Personal injury lawyers have heard it all and we certainly have had our share of bad press. But from where I stand, and without being too hackneyed about it, I really cannot conjure up a more precise example of a David-versus-Goliath setting in the legal industry. Most personal injury lawyers I know genuinely, sincerely advocate for victims of traumatic events and, in the current climate, are having an increasingly harder time doing so. In the realm of accident benefits specifically, it has become even more of an uphill battle fighting insurance companies so that clients can receive even the most basic of benefits. And all this while insurance companies continue to profit at great rates.
Allow me to illustrate the skewed scenario this way:
I would like to introduce you to two residents of Ontario, Tim A. and Tim B.
Tim A. was involved in a motor vehicle accident. He was injured but not as injured as he claimed. His insurance company hired an investigator to conduct surveillance. The investigator determined that Tim A., contrary to his prior statements, was indeed working. His insurance company quickly denied his claim, and his insurance company reported him to the police for insurance fraud.
Tim B. was also involved in a motor vehicle accident. He, too, was injured. Although generally in good health, Tim B. started feeling lower back pain that radiated down his legs soon after the accident. When he initially went to the hospital, he was diagnosed with muscular/soft tissue pain. After persistently going to his family doctor to complain about his lower back pain, his doctor finally diagnosed him with chronic pain syndrome without conducting further tests. He worked in construction, and because his insurance company denied his income-replacement benefits, he returned to work, even against the wishes of medical professionals. He had a mortgage to pay and he just didn’t have a choice.
Although massage and physiotherapy alleviated his pain, his insurance company denied any further treatment saying that his injuries fell within the minor injury guideline ($3,500 in treatment). Not only that, his insurance pays thousands of dollars to dispute a treatment plan of $1,800 designed by his physiotherapist and recommended by his family doctor, citing reports completed by routinely superficial assessments serviced by “objective” physicians.
Insurance companies will have you believe that Tim A.’s actions are the reason that premiums are so high. They will also argue that it is because of Tim A. that Tim B.’s benefits are denied, as they have to fight each claim zealously for “inflated injuries.” While no one will deny that there is fraud apparent in the industry — among physiotherapy clinics, mechanics and even lawyers or paralegals — insurance companies are certainly exploiting the fraud card to punish most victims, truly injured, who have been faithfully paying insurance premiums for years and are now suffering due to benefit denials.
In a recent report by York University’s Schulich School of Business economics professor Dr. Fred Lazar, prepared for Ontario Trial Lawyers Association called “Price Regulation and Possible Premium Overpayments: Automobile Insurance Companies in Ontario,” he concludes that, “Based on my calculations using the latest publicly available data, auto insurance companies in Ontario made $1.5 billion in pre-tax profits in 2016, an increase of 57% or $534 million since 2012.” He adds, “Given the levels of excessive profitability, consumers almost certainly have paid too much for their insurance coverage.”
So, while insurance companies continue to accumulate increased profits, victims of car accidents increasingly suffer due to the denial of necessary benefits.
Many of us can agree to disapprove of Tim A.’s actions; lying about or even inflating an injury is plainly unjustified and should rightly be deemed fraud. But, as for Tim B. — the vastly more common scenario — the question of who is getting defrauded is much more nuanced.
Ambulance chaser? Get us a better name.