www.claimscanada.ca
April/May 2012
Official Journal of the Canadian Indeépendent Adjusters’ Association
Not in
Kansas
Anymore Tracking a Torrent of Tornado Activity in North America
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Contents A P R I L / M AY 2 0 1 2 • V O L U M E 6 • N U M B E R
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Cover Feature 12 Not in Kansas Anymore A torrent of tornado activity has led to speculation that these severe convective storms are on the rise in North America. Claims Canada explores what’s really happening. BY CRAIG HARRIS
Spotlight 20 Weathering the Storm Townsend & Leedham Adjusters Ltd. has stayed true to its “small-office atmosphere” and built a solid presence in the Edmonton community.
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BY CRAIG HARRIS
Education Forum 44 Cell Phone Cancer Risk Scientific studies are inconclusive about the specific threats posed by increased use of cell phones, but the insurance industry is watching closely.
News Features 22 The Lost Art of Service When was the last time you had an excellent customer service experience? BY GINO FIORUCCI
24 The Business of Fraud Organized crime has moved big time into the world of insurance fraud. BY RICK DUBIN
26 Covering the Field Sports-related personal injuries cantrigger insurance coverage – what adjusters need to know about possible claims. BY ANITA G. WANDZURA
28 Steps to Subrogation Adjusters can follow a rigorous, well-documented process to ensure that subrogation recovery efforts are successful. BY SHAWN BURNETT
30 The Minor Injury Guideline A primer on what’s in – and, just as importantly, what’s out of – the Minor Injury Guideline (MIG) in Ontario auto insurance.
34 That’s Entertainment! While the drama of actors’ lives regularly makes Hollywood news, service interruptions can lead to costly claims in film production.
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BY NEIL GIBSON
36 Road Safety Accident reconstruction and forensic engineering have come a long way since the first vehicle-related fatality in 1869. BY GREG SYPHER
Departments
38 Independent Expert Examinations
4 First Notice
The role of the independent medical examiner has evolved substantially in recent years – and so too have insurer expectations. BY DAVID DOS SANTOS
40 Mental Health Claims Psychological-related illnesses have a major impact on employee absences and productivity; it’s key for organizations to develop meaningful back to work programs.
10 President’s Message 46 On The Scene
Columns 44 Education Forum
BY KAREN SOULLIERE
BY JOHN MALATESTA
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• first notice Ontario firms launch class action suit against VIA Rail following derailment Two Ontario law firms intend to launch a $10-million class action lawsuit against VIA and CN Rail following the Feb. 26, 2012 derailment of a passenger train near Burlington, Ontario. The law firms of Sutts, Strosberg LLP and Falconer Charney LLP intend to commence a class action seeking compensation for physical and emotional injury, damage to property and loss of income. An online statement from The Charney Practice Group says passengers may be entitled to compensation for physical and emotional injuries, loss of income, medical expenses, and/or out-of-pocket expenses. It added that family members might be entitled to compensation as well. At approximately 3:30 pm on Feb. 26, VIA Rail Canada train number 92 was travelling from Niagara Falls to Toronto with 75 passengers and five crew members on board when the six-car train derailed, a VIA release says. “There were numerous injuries to passengers and three fatalities, all VIA crew members who were in the locomotive at the time of the accident,” the release says. Three passengers were airlifted to hospital with serious injuries, including a broken back, a broken leg and a heart attack. Forty-two other passengers and one crew member were taken to local hospitals. All but nine of the hospitalized had been released within 24 hours. As of press time, the cause of the derailment has yet to be determined. ●
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FSCO reserves decision on awarding costs against paralegal pursuing an AB arbitration on behalf of his deceased client A Financial Services Commission of Ontario (FSCO) arbitrator in an accident benefits case has reserved a final decision on whether to award costs against a paralegal who brought an application for arbitration on behalf of his client — apparently without informing the insurer or FSCO that his client was deceased. The client, Corinne Warren Hancock, was injured in a motor vehicle accident on Feb. 18, 2009. She applied for accident benefits from RBC General Insurance Company. Hancock died on Aug. 14, 2010. The arbitrator and the insurer agreed the reasons for her death were unrelated to the motor vehicle accident. A mediator issued a report a few weeks after Hancock’s death, on Sept. 2, 2010. Since the parties had been unable to resolve their disputes in mediation prior to her death, her representative, Michael Wentzel, made an application for arbitration. FSCO found that he had done so without anyone authorized by law to bind the estate of the late Corinne Hancock.
“While there is no question that at the time of the application for arbitration, Ms. Hancock was in no position to be self-sufficient in housekeeping or other needs, all such benefits claimed in both the application for mediation and the arbitration are predicated on being alive and in need of the benefits,” the arbitrator found. “Any such ongoing claims after Aug. 14, 2010 were clearly both highly irregular and unsustainable.” The mediator’s report contained no indication that the mediator was aware Hancock was deceased, the arbitrator found. Also, Wentzel did not include in his application for arbitration that he was making the application on behalf of a deceased person. The arbitrator ruled the arbitration was a nullity. He then reserved a decision on costs awarded against Wentzel, pending contact with one of Hancock’s potential heirs. The arbitrator sought to clarify the heir’s status and whether or not he endorsed Wentzel’s actions on behalf of the estate. l
Water damage in New Brunswick almost quadruples in four years: IBC Insurance Bureau of Canada (IBC) took its message of climate change adaptation to New Brunswick, where data insured water damage losses have almost quadrupled in four years. Speaking to the Saint John Board of Trade on Feb. 22, IBC president and CEO Don Forgeron observed that water damage losses in New Brunswick escalated from $7 million in 2005 to $23 million in 2009. “That’s huge,” he said. “And when we compare this relative growth to losses from fire, water wins the race, hands down.” IBC commissioned a study by Dr. Gordon McBean, a professor at the University of Western Ontario, who found that Atlantic Canada was hit by 16 hurricanes between 1990 and 2005. Most recently, Hurricane Irene caused more than $130 million worth of wind and water damage in August 2011. “Here in Canada…home, car and business insurers have seen claims payouts from severe weather double every
five to 10 years since the 1980s,” Forgeron said. IBC presented a number of ways Canada’s P&C industry is responding to the escalating water claims, including a demonstration of the Municipal Risk Assessment Tool (MRAT), which is expected to be implemented gradually, starting in 2013. MRAT allows municipalities to collect data identifying a municipality’s greatest sewer and storm water vulnerabilities. Acknowledging that the federal government committed close to $150 million towards a climate change adaptation strategy, Forgeron said the sum “is not enough to address the adaptation problems our country faces.” Forgeron said he met with Finance Minister Jim Flaherty during pre-2012 budget consultations and encouraged the federal government to “undertake a focused effort to work with all other levels of government to improve water and wastewater infrastructure.” l
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20/04/12 2:13 PM
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• first notice FN B.C. Supreme Court awards $75,000 in punitive damages against ICBC for “multiple failings” in accident investigation The B.C. Supreme Court has awarded $75,000 in punitive damages against the Insurance Corporation of British Columbia (ICBC), which denied coverage to the plaintiff on the basis of impaired driving allegations even though all criminal charges for impaired driving had been stayed prior to trial. The plaintiff, Eleanor McDonald, took the wrong exit off Highway 1 in B.C. at the Mt. Lehman interchange, turned the wrong way against the traffic flow along the Fraser Highway and ran into an oncoming van driven by Thi Hoa To. A police officer at the scene smelled a faint trace of alcohol on her breath and had McDonald blow into a breathalyzer. But after multiple attempts, McDonald could not get a reading on the instrument. The officer assumed she was not trying hard enough and handcuffed her, charging her with refusal to provide a breath sample and impaired driving. McDonald was also issued a ticket for driving without reasonable consideration of others using the highway, and later charged with dangerous driving. ICBC’s investigation of the accident focused on whether McDonald, who was
in her 20s at the time, had borrowed her mother’s car without her mother’s permission. McDonald’s insurance on her own car had lapsed. One day after the accident, ICBC called to ask McDonald’s mother if her daughter had permission to drive her car that night. The mother related to the ICBC investigator that her daughter did not ask for permission to drive the vehicle that night. But there was some question about whether the ICBC investigator understood that McDonald had ongoing permission to take her mother’s car. The ICBC investigator waited until the outcome of the impaired driving charges in court. The charges were stayed before trial. But in consultation with a supervisor, the ICBC investigator resumed the investigation focusing on the theory that McDonald was “incapacitated” from driving because of alcohol.
ICBC went back to the police officer who had charged McDonald the night of the accident. His evidence was inconsistent with the evidence of another police officer who had stopped McDonald and her friends earlier that same night of the accident. The initial officer had not in fact detected alcohol on her breath, thus letting her go. “In my opinion, ICBC’s multiple failings in the investigation, assessment and breach decision [the theory that McDonald was driving without her mother’s permission] that I have outlined, and its misconduct in relation to the To Action [a civil action against McDonald, her mother and the mother’s leasing company], respectively, contravened the duty of fair dealing and good faith owed to the plaintiff,” the court found. The full case can be found at: http://www.courts.gov.bc.ca/jdb-txt/ SC/12/02/2012BCSC0283.htm l
Toronto police arrest 37 people and lay 130 charges following insurance fraud ring investigation Toronto Police have arrested 37 people and laid 130 charges in connection with Project Whiplash, an investigation into an alleged insurance fraud ring that resulted in insurance payouts totaling $4 million. Police say the ring featured staged auto collisions, false claims at several rehab providers across the Greater Toronto Area and the false use of several medical practitioners’ identities. The alleged scam targeted numerous insurers, police say. The allegations have not been proven in court. Insurance Bureau of Canada (IBC) collected and collated information from member insurers in support of the Financial Services Commission of Ontario (FSCO)’s role in the investigation.
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Project Whiplash was first established in 2009. At that time, the project identified 10 key people and 35 others who allegedly played a role in a series of fraudulently staged collisions and insurance claims. Police say the investigation found a number of billing inaccuracies made to insurers from various physiotherapy clinics in Toronto. Eight local physiotherapy clinics were owned and operated by the accused. Billing forms included names and registration numbers, fraudulently obtained, of several medical professionals who were not employed by the clinics and who had resigned from the clinics, police say. Or if they were employed by the clinics, they
did not provide treatment to the named patients. Police also allege that numerous staged motor vehicle collisions were executed. Some cases submitted to insurers did not actually happen. In some cases, the police said in a press release, previously damaged vehicles were made to appear as if they had been involved in a new collision. Police say they would start an investigation, generate reports and then the parties involved would later claim to be injured, seeking the assistance of identified paralegals who would file all the required paperwork with the insurance company. In some instances, police allege, the accused permitted their names to be used on the collision form and used by the clinics and paralegals when they were not involved in any collision, staged or fabricated. l
www.claimscanada.ca
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• first notice FN Hands-free phones not necessarily much safer than handheld phones while driving Canadian legislation is focused on the dangers of using handheld cell phones while driving, but using hands-free devices while driving may not be that much safer, according to panelists attending the Driven to Distraction conference in Toronto on Mar. 1. The Canadian Automobile Association (CAA) and the Traffic Injury Research Foundation (TIRF) organized the conference. Researchers at the conference said there are three basic forms of distraction while driving. Visual distractions such as billboards or video screens may take the driver’s eyes off the road. Manual distractions, such as eating or texting while driving, take the driver’s hands off the wheel. Cognitive distractions — for example, hands-free phone conversations while driving — take the driver’s mind off the road, even if the driver has full control of the wheel and has his or her eyes on the road. Researchers are currently studying the effects of cognitive distractions on driving safety. They say this form of driver distraction lead to a phenomenon called ‘inattention blindness.’ Basically, when a driver is engaged in a dual focus — driving and talking on a hands-free, for example — although the brain is taking in information while it drives, it is not fully processing the information. This particularly affects the navigation of a car. Dr. David Strayer of the University of Utah showed a video clip of a van driving through a red light in an intersection without reducing speed. The van crashed into a car that was following a green light and making a right turn into the van’s lane.
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A bi-monthly magazine (6x per year), Claims Canada is published by BIG Magazines LP, a div. of Glacier BIG Holdings Company Ltd. Business Information Group is located at: 80 Valleybrook Drive, Toronto, ON, M3B 2S9. Claims Canada magazine is the Official Publication of the Canadian Independent Adjusters’ Association [CIAA] and through its editorial content and circulation brings together the ‘entire property & casualty insurance claims market nationally’ with information and insight into the profession, business and people of insurance claims and loss adjusting. All key claims process stakeholders are reached as part of our readership community – including: both CIAA member and non-member independent claims adjusting firms; insurance and reinsurance company executive, claims management
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Strayer said the van driver was engaged in a phone conversation at the time and believed the red light was actually green. “When people miss traffic lights at intersections, they may be able to see stuff, but they may actually not be processing or registering the information they are seeing,” Strayer said. “What happens is they may not be paying full attention to the road, they aren’t processing information, they are talking on the phone, and that critical information [such as a red light] just simply disappears.” Strayer cited a study conducted in the United States, in which drivers were asked to follow directions along a highway and asked to turn off at a specific exit. Those who were on the phone while driving were 50% more likely to miss the designated turn-off than those who weren’t using the phone while driving. Cognitive distraction can also affect the longitudinal control of the car. “Mind off the road means that when you are driving around, say engaged in some phone or navigation task, it is quite likely that the quality of your interaction with the other road users will substantially deteriorate,” said Dr. Oliver Carsten of the University of Leeds. “The head is facing down, you are getting closer to the vehicle [in front of you] as it changes speed as the your distraction goes up.” Traffic safety researchers at the conference say they need to explore more fully the effects of cognitive distraction, which is much more difficult to track empirically than visual or manual forms of driver distraction. l
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Message from the President La Plume du Président GREG MERRITHEW It has been a busy start of 2012 for the CIAA executive as well as myself. Pat Battle has kept us on course leading up to our mid-year meetings held in Toronto, the first week of February. The week began with a meeting of the CIAA National Insurance Industry Advisory Board. This high profile board made up of senior claims officers from national insurers, along with executive members of CIAA, discuss national issues of importance that have a bearing on our organization. Carol Jardine, senior vice president claims services, TD Insurance, provided an informative presentation on insurance fraud. With losses estimated in the hundreds of millions of dollars annually, fraud continues to become more organized and sophisticated. A coordinated approach in detection, prevention, deterrence and reduction is critical and we can learn from models developed in the US and UK to assist in building a solution in Canada. Also joining us by video link were two members of the Canadian Insurance Services Regulatory Organizations (CISRO) to discuss the temporary licensing of adjusters within jurisdictions impacted by catastrophe claims. CIAA is the lead proponent within the industry to promote the use of a standard adjuster licensing process across all jurisdictions in Canada. Our efforts continue and we are meeting with CISRO at their June meeting to further promote the seamless mobility of adjusters in the event of catastrophe losses. Our mid-year meeting was well attended by members from coast to coast to coast. Our constitution was changed to allow retired members access to membership as well as to students studying in the field of insurance. Hopefully this will impact on our membership by retaining seasoned retired members as well as generating some interest by students to our organization. The Ontario CICMA/CIAA Annual Joint Conference was sold out and quite informative in the area of accident benefits which is the hot topic in Ontario right now. This is an event not to be missed given the large number of claims managers in attendance that have involvement with claims across Canada. I strongly urge members to consider CIAA’s midyear meeting and the Ontario Joint Conference every year as events not to be missed. The opportunity to meet with such a dynamic group of claims managers is certainly of value to most independent adjusting firms in Canada. Executive members of CIAA, CICMA and Canadian Defence Lawyers (CDL) discussed methods where education can be shared between our organizations. David Porter of Gran10 Claims Canada
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Ce fut un début d’année fort occupé pour les membres de l’exécutif de l’ACEI aussi bien que pour moi. Pat Battle nous a maintenus dans des activités aboutissant à des réunions semestrielles qui se sont tenues à Toronto durant la première semaine de février. Il y a d’abord eu la réunion du Conseil consultatif national de l’industrie de l’assurance de l’ACEI. Ce conseil prestigieux, formé de cadres supérieurs des services de sinistres d’assureurs nationaux et de membres de l’exécutif de l’ACEI, est chargé d’analyser les principaux enjeux nationaux ayant une incidence sur notre organisation. Carol Jardine, vice-présidente principale des services de sinistres de TD Insurance, a fait un exposé informatif sur la fraude en matière d’assurance. Avec des pertes annuelles estimées à des centaines de millions de dollars, cette fraude continue d’être mieux organisée et plus sophistiquée. Une approche concertée de détection, prévention, dissuasion et réduction est impératif et, en cela, les modèles mis au point aux États-Unis et au Royaume-Uni peuvent nous inspirer et nous aider à trouver une solution pour le Canada. Par liaison vidéo, deux membres de Canadian Insurance Services Regulatory Organizations (CISRO) se sont joints à nous pour discuter de l’attribution de permis temporaires d’experts pour des territoires enclavés dans des sinistres de catastrophe. L’ACEI est la principale association de l’industrie qui soutient sans équivoque le recours à un processus d’octroi de permis standard pour experts sur tout le territoire canadien. Nous poursuivons nos démarches en ce sens et lors de la réunion de CISRO prévue en juin, nous y soutiendrons le concept d’une mobilité accrue et facile des experts en sinistres dans le cas de pertes causées par des catastrophes. De nombreux membres de partout au pays ont assisté à notre réunion semestrielle. Nous avons alors modifié notre constitution, de façon à permettre à nos retraités de demeurer membres de l’association et d’y admettre les étudiants en assurance. Nous espérons ainsi dynamiser notre association, en retenant les membres chevronnés à la retraite et en suscitant l’intérêt à notre égard, chez les étudiants. La conférence annuelle conjointe ACDSA/ACEI de l’Ontario affichait complet et fut très instructive sur la question des indemnités d’accidents qui provoque actuellement une vive controverse en Ontario. C’est un événement à ne pas manquer, parce qu’il rassemble un grand nombre de directeurs de sinistres de partout au Canada, bien au fait de ce domaine. J’encourage fortement nos membres à considérer comme indispensable d’assister chaque année à la réunion semestrielle de l’ACEI et à la conférence conjointe annuelle de l’Ontario. La plupart des experts indépendants du Canada sauront tirer avantage d’un contact avec un groupe de directeurs de sinistres de cette envergure. Les membres de l’exécutif de l’ACEI, de l’ACDSA et des CDL (Canadian Defence Lawyers) se sont penchés sur les méthodes selon lesquelles nos associations pourraient collaborer à la formation. Dawww.claimscanada.ca
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ite Claims Solutions is our point man liaising with CDL and CICMA and in the next few months joint educational seminars will be offered to members across Canada. A strong core group of individuals have agreed to participate on our education committee under the guidance of Santo Carbone from Crawford & Company (Canada) Inc. Courses and examinations are currently being reviewed in preparation of our new CLA designation, which should be rolled out, hopefully, by the end of this year. We are always looking for volunteers in this endeavour and if you would be interested in assisting, please give Santo a call at Crawford’s Toronto office. Finally, we had a presentation by our new broker, LMS ProLink Ltd., for the professional liability coverage program sponsored by CIAA. We determined their quote for professional liability coverage for independent adjusters is significantly lower than what was available to us previously. Also, the coverage is enhanced. I strongly recommend all members that are not on the program to contact Chris Fay at 416-6447744 to discuss a quotation on your professional liability insurance. Existing members on the program will be receiving renewal notices in the normal course of the year. For those non-member firms who are considering membership in CIAA, you could be pleasantly surprised to find out savings on professional liability premiums more than offsets the cost of membership in CIAA. Remember to be safe out there and take care of your health. Enjoy the spring, which is a great time of year right across Canada. n
vid Porter, de Granite Claims Solutions, devient donc notre agent de liaison avec ces deux associations et, d’ici quelques mois, nos membres de partout au pays pourront s’inscrire à des séminaires de formation conjoints. Nombreux sont ceux qui ont exprimé le désir de joindre notre comité de formation dirigé par Santo Carbone de Crawford & Company (Canada) Inc. Les cours et les examens font actuellement l’objet de révision, en prévision de la future désignation d’expert agréé qui, nous l’espérons, entrera en vigueur d’ici la fin de l’année. Nous faisons appel à des bénévoles pour ce projet. Pour nous offrir votre aide, appelez Santo au bureau de Toronto de la Crawford. Enfin, nous avons entendu l’exposé de LMS ProLink Ltd., le nouveau courtier chargé du programme de couverture de la responsabilité professionnelle commandité par l’ACEI. Nous sommes d’avis que leurs tarifs pour la couverture de la responsabilité professionnelle des experts indépendants sont de beaucoup inférieurs à ce qu’on nous offrait précédemment. Et, de plus, cette couverture est augmentée. Je recommande fortement aux membres qui ne sont pas inscrits au programme de contacter Chris Fay au 416-644-7744, pour obtenir une estimation de leur assurance de responsabilité professionnelle. Les membres déjà inscrits recevront des avis de renouvellement dans l’année, comme d’habitude. Les sociétés qui ne sont pas membres de l’ACEI, et qui prévoient de le devenir, seront agréablement surprises d’apprendre que les épargnes sur les primes de la responsabilité professionnelle surpassent, et de loin, le coût de l’appartenance à l’ACEI. N’oubliez pas d’être prudent et de prendre soin de votre santé. Le printemps est une saison magnifique partout au Canada, profitez-en au maximum! n Translation provided by Henry Arcache, Themis Translations, Montreal, Que.
NATIONAL EXECUTIVE 2011-2012 2011-2011 PRESIDENT Greg G. Merrithew, CIP, FIFAA Arctic West Adjusters Ltd. 401 – 5204 – 50 Ave. Yellowknife, NT X1A 1E2 Phone: (867) 920-2212 Fax: (867) 873-2244 E-mail: gregm@arcticwest.ca
SECRETARY Marie C. Gallagher, FCIP, CRM Granite Claims Solutions 71 King Street, Suite 204 St. Catharines, ON L2R 3H7 Phone: (905) 984-8282 Fax: (905) 984-8290 E-mail: marie.gallagher@graniteclaims.com
1ST VICE-PRESIDENT Delores Thorbourne, BA, FCIP Granite Claims Solutions Suite 103 Greystone VII 4208 - 97 Street Edmonton, AB T6E 5Z9 Phone: (780) 442-3077 Fax: (780) 466-0325 E-mail: delores.thorbourne@graniteclaims.com
TREASURER Randy P. LaBrash, CIP, CFE, CFEI Crawford & Company (Canada) Inc. 300 – 191 Lombard Avenue Winnipeg, MB R3B 0X1 Phone: (204) 947-2340 Fax: (204) 943-9168 E-mail: Randy.Labrash@crawco.ca
2ND VICE-PRESIDENT John D. Seyler, AIIC ProFormance Group 2 Robert Speck Parkway, Suite 700 Mississauga, ON L4Z 1H8 Phone: (905) 270-1723 Fax: (905) 272-7486 E-mail: jseyler@prospecialty.ca
PAST PRESIDENT Mary Charman, CIP Crawford & Company (Canada) Inc. 1 – 120 Mulock Drive Newmarket, ON L3Y 7C5 Phone: (905) 898-0008 Fax: (905) 898-1705 E-mail: Mary.Charman@crawco.ca
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EXECUTIVE DIRECTOR Patricia M. Battle Canadian Independent Adjusters’ Association/ L’Association Canadienne des Experts Indépendants Centennial Centre, 5401 Eglinton Avenue West, Suite 100 Etobicoke, ON M9C 5K6 Phone: (416) 621-6222 Toll Free: 1-877-255-5589 Fax: (416) 621-7776 E-mail: pbattle@ciaa-adjusters.ca DIRECTOR James B. Eso, BA, CIP Crawford & Company (Canada) Inc. 539 Riverbend Drive Kitchener, ON N2K 3S3 Phone: (519) 578-5540 Fax: (519) 578-2868 E-mail: Jim.Eso@crawco.ca DIRECTOR John Jones, BA Granite Claims Solutions Suite 300, 5915 Airport Road Mississauga, ON L4V 1T1 Phone: (905) 671-3164 Fax: (905) 671-1889 E-mail: john.jones@granite.claims.com
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• cover story
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Not in
Kansas
Anymore A torrent of tornado activity has highlighted the risk of severe convective storms. While there is some debate over whether twisters are on the rise, the devastating potential for loss of life, injuries and extreme property damage means that the claims response from independent adjusters has to be quick and comprehensive. BY CRAIG HARRIS
T
he 2012 tornado season started with an early roar, and, as of mid-April, the losses continue to mount. To date, there have been more than 400 preliminary reports of tornadoes in the U.S. this year, far higher than the seven-year average of 268 twisters for the same time period, according to the U.S. National Weather Service. Following an astonishing $26 billion in insured losses from tornadoes in 2011, several questions persist: are these horrific storms increasing in frequency or do recent events represent merely an anomalous blip on the weather radar screen? And is Canada on the front lines in terms of vulnerability to severe convective storms? There is no scientific evidence directly linking tornado activity to global warming or climate change. In fact, weather observers such as Environment Canada and the National Oceanic and Atmospheric Association (NOAA) say there are yearly averages for tornado frequency in Canada (about 80-100) and the United States (roughly 1,000-1,200) – the two countries that face the highest risk from severe convective storms. Other factors, such as improved observation practices, more widespread Doppler radar and population growth, may
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contribute to perceptions of increased severe storm activity. “If you look at the history, over the last 60 years, there has not been an appreciable increase in the number of tornadoes that have happened,” says Jose Miranda, director of client advocacy for Eqecat risk modeling firm. “I think what you may see is a longer tornado season or a wider geographic area of exposure for tornadoes, but even with these, they are not necessarily caused by climate change.” Instead regional weather patterns are often the culprit behind a wild tornado season. For example, reinsurance broker Guy Carpenter observes that one of the main factors behind increased twister activity in 2012 is the above-average sea surface temperature in the Gulf of Mexico, resulting from a mild winter. This warmer water generates additional heat and moisture to the air passing over it, which then collides with cold, polar air coming from the north. It is the middle latitudes in North America, between roughly 30 and 50 degrees North or South, where the environment is right for tornadoes, hail and severe thunderstorms. Other factors, such as the track of the jet stream in North America, the Bermuda high (a semi-permanent, April/May 2012
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subtropical area of high pressure in the North Atlantic Ocean) and La Niña /El Niño cycles, can also affect the formation of tornadoes. “Over time, there are annual spikes and dips, but overall, the number of tornadoes recorded each year remain within a narrow band,” notes Glenn McGillivray, managing director for the Institute for Catastrophic Loss Reduction (ICLR). “There are times where huge outbreaks occur, and these can throw off an annual total.” Last year and the first four months of 2012 have been clearly one of those times. And, while the long-range pattern for tornado activity may not have increased, the insurance industry’s appreciation of the damage from severe convective storms has certainly changed. “An issue for the industry is that the losses in 2011 went beyond primary companies to reinsurers and into Lloyd’s as well, “ notes Matthew Nielsen, model product manager for Risk Management Solutions (RMS), a risk modeling firm.” So you are starting to see severe convective storm losses like tornadoes compared more to hurricane-type exposures.” Tornadoes were not typically considered one of the larger risks for the insurance industry from a singleevent loss viewpoint. Before 1994, there was only one tornado that caused $1 billion in insured property damage. However, from 1994 to 2008 there were 11 such events, including two in 2008, according to Munich Re. In 2011, there were six tornado events with over $1 billion in insured losses in the U.S., including two that exceeded $7 billion, Swiss Re noted in a sigma report. With the early start to tornado season this year, there has already been one severe convective storm in the U.S. in March that caused over $1 billion in insured losses. These figures don’t include the tornado that ripped through southeastern Michigan in the very unusual time period of mid-March, resulting in at least 20,000 insurance claims with payouts expected to exceed $150 million. While there is no official tornado “season,” there is a peak period for historical tornado reports in 14 Claims Canada
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a given area. Tornadoes can happen any time of the year and several have struck in Canada as late as November or December. However, the NOAA states there is a general northward shift in “tornado season” from late winter through mid summer. The peak period for tornadoes in the U.S. southern plains, for
Insurance and reinsurance companies are looking more carefully at risk modeling for severe convective storms, which involves using a risk platform that includes “stochastic” storm sets to estimate the effect of certain scenarios on a book of business, according to sources. example, is during May into early June. On the Gulf coast, it is earlier during the spring. In the northern plains and upper Midwest, which can extend into parts of Canada, it tends to be June or July. Many observers consider the outbreaks of March 2012, which also included parts of Alabama, Indiana, Kentucky and Ohio,
to be an early start to tornado activity in North America. It’s not just the early tornado season in 2012 that has caused concern in the insurance industry. Some research firms also suggest that the traditional geographic boundaries for tornado hotspots are shifting. CoreLogic Spatial Solutions, a California-based information and analytics company, states that, according to historical data, the frequency and severity of storms is much more widespread than commonly perceived. In fact, of the top ten U.S. states with the most tornadoes from 1980-2009, only three are in the traditional “Tornado Alley” – the region of the U.S. Midwest that includes Texas, Oklahoma, Kansas, Nebraska, Colorado, the Dakotas and Illinois. The possibilities of tornadoes moving east, south – and even north – are much higher today. Some of the most severe weather outbreaks of 2011 involved states such as Arkansas, Alabama, Tennessee and Virginia. “The apparent increase in the number of incidents and shift in geographic distribution of losses that occurred last year in the U.S. called the long-held notion of risk concentration in Tornado Alley into question, and is leading to changes in risk management policy and procedure,” says Howard Botts, a vice president with CoreLogic. Certain areas of Canada face a greater risk of tornado activity, according to Environment Canada. These include southern Ontario, southwestern Quebec, Alberta, and a band stretching from southern Saskatchewan and Manitoba through to Thunder Bay. The interior of British Columbia and western New Brunswick may also be vulnerable to severe storms. The most severe tornado recorded in Canada was an F5 storm (see sidebar on Fujita Scale) in Elie, Manitoba in June 2007 – an event scientists once speculated would never happen in Canada. Ontario has seen several damaging tornados in the past few years. A tornado that hit the Leamington area in June 2010 resulted in $120 million in insured damage, while another that www.claimscanada.ca
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tore across the Vaughan area north of Toronto in August 2009 cost $88 million. In August 2011, a tornado with winds of 300 km/h touched down in the town of Goderich, Ontario, killing one person. Insured losses reached $110 million, according to Insurance Bureau of Canada. While twisters often touch down in remote, sparsely populated regions, the main concern for the insurance industry is the danger and damage an F4 or F5 tornado could pose to a major metropolitan area. Nielsen says estimates from RMS show an F4 tornado that hit Toronto could cause $4 billion in insured losses. “You have a much more concentrated urban population, with high property values,” Nielsen adds. “The same holds true if you look at Western Canada. Calgary, Edmonton and cities in Manitoba and Saskatchewan have grown rapidly. If you have a severe convective storm in those areas now, the risk to property is much greater.” Insurance and reinsurance companies are looking more carefully at risk modeling for severe convective storms, which involves using a risk platform that includes “stochastic” storm sets to estimate the effect of certain scenarios on a book of business, according to sources. “Insurers and reinsurers are increasingly interested in our convective storm model,” Miranda says. “Tornadoes are a highly localized, high frequency type of occurrence, Insurers can look at a number of variables, such as their market portfolio, geographic exposures, census data, insurance take-up rates. They can apply these to our model and determine what effect a severe tornado would have in a specific region.” “We are seeing more inquiries from primary companies,” notes Nielsen. “They rely on their claims experience to look back 5-15 years to get some understanding of their exposures. However, our stochastic risk models can provide a much larger and richer view of data over a longer period of time.” For independent adjusters, the risk of tornadoes must be incorporated www.claimscanada.ca
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into disaster response plans, particularly in Ontario and Alberta, according to Jim Eso, vice president, national property & casualty for Crawford and Company (Canada) Inc. “Adjusters need to be able to mobilize quickly to areas that have been severely damaged since a change in course of only a few miles can mean the difference between a tornado spinning relatively harmlessly out into the countryside or hitting a metropolitan area,” Eso notes. “Windsor,
Ontario, for example, has been hit by tornadoes four times in the last 75 years but is in the most active tornado region of Canada, meaning numerous ‘near misses’ happen every year.” One example of a tornado hitting an urban area was the devastating storm that ripped through Edmonton in July 1987. The F4 tornado killed 27 people, injured more than 300 people and caused more than $330 million in property damage at four major disaster sites.
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While twisters often touch down in remote, sparsely populated regions, the main concern for the insurance industry is the danger and damage an F4 or F5 tornado could pose to a major metropolitan area.
“We are coming up on the 25th year since the Edmonton tornado so it is very much on our minds here,” says David Riddell, president of Edmonton-based Canadian Claims Services. “The reality is that in this part of the country, we have to be aware of the risk that a tornado could cause a lot of devastation, particularly if it hits a major urban area. The key issue with a tornado is localized damage and the need for a quick response.” Extreme localized property damage is one of the direct consequences of severe tornado outbreaks. The severity of damage can create multiple obstacles for adjusters, according to Eso. “To adjusters on the ground following a tornado, they will be dealing with a smaller number of more severe losses and most likely with insureds who have lost everything, which makes it a very challenging situation,” Eso notes. “Adjusters may find that the local infrastructure is severely damaged and that local accommodation is not available as displaced homeowners will often be filling local hotels. Transportation, accommodation and communication equipment must be part of the adjuster response plan.“ 16 Claims Canada
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For severe convective storms, the principal issue in loss frequency and severity comes down to the quality of building structures, particularly roofs, according to McGillivray. “There is much work being done by such groups as ICLR, particularly at Western University, into how and why buildings fail in wind storms and what can be done to prevent wind damage,” McGillivray says. “The key appears to be in keeping the roof on. If you keep the roof on, you stand a better chance of keeping the walls up. You can also mitigate mould damage, and you keep debris out of the wind stream. Debris causes more damage downstream, and is responsible for a large number of the deaths recorded in severe wind events.” To improve building structures, the ICLR is working on better roof and wall connections, improved nails and different nailing patterns and use of hurricane straps. New research shows that something as basic as missed nails in roof sheathing can reduce the capacity of the roof to withstand uplift by wind in a severe convective storm. For Eso, investments in better building structures and construction
Worst Tornadoes in Canada 1. Regina, Saskatchewan, June 30, 1912: 28 dead, hundreds injured 2. Edmonton, Alberta, July 31, 1987: 27 dead, 300 injured 3. Windsor, Ontario, June 17, 1946: 17 dead, hundreds injured 4. Pine Lake, Alberta, July 14, 2000: 12 dead, 140 injured 5. Valleyfield, Quebec, August 16, 1888: 9 dead, 14 injured 6. Windsor, Ontario, April 3, 1974: 9 dead, 30 injured 7. Barrie, Ontario, May 31, 1985: 8 dead, 155 injured 8. Sudbury, Ontario, August 20, 1970: 6 dead, 200 injured 9. St-Rose, Quebec, June 14, 1892: 6 dead, 26 injured 10. Buctouche, New Brunswick, August 6, 1879: 5 dead, 10 injured Source: Environment Canada
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techniques are solid approaches to vulnerable storm regions in Canada. “Improved building technology, such as better roof tie down systems, high quality roof shingles and even impact resistant glass and siding, in particularly tornado-prone areas would be an effective risk management option,” he says. Another primary concern with tornadoes is adequate warning systems to prevent widespread loss of life and injury. McGillivray suggests that there may be an element of “cry wolf” when it comes to mass notification systems. “There are places in the U.S. where hurricane sirens ring almost all day long due to severe weather warnings,” he says. “The concern here is that people tune them out after awhile. This was reported to be the case on many occasions with the outbreaks in 2011 and this year. Warnings are only of value when people heed them and do what they are supposed to do.” McGillivray notes that there are several jurisdictions in North America experimenting with other media, such as texting warnings to mobile devices. The National Weather Service in the U.S. is also piloting more
dire weather warnings in offices in Kansas and Missouri. The “impactbased” warnings are expected to be more direct and shocking, including phrases such as “Complete Destruction of Entire Neighbourhoods is Likely.” For the tornado outbreak that hit Kansas and Oklahoma in mid-April,
For severe convective storms, the principal issue in loss frequency and severity comes down to the quality of building structures, particularly roofs, according to McGillivray. the NOAA issued an advance warning more than 24 hours in advance of “severe thunderstorms capable of producing tornadoes.” The early notification sent on April 13 was credited with limiting the number of fatalities
and injuries in the widespread storm system. For Riddell, these notifications represent a major leap forward in handling tornado outbreaks. “I think now with technology, weather forecasting and social media, there is more advance warning of severe weather events like tornadoes, “ he says. “I have the weather channel app on my phone and I received updates on severe weather in real-time last summer. It is much more the case now than it was 25 years ago.” While news of tornado outbreaks will likely continue throughout the summer and cause much speculation about increasingly severe weather events, some point to another potential reason for high losses – the rapid expansion of urban sprawl in vulnerable storm regions. “I think it is just as relevant (to ask) the question of whether continued population growth and construction into tornado-prone areas is leading to a higher claim frequency when a tornado does occur,” Eso says. “This is similar to what some have suggested has contributed to increased flood and water damage to homes in the last few decades.”
Rating Tornado Severity The Fujita scale, devised in 1951 by American meteorologist Tetsuya (Ted) Fujita, is used to rate the severity of tornadoes as a measure of the damage they cause. It classifies tornadoes on the following scale.
• F4 devastating (winds of 331 - 417 km/hr; few walls, if any, left standing in well-built homes; large steel and concrete objects thrown great distances). Accounts for about 2% of all tornadoes.
• F0 light (winds of 64 - 116 km/hr; some damage to chimneys, TV antennas, roof shingles, trees, signs, and windows). Accounts for about 28% of all tornadoes.
• F5 incredible (winds of 418 -509 km/hr; strong frame houses lifted off foundations and carried considerable distances; automobile sized objects fly through the air in excess of 100 metres; trees debarked; steel reinforced concrete structures badly damaged). Accounts for about 0.1% of all tornadoes.
• F1 moderate (winds of 117 -180 km/hr; automobiles overturned, carports destroyed, and trees uprooted). Accounts for about 39% of all tornadoes. • F2 considerable (winds of 181 -252 km/hr; roofs blown off homes, sheds and outbuildings demolished, and mobile homes overturned). Accounts for about 24% of all tornadoes. • F3 severe (winds of 253 -330 km/hr; exterior walls and roofs blown off homes, metal buildings collapsed or severely damaged, and forests and farmland flattened). Accounts for about 6% of all tornadoes.
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An enhanced Fujita scale (EF scale) that contains additional damage guidelines and some modifications to wind speed was developed by the United States and is now used in that country. Canada has yet to adopt the enhanced scale. Both F and EF scales are essentially similar in terms of tornado damage ratings. Source: The Weather Network
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• spotlight S Weathering
STORM
the
BY CRAIG HARRIS
Staying true to its “small-office atmosphere,” Townsend & Leedham Adjusters Ltd. has staked out a solid presence in the Edmonton community.
M
ike Leedham remembers “Black Friday” well. On that date in Edmonton, July 31, 1987, a powerful tornado tore through the eastern part of the city, killing dozens and injuring hundreds. It also left a trail of property damage in the millions of dollars. The year before, Leedham had joined what was then Dobie Townsend Adjusters Ltd., now Townsend & Leedham Adjusters Ltd., as a partner. It was a “trial by fire” start for the independent adjuster, who had previously worked as a claims supervisor for Economical Insurance Group. “We had more claims in one month than we would typically get in a year,” he recalls. “At one point, my wife left with the kids to visit family out East for three weeks because I was simply not around. We were working from dawn until dark and then some.” One of the firm’s founding partners, Bud Townsend (ex of Wawanesa and now retired), was driving to his acreage residence on the eastern edge of Edmonton when he saw the tornado cross the road behind him in the rearview mirror. “Too close for Bud’s comfort – mine , too!,” Leedham remarks. Being exposed to the aftermath of dangerous situations and helping people recover from traumatic losses is one of the responsibilities that independent adjusters sign on for as part of their professional role. The 24/7 availability for response to losses of all types “is just part of the deal,” he says.
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Townsend & Leedham Adjusters partners (from left): Debra Schultz, Morris Blatz, Blair Richmond, Doreen Lennon, Mike Leedham (president), Chris Zambo, Chris Twardzik, (missing: Dean D’Agostini).
For Leedham, who is now president of Edmonton-based Townsend & Leedham Adjusters Ltd., that commitment to service extends to all types of claims that the firm handles – auto, personal, farm and commercial/ light industrial property and casualty losses. “We’re a general insurance adjusting business and that pretty well describes what we do,” says the 40-year veteran of the claims profession. “One never knows what’s coming in the door tomorrow.” Townsend & Leedham has 18 licensed adjusters and 12 support staff. In the adjusting business since 1980, the firm services the area of central Alberta from Jasper to Lloydminster, north to Slave Lake and south to Red Deer. Its business extends from the British Columbia to Saskatchewan provincial borders.
Leedham says that claims adjusting expertise is wide and varied at the firm, with most of their adjusters having 20, 30 or even 40-years of experience in the business. “This provides us with an enviable in-house resource that we all take advantage of from time to time,” he observes. “We’ve been fortunate to attract experienced adjusters with a good work ethic who have broadened our overall expertise. We’ve also been lucky to have a competent, loyal and stable support staff who have definitely contributed to our success. As we’ve grown, we have diligently maintained our ‘small office’ atmosphere.” Leedham adds that the adjusting expertise and committed support staff provide “stability for dealing with challenging situations.”
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One of those “challenging” situations was the Slave Lake fire of May 2011. The blaze caused more than $700 million in insured losses and was the second costliest disaster in Canadian history. But for Leedham, whose firm helped adjust several of the claims, the cold facts don’t describe the intensity of the event. “The pictures or television images didn’t truly show the extent of destruction,” he says. “You really had to be there. Walking along a street, there would be one house standing and the rest were completely destroyed. Concrete foundations had turned to powder.” Leedham notes that one of the most difficult aspects of the Slave Lake fire was the waiting period of up to two weeks before authorities allowed adjusters and residents back into the community. Policyholders simply didn’t know what their situations were and how or when things were going to be resolved. “Many of the residents stayed in and around Edmonton and some of them didn’t know if their property was standing or completely destroyed – and there were 374 total losses,” he says. “Once we got in, the authorities had done a lot of clean-up and labeled most of the properties making the initial claims adjusting process smoother.” Leedham notes “as in any catastrophic situation, the adjusters’ issues are insignificant compared to those of the people involved and, in this respect, the residents of Slave Lake have been nothing short of amazing.” “On the personal side, we encourage our adjusters to keep a proper balance between work and their personal lives” he says. “With the fire in Slave Lake and the subsequent summer storm claims on top, things got a little stretched throughout our industry last summer, but this business always seems to have its ups and downs. This past winter was unusually mild, with fewer claims, so we’ve been able to catch up.” Beyond the day-day workings of the office, Leedham is keenly aware that
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there are national legislative issues that can affect independent adjusters across the country. With Townsend & Leedham as a full member of the Canadian Independent Adjusters Association, he is supportive of the unifying role the association has on the regulatory landscape. “As individual adjusters, we can get caught up in the daily grind of what
Mike Leedham: Experienced adjusters with a good work ethic.
we do,” Leedham notes. “But we also need representation at the federal level. When politicians and legislators look at the insurance industry, they need a central point of contact and response - a ‘stakeholder’ to deal with. That is what the CIAA does for us as adjusters – it represents our interests on a national scale. It is the perfect vehicle for that role.” The CIAA can also provide guidance on a wide range of emerging policy issues, according to Leedham.
“Polices and procedures are ever evolving as our industry responds to the challenges and demands of a rapidly changing world,” he says. “This, in turn, affects the adjusting business. The Internet, Facebook, privacy legislation all make our business more interesting.” When asked about the future, Leedham says he doesn’t have a crystal ball for predicting what’s coming but knows that things will continue to change and service will remain the key aspect for the insurance industry. “I’m sure this is going to remain a ‘service’ industry and that will be the key issue for all components of the insurance business – from brokers to underwriters to claims departments to independent adjusters and service providers.” For his adjusting firm, Leedham emphasizes that the business approach is squarely focused on the customer, whether that be the insurance company client or the policyholder who has experienced a loss. “Our company philosophy is to provide quality claims services at a reasonable cost, with an emphasis on service,” he says. “We have developed and maintained long-term relationships with our clients, some of whom have been with us since day one. We take the approach that we’re in this business for the long haul and that governs our attitude towards our clients and the insuring public.” Customer service is a concept that is often tossed around loosely in today’s economy. Leedham says some of the trends on the retail side leave him with an impression of less, not more attention paid to the end consumer. “In this day of ‘big-box’ everything, where service is less of a priority, people are definitely looking for a higher standard from their insurers,” he observes. “We feel we are particularly well suited to respond to this demand with the training and experience of our adjusters, the quality of our office staff and our strong local knowledge and presence.” April/May 2012
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The Lost Art of Customer Service BY GINO FIORUCCI
With our increasing efforts to boost revenues, cut costs and improve gross margins, we often overlook something that doesn’t show up as a line item on a balance sheet or a profit and loss statement. It does, however, have a major impact on company results: Customer Service! Although senior executives can lead the strategy behind customer service, the front-line employees are the real drivers. Without proper training and retraining to create a culture of great customer service, a company will fail in its strategic efforts and customers will ultimately leave for competitors. To improve your customer service, you must first benchmark where you are from the standpoint of your employees. Internally, asking employees questions like: Does a live operator answer the phone? Do you pick up the phone before the 3rd ring? Do you view customer complaints as opportunities? Do you give customers compete attention when conversing? How many days does it take you to respond to a customer? Do you like your customers? The answers to these questions can help you determine where you need to improve and where you can focus training initiatives. Surveying your customers on their experiences – from the on-board process to the claims process and everything in between – will give you a great understanding of the good, the bad and the ugly. This will also give insight on how your customers feel and what they want. Generally, customers want the following: 1. Friendliness – Everyone wants to deal with someone who is friendly and has a smile on their face (even if talking over the phone – ‘smiles can be heard’) 2. Responsiveness – I recently dealt with the customer service department of a major auto manufacturer and it took four phone calls before I received a response. If we don’t respond to our customers what message are we sending them? 22 Claims Canada
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3. Understanding – No customer wants to be judged and we must ensure that all questions or concerns are handled with patience (even dumb ones). 4. Fairness – All customers must perceive they are being treated fairly. 5. Options – Obviously we want to solve all our customers’ problems, but if they can’t be addressed outright, some options should be offered. 6. Clear Message – If customers are asking the same questions over and over, your message must be changed. Adjusters are constantly trained on adjudicating claims, using claims management systems and understanding new legislation, but when was the last time they were trained on Customer Service? Do your adjusters know how to deal and speak with your customers? With the proliferation of adjudicating claims over the phone or over email different forms of training is required. Would it be surprising to your adjusters that during phone conversations customers listen more to the tone of the adjuster they are speaking with than the actual words the adjuster is saying (14% words and 86% tone)? This human condition makes email communication even more difficult. The tone that comes from voice inflection, a softer or louder voice or speaking fast or slow is more difficult to replicate in email messages. Today, social media makes customers more powerful than ever. They can tweet, post, email, blog, ping, text many people instantly, which makes it even more important to keep them happy and address their concerns quickly. Customer service is truly becoming a lost art. I can’t remember the last time I had a great customer service experience, whether at the grocery store, auto repair shop, restaurant or, dare I say it, insurance company office. Imagine the impact great customer service would have on your current customers! In my opinion, no company is leading the charge in this area. Gino Fiorucci is the CEO of ISB Canada. www.claimscanada.ca
20/04/12 2:48 PM
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Money for Nothing The business of insurance fraud BY RICK DUBIN
The war is on. Money for nothing is under siege. Consider the increased press about insurance fraud. Recent media attention focused on two fall milestones: the release of the Anti-Fraud Task Force report and the Auditor General of Ontario’s report. The former identified key issues that will go under the microscope: • The licensing and/or regulation of health clinics, and other gaps in regulation • The establishment of a dedicated fraud investigation and enforcement unit • The development of a consumer engagement and education strategy • The creation of a single web portal for Ontario auto insurance claimants The first two were initiatives recommended by IBC. While that is reassuring, at the same time, it’s clear that government expects insurers to be more aggressive in their own efforts to identify and investigate fraudulent behaviour. Moreover, the government appears to be looking to insurers to better communicate to the public the steps they are taking to prevent, identify, and ultimately eliminate fraud. The Auditor General’s report recommended that a comprehensive antifraud strategy be developed that would identify the roles of all stakeholders involved. It essentially supported the direction of the Task Force. Another media event likely to attract attention will be the release of a KPMG report in early 2012. This report is intended to give an objective assessment of the cost and impact of 24 Claims Canada
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accident benefits and service supplier fraud in the Ontario auto system.
Organized crime looks for maximum profitability IBC is currently investigating multi-case fraud projects in the Greater Toronto Area (GTA). Cases may involve tens of millions in fraudulent, or potentially fraudulent, claims. While fraud is a cross-Canada activity, the GTA is the epicenter. It’s no surprise that organized crime looks for maximum profitability. To that end, the criminal organizations often operate much as you would expect a mainstream business to do. Some of the most sophisticated groups are apparently adopting a business model called vertical integration.Vertically integrated companies seek to control and take profit from as many points as possible from one production process. Vertical Integration: the criminal model Take staged collision rings for example. At the collision scene, scheme organizers may control the tow operators involved so they gain some or all of the tow, storage, wait time, scene clean up, and hazardous waste disposal fees charged. Salvage vehicles that have been partially or mock repaired may be used in the collisions so that when they are settled as a total loss, more profit can be made than by using vehicles in good shape. The damage caused in the faked collision may never, on the other hand, actually be repaired even though it is billed for. Occupants alleged to have been in the vehicle may actually receive only some or none of the benefits claimed in their names. Income replacement benefits, housekeeping, caregiving
or attendant care fees may all flow to scheme organizers in part or in total. The injuries claimed by the occupants may be assessed and treated at schemeinvolved medical facilities. Multiple assessments, extensive treatments and numerous assistive devices such as orthotics or pain management devices may be invoiced for not because they were ever provided but simply to add to the income flows. In some cases, the cost of having real care providers involved in this process may be avoided by simply stealing the identities of practitioners and billing in their names. Alternatively, legitimate care provided may be exaggerated and overbilled without any knowledge on the part of the reported patients or providers. Some organizations may control the legal service representatives involved in order to control insurer contact with claimants who are being duped or used in a scheme. In this way the criminal organization may maintain control of claims and payments for services and benefits made by reported claimants.
Increasing Sophistication In the ever-changing business of insurance fraud, strategies and tactics are both becoming more sophisticated. Schemes have evolved: from manually-caused damage being reported to insurers or reporting centres; to damage created by intentional low-speed impacts with stationary vehicles or objects in private locations; to low-speed impacts with two participating vehicles either at private sites or on public roadways; to current schemes where www.claimscanada.ca
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innocent and unaware drivers are brought dangerously into collision on public roadways. Not all groups operate at the same level of sophistication. Any one group may adjust their operation by borrowing from ‘old school’ schemes from time to time. There is also a growing problem of fraudsters seeking out high-valued used or scrap cars to be used multiple times in staged collisions to claim replacement and refurbishment costs. Experienced fraud rings know that insurance companies would notice if the same people repeatedly submitted claims for injuries caused by car accidents. Therefore organizers systematically recruit new people simply to be the names in different staged collisions. Recruits may be enticed by some promised portion or fixed amount from the planned fraud, or they may be promised some perk or benefit such as a rental car use or free massage. Often recruits get cheated out of even the minor share promised them after participating in the scheme. Other re-
cruits participate to pay off debts, to support some cause or belief, or because of extortion. Sometimes legitimate collision victims are recruited into schemes and agree to allow vehicle repairs, treatments, assessments and other services to be billed on their claim in order to gain personally from the scam. Other legitimate collision victims are used in schemes unknowingly when inflated repairs or medical attention costs are billed to their insurers. Increasing fraud industry sophistication is also apparent in areas such as digital reproductions of benefit forms, false signatures, forged T-4 forms, fake pay cheques, medical provider identity thefts, forged Health Care for Auto Insurance (HCAI) signature cards and other new creative ways of gaining provider credentials.
TIPS line (1-877-IBC-TIPS) for the public to submit information about auto theft or suspected fraud. Two videos have been developed by IBC that have been viewed on YouTube more than 47,000 times. Both social and traditional media, through press releases and opinion articles, are being used. In 2011 IBC provided training sessions with numerous law enforcement agencies, authorities, and insurers on staged collisions and associated service provider fraud. These will continue throughout 2012. IBC and member insurers supported several significant law enforcement initiatives on fraud in 2011. Much more is expected for 2012 and into the future. Co-operative investigations and increased communication are critical to continued success. The war is on.
Communication: front line weapons in the war on fraud The war on fraud involves increased communication. This includes an IBC
Rick Dubin is the vice president of investigative services at Insurance Bureau of Canada (IBC).
24HR
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Covering the Field
Sport-Related Personal Injuries and Insurance Coverage BY ANITA G. WANDZURA
It is almost a certainty that when personal injuries are sustained in sport, various parties will be implicated. In many instances, a plaintiff claims that he or she sustained personal injuries due to a fellow player’s conduct. However, in addition to such a claim, the plaintiff may claim against the organization that sponsored or coordinated the sports activity or the party who supplied and maintained the sports facility. It comes as no surprise that these parties often hold insurance policies and as a result, there has been litigation concerning when insurers have a duty to defend these insureds. A review of recent case law identifies at least two themes or pertinent issues concerning insurance law and coverage for sport-related personal injuries. First, the case law indicates that personal injuries sustained during sports will likely involve overlapping insurance coverage from several insurers, triggering the prospect of contribution. Second, the case law indicates that careful consideration must be given as to whether a sport-related injury constitutes an intentional act on the part of a party defendant. The likelihood and implications of overlapping insurance coverage are effectively illustrated in a 2007 decision of the Ontario Court of Appeal: Canadian Universities Reciprocal Insurance Exchange v. CGU Insurance Co. of Canada, 2007 ONCA 650. In Canadian Universities, an individual was injured while sparring informally with a classmate after a judo class coordinated by the University of Windsor Judo Club. The University had provided the Club with access to its facilities to conduct classes and other activities. The insurer for the University, the Canadian Universities Reciprocal Insurance Exchange (CURIE), settled the matter; however, CURIE sought contribution from the insurer for the Ontario Judo Black Belt Association (Judo Ontario). Judo Ontario was a governing body for judo clubs in Ontario, and it was comprised of both individual and organizational members. Interestingly, the Club was a registered member of Judo Ontario during the academic year preceding the sparring incident, but the Club had not paid its registration fees for the academic year during which the sparring incident took place.
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At the superior court level, the Court held that CURIE was not entitled to contribution from Judo Ontario who was insured by CGU Insurance Co. of Canada (CGU). CURIE contested this finding, and the principal issue on appeal was whether the University of Windsor Judo Club was a “member club” of Judo Ontario. If it was a member club, coverage was available under Judo Ontario’s CGU policy. The Ontario Court of Appeal examined the Bylaws governing Judo Ontario and noted that under these Bylaws, members remain members unless they resign or are suspended or expelled. None of these actions had been taken by any of the relevant parties. The Court of Appeal held that despite the Club’s failure to pay its registration fees to Judo Ontario for the relevant academic year, the Club remained a member of Judo Ontario, although not a “member in good standing”. Overall, the decision in Canadian Universities illustrates the fact that actions for sport-related injuries are generally multi-party claims. In advancing or defending such an action, careful consideration must be given to implicated parties and insurers. The implications of multi-party litigation are further illustrated in a recent decision of the British Columbia Court of Appeal: Saanich (District) v. Aviva Insurance Co. of Canada, 2011 BCCA 391. More interestingly, this case highlights potential insurance complications for sports facilities which coordinate more than one activity at a time. In Saanich, the B.C. Lacrosse Association entered into a rental agreement for a facility operated by the District of Saanich. In addition to providing the lacrosse association with access
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to the facility for lacrosse activities, access was provided for The cases discussed in this article illustrate several dog obedience classes. In the course of attending the facility themes which may be of assistance in evaluating a claim for a dog obedience class, the plaintiff was allegedly hit on involving organized sports, especially those taking place in the head with a lacrosse ball and suffered personal injuries a facility. Multi-party litigation is almost inevitable due to and damages. Aviva had issued an insurance policy to the the involvement of various parties in the hosting, coordiB.C. Lacrosse Association covering bodily nation and provision of organized sports injury “arising out of lacrosse activities”, in Canada. In certain circumstances, a and the District of Saanich was an adplaintiff may advance a personal injury ditional insured for “lacrosse activities”. claim against fellow sport participants, Aviva appealed the lower court’s ruling coaches, facility providers, and any imthat it had a duty to defend the District After careful analysis, plicated sport organizations and/or asof Saanich, and as a result, the Court of sociations. The involvement of numerAppeal interpreted the policy and wheth- the Court granted the ous parties increases the likelihood that insurers’ petitions er the liability of Saanich “arose out of more than one insurance policy will be lacrosse activities.” The Court dismissed because “the claim is implicated, and as always, careful conthe appeal, ruling the lower court approsideration is required on the part of legal one for an intentional counsel in commencing, advancing and/ priately held that there was an unbroken chain of causation, potentially engaging act and that act is not or defending a claim for sport-related the liability of Aviva vis-à-vis the District personal injuries. Consideration must be an accident or of Saanich. given to the sufficiency and nature of the occurrence under The second pertinent issue amongst pleadings vis-à-vis the insurance policies, sport-related insurance coverage is wheth- either of the insurers’ as well as whether intentional conduct er a sports injury was caused by an intenby a fellow sport participant caused the policies” tional act on the part of a party. This isplaintiff’s injuries. sue is generally at the forefront of cases where in the course of playing a contact sport, it is alleged that a player delibAnita Wandzura is a lawyer with McKercher LLP. McKercher erately or intentionally harmed another player. This issue LLP is a member firm of the Risk Management Counsel. was recently canvassed in Economical Mutual Insurance Co. v. Doherty, 2009 BCSC 959. This case concerned injuries sustained by the plaintiff in the course of a soccer game coordinated by the B.C. Soccer Association. Akin to the other cases discussed, several parties and several insurers were involved. Economical Mutual Insurance Co. had issued a homeowners’ policy to Mark Doherty, the individual who allegedly kicked the plaintiff in the head during a soccer game, and Aviva had issued a commercial general liability (CGL) insurance policy to the B.C. Soccer Association. Broadly speaking, both insurance policies provided coverage for liability arising out of “accidents”, but not intentional acts. Both Aviva and Economical petitioned the Court for a declaration that they did not have a duty to defend the action brought against Doherty and the B.C. Soccer Association. After careful analysis, the Court granted the insurers’ petitions because “the claim is one for an intentional act and that act is not an accident or occurrence under either of the insurers’ policies”: Doherty, at para. 44. Originally, the Statement of Claim was only advanced a claim for the intentional tort of assault; however, later it was amended to allege negligence in the alternative. The Court examined the “true nature” of the claim and held that the particulars of negligence claim did not speak to negligence and the plaintiff’s use of the word “negligence” was not determinative. The circumstances in Doherty, can be contrasted with those in Thorne v. Royal & Sun Alliance Insurance Co. of Canada, 2003 NBCA 61, where the CGL policy contained an exception to the exclusion clause pertaining to intentional acts.
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The Adjuster’s Role In Subrogation Claims BY SHAWN BURNETT
In most cases, the adjuster is the first person on scene on behalf of insurers. It is critical for the adjuster to begin handling the claim properly in order to ensure the best possibility for successful subrogation against a negligent third party. The adjuster will rely on a variety of experts, including forensic engineers, accountants, investigators and legal counsel, to prepare and prove their case. However, there are many things that must be done at the very outset of the claim to properly document the file. When it comes to subrogation, you don’t want to lose before you even get started.
First arrival on Scene: Whether it is fire, water damage or equipment/product failure, it is imperative to not make unsubstantiated assumptions on the origin and cause of loss. Survey the entire scene and try to identify the suspected origin, and identify what evidence needs to be retained. Interview and obtain signed statements from any witnesses, and the owner or person responsible for the subject property. Statements should contain the interviewee’s full personal contact information, including all current addresses, phone numbers, date of loss, and date of birth. The person may be needed years later and this information will help locate them if they have moved or changed employers. When dealing with commercial or industrial losses, you must identify who owns the property/object deemed to be the “evidence,” in order to determine if you have the legal right to retain it. With Landlord/Tenant or Condominium Corporation/Unit owner relationships ownership of the evidence must be established at the outset. If possible, prior to any emergency remediation or major scene overhaul, 28 Claims Canada
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the entire scene should be photographed and/or videotaped. With digital photographs it is just as easy to take 100 photos as it is to take 10. Shoot as many photographs, from all angles, as you can.
Retention of Experts: After the adjuster has conducted interviews, surveyed the scene, identified the suspected area of origin and potential cause of loss, the right expert can be identified and engaged. It is important to hire the best expert for the particular loss – someone who is a specialist in the required field. If needed, seek a courtcertified expert consultant. Try to avoid hiring a “Jack of all Trades” consultant. An adjuster should develop a library of expert’s C.V’s in all disciplines for ease of reference. If circumstances allow, preserve the scene until your preferred expert is available, if they are unavailable immediately. The type of claim exposure will dictate if a delay in starting the origin and cause investigation is possible. If a claim has an ongoing Business Interruption exposure, it may not be practical to prolong an investigation. Removal and Handling of Evidence: Whether collected by an adjuster or a retained expert, any evidence removed from the site should be properly photographed “in situ” prior to removal. The item(s) should be tagged, identified and dated. A Chain of Custody letter should be drafted identifying the evidence removed, by whom, and when. The letter should confirm who had the evidence in their possession prior to releasing it to the current party. This letter should be signed by both parties involved in the transfer of evidence. If any evidence requires further examination, it is crucial that no destructive testing is done until all potential subrogation third parties have had a reasonable opportunity to inspect, and
arrange for their own experts to attend. Spoliation of evidence must be avoided at all times.
Coordination with Subrogation Legal Counsel and Claims Examiner: An early identification of the need for subrogation counsel leads to better legal privilege on all expert’s reports. Some insurers request that an adjuster provide two separate reports on a file involving a subrogated action: one report dealing with quantum, coverages and first party loss adjustment issues. The second report deals specifically with origin and cause findings and subrogation investigation details. The independent adjuster and assigned counsel should provide the insurer with timely, preliminary opinions on realistic chances of recovery. A claims examiner may have to authorize expensive cause and origin investigation costs at the onset of a claim. All parties must communicate to determine claims investigation dollars are being well spent. It is important to have all inclusive expert meetings with the claims examiner, independent adjuster, forensic accountants, engineers and subrogation counsel in attendance to review the full file and subrogation investigation. Often, the file handling is limited to the interaction between the independent adjuster and claims examiner. However, other participants on the file may have www.claimscanada.ca
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important questions and answers to add or have a different perspective on the file. A well documented claim file – outlining the physical evidence removed, how the evidence was retained, procedures followed and first party quantum calculations – makes the final third party settlement negotiations much easier.
Placing Third Parties on Notice: All effort must be made to identify all potential third parties, and not just the obvious ones. A full understanding of the Canada Sale of Goods Act is essential in identifying which potential entities may have liability exposure when it comes to a product defect or breakdown causing resultant damages. This is becoming more important each year with the growing trend of products being manufactured overseas, but distributed and/or supplied by local Canadian companies. While it may prove prohibitive to pursue an overseas manufacturer, if the product has been sold or distributed by a Canadian com-
pany the avenue of subrogation against this firm is far easier under the Sale of Goods Act. Where applicable, an adjuster must obtain copies of all contracts, purchase orders, bills of lading, etc. Confirm if the original documents were double sided with terms and conditions printed on the back. On commercial losses, it is important to obtain all related documents which may possibly tie in to a contract, i.e. electrical engineering drawings or fire sprinkler system designs etc. These addendums to a contract are often just as important as the contract itself. By reviewing the terms and conditions of all contracts, an adjuster will be able to identify early on if third parties have little or no liability exposure due to hold harmless agreements, limitations of liability clauses or no “special damages” clauses contained within the agreements. While a third party may be negligent for the insured’s damages, if the negligent party is legally protected it is best to know at the beginning of
Are you
the claim to avoid costly subrogation handling costs. All third parties should be placed on notice for a subrogated action as soon as possible. Finally, an adjuster must be aware of all limitation periods that may apply to the situation. In addition to the Limitations Act (2002), a private contract between the insured and a third party may contain a limitation period on commencing an action, and/or limit the monetary amount of recovery. By doing thorough and proper claims investigation from the beginning of a claim, the possibility of successful recovery from a negligent third party can become a reality.
Shawn Burnett is the managing director of MGB Claims Consultants Inc. This article is based on a presentation Shawn Burnett made during a National Association of Subrogation Professionals seminar.
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Minor Injury Guideline Refresher: What’s in? What’s out? BY JOHN MALATESTA
The Financial Services Commission of Ontario (FSCO) initially released the Minor Injury Guideline (MIG) in June 2010, and then followed up with a revised MIG that took effect November 2011. Overall, the MIG provides a FSCO-approved process for the treatment of uncomplicated musculoskeletal injuries resulting from a motor vehicle accident. The purpose of the MIG is to help expedite treatment by providing a pre-approved process, and as a result avoid delays due to lengthy approval requirements. In terms of intent, the MIG is similar to FSCO’s Pre-approved Framework (PAF) guideline, released in 2003, but the MIG provides a more concrete definition of soft tissue injuries. In some ways, the MIG could be thought of as ‘tightening up’ soft tissue injury definition offered by the PAF guideline. However, there still appears to be confusion around ‘which injuries are in’ versus ‘which are out.’ To get a better handle on what injuries are included in the MIG versus excluded, here is an MIG refresher.
Putting the MIG in context Before 1990, all benefits were resolved solely through law suits in the courts by way of what is known as a “tort action.” Then in 1990, the Ontario Motorist Protection Plan, Bill 68, became law introducing no-fault insurance and restricting the ability to sue—and establishing accident benefits. Fast forward to 1993 and Bill 164, the Insurance Statute Law Amendment Act, became law, expanding accessibility to accident benefits and introducing the Designated Assessment Centre (DAC) system. Then from 1994 to 2010, we saw the following developments: • 1996: Automobile Insurance Rate Stability Act, Bill 59: allowed motor vehicle accident victims to be compensated for their losses through the courts by way of a tort action and/or from their insurer through no-fault coverage. • 2003: Bill 198, Pre-Approved Framework (PAF) Guideline for Grade I and Grade II Whiplash Associated Disorders: outlined specific protocols for accessing treatment for whiplash associated disorders (WAD I and WAD II) without requiring prior insurer approval to start treatment, providing an overview of the expected course of treatment with a focus on maintaining normal daily activities. 30 Claims Canada
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• 2007: Revised Pre-Approved Framework (PAF) Guideline for Grade I and Grade II Whiplash Associated Disorders was introduced to improve the initial 2003 PAF guideline. At this time, the DAC system was eliminated because assessments were costing more than treatment. • 2010: MIG: Superintendent’s Guideline No. 02/10 was introduced to tighten up the PAF definition of soft tissue injury and expedite treatment of soft tissue injuries This brings us to where things now stand with the revised MIG, November 2011. What is the MIG based on and how does the Functional Restoration Model fit in? The MIG was developed in consultation with insurance industry stakeholders, healthcare professionals and legal representatives drawing extensively on findings identified by the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders. According to the task force, “for both WAD and other neck pain without radicular symptoms, interventions that focused on regaining function and returning to work as soon as possible were rel-
Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders The Task Force was made up of a “group of international clinician-scientists and methodologists to undertake a best-evidence synthesis on neck pain and its associated disorders.” The mandate of the Task Force was “to make recommendations of clinical practice guidelines for the management of neck pain and its associated disorders”¹ and to develop the guidelines based on: • “A systematic and exhaustive review of the literature on neck pain and its associated disorders. • The original research to be conducted by the Task Force on risks associated with the treatment of neck pain and on formal decision analyses of treatment. • The consensus of the top experts in the world in the absence of scientific evidence.” 1.The Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders, http://www.nptf.ualberta.ca/
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atively more effective than interventions that did not have recovery of minor injuries within the MIG cap of $3500. Put another way, a pre-existing injury/illness might exclude such a focus.” 1 Accordingly, the MIG is based on the functional resto- your client from the MIG if there is “compelling evidence” ration model with a structured 12-week program broken that the pre-existing illness or injury could delay healing of into three phases. The focus of the functional restoration the minor injury beyond the expected recovery timeframes. model is to not only provide your client with the knowledge In terms of determining “compelling evidence,” accordto effectively self-manage their condition, but most impor- ing to the MIG, it is the responsibility of the healthcare protantly, to reduce the risk of developing chronic pain. Based vider who is submitting the OCF-18 to provide “compelling on the functional restoration model, treatment should in- evidence” that a pre-existing illness/injury excludes your clude active care—only using passive modalities with the client from the MIG. For example, if your client had any intent of promoting active care—all supported by educa- of the following conditions an Insurer Examination would tion including self-management and copbe necessary to determine whether these ing strategies. Essentially, the goal of the pre-existing conditions are compelling The focus of the MIG is not necessarily to completely reenough to prevent healing within normal solve the injury in 12 weeks but rather to functional restoration timeframes—everything from mediprovide your client with the knowledge, cal conditions like diabetes, stroke, and model is to not only education, and strategies to help them reheart disease to degenerative changes turn to full function within a reasonable provide your client with like disc disease, joint disease or prior amount of time. musculoskeletal injury to psychological the knowledge to impairments or neurological conditions, What is considered a minor effectively self-manage as well as conditions like pregnancy and injury? obesity. their condition, The MIG outlines two criteria that Now what about the Revised MIG that but most importantly, must be met for an injury to be considcame into effect November 2011? ered a minor injury and included in the to reduce As explained by FSCO, “The revised MIG: (1) The injury must fall within the MIG provides direction for billing practhe risk of developing MIG definition of minor injury and (2) tices when a claimant changes health chronic pain. there must be no “compelling evidence” practitioners within the MIG, and diof a pre-existing injury that could prevent rection on the integration of extended recovery of minor injuries within the MIG cap of $3500. health care benefits with the MIG.” Apparently, FSCO had MIG definition of minor injury: The MIG defines a mi- received numerous questions about this situation because, nor injury as “a sprain, strain, whiplash associated disor- as they describe, “The first practitioner often bills for the der, contusion, abrasion, laceration or subluxation and any entire Block amount for treatments leaving the claimant clinically associated sequelea. This term (minor injury) is to with no funds for additional treatment under that Block be interpreted to apply where a person sustains any one or with their new practitioner. To address this issue the MIG more of these injuries.” Accordingly, the following injuries has been amended to provide that where a claimant changes would not be considered a minor injury and would be ex- health practitioners, the first health practitioner may only cluded from the MIG: bill 25% of the amount otherwise payable for a Block for Whiplash Associated Disorder Grade III: This refers to each week or part week in which that health practitioner a neck complaint where there is objective evidence of neu- provided treatment under the Block.” 2 rological involvement within the physical findings and/or radiographic findings. These findings would result in the John Malatesta is a chiropractor with Sibley & Associates injury being excluded from the MIG. Whiplash Associated Disorder Grade IV: This refers to a The role of the OCF-23… neck complaint with an associated fracture or dislocation. As with the Pre-approved Framework, the OCF-23 indiRadiographic evidence of a fracture/dislocation would recates a submission into the MIG with the client entitled sult in this injury being excluded from the MIG. to up to 12 weeks of treatment for approximately $1800, Grade III Ligament or Musculotendonous Tear: This replus an additional $400 for supplementary goods and serfers to a full tear of the ligament or muscle. Radiographic vices. At the end of 12 weeks ($2200), the client is either evidence of tear, with clinical correlation, would exclude discharged from care via an OCF-24, or additional treatthis injury from the MIG. In addition, although Grade III ment and interventions are submitted via an OCF-18, up ligament tears of the spine are rare, it is a very serious injury to an additional $1300. associated with spinal instability typically involving emergency surgery. No pre-existing condition that could delay recovery: to 1. Source: Spine: 15 February 2008 - Volume 33 - Issue 4S - pp S5-S7 be considered a minor injury, in addition to meeting the 2. Source: FSCO Bulletin: Revised Minor Injury Guideline, MIG’s definition of minor injury, there must be no “comOctober 19, 2011 http://www.fsco.gov.on.ca/en/auto/ autobulletins/2011/Pages/a-06-11.aspx pelling evidence” of a pre-existing injury that could prevent 32 Claims Canada
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That’s Entertainment! How to Avoid Film Interruptions BY NEIL GIBSON
Tabloids are flooded with stories of the mishaps that befall certain actors and actresses. For most, it may seem like mere gossip fodder. What is often overlooked, however, is that these celebrities are a main component of a business: the film business. The unavailability of an actor can result in a total interruption of the filming process, while the production company remains financially responsible for crew, equipment, locations, rentals and other expenses during this downtime. Damaging or preventing access to a set location can also lead to interruption or postponement of the scheduled filming at an additional expense to the production company. Entertainment production insurance packages, under certain conditions, provide protection against the extra expenses stemming from an interruption, postponement or cancellation caused by these types of situations. However, most production companies are unaware of the specifics of the policy and how it will respond to a possible loss. 34 Claims Canada
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Although most incidents are not foreseeable, there can be a smoother process to handle claims. Understanding potential problems, reviewing the policy, developing a plan before a problem occurs, dealing with the claims process and resuming production are all key steps in this process.
Review policy before production begins The first step in any production interruption plan should involve reviewing and understanding the policy before the start of shooting. While policy wordings may differ depending on the underwriter, the general and special conditions or definitions of the standard production policy include the following: • Special rights and duties: Under the terms of production coverage forms, the production company is required to ensure that all contract terms for performance services, facilities, property, equipment and supplies last sufficiently longer than the estimated time of completion. Before commencing filming, production companies should ensure they have reasonable flexibility to al-
low for possible interruption. Recovery may be limited if extra expenses incurred are increased due to a failure to meet contract term requirements of the policy. • Notice of loss: Companies must contact the insurer immediately to report a loss. Given the transient nature of the production industry, delays in reporting can also mean that payment will be delayed or even denied due to the insurer’s potential inability to properly investigate and gather sufficient information. • Due diligence: Production companies must use reasonable care and do all things reasonably practicable to avoid, minimize or diminish at their own expense any loss or circumstance that could result in a claim. The rule of thumb for this condition is for production companies to act as if they were paying for the extra expenses out of their own budget. • Access to records and examination under oath: Companies should provide requested documentation in support of the loss amounts claimed and give adjusters immediate access to anyone who must be interviewed during the course of the investigation. www.claimscanada.ca
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• Subrogation: Companies should also assist the adjuster in providing the required documents or other supporting evidence to assert recovery rights and ultimately minimize the loss.
Assess extra expense claims accurately When an extra expense claim occurs, a significant number of variables can affect the end result. For example, if a cast member suffers a minor injury or ailment, there may be options to shoot around the individual until he or she is able to return, which in some cases prevents a loss. The most important initial step by the production company is accurately assessing the situation at hand, as well as available options. An experienced adjuster can assist in the evaluation and possibly identify alternatives of which the production may be unaware.
regarding general policy conditions or scope of the los. It should be understood that the policyholder does have redress under the policy through the appraisal condition, although there is a time limit on lawsuits. However, such instances are rare, as most adjusters, insurers and the production policyholder can usually come to an agreement regarding items under dispute.
Insurers are committed to paying what is reasonably owed under a policy. With the advocacy of the broker in any dispute, most issues can be resolved without legal action, as all parties work to find common ground for resolution. Neil Gibson is a senior general adjuster with Crawford & Company GTS in Canada.
Provide appropriate documentation Extensive documentation is required during the claims process, and while it is impossible to prepare all documents before an event, organizing what is available and preparing a checklist will expedite the process. While each loss is different, production companies may expect to be asked to provide the following documents, among other things: • Incident report detailing facts of loss, along with independent supporting documentation • Contact information for crew • All call sheets and daily production reports • A separate accounting ledger set up after the incident to isolate and capture all insurance costs and gather all supporting documents to substantiate these costs (time cards, payroll reports, invoices, contracts, etc.). Communicate early and often Early and continued communication, along with the timely submission of the required information, usually will result in an expeditious and satisfactory resolution for all parties involved. Occasionally, a dispute will arise www.claimscanada.ca
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Collision
Investigation
Science on the Road BY GREG SYPHER
In the beginning... The first recorded motor vehicle related fatality occurred in 1869 in County Offaly, Ireland, when Mrs. Mary Ward fell from a steam powered carriage and was crushed under one of its heavy iron wheels (1). The resulting coroner’s inquest was far from a scientific examination. The jury concluded from eye-witness testimony that Mrs. Ward, lacking something to grasp, had fallen from the carriage while it was travelling at an impressive speed of 3.5 to 4 mph (5.6 to 6.4 km/h). 173 years later Motor vehicle technology has come a long way since the time of Mrs. Ward’s tragic end. So have the techniques and equipment used by today’s professional collision investigators and reconstructionists. Investigators are often able to use the available evidence to determine what occurred even when there are no independent witnesses, or when witnesses give conflicting versions of the events. Evidence The first and primary role of a collision investigator is gathering evidence – the pieces to the ‘puzzle.’ The more pieces of the puzzle that can be found and fit together, the clearer the picture of the crash becomes. There is very little a collision investigator, or a reconstructionist, can reasonably conclude without enough, reliable evidence. Being Proactive The best time to collect short-lived evidence is at the ‘live’ collision scene, when it is the most plentiful and the least contaminated. One of the most common problems facing collision investigators and reconstructionists is that they are often hired weeks, months and even several years after the crash they are hired to investigate. This often means that important live scene data, photos and vehicle damage measurements is collected by others – if it is collected at all. It is difficult, if not impossible, to give meaningful comments 36 Claims Canada
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and opinion about a crash when there are no longer any vehicles available to inspect, the crash site has been repaved and the witnesses’ memories are fogged by time – or by pending legal action. Collision investigators must be able to prioritize and work quickly to properly document a live scene. Inclement weather can rapidly put a foot of snow over critical evidence, or wash it away with heavy rain. The actions of emergency services, efforts to recover damaged vehicles and even bystanders can dramatically reduce what evidence is available at a scene. Fire fighters often cut up vehicles to extricate occupants, sweep away vehicle key debris evidence, hose down vehicle fluid trails and run over tire tracks – causing physical evidence to be lost or destroyed. Short-lived evidence, such as tire marks, debris and fluid trails, can also disappear with the movement of traffic. Failure to mark and record the final resting positions of the vehicles and bodies can severely hamper any future efforts to reconstruct the crash. Sometimes, it is not possible or practical to examine a site while the vehicles are still there; however, the sooner this work can be completed, the better. In the days after a crash, maintenance crews can replace crash damaged utility poles and broken signs, patch deep roadway gouges, re-grade shoulders. Affected homeowners can fix damage to buildings, fences, yard features, sod, or remove damage and debris.
Black Boxes Given the inherent limitations of witness testimony, investigators have used science and technology to find other means to establish and confirm the events of a collision. One of the most important recent developments for collision investigation and reconstruction has been the wide scale use of onboard data recorders in motor vehicles – from passenger cars to heavy commercial vehicles. Event Data Recorders (EDRs), sometimes referred to as ‘black boxes,’ are installed in most late model passenger cars, light trucks and/or SUVs equipped with airbag systems. EDRs typically capture data that is used to decide www.claimscanada.ca
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whether and how to deploy airbags during a collision. It can also capture data during the crash event. EDR data can simplify the process of determining what happened during a collision and who was at fault. This is admissible as evidence in court. EDR data can often be analyzed to help provide details about the crash and the occupant restraint systems, such as: • driver actions just before a crash (reasonable... or not ); • pre-impact vehicle speed; • measures of crash severity; • the status of the seatbelt restraints (buckled… or not); and • the functioning of the airbag system. EDR data can often be read by investigators using a commercially available download tool. What data gets captured is greatly dependant on the vehicle make, model and year. Not all cars have EDR data and they are not required by law, but the number is growing significantly. Pending regulations in the US regarding EDRs will likely result in even more data becoming available for download in the future.
Total Station A total station is a surveying instrument capable of electronically measuring and recording angles (horizontal and vertical) and distance to selected points. They are ideal for quickly and efficiently recording the geometry of the roadway and the relative location of vehicles, evidence and other objects of interest within a collision scene. Being stored digitally, the scene can then be generated as a scene diagram or a 3-D model using a computer. Total stations can also be used for taking precision measurements of damaged vehicles. These measurements can be used to create 3D models of the involved vehicle that can be stored. These 3-D models are then available for analysis sometimes long after the actual vehicle is no longer available for measurement. Photogrammetry Photographs are very often the only source of critical evidence. A technique called ‘photogrammetry’ can www.claimscanada.ca
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sometimes be used to obtain required measurements from photos taken at a crash scene, or of the involved vehicles. This technique is especially valuable if no one thought to, or was able to, take scene measurements. The fundamental principle used by photogrammetry is triangulation. By taking photographs from at least two different locations, so-called ‘lines of sight’ can be developed from each camera to points in a collision scene. These lines of sight can then be mathematically intersected. With sufficient data, photogrammetry can be used to create 3-D coordinates for a crash scene.
Animation For particularly complicated files, it can be challenging to translate findings from ‘techno-garble’ into something that most people can understand. Computer animation is often useful in this regard. A multitude of vehicle types and scenarios can be animated. The relative positions of all the involved vehicles can be shown for the critical seconds leading up to and after a crash. Animation is also useful for showing various collision scenarios, typically when there is conflicting testimony or when exploring ‘what if’ scenarios. Why hire a collision investigator or reconstructionist? Police reports often fail to answer critical questions about a crash from the perspective of civil litigation. The focus of a police investigation is often limited to a basic determination of ‘who’, ‘what’, ‘when’ and ‘where’, along with a cursory attribution of fault. The ‘why’ and ‘how’ of the crash is often left unexplored. These questions often require private collision investigators or reconstructionists to answer. Greg Sypher is the president of Road Safety Investigations Inc. 1. “Mary Ward 1827-1869”, Offaly Historical & Archaeological Society, Bury Quay, Tullamore, Co. Offaly, Ireland, http://web. archive.org/web/20060105215309/http://www.offalyhistory. com/content/reading_resources/famous_people/ward_mary.htm April/May 2012
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The Independent Expert Examination
Quality Benchmarks for Optimum Claims Management BY DAVID DOS SANTOS
Good claims management in personal injury cases often begins with a high quality, expert independent examination. To ensure balance with the needs of the insured person and claims closure, it is critical to obtain clarity on the issues in each specific case. This should include issues pertaining to the insured person’s injuries and impairments, outstanding questions around medical/rehabilitation and disability issues and sound recommendations to assist the claimant in reaching their pre-accident state or maximum improvement. The quality of the independent expert examination and the impartiality of the expert assessor will help mitigate the potential for further costly dispute resolution. Once, it was a prevailing presumption that an independent examiner merely had to be a medical/health care practitioner with an active licence to practice. The idea was that this would suffice to meet the needs of the insurer and their clients. This is no longer the case. The performance of an independent expert examination is becoming more recognized as a specialty unto itself, with requirements of expert examiners to have specialized knowledge of the rules of civil procedures, legal and arbitration decisions, legal principles such 38 Claims Canada
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as “thin skull” and “crumbling skull” theories, certification in impairment rating, and additional training within their fields of practice. Referral sources, courts and arbitrators are also increasingly recognizing the importance of independent expert evaluators with an active patient base. The quality of the independent expert examination begins with the
Evaluators should understand they also have a larger role in obtaining a clearer understanding on causality issues, and how pre-morbid factors may or may not contribute to the clinical presentation, or delay the recovery process. information provided to the independent evaluator from the referral source. This establishes a baseline for the information to be utilized. This baseline can be expanded once the evaluation occurs through the history taking and information obtained directly from the insured person. The independent expert evaluator should be adequately trained to understand the
importance of the history taking in the independent evaluation process, This differs from a typical history directed strictly at diagnosis and treatment goals. Evaluators should understand they also have a larger role in obtaining a clearer understanding on causality issues, and how pre-morbid factors may or may not contribute to the clinical presentation, or delay the recovery process. Therefore, the history taking will typically begin with open ended questions, and graduate to more specific and directed queries. Once appropriate written consent has been obtained from the insured, the evaluation can proceed. It can be broadly divided into observation and clinical examination, with the clinical examination further divided into the history taking and physical examination. Cumulatively, the information garnered will assist the independent evaluator in fulfilling their mandate – such as impairment rating, determination of causality or contributing pre-existing factors, need for and/or specifics of treatment, or residual ability to work. Common aspects of observation will include general appearance, first impression, and thought and behaviour patterns demonstrated during the evaluation process. The history taking will seek information about general background issues, pre-existing health status, history of present illness/complaints, diwww.claimscanada.ca
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agnostic investigation results, response to interventions, pre-morbid conditions/past medical history, intervening events, chief complaints, medications, family health history, systems review, psychosocial history, and functional inquiry. The history taking far exceeds typical interview questions for clinical purposes, as the mandate of the assessment will also include legal and causal issues. History taking is critical in the subsequent formulation of an accounting of the health claim. It will provide details regarding whether the person’s pre-existing health status is a contributing factor to the accident and/ or personal injury. History taking can also determine whether the accident has materially contributed to the injury, whether the person has participated in medical and rehabilitation interventions to minimize their loss. Qualified assessors should also be able to know if there is a need for causal apportionment with other injurious events. This will set the stage for the physical examination, which will help to validate the information obtained in the history taking or direct the evaluator to a different conclusion. Required components of the physical examination include inspection/posture, ranges of motion, neurological examination (including mental status screen and comment on mood and affect, language and speech), joint stability and laxity, and palpation findings. Comments on identified barriers to recovery should also be provided. The narrative report from the independent examination is much more than a recitation of clinical information and recommendations. It is critical to provide a synthesis of the data and information, and an explanation of the thought process which led to the conclusions. This is key to the defensibility of the report and assessment. The narrative report is central to the purpose of the independent evaluation, and the relevant elements of the claim. The information synthesis and reasoning of the expert evaluator is also important to minimize bias. Incomplete and/or inappropriwww.claimscanada.ca
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ate interpretation of data can lead to resulting inaccurate conclusions. Notwithstanding the best, or worst, intentions of some evaluators, bias occurs when they omit, distort, or preferentially use some data to support their conclusions. Perceived bias can be minimized by using a health care professional with similar educational background as those providing care to an insured person. The phenomenon of the “hired gun” evaluator will not serve to achieve any of the benchmarks outlined above. The quality of the assessment will be enhanced by employing a professional peer who possesses a higher level of training and experience. While a report will rarely be perceived as neutral by all parties, the process of choosing the expert evaluator can help ensure the best evaluation possible. The expert evaluator should have the requisite skill set to provide a quality assessment and report. The adherence to professional standards and guidelines will also assist in ensuring greater accountability. Most regulatory colleges for health care practitioners do not have adequate quality standards for this purpose. While the independent examination process may be perceived as naturally adversarial, the quality of the assessment and reportmust be able to stand on its own merits. Sound, thorough and complete reasoming should allow the report to be defensible in terms of factual arguments and conclusions. This will serve the ultimate purpose of providing clarity surrounding claims issues. The expertise required to perform a high quality independent examination is dependent on specialized training received by the expert evaluator. This training exceeds the skill set of most health care providers, in part because greater administrative and legal issues must be taken into account. Dr. David Dos Santos is the President of the Canadian Society of Chiropractic Evaluators. He is an independent health consultant and is affiliated with the Spine Clinic at Trillium Health Centre in Toronto, Ontario, a hospital-based inter-disciplinary facility.
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Controlling the Cost of Mental Health Claims
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Successful return to work planning is key BY KAREN SOULLIERE
One of the most unpredictable and uncontrollable risks encountered today by insurers and employers is human risk. The cost of absences that are work-related or non-work related can be reduced with proactive claims management and a well-coordinated return to work plan. This article focuses on the best practices that can be applied to a return to work process designed for absences stemming from mental illness. The topic of mental illness in the workplace has become increasingly important to businesses. Mental health disorders in the workplace cost Canadian companies nearly 14% of their net annual profits, up to $16 billion annually (Health Canada, 2002). Furthermore, calculations that include indirect costs suggest that the Canadian economy spends more than $30 billion annually on mental health and addiction-related problems (Scientific Advisory Committee to the Global Business and Economic Roundtable on Addiction and Mental Health 2002). A study called “Building Mentally Healthy Workplaces: Perspectives of Canadian Workers and Front-Line Managers” was completed by the Conference Board of Canada and released at the Workplace Mental Health 2011 conference in Toronto, June 20, 2011. The study pinpointed the rising cost of addressing mental health concerns in the workplace. It showed that from 40 Claims Canada
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2009 to 2010, 67% of long-term disability claims and 78% of short-term claims were related to mental health issues. The general public often associates mental illness with a violent disposition. However, statistics provided by the Canadian Mental Health Association indicate that a person with mental illness is more likely to be a victim of violence rather than the cause of it. Due to the negative attitudes, social stigmas and discrimination that are still common throughout society, a person may postpone treatment or forgo treatment completely. Although mental illness is often transient and short-term in nature, this negativity tends to linger for a long period of time. According to the Canadian Human Rights Commission’s Policy and Procedures on the Accommodation of Mental Illness, it is these stereotypes and misconceptions that may affect a person long after the symptoms of mental illness have dissipated. In my experience, assisting a person with his or her return to work after an absence due to a mental illness can be more challenging than assisting a person’s return to work after he or she has suffered from a physical illness. This is primarily due to the stigma surrounding mental illness. Employers and their staffs may have unfounded fears resulting from a lack of education, exposure and/or awareness about mental illness. Based on the different return to work programs and structures that I
have been involved with, it appears to be beneficial to have one person responsible for overseeing the coordination of the entire return to work plan. This person should have an in-depth understanding of mental health issues and the confidence to believe that return to work efforts will be successful. As the main driver of the return to work process, the coordinator needs to believe in the plan proposed for the claimant; otherwise, there is a tendency to extend less effort than needed to make the plan successful. This central coordinator facilitates the flow of necessary information amongst all the stakeholders in the return to work process. For the purpose of this article, we will call this person the “consultant”. When referring to the person who is returning to work, we will call him or her the “claimant.” Under typical circumstances, the consultant receives pertinent medical information from the insurer to review before meeting with the claimant. This would include reports from a psychologist, psychiatrist or treating physician. The consultant conducts an in-person interview with the claimant, preferably at his or her home, where additional information about the claimant is obtained, as a visual overview of the living conditions can potentially reflect the claimant’s functioning level. A detailed interview is then conducted to obtain information regarding the claimant’s daily routine. Aspects such as current medications (and side effects), current treatment, www.claimscanada.ca
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as well as the claimant’s personal opinion regarding his or her ability to return to work are reviewed at this point. Perceived barriers to recovery and the return to work process, and the claimant’s thoughts on how these barriers could be eliminated, are also discussed. The claimant knows what accommodations he or she needs in order to work productively more so than anyone else. The claimant must be able to perform the tasks of his or her job at a level where meaningful work is possible, inclusive of appropriate accommodations. The work itself and the employee’s presence in the workplace should not pose a risk to the employee and/or co-workers (Canadian Human Rights Commission Policy and Procedures on the Accommodation of Mental Illness, October 2008). The consultant should weigh the claimant’s self-assessment against those made by the treating physician and other stakeholders to determine its appropriateness. On occasion, a claimant may return to work when still experiencing significant symptoms of mental illness. These situations tend to occur when a claimant is running out of sick time or is worried about job security. Consequently, the claimant tells the treating physician that he or she is able to return to work even though recovery might not have progressed to a point for appropriate functioning on the job. Furthermore, the physician might approve the claimant’s return to work without having full knowledge of all work responsibilities. If the claimant returns to work and is unable to fulfill the job expectations, there is a high probability that the return to work process will fail. With the claimant’s consent, the consultant can supply treatment providers with the claimant’s job description to fully inform them of the job duties, as well as obtain input into the development of the return to work plan. The consultant is able to arrange a meeting with both the employer and the claimant to discuss and confirm the return to work plan. A return to work plan should include the following: • A clear objective or goal (e.g. a return to work date within a particular position) 42 Claims Canada
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• A complete and detailed job description • Hours of work associated with the job that the claimant is returning to, including the potential for graduated return to work hours if required • Job restrictions • Reporting lines (i.e. who the claimant reports to and when) • Approved time away from work to attend medical appointments
With the claimant’s consent, the consultant can supply treatment providers with the claimant’s job description to fully inform them of the job duties, as well as obtain input into the development of the return to work plan. • Evaluation dates for progress reports of the return to work plan • Lists of any required accommodations • Signed copies of the return to work plan by the stakeholders confirming their agreement and support Employers are responsible for providing accommodation to the point of “undue hardship”. There is no list of required accommodations to match a specific illness since each situation is individualized. Ontario has accessibility legislation for persons with disabili-
ties that addresses the duty to provide individual accommodations (AODA, 2005). Accommodations can include the following: • Modified or reduced work hours, graduated return to work hours and increased frequency of breaks • Reasonable time off to attend counseling sessions or medical appointments • Task variation to support stamina • Job re-design (e.g. exchanging tasks with other employees that maintain work balance and capitalize on the strengths of each worker) • Changes in supervision (e.g. brief weekly meetings with the supervisor may help deal with issues before they become serious and well-written instructions may help an employee focus on tasks more effectively than verbal instructions) • Extra time to learn tasks if a person has difficulty with concentration • The ability to perform some or all work from home • Job coaching (i.e. assistance on the job) • Flexible scheduling with respect to the start and/or end of normal working hours to accommodate effects of medications or appointments • Changes to the location of the workspace to reduce distractions and improve concentration • Use of technology (e.g. electronic organizers to keep track of items that need to be completed and associated deadlines or recording devices that track information discussed in a meeting) Accommodations for mental health problems are often inexpensive to implement and may be temporary as a person continues to recover. By engaging a consultant who has return to work experience specific to mental health issues and who is able to be creative in the use of appropriate accommodations, the cost of mental health claims can be significantly reduced and the quality of a claimant’s life can be greatly improved. Karen Soulliere is the business development manager of healthcare with Crawford & Company (Canada) Inc. www.claimscanada.ca
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National Standing Committees 2011-2012 ADVISORY Delores Thorbourne, BA, FCIP, CRM Granite Claims Solutions Suite 103 Greystone VII 4208 - 97 Street Edmonton, AB T6E 5Z9 Phone: (780) 442-3077 Fax: (780) 466-0325 E-mail: delores.thorbourne@graniteclaims.com John D. Seyler, AIIC ProFormance Group 2 Robert Speck Parkway, Suite 700 Mississauga, ON L4Z 1H8 Phone: (905) 270-1723 Fax: (905) 272-7486 E-mail: jseyler@prospecialty.ca Mary Charman, CIP Crawford & Company (Canada) Inc. 1 – 120 Mulock Drive Newmarket, ON L3Y 7C5 Phone: (905) 898-0008 Fax: (905) 898-1705 E-mail: Mary.Charman@crawco.ca James B. Eso, BA, CIP Crawford & Company (Canada) Inc. 539 Riverbend Drive Kitchener, ON N2K 3S3 Phone: (519) 578-5540 Fax: (519) 578-2868 E-mail: Jim.Eso@crawco.ca John Jones, BA Granite Claims Solutions Suite 300, 5915 Airport Road Mississauga, ON L4V 1T1 Phone: (905) 671-3164 Fax: (905) 671-1889 E-mail: john.jones@graniteclaims.com CIAA NATIONAL INSURANCE INDUSTRY ADVISORY BOARD Patti M. Kernaghan, FCIP, CRM Kernaghan Adjusters Limited 300 - 1575 West Georgia Street Vancouver, BC V6G 2V3 Phone: 1-800-387-5677 Fax: 1-800-387-5644 E-mail: pkernaghan@kernaghan.com Greg G. Merrithew, CIP, FIFAA Arctic West Adjusters Ltd. 401 – 5204 – 50 Ave. Yellowknife, NT X1A 1E2 Phone: (867) 920-2212 Fax: (867) 873-2244 E-mail: gregm@arcticwest.ca Delores Thorbourne, BA, FCIP McLarens Canada Suite 103 Greystone VII 4208 - 97 Street Edmonton, AB T6E 5Z9 Phone: (780) 442-3077 Fax: (780) 466-0325 E-mail: delores.thorbourne@ graniteclaims.com Mary Charman, CIP Crawford & Company (Canada) Inc. 1 – 120 Mulock Drive Newmarket, ON L3Y 7C5 Phone: (905) 898-0008 Fax: (905) 898-1705 E-mail: Mary.Charman@crawco.ca Patricia M. Battle Canadian Independent Adjusters’ Association/L’Association Canadienne des Experts Indépendants 5401 Eglinton Ave. West, Suite 100 Etobicoke, ON M9C 5K6 Phone: (416) 621-6222 Toll Free: 1-877-255-5589 Fax: (416) 621-7776 E-mail: pbattle@ciaa-adjusters.ca
Jo-Ann Eccleston, CIP Aviva Canada Inc. 2206 Eglinton Ave. East Toronto, ON M1L 4S8 Phone: (416) 689-3328 Fax: 1-866-805-8585 E-mail: jo-ann_eccleston@ avivacanada.com Bob Grouchy, BA, FCIP, CRM Allianz Global 1600 – 130 Adelaide Street West Toronto, ON M5H 3P5 Phone: (416) 915-4247 Fax: (416) 849-4555 E-mail: bob.grouchy@agr.allianz.ca Carol Jardine, FCIP, CRM TD Insurance 2161 Yonge Street, 4th Floor Toronto, ON M4S 3A6 Phone: (416) 486-2507 Fax: (416) 545-6022 E-mail: Carol.Jardine@tdinsurance.com
DISCIPLINE Mary Charman, CIP Crawford & Company (Canada) Inc. 1 – 120 Mulock Drive Newmarket, ON L3Y 7C5 Phone: (905) 898-0008 Fax: (905) 898-1705 E-mail: Mary.Charman@crawco.ca EDITORIAL Fred Silvestri, BA, CIP Sedgwick CMS Canada Inc. 21 Four Seasons Place, Suite 100 Toronto, ON M9B 6J8 Phone: (416) 695-5100 Fax: (416) 695-5120 E-mail: fred.silvestri@sedgwickcms.ca
Mark Stewardson, FCIP Royal & SunAlliance 2225 Erin Mills Parkway, Suite 1000 Mississauga, ON L5K 2S9 Phone: (905) 403-2333 Fax: (905) 403-2326 E-mail: Mark.Stewardson@rsagroup.ca
John M. Sharoun, FIIC, CFE, FCIAA Crawford & Company (Canada) Inc. 300 – 123 Front Street West Toronto, ON M5J 2M2 Phone: (416) 867-1188 Fax: (416) 867-1925 E-mail: John.Sharoun@crawco.ca
Mark Weir Intact Financial Corporation 700 University Avenue, 13th Floor Toronto, ON M5G 0A1 Phone: (416) 341-1464 Fax: (416) 217-0562 E-mail: mark.weir@intact.net
Mary Charman, CIP Crawford & Company (Canada) Inc. 1 – 120 Mulock Drive Newmarket, ON L3Y 7C5 Phone: (905) 898-0008 Fax: (905) 898-1705 E-mail: Mary.Charman@crawco.ca
Peggy Wong, CIP The Economical Insurance Group 111 Westmount Road South Waterloo, ON N2J 4S4 Phone: (519) 570-8500 Fax: (519) 570-8690 E-mail: Peggy.Wong@teig.com
EDUCATION David Porter, LL.B., FCIP, CRM Advance Claims Service Ltd. 206 - 2323 Boundary Road Vancouver, BC V5M 4V8 Phone: (604) 642-0660 Fax: 1-888-452-5246 E-mail: davidp@advanceclaims.com
CAREER RECRUITMENT PLANNING Richard Swierczynski, BA, CIP AZ Claims Services Inc. 1500 Upper Middle Rd., Unit #3 P.O. Box 76041 Oakville, ON L6M 3G3 Phone: (905) 825-0027 Fax: (905) 825-5543 E-mail: Richard@azclaims.ca COMMUNICATIONS Teresa Mitchell, FCIP, CRM, FCLA, FCIAA, FIFAA Crawford & Company (Canada) Inc. 14 – 431 Bayview Drive Barrie, ON L4N 8Y2 Phone: (705) 728-5597 Fax: (705) 728-2167 E-mail: Teresa.Mitchell@crawco.ca CONSTITUTION & RULES John Jones, BA Granite Claims Solutions Suite 300, 5915 Airport Road Mississauga, ON L4V 1T1 Phone: (905) 671-3164 Fax: (905) 671-1889 E-mail: john.jones@graniteclaims.com CONVENTION Karen Kuronen, CIP, Dip. Mech. Eng. Arctic West Adjusters Ltd. 401 – 5204 – 50 Ave. Yellowknife, NT X1A 1E2 Phone: (867) 920-2212 Fax: (867) 873-2244 E-mail: kkuronen@arcticwest.ca
Dennis N. Schembri, CIP, CFEI Granite Global Solutions 133 King Street East, 3rd Floor Toronto, ON M5C 1G6 Phone: (647) 789-2438 Fax: (647) 789-2449 E-mail: dennis.schembri@graniteglobalsolutions.com
DESIGNATION Paul W. Greening, CLA, FCIAA Greening Aviation Claims Inc. 26C Palliser Park, Box 190 Riverhurst, SK S0H 3P0 Phone: (306) 353-2000 Fax: (306) 353-2200 E-mail: pgreening@sasktel.net
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Robert V. Pearson, CLA, FCIAA AAL Alberta Ltd. 600 – 2424 4th Street S.W. Calgary, AB T2S 2T4 Phone: (403) 452-2195 Fax: (403) 452-3568 E-mail: bob.pearson@aaladjusters.com
Justin J. MacGregor Martin Merry & Reid Limited 3 Church Street, Suite 404 Toronto, ON M5E 1M2 Phone: (416) 366-3333 Fax: (416) 366-0730 E-mail: jmacgregor@mmr.ca
John M. Sharoun, FIIC, CFE, FCIAA Crawford & Company (Canada) Inc. 300 – 123 Front Street West Toronto, ON M5J 2M2 Phone: (416) 867-1188 Fax: (416) 867-1925 E-mail: John.Sharoun@crawco.ca
www.claimscanada.ca
E. Brian Gough, FCIP, CLA, FCIAA Marsh Adjustment Bureau Limited 1550 Bedford Highway, Suite 711 Bedford, NS B4A 1E6 Phone: (902) 469-3537 Fax: (902) 469-2396 E-mail: ebgough@marshadj.com
EMERGENCY MEASURES Richard Van Horne Action Investigations Inc. 2 Catelina Court Dartmouth, NS B2X 3G9 Phone: (902) 462- 1222 Fax: (902) 462-3688 E-mail: richardvanhorne@actioninvestigations.ca FINANCE Randy P. LaBrash, CIP, CFE, CFEI Crawford & Company (Canada) Inc. 300 – 191 Lombard Avenue Winnipeg, MB R3B 0X1 Phone: (204) 947-2340 Fax: (204) 943-9168 E-mail: Randy.Labrash@crawco.ca Greg G. Merrithew, CIP, FIFAA Arctic West Adjusters Ltd. 401 – 5204 – 50 Ave. Yellowknife, NT X1A 1E2 Phone: (867) 920-2212 Fax: (867) 873-2244 E-mail: gregm@arcticwest.ca Mary Charman, CIP Crawford & Company (Canada) Inc. 1 – 120 Mulock Drive Newmarket, ON L3Y 7C5 Phone: (905) 898-0008 Fax: (905) 898-1705 E-mail: Mary.Charman@crawco.ca IBC: LIAISON, LEGISLATIVE & FORMS Paul Hancock, B.Sc., CIP Crawford & Company (Canada) Inc. 300 – 123 Front Street West Toronto, ON M5J 2M2 Phone: (416) 867-1188 Fax: (416) 867-1925 E-mail: Paul.Hancock@crawco.ca
LICENSING J. Miles O. Barber, B.Comm. (Hons.), FCIP, CRM Network Adjusters Ltd. 67 Folkestone Blvd. Winnipeg, MB R3P 0B4 Phone: (204) 897-5793 Fax: (204) 897-5797 E-mail: mbarber@mts.net MEMBERSHIP & QUALIFICATIONS Santo Carbone, CRM, FCIAA Crawford & Company (Canada) Inc. 300-123 Front Street West Toronto, ON M5J 2M2 Phone: (416) 364-6341 Fax: (416) 435-0546 E-mail: Santo.Carbone@crawco.ca NOMINATING Mary Charman, CIP Crawford & Company (Canada) Inc. 1 – 120 Mulock Drive Newmarket, ON L3Y 7C5 Phone: (905) 898-0008 Fax: (905) 898-1705 E-mail: Mary.Charman@crawco.ca Greg G. Merrithew, CIP, FIFAA Arctic West Adjusters Ltd. 401 – 5204 – 50 Ave. Yellowknife, NT X1A 1E2 Phone: (867) 920-2212 Fax: (867) 873-2244 E-mail: gregm@arcticwest.ca James B. Eso, BA, CIP Crawford & Company (Canada) Inc. 539 Riverbend Drive Kitchener, ON N2K 3S3 Phone: (519) 578-5540 Fax: (519) 578-2868 E-mail: Jim.Eso@crawco.ca PRIVACY James B. Eso, BA, CIP Crawford & Company (Canada) Inc. 539 Riverbend Drive Kitchener, ON N2K 3S3 Phone: (519) 578-5540 Fax: (519) 578-2868 E-mail: Jim.Eso@crawco.ca Keith P. Edwards, FCILA, CLA, FUEDI-ELAE CIAA Honorary Life Member c/o CIAA National Office 5401 Eglinton Ave. W., Suite 100 Etobicoke, ON M9C 5K6 Phone: (416) 621-6222 Fax: (416) 621-7776 E-mail: info@ciaa-adjusters.ca
CIAA REGIONAL PRESIDENTS 2011 – 2012 NEWFOUNDLAND & LABRADOR Marcel Pitcher, CIP, CRM Crawford & Company (Canada) Inc. 300 – 44 Torbay Road St. John’s, NL AlA 2G4 Phone: (709) 753-6351 Fax: (709) 753-6129 E-mail: Marcel.Pitcher@crawco.ca NOVA SCOTIA E. Grant King, BA, B.Ed., CIP Crawford & Company (Canada) Inc. 120 – 237 Brownlow Avenue Dartmouth, NS B3B 2C7 Phone: (902) 468-7787 Fax: (902) 468-5822 E-mail: Grant.King@crawco.ca NEW BRUNSWICK & PRINCE EDWARD ISLAND Luc Aucoin, BBA, FCIP Plant Hope Adjusters Ltd. 85 Englehart Street Dieppe, NB E1A 8K2 Phone: (506) 853-8500 Fax: (506) 853-8501 E-mail: laucoin@planthope.com QUEBEC/AESIQ Elaine Savard, LL.B., FPAA Les Expertises Richard Racette 1090, rue Principale Sainte-Agathe des Monts, PQ J8C 1L6 Phone: (819) 326-0012 Fax: (819) 326-2023 E-mail: elaine.savard@exprr.ca ONTARIO Teresa Mitchell, FCIP, CRM, FCLA, FCIAA, FIFAA Crawford & Company (Canada) Inc. 14 – 431 Bayview Drive Barrie, ON L4N 8Y2 Phone: (705) 728-5597 Fax: (705) 728-2167 E-mail: Teresa.Mitchell@crawco.ca MANITOBA Timothy W. Bromley J.P. Hamilton Adjusters Ltd. 125 Enfield Crescent Winnipeg, MB R2H 1A8 Phone: (204) 944-1057 Fax: (204) 944-1606 E-mail: tbromley@mts.net SASKATCHEWAN Lee Dixon Crawford & Company (Canada) Inc. 210 – 227 Primrose Drive Saskatoon, SK S7K 5E4 Phone: (306) 931-1999 Fax: (306) 931-2212 E-mail: Lee.Dixon@crawco.ca WESTERN Bea Boutcher, CIP Horizon Adjusters Ltd. #207, 9814 – 97 Street Grande Prairie, AB T8V 8H5 Phone: (780) 402-8383 Fax: (780) 402-7888 E-mail: bea.boutcher@horizonadjusters.com PACIFIC David Porter, LL.B., FCIP, CRM Granite Claims Solutions 206 - 2323 Boundary Road Vancouver, BC V5M 4V8 Phone: (604) 642-0660 Fax: 1-888-452-5246 E-mail: david.porter@graniteclaims.com
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EF
• education forum
A SERIES OF ARTICLES PROVIDED BY THE INSURANCE INSTITUTE OF CANADA
Calling Up Cancer! Assessing the Risks of Cell Phone Use
T
here are now millions of cell phone users around the world, and almost as many rumours about the potential health risks the phones might pose – and the potential for associated liability issues. In this article, we look at some key scientific and legal findings on the subject. In May 2011, the World Health Organization’s International Agency for Research (IARC) announced that it had classified radiofrequency electromagnetic fields as “possibly carcinogenic to humans.” Given that there are estimated to be about 21 million cell phone users in Canada (and about 4.3 billion worldwide), some insurers are concerned about whether exposure to electromagnetic fields (EMF) emitted by cell phones might be the next asbestos-type liability to hit the industry. But the evidence so far remains uncertain.
IARC findings National health agencies often use the conclusions of the WHO’s IARC as support for their actions to prevent or limit exposure to potential carcinogens, so the agency’s conclusions are significant. The IARC is a frequently quoted source on the possible connection between cell phone use and brain cancer risk, and it has issued various pronouncements on the topic. Two of the most prominent have been the Interphone Study and the Monograph Working Group’s assessment. 44 Claims Canada
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The Interphone Study The Interphone Study was initiated in 2000 and reported on in May 2010. It was an interview-based, case-control study involving 13 international study centers, including one in Canada. The study focused on tumours in tissues that absorb radiofrequency energy emitted by cell phones. Its objective was to determine whether cell phone use increases the risk of brain tumours and tumours of the acoustic nerve and the parotid gland (the largest of the salivary glands). The results of the study suggested that regular cell phone users are actually at less risk of developing brain tumours (glioma or meningioma). In discussing this result, commentators noted methodological limitations of the study, as well as the fact that participants were self-reporting. It should also be noted that, in this early study, “regular use” was defined as an average
of at least one call per week for more than six months – a usage level that would be considered low today. Perhaps the most widely shared conclusion drawn from the study was that there should be further investigation into the possible effects of longterm heavy use of cell phones.
The Monograph Working Group On May 31, 2011, IARC’s Monograph Working Group announced that it was classifying radiofrequency electromagnetic fields associated with wireless phone use as “possibly carcinogenic to humans (Group 2B)” based on an increased risk for glioma, which is a malignant type of brain cancer. On the surface, the announcement appears to contradict the conclusion of the Interphone Study. However, it’s important to understand the various categories into which carcinogenic
Further Reading The following sites provide further information on some of the issues mentioned in this article: • International Agency for Research www.iarc.fr/en/media-centre/pr • Federal Communications Commission (US) http://transition.fcc.gov/oet/rfsafety/ rf-faqs.html#Q2 • Food and Drug Administration (US) www.fda.gov/Radiation-EmittingProducts/ RadiationEmittingProductsandProcedures/HomeBusinessandEntertainment/ CellPhones/ucm116335.htm • National Cancer Institute (US) www.cancer.gov/cancertopics/factsheet/Risk/ cellphones/print
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agents are grouped by the IARC’s Working Group. The scientific evidence linking a substance to cancer is seldom direct or indisputable, so the Monograph Working Group categorizes possible carcinogenic agents into four groups. • Group 1: The agent is carcinogenic to humans. This category is generally used when there is sufficient evidence of carcinogenicity in humans. • Group 2: This category is divided into two sub-groups. • Group 2A: Agents that are probably carcinogenic to humans. This is used where, for example, there is limited evidence of carcinogenicity in humans and sufficient evidence of carcinogenicity in experimental animals. • Group 2B: Agents that are possibly carcinogenic to humans. This is used when there is limited evidence of carcinogenicity in humans and less-than-sufficient evidence of carcinogenicity in experimental animals. • Group 3: The agent is not classifiable as to its carcinogenicity to humans. This category is used most commonly for agents where the evidence of carcinogenicity is inadequate in humans and inadequate or limited in experimental animals. • Group 4: The agent is probably not carcinogenic to humans. This category is for agents for which there is evidence suggesting lack of carcinogenicity in humans and in experimental animals. So the categorization of the cell phone risk into Group 2B means the causal connection is still somewhat tenuous. For comparison, other items in the Group 2B category include coffee, extremely low-frequency electromagnetic fields (power lines) and talcbased body powder. Based on the scientific evidence to date, it appears unclear at this point whether or not cell phone use causes cancer.
Cell phone lawsuits Several legal cases in the United States have sought to hold cell phone manufacturers accountable for alleged health risks of cell phone use. www.claimscanada.ca
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Newman v. Motorola (2002) was a product liability case in which the plaintiff claimed his use of a cell phone (manufactured by the defendant) had caused his brain cancer. The threshold issues were whether the use of a wireless phone can cause cancer (general causation) and whether the plaintiff’s use of his Motorola phone caused his cancer (specific causation). Motorola moved to have the plaintiff’s expert evidence on the issue of causation excluded. The U.S. District
The scientific evidence linking a substance to cancer is seldom direct or indisputable, so the Monograph Working Group categorizes possible carcinogenic agents into four groups. Court for the District of Maryland granted the motion, concluding that the plaintiff’s expert evidence was not generally accepted in the scientific community as reflected in published scientific and governmental reports finding “no sufficient proof that use of handheld cellular phones causes human brain cancer.” The District Court’s decision was affirmed by the 4th Circuit Court of Appeal.
In Murray v. Motorola Inc. (2009), the plaintiffs claimed that cell phones the defendants manufactured or promoted were unsafe because they emitted a dangerous level of radiofrequency radiation, regardless of the fact the radiation emitted was within the limits set by the Federal Communications Commission (FCC). In other words, the plaintiffs claimed that even if the phones comply with FCC rules, they could still be deemed unreasonably dangerous under state law. The D.C. Court of Appeals affirmed the Superior Court’s conclusion that the plaintiffs’ claims were barred under the doctrine of collateral pre-emption insofar as they applied to phones that were within FCC-set limits. However, claims relating to phones purchased before 1996 (when the FCC began issuing safety guidelines) were not pre-empted, nor were claims that defendants made affirmative misrepresentations or material omissions with respect to the manufactured phones’ EMF emission rates. Farina v. Nokia, Inc. et al (2008) was a class action against numerous cell phone manufacturers and retailers in which the plaintiffs sought to require manufacturers to provide headsets with all cell phones. The U.S. District Court (affirmed by the 3rd Circuit) rejected the claim on the basis that it was pre-empted by FCC regulations. Farina has petitioned the U.S. Supreme Court for review of the case, arguing that he is seeking a remedy for the manufacturer’s misrepresentations about the safety of their phones, given that no one yet knows whether claims about safety of cell phones are true. In the next issue of Claims Canada, Education Forum looks at insurance issues in cell phone cases. This article is based on excerpts from ADVANTAGE Monthly, a series of topical papers on emerging trends and issues provided to members of the CIP Society. The Chartered Insurance Professionals’ (CIP) Society is the professional organization representing more than 15,000 graduates of the Insurance Institute’s Fellow Chartered Insurance Professional (FCIP) and Chartered Insurance Professional (CIP) programs. April/May 2012
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• on the scene OTS Pat Van Bakel has been appointed chief operating officer at Crawford & Company (Canada) Inc., effective March 1. Van Bakel has been with the company for more than 20 years, having most recently served as senior vice president, operations, insurer markets. He began his career as an adjuster and has moved through a Pat Van Bakel number of management and special assignments with increasing responsibilities that have positioned him well to take on this new role, the company reports. Van Bakel is a member of many industry organizations, currently chairing and serving on several institute committees. Committed to continuing education, he has invested his career through technical, leadership and executive training. “Pat has been an invaluable member of our team for many years, and has shown great leadership skills and a strong dedication to our mission and values,” said John Sharoun, chief executive officer of Crawford & Company (Canada) Inc. l
FirstOnSite Restoration has opened its newest branch in St. Catharines, Ontario. The St. Catharines branch, located at 207 St. Paul Street West, will be led by Tom Baldassarra, a project manager at FirstOnSite. Baldassarra serves as a member of FirstOnSite’s infectious disease control team and has experience in trauma crime clean-up and large commercial losses. He holds certificates from Clean Trust (formerly IICRC) in water damage restoration, applied microbial remediation and applied structural drying. “This branch will allow us to provide a greater level of service to the Niagara Peninsula and to respond even faster in the event of disaster in the region,” said Warren Tom, senior vice president and managing director for Central Ontario. l RSA Canada has launched a mobile app that offers both home and auto claim reporting. The app is available on BlackBerry, iPhone and Android platforms. With it, RSA customers can report a home or auto claim, locate their broker, access product information, find auto repair shops and contact both emergency services and RSA. “Research shows a significant trend towards the adoption of mobile technology with 33% of Canadians owning smart phones,” said Irene Bianchi, senior vice president of claims and corporate services. “In the event of a claim, our customers want a fast and simple way to access the information and assistance they need and it makes sense they would use their cell phones.” The app is available through the iPhone App store, BlackBerry App World and Android Market. l 46 Claims Canada
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The Canadian Independent Adjusters’ Association’s (CIAA) Ontario region president Teresa (Teri) Mitchell, hosted a presentation for the Police Foundations program at Georgian College. The presentation was four sessions during Jan. 23 to 26, 2012 on Insurance Working Together With Police. The presentation involved explaining what an independent adjuster is and does, and the circumstances where they may find ourselves working side-by-side with police, such as accident scenes, fires, and burglaries. Mitchell expressed the importance of officers keeping clean, clear, and accurate notes, and outlined the types of documentation independent adjusters may request from police. Mitchell advised that independent adjusters and police need to work together, as both looking for the same thing: the facts and the truth. This is the first time CIAA Ontario has been invited to do a presentation within the community, and have already been invited to participate again in 2013. l Crawford & Company (Canada) Inc. is launching Crawford HealthWorks Advantage, an interview-based tool designed to speed the return to work for injured and ill workers and reduce costs for employers, across the Canadian marketplace. Using dynamic decision support technology, Crawford HealthWorks Advantage can help detect and evaluate critical medical and psychosocial factors in workers’ compensation and non-occupational disability claims. “The recommendations that HealthWorks ADVANTAGE produces are tailored for each claim and are based on specific responses in the interviews. They’re aimed at prompting specific actions or decisions by the adjuster,” said Heather Matthews, vice president, national claims management centre. “This allows us to attack the ‘80/20’ rule on claims to achieve faster return to work outcomes, resulting in lower medical and indemnity costs for our customers.” l David Porter has joined Giffin Koerth’s Casualty Group. Porter holds a bachelor of engineering science degree in mechanical engineering from the University of Western Ontario, as well as 10 years of relevant experience, a Giffin Koerth release says. Also, Matthew Allen, Giffen Koerth’s practice leader for its Environmental, Health and Safety Group, is now a certified health and safety consultant (CHSC) under the Canadian Society of Safety Engineering. The designation recognizes and promotes excellence in professional consulting within and to business and industry and government agencies at all levels. l www.claimscanada.ca
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APPOINTMENT
Pat Van Bakel
Regional Spotlight: Nova Scotia from left: Pam Mills — second vice president Grant King — president Sarah LeBlanc — director of southwest Nova Scotia Candice Colwell — secretary and treasurer Carol Messervey — director of central Nova Scotia Graham Campbell — first vice president. Missing: Janet Lee — director of eastern Nova Scotia and Cape Breton. l
Pat Van Bakel has been appointed to the position of chief operating officer, Crawford & Company (Canada) Inc., effective March 1. Van Bakel has been with the Company for more than 20 years and most recently served as senior vice president, Operations, Insurer Markets. Starting his career as an adjuster, Van Bakel has moved through a number of management and special assignments with increasing responsibilities that have positioned him well to take on this new role. A graduate of Wilfred Laurier University, Van Bakel is a member of many industry organizations and currently chairs and serves on several institute committees. He is also dedicated to continuing education, having invested in his career through technical, leadership and executive training.
Canadian Insurance Claims Managers Association’s Executive (from left) John Mendezcuria — arbitration Dan Langer — treasurer Sharon Clark — communication Jo-Ann Eccleston – president Cathy Wismer — secretary Teresa Drijber — program and general meeting director Kevin Chasty — qualifications Absent: Keith Dyson — membership Alex Walker — vice-President Mavis Haws — past-President l Winmar Franchise Corp. is pleased to announce the opening of its newest location in Yorkton, Sask. The location is owned by Doug Maes and Jason Thibodeau. Maes has been successfully operating Winmar Moose Jaw for the past two years. The office is located at 357B 7th Avenue North, PO Box 370, S3N 2W1. l
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“Pat has been an invaluable member of our team for many years, and has shown great leadership skills and a strong dedication to our mission and values,” said John Sharoun, chief executive officer of Crawford & Company (Canada) Inc. “Crawford will benefit greatly from his contributions to the company in this new role.” Crawford & Company (Canada) Inc. is a wholly owned subsidiary of Crawford & Company. Based in Atlanta, Ga., Crawford & Company is the world’s largest independent provider of claims management solutions to the risk management and insurance industry as well as self-insured entities, with an expansive global network serving clients in more than 70 countries. The Company’s shares are traded on the NYSE under the symbols CRDA and CRDB.
www.crawfordandcompany.ca April/May 2012
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• on the scene OTS L’Association des Experts En Sinistre Independants du Québec Inc (AESIQ) hosted the eighth annual Cabane à sucre event on Feb. 23. The event was held at the Cabane à Sucre Constantin in Saint-Eustache, Quebec. Greg Merrithew, president of the Canadian Independent Adjusters’ Association attended the event, along with more than 350 insurance personnel. l
Crawford & Company (Canada) Inc. has announced three new appointments in it operations. Randy LaBrash is now director of GTS in western Canada. He will focus primarily on commercial large loss files handling within the region, as well as assume responsibility for growing the GTS product line in western Canada. Shelley Upton-Landry has joined the company as director of operations for the Atlantic region. She is a bilingual claims insurance professional who has worked as a telephone and road adjuster and held various roles such as team lead and director of claims. Jules Giasson is now the branch manager for the Winnipeg, Brandon, Regina and Saskatoon offices. l
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CARSTAR Automotive Canada Inc. has been selected one of Canada’s 50 Best Managed Companies for 2011. The honour is awarded by Deloitte, CIBC, National Post and Queen’s School of Business. It recognizes Canadianowned and run companies that excel in overall business strategies and sustained growth. “CARSTAR has helped transform an entire industry by creating systems, standards and professionalism, and we are pleased to say that CARSTAR is one of this year’s recipients,” said John Hughes, partner of private services at Deloitte. “They have a relentless commitment to their vision, mission and values which are very strategic in the development of their business.” CARSTAR’s 50 Best Managed Companies application revolved around its BRIDGE strategy. This includes: • Building of the brand; • Renewal of leadership; • Integration through their Care Centre and information technology; • Diversifying products and services; • Growth; and • Enhanced value propositions to their customers and partners. “We are very honoured to receive this award and the timing is impeccable, as we are on a company-wide and nationwide mission to be best-in-class in all that we do,” says Sam Mercanti, president and CEO of CARSTAR. “Thank you to our franchise, insurance and vendor partners for their involvement in helping us achieve this milestone, and for their ongoing contribution in the improvement of our business.” l
CARSTAR Automotive Canada Inc. has added two new Ontario locations: CARSTAR Milton Service Centre and CARSTAR Newmarket — both part of the LC Group of CARSTAR Collision Centres. The LC Group of CARSTAR Collision Centres includes partners Ian Ladd and Peter Chavez and managing partners, Robin Juns and Tony Taj. Each of them has been in business with CARSTAR for more than 10 years. CARSTAR Milton Service Centre is located at 1245 Steeles Avenue East in Milton, Ontario. CARSTAR Newmarket is located at 180 Deerfield Road in Newmarket, Ontario. CARSTAR Milton Service Centre runs within the service drive-through at Milton Toyota, with vehicle repairs taking place minutes away at the LC Groups’ CARSTAR Mississauga 401 location. In addition to co-owing the location, Juns will be managing CARSTAR Milton Service Centre. Operated by Taj, CARSTAR Newmarket is equipped with a variety of specialty equipment and is formerly Steve’s Auto Body, a well-established Newmarket area business run by Steve and Rose Sewell. “We look forward to running this business as a well-presented, high quality enterprise that Steve and Rose began over 40 years ago,” says Taj. l
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CIAA New Members — February 2012 CORPORATE MEMBERSHIP Robichaud Claims Services — Cocagne, NB DSB Claims Solutions Inc. — Brampton, ON INDIVIDUAL MEMBERSHIP Crawford & Company (Canada) Inc. Justin Carlson Campbell River, BC Marie Ange Desbiens Victoria, BC Damien Goodyear Calgary, AB Dean Laroque Calgary, AB Patrick Heald Edmonton, AB Jeff Orkusz Edmonton, AB Sharon Schwieger Medicine Hat, AB James Johnson Red Deer, AB Jamie Birns Saskatoon, SK Sandra Foster Brandon, MB Lory Perizzolo Calgary, AB
Level 1 Level 1 Level 1 Level 1 Level 1 Level 3 Level 3 Level 3 Level 1 Level 1 Level 3
Curo Claims Services Riel Morin
Waterloo, ON
Level 3
DSB Claims Solutions Inc Dara Banga
Brampton, ON
Level 3
Granite Claims Solutions Paul Curtis Darren Berg Daryl Doiron Damien Thorboume Lynn Brantnall Brian Churchill Jim W. Coolen Gregory Doerr Les Telch Jennifer Chetcuti Amber Dobbie Robert Fiorido Sharon Hanks Wilson Igwe Mike Johnstone Kathy McKee Matt Underhill Deborah Casey Tony Collrin Gary Purser Margret Stone Carolyn Tweedie Sandy Capone Effie Fragiskatos Christopher Maitland Deborah Meyer Hema Jaipersaud Mark Anderson Shelley Foran-Vukovich Don Gravelle John Mah Larry Matsuyama Sharon O’Halloran Jennifer Pelkman Lynn Adams Matthew Allan Debbie Attardo Robert Greig Boyle Dan Burns
Abbotsford, BC Burnaby, BC Edmonton, AB Edmonton, AB Moncton, NB Halifax, NS Halifax, NS Barrie, ON Barrie, ON Bolton, ON Hamilton, ON Hamilton, ON Hamilton, ON Hamilton, ON Hamilton, ON Hamilton, ON Hamilton, ON London, ON London, ON London, ON London, ON London, ON Markham, ON Markham, ON Markham, ON Markham, ON Mississauga, ON Mississauga, ON Mississauga, ON Mississauga, ON Mississauga, ON Mississauga, ON Mississauga, ON Mississauga, ON Mississauga, ON Mississauga, ON Mississauga, ON Mississauga, ON Mississauga, ON
Level 3 Level 3 Level 3 Level 3 Level 3 Level 3 Level 3 Level 3 Level 3 Level 2 Level 1 Level 3 Level 3 Level 3 Level 3 Level 1 Level 3 Level 3 Level 2 Level 3 Level 1 Level 3 Level 2 Level 3 Level 3 Level 3 Level 3 Level 3 Level 3 Level 1 Level 3 Level 3 Level 3 Level 3 Level 3 Level 3 Level 3 Level 3 Level 3
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Chris Cantrell Carrie Dodson Tara Drabik Carrie Evans Jean Glover Karen Heaslip Gabriela Hrdlicka Doris Jones Karen Jones Eva King Janice Knickle Ellen Lockley Josie MacKinnon Alessandra Madge Olusegun Ojikutu Alexander Pappas Neville Patrawala Jason Ponton Joanna Presley Anita Putos Jennifer Rennie Stefanie Schone Terrence Soltys Garrett Spina Michael Ta Patricia Tantalo Stanley Thomas Sloane Hillis Margaret Knebel Stephanie Snider Alan Gallagher Tony Galletta Isabelle Tanguay Kathleen Dupon Linda Heggarty Cathy Grant-McDowell Robert Carscadden Corry Martin Ronald Mark Sullivan Dennis Schembri Neil Castonguay Naji Kayal Ashley Misurka Isobel Hunter Greg Renaud
Mississauga, ON Level 3 Mississauga, ON Level 3 Mississauga, ON Level 3 Mississauga, ON Level 2 Mississauga, ON Level 2 Mississauga, ON Level 2 Mississauga, ON Level 3 Mississauga, ON Level 3 Mississauga, ON Level 3 Mississauga, ON Level 3 Mississauga, ON Level 3 Mississauga, ON Level 3 Mississauga, ON Level 3 Mississauga, ON Level 1 Mississauga, ON Level 3 Mississauga, ON Level 3 Mississauga, ON Level 3 Mississauga, ON Level 3 Mississauga, ON Level 3 Mississauga, ON Level 3 Mississauga, ON Level 3 Mississauga, ON Level 2 Mississauga, ON Level 3 Mississauga, ON Level 3 Mississauga, ON Level 1 Mississauga, ON Level 1 Mississauga, ON Level 3 Newmarket, ON Level 3 Newmarket, ON Level 3 Newmarket, ON Level 2 Ottawa, ON Level 3 Ottawa, ON Level 3 Ottawa, ON Level 3 Peterborough, ON Level 3 Peterborough ON Level 3 Sault Ste. Marie, ON Level 3 Sudbury, ON Level 3 Sudbury, ON Level 2 Thunder Bay, ON Level 1 Toronto, ON Level 3 Toronto, ON Level 3 Toronto, ON Level 3 Toronto, ON Level 3 Windsor, ON Level 3 Windsor, ON Level 3
Kernaghan Adjusters Limited Michelle Short Calgary, AB Kelsey Wayne Kenora, ON
Level 3 Level 1
Robichaud Claims Services Leo Robichaud
Cocagne NB
Level 3
Sedgwick CMS Canada Inc. Kurt Baksh Maria Luisa DeLeo Colleen Dickson Tyler Peeters Paolo Salvatore Michael Gordon Wright
Toronto ON Toronto ON Toronto ON Toronto ON Toronto ON Mississauga ON
Level 3 Level 1 Level 3 Level 1 Level 1 Level 1
Westman Claims Adjusters Stefan Brock
Brandon MB
Level 1
April/May 2012
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• on the scene OTS The Insurance Institute of Ontario held its 113th Annual Convocation & Awards Night on Jan. 26 at the Metro Toronto Convention Centre. Paul Martin, president of the Insurance Institute of Ontario, served as the master of ceremonies. Karen Barkley, chairwoman of The Insurance Institute of Canada, addressed more than 400 graduates. Humanitarian, social activist and bestselling author Craig Kielburger was the keynote speaker. l
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www.claimscanada.ca
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The CICMA/CIAA Ontario Chapter’s 45th Annual Joint Conference, Auto Reform…Did It Perform, was held on Feb. 7, 2012 at the Metro Toronto Convention Centre. Guest speakers included Becky Cameron, Aviva Canada; Tammie Norn, Proformance Group Inc.; Fred Plant, Plant Hope Adjusters Ltd.; Philippa Samworth, Dutton Brock LLP; Sandra Corbett, Field Law; and Dennis Giesbrecht of LifeMark Health. Eric Grossman of Zarek Taylor, Grossman Hanrahan LLP moderated the event. Keynote speakers included Kirk Quinn and Kathy Metzger of IBC Investigative Services. l
N
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• on the scene OTS Hundreds of insurance claims industry guests attended the 6th Annual Post CICMA/CIAA Joint Conference Cocktail on Feb. 7, 2012. Entitled The Big Mingle, the event featured a Prohibition Era theme. Giffin Koerth Forensic Engineering and Blouin Dunn LLP hosted the event, held at the Maison Mercer in Toronto. Event sponsors included Direct IME, MasterClean, A.R.S., Belfor, FirstOnSite, ServiceMaster, STRONE and WINMAR. l
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www.claimscanada.ca
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CAPTION CONTEST Submit your idea for the caption to Debby Matz at debbymatz@winmar.ca Winmar owners and employees are not eligible. Prize: Gift Certificate to The Keg Steakhouse. Winner to be announced in the next issue.
Winmar Property Restoration Specialists with over 60 locations across Canada www.winmar.ca
24 HOUR ASSIGNMENT/EMERGENCY RESPONSE • TOLL FREE 1-866-4-WINMAR (494-6627) www.claimscanada.ca
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• on the scene OTS More than 150 exhibitors from across Canada showcased their works at the Ontario Insurance Adjusters’ Association (OIAA)’s Professional Development & Claims Conference in Toronto on Feb. 8, 2012. The event featured a trade show and seminars covering a wide variety of timely claims topics. Olympic and humanitarian champion Mark Tewksbury was the luncheon keynote speaker. l
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www.claimscanada.ca
20/04/12 4:17 PM
ClearRisk Seeks Exceptional Sales Leaders Are you a top performing sales leader with proven results? Are you well connected, and highly respected in the Canadian Insurance Industry? Are you looking to play a key role in the revolution occurring in the global insurance industry? If so, ClearRisk wants to speak with you! ClearRisk is a rapidly growing Software as a Service (SaaS) company providing innovative solutions to the North American Insurance Industry. Utilizing the latest technologies and business practices, ClearRisk seamlessly integrates the insurance community, from application and underwriting, to claims management and loss control. ClearRisk’s suite of applications drive sales, increase efficiency,and improve the bottom line of Insurers, Brokers, Adjusters and Insureds. If you are interested in being a leader in the insurance technology revolution, contact ClearRisk at careers@clearrisk.com or 1-877-734-7475
www.claimscanada.ca
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• on the scene OTS The Toronto Insurance Women’s Association (TIWA) Wine and Cheese Reception was held at The Hyatt Regency in Toronto on Feb 16. More than 1,200 guests attended the association’s annual signature event. l
McCauge Borlack LLP hosted its sixth annual ski day event at the beautiful Alpine Ski Club in Collingwood, Ontario. Raffle proceeds were donated to Darearts, a charity devoted to empowering “at risk” children through access to the arts. l
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CU March 2012 Quarter Century
3/8/12
4:39 PM
Page 4
Announcing the
QUARTER CENTURY CLUB 53rd Annual Reception
Thursday, May 17th, 2012 Hilton International Toronto (Richmond Street at University Avenue) Reception – 12:00 p.m. Cost - $75.00 53rd Annual Reception Committee: John Cherrie - 416-737-7525 Stewart Ponton - 905-740-1100 Ford Blow - 416-457-7072
Send Contact Info and Cheque Payable to (or VISA, provide exp. date):
Featuring… ‘The Roasting of Gary Gardner’
Stewart Ponton Quarter Century Club Granite Claims Solutions 5935 Airport Road, Suite 210 Mississauga, ON L4V 1W5 Phone: 905-740-1100 Fax: 905-671-2088 Email: stewart.ponton@graniteclaims.com
Thank you for the support of these generous event sponsors:
Once again this year, the Quarter Century Club plans to continue to make a donation in the name of Doug Hurlbut to the Insurance Institute Scholarship Fund and other charitable organizations. Design compliments of
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• on the scene OTS WINMAR’s Burlington/ Hamilton, Markham/Toronto East, Newmarket, Oakville/Mississauga and Guelph/ Orangeville locations graciously hosted nearly 100 industry guests on Feb. 23 to celebrate the closing of the holiday season at Real Sports Bar & Grill. The evening of food, drink and networking occurred while watching the hometown Toronto Maple Leafs take on the Philadelphia Flyers. Donations were collected in support of the Starlight Children’s Foundation. l
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DISCOVER THE APP THAT GETS YOUR CLIENTS BACK ON TRACK FAST AND HASSLE FREE. Don’t let a car accident put the brakes on your clients’ lives. Show them they can get back on track fast with RSA’s new Mobile App. With hassle free ease your clients can repor t a claim, upload photos, find a broker and more, all from their mobile devices. It’s just one more way you can help your clients get the most from RSA and our Hassle Free Claims® service. HASSLE FREE CLAIMS® JUST WENT MOBILE. DOWNLOAD IT NOW AT RSABROKER.CA/MOBILEAPP Available for iPhone, Blackberry and Android smartphones. ©2012. RSA is a registered trade name of Royal & Sun Alliance Insurance Company of Canada. “RSA” and the RSA logo are trademarks used under license from RSA Insurance Group plc. ® “Hassle Free Claims” is a registered trade mark licensed for use by Royal & Sun Alliance Insurance Company of Canada.
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