A Bad Season For WSIB As Complaints Mount

Toronto personal injury lawyer Albert Conforzi: The faces may change but the results are the same:

A group of Ontario psychologists say their patients are being unfairly denied workers' compensation. 

They say that the Workplace Safety and Insurance Board of Ontario (WSIB) has been cutting workers' compensation claims in order to pay off its deficit. To do that, the psychologists say the board is getting other doctors to overrule their conclusions about their patients' fitness to return to work.

The psychologists are holding a news conference at Queen's Park on Thursday, calling on WSIB to restore benefits for injured workers.

The recommendations of health care professionals are routinely being ignored or overruled by the faceless claims people at the WSIB? Sorry if I don't act surprised.

Loss of Benefits

The sad reality is that the very same thing happens in the auto insurance sector. Patients lose the benefit of early intervention and society ends up with more marginalized members who then have to knock on the door of an overburdened health care system.

Last month I highlighted the plight of one doctor who claims that she lost her job because she wouldn't change her medical opinion to WSIB and an insurer's liking. With these stories piling up, perhaps it's time to appoint an independent body to look at WSIB's policies and practices.

I am a personal injury lawyer with Pace Law Firm in Toronto. Contact me if you have any questions.

Guess What? Ontario Car Insurance Premiums Still Haven't Been Lowered 15%

Toronto personal injury lawyer Albert Conforzi: If you've been reading my blog - but of course you have - then you'll know that I've been following this story for quite a while. Two years, in fact:

Auto insurance rates are down by an average of just under seven per cent in Ontario, much less than the 15 per cent reduction promised by Finance Minister Charles Sousa two years ago.

The latest figures from the Financial Services Commission of Ontario, released Thursday, show rates fell half a point in the quarter ended Sept. 30, to 6.96 per cent for the province’s 9.4 million drivers.

Sousa took credit for the drop, saying reforms to benefits, anti-fraud measures and mandatory discounts for motorists with winter tires have helped cut costs for drivers.
But he acknowledged “there is more work to be done.”

Critics said that line is wearing thin given that the Liberals pledged the 15 per cent cut to win NDP support of their 2013 budget during the minority government years.

As the story points out, this latest piece of news isn't exactly "new." We see the same type of story every six months or so. That is, the 2013 promise of a 15% reduction in car insurance premiums for Ontario drivers still hasn't happened.

Hold The Champagne

Celebration of rate reductions seems premature, anyway. Check out the fine print at the bottom of the article: "The third-quarter drop of 0.5 per cent compares with an average increase of 0.6 per cent in the second quarter." So it went up before it went down, making the past six months a wash.

Whatever happens with these slight rate fluctuations, rest assured that your benefits are decreasing. This is from a post I wrote a month back:

Starting on June 1, 2016, standard medical, rehabilitation and attendant care benefits will have a maximum combined limit of $65,000 for non-catastrophic cases. After that money is spent, you are on your own. Since September 2010, that limit has been $86,000. Before that it was $172,000.

While the cost of health care keeps rising and rising, the money available for your benefits keeps dropping and dropping. Further, as of June 2016, the coverage period will be cut in half from the current 10 years to a mere 5 years.

Perhaps it's worth phoning your MPP and asking when your 15% premium reductions will kick in to offset all of the benefits you'll be missing next year.

I am a personal injury lawyer with Pace Law Firm in Toronto. Contact me if you have any questions.

Stiffer Penalties Needed For Drunk Drivers

Toronto personal injury lawyer Albert Coforzi: In the wake of a tragic accident in Ontario this past Sunday that saw three children and a grandfather killed by a drunk driver, we find a woman in Nova Scotia being sentenced for driving drunk with her kids in the car (bold mine):

A Cole Harbour mother has been sentenced to nine months in jail for driving while heavily impaired with her children in the car. 

Jennifer Ann Sims, 38, blew more than five times the legal limit on the breathalyzer after RCMP arrested her on the Forest Hills Parkway in Cole Harbour on April 6, 2014. 

Sims, who has three previous convictions for drunk driving, pleaded guilty this spring to charges of impaired driving, driving while disqualified and breaching probation...
“I’m not confident that she would not reoffend,” the judge said Monday. 

“Courts cannot wait until Ms. Sims kills somebody to send her a message, and others in the community, that this type of conduct is not acceptable and must be denounced.”

Three previous offenses? No wonder there are calls for stiffer penalties that include jail time. Clearly the message of "don't drink and drive" isn't getting through.

As for the alleged offender in the Vaughan case, he doesn't have a history of driving drunk, although he does have prior speeding, electronic device use in the car, and drunk and disorderly charges. He is now charged with 18 offences in connection with this crash. I expect that the Crown will try hard to make an example out of this case.

My thoughts and prayers are with the grieving family.

I am a personal injury lawyer with Pace Law Firm in Toronto. Contact me if you have any questions.

Doctor Fired For Not Giving WSIB The Answer They Wanted?

Toronto personal injury lawyer Albert Coforzi: An interesting case out of Hamilton, which throws some light on the behind-the-scenes workings of insurance companies and medical exams.

Doctor's Orders

If a doctor examines you and says you're sick or injured, it's the medical expert's opinion that counts, right? Perhaps not:

A Hamilton-area physician is suing the Workplace Safety and Insurance Board and her former employer for $3.2 million, claiming she was fired when she wouldn’t deliver a medical opinion that suited the WSIB.

Dr. Brenda Steinnagel, 50, is alleging in her statement of claim that she was terminated last April after the WSIB repeatedly demanded that her employer, Vaughan-based Workplace Health and Cost Solutions, change the medical opinion she authored on a hospital worker who was claiming benefits after suffering head injuries while trying to restrain a patient.

Steinnagel had concluded in late 2014 that the worker’s emotional issues could be related to his workplace accident, according to the statement of claim. Within two weeks of delivering her opinion, she alleges the WSIB requested clarification.

After further review, which included speaking with the worker’s family doctor, Steinnagel says she reached the same result in her medical opinion, but “the WSIB continued to resist her conclusion,” according to the statement, filed in Toronto Superior Court in July.

The doctor goes on to allege that when she refused to tailor her opinions to what the WSIB adjuster wanted, she was told that she was no longer going to perform such exams. She also alleges that WSIB pressured her boss (WHCS), reminding them of the volume of work the doctor's company did for WSIB. It is alleged that when the doctor still refused to change her medical opinion of the case, she was fired.

"Independent" Medical Exams

These allegations have yet to be proven in court, but I can assure you that every personal injury lawyer worth their salt is keeping a close eye on this case.

For those of us who do personal injury litigation, so-called "independent " medical exams by doctors hired by motor vehicle insurers are predictable to a very high degree: Dr. So-and-so hired by insurance company Such-and-such is going to give you outcome X. My colleagues and I often wonder whether the volume of work given to these doctors influences the outcome in the same manner as alleged in the article. That is, is there at least an implied message that if you want future files, you'd better provide satisfactory opinions.

I am going to watch this case carefully.

I am a personal injury lawyer with Pace Law Firm in Toronto. Contact me if you have any questions.

Insurance Companies Playing A Shell Game With Your Benefits

The benefits you will lose as of June 1, 2016.

Toronto personal injury lawyer Albert Coforzi: A couple of weeks ago I alerted readers to the coming changes to Ontario car insurance. The government of Ontario, in close collaboration with insurance companies, has planned these changes for motorists. You may recall the letter you received asking you to collaborate on something that will greatly affect your life. No? Alas, it's too bad you missed the memo.

Benefits gutted again

Starting on June 1, 2016, standard medical, rehabilitation and attendant care benefits will have a maximum combined limit of $65,000 for non-catastrophic cases. After that money is spent, you are on your own. Since September 2010, that limit has been $86,000. Before that it was $172,000.

While the cost of health care keeps rising and rising, the money available for your benefits keeps dropping and dropping. Further, as of June 2016, the coverage period will be cut in half from the current 10 years to a mere 5 years.

Now you see me. Now you don't.

It's not that the extra coverage isn't available. It's that you must now pay extra for it, as more of your benefits - and their duration - become "optional."

Insurance companies love the optional stuff. "Hey, we didn't remove coverage. We just wanted you to decide for yourself if you really need it." How would a regular consumer know that? Experience has shown me that these options are rarely purchased and most consumers do not know that they even exist, let alone that the coverage might change on some arbitrary future date.

Indeed, the average person who purchases car insurance does not know that their benefits are ever-changing. Ask five of your friends if any of them have heard that the standard benefits I listed above will be cut by over twenty grand next year. I'd be floored if any of them have.

From out of nowhere

That's part of the problem. Neither the insurance companies nor the government throw up red flags to warn consumers of car insurance changes. Well, sometimes a flag does go up, as when the government touts a plan to lower your car insurance premiums by 15%. Guess how that went?

I'll have more on the 2016 changes in the weeks ahead. In the meantime, it is worth looking at your car insurance policy and asking questions not only of your insurance representative, but also your MPP. Ask them how your policy will change next year and why. The answers may amuse you and frighten you in equal amounts.

I am a personal injury lawyer with Pace Law Firm in Toronto. Contact me if you have any questions.

Are Your Medical Records Up For Auction?

Toronto personal injury lawyer Albert Coforzi: A hospital employee recently got caught with their hand in the cookie jar:

A former Rouge Valley hospital clerk has pleaded guilty to stealing thousands of patient records and selling them to financial brokers over the course of more than a decade. 

Shaida Bandali, 61, who worked at Rouge Valley from 1995-2014, accessed confidential maternity ward records, including the names and contact information of mothers as well as the names and birthdates of their babies, and sold them for between $1 and $2.75 each to salespeople of Registered Education Savings Plans, according to an agreed statement of facts read out in court Monday.

Apparently the leaking of personal, confidential information by Bandali was not itself a crime but the sale of the information created a breach of the Securities Act.

Hopefully hospital administrators and the law will continue to root out the sources of these "favours."

This reminds me of someone who came to see me at my office not too long ago. They described having been to the emergency room following a car accident. Nothing unusual there. However, the next day they were called by a clinic saying, “We are following up on your visit to emergency yesterday to arrange for your physio assessment.”

Assessment? Clinic? News to the patient.

I wonder how that clinic got the patient's personal information. I also wonder who received a little “show of gratitude” for the info.

Hopefully hospital administrators and the law will continue to root out the sources of these "favours."

I am a personal injury lawyer with Pace Law Firm in Toronto. Contact me if you have any questions.

Upcoming Changes To Accident Benefits: Insurance Companies Win Again

Toronto personal injury lawyer Albert Coforzi: The current government of Ontario, following in a long tradition of governments of every political stripe bending over backwards for the benefit of the insurance company lobby, has signaled changes to what constitutes a "catastrophic impairment." The changes come into effect on June 1, 2016.

Among the more egregious changes: the amputation of an arm as a result of a motor vehicle accident will be considered catastrophic while the amputation of a leg will not.

Missing leg? Not "catastrophic" enough

Under the current Statutory Accident Benefits regime, a person who has lost an arm or a leg has a million insurance dollars available for medical and rehabilitation benefits. This helps for such things as stump care and prosthetic limbs. The coming regime change will reduce that money available for a leg amputee as described in the regulation to $65,000 of combined coverage: medical/rehab plus attendant care.

If you've ever had $2000 worth of dental work for a root canal and crown, ask yourself how quickly 65 grand will go when you are recovering from a leg amputation and you need to learn how to use a prosthetic device.

Insurance industry wins another round

But hey, there's always someone available to pick up the short fall. Guess who that will be? Yes, the Ontario taxpayer. A careless motorist causes a victim to lose a leg and it's our healthcare system that will take on the financial burden of care and recovery, rather than an insurance company that actually plans for this type of event. Makes a lot of sense....to insurers, I bet.

I'll be posting more information on the insurance regime changes in the months ahead. Stay tuned.

I am a personal injury lawyer with Pace Law Firm in Toronto. Contact me if you have any questions.