Wanted: Humble Investment Experts

Goldman Sachs back 8-10 years ago charged ahead with superior profits and assembled a super duper hedge fund team led by Mark Carhart. They called themselves the Global Alpha team, sounds so Fantastic Four like. 

If you are Mark Cahart, you almost have it all your way for most of your life. Mark Carhart looks out over the packed New York conference back in 2005 and tells investors that Warren Buffett has it all wrong. Carhart, 40 then, co-head of the quantitative strategies group at Goldman Sachs Group Inc., uses his July speech to poke fun at Warren's penchant for investing in market-leading brands like Coca-Cola and Gillette. He cites study after study showing that big-name companies with high price-earning multiples or rapid growth rates make poor bets. Traditional stock pickers like Buffett, a fabled raconteur, do have one redeeming quality, Carhart jokes: ``They tell great stories.'' (Lesson - Don't fuck around with people who have done better and longer than you)


Carhart is one of the world's most successful money managers, a mastermind behind Global Alpha, a US$10 billion hedge fund for wealthy clients and employees of Goldman Sachs. In 2005, Carhart and co-manager Raymond Iwanowski, 40, notched a 51 percent gross return at Global Alpha. Posting that kind of gain requires taking risks -- and last year, Alpha lost 6 percent, its first deficit since 1999. Carhart, a former assistant professor of finance at the University of Southern California, helps oversee other hedge funds, four mutual funds and scores of separate accounts. In all, he and Iwanowski have US$101.5 billion at their command. Carhart and Iwanowski use math-heavy trading tactics that fund consultant Sol Waksman likens to counting cards in a casino. The two lead a corps of computer-loving traders, statisticians and finance and economics Ph.D.s. (Lesson - If you have the scores of Phds, math wizards and other brilliant minds at your disposal, you should generate superior returns... NOT! Be humble with financial markets, once you think you have mastered it, you are fucked. If you approach with the attitude that the more you know, the less you know of it, you stand a better chance of not have egg on your face, and live to fight again.)

Their team makes -- and sometimes loses -- millions of dollars a day. At the heart of their empire is Global Alpha, which generated about US$700 million in fees for Goldman Sachs in fiscal 2006. This money machine hums mostly behind the scenes. Carhart and Iwanowski, friends since their days at the University of Chicago Graduate School of Business, oversee about 10 other Goldman hedge funds, too. Together, they trade everything from Japanese stocks to U.S. soybeans, to Israeli shekels. Global Alpha is part of the richest hedge fund empire the world has ever seen. Last year, Goldman Sachs eclipsed D.E. Shaw & Co. and Bridgewater Associates Inc. to become the largest hedge fund manager, with US$29.5 billion in assets as of Dec. 31, 2006. That figure excludes Goldman's proprietary-trading funds and its funds of hedge funds.


Carhart and Iwanowski hunt for market variables called risk factors that often lead to excess investment returns, or premiums, according to people familiar with the fund. Some, such as a measure called the value premium -- the difference between the return of a group of stocks with high book values relative to their prices and that of a group with low book value-to-price ratios -- have been used by other money managers for years. Goldman Sachs has identified more than 20 new risk factors, which it doesn't disclose, even to its own investors. Carhart never reveals the secrets. Old friends and people who've invested in the fund say they're not really sure how it works. (Lesson - Once you think you have found the key, it will evaporate right in front of you.)


On any given day, Carhart's team of 50-60 investment professionals uses Global Alpha's factors to deploy 20 trading strategies in markets the world over, according to an investor in the fund and Global Alpha documents. During 2006, the fund's picks ranged from Japanese and Dutch stocks to bets on and against the Polish zloty. At the center of the Global Alpha story are Carhart and Iwanowski, devotees of quantitative analysis, or quants, who came to Goldman Sachs from opposite ends of the financial world.

Carhart first turned heads in money circles as a doctoral candidate at the University of Chicago and later as an assistant finance professor at the University of Southern California's Gordon S. Marshall School of Business. Iwanowski, by contrast, has spent his entire career on Wall Street. What unites them is that they're quants, who put their faith in data, rather than human judgment, when deciding what to buy or sell. To money managers like them, what you think about a company's management or products doesn't matter much. ( Lesson - Quants take the human element, the human judgment out of the equation.... well, you can't and shouldn't.)


Jokes aside, Carhart would do well to heed two Buffett rules. No. 1: Never lose money. No. 2: Don't forget rule No. 1. In 2006, Global Alpha went wrong when just about everything else at Goldman Sachs went right. After a roller-coaster ride that included a 10 percent August plunge, Global Alpha ended the year down 6 percent, according to an investor in the fund. The loss, the first since 1999, came in a year when Goldman earned US$9.54 billion, the most in Wall Street history. The investment bank made headlines by earmarking US$16.5 billion for salaries and bonuses, including a record US$53.4 million bonus for Chief Executive Officer Lloyd Blankfein. Carhart and Iwanowski declined to comment for this story, as did other Goldman Sachs executives. It was a rare misstep for Global Alpha. The fund skated through the 2000-02 U.S. bear stock market without a down year and posted an annualized return of 19.75 percent, after fees, from Dec. 4, 2001, to Dec. 31, 2005, according to Global Alpha's 2005 annual report. The average hedge fund returned an annualized 9.1 percent from Dec. 1, 2001, to Dec. 31, 2005, according to Hedge Fund Research. Shares of Buffett's Berkshire Hathaway rose a mere 5.9 percent during the period.


Only now, Carhart and Iwanowski are in a hole. Like most hedge funds, Global Alpha charges an annual management fee of 1.5 percent or 2 percent and takes a 20 percent cut of any profit. Before the fund can take its 20 percent in 2007 -- assuming it makes money -- its quants must first make up the 2006 loss.
 
One of the most-surprising things about Carhart is that for a guy in an industry known for big money and bigger egos, it's hard to find anyone who'll say a bad word about him. Former colleagues, classmates and teachers remember him as one of the smartest people they've known. After graduation, Carhart headed for Yale University, where he majored in economics and served as managing editor of the Yale Economics & Business Review. He also began dabbling in the markets as a director of the Yale College Student Investment Group. After Yale, Carhart set to work on a doctorate in finance at Chicago. He studied under finance professor Eugene Fama, best known for his work on the efficient-market hypothesis, which holds that prices reflect all there is to know about stocks or other securities.

Global Alpha doesn't merely bet on the direction of stock or bond prices. It bets on differences between those prices. Global Alpha employs seven strategies in the bond markets alone, according to Goldman Sachs Global Alpha Fund Plc's June 30 semiannual report. The simplest of them is to buy government bonds of one country while shorting those of another. In the U.S. stock market, Global Alpha might buy oil and insurance stocks and simultaneously bet against semiconductor shares. The fund also allocates part of its US$10 billion to something called ``global event anomalies,'' according to a November 2001 prospectus. With this strategy, the fund attempts to make money from corporate stock buybacks and divestitures and from changes in how market indexes like the S&P 500 are calculated. Carhart and Iwanowski also employ a commodities strategy and an asset-allocation strategy that bets on various mixes of investments: stocks, bonds, currencies and beyond.

Global Alpha quants have designed their fund so that if things go wrong, the probability is low that the 20 strategies will lose a lot money at the same time. That, anyway, is the idea. In the 2005 report filed with the Irish exchange, Global Alpha reported a gross return of 51 percent for the year. The report says only two strategies -- global anomalies and the country bond selection -- suffered losses of more than 1 percent. During the first quarter of 2006, Global Alpha rose a net 9.5 percent. The next quarter, a bunch of the fund's strategies soured. Global Alpha lost 3.5 percent during the period. Its ``developed equity country selection'' fell 2.5 percent, hurt by bad bets on Japanese and Dutch stocks. Its developed country currencies strategy sank 1.9 percent, whacked by a wrong-way wager on the dollar and another against the pound. Emerging market currencies strategy sank 1.7 percent, nipped by short positions in the shekel and zloty.
 
Piecing together the second half of 2006 is harder. A Global Alpha investor who asked not to be identified says the fund's roughly 10 percent slide last August mostly reflected bad bond market investments. Global Alpha also bet that stocks in Japan would rise while those in the rest of Asia would fall -- wrong; that U.S. stocks would stumble -- wrong; and that the dollar would rise -- wrong again. Global Alpha finished November down 11.6 percent in 2006.

Trees don't grow to the sky. Neither do hedge fund returns. Superman exists only in comics.


Where Is Mark Carhart and Global Alpha now?

Goldman Sachs shut down the fund in September 2011. The closure of Global Alpha is a striking reversal for a fund that was once the toast of Wall Street and spawned the careers of some of the most well-known quants in the business, including Cliff Asness, founder of AQR Capital, and Mark Carhart, the founder of Kepos Capital. Global Alpha gained prominence as high-frequency trading, in which computer models execute lightning-fast trades, became a common strategy among hedge funds.

Global Alpha was started in 1995 with just $10 million. Over time its results soared. At its peak in 2007, Global Alpha ran about $12 billion, although that number has dwindled to about $1 billion now in the wake of a number of wrong bets. The fund is also having a rough year, according to a person close to the firm, and is down about 12 percent so far for 2011.

In 2010, Carhart launched his own quant shop (Kepos Capital), now managing just $500m. Let's just say his fund's performance to date have been lukewarm.

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The Amount of Fraud in Ontario

The Auto Insurance Anti-Fraud Task Force delivered a Status Update to the government on July 23, 2012. I will be providing a review of the report on this blog. Today I will review the Task Force's efforts to estimate the amount of fraud in Ontario.

At the time of the Interim Report the Task Force was not sufficiently informed to make a quantitative estimate of the extent of auto insurance fraud in Ontario. It did conclude that the figure of $1.3 billion that has been used to describe the cost of auto insurance fraud in Ontario for some time cannot be considered a verifiable measure of the current extent of fraud.

Although not able to measure the extent of fraud, the Interim Report conceptually defined auto insurance fraud in three categories:

Organized Fraud: several participants with different roles within Ontario’s auto insurance system create an organized scheme designed to generate cash flow through a pattern of fraudulent activity;

Premeditated Fraud: a participant within Ontario’s auto insurance system consistently charges insurers for goods or services not provided, or provides and charges for goods and services that are not necessary; the participant is involved in a pattern of fraudulent activity, possibly at the expense of motor vehicle collision victims or possibly with their complicity; and

Opportunistic Fraud: an individual pads the value of his or her auto insurance claims by claiming for benefits or other goods and services that are unnecessary or unrelated to the collision that caused the claim.

The Interim Report reviewed trends in claims cost data and information gathered from industry stakeholders and regulators. This review led to the following conclusions:

• auto insurance claims costs, specifically Accident Benefits claims costs, increased dramatically from 2006 to 2010, and this increase in costs had a direct impact on auto insurance premiums.
• a large and unexplained gap exists between changes in Accident Benefits claims costs and changes in factors that would have been expected to influence those costs; this ‘unexplained gap’ amounted in 2010 to an average of $300 per insured motor vehicle in Ontario.
• the most dramatic increase in costs has occurred in the Greater Toronto Area, where the ‘unexplained gap’ in 2010 amounted to an average of $700 per insured motor vehicle.
• anecdotal evidence suggests that fraudulent activity, and in particular, premeditated and organized fraud may have accounted for a substantial portion of the ‘unexplained gap’.

IBC engaged KPMG Forensic to conduct a study aimed at estimating the extent of auto insurance fraud in Ontario. This study was provided to the Task Force and is available online. The Task Force also engaged Ernst & Young to provide the Task Force with an independent assessment of the KPMG methodology and results. Their study is also available online.

The KPMG study concluded that “there is insufficient information to provide a precise and statistically based estimate of auto insurance fraud in Ontario.” The study did, however, provide a wide range for the scope of fraud. It estimated that the cost could range from 9-18% of annual claims costs, which in 2010 would have amounted to between $769 million and $1.56 billion. KPMG calculated the impact of this estimate of fraud on the average auto insurance premium in the province to be between $116-236 in 2010.

KPMG primarily used the data analytics studies, which combine claims information from participating companies with highly sophisticated tools that can identify suspicious patterns between claims, to develop an estimate of the extent of organized fraud in Ontario. Their report notes that these studies were undertaken by insurers to test the use of fraud identification technologies in their businesses, and not for research purposes.

KPMG was able to extrapolate results from two of the three studies to estimate the scope of organized fraud. The design limitations, in KPMG’s view, made the extrapolations consistent underestimates of the true extent of organized fraud. While recognizing this problem of underestimation, as well as the importance of providing some quantification, KPMG noted that, on the basis of its review of these studies, organized fraud in Ontario was at least in the range of $175-275 million in 2010. The cost of Organized and Opportunistic Fraud could be between $769 million and $1.56 billion annually. KPMG indicated that their estimates are understated because industry-wide data was not used in the studies and excluded certain types of claims.

Ernst & Young has completed a preliminary assessment of KPMG’s report in which it also agrees that organized fraud is likely greater than the range estimated by the data analytics studies used by KPMG.

KPMG has not included Premeditated Fraud in their estimate of total fraud in Ontario.

In addition, Ernst & Young indicated that KPMG’s report may significantly underestimate the extent of overall auto insurance fraud in Ontario because it does not specifically address premeditated fraud, which, as Ernst & Young noted, could range between $130 to $260 million per year. Combining this estimate of premeditated fraud with KPMG’s understated estimate of organized fraud, creates a value of organized and premeditated auto insurance fraud in Ontario of between $305 to $535 million per year (which itself should also be viewed as an underestimate).

Conclusion

Judging from these two reports it appears that the $1.3 billion figure that has been bounced around for years may have some merit. When looking at the combined total of Opportunistic, Premeditated and Organized Fraud it may very well have been above billion dollars prior and up to 2010. However, there is no discussion on the impact of the 2010 auto insurance reforms on fraudulent claims in Ontario. Although it is still early to assess what impact those reforms have had on the sector.

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The Equaliser - Important Insights For Coffee Shop Talk

Casual conversations can sometimes elicit the roll of our eyes, and sometimes I have to stop myself wanting to explain an investing issue further among friends as it could drag on and on. However, when you can add logic and persuasion into an investing issue, we musn't be stingy. 

There are again two types of people in the world when it comes to knowledge and information dissemination. Group one are those who will try and get by by hoarding as much knowledge and information for their advantage (what the rest don't know would benefit me, I have leverage and the edge). 


Group one are also those who are likely to "lord over people" with their "extra knowledge and information". For example, they are the ones who may have a passion for wines and would read up voraciously on it, and in social settings will snigger and gently shake their heads at any faux pas or shallow commentary on certain wines - that's lording over people. Get me away from these types. 


No one is better or should be compared based on what they know, who they know, what jobs they do, how much they earn, ... we just are. Nobody will know everything, can the same wine expert tell me the difference between aMontecristo Edmundo and a Trinidad Robusto Extra? Or what's a kimedashi, okuridashi and oshidashi in sumo? So why lord over people in the first place?


The more you know, the more you realise that you don't know... in anything and everything.
 

Group two are those who will share their expertise, and are willing to be corrected, and learn from each other. I am sure you have worked for bosses/superiors from the two groups - one will only share only a part of what he knows, while another who will committ to telling and sharing everything. Naturally the second one will do much better in his life and career: the person who is more willing to share all will learn a lot more. Group one types lack confidence and has a low self-esteem, too cynical and probably a boot licker at every right opportunity, kowtow to the seemingly high and mighty - please .... 

My favourite word in English/French is egalite or egalitarian. Meaning:asserting, resulting from, or characterized by belief in the equality of all people, esp. in political, economic, or social life. I don't lose out if others benefit, its all in your mindset, which is why I blog, I believe the internet is The Great Egalite (French), the great equaliser. 


Of course, equality is a desired quality to aspire to, and true equality must not be based on a desired quality as reality may dictate that the flip side is true. True equality can only be pursued when you are convinced that ITS TRUE, just existing gives you the "rights", that should be the entire argument and basis. Or if you are spiritually minded, the maker maketh, hence I am. No one can or should make another person anything "less". My blog welcomes group two types; if you are in group one, well ... , hope you grow up someday and you will lead a happier life.

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How To Hire Well

Put about 100 bricks in some particular order in a closed room with an open window. Then send 2 or 3 candidates in the room and close the door. Leave them alone and come back after 6 hours and then analyze the situation. 

If they are counting the bricks.
Put them in the census taking department or the estimator for the number who turned out for Bersih.

If they are recounting them.
Put them as returning officers for election votes.

If they have messed up the whole place with the bricks.
Put them in MCA.

If they are arranging the bricks in some strange order.
Put them in Pemandu.

If they are throwing the bricks at each other, put them in MIC.

If they are sleeping. Put them in civil service.

If they have broken the bricks into pieces. 

Put them in ETP Tender Committee.

 

If they are sitting idle. 
Put them in VP positions of any top political parties.

If they say they have tried different combinations, yet not a brick has been moved. 
Put them in PDRM.

If they have already left for the day. 
Put them in VP positions of any top political parties.

If they are staring out of the window. 
Put them in MACC.

And then last but not least. If they are talking to each other and not a single brick has been moved. Congratulate them and put them in top management of any listed GLC.

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Proposed Regulatory Model For Healthcare and Assessment Facilities

The Auto Insurance Anti-Fraud Task Force delivered a status update today to the government. I will be providing a review of the report on this blog over the next week. Today I will review a proposed model for regulating healthcare and assessment facilities that operate in the Ontario auto insurance sector.

I worked on the model on behalf of the Task Force and hope that readers of this blog take the time to review it and provide the Task Force with feedback.

The proposed regulatory model is intended to:

• Create barriers for healthcare/assessment facilities that wish to practice in the Ontario auto insurance system based on a "fit and proper" test.
• Sanction participants for fraudulent acts including denying the ability to operate in the Ontario auto insurance sector.
• Evolve HCAI into a regulatory tool to support market conduct regulation and a mechanism to sanction fraudulent behaviour.
• Designate a "regulator" with appropriate powers to oversee the market conduct of healthcare/assessment facilities and coordinate with the health regulatory colleges on issues dealing with professional misconduct. The proposed regulator would be FSCO.

All providers of medical and rehabilitation goods and services as well as providers of independent medical assessments would be covered by this model including:

• Multi-disciplinary treatment facilities
• Regulated health professions who are sole practitioners
• Assessment facilities supporting insurers and claimants
• Unregulated providers who provide specialized medical and rehabilitation services to claimants (e.g., vocational rehabilitation, case management, home modifications)

There would be 3 types of licences issued by FSCO. Licences would be not be transferable.

• Facility Licences for large providers (based on HCAI billings)
• Restricted Licences for providers not owned or operated by a regulated health professional
• General Licenses for small providers

Facility and Restricted Licences would involve a paper application process while the General Licence would involve an electronic filing process similar to the HCAI registration process. Licences would be valid for one year and would be renewed by submitting an acceptable Annual Information Return which would be an electronic filing process that would update the information on file at FSCO.

Facilities would be required to maintain business practice standards set out by FSCO, a combination of Regulations, the existing HCAI terms and conditions, and Superintendent's directives/guidelines. The regulatory health colleges would continue to be responsible for clinical practice standards of the regulated health professions working in the licensed facilities.

Some of the new proposed business standards include:

• No owner, operator, director or practitioner may have a felony conviction (going back 5 years)
• Facility is independent of all insurance companies, claims adjusting companies, personal injury lawyers and paralegal operating in the auto insurance sector
• Clinical Director of a facility with a Facility Licence must be a regulated health professional
• Clinical Director must be on-site for a minimum of 50% of the facility's operating hours
• If the facility is conducting third party medical exams, all practitioners conducting exams must have at least five years of applicable clinical experience and attest that they working within their scope of practice
• Facility will file all fees with FSCO and will not invoice for amounts that unreasonably exceed amounts charged by others for similar goods and services

FSCO will be provided with new authorities with respect to licence applicants and licensed facilities:

• Deny a licence application for failing to meet the required standards
• Investigate complaints regarding improper business practices of licensees
• Conduct risked based audits of licensees
• Issue orders to licensees regarding deficient business practices
  
• Suspend licenses of facilities and/or individuals for fraudulent practices or for ongoing deficient business practices
• Pass on to the appropriate authority when suspected criminal activity is uncovered
• Inform HCAI and Regulatory Colleges of facilities and health professionals that have been sanctioned
• Inform the public of enforcement action

HCAI would have a role in the licensing process. HCAI would be expected to develop a quarterly attestations regarding accuracy and appropriateness of bills submitted through HCAI. Facilities that failed to complete the attestations would have their billing privileges suspended.

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Remi Gaillard's Funny Videos

He is creative and funny. He uses real life situations and basically inserts his own wackiness into that situation. Good stuff.


The first one sees him at a tennis exhibition match between Yannick Noah and Henri Leconte. He basically psyches himself up to go down to court and just wants to play a point or two with them. Great guts.





Its to create the Tour de France dream for normal people, and on a normal Sunday, he spots casual riders on their own and creates a scenario as if these people are about to cross the finishing line of a major cycling event. Tons of extras.



This is a brilliant spoof of Rocky, self explanatory.


Sometimes we just need to not take things so seriously, have a laugh or two, life is hard enough.

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Its Friday

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Ontario Appeals Court upholds large non-economic loss award decision for young children who lost their mother

Ontario's top court has upheld a jury award of more than 100-thousand dollars to each of two young children for the loss of their mother in a car crash.

The Appeal Court says the amounts may have been high but were still reasonable.

The case involved the death of 30-year-old Michelle Vokes, who was killed when her minivan was demolished by a car driven by Randy Palmer six years ago in Owen Sound, Ontario.

Palmer was driving as fast as 120 kilometres an hour in a 50 zone when he slammed into Vokes.

The awards of $135,000 to the then-three-year-old daughter and $1117,000 to the then-five-year-old daughter $117,000 for the loss of care, guidance and companionship of their mother set new benchmarks. The previous high award to a child who lost a parent in Ontario, $65,000, was awarded in 2011.

read more...

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An Excellent Health & Beauty Blog

It is so hard to start a blog, do you have something to share, will you be able to post regularly, will you run out of things to say after a few weeks? I think 90% of all blogs close within 6 months, most will just give up. It takes passion but also a desire to share something. If it is just an ego trip, you will also tire of it easily as it takes a couple of years to build traffic.


I have know Fui Ping for a while. I know of her blog and have been reading it for some time. Its an excellent health and beauty blog. She takes care in research and uses the blog as a platform to sell some of the more effective products as well. This is obviously not her full time job and she handles the blog very well.


I have included just the front page of her blog's previous few postings, that in itself is so concise and thoughtful in its research. Check it out and do your own research as well, it is good to hear things from a very passionate person about health and beauty.


http://www.pingofhealth.com/

FRIDAY, 13 JULY 2012

Preventing Colon Cancer

Colorectal cancer (cancer of the colon (large intestine) and rectum) is currently the2nd most common cancer among men and women. It usually starts as a polyp, which is a small growth in the walls of the colon. Most polyps are benign, but as they grow, can become malignant and develop into colon cancer.

Lack of Symptoms

Colon cancer can be deadly because it exhibits no outward symptoms in the early stages. By the time there are symptoms, the cancer has probably spread to other parts of the body. Detecting colon cancer at the early stage increases the chances of treating it.

Some Telltale Signs

• Blood in the stools. Diarrhea or constipation for no obvious reason, lasting longer than 6 weeks
• A feeling of not having emptied the bowel properly after a bowel motion
• Unexplained weight loss
• Pain in the abdomen (frequent gas pains, bloating, fullness, cramps)
• Constant tiredness
• Vomiting

Risk Factors

• Age - 50 years and above.
• Family history - your risk is higher if your parents / siblings have colon cancer or polyps.
• Unhealthy diet - high in fat and calories and low in fibre.
• Unhealthy lifestyle - smoking, alcohol intake, sedentary lifestyle, overweight.
• Personal history of cancer - women who had cancer of the ovary, uterus or breast are more like to develop colon cancer.

How to Reduce the Risk

• Ensure regular check-ups if above 50 years old. Check-ups may include a physical examination, a faecal occult blood test, a colonoscopy, chest X-rays and lab tests.
• Maintain a healthy diet. A balanced, nutritious diet will keep you healthy and cope with the cancer and side effects of treatment.
• Exercise regularly.
• Limit alcohol consumption and quit smoking.

Colon cancer is a preventable disease. Act now to prevent colon cancer.

(Source: Prevent gut cancer, Datuk Dr Muhammad Radzi Abu Hassan, StarFit4Life 17 June 2012)

Any Preventive Solution? 

Check out this article, which gives you comprehensive evidence of the safest preventive solution I know, The Role of Lingzhi in Cancer Treatment.

Email me at laifuiping@gmail.com. to choose Lingzhi / Ganoderma as your answer to preventing colon cancer and all other types of cancer. Click here to refer to Shuang Hor company website for Product Description and Price.

THURSDAY, 5 JULY 2012

Tired, Tired, Tired: Poor Blood Circulation

Hey guys, do you constantly feel fatigued? Do you suffer from shortness of breath, irregular heartbeat, poor memory, lack of stamina or infections that are too slow to heal? You may be suffering from poor blood circulation.

What cause poor blood circulation?
Working long hours, constant pressure and stress, lack of exercise..

This condition was previously seen in mainly middle-aged men, and those with hypertension, diabetes orarteriosclerosis. It is now increasingly seen in otherwise healthy younger men.

Symptoms of poor blood circulation

• Erectile dysfunction
• Frequent urination
• Cold limbs
• Lower back pain, chest pain, numbness and weakness in arms and legs, pain or cramping in leg and hip
• Impaired or slurred speech

Ignoring these signs can lead to serious health conditions, including the loss of limbs,heart attack or stroke.

(Source: Tired of being tired?, StarFit4Life, 10 June 2012)

Solution to get your energy back

There are scientific evidence to show that Lingzhi / Ganoderma has the effect in reducing blood pressure (click herefor article) and the ability to prevent diabetes (click here for article). 

All the fats and cholesterol that's clogging up your blood vessels will narrow the walls of the vessels, slowdown blood flow and form thrombo-embolism (which can cause stroke or heart attack).

Lingzhi / Ganoderma is able to dislodge all these dangerous garbage and henceimprove blood circulation. The good news is, as the mobility of the blood flow is improved, you will also feel more stamina and less tired.

Please email me at laifuiping@gmail.com if you want to buy Lingzhi as your solution.

Click here to refer to Shuang Hor company website for Product Description and Price.

SUNDAY, 1 JULY 2012

What is Non-Alcoholic Fatty Liver Disease and How to Prevent It

Fatty liver is expected to be a major health problem in Malaysia due to increasingly affluent lifestyles and poor dietary habits. These factors have led to the increasing prevalence of obesity amongst Malaysians. Fatty livers that are not well managed can progress to liver scarring, hardening and also liver cancer.

Fatty liver is a condition where excess fats are deposited in liver cells. Excessive accumulation of fats (where it exceeds 5% of the liver's weight) can lead to inflammation and liver tissue scarring (fibrosis).

Non-alcoholic fatty liver disease (NAFLD) is a condition when there are fatty deposits in the livers of people who never drink alcohol. Fatty liver a strong factor that puts such people at risk for cardiovascular or heart disease. The conditions of diabetes and obesity have strong links. Diabetics who have poor blood sugar control are at increased risk of having liver disease. People who are overweight and have high blood cholesterol also have a higher tendency to accumulate fat in the liver.

The widespread presence of NAFLD is disturbingly high worldwide, reported to be between 15% and 30% in Western countries (including Malaysia) and 18% to 30% in Japan. Unfortunately, most of the NAFLD are discovered incidentally e.g. when doctors find an enlarged liver or notice abnormal liver function test readings, in the course of looking for something unrelated. This is because the symptoms of liver disease are usually not obvious, e.g. tiredness, or a general feeling of being unwell.

There is no drug that can effectively cure NAFLD at the moment, even though some scientific studies are being done on tocotrienols from palm oil. While waiting for medical breakthroughs, a sensible solution is lifestyle modifications like exercising and watching one's diet.

However, there are over 30 scientific studies which have been published on the usage of ganoderma (lingzhi) in liver protection. Numerous statistical data have been collected from tens of thousands of people who showed improvements in their health after taking ganoderma. The advantages of ganoderma are well acknowledged in itsrole in protecting the liver.

Click here to read about the Research into the Effects of Ganoderma on Liver Protection.

(Source: 
E-liminating fatty livers, by Meng Yew Choong, StarFit4Life, 29 April 2012
Ganoderma the Ultimate Herbal Medicine, Chapter 4 by Dr Deng-Hai Chen)

Are you afraid of suffering from the complications of Fatty Liver Disease? Here is your solution - email me at laifuiping@gmail.com to buy. Click here to refer to Shuang Hor company website for Product Description and Price.

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Inconsiderate Malaysians

Thanks for all the comments on rude Malaysians. I do agree, we can rid of most of the problems if we have strict enforcement and no bribing, much like Singapore. That will certainly cure the bad behaviour but it does not change the very make up of the person. 


Malaysians are generally the nicest people when you go to their homes, they make you feel welcomed. They offer you drinks and food even though you have obviously just eaten. They are the most gracious hosts. If you come into my circle of intimacy or closeness, be they family, friends of my kids, friends of my family ... and I have been introduced to you - we certainly treat you much better.


One of the issues lie with our neighbourliness. We sometimes rubbish some Western society for being overly friendly in striking up conversations with strangers, we seemed averse to bid a smile and wave to our neighbours even when we do not know them. Why is that? I believe Malaysians back in the 50s and 60s were much friendlier, yes, small towns even now are much much friendlier. There is more compassion, empathy ... in smaller towns you kinda know everybody or they would be somebody who knows somebody you know- hence the better behaviour? 


Cities are impersonal and cruel. Cynicism is rife, we tend to be too cautious. Naturally, our very bad crime rate causes us to be extremely wary of scams, strangers ... everyone thinking the worse of whomever they they come across. 


However, many of the rude behaviour cited in the previous posting was not due to the above reasoning. Its plain selfishness, its pure "what I can get away with mentality". First, lack of punishment and enforcement, we take our chances, chances of getting caught or fined is so remote. We cannot really take the law into our hands and smash the windows of the double parkers, can we, then its two wrongs. 


People in L.A. behave better, but not because they are nicer, its because if you anger some motorist, they could have a gun in their glove box and we know what could happen next. Fear is certainly not the way to go.


It all goes back to how we were brought up. If you have kids in the car and they see you double park, tailgate or road hog ... what do you think they will learn? The bad behaviour is all a reflection of bad parenting mainly, or rather ineffective parenting. Some parents will say ... well, friends' influence is also important when they get to their teens. Every layer shoulders some blame I guess. 


There is not enough peer pressure from the 'good guys'. I mean when someone does not give up their seat for the elderly or pregnant woman, there has to be sufficient "peer pressure" from the good guys around that fucker that would cause him/her to do so. But we fear we get ourselves into trouble.


Its the same mentality that has driven us to doom in politics, but when enough 'good people' do something, we get Bersih. If we see someone doing the "right stuff", stand up alongside that person, to let him/her know he/she is not alone. Power in  numbers. No point just whining and bitching, do you stand up with your fellow man? The "bad ones" may threaten one good guy, but not when a few more just step up and join forces. We must reward good behaviour to encourage good behaviour. We cannot stand by the side and then whine and complain.


Why is a person considerate? Being nice is a fucking burden in a soul-less city. But we try to be considerate because its the right thing to do, because you know if everyone does not do likewise, we will have anarchy. Good social behaviour has a lot to do with ethics, or rather self-imposed ethics. That kind of behaviour will translate to other aspects of society and economy.


I don't think I am exaggerating when I say, the proliferation of bad behaviour socially is but a reflection of similar bad behaviour in politics, in the boardroom, in the corporate world, even in personal relationships, in some lawyers or accounting offices, in HR, in the police force, in the legal system, etc... 


Fuckers using mobile phones in cinemas .... they are probably the same kids that parents allow them to do texting n play games on their phones 99% of the time when they are dining out with their parents. 


Are you a good person? What is a good person? Have a heart, have a decent heart, empathise ... You are not a good person just because you don't steal, kill or maim. You do not have a decent heart when you only are nice when it suits you.

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Why We So Like Dat?

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US Healthcare Index Breaching All Time Highs

This is an indication of how IHH is being viewed by global market players.


Health Care is breaking out to new all-time highs. The S&P 500 Health Care Index is breaking out to new all-time highs above the December 2000 high near 445. Unlike the S&P 500, which is 14%-15% below its all-time high of 1576, Health Care is breaking through the upper end of its 11-to-12-year trading range and has the potential to establish a new secular bull market trend. Health Care joins Consumer Discretionary and Consumer Staples as the only three sectors to reach new all-time highs in 2012. Prior to that, Health Care broke above the highs from 2007 near 425 – the only other sectors to break above 2007 highs are Discretionary, Staples and Technology.

Taking a look at the S&P Healthcare index (a defensive sector) versus SPX we can see how this sector underperformed (trended down) during the October – April advance in the S&P 500 just as we would expect it to during a market rally. We can also see how it turned upward at the April top in the S&P 500 and broke out from a descending trend channel. It has even been outperforming during the post-June advance! A simple measured move from the breakout implies that outperformance in healthcare still has a big move ahead.

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Standing Committee on Finance and Economic Affairs Auto Insurance Hearings - Day 3

The following are summaries of presentations made on July 10, 2012.

Ontario Trial Lawyers Association
Andrew Murray

On the issue of catastrophic impairment changes the perspective that I have to offer is from my review and summary of the freedom-of-information data.

We’ve heard the superintendent and from Minister Duncan comment that it’s all about science and getting the medical science right. When you take a look at the minutes from the expert panel group and some of their weekly commentary, which is not information that was ever disclosed publicly—it’s clear that it’s much more vague than how it has been presented in terms of this being a consensus viewpoint, certainly in terms of this all just being about the science.

Almost all of the panel members made comments, initially, indicating support for the notion of combining mental and physical impairments together when looking at the whole-person impairment. That ultimately did not form part of the recommendations, but when you look at the commentary, you can see that they were struggling with this. It almost looks like there was, for some reason, some arm-twisting going on.

With respect to whether or not the current definition for brain impairment, being a Glasgow coma score of nine or less, was appropriate, the initial dialogue between the eight panel members resulted in only three of them strongly disagreeing or disagreeing, so sort of being against that notion. It begs the question that if their initial impression was that it’s probably an adequate tool, why have the need for a change to make something more complicated?

When asked to provide recommendations for improvement to the definition of catastrophic impairment, one of the comments was this: “One thing is certain: It is not always better to change a system without understanding the consequences of implementing new rules.”

On the issue of combining—this is combining mental and physical impairments—one of the comments was this: “To enshrine the prohibition to quantify is arbitrary, discriminatory and inaccurate.” I note that the Court of Appeal has more or less made similar comments, but on the expert panel itself, certainly this individual supported the need to combine mental and physical impairments.

Pierre Côté, who was the chair, had this comment: “How things are done in the field is beyond the scope of this project.” So, expert panel, don’t be concerned about what actually happens in the field. It’s a huge issue but not required in order to make recommendations on the definition. We say, of course, that that is wrong-headed and that you must have regard for what’s going on in the trenches before you make any of the changes.

Willie Handler, who was involved at the time, noted that the cost impact of what the expert panel was analyzing was not part of the discussion. That was off the table. It wasn’t something that they were to consider. It will be a discussion that the government will be undertaking later.

I now want to make some comments about the superintendent’s recommendations, because that’s new from the time of my last appearance. Something that was new was the recommendation by Mr. Howell to have family physicians sign all of the insurance forms for ongoing treatment and therapies for individuals who have a catastrophic impairment. There are some significant flaws with that approach. First off, as we all know, many people do not have a family physician. Even those who have a family doctor will fill find that the doctor is very disinterested because they’re busy.

Phil Howell is to be commended for hearing the stakeholders when they said that you cannot make hospitalization in an in-patient rehab facility a prerequisite to passing any of these various definitions.

I want to end this segment of my talk reflecting on the interim catastrophic impairment designation, because the expert panel said that there needs to be some mechanism to get benefits in a timely way to those who need them, and they came up with the interim catastrophic impairment designation. Mr. Howell, unfortunately, seems to have hollowed out the spirit and intent of that recommendation by restricting any interim benefits, seemingly for all categories, attendant care and medical rehab, to an additional $50,000. This interim benefit, essentially, for those who have an interim catastrophic designation, would simply restore a benefit that people had 15 years ago.

What are OTLA’s main criticisms with the proposals that have been put forward by Mr. Howell? We say it is far too complex. If these recommendations are accepted, we now have injected into the analysis the American Spinal Injury Association classification of spinal injury; the extended Glasgow outcome scale for traumatic brain injuries; the global assessment of functioning for psychiatric disorders; and a very long list of psychiatric impairments.

I can tell you that whenever you add new tests like this, which incorporate external documents, you’re injecting uncertainty, you’re adding unpredictability to the system, you’re going to increase the disputes.

Our other main criticism is rebutting the suggestion that this is all just based on good science. I’m hopeful that the excerpts that I reviewed with you from our freedom-of-information request show how even the expert panel didn’t feel that this was all about good science. You may use some scientific measurements to assist you, but when it comes down to figuring out where on a spectrum someone sits, it’s basically a policy decision.

The last point that I want to make, then, relates to the need for data and the type of data that this group should insist on having and should use your powers to obtain in order to make properly informed decisions.

Hughes Intelligence Investigation Services
Barry Bentley
Ron Prior

The Ontario Auto Insurance Anti-Fraud Task Force December 2011 interim report identified four key areas which they believe need to be addressed—prevention, detection, investigation and enforcement—to successfully combat fraudulent activity and its effect on automobile insurance premiums and related health care expenses in Ontario. We agree with this finding, along with the need for consumer awareness of fraudulent activities.

In our experience, it is essential to establish a central control unit which utilizes all available police and private investigator resources in Ontario to reduce fraudulent activities.

Mr. Justice Archie Campbell recommended that police meet required core competencies. We recommend that a similar approach be taken to combat fraudulent automobile insurance injury claims, including health care fraud. To meet this objective, we recommend the following:

—adopt a criminal investigation technique similar to those developed by the United States Health and Human Services Office of Inspector General;

—develop a central and regional insurance fraud control unit and certification programs;

—implement a health care fraud investigation certification program for investigators, adjusters, service providers and all others involved in insurance fraud assessment, review, prevention, detection, investigation and enforcement;

—apply statistical and artificial intelligence fraud detection techniques to existing data banks. Remove barriers to data mining by certified fraud investigators;

—explore the development of a special roster of crown prosecutors specializing in handling insurance and health care fraud cases.

[For anyone reading the Hansards transcripts there is a quote from Mr. Paul: Basically, an insurance company right now can’t walk into a chiropractor’s office or a physiotherapist’s office or a healthy-equipment supply place and say, “You’ve billed us. We want to see your invoices or we want to see your records.” They can’t do that right now. I feel compelled to provide a correction. O. Reg. 194/11 amended the SABS to include provisions (ss. 46.1, 46.2 and 55) that enhance the ability of insurers to seek verification of invoices received for goods and services provided to claimants. Those amendments came into force on July 1, 2011.]

Dr. Michel Lacerte

I want to give you my perspective as a busy treating physiatrist, which is a specialist in physical medicine and rehabilitation, and also the perspective of a rehabilitation counsellor and, on occasion, a disability management policy analyst.

I would like to stress that when we’re talking about all of this, we’re talking very much about private sector rehabilitation, and I have strong views in terms of strengthening the public health care system that basically treats everybody equally.

Since the beginning of my practice in 1990, being trained in the US, I clearly identified the Americanization and lawyer-ization of service delivery in Ontario. You see many American companies where services that are being provided in a gunshot approach, which is basically you come in the door and you can have access to all sorts of treatment, not just the physio, not just the chiro. What is important is that in contrast to the US system, we do not have strong utilization management controls.

Hospitals have been creative and have been offering their own private services. The reason why, in many cases, they move them out quickly is so that they can get other services—the other door. Hospitals right now can go in direct competition with the folks and in many cases will take away the folks who were providing physiotherapy, for example, to the public and will put them instead to provide services now that can be billed to insurers.

What is important for me is that when you look at rehabilitation right now, we’re really facing what I would refer to as a Chinese buffet, because basically you can have all sorts of services; there’s no limit. You want to have aromatherapy? You want to have a colon enema?

What we see is that the family doctor, as was referred to earlier, is oftentimes not equipped or remunerated to try to do the case management, so by default in many cases, plaintiff lawyers basically have hijacked the whole rehabilitation service delivery in Ontario.

I agree, when we were talking about for catastrophic, that there should be—the family physician maybe is not the best person, but at least make it a physician. To raise the case manager to be the one doing it—many of them have no background; they may be social workers, and they’re generally selected by the plaintiff attorney—is absurd. I would certainly not support this.

Katherine Worotny

I am a brain injury survivor. I’ve come to talk to you today from a survivor’s perspective on the changes to the catastrophic definition and what that means to other survivors and to drivers in Ontario who may one day be in a crash.

Back in 2001, I was a founding board member of the Brain Injury Association of Windsor/Essex County, and 11 years later I’m still an active board member. As our local survivor representative to the Ontario Brain Injury Association advisory committee, I go to Toronto five times a year. My job is to bring survivor concerns locally to the provincial level.

Before my car crash I was a teacher in life skills and I was a supervisor of six educational assistants and had 21 mentally and physically handicapped students in my class. I spent eight years in rehab. Today, 19 years after my car crash, I still do some therapies. I never went back to my career as a teacher. I do volunteer work with the Chrysalis Day Club and I volunteer at Hôtel-Dieu trauma services.

I want to just end this by saying I understand that the proposed changes to auto insurance may make it harder for people who are seriously and catastrophically injured to get benefits, including the medical and rehabilitative benefits that they need. This means that they will look to the public system and they will go without therapy. This is troublesome. After an accident or a car crash, people want to get better. I am an example of how, after a crash, someone can be rehabilitated and is able to give back to the community. Without therapy, paid for by my car accident insurance company, I would not be where I am today.

On behalf of car crash survivors like myself, I would like you to consider how changing the definition and making it harder to get benefits after a crash will affect other crash victims like me.

Honourable Howard Pawley

I should say that in 1969, the newly elected Premier Schreyer contacted me and said, “I want you to look after the red-hot-button issue: automobile insurance.” We established a committee called the feasibility committee—feasibility insofar as whether public automobile insurance ought to be established or not. We travelled throughout the province. We heard from Manitobans. When we returned, we recommended the establishment of public automobile insurance.

Subsequent to that, I became the minister who was responsible for introducing it in the Legislature. It was enacted, and I was the first chair of the Manitoba Public Insurance Corp., so I do come with a certain amount of bias this morning, because of what has been a very positive experience.

When the decision is made to establish compulsory and universal coverage, it follows that there must be an obligation on the part of government to provide auto insurance at the lowest possible price.

The most effective way of comparing auto insurance programs from province to province is to look at how much of every premium dollar is returned to the ratepayer in the form of claims payments and benefits. This gives us an apples-to-apples comparison. Recent published annual reports illustrate how the administrative costs of the public plan avoid costly administrative duplication and are only one half as much as those incurred by private insurance companies. Public plans return a maximum return of each premium dollar of 85 cents to 90 cents—that’s administrative costs. With private plans, the administrative costs range from 65 cents to 70 cents on the premium dollar.

Since 2002, Manitoba’s auto insurance cost has increased at a much lower rate, 1.5%, as compared to the countrywide performance of 5.3%—3.5 times less than the national average. Last year and this year, MPI returned just over 90 cents on the dollar.

The inclusion of basic compulsory automobile insurance with the licence plate is the most efficient and economically capable method of delivery. Supplementary auto insurance is also available from either government plans or from private auto insurance companies.

For example, a 21-year-old male with a clean driving record living in Ontario would pay more than six times the rate that we charge, and in Alberta, it would be 2.5 times what the province of Manitoba would charge.

Why do public, driver-owned, public-profit auto insurance plans win, hands down, over the private auto insurance systems? Provincial insurance corporations, as the owners of public auto insurance, have every political reason to reduce accidents and claims by insisting on safer driving conditions for their motorists, and pursue traffic safety and loss-prevention programs.

In Manitoba, there is no discrimination based on age or sex. Bad motorists are surcharged additional dollars on their driver’s permit. That is a fairer way than discriminating based on sex or age.

This past year, the Public Utilities Board ordered that a dividend be paid to Autopac customers, which means a $338-million rebate, plus lower rates for most. The dividend gave motorists varying amounts of rebate. It’s not unusual for them to range from $250 to $350 for that one year.

Ontario and other provinces have legislated reduced benefits, unfortunately and sadly—and this where the catastrophic comes in, where I think it’s basically wrong in principle—where there has been legislation of reduced benefits by putting caps on payments to the victims of crashes in the hope rates will come down, but rates haven’t come down elsewhere.

In Ontario there exists a minor role for regulatory bodies in respect to rate applications. There must be an appropriate and strong regulatory body to examine the following issues:

(1) It should examine significant cuts in coverage in auto insurance, resulting in the introduction of deductibles and caps in respect to awards and general damages. Can we be assured the insurance companies are passing all these savings on to the motorists?

(2) Are there costs or expenditures included in rate calculations for Ontario for losses, for adverse experiences encountered in other jurisdictions, including other Canadian provinces that operate with private insurance? If so, should we object to any such inclusion?

(3) Is the investment income properly reflected in the rate calculations and being used to reduce premiums or increase benefits?

(4) Is there industry creaming taking place? Some companies offer very low rates by limiting their business to only the least risky motorists. The result of this can be highly unfair rates to younger and risk-prone drivers.

(5) Do the rates charged in the various regions reflect the loss experience in that particular region?

(6) Are private companies promoting accident benefit programs, as they do in western Canada, where governments, as the owners of public auto insurance, have every political reason to reduce accidents by insisting and encouraging safer driving conditions for their motorists?

Victoria Cross

I’m a general practice lawyer here in Windsor.

I want to make three points. I recommend that this committee expand its mandate to include serious, intense, short-time-limited public review of the various public models of auto insurance in Canada for the express purpose of developing a made-in-Ontario public auto insurance plan. Second, I want to debunk a few myths and misunderstandings about auto insurance. Third—and this may be even the most imperative—I am going to make an appeal for this committee to take strong recommendations on the comprehensive European trade agreement, so all of Ontario’s future or potential public enterprises and present ones are protected before it’s too late.

The Financial Services Commission of Ontario is preparing for its mandated five-year review of services. All of the auto-insurance-related objectives in its most recent statement of priorities and strategic direction can be met with convening such a public review, and such objectives may be easily amended to include such a review without having to, I believe, go to the Legislature on the matter.

We’ve had 20 years to review our no-fault system and deal with successive periods of increases, regulation and re-regulation. Some can argue that Ontarians prefer our much-revised, modified tort and enhanced no-fault insurance system. This is how it’s provided. Wrong: Insurance providers prefer it.

Injured parties in auto accidents need to be treated as whole beings. It is wrong to return, through the back door, to the days when psychological benefits are limited, and we are left with a meat-chart vision of a person, relying on a capped percentage of impairment. We need lower rates, and rates that will continue to be affordable for persons who are low-income. Fewer young people are choosing to drive, or have chosen to put off learning to drive, due in part to the cost of insurance.

I know that in other provinces, there are perhaps three to five territories. In this province, there are 55 territories available to insurance companies, some of which could be as small as 2,500. That I got from the testimony from May 28. I think that’s something that—you know, the FSCO has been rubber-stamping these requests over and over again. I do not support narrowing territories as a tool to discriminate against drivers. All decisions, and the primary decisions, should be made on the individual driver’s risk. It shouldn’t be about age; it shouldn’t be about marital status or gender.

Driver-based fees are the best way to be fair. Individual driving records should be the predominant, if not the only method, of determining rates. A tort component, I believe, must remain in the system to ensure justice for people.

I do want to say something very important. International agreements will not keep us from setting up a plan. The Lord government retreated in part or in whole because of fears about NAFTA and GATS. That is only true if we let those fears take over. The left and the right in this province have been captured by their own rhetoric about what these trade agreements will mean for insurance. According to Steve Shrybman and Scott Sinclair, NAFTA and GATS are navigable concerns.

CETA involves the provinces in decision-making in a way that NAFTA and GATS do not. The province of Ontario unfortunately has not taken the time or interest, or perhaps has decided not to involve itself in the CETA process.

Brain Injury Association of Thunder Bay and Area
Janet Heitanen
Karen Pontello

The Brain Injury Association of Thunder Bay and Area, which is the regional representation of the Ontario Brain Injury Association, would like to present the following concerns regarding the changes to the cat determination for individuals with traumatic brain injuries, referred to later in this report as TBI.

In supporting people who have sustained brain injuries in motor vehicle collisions, we believe that individuals require a system that emphasizes integrity in the areas of access, accountability, fairness, transparency, consistency and expertise as outlined below.

(1) Access to medical and rehabilitation care: Individuals with TBI require access to care that is available to them in a responsive and timely manner. Individuals require care that addresses their needs at the point in time when it is important for them. In order to access care, funding from their accident benefits must be available for medical and rehab services. The stipulation on the proposed interim cat determination that requires individuals to be treated in an in-patient neurological facility, outpatient rehab program or day-patient rehab program may limit access, particularly if these rehabilitation services are not immediately available in the larger centre of Thunder Bay or if the interest of the individual is to stay in their home community, which is in the rural areas in the district.

The proposed change for removing the Glasgow coma scale used for cat determination, for TBI individuals who are impaired in completion of their daily activities, considering work and other activities, and who are left with a choice of working and being limited in other activities or completing other activities and being unable to work, may no longer meet the catastrophic threshold using the Glasgow outcome scale extended. Without the cat funding available, these individuals will place increased burden on the OHIP system when the non-cat $50,000 limit is depleted.

The proposed change for limiting the combining of impairments and determining cat designation related to whole person impairment is problematic. Individuals who suffer mild to moderate TBI, along with other psychological impairments such as depression, post-traumatic stress disorder and orthopaedic injuries, deal with the combined effect of each impairment on a daily basis.

(2) Accountability, fairness and transparency: Individuals with TBI require their insurance companies to be accountable and fair in managing claims based on medical rehabilitation need. Insurance companies are not responsible for determining need. The management of medical and rehabilitation benefit under the SABS requires transparency so that individuals can receive services to manage the brain injury even when the insurer questions individual need. The ability of the insurance company to question need is considered okay if the individual can continue with services until the need is determined not to be required based on expert opinion.

(3) Consistency: Individuals with TBI require their insurance company to maintain consistency of care as they manage the claims process. For example, a claimant receiving medical and rehabilitation services should have these services continue while insurance examinations are being conducted. For individuals with significant injuries, consistent services are required to maintain the gains achieved in treatment. It is not clear how continuation of services will be addressed as cat determination is being reconsidered with the interim cat designation.

(4) Experience and expertise: Therapists and practitioners treating individuals with TBI and those completing insurance examinations should be using the same frame of reference when assessing individuals’ medical and rehabilitation needs. It is not okay for insurance examiners to have less experience than the treating providers, as opinions may not be reliable or consistent.

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