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• first notice FN Fort McMurray airport suing By Jason Contant
The Fort McMurray Airport Authority (FMAA) is suing FM Global for more than $34 million, contending the insurer breached its obligations under a policy in place during the Fort McMurray wildfire in May 2016. In a statement of claim filed with the Court of Queen’s Bench of Alberta in May, the FMAA alleges it submitted a proof of loss to FM Global for more than $34.2 million in wildfire damages, which included lost revenue associated with various airport fees. FM Global advised the airport in April 2018 that its proof of loss had been rejected and that the insurer would not be indemnifying for all damages and losses as set out in the proof of loss, according to the airport’s statement of claim. Interim payments have been made to FMAA for a portion of the Authority’s losses caused by the wildfire, the claim adds. The airport is seeking aggravated damages of $1 million and punitive and exemplary damages of $1 million. “FM Global owed
the Airports and the Authority a duty of care to ensure that proper and adequate insurance coverage was in place to indemnify the Authority for losses or damages resulting from the wildfire,” the statement of claim says. “FM Global’s refusal to honour its obligations under the policy is a breach of its duty of good faith, for which the plaintiff is entitled to aggravated, punitive and exemplary damages.” The statement of claim accuses the insurer of representing to the airport that lost revenues from airport fees would be covered under the policy. The fees, which the airport describes as a “significant source of income,” include airport improvement fees, as well as terminal and landing fees. “FM Global represented to the Airports and the Authority that in the event of a loss, the policy would provide coverage for lost revenue, including airport fees,” the statement of claim says. FMAA also alleges it believed that the time element coverage provided by the policy would extend to the loss of both direct and indirect customers and suppliers, regardless of how indirect the connection to the loss. ●
Recent Ontario storms are notable claims events By Jason Contant
The early May windstorm that struck Ontario and parts of Quebec topped $410 million, the costliest insured event since the 2013 Toronto floods, Catastrophe Indices and Quantification Inc. (CatIQ) said recently. The majority of the damage from the windstorm – $380 million – was in Ontario, CatIQ said, making it the most expensive for insurers since the 2013 flooding in Toronto, which cost nearly $1 billion in damage. Beginning May 4, widespread wind damage was reported across several regions of 4
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Ontario and parts of Quebec. Strong wind gusts lasted for several hours, leading to roof damage, downed trees and power outages, CatIQ said. Hurricane-force wind gusts of up to 150 km/h reportedly struck parts of Ontario, including up to 120 km/h in Toronto. The Canadian Press reported at the time that more than 80,000 Hydro One and about 10,000 Toronto Hydro customers were without power. A June 13 southern Ontario thunderstorm resulted in losses of between $10 million and $25 million. In its Weekly Cat Report issued on June 15, Aon Benfield’s Impact Forecasting noted that the storm system left more than 40,000 people without power in southern Ontario alone. “The trail of damage, which stretched over 30 kilometres and was about 600 metres at its widest point, was reported by the local survey team to be consistent with damage from an EF1 tornado,” Aon Benfield said. “In Toronto, strong gusts from a thunderstorm downed trees and snapped powerlines, resulting in several houses and vehicles being damaged. Some areas also
reported minor flooding.” The last few months in Ontario have brought a series of severe, and unique, weather events. So far in 2018, the following storms have hit Ontario: • January – Winter storm damage in Toronto, London and south-western Ontario of nearly $10 million; • February – Water and winter storm damage in southern Ontario of over $40 million; • Early April – Wind and rain storm damage in southern Ontario topping $79 million; • Mid-April – Winter storm and ice storm in Toronto and south-western Ontario of over $187 million; • May – Windstorm damages of $380 million across Ontario. • June – Thunderstorm damages of between $10 and $25 million in southern Ontario. The numbers above are just the insured losses associated with these natural catastrophes and not the costs to governments, which have been “growing at an even faster rate, CatIQ noted. ● www.claimscanada.ca
• first notice FN Manitoba leads in flood defence By Greg Meckbach
Manitoba provides the best examples of overland flood defence work in Canada, says Paul Kovacs, founder and executive director of the Institute for Catastrophic Loss Reduction (ICLR). “They are second to none in Canada.” The Manitoba government estimates that the Red River Floodway on the outskirts of Winnipeg has prevented about $40 billion in flood damage since the project was completed in 1968. Both Manitoba and Ontario are provinces that can serve as an example to Alberta, which was hit five years ago with record flooding that put downtown Calgary under water. While Manitoba has good flood defences, Ontario’s strength lies in strict zoning regulations that prohibit development in the riskiest areas, Kovacs says. In Winnipeg, which is situated on the confluence of the Assiniboine and Red Rivers, a 1950 flood resulted in damages of about $1 billion (adjusted to today’s dollar) and the evacuation of about 100,000 residents. A larger flood hit Manitoba in 1997, but fewer properties were affected because much of the water was diverted into the Red River Floodway. In 1997, the floodway was expanded to handle a one-in-700 year flood. Before 1997, the floodway was capable of handling a one-in-160 year flood.
Oil sands workers may get A recent Supreme Court of Canada ruling opens the door to random drug and alcohol testing of Alberta oil sands workers operating By Greg Meckbach heavy equipment. The outcome will no doubt affect some risk managers because employers can be held responsible for injury or damage if a worker causes an accident while under the influence of alcohol or drugs. Suncor Energy Inc. started testing oil sands workers north of Fort McMurray, Alta. for drug and alcohol impairment in 2012 but were stopped when a provincial arbitration panel ruled in favour of labour union Unifor. The union argued that random testing is an invasion of privacy. As a result of a recent Supreme Court of Canada decision, the issue will go before a new arbitration panel. Suncor is now prohibited from random drug and alcohol testing of workers in safety sensitive positions. In December, 2017, Unifor requested and received an injunction, essentially prohibiting random drug and alcohol testing. This injunction is intended to apply unless the new arbitration panel (initially ordered by the Court of Queen’s Bench in 2016) rules in favour of the employer. The injunction was upheld in February 2018. ●
Drug Testing
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Marijuana use spikes after legalization By Greg Meckbach
In jurisdictions where cannabis has been legalized “we see spikes in use at the onset of sales,” Lewis Koski, former director of the Colorado Marijuana Enforcement Division, said during a recent panel discussion in Toronto. In Colorado, it is legal for adults 21 and older to have up to an ounce of marijuana. In Canada, medical marijuana is legal whereas recreational marijuana is not – but will be soon. Bill C-45 – which legalizes recreational marijuana – is now law. It will come into force on October 17, 2018. The bill will also control and regulate how cannabis is grown, distributed and sold. Cannabis legalization is cause for concern for Canada’s largest property and casualty insurer, Toronto-based Intact Financial Corp. In its annual report for 2017, Intact said its concerns include the possibility of “higher frequency and severity of auto insured losses as a result of impaired driving.” Consumers “expect to buy cannabis more often after legalization, and less frequent consumers expect to spend more,” Deloitte Canada stated in a recent report. The survey results “strongly” suggest that cannabis consumption “will become a normalized activity more quickly than many might have anticipated,” Deloitte added in the report. ●
Hundreds of Fort McMurray claims still unresolved By Jason Contant
With hundreds of claims from the 2016 Fort McMurray wildfire still unresolved, Alberta residents could be forgiven for still worrying about wildfire risks in their own backyard. The Canadian Press recently reported that as of May 10, some 900 insurance claims were outstanding. Alberta’s Minister of Finance and president of the Treasury Board, Joe Ceci, said in a press release May 23 that there has been some confusion regarding the extension of claims for those affected by the wildfire, which cost insurers nearly $4 billion. “Let me be clear that there will be a blanket extension within which to file claims for an additional year,” he said. “Our government has been in touch with every insurance company in Alberta and the vast majority have already agreed to grant these extensions voluntarily. Should a company choose not to grant this extension, our government is ready and prepared to amend the legislation to ensure residents are being treated fairly and given the additional year to resolve their claims or file legal action.” ● August-September 2018
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Cover Story
Water woes The mental side of building flood resilience By Emily Atkins
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F
looding is the costliest type of catastrophe in Canada, and it is hitting people ‘upstairs’ as well as harming basements. A recently released study by the Intact Centre on Climate Adaptation has found that survivors of residential flooding are more likely to suffer from residual mental stress than people who have never experienced a flood. The study, “After the Flood: The impact of climate change on mental health and lost time from work”, suggests the experience of flooding causes significant mental and physical health impacts and lost time from work that are should be of interest to health and disability insurers. With adaptation to climate change becoming a major focus for industry and government alike, the study also provides insights into how improvements in insurer practices, including claims management, may help to mitigate some of the negative mental health implications of all types of catastrophes.
Climate change and mental health While climate change has been widely discussed for many years, recent events and newly available statistics are underlining the impact and increasing severity of climate-related catastrophes. For example, Canadian loss index provider CatIQ recently revealed that as of April 2018 Canada had experienced more than 100 catastrophes in the past 10 years. As well, the four mostly costly of these events occurred in the second part of the decade, with insured losses more and more frequently surpassing the billion-dollar-a-year benchmark. While the most expensive of these cats included wildfires (Fort McMurray in 2016 and Slave Lake in 2011), hailstorms (Central Alberta in 2014), two floods in 2013 (Southern Alberta and Toronto) also made the list. In fact, approximately 50 percent of all natural disasters in Canada since 1970 have been caused by floods. In 2016 Swiss Re published a paper, “The road to flood resilience in Canada”. “Historically, flood is the leading cause of losses among all natural hazards,” the report noted. “This is true both around the world and in Canada. No other natural peril has affected more people or caused greater financial strain on economies.”
Post traumatic effects of flooding This is why the Intact Centre decided to look into the health effects of flooding. Study co-author Blair Feltmate, head of centre, told Claims Canada in an interview “we’ve got flood, fire, drought, hail, wind, ice road, shoreline erosion, permafrost loss. There’s lots of things that are stressors and extreme weather events, but we focus on water simply because it’s the elephant in the room in Canada that’s costing the most.” After “hearing anecdotal stories about the stress and the strain that people go through when they have a flooded basement, and the time off work pertaining to dealing with contractors or whatever else you have to do to put a flooded basement back into working order,” Feltmate said the centre decided to try to quantify the issue. What they found is a pronounced difference between symptoms reported by people in the same community who have and have not experienced home flooding. The study looked at residents of Burlington, Ontario, which experienced a major inundation in August 2014. “Atypical and severe” precipitation of 196 mm of rain fell over seven hours, resulting in 3,500 flooded homes. Three years later, the researchers conducted doorstep interviews with 100 respondents; approximately half had experienced flooding while the rest had not. People who had gone through the floods reported anxiety and stress and had to take time off work to deal with claims and contractors (see infographic page 8). “Three years later people were still say-
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ing, ‘Look, every time it rains with a big storm, my husband and I are up in the middle of the night checking the basement to see if there’s water, or the kids come home from school and they check the basement,’” Feltmate recounts.
Not just flooding Reports from other countries and other types of cats corroborate these results. A study in Australia, called “Beyond Bushfires”, following a devastating series of wildfires in 2009 discovered that even up to six years later, survivors had significant “mental health problems that were beyond levels likely to be manageable and may require professional support,” at a rate twice what would be expected in the general population. Anecdotal accounts from adjusters working on catastrophic events also support these findings. Pieter Heydenrych, CEO of Omnia Adjusters Cooperative, believes that while flooding is a significant stressor, a house with an inundated basement can still be habitable, but a home destroyed by fire represents a total loss of everything an individual or family has. “These losses can also be accompanied with loss of loved ones (pets), never mind the challenges of resolving immediate problems like where to live and how to live – access to basics like clothing and food and a roof over your head,” he says. Extended resolution times and the pressures involved in re-creating survivors’ pre-loss lives increase dramatically in these instances. “Emergencies can take a tremendous toll on the emotional and mental well-being of those affected,” said Jean-Philippe Tizi, vicepresident of emergency management for the Canadian Red Cross, in a blog post. “The traumatic experiences within disaster situations have profound consequences on emotional and social functioning for individuals, families, and the entire community.”
How the claims process fits For those with insurance, the claims process can also have a major impact on their reaction to a cat. The “After the Flood” researchers found that difficulty contacting an insurance provider was one of the key factors exacerbating post-cat stress and worry. Homeowners told interviewers they were often uncertain about their insurance coverage and were frustrated by delays in compensation. The report recounts the story of one respondent who waited four days after the flood for an adjuster to arrive, while her food rotted away in an overturned basement refrigerator. Heydenrych notes that in a large cat the high volumes of claims add to the insureds’ stress because of extended resolution times. “Even if things go perfectly right they take longer to resolve,” he says. And that correlates directly with “increases in stress and the demands of just trying to maintain a relatively normal life, like going to and keeping a job”. In a major cat situation there’s also the likelihood of delays in having contractors arrive to effect repairs, and the added burden of taking time off work to deal with them. Heydenrych says that the resulting anxiety often percolates back to claims adjusters: “The desk adjusters deal with the insureds after the scope is completed and they take the brunt of the abuse that stems from stressful situations insureds find themselves in,” he says. “It is tough dealing with voices over the phone, trying to help and often not being able to do so effectively, even when all the stars align…Adjusting cat losses results in a level of adjuster emotional numbness, necessary to just survive the pressures of high file loads, and severely distressed insureds.” Swiss Re noted in its report that during the 2013 Calgary flood, where losses were primarily from sewer backup, “ambiguity concerning coverage was a primary source of confusion and frustration for
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Cover Story the loss-exposed policy-holders and consequently negatively affected the industry’s reputation.” The Intact Centre’s study also found that almost half of the respondents in the Burlington flood interviews did not have full coverage for flood damage. Respondents reported that the discovery that they lacked coverage was another significant source of stress.
Reducing the pain “Mental stress is a problem,” Feltmate says. “When you think about it, for the average person who owns a home, their home is their primary investment vehicle in life. It’s their retirement plan. To have this thing knocked out from under them, with sewer water in basements, it does make sense that this is dire stress.” While the claims process could use some refinement to help reduce the incidence of post-cat stress, the problem definitely spans many areas of responsibility. And it will pay to make changes. In 2015 $32.2 billion was paid out in Canada for health benefits. Measures taken to reduce the impacts of floods and other cats on mental health will help to contain those costs and reduce risk for health insurers. The first line of defence, according to Feltmate, is prevention. He is advocating a two-pronged approach – first, encouraging homeowners to improve their properties to reduce the risk of flood damage, and second, implementing new standards for infrastructure and
community planning. On the first front the Intact Centre has made many resources available for homeowners to educate themselves. On the second, new standards that will reduce and mitigate flood risk are in the works for existing communities, new communities and for homes themselves. Feltmate says they should be ready in the next 18 to 24 months, and are being prepared with the support of the insurers, primarily property and casualty, in collaboration with the National Research Council, the Standards Council of Canada, and the Canadian Standards Association.
Filling the gap But there’s still a gap between flood coverage and the public’s perception of what they are covered for. As Swiss Re pointed out in its study, “whether warranted or not, today there is a strong belief amongst the Canadian public that they will be protected from flooding losses, either through government relief programmes or under atypical interpretation of their home insurance policy.” In fact, recent IBC research indicates that about 45 per cent of Canadian homeowners with a ground-level home believe their regular home insurance policy protects them in a flood. And as long as that gap exists, there will be extra psychological pain felt every time there is a flood. As Feltmate points out, “one of the things the insurers are realizing is their materials that describe to their
AFTER THE FLOOD The Impact of Climate Change on Mental Health and Lost Time From Work
EXTREME WEATHER IN CANADA IS ON THE RISE AND GETTING WORSE.
THE AVERAGE COST OF A FLOODED BASEMENT
IN CANADA IS $43,000 Insurance Bureau of Canada, personal communication, 2018
*
THREE YEARS after their home was flooded, almost half (48%) of survey respondents were STILL WORRIED EVERY TIME IT RAINS.
0
7 DAYS OFF WORK
average per working flooded households.
Compared to 3% of respondents who never experienced a flood. 8
*
10x
Ontario average.
10
20
30
40
50
In the first month after experiencing a flood, 47% of people experienced worry and stress compared to only 11% of people whose homes had never been flooded.
WHEN IT RAINS, IT MAKES YOU ANXIOUS.
www.claimscanada.ca NOT ADAPTING IS NOT AN OPTION — REDUCE YOUR RISK AND SECURE PEACE OF MIND
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August-September 2018
client base what they’re covered for and what they’re not covered for relative to particularly flooding, historically has been rather challenging to interpret, to understand.” The insurance industry is stepping up he says, and trying to make it clearer. To that end, Feltmate reports that the Intact Centre is working on educating brokers about the basics of climate change, how that relates to flood risk and how to communicate it to their clients. There’s also a push on to educate consumers directly. IBC launched a program in Ontario, British Columbia and Ontario this spring to raise awareness of flood risks and educate homeowners on how they can protect their property. While prevention is the best defence, on the adjusting side an opportunity for improvement remains. Heydenrych says that because most adjusters working cats are independent, specific training on how to better deal with insureds’ anxiety is just not on their radar. Feltmate also admits that adjuster education is an area that needs to be addressed. “It’s not that it’s not important,” he says. “We’re just not that far yet.” As well, insurers could look at ways to speed up the claims process for large cats so the backlog doesn’t become an additional source of frustration. This might mean adding resources or providing additional training to ensure adjusters are equipped to understand the experiences of those who have endured a catastrophic event.
A community effort Ultimately, responsibility for reducing the severity of flooding and its aftermath falls on many shoulders. This includes the individual homeowner who can take steps to decrease risk by improving their residence and understanding their insurance coverage. It includes the insurer who can better inform clients, as well as working towards the adoption of better standards for community and household flood prevention. “Along with the property and casualty insurers the life insurers should be pushing hard for the uptake and deployment of these standards…by provinces, municipalities, and other agencies,” Feltmate asserts. The responsibility also falls to the adjuster on the front line, who must be compassionate, efficient and cognizant of the enduring effects of the trauma. And, it includes those providing post-cat community resources. “Adapting to the impacts of climate change takes a whole-of-society approach,” says Craig Stewart, vice-president of federal affairs at IBC. “It is imperative that we raise Canadians’ awareness of the escalating climate-change risks that we all face. Floods in Canada will continue to happen, and only together can we build a resilient country.” •
“Mental stress is a problem,” Feltmate says
A SMALL CHANGE CAN MAKE A BIG DIFFERENCE Protecting the environment is of importance to us all. First General Property Restoration Services has taken on the challenge of doing what they can to help reduce their environmental footprint. They are looking closely at how they, as a company can make a difference, and are committed to using more sustainable products whenever possible. One easy change First General is making is eliminating their use of plastic bags. They are providing reusable canvas bags to all First General technicians and employees across Canada. They will use these bags rather than plastic ones whenever they purchase supplies, tools, and other items for their projects. This one simple step should help eliminate approximately 78,000 plastic bags per year from entering the landfill.
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INTERESTING FACTS
• A single plastic bag will take approximately 1,000 years to degrade. • Every plastic bag that has ever been made still exists in some form or another on this planet. • The Great Pacific Garbage patch that is floating in the Pacific Ocean is mostly composed of plastic. It is approximately twice the size of the state of Texas. Source: www.theworldcounts.com/stories/ interesting-facts-about-plastic-bags
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Rise of the Machines
Appliance Fire and Flood Claims – Part 2 BY MAZEN HABASH
In the last issue, we unearthed a New York Times article from 1984, titled "The Digital Revolution Breeds Smart New Appliances". It stated, “For better or worse, the digital revolution has come to the laundry and kitchen. Appliances are beeping, blinking, flashing messages and signaling when doors are ajar, cycles over and motors burned out…Quality has improved because of increased automation in factories – but so has appliance complexity, oftentimes with irksome results.” That led us into a discussion about appliance fires in the kitchen, with an eye on the technology present in those appliances – a discussion that we will now continue as we explore appliances in the laundry room, and their capacity to start fires and floods.
Laundry Room The National Fire Protection Association (NFPA) reports that between 20102014, U.S. fire departments responded to an estimated 15,970 home fires involving clothes dryers or washing machines each year. The estimated annual losses from these events were 13 deaths, 440 injuries, and $238 million in property damage. It is clear that the equipment in laundry rooms is worth studying as it is commonly involved in insurance claims and incidences. Dryers Of those nearly 16,000 annual fires, 92 per cent were caused by dryers. Dryer fires generally fall into three categories: Installation errors, manufacturing defects, and misuse. One common error is the improper installation of the ducting. The job of the exhaust is to expel moisture from the 10 Claims Canada
dryer. The amount of air flow through the appliance is determined by the length of straight sections, how the ductwork is positioned, and the material from which it is constructed. If airflow is insufficient or impeded by lint, kinks or excess ductwork, it can contribute to starting a fire. With so many electrical and mechanical components in a dryer, there are a number of failures that can result from manufacturing defects, including: • Heating element failures • Motor failures • Electrical arcing events • Welded temperature sensor contacts • High-resistance connections. High-resistance connections, for example, are the result of bad or loose electrical connections. When energized, they generate heat, causing oxidation, which increases the resistance of the connection, which in turn generates more heat, and so on. Eventually, high-resistance connections can become hot enough to ignite nearby combustibles, including clothing that has been exposed to flammables (cooking oil, gasoline) and lint. There are also instances where a load of laundry will ignite through no fault of the dryer, but rather, from misuse. Usually, because it contains things that
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should never be put in a dryer, like cushions, butane lighters and plastic tablecloths. In these cases, having the load of laundry available to your forensic expert for review is extremely beneficial for an investigation, and should always be kept. A dryer fire is a very recoverable type of incident, but it is up to the insurer and the contractor to ensure the opportunity for subrogation is preserved. Here are a few key tips for preserving and/or recording the information needed for a successful investigation. • Do not move the dryer – keep it and its surroundings undisturbed • Keep the exhaust ductwork • Retain all the dryer components • Do not throw out the load in the dryer.
Washing Machines Water damage is the number one cause of insurance claims in Canada, and the frequency and the average cost of water damage claims have increased over the past several years. In homes, this can be partly attributed to the trend of transforming basements into living areas. While in condominiums, laundry facilities have moved from the basement into each unit. So, a water loss in one unit can result in damages www.claimscanada.
to neighbouring units as well. The most common causes of water losses in washing machines are: • Solenoid valve failures • Circuit board/control malfunctions • Hose failures. Solenoid valves can be found in kitchen appliances as well, such as dishwashers and refrigerators. However, regardless of the appliance, the job of a solenoid valve is to open, allowing water to flow into the appliance, and then close, shutting off the water supply. A failed solenoid valve can result from stress cracking, freezing, or installation errors. It can also be as simple as small pieces of debris getting caught in the valve and preventing it from closing after it has opened. With nothing to cut off the supply, water continues to flow indefinitely. Circuit board and control malfunctions have become much more prevalent with the adoption of technology in the laundry room. Circuit board failures can result in fires, as we saw in dishwashers, but we have also investigated malfunc-
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tions that caused floods. This can happen when people use too much detergent. The overflow of bubbles infiltrates the housing of the washing machine and come into contact with the circuit board, causing future malfunctions. The third most common cause of water losses in washing machines is hose failures. Hose failures happen for a number of reasons, including age, design deficiencies and installation errors. Studies show that failure rates increase dramatically in hoses over five years old, as the material they are made from begins to lose resiliency. Deficiencies relating to the material (improper choice of material or poor material formulation) can also cause hoses to crack or corrode. And installation errors, such as not leaving enough slack in the line to prevent kinks or bends, can lead to leaks.
Take Steps The advancement of technology in the home has made our lives infinitely easier. We no longer have to manually
light our ovens – or use them at all if you are a fan of microwave cooking. Dishpan hands are a thing of the past, and even your teenage children can learn to do the laundry (whether they do it is a different story). But risk always increases proportionately with reward, and the fallout from a dryer installation error is much worse than that from a clothesline. Fortunately, while these incidents can be very complex, they are also very often recoverable. Before even bringing in a forensic engineer, insurers can take steps to increase their chances of a successful subrogation by preserving evidence, securing documentation and maintaining chain of custody. This will help support the case should an insurer decide to commence a comprehensive investigation and pursue legal action. • Mazen Habash is president and consulting forensic engineer at Origin and Cause.
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Stuck in a claims
tug-of-war? Invoke the appraisal process The fair and efficient processing of an insured’s claim on lost or damaged insured property is the ultimate goal of all involved parties including the insured, the insurer and the claims adjuster. In an ideal scenario the insured suffers a loss, reports it, coverage is promptly determined, and the insurer issues payment for a fair and reasonable sum for the value of repair or replacement. The insured is indemnified, enabling him/her to return to a financial state comparable to what he/she was in prior to the loss. Not every claim follows this path, however – there are a few that stall. In such instances the insured and the insurer reach a roadblock in agreeing upon either the scope of damages (insured), and/ or the costs associated with the necessary repairs or replacement of damage property (insured). This may be accompanied by numerous exchanges of communications and meetings, escalations, and even at times litigation or unwanted media/ social media mentions. Both parties are left at a disadvantage when the process breaks down; the insurer has an unhappy client and spends considerable time and effort trying to satisfy them, while the insured continues to suffer from the loss and feels frustrated and unhappy with the service provided. There are a few options that can be explored in such instances; however, more often than not the dispute ends in litiga12 Claims Canada
tion. One of the lesser known – and arguably underutilized – options is to invoke the appraisal process provision, which is the dispute resolution mechanism contained within all property insurance policies. The Statutory Condition contained within every policy wording in Ontario is as follows: “11. In the event of disagreement as to the value of the property insured, the property saved or the amount of the loss, those questions shall be determined by appraisal as provided under The Insurance Act before there can be any recovery under this contract whether the right to recover on the contract is disputed or not, and independently of all other questions. There shall be no right to an appraisal until a specific demand therefore is made in writing and until after proof of loss has been delivered.”
What is an appraisal? Appraisal is to be used to provide a simple, speedy, inexpensive and fair method to determine the fair price, valuation and estimation or worth for lost or damaged insured property, when there is a disagreement between the insurer and the insured on the value of insured property, salvaged insured property and the amount of an insured loss. If it is properly invoked, carried out and awarded, the amount of loss is binding on both the insured and the insurer. The appraisal provision can be invoked by either the insured or insurer.
August-September 2018
BY JOHN VALERIOTE
How does appraisal work? Although appraisals are less formal than arbitration, they are still conducted according to a prescribed flow. To begin the process, a proof of loss must be filed. Essentially, a letter (notice) by either the policyholder or the insurer is all that is required to start the appraisal process. In this letter, the party making the demand formally identifies who will be acting as the appraiser in this process. The other party then has seven working days to appoint its chosen appraiser. Once both appraisers are elected, they move forward with full authority of the respective principals to agree on the amount of loss in accordance with the terms of insurance regulator of that province. If their efforts do not yield a full agreement, an umpire is appointed to settle their differences. It is often required by provincial insurance regulators that within 15 days both sides must agree on an umpire. Alternatively, a judge can appoint an appraiser or an umpire. In situations where an insurer triggers this mechanism and the policyholder refuses to participate in the process, the insurer can petition the court to appoint an appraiser. An itemized decision agreed by two of these three will set the amount of loss. Such award is binding and each party pays its own appraiser and bears the other expenses of the appraisal and umpire equally. www.claimscanada.ca
How does appraisal work?
Process is initiated
Tribunal meeting is held & evidence presented
Decisions are made on two thirds (2/3) majority
The purpose of the appraisal process is to come to a resolution on quantum disputes – the tribunal’s determinations are final and binding. The only time the matter can enter litigation is if there is suspicion or evidence of fraud, collusion or bias, or if the insurance policy contains limitations concerning the expected roles of appraisers that are not followed in the process.
The key players The primary players in the appraisal process are the appraisers, one appointed by the insured and the other by the insurer. The appointed appraiser serves as an advocate for the party they represent and as mediator to ensure a relatively smooth process and mutually beneficial outcome. Unlike arbitration, the use of an umpire is not necessary and is only called for when the two appointed appraisers cannot come to an agreement. The umpire acts to reconcile the differences between the two appraisals and ultimately determines the property’s value. The umpire does not have to establish the property’s value to a specific burden of proof and neither party is obligated to ‘tip the scales’. The umpire simply takes all available information and assesses a value that is usually consistent with the original appraisals. As there is no burden of proof in the appraisal process, there are no evidentiary rules. Essentially both parties agree on the matter by which information regarding the loss is compiled and www.claimscanada.ca
Appraisers are selected
Umpire is selected
Dates are selected for tribunal meeting and for briefs to be exchanged
Parameters are established
Appraisal award is drafted and signed
bring forward validating information or expert testimony. Specialists or experts, including engineers, architects, artists, etc., can play a role in the appraisal process.
Conclusion Through the use of this provision, the valuation process is both streamlined and expedited. Litigation and its associated costs are avoided. The ap-
praisal provision is one of the best-kept secrets within the insurance industry, and its utility in addressing and resolving claim disputes concerning quantum is unequivocal. It is certainly something to consider if you find yourself in a claim tug-of-war. John Valeriote leads the property appraisal practice and handles complex claims at Crawford & Company (Canada) Inc. •
Knowledge And Experience That Has You Covered
Philip Turner TORONTO
Alain Viger MONTREAL
Kevin Copeland CALGARY
Edward Robinson VANCOUVER
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• on the scene OTS Sedgwick has announced several leadership appointments now that its acquisition of Cunningham Lindsey is complete. Terry Deamer will be senior vice-president of finance; Rob Ginn is appointed as senior vice-president of national operations; Gary Dalton is senior vice-president of specialty services; and Laurie Walker is senior vice-president of corporate services. Deamer previously served as senior vice-president of operations for Vericlaim, a Sedgwick subsidiary, and worked together with Holden leading the company’s Canadian expansion. Ginn was vice-president of operations for Vericlaim Canada and has been with the company since its inception in 2016. Dalton was senior vice-president, London market. Walker is an experienced industry professional who previously held the position of senior vice-president TPA operations for Sedgwick in Canada ●
Paul Burns will be joining International Programs Group (IPG) as director of business development. An experienced claims specialist, Paul has worked in both the domestic P&C insurance and Lloyd’s of London markets. Most recently he was director of global business development at a national restoration firm. He will report directly to IPG’s managing director, Patrick Scott. ●
Natasha Pinto has joined DKI Canada as national director of corporate accounts. She will be responsible for the enhancement of innovative client solutions and national operational performance. Natasha will report directly to Lory Perizzolo, senior vice-president, DKI Canada. She brings a wealth of knowledge, with over 14 years of experience in the insurance industry, most recently as director, insurer management services at one of the largest independent adjusting companies in Canada. Natasha holds a Bachelor of Commerce, Honours from Queens University and is working towards her CIP designation. ●
Crawford & Company (Canada), Inc. has launched a staffing solution designed to place Crawford claims management professionals in-house at their clients’ place of business to meet staffing demands associated with unexpected leaves, influxes in work volume or special projects. The Workforce Advantage program was introduced in response to growing workforce demands for specialized expertise in the industry, and to provide an industry solution for clients in need of flexible staffing solutions. Workforce ADVANTAGE is overseen by Carmin Lakhanpal, who joined the company in December 2017, bringing over 14 years of experience in the insurance industry and human resources to the team. Jim Eso, senior vice-president, property & casualty with Crawford Canada, noted that the solution provides clients with on-demand access to a pool of professionals across all insurance disciplines, including auto, property, casualty, short-term and long-term disability, and workers’ compensation. ● 14 Claims Canada
August-September 2018
Gerry Spina, owner of the First General London-Middlesex office for over 16 years, has decided to take a new path in life. Hosain Ebad and Noor Ebad are the new owners of the London-Middlesex office. Hosain and Noor have been working in the restoration industry for several years. Gerry will continue to work with them for an extended period of time. ●
After twenty years in separate businesses, Ken and Doug Woodhouse, of Woodhouse Group Inc., and their brother Jim Woodhouse Jr., of First Response Restorations, are reunited in the disaster restoration industry. Woodhouse Group Inc., a full-service contractor, has acquired restoration contractor, First Response Restorations. This acquisition positions Woodhouse Group Inc. as one of the largest and most experienced disaster restoration and general contractor companies in the Waterloo, Ontario, area. ●
ServiceMaster Restore teamed up with Ronald McDonald House Charities Atlantic as the presenting sponsor for the PJ Walk for Kids. The event took place on June 10th in four locations – Halifax, Charlottetown, Moncton and Saint John. This year the walk raised $230,453 across the Maritimes in support of families with sick children. These funds will help the 2,200 families who stay at Ronald McDonald House and use the Family Rooms each year. “It is very rewarding to participate in the Ronald McDonald House Charities,” said Sienade Earle, a business development representative with ServiceMaster Restore who attended the Halifax event. “We know the importance of helping families get their lives and homes back to normal, and the impact the charity provides those in need is truly amazing.” ●
Jeffrey Chubry has accepted the role of branch manager at Strone Barrie and Bracebridge. Since joining the team as project manager in January, he has provided outstanding customer service and leadership on a Jeffrey Chubry daily basis. He has worked in the construction industry for over 18 years, spending the first 12 as a general carpenter on a large loss crew in the insurance restoration industry. He has also gained valuable experience in Industrial, Commercial, and Institutional (ICI) Construction as a general foreman in both carpentry and heavy equipment roles. Jeffrey and his family have moved from big city life in the GTA to settle on the outskirts of Barrie, beginning a new chapter in their lives. ● www.claimscanada.ca
ing profession. CIAA’s blended learning programs equip independent h the ability to manage all your claim services requirements.
Canadian Independent Adjusters’ Association/ L’Association Canadienne des Experts Indépendants
ice of Independent Insurance Adjusters in Canada
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