrators in an open and honest way?

How many hours were afforded the insurance industry lobby group, the
IBC? How many constituents does the IBC represent?

How is the IBC and their member insurance companies going to be
impacted and how many more billions will end up in insurance company
pockets while accident victims are starving, are without treatment and
without adequate resources?

You don‟t know and I can‟t say because Bill 15 doesn‟t have any
inconvenient details on that. According to discussions at Queen‟s Park you
don‟t even know whether a new dispute resolution system will even save
any money and yet it is full steam ahead. We can‟t tell if the fully
experienced arbitrators we already have are going to be replaced with less
experienced adjudicators either because that hasn‟t been determined yet.

But you do know that fewer victims will have access to justice and that
seems to be a minor pesky detail that isn‟t worth consideration.

The proposed reduced 1.3% prejudgement interest rate has absolutely
nothing to do with combating fraud but will surely be an incentive for
unscrupulous insurers to defraud their customers out of timely benefits.
After all, in yet another questionable move, legislators have already

FAIR – supporting auto accident victims through advocacy and education

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guaranteed a substantial ROE interest rate that insurers can enjoy. Some
insurers are already beating their customers down and defrauding the
victims out of what they paid for by delaying and denying claims.

Think the court backlog, caused by Ontario‟s insurers and the legislators
that assist them, will get better? Maybe even disappear like the insurance
coverage you keep legislating away?

Sure, you can quietly download the costs of unpaid injured claimants to the
taxpayer but even now questions are being asked about why so many
more people are at the food banks in recent years. Injured people don‟t just
disappear or magically recover without treatment. You can ignore that
some of the 10,000 people waiting in the queue for CPP disability are
Ontario‟s unpaid accident victims or that the province is picking up the tab
through welfare and ODSP but it‟s going to get a little harder as the number
of desperate people rise and the insurance profit margin rises at a
comparable rate.

Maybe you think it is OK that many victims wait 10 years or more to get
what they paid for. Maybe you think it is right to strip coverage and
treatment to increase insurer profits. You seem prepared to make it harder
for victims to hold insurers accountable - voting for the changes in Bill 15
that will reward those insurers that regularly fail to pay legitimate claims.

Even as victims have mortgaged or even lost their homes and are unable
to pay for their own treatments or they‟ve gone into serious debt to fund
treatment or to just put food on the table.

We think reducing the prejudgement interest insurers pay will encourage
insurers to turn down even more claims. If there are no punitive measures
to discourage delaying claims insurers will take that money owed to
claimants and invest it while claimants go without supports or treatment
and have to pay interest on money they borrow. Debt incurred in order to
survive and to hire expensive lawyers to get what they paid for and are
entitled to. Many will not be able to afford to even go to court.

Reduced interest payable on SABs won‟t benefit insurers who are properly
handling their claims and paying what they owe but it will incentivize those
insurers who do deliberately delay claims and it will reward those with more
shady business practices.

FAIR – supporting auto accident victims through advocacy and education

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Right now all legitimate victims have is the occasional 'special award' equal
to 50% of the amount wrongfully denied by an insurer at FSCO hearings
and the prejudgment interest awarded at FSCO (1% per month or 12% per
year) and at civil court (5% per year). It is already not enough to deter
excessive claims denials or poor claims handling practices.

Borrowing money to cover the costs that absent insurers should be paying
and then not being able to recover the cost of that expense is unfair.
Victims are often paying in excess of 20% interest and even up to 50% on
funds they need for treatment. Why are our legislators on board to help the
insurers and the IBC to put an extra financial beating on victims by
rewarding insurers with a lowered interest rate payable on amounts that
they should have paid in the first place? Insurers will invest our treatment
and other SAB dollars and only have to pay 1.3% interest on the money the
victims has to borrow to get through a claim – they are already doing it.

The message we hear is it‟s all about insurer profits and the health and
welfare of Ontario‟s citizens will have to come second after private
company profits.

Insurance is a business and notably one without a heart so we can‟t really
fault them for looking for extra profit when each has its own bloated
business hierarchy that must be financially supported. Have they managed
to cut any costs to accommodate the 15% reduction in premiums that
you‟ve mandated? Have you even asked the insurers what they‟ve done on
their end or is the plan to just strip benefits and punish victims until they
stop making claims?

You might want to hurry the process up with 80% of claims capped at
$3500 for med-rehab (less the cost of the often biased medical
examinations so really $2000) because you are fast running out of
giveaways to the industry.

What will you tell your constituents when they come to your office looking
for help with their insurance claim? Sorry, the insurers needed to make a
few billion more and I forgot that this affects real people so I voted for it?
Will you have a handout brochure for victims to direct them to the nearest
food bank and the closest welfare office?

FAIR – supporting auto accident victims through advocacy and education

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Will you be the one to tell them that their access to court sounds like a
better system under Bill 15 than the DRS we have now but they might not
be able to gain access because you didn‟t ask for details in the rush to
agree with Ontario‟s insurers? Or that the person who hears their case may
not have any experience with personal injury. Maybe explain how you
voted for something without adequate information on only one
recommendation and a 15 minute talk with a few victims? Or how their
rights are being violated when legislation treats MVA victims like third class
citizens by removing their right to sue an insurer - leaving them without the
same access to justice as other Ontarians enjoy?

Will you tell them that each time you voted to change the Insurance Act,
with band-aid legislation that favoured insurers and that you made the
problems worse and more victims were denied and/or punished? Will you
tell them it‟s because insurers love this sort of thing because it gives them
an excuse to make new „case law‟ for the new regulations and that they,
the victim, and not their insurance company, will be the ones paying for that
too through drawn out hearings and expensive lawyers?

Will you tell them that they should be satisfied with the 1.3% interest they
get on benefits that were wrongfully denied to them and never mind that
they are bankrupt now. Maybe you can garner some sympathy and support
by telling victims that insurers more often than not are spending far more to
deny a claim than the cost of the treatments and rehab that are requested
and they needed a „break‟ and we should feel sorry for them.

Maybe you can come up with a better explanation for the backlog in the
court systems. Something other than the reality that biased and bogus
medical information that their insurance company bought and paid for in
order to deflate and then derail their legitimate claims is at the core of the
problem that no one wants to fix, including MPPs.

Maybe there‟s a reason why medical practitioners who do a bad job
evaluating accident victims‟ injuries or who write biased or poor quality
reports are allowed to continue to abuse and bully victims. Why are you
allowing assessors to repeat their offences over and over and not
demanding that the Colleges in Ontario do the job they‟ve promised to do
and stop harming the public and vulnerable accident victims? Why aren‟t
you fixing that problem – the one thing that will make the system
substantially more functional and honest?

FAIR – supporting auto accident victims through advocacy and education

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Ontario‟s auto insurance is an increasingly unstable and unpredictable
product that has become unmanageable or dysfunctional over the last two
decades. With every change to coverage, every threshold put in place,
there is more uncertainty and more cases in dispute. Accident victims have
taken no role in initiating or implementing these changes that cause
confusion and delays, insurers have.

Victims didn‟t break the system and they certainly have not been listened
to. You, our legislators, have done the damage each and every time the
IBC and the industry has asked you to do so.

We are asking you not to pass Bill 15 as it now stands. We ask that you
take the time to clarify what it is you are really voting for. Walk a mile in
MVA victim shoes, after all, you are only one bad driving decision away
from being one yourself.

Ontario ought to be looking at alternatives that would serve the public
better; it is after all a system with a purpose, to serve Ontario‟s accident
victims and not just about doing favours for insurance companies.

FAIR Association of Victims for Accident Insurance Reform

FAIR – supporting auto accident victims through advocacy and education

Page 7

Source: http://www.fairassociation.ca/

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