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Insurance Business | 21 Nov 2017, 04:13 AM Agree 0
Professional's testimonial could have deprived policyholder a much-needed medical claim
  • | 21 Nov 2017, 10:44 AM Agree 0
    This case raises an interesting question regarding what the ON auto insurers and IBC refer to as "opportunistic fraud". The public is repeatedly told by the IBC that falsely exaggerating symptoms so as to drive up the value of a claim constitutes opportunistic fraud. And as we see, in this case (like so many others), we have a highly flawed assessment performed by a neuropsychologist with a "problematic attitude" alleging the injured claimant is a symptom exaggerator (i.e.. an opportunistic fraudster). To add insult to injury the findings were based largely on the psychometric testing of the assessor's daughter who has no formal training whatsoever in psychological testing. Put simply, what we have in this case is a bogus accusation of symptom accusation in a shoddy assessment being used by the insurer as "proof" of symptom exaggeration (i.e.. opportunistic fraud).

    So is this the flip side of opportunistic fraud? When an insurer trots out a hatchet-job assessment alleging opportunistic fraud (symptom exaggeration) - do we count that as fraud. After all, what is the insurer doing if not wrongfully trivializing legitimate injuries a means to drive down the value of the claim. Put succinctly - isn't this an example of alleging fraud as a strategy to perpetrate a fraudulent denial of injury benefits?

    These is another problem with the endless shoddy assessments ON auto insurers buy from their preferred vendors of medico-legal second opinions. It is the totality of these accusations that comprise the basis of the ON auto insurers' endless assertion that they are being bilked by symptom exaggerators legion in their number. But how many of these insurer accusations of symptom exaggeration are as baseless and wrong-headed (and perhaps even fraudulent) as this one? The insurance lobby drives up its "evidence" of widespread symptom exaggeration/malingering/fraud by buying shoddy assessments from sketchy assessors and in this way spiking its fraud loss estimate (used to lobby to gut benefits and raise premiums).

    So when ON auto insurers deploy dubious media-legal experts to supply them with bogus accusations of fraudulent malingering - it isn't just the injured clamant who is hurt via denied/delayed treatment. All On motorists are hurt by policy benefit cuts and premium increases justified by the totality of findings in insurer assessments/testimony the likes of this. It's oughta be a crime!

  • Kathy | 22 Nov 2017, 07:21 PM Agree 0
    Saskatchewan experience. My son was in a serious motorcycle accident 16 months ago and continues to fight with the SGI system.
    The experience began with no contact for a month from SGI. It wasn't until my son was found in the dark throwing up and unable to walk or talk that a series of tearful begging phone calls with an advocate began. Attempting to function with an obvious brain injury, he asked for help to complete reports, receive assistance for childcare, assistance to help with the marital stress and life with a new child with his condition. Although more than one agent recognized lack of mental clarity over numerous telephone conversation, he was told SGI cannot make recommendations for assistance and continued to delay with their obligations. There is not an ounce of client centred approach demonstrated by this government company. His persistence along with vocal advocacy came with some success, however, it was not until month 8 that he was assessed by the insurer's Neuropsychologist, and that he would not receive any benefits if he did not also attend their 12 week to return to work program which could not be directly related to his workplace, however required to get to work. When questioned the goal and objectives of their mandatory program, he was told this is just what they do. Unfortunately he was caught in a rote system. Even when asking for an advocate to be present during an initial assessment or recording of an assessment due to lack of memory etc., he was refused. He did have some recollection of portions of his session, however he left the in a state unable to drive, throwing up within 24 hours and incoherent (his physician had to physically carry him into his office). His physician reports were dismissed within the 28 page report, with suspiciously but not surprisingly non committal findings. The government insurance company wiped their hands of full obligation.
    My son continues to work hard in attempts to 'get better' and can nearly complete a full day of work at month 16. He has not given up on his health and in doing so he has done research for further resources on his own. He has found another Neuropsychologist (which he learned the Insurer is fully aware of) in our province. His first appointment has confirmed brain injury with recommendation to return for rehabilitation. He and his wife both have had to pursue counseling in attempts to save their relationship and relearn and have experienced a serious financial burden as new parents. Fortunately my son has several supports who continue to encourage him to be persistent in pursuing retribution, and to not give up.
    When I hear my son say I missed out my new baby's first year, my sister's wedding, Christmas, gatherings, conversations and anything business related for 12 months, I become tearful...and discouraged... that in Saskatchewan we are forced to be pawns of such a flawed and corrupt system.
  • Neep | 13 Feb 2018, 10:21 AM Agree 0
    Lawson did my assessment. It was a week before the Post article hit the stands. His daughter did my testing. I had to repeatedly tell her not to prompt me or give me clues. We stopped and talked in the middle of testing for a few minutes. All against the rules. Lawson himself was beyond awful. He made fun of the way i spoke- i have aphasia from a brain injury, talked over me and laughed at me. I cried on the phone to my mom after his assessment. As for his results? A joke. He said i could work. I ended up getting a catastrophic designation despite his very flawed report. I've been told lawyers love seeing his name in reports. Why? Because he is the weakest link and the lawyers always win on appeal. Why does this man have a lisence? Why is he still practicing?
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