MEETING - Wednesday, July 13, 2005

10:00 a.m.

Tribunal Room - Room 20, 14th floor

Dispute Resolution Group Companies Forum

Minutes of Meeting

July 13, 2005

Attendees:

The Dispute Resolution Group – Companies Forum includes representatives from auto insurance companies dealing with disputes before the Commission involving motor vehicle accident claims and Statutory Accident Benefits. It consults with the Dispute Resolution Group of Financial Services Commission of Ontario on issues relating to the dispute resolution system.

Opening

Welcome to the new chair Mike De La Haye.

The meeting was called to order at 10:00 a.m. on July 13, 2005.

The minutes of last meeting were approved with no changes.

There were no matters arising from the previous meeting’s minutes.

Auto Insurance Reform Update: - Roberto Pegoraro & Susan Naylor

• Draft Regulation released 27th of June to eliminate the DAC’s.
• Government now looking for comments from stakeholders on technical and operational issues only.
• Meetings arranged for the week of July 18-22
• Regulation to be finalized in September 2005
• Operational November 1, 2005

Draft Regulation Outline:

• Denial of benefits must be supported by Insurer Examinations
• Insurer Examinations can be paper review
• Can still terminate for non-medical issues - example fraud
• 3 assessments          
• initial to assess entitlement
• 2nd to stop benefits
• 3rd by Insured’s treating practitioner
• Cap on fees for 3rd assessment –paper review $450, other $775, Specialist $900
• Specific time frames to conduct 3rd assessment
• Pre-claim assessment – in-home for Attendant Care & assistive devices if Insured in hospital or LT care home
• Compensation for Health Care provider to speak to Insurer Examinations doctor to 30 minutes
• Elimination of prohibition of non-attendance at Insurer Examinations before mediation allowed* - sec. 50
• Attendant Care paid at Catastrophic level until CAT determination is made
• Amendments to Unfair or Deceptive Acts & Practices

New fee guidelines effective July 1, 2005.

Statistics Review:

Mediations

• Average processing time is good last quarter
• Face to Face mediations still at 3%. FSCO aware of the Insurers’ wishes to have more Face to Face mediations
• Full settlements are down
• Anticipate an increase in volume due to the no DAC legislation

Arbitrations

• Huge increase in the last quarter
• Arbitration applications are issued shortly after failed mediation
• Suspect 1 year non-settlement to be the cause

Appeals

• Numbers have fallen

DRS Operational Changes:

• David Draper and John Lobo updated the group. There are presently 19 arbitrators with an anticipated increase to 21 by early fall as well as additional support staff. Ongoing competitions for contract mediators and team leaders. Aiming for 36 mediators with possibility of an increase to take into account the effects of the new legislation.
• The new Website will be up and running in August 2005 with many upgrades including better search engines.

FSCO Policy on mediating non-SABS issues:

• Adam expressed his concerns that FSCO allowed non-SABS issues to be mediated which could allow them to get into litigation. An example was given where the Application for Mediation was for over $300.00 per week for housekeeping benefits under Bill 59 when there is a clear maximum of $100.00 per week. In this instance there were also were some SABS issues, such as duration of the benefit, which would normally go to the DR process, therefore FSCO would hear them.
• If you encounter any non-SABS issues call John Lobo to discuss.

FSCO's Policy re: French Language Mediation for both Insured & Insurer:

• Adam also expressed concerns that when an insured requested a mediation in French, the Insurer representative who does not speak French is not provided with an interpreter.
• The practice code is unclear in this issue and the French Language Act only deals with the opposite situation.
• The current attitude of mediators of “it’s the insurer’s problem, not our” does not lend a positive air to the initiation of mediation proceedings.

Items Raised by the Chair:        (Mike De La Haye)

• Dispute Resolution Smart Forms - E-filing (Dec. 5/02) -this project has not moved forward.
• Loss Transfer – the group requested that FSCO consider updating the Loss Transfer Guideline (Apr. 21/04) and (Apr. 6/05) –FSCO has indicated that this is not a DR issue. Margaret Orlander from Policy Division of FSCO was to get back to the group on this. Initial guidelines/Bulletins were issued by FSCO in the early 1990s.
• Dispute Resolution Practice Code - amendments- 5th release (Apr. 21/04) – from now on the practice code will be only available on the Website and not hard copy.
• Expert Assessor Network (Apr. 21/04) – dropped.
• Auto Insurance Reform (DAC System) (Sept. 29/04) – Discussed above with the elimination of DACs.
• DRS Operational Changes (Sept. 29/04)
• FSCO Website – redesign updates (Apr. 6/05) – Stage 1 to proceed in August 2005.
• FSCO Decisions – Password protection to be removed (Apr. 6/05) – password protection will remain so as to protect the privacy of the individuals named in the decisions.
• Forum Minutes – posted on website without password protection (Apr. 6/05) – this was agreed at the last meeting.

Other Business:

• Elect Co-Chair - Adam Fox has agreed to be the co-chair.
• John Lobo  reminded insurers of the requirement of providing a response to the Application of Mediation, under Section 14 of the DRS Practice Code, which prompted discussion amongst members who met the requirement and those that did not.

Minutes taken by Martine Vaz

Next Meetings:      Wednesday, October 5, 2005, 10:00 AM
                               Wednesday, January 18, 2006, 10:00 AM