Insurance News - Monday, February 6, 2012

P&C Industry Supports U.S. Crash Parts Law

The property and casualty insurance industry is supporting legislation that would alter patent law to allow for use of parts not made by the manufacturer in repairing damaged vehicles.

The Promoting Automotive Repair, Trade, and Sales or PARTS Act, was introduced by Rep. Darrell Issa (R) and Zoe Lofgren (D), both of California.

The bill amends currentU.S.design patent law to limit to 2 and half years the period during which car companies can enforce their design patents on collision-repair parts against alternative suppliers.

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Florida Auto Insurance Reforms Clear Senate Subcommittee

The automobile insurance industry scored a small victory Thursday when the Florida Senate banking and insurance subcommittee approved a bill that would limit the types of health care clinics that could get reimbursements under the state’s personal injury protection law.

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Claim for Mental Stress Puts Pressure on Insurers

The Ontario Court of Appeal has sounded a warning to insurers who deny benefits under a policy despite the medical evidence by awarding damages for the loss of the policyholder’s peace of mind.

Defence lawyers hope the decision may bring some balance to what they say is the current arbitrary treatment of minor injury claims.

In its judgment in McQueen v. Echelon General Insurance Co. on Nov. 16, the Court of Appeal refused to overturn an award of $25,000 for mental distress caused by the denial of benefits.

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Insurance News - Thursday, February 2, 2012

Insurance Benefits Backlog a Nightmare for Accident Victims

Getting hurt in a car crash is bad enough, but for many people in Ontario, it’s only the beginning of a lengthy nightmare.
People turned down for accident benefits by insurance face a wait of as long as two years before their appeals wind their way through the system administered by the Financial Services Commission of Ontario.
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Steps being taken by the Financial Services Commission of Ontario (FSCO) to address the mediation backlog include mandatory settlement blitz days, joint consent to fail mediation, and the introduction of an electronic scheduling process.
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FSCO also released a Request for Proposal on January 16, 2012 with the intention of contracting with up to four dispute resolution companies to provide high volume services to eliminate the file backlog. The companies would need to be able to provide arbitration services in addition to mediation services to prevent a backlog in arbitration cases as files work through the system. The deadline for proposals is February 24, 2012 and contracts are expected to be in place by May, 2012.
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FSCO Releases the Costs of Goods Guideline

The Financial Services Commission of Ontario (FSCO) has released a guideline on the costs of goods. The Guideline was developed as a result of a recommendation by the Auto Insurance Anti-fraud Task Force in its interim report regarding measures that should be undertaken as soon as possible.

The Guideline indicates that where an insurer has agreed to pay for a medical or rehabilitation good under sections 15 or 16 of the SABS, they are only required to pay the lowest retail price available to any member of the general public in Ontario. In the event of a dispute, the onus is on the insurer to provide evidence of the retain price of an item.

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Social Media Sleuthing

Social media has quickly become the foremost activity on the Internet. The explosive growth in user-generated content has been a boon for insurance claims adjusters and fraud investigators. Navigating the social media landscape, however, can be tricky.

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Ontario Court Finds Broker Failed to Properly Offer SABS Optional Coverage

The Ontario Superior Court has dismissed a plaintiff’s action against a broker, claiming the broker did not ‘properly’ offer him the chance to purchase optional income replacement benefits.

In Zefferino v. Meloche Monnex Insurance, the plaintiff was injured on a May 27, 2005 in a motor vehicle accident. The plaintiff had purchased standard coverage including income replacement benefits to a maximum of $400 per week.

The plaintiff alleged that the insurer failed to offer optional income replacement benefits which, if they had been offered, the plaintiff would have purchased. His income at the time of the accident would have qualified him for income replacement benefits of $1,000 per week.

The defendant claimed that their practices were consistent with industry practices which was to mention the availability and only follow up if the consumer showed some interest.  The judge found that the broker’s conduct fell below the required standard of care required of a seller of insurance as set out in the SABS.

However, the judge dismissed that action because the judge was not convinced that the plaintiff would  have purchased the optional benefits had they been properly offered. The plaintiff and his spouse purchased insurance from four other insurance companies during the ten years and never purchased more that the standard accident benefits coverage.

This case has some significance in light of the reforms introduced in Ontario on September 1, 2010.  With the reduction of standard accident benefits coverage and the expanded  optional coverage, brokers, agents and direct writers are vulnerable to similar actions if their practices fall below the standard of care expected. 

 Zefferino v. Meloche Monnex Insurance, 2012 ONSC 154

If the Shafia Family Lived in Ontario Would They Qualify for SABS Benefits?

The Montreal Gazette reports that despite some media reports the Shafia family, who resided in Montreal before they were convicted of first-degree murder, might receive payouts under Quebec's no-fault auto insurance system, there will be no payout, the board says.

The three Shafia family members convicted of four counts of first-degree murder made no request for auto insurance compensation for their four relatives found dead in a car in an Ontario canal, said Gino Desrosiers, a spokesperson for the Société de l'assurance automobile du Québec (SAAQ).

In any case, they would not be eligible, he said, because the Shafia case does not meet the criteria for compensation.

SAAQ rules state that the car involved must have been in an accident on a public roadway; that the vehicle must not have been used for anything other than its intended purpose (to transport people from A to B under its own power); and that the injuries or deaths that resulted were due to a car accident.

So if the Shafia family resided in Ontario, would they be able to claim death and funeral benefits under the Statutory Accident Benefits Schedule (SABS)?

Subsection 3(1) of the SABS defines an “accident” as “incident in which the use or operation of an automobile directly causes an impairment.” The Crown in this case contends that the four passengers in the vehicle were likely killed before it went into the lock. If that is the case then clearly there is no entitlement because the use or operation of an automobile did not directly cause their death.

Even if the four passengers had drowned in the lock, the evidence presented at trial was that the vehicle was not driven into the lock. The key in the ignition was on the off position and the front seats were reclined in a position that would have made it impossible to operate the automobile. The evidence suggested that the automobile had been pushed in by another vehicle owned by the family. Again, their death was not directly caused by the use or operation of an automobile.

This is consistent with Ontario Court of Appeal decision Chisholm v. Liberty Mutual Group. In that case the plaintiff had become a paraplegic while driving his wife’s car as a result of wounds from gun shots fired by an unknown assailant. Liberty Mutual denied SABS benefits because the use or operation of the automobile did not directly cause the impairment. The Court agreed and indicated that the provision in the SABS provided a restrictive causation requirement.

Insurance News - Monday, January 30, 2012

Read more here: http://www.bradenton.com/2012/01/29/3826908/no-fault-auto-insurance-fraud.html#storylink=cpy

Legislation Puts Florida's No-Fault Auto Insurance Fraud on Ropes

Legislation championed by Rep. Jim Boyd of Bradenton gained momentum over the past week -- and deservedly so. With Florida serving as ground zero for staged vehicle accidents, bogus injuries and auto insurance fraud for several years now, the Legislature has tried but failed to adopt remedies. This session looks like the game-changer.

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More Auto Insurance Victims Being Denied in Ontario

Insurance companies in Ontario are turning down an increasing percentage of requests for the assessment and treatment of serious injuries sustained by motor vehicle crash victims, according to a new survey.


The survey, spearheaded by the Alliance of Community Medical and Rehabilitation Providers, found that 42 per cent of requests of treatment are now being rejected, up from 11 per cent prior to the government’s changes to the insurance system in September 2010, a jump of 282 per cent. The survey looked at 1,143 rehabilitation providers, including 889 sole practitioners and 254 company/practice owners.

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Ontario Court Prevents Property Transfers by Convicted Auto Insurance Fraudster

The Ontario Superior Court of Justice has upheld a summary judgment that set aside two property transfers by a convicted auto insurance fraudster over to his wife, ruling that the conveyances represented an attempt to put his assets out of "past and future victims of his fraudulent activities."

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CBS Report: Scammers Cash in on Car "Accidents"



In this tough economy, one type of insurance fraud is more popular than ever. It involves scam artists who stage car crashes in order to cash in. CBS News chief investigative correspondent Armen Keteyian shows us how it works.

In Tampa, Florida, security cameras outside a business captured an accident: an SUV "slammed" into a car.

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Read
In this tough economy, one type of insurance fraud is more popular than ever. It involves scam artists who stage car crashes in order to cash in. CBS News chief investigative correspondent Armen Keteyian shows us how it works.
In Tampa, Florida, security cameras outside a business captured an accident: an SUV "slammed" into a car.
more here: htt
In this tough economy, one type of insurance fraud is more popular than ever. It involves scam artists who stage car crashes in order to cash in. CBS News chief investigative correspondent Armen Keteyian shows us how it works.
In Tampa, Florida, security cameras outside a business captured an accident: an SUV "slammed" into a car.
p://www.bradenton.com/2012/01/29/3826908/no-fault-auto-insurance-fraud.html#storylink=cpy

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