Automobile insurance review : An interesting submission

AS HEARD BY the Legislative Assembly of Ontario Standing Committee on Finance and Economic Affairs - July 09, 2012 - Automobile insurance review

Ms. Nadira Kanhai: Hi. My name is Nadira Kanhai. First of all, I’d like to state that I’m grateful for this opportunity to provide feedback on auto insurance practice and trends. My comments today are informed by my personal experience and my profession as a registered nurse with working knowledge of the Regulated Health Professions Act. By sharing my experience, I intend to shed light on a disturbing practice in trends I encountered. I’d like to provide you with some background information. On October 2, 2004, I survived a two-car collision. The auto insurance carrier required an in-home assessment for a claim for statutory accident benefits. An occupational therapist/registered nurse conducted the assessment. The report generated was inaccurate and biased and the health professional used and abused my personal health information to discredit my injuries. My request to have the report corrected by the member was denied. The insurance adjuster utilized the report to decrease and stop benefits, ordered me to attend a functional abilities assessment by an orthopaedic surgeon, and suggested that if I had a problem to contact the Financial Services Commission of Ontario. Needless to say, the orthopaedic surgeon’s report followed the identical template of minimizing, trivializing and discrediting injuries. The insurer sent a kinesiologist to implement the OT’s recommendations of a long-handled toilet brush, a duster and a long-handled bathroom scrubber. Her report also restored my health. FSCO does not have jurisdiction over health professionals. I reported my concerns to the respective health colleges—namely, the College of Occupational Therapists and the College of Nurses of Ontario. COTO conducted a mediocre investigation and issued a lame reprimand to justify to the public that some action was taken, but it did not address my issues concerning the accuracy of the report, the member’s unprofessional conduct and the impact on the vulnerable public. COTO informed me in writing that these assessments are considered non-therapeutic. CNO dismissed my complaint on the grounds that the member was not providing nursing services and was not acting in the capacity of an RN, although this member is currently registered and holds a current licence to practise and is utilizing her credentials to augment and enhance her credibility. My requests for reviews by the Health Professions Appeal and Review Board, HPARB, fell on deaf ears and were completely fruitless. I’m sure you can all read as good as I can. A follow-up with the Office of the Information and Privacy Commissioner of Ontario concluded that this member was not acting as a health information custodian as defined under the act. Furthermore, these assessments are not conducted under the health professionals act for the purposes of providing care and are therefore deemed commercial assessments under the Insurance Act. Other third party assessments were arranged and funded by the insurer with specialists, who, even though their websites indicate that they’re not taking new patients, are readily available within a matter of days to conduct these assessments. Their CVs are impressive volumes, and many are professors and associate professors at one of our top universities in Toronto. These experts are practising in world-class institutions. Some assessments were even conducted in the hospital setting, a taxpayer-funded facility, and reports were placed on the hospital’s or university’s letterhead to add authenticity. Please note that after all the experts paid by the insurance carrier declared me a malingerer and that my pain was subjective, a bone scan report revealed healing fractures to three of my ribs as a result of the impact from the airbag and fractures in my pelvis and symphysis as my knee went into the dashboard. This has led me to my insights. My experience clearly demonstrates that there are “trusted” health professionals, whom I prefer to call mercenaries, whose credentials and opinions are for sale. These third party assessments, initiated and funded by the insurance carriers, are the first step in denying injured accident victims benefits and validating them as malingerers. It is imperative that we expose who is really gaming the system. By the way, spell-check considers the word “gaming” as a verb confusion and suggests a revision. It is crystal clear to me that it is the insurance companies who significantly contribute to driving up costs by paying exorbitant fees for excessive assessments which produce bogus reports that serve their interests. Some health professionals are comfortable providing this service because they have been reassured that they are protected. This is a very lucrative business. 1410 When there are staged accidents, they are prosecuted under the Criminal Code, and rightfully so. Why, then, when there are staged assessments, is there conveniently no recourse for the vulnerable accident victim? Are these assessments conducted in a vacuum? My efforts have clearly demonstrated that conflict of interest is the foundation upon which the insurance industry operates. The golden triangle amongst the regulated health professionals, the arm’s-length government agency FSCO and the insurance giants is dependent upon all parties remaining silent about conflict-of-interest issues. The spinoff economy generated within the financial sector of Ontario’s business industry is mind-boggling—all done on the backs of vulnerable accident victims. One would reasonably expect that when the government of Ontario agreed to have these assessments conducted by regulated health professionals, the intent was to level the playing field and ensure the public is treated fairly and equitably. However, these assessments have evolved into a parallel system in which regulated health professionals can practise within the complexities of the law and not be held accountable by the colleges or the public. They are essentially untouchable. This is an outrage. If the government was serious about regulation of the industry and protection of the public, it would slap hefty fines on the insurance carriers, and the health colleges would discipline their members by enforcing their own standards, leading to revoked licences. However, conflict of interest is the grease that oils the wheels of the insurance giant and the financial sector of Ontario’s economy. There is a clear disconnect between the Regulated Health Professions Act and the Insurance Act at the assessment point. The former is for providing care and the latter is commercial. My personal health information is reduced to a commodity which I have no control over or access to. My experience has left me to conclude that the Regulated Health Professions Act, the Personal Health Information Protection Act, the Insurance Act etc. are all an act to lull the public into a false sense of security and allow trusted members of our society to take full advantage of vulnerable accident victims. What can one do when the trusted members of our society are untrustworthy/unscrupulous and the systems in place to protect the public fail? Regulation and self-regulation have failed in their mandate to protect the public, and this is a betrayal of the public’s trust. A starting point would be to call for an immediate moratorium on all third party assessments initiated and funded by the insurance carriers and an inquiry into the exploitation of injured claimants by regulated health professionals within the Insurance Act. There are other issues. Currently, the insurance carriers are secondary source providers. What that means is that one must exhaust their primary benefits before the secondary benefits are activated. There is a problem with wage loss when one utilizes their sick time from their employer’s bank to recuperate from an injury caused by an auto accident. When the employee returns to work and should other illnesses not related to the accident arise, they have no banked sick time. This results in an economic loss for the person. The other issue is with rehabilitation physiotherapy offered through one’s extended health benefits. One has to exhaust these benefits first. Should the person require physio for another injury not accident-related, the expense is out-of-pocket. This must be changed. The accident carrier must be the primary source when it is an auto-related injury. That’s my submission.

The Chair (Mr. Bob Delaney): Thank you very much. Mr. Singh.

Mr. Jagmeet Singh: Thank you for your deputation today, and thank you for taking the time out of your schedule to be here. I want to ask you: When you went through the process and had the insurance company arrange for the occupational therapist and registered nurse, it was one and the same person who conducted the assessment?

Ms. Nadira Kanhai: Correct.

Mr. Jagmeet Singh: Were you able to get an assessment from a person of your own choice; for example, your family physician or anyone else?

Ms. Nadira Kanhai: Yes, I did. My family physician assessed me; he completed a disability certificate, and he referred me to a physiotherapist. At the time, I was under the care of a physiotherapist. As a matter of fact, the actual day that the occupational therapist found me to suffer from no substantial injuries was the exact same day that I was receiving treatment from the physiotherapist for substantial injuries.

Mr. Jagmeet Singh: Wow.

Ms. Nadira Kanhai: Wow.

Mr. Jagmeet Singh: No, that’s what I was getting at. So you had essentially two completely different opinions from two essentially completely different—you had your family doctor and another physiotherapist providing rehabilitation, and then you had the registered nurse provide a completely different assessment altogether.

Ms. Nadira Kanhai: Correct.

Mr. Jagmeet Singh: Were you able to show that you had two other people, both registered medical practitioners, a doctor and a physiotherapist, both indicate that you were suffering from some serious injuries? Was that ever taken into consideration by the insurance company? Were you able to use that evidence or those assessments to counter the assessment of that registered nurse?

Ms. Nadira Kanhai: While a stack was on the table of the adjuster, having both the disability certificate of my family doctor along with the physiotherapist sending in her treatment reports—that was on her table, along with the assessment that was sent in by the insurance provider. She decided, “No, if you had a problem, why don’t you go to FSCO? This is my opinion.”

Mr. Jagmeet Singh: And did you ever follow up with FSCO? How did you find that experience?

Ms. Nadira Kanhai: I called FSCO. I was told by FSCO that they have no jurisdiction over the occupational therapist; however, if I wanted, I could enter into the dispute resolution process. That was going to be a very lengthy process, and at that time I really needed my energy to focus on recovering myself and recovering my health. Going through this process with the colleges was extremely lengthy. It was like hitting your head against a brick wall. It is quite a maze to try and navigate to get your health as well as to have this added on top of you whilst you’re trying to recuperate from an injury. I was just treated as a criminal.

Ms. Teresa J. Armstrong: Did you actually get a resolution at some point and get some benefit recovered—payments for your injuries from the insurance company? Or were you denied altogether?

Ms. Nadira Kanhai: I did have to hire a lawyer and I did have to get some benefits restored, but it is the process, the lengthy process—for example, when someone goes to the hospital, they basically are filing a claim against OHIP, which is an Ontario health insurance plan. You do not have to put up with what you have to put up with with the insurance carriers; for example, my extended health benefits. If you are prescribed a medication by your family doctor or specialist, they fill it. They don’t arrange for you to go and be seen by their own doctors and then decide whether or not you need the medication or if there’s an alternative medication for you. So why then are insurance carriers allowed to do this to the public?

The Chair (Mr. Bob Delaney): Thank you. Mr. Naqvi.

Mr. Yasir Naqvi: Ms. Wong.

Ms. Soo Wong: Thank you so much for coming to present to us today. What we heard this afternoon by your presentation is that there’s—can you share with us your suggestions to the committee in terms of fighting fraud in terms of the auto insurance business? Because I’m sensing that there’s frustration, and the third party assessment you want to put a moratorium on. Can you give us some more examples of how to improve the system but also the issue of fraud within the industry?

Ms. Nadira Kanhai: I like your word “fraud,” because that is exactly what it is. When there are staged accidents, that’s fraud; these clearly are staged assessments. This is why I suggested, after the moratorium, that we need to have an inquiry into the exploitation of vulnerable accident victims by regulated health professionals. As to how you go about doing this, you are the experts in knowing all of the areas in how to get this together, but we definitely need to get to the bottom of this, because in the Regulated Health Professions Act, the only two things that are criminalized are if there’s sexual misconduct or if there is death. I can tell you that surviving an accident is worse than death. So, clearly the Regulated Health Professions Act is not prepared to deal with fraud at the level that the Criminal Code can deal with fraud. I don’t know if that helps. This is my suggestion from a layperson, a member of the public.

Ms. Soo Wong: Thank you.

Johns Hopkins School of Medicine students invent app that checks your symptoms

Called Symcat, (symptoms-based, computer-assisted triage) the app allows the user to enter in various ailments such as a fever, cough, swelling etc. and receive an instant diagnosis.

The app is currently available through their website, or can be accessed via an Android beta app. A version for the iPhone and other Apple products is said to be in the works.

The link to the is:
http://blog.symcat.com/


Below is an earlier youtube presentation.

Development of a tool for evaluating obstacles to a return to work of workers with mental disorders, called Diagnosis of the work handicap situation (DWHS).

Mental health problems are increasing in companies. And even if we know better how to prevent them, little is being done to facilitate the return to work of affected people. A reduction in the symptoms associated with these disorders has no impact on a return to work, as indicated by recent studies.
This tends to confirm that the disability associated with such a state of health constitutes a complex multifactorial phenomenon. Few investigations have specifically evaluated the predictive factors and the obstacles to the resumption of occupational activities in these cases. The research team, by basing itself on a proven approach, will develop a tool for evaluating obstacles to a return to work of workers with mental disorders, called Diagnosis of the work handicap situation (DWHS). The prototype of the DWHS thus produced will be based on evidence, and the feasibility of its use in a return-to-work process will be tested. This tool is a first in this field and can be used by clinicians and researchers who interact with workers absent from work due to a mental health problem.
Free download at: http://www.irsst.qc.ca//en/-irsst-publication-development-of-an-instrument-for-evaluating-the-factors-influencing-long-term-sick-leave-attributable-to-mental-health-problems-r-743.html

Auto Insurance: A claimant's status as an employed person does not, in itself, establish that the claimant is ineligible for non-earner benefits

In its July 24 decision in Galdamez v. Allstate Insurance Co. of Canada, the Court of Appeal overturned the motions judge's finding that the plaintiff couldn't qualify for non-earner benefits because she was working, regardless of whether or not she had a complete inability to carry on a normal life. For more information click the link below.

http://www.lawtimesnews.com/201207309239/Headline-News/Personal-injury-ruling

Be a contributor to NEWSREHABNET!

Long time ago I realized that I cannot do things all by myself. Team work is always the key! Contributions to Newsrehabnet+ are welcome. Send me a note at ncnss@rogers.com and let me know if you would like to be a guest author, submit an article of interest or just if you want get involved in a special project. I'll be glad to discuss with you any innovation or suggestion you might have.

Interesting resource for RTW

Thinking About Creating a New Medical App? Check with Doctors First

 Doctors are adopting mobile devices, Apple devices - iPod, iPhone and iPad - at alarming rates. Follow the advice from iMedicalApps when creating a mobile app for healthcare or HCPs.

Behavioural treatment for chronic low-back pain

Behavioural treatment for chronic low-back pain

Newsrehabnet joined CNI Health Sevices!

We are happy to inform you that Newsrehabnet has merged with CNI Health Services / New Career Navigators as part of their team of professional services providers. Thanks to the leadership and innovations brought forward by John Lepore, our managing director and senior rehabilitation services consultant, we will continue to provide needed and up-to-date resources to the community of Rehabilitation Services providers and their clients.

Team Rehab
 @newsrehabnet

Post Concussion Syndrome

If you have a host of symptom such as headaches, fatigue, irritability, difficulty concentrating and brain scans show no visible damage but you still experience apathy, depression, anger, and mood shifts even after months after the injury, post-concussion syndrome might be the operational diagnosis.

Rehabilitation psychology may offer you cognitive behavioral therapy to learn to manage the mood swings and fatigue.

You will be told that your “brain injury” is mild, yet it causes subtle but persistent changes in mood, memory, and cognitive abilities.

Patients with TBI and other conditions whose injuries have impaired their consciousness in some way should be aware that there is no gold standard for measuring consciousness and very little evidence concerning treatment effectiveness. There is not a single proven treatment for promoting recovery from brain injury. Instead, physicians manage medical symptoms and rely on rehabilitation to help restore cognitive and motor functions.

Application of Ontario's Minor Injury Guideline is "crazy right now": AB lawyer

(Article appearing on The Canadian Underwriter.ca) 

2012-02-09

---

The application of Ontario's new Minor Injury Guideline (MIG), which defines the scope of minor injuries sustained in vehicle collisions, is "crazy right now," according to Kadey B.J. Schultz, partner with Hughes Amys LLP.
In some instances, she said, the MIG protocol is being applied to files that include injuries such as fractures, complete tears and very serious psychological complaints.
Schultz spoke at the Ontario Insurance Adjusters Association's (OIAA) 2012 Professional Development & Claims Conference in Toronto on Feb. 8.
If a claimant has a fracture, an insurer cannot, in Schultz's opinion, be placed in the MIG, which is a treatment protocol that includes a $3,500 cap on insurance payments for minor injuries.
Nor can an insurer pay for the treatment of a fracture injury for the full duration of the staged treatment process defined in the MIG, and then re-instate new treatment of the fracture using a subsequent OCF 18 (treatment and assessment plan), she added.
"You're either in the MIG, or you are out of the MIG," she said.
Insurers and the province's insurance regulator, the Financial Services Commission of Ontario (FSCO), are trying to capture the minor injuries and treat them within the MIG protocol whenever possible, she said. "The MIG is something that needs to be applied aggressively, assertively, but it has to be applied correctly."