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Arbitrator Musson, in the recent decision SP and RBC Insurance, reviewed the conduct of Aviva Insurance (who bought out RBC Insurance) in adjusting an injury claim made by a young woman hurt in a motor vehicle collision. The decision concluded with a comment upon the behaviour and conduct of Aviva/RBC insurance staff which were observed as “borderline harassment”:[1]

Further, the conduct and borderline harassment demonstrated by the Insurer as it related to some witnesses that the Insurer called is rarely ever seen. The Insurer had its investigator attempt to serve witnesses in a hostile and confrontational manner, including threatening to have witnesses arrested if they did not comply with their summons. In addition, the Insurer used photocopied pre-signed summonses to serve individuals, which did not afford an Arbitrator or FSCO the opportunity to oversee who was being summonsed and why. It left the Insurer with unchecked power in which it overstepped its bounds on numerous occasions. Insurer’s counsel misled the court when requesting a bench warrant and stated before the court that a witness failed to attend this Hearing when in fact Mr. Brown knew that this was false.

Unfortunately, this behaviour is not as rare or unusual as one would expect. Fundamentally, the accident benefits process places the injured party at odds with their own insurance company. The less is paid out in claims, the more profits remain. While it is undisputed that some oversights and controls are appropriate, the measures currently being seen are approaching the unreasonable.

Clients seeking funding for treatment from their own insurer, as simple as approval for 10 physiotherapy sessions recommended, are expected to:

  • Attend medical assessments with doctors hired by the insurance company;
  • Cooperate with the insurance company investigating and adjusting your claim;
  • Be followed by private investigators keen to show them smiling or walking around;
  • Have their use of social media monitored and scrutinized; and,
  • Endure questioning and investigation of treatment providers, family and friends etc.

Insurance companies routinely request insurance assessments to determine whether treatment is “reasonable and necessary”.[2] This is question addressed during an in-person Insurance Examination, permitted by the legislation with no oversight on how often this takes place. The cost of these IE assessments can outweigh the cost of the treatment provided. The assessments are intrusive, often ghostwritten by assessment companies who comments out of context and tailor their report to the needs of the hiring insurance company. This practice was reported on recently by the Globe & Mail[3] and discussed by my colleague Chris Collins.[4]

The insurance industry’s practices have implications on public policy in Ontario as well. Denied claims prevent hurt individuals from optimizing their recovery. This makes them more vulnerable, negatively impacting on their ability to maintain employment. If treatment is not funded by the insurer, the burden falls upon our OHIP health care system.

Ontarians continue to see insurance benefits decrease, now cut by half from September of 2010. Premiums have not decreased. Record profits have been posted. With the coming election, speak to your MPP to make sure your needs are represented.

If you are being denied treatment recommended to recover or return to work, speak with a lawyer. We can help. Please do not hesitate to contact me by email or at 519.660.7784 for a free consultation.

[1] SP and RBC General Insurance Company FSCO A16-000329, released January 3, 2018.

[2] Licensed to bill: How doctors profit from injury assessments that benefit insurers, Globe and Mail Investigation dated December 1, 2017.

[3] Insurance assessment firms altered, ghostwrote accident victim reports, Globe and Mail Investigation dated December 4, 2017 .

[4] Chris Collins Comments on Globe & Mail Article about Insurance Assessment Firms and Accident Victim Reports dated December 6, 2017.

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