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‘Hardball’ auto insurer hit with $40,000 ‘remedial costs penalty’

Oct 04, 2010

By Cristin Schmitz, Ottawa


September 17, 2010


Auto insurers in Ontario who refuse to participate in mandatory mediation — or who flout their companion statutory obligation to try to speedily settle a case — face “significant remedial costs penalties,” warns the Ontario Court of Appeal.


On Aug. 31, the appeal court slapped auto insurer Aviva Canada with paying an additional $40,000 of Glen and Heather Keam’s legal costs, on top of the partial indemnity costs of $110,000 the plaintiffs were awarded last year after an 11-day jury trial in 2008.


The Court of Appeal’s award of a $40,000 “remedial penalty” increases the plaintiffs’ costs recovery by a hefty 36 per cent, and sends a strong message to insurers that they risk serious financial consequences if they fail to meet their statutory duty to mediate under s. 258.6(1) of the Insurance Act, says the Keams’ counsel, Lawrence Hatfield of Flaherty Sloan Hatfield in Hamilton, Ont.


Hatfield told The Lawyers Weekly that, so far as he knows, the decision marks the first time that a court has imposed a costs penalty on an auto insurer for breaching its statutory duty to mediate.


Commenting that Aviva played “hard ball” with the plaintiffs, Justices Marc Rosenberg, Stephen Goudge and Kathryn Feldman held that “although the insurer’s conduct may not have risen to the level required for the imposition of substantial indemnity costs,…a significant remedial penalty was required in all the circumstances…to reflect the censure of the court and to provide an appropriately significant recovery for the appellants.”


Hatfield said some Ontario insurers have been refusing to mediate — or alternatively demanding that plaintiffs’ pay half of any mediation costs — in violation of the Act and its regulations.


He said the Court of Appeal’s decision makes it clear that insurers who flout their statutory obligation to participate in mediation — and their companion duty to “attempt to settle the claim as expeditiously as possible” under s. 258.5(1) of the Insurance Act — now face substantial costs sanctions, even if the defendant ultimately wins the case at trial.


As Justice Feldman put it “the cost consequences will follow whether the plaintiff or the defendant has been successful at trial, so that, for example, where a plaintiff’s claim is dismissed, the trial judge may deprive the winning defendant — represented by the insurer that refused to accept a request to mediate — of all or part of its costs that would normally follow the event.”


“There is no exit for the insurer,” Hatfield emphasized.


However, the statutory obligation to participate in mediation on request applies equally to plaintiffs. “In theory a cost sanction could be awarded against a plaintiff for failing to mediate when requested,” Hatfield acknowledged. “However, in reality, I must admit I have never heard of a plaintiff refusing to mediate a case.”


Matthew MacIsaac, counsel for the defendants along with lead counsel Robert Rogers of Hamilton’s Evans Philp, told The Lawyers Weekly no decision has yet been made on whether to apply for leave to appeal.


In the wake of Keam, he queried whether it remains open to an insurer as “a tenable position” to reasonably argue that a plaintiff’s injuries are not “serious and permanent” and thus do not meet the Insurance Act’s threshold for litigation. “Would you be considered to be mediating in bad faith, or wasting time, if you go to mediation with that position that the injury doesn’t meet threshold?” he asked. “If the injury doesn’t meet the threshold, the chances are you are not going to volunteer to pay anything on it. Could the plaintiff’s counsel then, at the end of the day, say: ‘Well they attended mediation, and mediated in bad faith because they had no intention of paying’ — and does that ultimately result in increased costs against the insurer?”


MacIsaac also queried how Keam jibes with the Court of Appeal’s ruling in McCombie v. Cadotte, (2001), 53 O.R. (3d) 70. McCombie seems to indicate that plaintiffs who fail to meet their s. 258.3(1) Insurance Act duty to attend a defence medical before suing should face cost sanctions only if their failure to attend prolongs the litigation, MacIsaac noted. “It seems what the Court of Appeal is saying with [Keam] is that there will be cost consequences [for failing to mediate] regardless, so it’s tough to reconcile the two decision from the same level.”


Hatfield’s client, Glen Keam, suffered chronic pain after receiving soft tissue injuries to his neck and back in a 2003 auto accident. The defendants’ insurer twice refused the plaintiffs’ request that the defendants participate in mediation. This violated s. 258.6(1) of the Insurance Act which requires the parties to participate in mediation at either party’s behest. Moreover, O.Reg. 461/96 requires the defendant’s insurer to pay the reasonable expenses and fees of the mediator (which typically range from $3,000 to $5,000, Hatfield said.)


The defendants maintained for more than four years after Keam sued, that the plaintiff’s injuries did not meet the s. 267.5(5) Insurance Act litigation threshold of a “serious and permanent” injury. In light of its position, the defence said mediation would be futile and it therefore refused two separate requests from the plaintiffs for mediation.


The plaintiffs ultimately won their case, but the trial judge rejected their request for substantial indemnity costs of $196,145. Instead he awarded partial indemnity costs of $110,000. He accepted the insurer’s position that it was entitled not to participate in mediation because of its belief that Keam’s injuries did not meet the “serious and permanent” threshold for litigation.


The plaintiffs based their request for a “remedial cost penalty” against the defendants on s. 258.6(2) of the Insurance Act which stipulates that a person’s failure to participate in a requested mediation “shall be considered by the court in awarding costs.” (Section 258.5(5) further stipulates that an insurer’s failure to attempt to settle a claim as expeditiously as possible “shall be considered by the court in awarding costs.”)


“In this case the respondents’ insurer took the position that the claim did not meet the threshold and therefore there was nothing to negotiate,” Justice Feldman observed. “However, it is this approach that the Legislature has disavowed by making mediation mandatory. Rather, the Legislature’s approach recognizes that participation in mediation could have a salutary effect on one or both sides, with input from an experienced and respected mediator.”


Justice Feldman said that in a case where the insurer has not fulfilled its obligation to mediate, the trial judge must consider the appropriate cost consequences.


She described the “costs sanction” as a “remedial penalty.” It is remedial in the sense that it is intended not only to compel insurers to comply with “an important statutory purpose” of promoting early out-of-court settlement, but also to give a remedy to the party who was deprived of an opportunity for early settlement of the claim.


“It is a penalty because it is not intended to be merely compensatory of costs unnecessarily incurred by the other party or parties, as that objective is already addressed by other costs provisions of the Rules of Civil Procedure, but to provide a meaningful consequence to an insurer that elects not to comply,” Justice Feldman explained.


She suggested such meaningful financial consequences could include substantial indemnity costs against a losing defendant, or depriving a winning defendant of its full, or partial, costs.


In this case Justice Feldman said the appeal court decided the size of the $40,000 costs penalty by taking into account: the fact that the insurer twice refused to mediate (the first time two years before trial, and the second time, more than a year before trial); the fact that the insurer “decided to ‘play hardball’ by taking the easy position that the claim did not meet the threshold”; the fact that shortly before trial, the insurer served an offer to settle which, while low, amounted to acceptance that there was a potential claim to litigate — and therefore to mediate; and the duration of the 11-day trial.


Keam v. Caddey, [2010] O.J. No. 3650.

Original Article from: www.LawyersWeekly.ca/article-1251

11 May, 2015
We are paying something for nothing. The mandatory accident benefits policy in Ontario provides minimal coverage for the vast number of people injured in car crashes. Presently, over 90% of victims are restricted to payment of a maximum of $3,500.00. They are forced by law to pay hundreds if not thousands of dollar PER YEAR for this coverage. Ask yourself. Would you voluntarily pay $1,000.00 per year of $3,500.00 worth of life insurance? Of course not. But the Government of Ontario forces you to pay for this very poor product. It’s time to speak to your Member of Provincial Parliament. See the full facts here. http://truthaboutinsurance.ca/drs-lazar-prisman-report/
11 May, 2015
The Ontario Trial Lawyers Association has prepared a series of blogs identifying current issues with the recent budget and how it impacts people injured by Motor vehicles. Please read the full blog here. http://otlablog.com/hidden-costs-of-the-provincial-budget/ Part One of a Three-Part Series on the 2015 Ontario Budget Last month, the Ontario Liberal government revealed its latest budget entitled “Building Ontario Up” but what it does to our auto insurance benefits is actually the opposite by significantly slashing benefits available to accident victims. This follows promises that tout more affordable insurance but do not disclose the true cost to those who find themselves in need of the coverage now, and those who will unfortunately need the protection in the future. The rationale of the Liberal government is that the reduced benefits will lower claim costs which will then be passed on to the consumer in the form of savings on premiums. A promise to reduce rates by 15% was made about two years ago but in reality, and by their own admission, has not been realized. It is estimated that since 2013 rates have decreased by only about 7%, and many of us still have not seen that reduction. On the other hand, the cuts to benefits will be effective immediately once the budget is passed. The reduced premiums come at the cost of a 50% slash to (or total elimination of) many benefits that were once part of mandatory insurance coverage prior to the 2010 reforms. The erosion of available benefits is disproportionate to any rate decrease and is unfair to consumers. According to the Liberal budget, “…costs in Ontario’s auto insurance system remain too high,” While a reduction in claim costs is welcomed by consumers and stakeholders alike, it can be achieved through other means. For example, as discussed on the OTLA blog following the release of Justice Cunningham’s review of the Dispute Resolution System late last year, insurers spent thousands of dollars on Independent Medical Assessments which account for roughly 25% of total health claims expenses. Despite this, the Liberal government made the choice to save costs by reducing available benefits rather than regulating insurer practices. The insurance industry has been crying poor through persistent lobbying (that also comes at a great cost), while profits have been on the rise since the initial cuts began in 2010. The latest benefit cuts will surely continue to boost these margins. Data released by the General Insurance Statistical Agency (GISA) suggests a dramatic reduction in Accident Benefit claims from $3.8 billion in 2009 to a low of $1.9 billion in 2012. While claims over the past year were projected to rise to $2.2 billion they are still down overall. This has allowed insurers to reap massive profits at the expense of those who need it most: accident victims. Profits remain high, payments to claimants remain low, and benefits are further restricted with trivial savings that may never end up in the consumer’s pocket. What additional cuts can we expect from this budget? The budget combines the medical and rehabilitation benefit which currently offers $50,000 of coverage and the attendant care benefit which currently offers $36,000 of coverage into one cumulative coverage limit of $65,000 – a reduction of more than $20,000. In the case of the catastrophically injured, attendant care and medical and rehabilitation benefits have been reduced from $2 million to a combined total of $1 million. This begs the question: is a 50% reduction in benefits worth a 7% reduction in premiums to some consumers in Ontario? The real kicker is that Ontario NDP leader Andrea Horwath – whose party propped up the Liberal minority in exchange for the 15% reduction to auto premiums – has publicly opposed the proposed changes stating, “…if you are talking to the insurance industry, they are going to try to paint it in a way that looks like they are really struggling. I don’t think anyone in this room believes that for a minute and I certainly don’t.” She went on further to say that “…in 2010 the (Liberal) government made changes to the policies around insurance and all that did, instead of creating an opportunity for reductions, is it created an opportunity for insurance companies to pocket more money.” So what has the Liberal government and the insurance industry offered the public in exchange for the slashing of benefits? A mandatory discount for winter tires. Think about that the next time you’re shopping for a set of Michelins. This blog post was contributed by Michael Giordano, Junior Partner and Monty Dhaliwal, Associate Lawyer of Sal Guzzo LL. B.
23 May, 2014
Ontario auto insurance: How much worse can things get for victims? Changes in 2010 created windfall profits for insurers by slashing coverage for the vast majority. We need to restore fairness and impose a moratorium on further reductions in coverage! In September 2010, the Ontario government introduced sweeping changes to auto insurance in response to pressure from the insurance industry to contain injury costs despite the industry’s long-standing failure to address systemic fraud in the system. The MIG: Minor Injury Guideline for victims The main feature of the so-called reforms was the MIG – the Minor Injury Guideline. What did it mean? Coverage for the vast majority of policyholders was slashed from $100,000 for medical and rehabilitation treatment to the paltry level of $3,500 maximum for medical and rehab needs following an accident. The MIG currently captures up to 75 per cent of all accident victims in Ontario, often without regard for the seriousness of the injuries involved. OTLA members report that many clients in the MIG typically exhaust their maximum benefit of $3,500 very quickly, leaving them without access to needed treatment. Clients are often forced in the Minor Injury category despite having injuries that could not reasonably be considered as “minor” e.g. serious fractures and brain injuries. The MIG: Major Income Generator for insurance companies It’s really no surprise what happens when premiums are increased and insurance payments are dramatically reduced for most injured accidents victims. In fact, the “good news” for insurance companies started to become apparent almost immediately. Here’s what one insurance CEO quipped, perhaps a bit too candidly, mere months after the changes: “We are starting to see the benefits of the 2010 auto reforms in Ontario, which is combining with our recent focus on proactive broker management and underwriting discipline to generate stronger results.” The early trend that this CEO was talking about here materialized and, by the end of 2012, total auto insurance claims were down more than 20 per cent or a reduction of $4 billion. The tally for auto insurers was more than $3 billion in profits in the first two years following the 2010 changes. Early indications for 2013 indicate that auto insurance companies in Ontario continue to enjoy strong results to this day. It should come as little surprise to anyone that insurance companies are doing extremely well under this model: then again, you can’t lose when you’re charging more and paying out a lot less. Ontario, now the worst coverage in the country As a result of the September 2010 changes, Ontario emerged as the only jurisdiction in the country with a special category of insurance for so-called “minor” injuries. And, significantly, Ontario has the lowest level of compensation for this category of injury. Even the insurance industry’s own data supports this contention with average claims payouts down dramatically from previous levels and more claimants than ever being captured by the MIG. But how much worse can things get for victims? Once again, columnist Alan Shanoff has documented the steady slide in coverage over the past few years in Ontario. Read his comments here. He ends his article this way: “One thing is certain. The current system can’t get much worse for accident victims. Victims need timely, adequate accident benefits even more than they need premium cuts.” Help make things better for victims! As a candidate, here’s how you can help ensure that the system doesn’t get any worse for victims: Demand that your party impose a moratorium on further auto insurance coverage reductions It’s time for our politicians to stop worrying about how to allow insurance companies to make more money, and start concerning themselves with how to restore fairness in our automobile insurance system.
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