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Insurance Business | 07 Feb 2017, 11:15 AM Agree 0
Details of unverified claims by personal injury legal firms in province come to light
  • Jokelee Vanderkop | 07 Feb 2017, 05:25 PM Agree 0
    Insurers want the public to think that “Contingency fees are one of the key drivers of claims costs and, as a result, increase insurance premiums that all Ontario drivers pay,” according to Irene Bianchi, executive vice president of claims, Aviva Canada. But this is not true. Contingency fees are what claimants often pay personal injury lawyers to defend wrongful denial of claims for accident benefits such as treatment, rehab, income replacement benefits and to fight for tort settlements.

    Insurers pay multi millions of dollars annually to insurer-hired second opinion medical assessors working out of assessment centres whose primary clients are insurer-sent claimants. Injured parties are sent, not to help them get better, but primarily to discount, downplay or dismiss diagnoses by treating physicians so that insurers can deny claims. A lot of money is spent to deny legitimate claims, forcing accident victims to hire lawyers to have their policy honoured. As few have the money to be able to afford a lawyer, thankfully contingency fee agreements provide a means for them to access legal representation, without which they would be completely dismissed by their insurer. There are problems to be sure with CFAs but that is nothing compared to the problem of insurer-hired second opinion medical experts who retain their lucrative status as insurer assessors thanks to the number of claimants they deny, point to as fraudsters or as malingerers. For auto insurers, it is not about the claimant, but about dollars and cents to the detriment of the health and recovery of accident victims. Insurers know they can wear down seriously injured claimants by sending them to dozens of insurer examinations extended over years. Struggling to deal with their injuries, most of these claimants don't have the physical, emotional or financial means to continue to fight their insurer. Not being able to work at all or not enough hours to make a sustainable living, they can't handle the additional pressure of a claims process geared to deny them. Many give up, a few settle for far less than is owed, and the odd person fights on to the bitter end.

    In addition to the expense of paying their assessors, insurers have their own stable of costly lawyers to defeat a claimant if that person continues the fight. Add to that the multi-million dollar salaries the insurance industry's senior management pays itself, it is the industry, and only the industry itself that is responsible for high claim costs. "So You Think You're Covered! The Insurance Industry Rip-Off" outlines exactly what is happening in this industry and it is not a pretty picture.
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