Companies Forum Minutes of Meeting - June 7, 2007

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

The meeting was called to order at 10:00 am on June 7, 2007.

The minutes of the last meeting were approved, with one minor clarification, FSCO has set up three formal hearing rooms instead of two.

Recent Decisions Discussed

McMichael vs Belair – The decision provided clarification around " what does incurred mean ?". FSCO had issued a decision that if a client cannot access a benefit because it was denied and the client could not fund it, then it can still be ordered at arbitration even though no funds were expended. The Divisional Court upheld the decision. It is unknown if an appeal will be filed. It was noted that this creates difficulties for insurers as receipts can be produced without verification.

David Draper reported on a discussion at Council Forum about WSIAT decisions on an insurer’s right to apply to WSIAT for a determination of worker’s compensation coverage. Decisions had gone both ways, but seem to be favouring the view that insurers can apply to WSIAT.

Mamaca vs Coseco – The Master determined that, contrary to the prevailing view at FSCO, the date of the application for mediation is not the date at which litigation privilege starts. Not aware of any appeal of this decision.

Special Awards

Clarification provided that production orders for Special Awards are guided by the relevance of the documents, not a blanket order to produce all documents, whether relevant to the issue or not.

It is felt by insurers that the tickbox for Special Award is irrelevant as a Special Award can be awarded at any time, and representatives mark the box as a matter of standard practice. .David Draper advised that when the forms will be reviewed, consideration will be given to whether the tick box for Special Award should continue to be part of the form..

It was requested by Insurers that FSCO make every attempt to ensure that claim and/ or policy numbers be completed on all Arbitration documents. FSCO will address this internally.

FSCO Dispute Forms

Discussion that DRS forms will be available in fillable, saveable PDF format., likely by the end of August.

In response to a question regarding mediator contact and scheduling of the mediation meeting, John advised that the mediator typically contacts the Insurer ADR Coordinator after five business days following registration, if they have not been notified as to who will be handling the file for the Insurer. In addition, there are other internal standards that the mediators are expected to meet including contact with all the parties within 14 days and making best efforts to schedule the mediation within 60 days, unless the parties agree to an extension.

The forum was reminded that the Dispute Resolution Case Directory is available and is a tool that can be utilized by Insurers regarding their open cases within the DRS system. Judy Anderson, Manager Support Services can be contacted regarding Insurer registration. It was suggested that the Directory could be demonstrated at a future meeting.

For Arbitrations and Appeals, there are approx 30 days for internal processing, (7 days from perfection and assignment, and 14 days to be assigned to an Arbitrator). If settlement has been reached prior to the due date, the Administrator to be notified by both parties in writing and that will negate the fee. The same protocol applies to Mediations.

Operational Concerns raised by Insurers :

The following practices have been noted :

• health practioners are amending the fax back form by either adding boxes allowing them to be noted as regulated health provider, suggested that a reminder be sent to all regulatory bodies
  
• certain facilities are turning forms upside down thereby having the blank back of the form faxed to the insurer and subsequently insisting that payment be made as they are able to produce the confirmation of fax document. It is expected that HCAI will correct this.
  
• that there have been some instances where mediation has proceeded on an issue that was not received by the insurer and therefore not formally denied. A reminder that speaking to the mediator in advance of the mediation meeting, usage of the Response Form and the Case Directory could assist to reduce such instances. $500.00 mediation fee not being reviewed at this time.

Mediation Statistics – John Lobo

Application intake between March 07 to May 07, was higher than in the last two quarters. Average processing time continues to be monitored and best efforts are being made to move complete and perfected files through to assignment.

Face to face mediations at 3%.

Currently there are 34 Mediators and expecting to fill the Team Leader position shortly.

Arbitration Statistics

Slight increase in Arbitrations received, 635 in third quarter of 2007 and 672 in fourth quarter of 2007. Increase noted in all lines. Appeals numbers are staying consistent. Noted that there has been no increase in Arbitrations with legislative changes in March 06, closure of DACS.

Currently there are 21 Arbitrators and some contract positions, will be filling a second Senior Arbitrator position shortly.

Operational Issues : David Draper

• renovations have been completed with increased air flow and soundproofing of walls and ceilings. Feedback by Insurers would be appreciated.
  
• DRS Excellence Project is continuing
  
• will look at posting Judicial Review cases on FSCO website
  
• policy work is being done on regulations surrounding disputes between Insurers. May need to wait until after upcoming election.
  
• Law Society will regulate SABS paralegals effective May 1, 2008. Reps have a deadline of October 31, 2007 to apply to the Law Society for grandfathering provisions.
  
• Outreach Committee are looking for opportunities for public education for Insurer based committes and not individual companies. Mary Wright and Margaret Rees will be available to provide feedback to the Committee.

Future Meeting Dates :

September 20, 2007
December 6, 2007
March 6, 2008
June 5, 2008

Election of Insurer Representation

Mike De La Haye , Wawanesa, was thanked for his service of the past two years as Chairperson of the committee and was re elected for the next term of two years. Co- chair was also appointed, Dave Alpert from Belair, for the next term of two years.

Minutes – Maria Joshua