Category Archives: News

OPP Investigate 16 Deaths, Most Preventable

ORILLIA, ON, Aug. 5, 2015 /CNW/ – From vehicle occupants and motorcyclists, to boaters and swimmers, the Ontario Provincial Police (OPP) worked around the clock over the Civic Day Long Weekend investigating numerous tragic deaths that occurred during a wide range of transportation and recreation activities on roads and waterways.

By midnight on Monday, August 3, a total of nine people had lost their lives on OPP-patrolled roads. An additional six people drowned and one person died in a boating incident on waterways within OPP jurisdiction.

Of the nine people who died in road crashes, three of them were travelling in one vehicle and four by motorcycle. One was a cyclist and the other a pedestrian. In the fatal car crash, all three vehicle occupants – all in their twenties – were killed.

In one of the motorcycle crashes, both the 59 year-old driver and his 61 year-old passenger died.  While OPP investigations are ongoing, initial reports reveal that at least two of the deceased motorcyclists were driving properly at the time of the incident.

Investigations into the weekend’s drowning incidents revealed that all six of the victims were males and three of them were youths.

The marine fatality occurred after a canoe carrying two males capsized. Neither of the men was wearing a personal floatation device at the time.

Over and above tending to the weekend’s numerous tragic incidents, OPP officers also kept busy on roads conducting education and enforcement of Ontario’s Move Over law.

OPP marine officers also took part in Operation Dry Water, an annual education and enforcement campaign aimed at raising awareness of the dangers associated with operating a marine vessel under the influence of alcohol or drugs.

Source: OPP

Victims of a car accident will face more suffering if the Ontario government’s changes to cut auto insurance benefits are made.

Currently, catastrophic victims are able to access one million dollars of medical rehabilitation benefits (outside of OHIP funding) and another million dollars for attendant care needs in order to assist with lifelong limitations and necessary care needs.  The proposed changes will cut this funding in half.

Also, non-catastrophic injury victims will see their coverage for med/rehab and attendant care be reduced to $65,000 from $86,000.

Insurance companies would pay out less to victims, which could greatly impact their recovery and well-being.

These changes were introduced by Ontario’s finance minister to help reduce car insurance costs, tax payers will end up paying more instead.

“The catastrophic insurance coverage is going to remain. It’s going to be at a million dollars. We want our dispute resolutions to be expedited more quickly so that those that are victims get the coverage that they deserve,” Finance Ministers told CBC News.

Source: CBC News

In 2013 alone, they may have paid $840 million more than they should have to insure their vehicles, according to the study by Fred Lazar and Eli Prisman, professors at the York University Schulich School of Business.

• Ontario car insurance rises despite promised cut, says NDP
• Liberals target auto-insurance fraud in bid to drop premiums

The OTLA is calling on Ontario’s auditor general to review how auto insurance rates are set in Ontario.

Of particular interest are the tools used to set the return on investment for auto insurance companies.

“Auto insurance companies in Ontario have had a relatively free ride during the past 20 years,” Lazar wrote in the report, released Friday.

Room to reduce rates

He said there is significant room to reduce rates by as much as 7.9 per cent based on 2013 data about profit in the insurance industry.

The study looked at how the Financial Services Commission of Ontario (FSCO), which regulates auto insurance, calculates returns on investment in the industry.

Lazar found the KMPG study which the FSCO used to set a return on premiums rate for the industry was flawed, as it underestimated industry profitability.

The FSCO sets a return on premium benchmark of six per cent in the auto industry. That is the equivalent of a 12 per cent return on equity, the study said.

Lazar recommends return on equity as a more appropriate tool to measure industry profitability. He says Ontario should set return on equity of 5.7 per cent, about half the level it is now.

FSCO said in an email it has just received the report and is in the process of reviewing it.

Industry is profitable

The study looked at 18 companies that dominated the auto insurance sector in Ontario and found they had returns on equity of 14.9 per cent in 2012 and 17.5 per cent in 2013, considerably above the benchmark set by the province.

It acknowledged the insurance industry can be cyclical, with periods of low return leading to higher premiums, but argued the auto insurance industry has had high returns for 20 years.

In 2013, the Ontario government promised to reduce auto insurance premiums by 15 per cent and made efforts to reduce fraudulent claims in the industry.

The study did not assess that effort, though it said there was evidence that claims had been reduced.

A spokesman for Ontario’s Minister of Finance said the province is committed to reducing auto insurance rates, but that “reviewing the financial statements and economic activity of private companies is not within the Auditor General’s mandate.”

In 2012, Ontario had the lowest number fatalities in auto collisions per 100,000 drivers and a number of injuries lower than the Canadian average, according to figures from the Conference Board of Canada.

Source: CBS News

TORONTO – The Ontario Health Claims Database, August 2014 Report, was issued earlier this month.

It discloses data for auto insurance health claims expenses for six-month reporting periods, beginning January 1, 2011 and ending June 30, 2014.

It will be interesting to see how the insurance industry explains the inconvenient numbers and statistics disclosed in the Report.

Perhaps the most alarming statistic relates to the number and cost of insurer-initiated medical examinations (IMEs).

These are the so-called independent examinations insurance companies force accident victims to take.

Victims have long complained about the number of examinations they are required to attend as well as the quality of the examinations and examiners.

In 2011, insurers spent $132,950,124 on these IMEs.

They spent $453,923,425 on all health claims expenses, meaning insurers gave their medical experts 29.3 cents out of every dollar they spent on health claims expenses.

They ordered IMEs for 26,957 of 59,080 claimants, almost one out of of every two claimants.

They paid an average of $4,930 per claimant examined to their medical experts.

Yet the total average amount paid per claimant, including payment for treatment, was $7,683.

The numbers dipped in 2012 when insurers only spent $99,060,443 on IMEs.

But there were fewer claimants, only 54,440, and the total amount paid on all health claims expenses dipped to $364,621,262 so insurers still gave their medical experts 27.1 cents out of every dollar they spent on health claims expenses.

They ordered IMEs for 21,529 out of 54,440 claimants, paying an average of $4,601 per claimant examined to their medical experts. Yet the total average amount paid per claimant was only $6,697.

In 2013, insurers spent $64,945,218 on IMEs for 55,799 claimants. The total amount paid for health claims expenses plummeted to $262,089,955 so insurers gave their medical experts 24.8 cents out of every dollar spent on health claim expenses.

They ordered IMEs for 17,465 out of 55,799 claimants paying an average of $3,718 per claimant examined to their medical experts. Yet the average amount paid per claimant dropped to $4,697.

These numbers tell us a shocking story.

The average amount of health claims paid per claimant has dropped a significant amount from $7,683 in 2011, to $4,697 in 2013.

Insurers spend a disproportionate amount of money on medical experts.

While the gross numbers are dropping, they still take up almost 25% of all health claims expenses.

Again, while the numbers are dropping, insurers order examinations for huge numbers of claimants, about 46% in 2011, 40% in 2012 and 31% in 2013.

Insurers are also paying huge amounts to their experts for missed or canceled appointments, about $16.6 million in 2011, $10.6 million in 2012 and $7.8 million in 2013.

The average amount paid for missed or canceled appointments was $1,308 per claimant in 2011, $1,193 per claimant in 2012 and $1,120 per claimant in 2013. Paying over $1,000 for a canceled appointment is ridiculous.

While the Report highlights aggregate amounts paid to insurer medical experts, it also highlights diminishing average amounts paid per claimant in every six-month period from January 1, 2011 to June 30, 2014: $7,901 to $7,472 to $6,858 to $6,554 to $5,557 to $3,934 to $1,790.

Because of on-going treatment for injuries, these numbers will increase with the passage of time but the trend is very clear.

Of course, insurance fraud has a large impact on insurance expenses, but perhaps insurers should focus more on what they are paying their medical experts.

Clearly, many physicians are getting rich by providing insurance assessments.

It’s no wonder some physicians appear to be beholden to the insurance companies.

Perhaps it’s time we initiated the same disclosure that British Columbia mandates, whereby each physician and expert who provides services to an auto insurer is listed in an annual report, along with the aggregate amount paid during the year.

Source: Toronto Sun