Monthly Archives: March 2013

THE INSURANCE FIASCO – or should it be termed a disaster

03/26/13

In the practice of medicine today, the complexity of insurance is infinite, however only becomes a problem when an “event” occurs.

The following story is becoming more typical and frequent than one realizes or would wish.

The patient in question had a severe automobile accident, not his fault, over five years ago. He has lost his business and his home. Throughout this period, he has undergone countless courses of medical therapy, an unending series of tests and many medical and other assessments. As a final insult, he has been evicted from his home due to his inability to service the mortgage. At this time he is living in semi-abject poverty.

Here is his wife’s recounting of the proceedings; she writes as follows:

We trust this is a good moment to bring you up to date. John has been going through countless assessments and most recently, the ones for his catastrophic designation, which will be finally arbitrated at the end of April. The scheduled hearings with all the experts will last over two weeks. The assessments John went through lasted from forty minutes to two days. The medical evaluations that were initiated by the insurance companies and executed by their “selected doctors” did not lack briefness, trickery and manipulation. Their reviews are insincere and dishonest with ample insulting efforts and frustrating moments to disturb and offend the victim. It must be their principle to close all their prejudiced reports with the same findings – to decline anything and everything.

Our side applied for the arbitration, which will take place in front of FISCO, the Ontario government’s controlling body for all insurance issues. FISCO has no power to decide on financial losses and damages of the plaintiffs, but is the organ and consequently imperative for defining the victim’s rights and the insurers obligations (up to two million) for retroactive and future payments regarding John’s care taking, rehabilitation, medication and treatments. The Superior Court of Justice in Ontario will eventually hear the damage claim.

After all, John did not cause the accident.
He was t-boned on a Monday afternoon in October 2007 and his mistake was that he showed up in the wrong place at the wrong time. The result of this error is permanent brain injury, back and balance problems, chronic headaches, etc., the loss of all income with only expenses left, including and not limited to all his equity, retirement savings, valuable life insurance policies etc. and a smashed and beyond repair automobile.
John has been disabled and absent from his business and social life ever since. The seventeen year young driver was charged and pleaded guilty. No support or reimbursement has been presented yet.
Is this a scandal? Yes! Is John the only victim of the insurance system? No!

The last year was most stressful.
We have been constantly working on our financial survival and the reinstatement of John’s treatments that had been cut off by the insurer in 2009. One may question why you have insurance at all when they refuse support and follow through when needed. John’s motivation to have the family well provided for has always been evident. His guiding principle to have any thinkable incident insured and financially secured is fact but has not materialized or manifested in any compensation by today.
What has become apparent is the scandalous reality and truth that he was, is and will be at the mercy of the insurance companies, their counsel and doctors, who are deciding on everything including the timing of when to get treatments and of course the payments. It is just a nightmare. Not to mention that down the road the judges and jury will have a say if no prior settlement is achieved.
Actually, October first 2012 was our ‘fifth accident anniversary’!

John went as far as to obtain through Chubb Insurance an umbrella policy of ten million dollars twenty years ago. This was supposed to provide the safety net in the unfortunate situation of an automobile accident where the other driver has no or insufficient insurance coverage. In our case the other driver was covered for two million under her father’s Toronto Dominion Insurance Policy as the principal car owner.
The pending hearings in John’s family tort claim vs. the driver, her father and their TD Car Insurance as well vs. John’s Chubb personal insurance for amounts exceeding the TD coverage will take place in the ‘Ontario Superior Court of Justice’. Three weeks will be needed for the court hearing in case no pre trial settlement is reached.

John’s different life and disability Insurers in Germany (Allianz Insurance and the Unfall und Renten Versicherung) and Switzerland (Winterthur Insurance and AHV) handled and settled our legitimate claims professionally and timely after they had completed their due diligence and comprehensive and ongoing medical assessments. Contrary to that attitude is the behavior of the two major Insurance Companies at whose mercy we now exist.
Their concept of processing a claim is definitely not based on fact-finding or to provide relief and financial help for the victims and their families. Their well-set principle is based on delaying, declining and intimidating.
This is a “business world” in itself, a kind of an ‘insurance mafia’ where the insurance providers are investing substantial funds for delaying and fighting any claims by well thought out legal maneuvers, by screening the victims to their bones and involving investigation agencies to have the sufferers monitored and followed.
The insurers appointed doctors conducting the so-called “independent” and “non-bias assessments” and the insurers lobby and financial power in the political arena and lawmaking body don’t necessarily improve the victim’s position.

The more you get involved the clearer the concept becomes. It did not come as a total surprise that the outcome of the insurers independent assessments are in reality “prejudiced reports” to hide and justify the insurers disapproving rightful demands. They just decline and the victims are left all over again with the same task on hand… “prove it”. Or to paraphrase, prove what?

Everybody who knows John will confirm that he would be the last one who didn’t want to be on the hospitality world stage anymore.
For the longest time after the accident John was in a denial frame of mind and would not even admit or accept that his days are over and that he had become disabled indefinitely. For him not to be able to be with people and create, lead and execute ideas and concepts any longer is catastrophic.
In a split of a second, he was taken away from his successful, fulfilling and rewarding business, family and social life and confined to being a non-entity.

The insurers self-serving delay tactics by ignoring the numerous non-biased doctors and specialist assessments, by declining treatments and payments and even questioning John’s integrity is totally insulting, wrong and harmful. These insurance companies try to wait the victims out, financially and morally until they give up and throw in the towel, pass away or depart this life voluntarily before any settlement is achieved or just give up and face the financial reality of being ruined permanently. Ever listen to an insurance ad? Total deception!

We try very hard to stay positive, ever getting closer to the boiling point. We truly hope that the latest events are an indication that the parties are moving to ultimately determine the severity of John’s injuries and his ability to continue what he always enjoyed doing.
His whole life shows his dedication to his profession, his total commitment to deliver the best and his always-positive approach to people and life.
All this is evident in his letter “to whom it may concern”, his essay “my life” and “other supporting documentation”, not to mention the medical file with “the assessments, expert reports and treatment history” and the supporter list with the “seventy-seven support letters” our counsel and I received describing John.

If you have interest in any of the credentials, we would be excited and very pleased to provide them to you.

This automobile accident has such a devastating effect on us.
Not enough, that John couldn’t carry on his profession and business that he loved so much, now we no longer have any hope. It has been taken away.

After we had used up our savings, closed both retirement saving accounts, surrendered John’s very valuable and paid up Life Insurance used up all our investments and savings, we were left with no choice than to take our daughters out of their private school, which they had enjoyed for eight years. Last but not least, John’s Royal Bank’s disability payments came to an end in January 2011 when he turned 66. Since that day, only some small pension payments are received monthly.

It has been really tough and believe us, we are looking more than forward to the day when we may be able to show our appreciation to those who have helped.

And now in its sixth’s year we are close to losing our last family asset, which was already highly leveraged for the reasons indicated. John’s Family Trust owns our beautiful home. Most channels have been exhausted. We must have tried every avenue to get our first mortgage increased to a level where we would be able to consolidate the first and the second mortgage into one, and still have an additional amount reserved (escrowed) to secure the interest and tax payments for a period of up to 18 months so that no default could be possible. The property provides sufficient equity but our almost non-existing income stream made any refinancing an impossible task.

Please forgive us for the lengthy and sometimes-repetitive report. We like to tell you how much we appreciate the opportunity to express our thoughts and feelings and were able to describe what our family has experienced going through the last five years and what may be the next steps in our saga.

We are still blessed with our family and we need to carry on until such time as we have found common ground with the Insurers and their troops.

Thank you for listening, thank you for your compassion and thank you for your friendship and trust and your readiness to bear with us.

Reflections on Neurological Conditions

03/12/13

Many illnesses share common DNA roots. The five most common mental illnesses present in the following order:

1. Autism.
2. ADD.
3. Bipolar disease.
4. Schizophrenia.
5. Depression.

The latest research published in the journal Lancet indicates that all these diseases are the result of genetic variations, some of which have been extensively reviewed. i.e.:

• Chromosome 3
• Chromosome 10
• Calcium channels, which play a significant factor in controlling cell function
• Environmental influences

This synopsis of mental illnesses and the factors involved (many of which are unknown) are challenging, particularly with regard to effective therapies.

Currently, there is an extensive amount of research being carried out in many leading clinical and research centres throughout the world and it would appear that genetic factors may be pre-eminent as the etiological causes responsible for these disease processes.

Laser Therapy is beginning to play a role in this therapeutic area, which of course is important, in order to achieve positive clinical outcomes. Some of the effects of Laser Therapy on neurological tissue include the following:

• Increase in ATP production raising energy levels within the cells
• Increased deoxyribonucleic acid (DNA) and ribonucleic acid (RNA)
• Increased nitric oxide (NO) release
• Enhanced cytochrome c oxidase activity
• Modulation of reactive oxygen species (ROS)
• Modifications to intracellular organelle membrane activity
• Cytoprotective effects
• Down-regulation of pro-inflammatory mediators
• Increase in secretion of anti-inflammatory mediators
• Angiogenesis
• Neurogenesis and neuroplasticity facilitation

All of these physiological activities produce a neuromodulating or neuromedation type of effect, particularly on brain tissue.

This commentary is appropriate as at this time more effective therapies need to be developed to deal with these problems. At Meditech, we have had a long standing interest in these pathologies and recent discussions with several neuroscientists stimulate our efforts to accelerate the development of reliable therapeutic options.

As an increasing number of patients are treated, we gain experience, establish effective protocols and expect that our work in the treatment of these complex and problematic conditions will be particularly rewarding for patients.

THE JOYS OF GOVERNMENT HEALTHCARE

03/4/13

This article published in the Financial Post, Wednesday, February 27th, clearly demonstrates the absurdities resulting from government controlled healthcare. The degree of relevance may best be compared to the book, Animal Farm, penned by George Orwell many years ago.
Unfortunately in our current culture, rhetoric trumps reality, as recently demonstrated by the election of Barack Obama over Mitt Romney. The former is an orator, the latter a skilled proven businessman who is best equipped to run a company (i.e. the USA), balance the budget, and meet the needs of the people.
Evidence based results are no longer a factor in our society and some day we will rue the day this ceased to be the basis of all focus and reason.
Incidentally Laser Therapy, a technology that Meditech International has developed over the past 20 years, would probably take 3400 plus of those patients off the waiting list and improve the patient’s status so they would no longer require surgery or pharmaceuticals, and could resume a normal lifestyle.
The costs for this therapy would be approximately $1500-2000 per patient.
When will governments begin to devote some attention to the welfare of the people rather than the housing allowance of senators?
Fred Kahn, MD, FRCS(C)

WOMAN STILL WAITING FOR SURGERY AFTER 11 YEARS

Wendy Berringer’s feet are killing her. They hurt when she stands, when she walks and when she sits, which is what she was doing Tuesday, in her favourite rocking chair in her Halifax home, telling me about her bunions, a tiny broken bone in her left foot and her creaking left ankle, which cracks and groans and aches, causing her all manner of grief.

“I had my first appointment with my family doctor for my feet in 2002,” she says. “The original problem was my bunions. They rub in your shoes and you can’t walk properly. They are very sore. My family doctor made me an appointment to see a foot surgeon in Halifax to get the problem fixed.

“That was 11 years ago.”

In what seems like a parody of complaints over medicare waiting lists, Wendy Berringer is still, 11 years later, waiting for that appointment. Her would-be foot surgeon, an otherwise staunch defender of public healthcare, says there is nothing he can do about it, not when Ms. Berringer’s foot problem isn’t life and death — and not when his waiting list is 3,500 names long — and not when he is the only foot and ankle man in the entire province.

“I’ve been alone out here, really, for a long, long time,” says Dr. Mark Glazebrook from Halifax. “Dr. Andrea Veljkovic, in Kentville, is taking a job in Toronto.

“She was out here on a locum and we were hoping to extend her stay but the government said we didn’t have the money for her. Right now I have 3,500 people waiting to be seen by me in consultation. I have a private office where I see my referrals and the referrals are dated 2003 and 2004 now — and I have them chronologically up to 2013 — and I get close to 40 new referrals a week. And it’s for all of Nova Scotia.

“The province now acknowledges that there actually is a problem here, and they want to help us to get it sorted, so the Minister of Health has been fairly co-operative.

“But they still talk about resources and making decisions and, well, come on: maybe foot and ankle is not as important as cancer, and not as important as heart conditions, but a 10-year waiting list is way outside the norm in terms of what you should expect in public care, and if 10 years is the norm in public care than it is time to think of going private. People have the right to be seen for their problems.”

Dr. Glazebrook believes the public health care system is the “jewel in Canada’s crown,” and yet, he says, it is expensive to operate and if the government is more concerned with finding “efficiencies” than in hiring more doctors to tackle what is a Canada-wide wait time problem — that only additional manpower can truly fix — then we, as a country, are eye-to-eye with the proposition of actually having an honest conversation about private medicine.

David Wilson, a former paramedic, is Nova Scotia’s Health and Wellness Minister. He says the province’s NDP government has been “working hard” to ensure “that the province has a good complement of surgeons and specialists.”

How having one foot and ankle surgeon, with a 3,500 person backlog, qualifies as “good” is unclear. But, no matter, the politician says creating a parallel private system or offering health consumers a private option would pull money away from the public till and erode what the province already has, flawed though it may be.

“I think, and this has been a view of our party, and we have been very vocal about it, but I think we have to be very careful because the minute you [talk privatization] you open up the opportunity for profit to play a role and really siphon funds from a public system,” he said.
Dr. Glazebrook says hiring three additional foot and ankle specialists would cure his wait list woes. David Wilson says there is no money to hire them with. And so here we are, in a perfect pickle, with people like Wendy Berringer being told to grit their teeth and get in line.
“I know you have to wait your turn in Canada,” Ms. Berringer says. “I understand that. But sometimes the system doesn’t seem to work for the people that need it.

“I am kind of back to full circle, back to Dr. Glazebrook, and he has a 3,500-person waiting list. I have waited over 10 years to see him and I’m not getting any younger, you know.”

Timothy Caulfield