By
Pace Law

Insurer Sleight Of Hand

November 5, 2012

Toronto Personal Injury Lawyer Albert ConforziLast week, yet another shady trend in insurer behaviour came to light.

Under the standard automobile policy, insurers provide accident benefit coverage for such things as attendant care, income replacement benefits, and medical/rehabilitation benefits. The specific items that qualify as a medical/rehabilitation benefit are set out in s.14 of the Statutory Accident Benefits Schedule (SABS). They include “medical, dental, optometric, hospital, nursing, ambulance, audiometric and speech language pathology service[s],” as well as “other goods and services of a medical nature that the insured person requires.” Emphasis mine.

It has come to my attention that some, but not all, insurers are paying for medical records obtained by them by making the payments from the med/rehab benefit entitlements.

What this does is effectively short-change the insured in accessing their limits of coverage under this provision. It takes money that is supposed to be used for therapies to assist with recovery, and uses that money to pay for items that are not covered by the section. Worse yet, the insurers are not telling their insured clients about it. They are not sending out explanation of benefit forms, as they would be required to do when paying out a benefit, and when they are called to task on this corrupt behaviour, they simply ignore the complaint.

Insurers these days are secure in the knowledge that the backlog of processing mediations of accident benefits disputes at the Financial Services Commission gives them a year-long delay in having to face the reality of their actions. They seem to have it in their heads that they can act with impunity.

They are dealing from the bottom of the deck. Now that is a real world example of insurance fraud.

Albert Conforzi is a personal injury lawyer with Pace Law Firm in Toronto. Pace’s personal injury lawyers have been helping accident victims since 1980.

Share This Post
Email
Facebook
LinkedIn
Twitter
Trending Posts
Read More Insights
Events
By
Pace Law
Pace Law Firm is always looking to expand our business and elevate it to the next level. On Thursday November 24th, Pace Law Firm attended the Canadian Mortgage Summit (CMS) to hear from the industry’s top mortgage brokers, lenders and solution providers.
Firm News
By
Pace Law
We are proud to announce that Pace Law has become a multi-service firm and is launching a new website to accommodate our growth in different areas of law!
Events
By
Pace Law
The National Day for Truth and Reconciliation takes place on September 30th for the second consecutive year. Each year, September 30th marks both Orange Shirt Day and National Day for Truth and Reconciliation.
Real Estate Law
By
Pace Law
In key Canadian cities, the housing inventory may reach a crisis stage, according to a recent analysis from RE/MAX Canada. The analysis confirms that governments must take quick action to address the critically low supply of available homes.
Personal Injury
By
Pace Law
As the winter months get closer, it is critical to plan ahead and take precautions as needed to reduce the likelihood of mishaps. Nearly 30% of all motor vehicle incidents, according to recent RCMP data, happened on slick, snowy, or icy roadways.
Real Estate Law
By
Pace Law
Two weeks after the provincial administration submitted Bill 109, the More Homes for Everyone Act, 2022, on March 30, 2022, it obtained royal assent on April 14. The last step needed for a legislative measure to become law is royal assent.

Get in Touch

Call us now or fill out the form to discuss your case with an experienced legal professional.

Our Locations

Office Location

191 The West Mall, Suite 1100
Toronto, ON M9C 5K8
Phone: 1-877-236-3060
Fax: 416-236-1809

Office Location

191 The West Mall, Suite 1100
Toronto, ON M9C 5K8
Phone: 1-877-236-3060
Fax: 416-236-1809

Scroll to Top