Claims Canada April May 2013

www.claimscanada.ca

April/May 2013

Official Journal of the Canadian Indeépendent Adjusters’ Association

Breaking through the

Clichés Customer Service and the Modern Claims Professional

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Contents A P R I L / M AY 2 0 1 3 • V O L U M E 7 • N U M B E R

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Cover Feature 12 Blowing up the Clichés Customer service is a “motherhood and apple pie” issue; everyone is in favour of it, at least in theory. Yet service levels vary considerably by industry, company – and adjusting firm.

Instead of relying on lip service or empty platitudes, modern claims professionals have to embrace a culture of service that emphasizes fairness, expectations and respect.

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BY CRAIG HARRIS

Spotlight 22 Start Up Brampton’s Dara Banga caught the entrepreneurial bug and launched his own adjusting firm, DSB Claims Solutions, just over a year ago. His main weapon? A singular focus on quality and customer satisfaction.

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BY CRAIG HARRIS

Education Forum 40 Testing the Waters For insurers and claims adjusters active in environmental insurance, the definition of liability can be a challenging issue.

News Features 24 Collision Course Car repair facilities are under financial pressure – one estimate suggests that half of all shops could close within ten years.

BY JOHN NORRIS

30 The Cost of Ignorance in Structural Engineering Many investigations into structural failure ignore an important side of the story – the pre-existing condition of the building.

BY DR. FARHOOD NOWZARTASH

32 Risk and the Older Driver

38 What Exactly is an “Accident?”

Conflicting decisions have made the interpretation of an automobile accident for insurance purposes about as clear as mud.

40 The Other Side of the Fence One lawyer argues that Independent Medical Exams are often unnecessary.

BY DARCY MERKUR

34

BY ANGELA VERI

34 The MIG’s Grey Area

BY TAMMIE NORN

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Departments 4 First Notice

Why your future caseload may increasingly include clients 50+ years of age.

A recent challenge to the Minor Injury Guideline raises several questions about what is – and what isn’t – included.

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BY DANIEL STRIGBERGER

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44 On The Scene

Columns 10 President’s Message 42 Education Forum

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• first notice FN Government pledges $53 billion for infrastructure The federal government has allocated $53.5 billion over the next decade for infrastructure across the country, a move that Insurance Bureau of Canada (IBC) has commended.

In the 2013 budget, the Conservative government set out the amount for provincial, territorial and municipal infrastructure over the next 10 years. Infrastructurebased funding highlights include: • $32.2 billion through a Community Improvement Fund consisting of an indexed Gas Tax Fund and the incremental Goods and Services Tax Rebate for Municipalities to build roads, public transit, recreational facilities and other community infrastructure across Canada; • $14 billion for a new Building Canada Fund to support major economic projects that have a national, regional and local significance; • $6 billion in federal support to provinces, territories and municipalities under current infrastructure programs in 2014–15 and beyond;

• $7 billion in First Nations infrastructure, such as roads, bridges, energy systems and other priorities; and • About $10 billion in investments in federal infrastructure assets, including bridges, fishing harbours, ports, military bases and departmental accommodations across the country.

“As severe weather becomes more common in Canada, updated storm and waste water infrastructure is essential for municipalities,” noted Chris White, vice president of federal affairs with IBC. “Because of the devastating human and economic impacts of severe weather, home, car and business insurers have made climate adaptation a top priority. We’re pleased to see the federal government helping fund this vital challenge.” l

Industry posts solid premium growth, lower combined ratio The Canadian property and casualty insurance market saw substantial growth in premiums in 2012, largely because of growth in personal lines, including improvement in Ontario auto results, according to preliminary data from MSA Research.

The industry’s combined ratio for the year came down to 96.7% from 99.5% in 2011 (not including those in the Lloyd’s market and government insurers), according to the firm’s preliminary figures for the year.

Improved accident benefits results in Ontario and lower property losses allowed for the growth in personal lines, Joel Baker, MSA’s CEO, noted.

Improvement in the Ontario auto market was, however, offset by deterioration in third party liability-bodily injury losses, Baker said. The year-end industry loss ratio for private passenger Ontario auto third party liability-bodily injury topped 102%, he added.

On the commercial side, excluding the Lloyd’s market, commercial writers saw their premium shrink by 4.4% in 2012, Baker noted.

Reinsurers also saw their results improve, reporting a combined ratio of 97% in 2011 to 89% in 2012, Baker said. That was in part due to a less severe catastrophe year in Canada, as well as somewhat harder rates on cat exposed risks, he said. However investment income in the reinsurance market dropped, yielding a growth of 12.6% in net income, Baker added. l 4

Claims Canada

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April/May 2013

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• first notice FN OSFI release final earthquake exposure guideline The Office of the Superintendent of Financial Institutions (OSFI) released the final revised version of its Earthquake Exposure Sound Practices (Guidelines B-9) in late February, following public consultations that began last August.

The revised guideline comes from a working group created in 2010 comprised of OSFI and several provincial regulatory partners, including British Columbia Financial Institutions Commission (FICOM) and Québec’s Autorité des marchés financiers (AMF), along with Insurance Bureau of Canada (IBC). The group was formed to “emphasize and strengthen the principles-based approach to managing earthquake exposure” and “update the description of best practices in earthquake exposure management,” according to OSFI. A letter containing a summary of comments received and OSFI’s responses to them are available on its website along with the new guidelines, which takes effect Jan. 1, 2014. In the letter, OSFI has asked all insurers to complete a self-assessment of their practices compared with the new guideline by Sept.30, 2013.

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April/May 2013

“OSFI has refreshed its guidance to reflect the lessons learned and technological changes that have occurred over the past fourteen years,” noted Mark Zelmer, assistant superintendent of the regulation sector. “The revised guideline will help Canadian insurance companies continue to be well prepared for the financial consequences if a major earthquake were to occur in Canada,” he added.

OSFI will continue to work with IBC and provincial regulators on related financial requirements and will incorporate any future changes made to the Minimum Capital Test (MCT) Guideline, it noted. l

Auto collision repair costs to increase: report Software maker Mitchell International Inc. recently released predictions for the property and casualty insurance and automotive repair industries, forecasting lower prices for recycled parts, an overall increase in the cost to repair damaged vehicles and an increased demand for cloud computing.

“The average industry cost to repair auto collision damage will increase,” San Diego-based Mitchell stated in a press release. “This will occur in part, to the softening of salvage values, putting more borderline vehicles in the ‘repairable’ column rather than ‘total loss.’”

The firm predicts “an overall inflation” of parts, price and labour prices this year plus an increase in new car sales.

“Combining these factors with the 250,000 total loss vehicles expected out of Hurricane Sandy will depress salvage car values in 2013,” Mitchell stated. “For consumers, this means that there will be an increase in the availability of recycled parts for vehicle repairs at a lower cost.”

The company also predicts this year that insurance carriers “will begin to consolidate cloud computing vendors and realize the benefits of working with a single provider, such as streamlined and accelerated deployment of new offerings, reduced operational costs and improved data exchange and information sharing.” l

www.claimscanada.ca

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• first notice FN More severe storms predicted for 2013

FSCO nears halfway point of mediation backlog pilot

Forecast services company ImpactWeather has released a prediction for this year’s hurricane season, suggesting that 2013 will have a series of storms more severe than last year.

Based on “averages of past seasons, ocean temperature trends, and the absence of an El Nino influence from the Tropical Pacific,” the company’s senior meteorologist Chris Hebert said this year could have between 16 and 20 named storms.

Last year saw 19 named storms, 10 of which were hurricanes. Hebert has predicted seven to nine hurricanes for this year, but two to four “intense” hurricanes, or those that reach categories three, four or five. Last year saw only one such storm, according to ImpactWeather.

Businesses should be aware of the potential costs from severe storms,, flooding, power outages and other damage, ImpactWeather noted.

“Since weather is the number one cause of business disruption, this prediction carries much weight for companies focused on protecting their people and their assets,” Mark Chambers, president of ImpactWeather commented in a statement.

“Considerations such as when – or even if – operations must be shut down, damage to facilities, supply chain interruptions, and safety protocols are all top-of-mind when severe weather is imminent,” he added. l

The Financial Services Commission of Ontario (FSCO) is reaching the midway point of a six-month pilot aimed at streamlining part of its mediation process and saving mediators’ time.

Effective Jan. 2, the pilot program allows the parties involved in mediation who have already been assigned mediation dates, or who have files more than 50 days old, to go through one e-mail address to request rescheduling or adjournment.

“We introduced this pilot project to ensure primarily that we could continue to clear the backlog as quickly as possible while still offering mediation within the required 60 day timeline,” said Kristen Rose, a spokesperson for FSCO. The commission’s mediation backlog is significant, and it has been working to address it for some time. Last September, FSCO began assigning up to 2,000 files per month to private vendor ADR Chambers to help reduce the backlog. For 2012, the mediation backlog was 17,540 and the average wait time for mediation was 414 days. l

Paul Aquino Publisher (416) 510-6788 paul@canadianunderwriter.ca

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Subscription inquiries (416) 442-5600 • 1-800-668-2374 Fax: (416)Indeépendent 442-2191 Official Journal of the Canadian Adjusters’ Association

www.claimscanada.ca Produced by the publishers of Canadian Underwriter magazine

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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Claims Canada

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April/May 2013

Gary White Production Manager (416) 510-6760

and claims adjusting personnel; corporate risk managers and loss control professionals; insurance brokers; insurance law firms; forensic engineers and accountants; appraisal, restoration, rehabilitation and collision repair professionals; Insurance Institute chapters; insurance associations, regulators and related claims market recipients.

The contents of this publication may not be reproduced or transmitted in any form, either in part or in full, without the written consent of the copyright owner. Nor may any part of this publication be stored in a retrieval system of any nature without prior written consent.

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Message from the President La Plume du Président JOHN D. SEYLER

Spring is upon us in Canada and we can all shed those heavy winter clothes and put away the snow shovels. I can already hear the smug comments of those on the Pacific coast chiming in about spring arriving two months ago and flowers in bloom. I suppose I can only speak for my personal happiness at the winter being over as my travels in February and March involved the winter storms our country is famous for.

In February, I was in Quebec at the invitation of Claude Nadeau, President of Association des Experts en Sinistres Independants du Quebec (AESIQ) – the Quebec affiliation of the CIAA. I attended one of their signature events “Sugar Shack,” which is a traditional Quebec celebration in St. Eustache at a local sugar bush (for photos, check out the On the Scene section). By the time of my arrival, the snow had been dealt with.

I have to admit that as an Anglophone I was intimidated to be attending this event, but that quickly disappeared when I entered the room to a warm welcome by AESIQ Executive Director Sandra Ross. The room was buzzing with conversations of old friends and colleagues happy to have a reason to visit and catch up. While it is clear to me there is a distinct cultural difference between Quebecers and the rest of Canada, we are more similar than we care to admit. Claude and I discussed the need to ensure benefits of membership are expanded in Quebec and ensure that we recognize the different needs of their adjusters.

I am looking forward to returning the warm hospitality Claude extended to me at the AGM and National convention in Banff, Alberta in September 2013. The dinner was traditional Quebec fare with eggs, ham, cretons and sugar pie. I was lucky enough to receive two large packages of Maple syrup products to take home and enjoy. It was a real Canadiana experience!

The second weather encounter I enjoyed was during the Western Region CIAA/CICMA Educational Seminar in Edmonton. It was one of the largest snow storms of the season on the day of the seminar. Despite this the Albertans dealt with it with the usual western resilience I became accustomed to when I lived in Calgary. It was not unlike my earlier experience in Quebec. I couldn’t help but think the Greater Toronto Area would have shut down for such a storm. The seminar was well attended and I was hosted by Doreen Lennon of Townsend & Leedham Insurance Adjusters and Reid Townsend of Canadian Claims Service. The organizing committee did a great job and the presenters were excellent. Angela Kos of Brownlee reviewed changes to the Alberta Insurance Act. President of the CICMA Northern Alberta Chapter, David Sorenson delivered an in depth review of the Inter Company Settlement agreement and Arbitration process. He put the audience through their paces and we worked through scenarios to apply the fundamentals of 10 Claims Canada

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Le printemps est à nos portes; alors finis les vêtements encombrants de l’hiver et les pelles à neige. Je peux déjà entendre les commentaires de nos confrères sur la Côte du Pacifique en vantant l’arrivée du printemps deux mois auparavant avec son lot des fleurs. Je suppose que je ne peux parler que de ma joie personnelle à propos de la fin de l’hiver sachant que j’ai dû voyager en février et mars en bravant ces tempêtes qui font la renommée de notre pays.

En février, j’étais à Québec à l’invitation de Claude Nadeau, président de l’Association des experts en sinistres indépendants du Québec (AESIQ) qui est l’affiliation de CIAA au Québec. J’ai assisté à un événement très populaire au Québec : la Cabane à sucre. C’est une fête traditionnelle qui a eu lieu dans une érablière locale à St Eustache. À mon arrivée, le problème de la neige était déjà réglé. Je dois admettre qu’étant anglophone, j’ai été un peu intimidé à l’idée de participer à cet événement, mais ce sentiment s’est rapidement dissipé par le chaleureux accueil que m’a réservé le directeur général de l’AESIQ dans la salle. La salle bourdonnait du bruit des conversations d’anciens amis et collègues qui étaient heureux de trouver une raison à leur visite et de se mettre au fait de l’actualité. Je pense qu’il y a une nette différence culturelle entre les Québécois et le reste du Canada; néanmoins, nous avons beaucoup plus de similitudes que nous ne voulons l’admettre.

Claude et moi avons discuté de la nécessité de généraliser les avantages des adhérents au Québec et de reconnaître les différents besoins de leurs experts en sinistres. J’ai hâte de retourner l’hospitalité chaleureuse que Claude m’a réservée lors de l’assemblée générale annuelle et la convention nationale qui a eu lieu à Banff en Alberta au mois de septembre 2013. Le déjeuner se composait d’un plat traditionnel québécois : œufs, jambon, cretons et tarte au sucre. J’étais chanceux de recevoir deux grands emballages de sirop d’érable que j’ai emportés chez moi pour déguster. C’était une expérience canadienne par excellence!

La deuxième expérience relative au temps que j’ai appréciée je l’ai vécue lors du séminaire sur l’éducation de l’ACEI et de l’ACDSA, région de l’Ouest, à Edmonton. Ce jour-là, nous avons eu l’une des plus grandes tempêtes de neige de la saison. Mais cette tempête n’a pas perturbé le rythme des Albertains qui l’ont surmontée grâce à leur habituelle résilience de l’Ouest que j’ai appris à connaître lorsque j’habitais Calgary.

C’est une expérience tout à fait différente de celle du Québec. Je n’ai pu m’empêcher de penser qu’une tempête de cette ampleur aurait paralysé la région du Grand Toronto. Le séminaire a vu la participation d’un grand auditoire et j’étais accueilli par Doreen Lennon de Townsend & Leedham Insurance Adjusters et Reid Townsend de Canadian Claims Service. Outre le bon travail du comité organisateur, les présentateurs étaient excellents. Angela Kos de Brownlee a passé en revue les modifications apportées à l’Alberta Insurance Act. Le président du chapitre du nord de l’Alberta de l’ACDSA, David Sorenson, a fait une analyse approfondie de la Convention canadienne d’arbitrage inter-sociétés et du processus d’arbitrage. Il a mis à l’épreuve l’auditoire en l’invitant à faire des exercices sur des scénarios visant à appliquer les notions de base de la séance. La séance de l’après-midi a été consacrée aux réclamations relatives à la sécurité de l’expert en sinistre et à l’environnement.

L’ancien président de l’ACEI, Greg Merrithew, et Barry Rakewich de www.claimscanada.ca

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the session. The afternoon session was on Adjuster Safety and Environmental claims. CIAA Past President Greg Merrithew and Barry Rakewich of Nicholls Environmental presented on their respective topics. It was another example of the wonderful relationship between CIAA and the CICMA. Special thanks to the various vendors that presented during the lunch hour tradeshow!

The common experience between both events was neither my friends in Quebec nor their western counterparts appreciated the recent success of my Toronto Maple Leafs. The secret to Canadian unity may be the general disdain for Toronto sports teams.

The cultural similarities between our various regions are not unlike our industry wherein independent adjusters are similar to all adjusters, but we face our own challenges. I was reminded of this recently when an examiner friend of mine was questioned by his manager for working on a weekend with the comment “Working on a weekend? Do you think you are an independent adjuster?” While I believe all independents understand after hours work is one of the mainstays of our business, insurers must realize we need to be factored into their business models for regular business as well – or we will not be around.

I believe that some insurers appreciate this and build their business plans to include outsourcing but this must be maintained and expanded or else the 24/7 service and the catastrophe response they rely on from independent adjusters will disappear.

Insurers must understand and help to preserve the cultural difference of our profession in order to ensure the public is served and protected. n

Nicholls Environmental, ont exposé leurs sujets respectifs. Ce fut un autre exemple de la relation extraordinaire entre l’AECI et l’ACDSA. Je remercie particulièrement les différents fournisseurs qui ont fait des présentations durant le dîner au salon professionnel!

Le point commun entre les deux événements réside dans le fait que ni mes amis au Québec ni leurs homologues de l’Ouest n’ont apprécié le récent succès de mes Maple Leafs de Toronto. Le secret derrière l’unité canadienne réside dans le mépris général à l’égard des équipes sportives de Toronto.

Les similarités culturelles entre les diverses régions nous font penser à notre secteur d’activité où nous constatons une ressemblance entre nos experts en sinistres indépendants et tous les experts en la matière, sauf que chaque catégorie de professionnels a ses propres défis à relever. Cette situation m’est venue à l’esprit récemment lorsqu’un ami examinateur a été questionné par son directeur au sujet du travail en fin de semaine qui a fait le commentaire suivant : « Vous travaillez en fin de semaine? Vous pensez que vous êtes un expert en sinistre indépendant? » Je crois que tous les experts en sinistres indépendants sont conscients du fait que le travail pendant les heures supplémentaires est l’un des principaux piliers de nos activités; toutefois, les assureurs doivent admettre que leurs modèles opérationnels doivent également tenir compte de nos activités normales, sinon, nous serons exclus du jeu. Je crois que certains assureurs apprécient ce point de vue et élaborent leurs plans d’affaires en tenant compte de l’impartition, mais cela doit être maintenu et élargi, sinon le service 24 heures sur 24 et l’intervention en cas de catastrophe sur laquelle ils comptent de la part d’experts en sinistres indépendants.

Les assureurs doivent comprendre et contribuer à la préservation de la différence culturelle de notre profession, et ce, afin de garantir les services et la protection du public. n

NATIONAL EXECUTIVE 2012-2013 2011-2011 PRESIDENT John D. Seyler, CIP ProFormance Group Inc. 5080 Timberlea Blvd., Suite 214 Mississauga, ON L4W 4M2 Phone: (905) 238-4985 • Fax: (905) 238-2735 E-mail: jseyler@prospecialty.ca 1ST VICE-PRESIDENT 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 2ND VICE-PRESIDENT 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 SECRETARY 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

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TREASURER Russell Fitzgerald, CIP Kernaghan Adjusters Limited 203 – 4246 97 Street N.W. Edmonton, AB T6E 5Z9 Phone: (780) 488-2371 Fax: (780) 488-0243 E-mail: rfitzgerald@kernaghan.com

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

PAST-PRESIDENT Greg G. Merrithew, CIP, FIFAA Arctic West Adjusters Ltd. 201 – 5204 – 50 Ave. Yellowknife, NT X1A 1E2 Phone: (867) 920-2212 Fax: (867) 873-2244 E-mail: gregm@arcticwest.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@graniteclaims.com

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 Craig J. Walker, CIP, FCIAA, FIFAA Maltman Group International 3550 Victoria Park Ave., Suite 301 Toronto, ON M2H 2N5 Phone: (416) 492-4411 Fax: (416) 492-5657 E-mail: cwalker@maltmans.com

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• cover story

Breaking

through the

Clichés

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Customer service is a “motherhood and apple pie” issue; everyone is in favour of it, at least in theory. Yet service levels vary considerably by industry, company – and adjusting firm. Instead of relying on lip service or empty platitudes, modern claims professionals have to embrace a culture of service that emphasizes fairness, expectations and respect.

BY CRAIG HARRIS

s

top me if you’ve heard (or used) these ones before: • We provide excellent customer service; • We want to be number one in customer service in this industry; • The customer is always right.

Nowhere it seems do stale truisms and meaningless bromides gather more frequently than in the world of “customer service.” Companies spend endless hours and dollars on consultants to improve service levels, yet the results are often marginal to non-existent. Typically, projects designed to bolster and measure client satisfaction come and go with the latest management fads.

Worse still, a reliance on convenient standbys and clichés can mask a poor culture of service and allow companies to avoid the real work of reconfiguring the business to actu-

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ally better serve the customer. So the pressing question becomes: How can companies truly embrace a culture of customer service and ensure meaningful commitment from senior management and employees?

That was the main theme of this year’s 46th annual CICMA/CIAA Ontario Chapter joint conference held February 5 in Toronto. Entitled Customer Service: The Good, The Bad and the Ugly, the event featured three dynamic speakers – Carl Van, president & CEO, International Insurance Institute; Brian Maltman, executive director of the General Insurance OmbudService (GIO), and Stephen Scullion, branch manager, Granite Claims Solutions.

Van, whose firm provides training and support to claims environments, gave a lively and iconoclastic presentation on why customer service is im-

portant to claims. In fact, he argued, customer service is claims.

“Customer service is what we do. It is all we do,” Van observed. “We don’t actually do anything other than serve customers. We don’t build anything.

We don’t make anything. Do we fix peoples’ cars? Somebody else does that. We arrange for that to happen.

That is customer service. What we really do is help people and all the other things are tasks we do to achieve that.”

He noted that his firm has been asked by nine insurance companies in Canada to help them with customer service – “they all want to be number one customer service providers in the insurance industry, so I guess there is a nine-way tie right now,” he joked.

However, when Van met with the senior managers at these insurers, his response was simple: “you’re shooting way too low.” Why?

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“Because the insurance industry does not have a stellar reputation for customer service,” he said. “We are not among the elite; we are in the middle. We are not up there with Disney and Ritz-Carlton. If you say we want to be the number one insurance company, that’s like bragging that you are the healthiest person in the emergency ward. You have to do something different. You have to find out what the truly extraordinary customer service companies do and start doing what they do.”

Van explained the “five standards of great service companies” as critical measures for firms in the insurance industry to emulate.

1. They know why they’re great One of the first things Van asks when he visits insurance companies is how they know if they’re offering great customer service. Most companies immediately quote their customer satisfaction rate. “Surveys are great if they

tell your company it is getting better or worse,” Van said. “But if you hang your hat on the fact that the number means anything, you may be lulling yourself into a false sense of security.”

If a company’s satisfaction rate is 93%, for example, what does that really mean? What are competitors’ satisfaction rates? What is the client retention rate? Van cited a Harvard Business Review study that showed 68% of customers who say they are satisfied or very satisfied will leave a company.

“Retention rate is important,” he said. “You may have a good satisfaction rate, but a lousy client retention number. So your customers are happy, but they are leaving. What you have to figure out is what makes people stay versus leave. And customer satisfaction ain’t it.”

2. They know where they stand Van is often surprised that senior managers of a company don’t know what their retention rate is.

“If your whole reason for saying you’re great is your retention rate and you don’t know it, what does that show?” he asked. “At great service companies, everybody knows why they are great and everybody knows where they stand, not just the senior management. If the employees are carrying out the instructions of customer service, they have to know where they stand. Where are we right now?”

Van used the example of a professional NBA basketball player. “That player might say, ‘I am a great basketball player,’ and you ask, ‘well, how do you know? What is your shooting percentage, your rebound percentage, points per game?’ If he doesn’t know, maybe he isn’t that great.”

3. They know where they are going Implicit in this standard of customer service for elite companies is the understanding that customer service is not a “once and done” project,

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but rather a continuous commitment. As such, it means companies; if you ask every employee what their job is, that service levels are constantly measured and projected they say ‘I provide customer service first’ and then they list into the future, with meaningful targets for improvement the tasks. Is that important? Well, a lot of people say they and innovation. won’t do something if it’s not their job.”

“Truly extraordinary service com5. They know what customer panies say – ‘we have a great retention service is rate. Here is where we stand now. And “Imagine a company saying, ‘we here is where we are going to be next are great at customer service,’ and year,’” Van noted. “Every employee has You have to find they don’t even know what it is,” Van to be brought into that process.” out what the said. “Customer service is meeting or 4. They can accurately describe exceeding their expectations. It is not truly extraordinary their jobs about the customers’ needs or their customer service Pretend someone doesn’t know wants – but their expectations. If you anything about claims and asks: ‘what meet peoples’ expectations, they are companies does a claims adjuster actually do?’ satisfied. If you fall short, they are disdo and start doing What would be your response? Van satisfied. That is pretty much all there what they do. actually asked audience members and is to it.” the answers trickled out – answer the “You can’t necessarily make them phone, take statements, visit the client, happy, but you can meet their expecnegotiate, arbitrate, pay claims, etc. Fitations,” he added. “Loyalty depends nally, someone mentioned it – ‘to serve much more on people getting what the customer.’ they expected, rather than whether they were satisfied.”

“Our job is to provide customer serIf the discussion of service standards at elite companies vice but the problem is we don’t describe ourselves that way. seemed a bit esoteric, Brian Maltman of the GIO talked We describe our jobs in terms of our tasks,” Van noted.

“That is the difference with truly extraordinary service directly about the very real-life nature of customer com-

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plaints in the p&c insurance industry.

The GIO, which has been resolving consumer disputes since 2003, has a grass-roots view of customer service.

Maltman noted that half of all calls into the GIO were claims-related, with liability disputes leading the way.

“I think, in general, 95% of the time the industry gets it right; it is the other 5% that represents the bleeding edge,” Maltman observed. “In the consumer head space, we often hear things like: ’the adjuster did not listen, did not get back to me, was unfair … I felt powerless.’ And this is often what leads to anger. Now, did you hear anything about insurance in this?”

In fact, Maltman demonstrated a mini-case study during the presentation involving an auto insurance claim to illustrate how the GIO handles customer disputes. The technique involves creating and meeting expectations (such as calling a customer back when you said you would), patience (allowing customers to compose themselves), self-deprecating humour (making light of yourself, but not the situation), validation (showing empathy with a customer’s frame of mind, but not getting stuck in a trap of agreeing with untrue or unreasonable statements) and creating trust.

Can the Customer Be Put At Ease?

“Then and only then is the customer willing and able to hear a message that contains bad news,” Maltman explained. “In other words, she was put at ease. If you take nothing else away from this presentation, remember those five words: she was put at ease. Ask yourself this question: what frame of mind does a person need to be in order to absorb our message?”

He said that customer service standards and dispute resolution techniques are sometimes perceived by claims adjusters as soft skills. “Maybe some of you are thinking, ‘here is that soft skill stuff again, haven’t we beaten that to death,’” Maltman noted.

“No, we haven’t because if we had, we (GIO) wouldn’t be here.”

He explains that there is a technical and legal mindset in the insurance 18 Claims Canada

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industry, in which problems and disputes are perceived to be solved in a complex environment within a fixed timeframe – “if only they would let us close the claim file in two phone calls flat.”

“I often feel the gravitational pull of the technical solution,” Maltman observed. “I sometimes think that the type of consumers who respond to (our) approach are, well, high maintenance. But then I listen to our (customer satisfaction centre) staff and I realize just how important this is. They do use this stuff, it is what gives them

If people feel they are being listened to, respected and treated with patience and kindness, that translates into fairness in the consumer’s mind.

their batting average, it is what builds bridges to a closed file. I confess that after five years with GIO I am astounded at just how successful it is. And if it works for us, there is absolutely no reason it shouldn’t work for you.”

Fairness as an Emerging Principle Another vital principle in customer service – one that is emerging more prominently on a global scale – is fairness, according to Maltman. He explained that in 2011, the finance ministers from the G20 countries asked the Organization for Economic Cooperation and Development (OECD) to develop high-level principles for

financial consumer protection. Consumers should be able to have mechanisms that are accessible, affordable, independent, timely, efficient – and fair.

“Then (the OECD) said something that really put it into perspective for me,” Maltman noted. “They linked consumer confidence to financial stability; consumer confidence on an individual level to financial stability on a global scale. So, if fairness is so important at this high lofty level, where do we find it?”

He cited one example of a new group called the International Network of Financial Services Ombudsman (INFO), which is working on developing a set of international principles for complaint handling in all financial services. “This stuff is current for finance ministers in governments all over the world,” he said.

The principle of fairness can also be driven home on a company-bycompany level in the p&c insurance industry in Canada, according to Maltman.

“We are dealing with issues such as: ‘it may be legal, but is it fair?’ What we have learned is that customer service has as much to do with recognizing the customer’s need for communication and understanding as it does with money,” he said.

“Fairness, or going that extra distance, is not just about throwing money at the problem. If people feel they are being listened to, respected and treated with patience and kindness, that translates into fairness in the consumer’s mind. It doesn’t have to cost more money; we see that every day,” Maltman noted.

Good Faith and Bad Faith The “legal” aspect of customer service, in terms of insurance companies and claims adjuster upholding duties of good faith and avoiding findings of bad faith, was dealt with by Stephen Scullion. He noted that legal definitions and principles can “force you to be nice; you don’t want to be nice – well, I am afraid that you have to be nice.”

“An adjuster’s job is to properly indemnify the insured as per the prowww.claimscanada.ca

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visions of the insurance contract,” Scullion said. “How and when you communicate, convey and apply these provisions to a claim separates good adjusters from, well, the not-so- good adjusters. Failure to do so may lead to the actionable claim of bad faith against the adjuster and/or insurer.”

He used a legal definition of good faith as “an implied covenant of fair dealing in every contract that neither party will do anything which injures the right of the other to receive benefits of the agreement.”

Specifically, Scullion enunciated the “five commandments of good faith” in contractual relations, as enunciated by Justice Forget. These include: • the insurer should refrain from nullifying the reasonable expectations of the other party created by the contract; • the insurer owes the insured a duty of fairness and a duty to be prompt in handling and assessing the loss; • the insurer owes the insured a duty of fair dealing which includes payment in a timely fashion; • the insurer must give as much consideration to the insured’s welfare as it gives to its own interests; and • the insured is dependent on the insurer to undertake adequate investigation and proper evaluation of claim expeditiously.

To avoid bad faith claims, the antithesis of good customer service, insurers and adjusters should also follow some prudent guidelines, according to Scullion.

“Be aware, diligent and proactive so that your file is your strength, not your weakness,” he warned. “To be safe, work on the real possibility that your file contents will be seen by the whole world. This will force you to keep a tight file with limited opinions in it and it will guide your conduct as you investigate.”

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agent wanted to know the status of the claim.

“The adjuster said, ‘it is not on my list, call the 1-800 number and report it, they will take care of it.’” Van recalled. “Now, did that adjuster provide outstanding customer service? Of course not. She could have taken care of it; there weren’t any rules around that. So I asked her, ‘why didn’t you take the call?’ She wasn’t lazy, she was

404

Culture of Customer Service While legal principles protecting the insured/customer are important, Carl Van asserted that real customer service is more about creating a cultural change within an organization. Through his consulting

firm, the International Insurance Institute, he often monitors telephone calls to and from employees to gauge levels of service for a specific company.

Van used the example of an adjuster receiving a telephone call from an insurance agent, who was inquiring about a loss report that was sent in to the company’s 1-800 number. The insured had not been contacted, so the

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there until 6 p.m., She said: ‘it’s not my job.’ So she described her tasks, but guess which words never left her lips: customer service. She didn’t know she was in the business of customer service. She was under the illusion that she was a claims handler.”

These types of examples abound in Van’s work on customer service with insurance companies and claims adjusters. “So here’s the challenge – get your adjusters and claims people in a room and see how they describe their jobs,” Van advised. “If the words ‘customer service’ don’t come up, you know you have a problem. If (your employees) don’t know what customer service is, it is very unlikely they are delivering extraordinary customer service. They will make the same decision as that adjuster.”

Van made it clear that he didn’t single out the adjuster at the company for blame or embarrassment.

Instead, he put the onus squarely on the managers or the trainers for that position.

“I get this a lot from companies who call me and say, ‘you need to fix our peoples’ attitudes,’” Van noted.

If customer service is important, then you damn well better be talking about customer service.

“They can’t all have the wrong attitude. That is impossible. As a group, the only attitude they could possibly

have is their interaction and training with senior management. That’s it. You can have one bad apple. But as a group, that is impossible to have the wrong attitude. Don’t blame them.”

Instead, Van turns the mirror around and asks how senior management approaches customer service.

“The first thing I say to executives is: ‘you have to start here,’” he explained.

“You can’t come in once every six months and talk about the customer and leave. If customer service is important, then you damn well better be talking about customer service. Make that part of your culture.”

In the end, Brian Maltman may have had the most telling message for claims adjusters on the topic of customer service.

“I invite you to take those words, ‘closed file,’ which we view as a nirvana in our industry, and substitute, ‘satisfied customer,’” Maltman concluded. “If you do that, it starts to change the way you think.” 

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NAVIGATE YOUR WAY TO VICTORIA BC ON OCT 6–9 2013 TO DISCOVER THE FUTURE OF RISK MANAGEMENT. The BC Chapter is excited to invite you to a city proud of its rich heritage, historic downtown, gorgeous gardens and parks, and scenic Inner Harbour. It’s the perfect backdrop for this voyage of discovery, chart your course for 2013 RIMS Canada Conference in Victoria, BC. The organizing committee has its sails fully furled as it navigates past the buoys marking the final months. Our program committee is putting together an exciting nautical map with ports of call at ERM, Claims, Legal and Insurance, with 25 concurrent sessions over 6 blocks.

Our exhibit hall is already 75% full; be sure to meet your friends and colleagues on the exhibit hall floor starting on Sunday. Tuesday night’s first port of call is our Rose Compass Reception followed by the Discovery Regatta.

The Convention Centre is connected to the historical Fairmont Hotel overlooking the pictureseque Victoria Inner Harbour. There are six conference hotels, Fairmont Empress Hotel, Marriott Inner Harbour, Hotel Grand Pacific, Executive House, Inn at Laurel Point, Chateau Victoria Hotel & Suites; all accommodations are within walking distance.

Look to our website www.rimscanadaconference.ca for all the latest information. The local organizing committee and all our volunteers look forward to seeing all delegates and industry partners.

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• spotlight S

Start Up

Brampton, Ontario’s Dara Banga caught the entrepreneurial bug and launched his own adjusting firm, DSB Claims Solutions, just over a year ago. His main weapon? A singular focus on quality and customer satisfaction.

BY CRAIG HARRIS

A

fter lengthy working stints as an adjuster at both the insurance company and adjusting firm level, Dara Banga decided to start his own operation in a very competitive marketplace. When asked why, his response is clear and direct.

“I have an entrepreneurial background,” says Banga, who opened DSB Claims Solutions in January 2012. “The timing was right for me to branch out on my own and to pursue my passion and dream.”

He has combined his skill sets as a property and transportation loss adjuster with a perceived need for a truly service-oriented approach to customer satisfaction in property and casualty insurance claims. The result is a boutique firm based in Brampton, offering inde22 Claims Canada

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pendent adjusting services across a geographic territory that spans a sizeable chunk of Ontario – from Niagara Falls in the south to Bracebridge in the north and from London/Goderich in the west to Peterborough/Cobourg in the east.

“I had a vision for the firm,” Banga says. “There was a need in the market for a specialty boutique firm that focuses on quality adjusting and customer service.”

While working for large national firms offered a crucial opportunity to gain experience and knowledge, Banga says the day-to-day grind of volume adjusting took a toll.

“I found that claims adjusting for a national firm was all about quantity, at least that was the situation for me,” he notes. “I was the top producer for my previous firm, I was always very busy, I

was working 6-7 days a week and doing a lot of after hour claims – it affected my family life. It can be a very demanding and intense job at times. So I felt that it was time that I use my entrepreneurial drive that I always had and start my own firm.”

Banga says property and transportation loss adjusting is his specialty, with his firm concentrating on property and transportation claims no matter the size or complexity. “At my previous employer, a majority of what I did was property and transportation claims. I consider myself a specialist, covering any kind of property or transportation losses.”

A critical part of that specialization is continuing education. With a FCIP, Banga also has a Certified Fire and Explosion Investigator (CFEI) certificawww.claimscanada.ca

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tion from the National Association of Fire Investigators (NAFI). In addition, he is Exactimate trained and he has completed several technician programs through the Institute of Inspection Cleaning & Restoration Certification (IICRC), including fire, smoke, water, applied microbial and applied structural drying.

“For a specialty firm, continuing education is key,” he notes. “Professional development has to be an ongoing commitment and investment in you to become a better adjuster. For me it’s simple – the more education, the more qualified and experienced you are.”

“We are also a very innovative firm,” Banga adds. “We utilize the latest in claims management software and tools.

Our claims management system allows our business partners to view their claims in real time. Insurers are also able to upload claims assignments and documents via our website.”

Customer service, however, is where Banga really wants to stand out from the crowd. He notes that DSB Claims Solutions has a couple of features that distinguish it from other adjusting firms.

“I do several things differently,” he explains. “First, I offer a customer satisfaction guarantee. There is no other adjusting firm in Canada that offers the same guarantee or anything close to it. That is, if you are not fully satisfied with my services, I am not going to charge you my fees. I believe we need to be more accountable as independent adjusters, given the changing and competitive marketplace.”

While to date Banga has not had to waive any fees, he says that the satisfaction promise is a lot more than window dressing. “At DSB we don’t just talk the talk, we walk it. I stand behind the guarantee and it’s on our website and marketing materials,” he observes. “It is there because we want and value longterm relationships and partnerships with our business partners.”

Another point of differentiation for DSB Claims Solutions is a brief but informative claimant satisfaction survey done after every covered loss. The poll asks eight questions about communication, courtesy, efficiency and level of service, which is then sent to the insurance company at the end of the claims process. www.claimscanada.ca

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“We use this as feedback and a benchmark for our performance because we are constantly trying to improve what we do,” says Banga. “We know we can’t please everyone every single time, but we try our best. No other adjusting firm that I know of offers this survey. We stand behind our services, and we want the insurer and the broker to know we have done an excellent job representing them.”

The final question in the claimant satisfaction survey is telling: Based on the handling of the claim, would you renew your insurance policy with your insurance company or broker? “That is a very important question in terms of customer satisfaction and retention,” he notes. ”As an independent adjuster, I know that insurance satisfaction levels

Dara Banga: Passionate about adjusting are closely tied to the quality of claims experiences. Every touch point for us represents an opportunity to earn a customer for life for our business partners and we need to be mindful of this. That is why we work to build close relationships and partnerships with insurers and brokers.”

Yet another distinguishing characteristic that DSB Claims Solutions recently introduced is a flat fee for mileage and travel anywhere in its service area.

“We want to make it easier for our business partners to do business with DSB Claims Solutions and our goal is to be their only adjusting firm,” Banga says.

“These travel rates are unheard of in the industry, because as you know, most trips require much more travel time than what we are now charging. I know it is a wide area, but we love claims.”

That is a good thing, given that DSB Claims Solutions’ staffing level is lean and

mean – with Banga as the principal adjuster and two administrative assistants.

He says he will be bringing on more staff as the business continues to grow. “I am very selective; I have high standards for myself. I have to find the right adjusters that fit with my vision and brand.”

In fact, Banga has some very specific ideas about the key traits that independent adjusters must possess to succeed in a pressure-filled environment. “You have to be able to manage your time well, be dedicated to the job in terms of time commitment and you must love what you do. If you get a call at 3 a.m., you need to assist the insurer and service the policyholder. That means you have to focus on customer service to policyholders and insurers. As adjusters, we have to walk the line between both.”

These unique, even rarified, characteristics of adjusters pose a big-picture challenge for the independent adjusting profession – recruitment and training.

Banga says one of the central concerns for loss adjusting in general is the dearth of newcomers to the industry.

“There is a clearly changing demographic in the industry, where baby boomers are retiring and not a lot of newcomers and younger people are entering the profession,” he observes.

“This represents a very real skills gap we are facing. As a profession, we need to invest in young people through education, job experience and mentoring.”

Getting more involved with associations as a volunteer and spokesperson is something that Banga says he relishes in the months and years ahead. ”I constantly tell people that it is a great industry to be part of,” he notes.

“In the future, I plan to be more involved in the industry going forward through the OIAA and the CIAA. I want to give back to the industry that I am passionate about, and these associations are really the voice of the independent adjuster, provincially as well as nationally.”

The role of ambassador for the adjusting profession is in many ways a natural fit for someone who clearly loves the work.

“I am passionate about adjusting,” Banga concludes. ”I love what I do and I am driven by helping policy holders turn a negative event into a positive experience.”  April/May 2013

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Car repair facilities are under financial pressure – one estimate suggests that half of all shops could close within ten years

BY JOHN NORRIS

T

he Financial Services Commission of Ontario (FSCO) reported that medical assessment and remediation clinic costs have risen some 158% in the last five years. Much of that increase has been reported as fraudulent activity, with phony billings identified as one of the main causes driving up the price of consumer auto insurance premiums.

While that was happening, however, the price that insurers paid to repair a damaged vehicle had actually done the reverse. That price is now 1% lower, on an aggregate basis, than it was in 2004.

In the last eight years, collision repair shops have faced several obstacles.

Hourly door labour rates have not kept pace with inflation. Most shops advise us that they are receiving from $52-56 per-hour payment rates from insurers (compared to most mechanical repair shops at over $80 per hour). Insurers can also use their marketplace dominance to simply ignore that labour rate posting.

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One insurer then takes a further up to 5% “fee” from the cheque they send to the shop to pay for the completed repair.

If you compare these Ontario figures to Manitoba’s public insurer collision repair door labour rate of $66.69 per hour, you can see the difference in just the next province.

Some insurers favor Direct Repair Programs (DRP). Here, collision repair shops have lowered their labour rates and offered other services in return for the hope of more insurance repair business volume.

Cost increases above the cost of inflation range from fuel surcharges to uniform and laundry bills to 5-8% price increases yearly in paint product purchases. In addition, there are often yearly additional equipment costs, increased demands for funds to meet regulatory compliance issues and increased retention of staff costs.

Insurer demands for extra unpaid work, photographs, imaging, paperwork, priority repairs and, in some cas-

es, rental vehicle costs continue to burden shops with a greater financial load.

And then there are the cars themselves. Complexity of vehicle design, vehicle construction changes, new materials and compounds used to make the cars today require extra ongoing training. The increased use of electronics in vehicles means that the shop needs more repair and diagnostic equipment for proper and safe vehicle repair – but with little money to pay for this.

Meanwhile, insurance company parts procurement programs have made proper and safe vehicle repairs more difficult. Shops fear that aggressive insurance-driven parts procurement will be the final “nail in the coffin” that eventually will reduce their profits to the point that the shop can no longer stay in business.

Shops are pulling out their collective hair with the frustrations of aggressive insurer parts procurement programs. Most think this is a process designed to drive down their profits to the level of a 10% handling fee, rather www.claimscanada.ca

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than their normal parts profit, and obligate them to provide that profit to insurers. The only profit left for shops today is in the parts they needed to repair the damaged vehicle – and that is now disappearing.

Shops that belong to insurer parts procurement programs must buy their parts from suppliers that they do not know, have no history with and often are not in their own area. Repair facilities often do not know when those parts will now show up on their doorstep, so repair scheduling and planning is difficult if not impossible. Parts dealers, understandably, are upset that their long time costumers are no longer allowed to buy from them, even though they can sell the same parts at the same price or cheaper and deliver immediately.

For example: A shop in Sault Ste. Marie is buying from a parts dealer across the road. On their insurerdriven parts procurement program, that shop is now forced to buy the same part from a dealer in Newmarket – even though it is the same price.

An immediate parts delivery is replaced with a four to five day wait for hopefully the correct and undamaged part.

Why? Because the insurance-approved selling dealer is providing an additional fee (up to 3%) off the price of the part to the insurer. Meanwhile, some shops are also asked by the insurer to pay for vehicle rental costs while the vehicle is waiting for those distant parts.

Another example: A shop has been buying for its favorite parts dealer for years and has obtained a 30% profit margin on the part. Under a new insurer parts procurement program, the shop in this case still buys from the dealer, but its profit margin is now 27%, as the insurer takes the additional 3% as a fee.

In the past, when shops were faced with an insurer demanding aftermarket parts, they could “price match” and obtain Original Equipment Manufacturer parts that were crash-tested and designed for that car, for the same quoted price. Today, parts procurement software does not allow that to be available for the shop.

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Shops that have electronic parts ordering systems are forced to use additional insurance company demanded parts ordering systems as well. Those that want to continue to buy parts from their local supplier are told that they must now demand that the supplier pay the insurer a fee of 2% on ordered parts in order for that shop to continue to buy from them. Some worry that they may be in violation of federal Competition Act requirements with that demand.

Today, shops find that the collision damage estimates they generate are

Insurance parts procurement programs also demand that the shop allow a third party to take their data each day from their computer – without a strong guarantee that the information is not being used by other companies. now the property of the estimating company who can then sell them to other insurers and reporting agencies.

Shops receive none of that income.

Insurance parts procurement programs also demand that the shop allow a third party to take their data each day from their computer – without a strong guarantee that the information is not being used by other companies.

Shops are now faced with someone taking their computer data, and using

it in the absence of any clear privacy policy. Is it being used by a competitor? Shops worry that the private data on their computers from other insurers now may be in peril of being taken.

Other competing insurance carriers may not be happy with another insurance company’s contractor possibly accessing their insurance and claims data.

Shops may face a bleak future – if you deal with one insurance company, the other insurers will drop your DRP status or no longer deal with you, for fear of having their data taken. That would destroy the business of many good repair facilities.

Add to the picture the decreasing number of motor vehicle collisions and claims and the eagerness of insurers to “total loss” vehicles and fewer shops will be able to survive. A guest at a January industry conference in Toronto envisioned that half of the collision repair shops in Canada will disappear within the next ten years.

So how can strong and competent collision repair shops survive and prosper? There are several strategies we are seeing used more frequently, which will likely become more prevalent in the years ahead. These include: • adding other shops and becoming a multiple shop operator — more cars, more efficiencies; • learning to change a shop’s outlook — what makes it different and how to “brand” those differences; • becoming an expert in a geographic area for electronics, specialty metals, manufacturer level repairs, specialty repairs, fleet and company repairs and customer-pay work; • being recognized as the employer of choice — employees are eager to stay and work at the shop; • recognizing the perils of aggressive insurance company parts procurement at the shop and being determined to ensure that the facility can continue to flourish.  John Norris is executive director of the Collision Industry Information Assistance (CIIA) in Ontario. www.claimscanada.ca

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National Standing Committees 2012-2013 ADVISORY 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 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 Greg G. Merrithew, CIP, FIFAA Arctic West Adjusters Ltd. 201 – 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 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 Craig J. Walker, CIP, FCIAA, FIFAA Maltman Group International 3550 Victoria Park Ave., Suite 301 Toronto, ON M2H 2N5 Phone: (416) 492-4411 Fax: (416) 492-5657 E-mail: cwalker@maltmans.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 John D. Seyler, CIP ProFormance Group 5080 Timberlea Blvd., Suite 214 Mississauga, ON L4W 4M2 Phone: (905) 238-4985 Fax: (905) 238-2735 E-mail: jseyler@prospecialty.ca 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 Greg G. Merrithew, CIP, FIFAA Arctic West Adjusters Ltd. 201 – 5204 – 50 Ave. Yellowknife, NT X1A 1E2 Phone: (867) 920-2212 Fax: (867) 873-2244 E-mail: gregm@arcticwest.ca Craig J. Walker, CIP, FCIAA, FIFAA Maltman Group International 3550 Victoria Park Ave., Suite 301 Toronto, ON M2H 2N5 Phone: (416) 492-4411 Fax: (416) 492-5657 E-mail: cwalker@maltmans.com 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

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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 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 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 Justin MacGregor Avec Insurance Managers - Inc. 25 Toronto Street, Suite 200 Toronto, ON M5C 2R1 Phone: (416) 862-9527 Fax: (416) 862-9388 E-mail: justin.macgregor@avecami.com 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 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 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 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 David S. Riddell, FCIP, CRM Canadian Claims Services 17958 – 106 Avenue Edmonton, AB T5S 1V4 Phone: (780) 443-1185 Fax: (780) 443-1893 E-mail: driddell@canclaims.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 E. Brian Gough, FCIP, CLA, FCIAA Marsh Adjustment Limited 1550 Bedford Highway, Suite 711 Bedford, NS B4A 1E6 Phone: (902) 469-3537 Fax: (902) 469-2396 E-mail: ebgough@marshadj.com Robert V. Pearson, CLA, FCIAA Hansen Labelle Adjusters Ltd. 1328 17th Avenue N.W. Calgary, AB T2M 0R1 Phone: (403) 284-2211 Fax: (403) 284-2299 E-mail: bob@hansenlabelle.ca DISCIPLINE Greg G. Merrithew, CIP, FIFAA Arctic West Adjusters Ltd. 201 – 5204 – 50 Ave. Yellowknife, NT X1A 1E2 Phone: (867) 920-2212 Fax: (867) 873-2244 E-mail: gregm@arcticwest.ca EDITORIAL Mary Charman, CIP Crawford & Company (Canada) Inc. 14 & 15 – 431 Bayview Drive Barrie, ON L4N 8Y2 Phone: (705) 728-5597 Fax: (705) 728-2167 E-mail: Mary.Charman@crawco.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 EDUCATION 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 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 Russell Fitzgerald, CIP Kernaghan Adjusters Limited 203 – 4246 97 Street N.W. Edmonton, AB T6E 5Z9 Phone: (780) 488-2371 Fax: (780) 488-0243 E-mail: rfitzgerald@kernaghan.com John D. Seyler, CIP ProFormance Group Inc. 5080 Timberlea Blvd., Suite 214 Mississauga, ON L4W 4M2 Phone: (905) 238-4985 Fax: (905) 238-2735 E-mail: jseyler@prospecialty.ca Greg G. Merrithew, CIP, FIFAA Arctic West Adjusters Ltd. 201 – 5204 – 50 Ave. Yellowknife, NT X1A 1E2 Phone: (867) 920-2212 Fax: (867) 873-2244 E-mail: gregm@arcticwest.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 Georgiana Chen, CIP ProFormance Group Inc. 1101 Kingston Rd., Suite 280 Pickering, ON L1V 1B5 Phone: (877) 539-3111 Fax: (905) 554-3776 E-mail: gchen@proadjusting.ca NOMINATING Greg G. Merrithew, CIP, FIFAA Arctic West Adjusters Ltd. 201 – 5204 – 50 Ave. Yellowknife, NT X1A 1E2 Phone: (867) 920-2212 Fax: (867) 873-2244 E-mail: gregm@arcticwest.ca John D. Seyler, CIP ProFormance Group Inc. 5080 Timberlea Blvd., Suite 214 Mississauga, ON L4W 4M2 Phone: (905) 238-4985 Fax: (905) 238-2735 E-mail: jseyler@prospecialty.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 Craig J. Walker, CIP, FCIAA, FIFAA Maltman Group International 3550 Victoria Park Ave., Suite 301 Toronto, ON M2H 2N5 Phone: (416) 492-4411 Fax: (416) 492-5657 E-mail: cwalker@maltmans.com 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 2012 – 2013 NEWFOUNDLAND & LABRADOR Christopher Goodwin Crawford & Company (Canada) Inc. 96 Clyde Avenue, Suite 100 Mount Pearl, NL A1N 4S2 Phone: (709) 753-6351 Fax: (709) 753-6129 E-mail: Christopher.Goodwin@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 Claude Nadeau Cunningham Lindsey 1250 Guy Street #1000 Montreal, QC H3H 2T4 Phone: (514) 939-1570 Fax: (514) 938-5445 E-mail: cnadeau@cl-na.com 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 Cheryl Hanson Crawford & Company (Canada) Inc. 210 – 227 Primrose Drive Saskatoon, SK S7K 5E4 Phone: (306) 931-1999 Fax: (306) 931-2212 E-mail: Cheryl.Hanson@crawco.ca WESTERN Russell Fitzgerald, CIP Kernaghan Adjusters Limited 203 – 4246 97 Street N.W. Edmonton, AB T6E 5Z9 Phone: (780) 488-2371 Fax: (780) 488-0243 E-mail: rfitzgerald@kernaghan.com PACIFIC David Porter, LL.B., FCIP, CRM Granite Claims Solutions 400-4370 Dominion Street Burnaby, BC V5G 4L7 Phone: (604) 699-6550 Fax: (604) 659-6570 E-mail: david.porter@graniteclaims.com

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Get to know your CIAA Executive – Ontario Region Teresa Mitchell FCIP, CRM, FCLA, FCIAA, FIFAA Teresa Mitchell is our current Ontario Region President. She is a Senior General Adjuster of the Global Technical Services division of Crawford & Company (Canada) Inc. Having been in the industry for 28 years she is currently an all lines adjuster specializing in medical malpractice claims. As the President she convenes and runs the executive meetings, participates in industry functions to promote and raise awareness of the CIAA; address inquiries and concerns of CIAA members; liaise with other industry associations to bring information to our members and participates on the CIAA National Executive. She has been involved with the executive for 20 years and has held various positions. Teri can be reached at Crawford & Company at 705-728-5597 or by email at Teresa.Mitchell@crawco.ca Dorothy Lowry, FCIP Dorothy Lowry works for Crawford & Company (Canada) Inc. and holds the position of the 1st Vice President and current Treasurer on the Executive. With 37 years of experience in the industry she is an all lines licensed adjuster and handles a variety of claims with the majority focused on casualty losses. In the absence of the President, as the 1st Vice President she is responsible for chairing executive meetings, attend industry functions and liaise with other industry associations. As the Treasurer she has custody of the funds and securities for the Region and is responsible for keeping accurate accounts of receipts & disbursements in books belonging to the Regional Committee. She has been on the Executive for 9 years and previously the Chair of the Convention Committee.

Dorothy can be reached by phone at 705-728-5597 or by email at Dorothy.lowry@crawco.ca Maria Joshua, BA, FCIP, CRM Maria Joshua is a Supervisor at Sedgwick Claims Management Services Canada and is the 2nd Vice President as well the Insurance Institute Chair on the Executive. She has been in the industry for 28 years and on the Executive for 4 years and has previously held the position of the Membership Chair. At Sedgwick she is responsible for managing a team of adjusters working on behalf of a National Retail Client. As the 2nd Vice President Maria shall act as the President’s representative at Executive meetings and industry functions in the absence of the President and 1st Vice President. As the Insurance Institute

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Chair she acts as a liaison between the Insurance Institute and the CIAA to keep both organizations appraised of new developments and addresses concerns raised by stakeholders. Maria can be reached by phone at 416-695-5105 or by email at maria.joshua@sedgwickcms.ca

Georgiana Chen, CIP Georgiana Chen is the Director of Marketing at ProFormance Group, the Secretary and the Editorial Chair on the Executive.

As the Director of Marketing Georgiana is responsible for directing overall marketing and strategic planning programs for both ProFormance Adjusting Solutions and ProFormance Specialty Claims. She has been in the industry for 19 years and on the executive for 2 years. As the Secretary, she is responsible for keeping proper records and minutes of the votes and minutes of the Executive Committee meetings. As the Editorial Chair she is responsible for the acquisition of suitable editorial for the Association’s magazine. Georgiana also holds the Membership Chair position on the National Executive of the CIAA. Georgiana can be reached by phone at 905-420-3111 or by email at gchen@proadjusting.ca Richard Swierczynski, BA, CIP Richard Swierczynski is the President of AZ Claims Services Inc. specializing in the handling of complex motor truck cargo losses and any claims relating to the transportation industry. He is the Executive’s current Past President and is responsible for addressing any disciplinary issues and is also a member on the CIAA/CICMA Joint Conference planning committee. He has been in the industry for 21 years and 13 years on the Executive. Richard can be reached by phone at 905825-0027 or by email at richard@azclaims.ca Carolyn Tweedie, BA, CIP Carolyn Tweedie works for Granite Claims Solutions as a Senior Accident Benefits Adjuster. She has 18 years of experience in the industry and is currently an all lines licensed adjuster specializing in Accident Benefits and Bodily Injury Auto claims in the London, Ontario Branch. She is the Southwestern Ontario Director and is responsible for the monitoring of claims activity within the southwestern region and to promote the Association to its members within that region. She has been on the Executive for 2 years. Carolyn can be reached at Granite Claims Solution at 519-858-8888 or by email at Carolyn.tweedie@graniteclaims.com www.claimscanada.ca

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David K. Marshall David Marshall works for Crawford & Company (Canada) Inc. and is presently the Branch Manager of the Sault Ste. Marie office and a member of the Global Technical Service Division. He is responsible for managing the branch and is also an all lines licensed General Adjuster. He is the Northern Director and is responsible for the monitoring of claims activity within the northern region as well as promoting the Association to its members within that region. He has been in the industry for over 36 years and on the Executive for over 5 years. David can be reached by phone at 705-942-1300 or by email at david.marshall@crawco.ca Niki McConnell, BA (Hons), CIP, CRM Niki McConnell is a Senior Adjuster at ProFormance Group handling a variety of claims including accident benefits and bodily injury claims along with specializing in the handling of mediations and has been in the industry for 14 years. This is Niki’s 2nd year on the Executive and is currently the Central Region Director and the Sick & Vigil Chair. As the Central Region Director she is responsible for the monitoring of claims activity within the central region as well as promoting the Association to its members within that region. As the Sick & Vigil Chair she sends cards to members on behalf of the Association acknowledging various events such as retirement, illnesses, death etc. Niki can be reached by phone at 905-238-2735 or by email at nmcconnell@proadjusting.ca David Cernak David Cernak, President and Operations Manager of PCA Adjusters is the Eastern Region Director on the Executive. As President of PCA Adjusters, he works with his team of adjusters in the company’s multiple branch locations throughout the Eastern Region of Ontario. As the Eastern Region Director he is responsible for the monitoring of claims activity within the eastern region as well as promoting the Association to its members within that region. He has been in the industry for 33 years and 3 years on the Executive. David can be reached by phone at 613-726-9556 or by email at davidc@pca-adj.com

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Kelly Stevens, Hons BA, CIP Kelly Stevens works for Crawford & Company (Canada) Inc. and is the Education Chair on the Executive. She has been in the industry for 18 years and is an Assistant Branch Manager involved with business development and is responsible for managing a team of adjusters specializing in Accident Benefit and Bodily Injury claims. As the Education Chair she organizes an annual Spring Educational seminar for our members and has been on the Executive for 4 years. Kelly can be reached by phone at 905-206-5414 or by email at Kelly.stevens@crawco.ca Matt J. Allan, CIP, CRM Matt Allan is the National Manager of Corporate Training at Granite Claims Solutions and the Ontario Conference Chair.

At Granite, Matt is responsible for developing & delivering training and education materials to both internal and external clients. As the Conference Chair, Matt is responsible for organizing the Ontario region’s Annual General Meeting weekend retreat. He’s been in the industry for 19 years and new to the Executive. Matt can be reached by phone at 905-7400048 or by email at matt.allan@graniteclaims.com Trevor Cortese Trevor Cortese is the president of TC Insurance Adjusters Ltd. managing a team of 7 staff and is involved with the handling of claims in all lines. He has been in the industry for 22 years and is new to the Executive holding the position of the Membership Chair. As the Membership Chair, Trevor is responsible for reviewing all incoming membership applications to ensure good standing with FSCO and makes recommendations to the Executive on such applications. Trevor can be reached by phone by 519-663-0700 or by email at tc@tcia.ca

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13-04-19 3:33 PM

The Cost of Ignorance in Structural Engineering

BY DR. FARHOOD NOWZARTASH

From the seven ancient wonders of the world, the only one left standing today is the Pyramid of Khufu in the Egyptian desert. Any man-made environment is destined to vanish eventually, but we are convinced that buildings will stand forever. When some do collapse or suffer some type of performance failure we are surprised and concerned; we want to know what went wrong and why. This was particularly true during the recent collapse of a roof at a mall in Elliot Lake, Ontario (see below).

From an insurance point of view, one of the main concerns is determining who should cover the costs associated with the failure. In order to answer this question, one needs to determine the true cause of the failure. This can be a daunting task and experts’ assistance is often required to unveil all the factors involved in a failure.

Structures come in various shapes and serve many different purposes.

They are built of many types of materials and have to resist many kinds of loads. These loads can originate from various sources and contain many uncertainties. In order to determine why a structure failed, an understanding of how the various elements of the structure work and interact with each other is necessary. Which element failed first and why? How did the failure of that 30 Claims Canada

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element result in the failure of the rest of structure? Was the failure caused by excessive loads, design flaws, faulty material, ground movement, poor construction, inadequate maintenance, a combination of these, or an unforeseeable circumstance?

After any loss, one question that both the insured and the insurer want to answer is: Can the structure be repaired or does it have to be demolished? The easiest and the most straightforward response will be “demolish and rebuild.” In our experience this approach is often proposed despite the building being a good candidate for repair at substantially reduced costs and with a fraction of business interruption time.

One typical reason for not considering the repair approach can be a lack of expertise in damage assessment and evaluation of the remaining structural capacity. This is how ignorance can be costly. To properly evaluate a damaged building requires deep-seated knowledge, thorough investigation and

sound engineering judgment, which, except for the simplest of structures, only an experienced expert can provide. While involving an expert may add some additional costs for the investigation, it can potentially save a significant amount of money as the expert will be able to maximize the utilization and rehabilitation of the damaged building.

The failure story has an often ignored side: the pre-existing condition of the structure. Imagine that a truck impacts an industrial steel frame building and destroys two bays. The clean-cut scenario is that the building owner claims the whole repair cost and the truck insurer pays. However, the reality is likely much more complicated than that.

Consider the following possible scenarios regarding the pre-existing condition of the building prior to the vehicle impact: What if the steel frames had been heavily rusted and the owner had planned to replace them in two years anyway? What if www.claimscanada.ca

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the frames and their connections had not been designed to the applicable codes/standards originally? What if the building construction was faulty so that it was only a matter of time before deficiencies were detectable, and these deficiencies just happened to be materialized during impact? What if the owner had added extra loads (e.g. roofing, cranes, walls, extra office spaces, etc.) in excess of what the building was originally designed for, thus, the impact only initiated the failure (but did not cause it)?

As often is the case, whoever touches the structure last may incorrectly foot the entire repair bill. In these cases there are possibilities for subrogation and mitigation of the costs that would be lost unless all the relevant facts are discovered and considered objectively by an experienced expert.

Among the many potential causes of a structural failure, inadequate maintenance requires special attention, as maintenance is often neglected since the need is not always readily obvious. Proper maintenance becomes critically important for large buildings and aging infrastructures as negligent maintenance could result in catastrophic losses.

The following are just a few examples of recent large losses in which the lack of a proper maintenance program may have caused or contributed to the loss. In 2007, the collapse of the Mississippi River Bridge (HW I35) killed 13 people, injured 145, and caused a direct loss of over $300 million and a lot more indirect losses. A photograph taken four years before the bridge collapse showed bowed gusset plates which had gone unnoticed at the time. The same plates eventually failed and caused the entire bridge to collapse.

In June 2012, the roof of a mall in Elliot Lake, Ontario collapsed, killing two people and trapping dozens.

The roof had shown signs of excessive water leakage during the previous decade; furthermore, a piece of concrete from the roof had fallen through the ceiling at a mall restaurant just one year before the collapse near to the failed section. www.claimscanada.ca

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More recently, in December 2012, concrete ceiling panels inside a tunnel section in Tokyo, Japan collapsed, killing nine people. Preliminary reports pointed to undetected decay in the fixtures that had held the concrete panels to the roof.

Although structural failures often occur suddenly, in most cases there are many signs of impending failure before it actually happens. Proper maintenance and inspections can reveal signs of deterioration before it becomes too late. The U.S. government plans to spend over $1 trillion over the next decade on existing infrastructure such as roads, waterways and power lines to prevent their deterioration.

Proper maintenance becomes critically important for large buildings and aging infrastructures as negligent maintenance could result in catastrophic losses.

The situation of Canadian infrastructure is not any better; however, such a plan does not exist here. Years of neglecting proper maintenance and current financial belt-tightening are causing vital repairs to be pushed dangerously down the priority list.

One thing of particular relevance to the insurance industry is the claimed damages relating to losses involving aging infrastructure. For instance, a small piece of concrete that falls off a bridge and cracks a car windshield may be a sign of a much bigger problem (e.g. the QEW/Gardiner in Toronto, Ontario). Such a structure should be checked at the proximity of the incident to reduce the risk of a large loss in the future

as well to explore the potential subrogation avenues. Further, if a loss occurs that specifically causes damage to the infrastructure (e.g. a piece of heavy equipment on a trailer strikes a bridge), be sure to evaluate the previously planned remediation for the structure. We have seen many cases in which the owner of the infrastructure attempts to recover, from the insurer of the trucking company, the cost of repairs that were slated to occur in any event. This is where an expert who has a deep understanding of the nature and life-cycle of structures can be of great assistance.

When a structure fails, especially if it involves a large loss, the general tendency of the insurance industry is to retain a large structural design firm to investigate the origin and cause. Unless that specific firm has an in-house forensic group, this is not always the best choice.

Large failures are usually complex and multi-faceted and, in many cases, the structural failure is only the symptom of other issues in the building. A typical structural designer often looks at the structural elements, but cannot see the overall picture of the failure. This is where a multidisciplinary forensic firm, a group of people specialized in different aspects of the building and its construction, can investigate a failure from various angles to find out all the involving facts and pinpoint the true probable cause(s).

As the saying goes: “To a hammer, everything looks like a nail!â€? (Individuals specialized in one specific area may have the tendency to relate everything back to their area of expertise and ignore other possible aspects outside of their expertise). î — Dr. Farhood Nowzartash, P.Eng., is a structural engineer at Giffin Koerth who has wide-ranging structural expertise, from large-span steel sports stadiums to high-rise reinforced concrete buildings. He combines academic strength with real world design and construction expertise. For more information on Farhood and Giffin Koerth, please go to www.giffinkoerth.com

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Risk and the Older Driver

Why your future caseload may increasingly include clients 50+ years of age

BY ANGELA VERI

Just like death and taxes, you can think of age-related physical deterioration as inevitable. Unless there really is a fountain of youth, it’s safe to say that as we age, our physiology changes.

However, it doesn’t just “change,” it deteriorates and this deterioration affects our ability to drive safely. Simply put, it’s not age alone that determines unsafe driving – it’s not the actual number of birthday candles that is to blame. It’s our deteriorating physiology.

As a Statistics Canada study about seniors’ transportation habits conveys: “It is not seniors’ more advanced age that increases the risks of traffic accidents, but rather certain medical conditions that they are more likely to have.

Driving a vehicle safely requires good vision, good hearing, adequate cognitive abilities and adequate motor skills – functions that deteriorate naturally with age.” Does this age-related deterioration, combined with society’s ageing demographics, foreshadow a future caseload destined to include an increasing number of clients 50+ years of age?

Let’s put this theory to the test by taking a look at what happens to these safe driving requirements as we age. Can we point a finger at deteriorating physiology as a possible suspect in making older drivers more prone to accidents?

Vision Problems As most of us eventually experience firsthand – either putting on or taking off glasses to read this article– aging affects our vision in a wide range of ways.

Regarding safe driving, age-related vision issues include decreased ability to 32 Claims Canada

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see well in the dark and to effectively scan the scene. Our eyes become increasingly susceptible to glare because as we get older the lenses of the eyes thicken and the pupils shrink. In addition, refocusing from one object to the next takes longer and our peripheral vision suffers, as well as our depth perception and colour perception. Accordingly, distinguishing between the colour of traffic lights, as well as brake lights and other lights that line the streets becomes increasingly difficult.

Although safe driving requires good vision, a Statics Canada study discovered that 19% or 14,000 seniors with limited sight have a driver’s license.

These seniors are at what is considered Level 5: “Unable to read ordinary newsprint and unable to recognize a friend on the other side of the street, even with glasses…” Makes you think: as age increases, vision deteriorates and in turn, safe driving ability deteriorates.

Diminished Hearing Many aspects of safe driving rely on our ability to react properly and quickly to “signals”–everything from ambulance and police sirens to screeching car tires and honking horns. However, similar to vision, as we age our hearing deteriorates. The age-related decline in hearing, called presbycusis, is usually due to degeneration of the hearing nerves and of the organs of the inner ear.

Although safe driving requires good hearing, a Statistics Canada study discovered that “among seniors who had the most serious hearing problems (Levels 5 and 6), 53% had a licence, and about one-half had driven a vehicle in the previous month.” Makes you think: as age increases, hearing deteriorates

and in turn, safe driving ability deteriorates.

Deteriorating Cognitive Abilities More easily distracted, more easily confused, more forgetful – just some of the milder effects of ageing on our cognitive abilities that don’t sound like positives for safe driving. In addition, these declining abilities can be symptoms of bigger issues to come. For instance, Alzheimer’s disease and other types of dementias are on the rise; currently about half a million seniors suffer from Alzheimer’s disease and other dementias, expected to rise to over a million by 2038.

In addition, many seniors have difficulty sleeping, making drowsiness a common problem – and a dangerous one where driving is concerned. Although safe driving requires adequate cognitive abilities, a Statistics Canada study found that at Levels 5 and 6 – people who are very likely to forget things and have a great deal of difficulty thinking clearly and solving everyday problems – about 40,000 seniors had a driver’s licence. In addition, about 20,000 seniors who had been diagnosed with Alzheimer’s disease or some other form of dementia had a driver’s licence.

Makes you think: as age increases, cognitive abilities deteriorate and in turn, safe driving ability deteriorates.

Inadequate Motor Skills Slamming on the brakes, checking the blind spot, quickly turning the steering wheel – all these actions require motor skills. However, motor skills gradually decrease with age –muscles weaken, reflexes slow down, www.claimscanada.ca

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and flexibility decreases – resulting in diminished ability to react. Motor skills are also influenced by pain that is often associated with physical changes. In fact, pain is increasingly a fact of life as we age with the percentage of pain sufferers reporting severe pain higher for older adults.

Motor skills can be affected by a wide range of mobility issues like arthritis, which affects numerous older adults, and hip fractures are also more prevalent as age rises. Although safe driving requires adequate motor skills, a Statistics Canada study found that “just over one-quarter (28%) of seniors with reduced mobility had a driver’s licence.” Makes you think: as age increases, motor skills deteriorate and in turn, safe driving ability deteriorates.

Unfortunately, there’s more bad news regarding safe driving ability as we age. In addition to what could be considered natural physical deterioration, many people also experience a range of health issues as they age due to a range of contributing factors like environment, genetics, and circumstance.

Just by virtue of living longer, we are likely to have more pre-existing medical conditions than younger drivers.

Plus regardless of the type of deterioration, another consideration is the use of medication. Some medications can negatively affect safe driving by causing drowsiness, confusion and decreased reaction times.

Good vision, good hearing, adequate cognitive abilities, and adequate motor skills are all considered safe driving requirements – and they all gradually deteriorate with age. It appears that aging is in fact a key ingredient for increased car accidents and accordingly, your caseload may increasingly include clients 50+ years of age.

The good news is that when car accidents occur, a tailored approach to rehabilitation based on age makes all the difference. Taking a client-centred approach is beneficial regardless of the type of client population; however, it is essential for those 50+ years of age. As we’ve seen, aging affects physiology and consequently, physiological issues specific to the 50+ client population can affect rehabilitation. www.claimscanada.ca

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For instance, a rehabilitation plan needs to take into consideration characteristics unique to the 50+ client population such as decreased skin sensation, larger adhesions, and tissue shortening, as well as susceptibility to secondary infections and respiratory issues.

All of these issues and more, have a potential impact on healing outcomes and recovery timeframes. As Canada’s demographics continue to age, keep in mind that just as age makes a difference

regarding safe driving ability, it also makes a difference regarding the best rehabilitation approach.  Angela Veri, BA, CRS, RRP, CVRP, is senior vice president of sales, Sibley & Associates LP. Additional information about this topic is available through the Sibley Resource Library and Complimentary Educational Training Seminars. Please contact Angela Veri at 1.800.363.8900.

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13-04-19 3:40 PM

The MIG’s Grey Area

A recent decision raises questions on what is – and what isn’t – included in the Minor Injury Guideline (MIG)

BY TAMMIE NORN

We are now two and a half years post the September 2010 regulatory changes that introduced the concept of “Minor Injury” and the associated Minor Injury Guideline (MIG).

The pressing question over these past 30 months has been how the courts and arbitrators would interpret this definition and the applicable Guideline.

Well, the first decision has now been released. Heard February 22, 2013 by Arbitrator John Wilson, Lenworth Scarlett and Belair Insurance Company is the first decision to come down regarding the application of the MIG. In this case, Mr. Scarlett was injured in a motor vehicle accident on September 18, 2010. He was new to Canada and did not have access to OHIP. The decision does not tell us whether or not Mr. Scarlett’s policy renewed after September 1, 2010; therefore it is difficult to comment on the housekeeping component of the case.

That being said, the main issue here is the application of the MIG. Mr. Scarlett submitted a Disability Certificate less than a month post accident that confirmed he sustained various sprains and strains to the joints and ligaments of the lumbar and cervical spine, as well as headaches and acute stress reaction. Subsequent to this, a report was submitted that confirmed Mr. Scarlett suffered from TMJ as well as intra-capsular TMJ syndrome.

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In December 2011, an orthopaedic surgeon reported positive Waddell signs and noted positive testing for an adverse psychological and emotional response to injury and a poor prognosis for recovery. Also in December, a psychologist assessed Mr. Scarlett and found that he suffered from pain disorder, severe depressive symptoms, chronic symptoms of a post-traumatic stress disorder and driver anxiety.

Plaintiff counsel submitted that based on the above, Mr. Scarlett’s injuries cannot be treated within the MIG. The insurer, Belair, completed a paper review with a chiropractor to address the nature of the injuries and application of the MIG after it received the initial treatment plan. The chiropractor found that injuries were commensurate with minor injuries as described in the MIG and that the minor injury guideline applies.

The insurer completed a further assessment with a psychologist after receipt of the attendant care and TMJ report. The psychologist concluded that based on Mr. Scarlett’s narrative and presentation, his symptoms did not meet the criteria for any psychological diagnosis.

Finally, a paper review was conducted by a dentist in response to the TMJ Assessment. The dentist indicated that the file documentation did not provide compelling substantive objective evidence or subjective complaints to suggest the claimant has an ongoing concern with TMJ. For purposes of this article we will look at how Arbitrator Wilson came to his decision and the areas that may

prove to be problematic as a result of some of his reasonings.

This case is interesting for a number of reasons. In contemplating his decision, Arbitrator Wilson considered the application of the MIG, the French translation of the Guideline, as well as where the Burden of proof lies when applying exceptions to the policy.

First, Arbitrator Wilson looked at the Guideline itself. He made it very clear that the Guidelines are informational and non-binding – despite the fact the Guidelines are specifically referenced in the Statutory Accident Benefits Schedule (SABS) and the provisions of the Schedule are binding.

Section 1 of the Guidelines specifically state that the Guideline is pursuant to sec. 268.3 of the Act. There is a hierarchy of legislation and the Act trumps the Schedule. Section 268 of the Act basically states that a guideline shall be considered in any determination involving the interpretation of the SABS. Arbitrator Wilson suggested that guidelines are non-binding and are no more than an interpretive aide.

Notwithstanding his opinion of the Guideline and its application, Arbitrator Wilson did choose to take it into consideration when determining whether or not Mr. Scarlett’s injuries were minor in nature and if the Guideline should apply.

To date, I believe that the insurance industry has been relying on the Guideline as being part of the SABS, which is a binding regulation. In his interpretation, it appears as though Arbitrator Wilson has diluted the inwww.claimscanada.ca

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tent of the Guideline, which may open the door to further challenge as to the application of the MIG Arbitrator Wilson then spoke to the Burden of Proof. The intent of the Guideline is for the Insured to prove that: a) Based on compelling evidence provided by his or her health practitioner, the insured person has a pre-existing medical condition that will prevent the insured person from achieving maximal recovery from the minor injury if he or she is subject to the $3500 limit referred to in section 18(1) of the SABS or is limited to the goods and services authorized under this Guideline; OR b) His/her injuries do not fall within the definition of Minor injury.

Arbitrator Wilson reported that Section 14 of the SABS states an Insurer is required to pay medical and rehabilitation benefits under section 15 and 17 of the schedule. Barring

exceptions, the Insurer is obliged to make payments in accordance with this section.

Once the Insured has proved that he/she is an insured and has suffered impairment, the onus is on the Insurer to prove that the Insured falls within an exception that would justify part or non-payment of the whole benefit, in this case the MIG. In his opinion, Arbitrator Wilson found that the Insurer did not meet the burden of proof and refers to “the Insurer positioning itself on the basis of a single report.”

I believe that this shift of onus creates another area of challenge for insurers. If the insured submits a treatment plan by their treating health care practitioner, the insurer must prove on the balance of probability that the treating physician is incorrect in regards to their opinion as to whether the injuries fall within the MIG. In certain cases, it may be that the treating health care practitioner is not familiar with the insurance definition of minor

and the application of the Guidelines.

This should be easily resolved with a phone call from the adjuster to the practitioner and, if agreed, the practitioner can submit an amended plan on the appropriate OCF-23 that coincides with the MIG. In those cases, however, where the practitioner does not agree that the injuries are minor or that they can be treated within the MIG, it may be difficult for the Insurer to prove this with a single assessment. It is even more important now that insurers conduct proper assessments with the appropriate health care practitioners at the right time and in the correct format (in-person versus paper). It is highly recommended that the initial MIG assessments be conducted in person with a GP and any other practitioner that may be reasonably require based on the treating practitioner’s diagnosis. It is equally as important to continue to address all new medical evidence in a similar manner as it is received.

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In regards to the issue of “Compelling Evidence”, Arbitrator Wilson seemed to put quite an emphasis on the translation of the French guideline. The French Guideline once translated merely “encourages” submission of compelling evidence, it does not mandate it. He suggested the only way to reconcile the English and French versions would be to interpret both as encouraging or urging medi-

required to be submitted by the Insured.

Notwithstanding Arbitrator Wilson’s interpretation of the application of the MIG, onus of proof and translation of “compelling,” in this case much emphasis was placed on the fact the insured was diagnosed with TMJ, psychological impairments, as well as neurolocogenitive and emotional impairments. He found that Mr. Scarlett

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In conclusion, it is clear that the application of the MIG should be decided on a case by case basis and, in the words of the Arbitrator Wilson, a “cookie cutter” application should not be used where there is a soft tissue injury present. cal practitioners and other stakeholders to provide credible or convincing evidence if they are looking to be taken out of the MIG. In addition, he suggested that it is not clear at all that compelling evidence translates directly into any burden of proof when adjudicating whether the Insured falls within the MIG. Again, I believe this dilutes the intent of the Guideline. If we go with this interpretation, coupled with a shift in the burden of proof as outlined above, then it can be argued that credible or convincing evidence is encouraged, but not necessarily 36 Claims Canada

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provided timely and credible information and came to the conclusion that when the totality of his injuries is assessed, they come outside of the MIG. A key point to consider here is that the Arbitrator specifically noted these additional impairments were separate from the soft tissue injuries and were not sequalae related to the soft-tissue impairments. In many other cases, it can be argued that anxiety, stress, headaches or other minor psychological impairments are resulting sequalae of the soft tissue injuries and therefore may fall with the MIG.

In conclusion, it is clear that the application of the MIG should be decided on a case by case basis and, in the words of the Arbitrator Wilson, a “cookie cutter” application should not be used where there is a soft tissue injury present.

From a handling perspective, adjusters need to be proactive in their approach. This means early contact with claimants to secure information, explain benefits, the definition of minor and the associated available treatment.

In addition, it also should involve early contact with the treating health care practitioner to educate them on the definition of minor and the application of the Guideline.

Open communication should continue throughout the duration of the claim with both the treating practitioner and the claimant, to set expectations, measure progress and ensure outcome-driven results. Practitioners should be held accountable to the expected improvements they have identified as a result of the treatment. Insurers should properly utilize Insurer examinations to help them understand diagnosis, prognosis, the effect of prior injuries/ conditions and reasonable treatment required.

It is important to have a good understanding of the claimant’s pre-accident health, to continually evaluate new information as it is received and to assess the claim based on its own merits and the totality of information, as opposed to each individual submission.

Notwithstanding the conclusion that Mr. Scarlett’s injuries were not “minor” and therefore the MIG does not apply, I do believe that by diluting the meaning of compelling, shifting the onus onto the insurer and viewing the Guidelines as “non-binding,” Arbitrator Wilson has opened the door to further challenges regarding the application of the MIG. It should be noted that this decision will most likely be appealed. It will be interesting to see how it all plays out in the end.  Tammie Norn, FCIP, is CEO of ProFormance Group Inc.

www.claimscanada.ca

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13-02-11 2:02 PM

What exactly is an

“Accident?”

Conflicting decisions have made the interpretation about as clear as mud

BY DANIEL STRIGBERGER

When I was growing up in Toronto, my family would often drive through the city to get from Point A to B. Unfortunately, there were times when we would drive past an automobile accident scene. I remember my mother always saying, “I sure hope no one was hurt in that accident.” Now as an insurance lawyer, whenever I see an accident (which may result in a new file), I usually say, “I sure hope no one was hurt (too much) in that accident.”

Today, more often than not with a new automobile claims file, I receive a request to provide a legal opinion as to whether the claimant was involved in an “accident.” These files usually involve incidents where a claimant had a slip/trip and fall near an automobile.

In some cases, an individual has done maintenance work on a vehicle and has been injured. (Rarely, fortunately, they are shot at in their vehicles). As I analyze these cases, I find that my mother is never able to help me on those files.

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The reason why automobile insurers ask these questions is that a claimant who seeks statutory accident benefits from an insurer must establish that they were involved in an “accident”.

Luckily for us, section 3 (1) of the SABS defines “accident”, as follows: “’Accident’ means an incident in which the use or operation of an automobile directly causes an impairment or directly causes damage to any prescription eyewear, denture, hearing aid, prosthesis or other medical or dental device.”

In other words, for an accident benefits claimant to have been in an “accident”, he or she would have to prove: 1. There was an incident involving an automobile; and 2. The use or operation of an automobile directly caused the impairment.

To an outsider, this definition might seem simple and clear enough for claimants and the industry to handle. A pedestrian struck by a car would have access to accident benefits.

So would an occupant of a truck or a motorcycle involved in some sort of collision. My mother would agree.

However, there has been a number of arbitration decisions over the years from the Financial Services Commission of Ontario (FSCO) that would make anyone – even those people who have never seen an automobile – question whether they also qualified for accident benefits. Who would have thought that an inebriated 62-year-old man injured while doing a headstand against a stripper pole, in the back of a moving limousine bus, would be found to have been in an “accident?”

(See Whipple v. Economical Mutual Insurance Co., 2011).

So how are automobile insurers and their lawyer supposed to apply this “clear as mud” definition? (Often in circumstances where truth is stranger than fiction). In some cases, I get asked whether the vehicle in question is an “automobile,” but that is a topic for another article.

As a history major, I feel compelled to explain how we got here: The Bill 164 SABS defined “accident” to include those incidents where an automobile directly or “indirectly” caused an impairment. With the introduction of the www.claimscanada.ca

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Bill 59 SABS, the Legislature narrowed the definition by removing the word “indirectly” from it.

Defining “accident” has been the subject of debate ever since the Bill 59 SABS narrowed the definition of “accident.” The Court of Appeal set the Bill 59 era test in Chisholm v. Liberty Mutual Group and in Greenhalgh v. ING Halifax Insurance Co., as follows: 1) Did the incident arise out of the use or operation of an automobile (the “purpose test”); and 2) Did such use or operation of an automobile directly cause the impairment (the “causation test”)?

In Greenhalgh, the causation test was broken down into two further tests: 1) Was the use or operation of the vehicle a cause of the injuries?

2) If the use or operation of a vehicle was a cause of the injuries, was there an intervening act or intervening acts that resulted in the injuries that cannot be said to be part of the “ordinary course of things?” In that sense, can it be said that the use or operation of the vehicle was a “direct cause” of the injuries?

With that in mind, consider the following facts (from real-life cases stemming from accidents after November 1, 1996). Decide for yourself whether the following claimants were involved in an “accident” (answers are below): (A) The applicant was attempting to repair his wife’s van inside his garage.

In the process, he removed the van’s gas tank to access the fuel pump. An arc from an air compressor inside the garage ignited the gasoline vapours and resulted in the applicant receiving burns to his head and body.

(B) The applicant was watching his vehicle being repaired at a garage. While he was watching, gasoline spilled from the gas tank of his vehicle and ignited, causing him injuries.

(C) The applicant decided to stop for gas at a station and check his vehicle’s tires. He was injured after falling on some ice at the gas station.

(D) The applicant drove to a Canadian Tire store to purchase the new wiper blades. She parked her car in the lot without incident and walked www.claimscanada.ca

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into the store without incident. On her way back to her car but before arriving there, and at least 20 feet from it, she slipped and fell on the ice that had accumulated in the lot.

(E) The applicant was one in a group of cyclists training for a charity event. One of the roads on the route was blocked. Their ride guide led them to the sidewalk and directed them to follow him in a single file.

While travelling east on the sidewalk, the cyclists encountered a parked automobile. While manoeuvring around this automobile, the applicant fell off her bicycle and sustained injuries.

There has been a number of arbitration decisions over the years from the Financial Services Commission of Ontario (FSCO) that would make anyone – even those people who have never seen an automobile – question whether they also qualified for accident benefits.

More recently, in Dominion of Canada General Insurance Company v. Prest (2013 ONSC 92), the claimant had parked his vehicle in his parking spot at his residence in order to wash it. He exited the vehicle and walked to the end of his car. He then tripped over a concrete curb that “sticks out” from the wall of the parking garage. He stated his right hand was touching the car when he tripped. There was no issue he suffered an impairment as a result of the incident.

As a result of the incident, Prest applied to Dominion for accident benefits. Dominion then sought a determination in Court as to whether the claimant was involved in an accident. The judge found that Prest

failed to meet the “purpose” test. He held that the incident or accident did not result from the ordinary and well known activities to which automobiles are put. The judge ruled that at the time of the incident the vehicle was neither being used nor operated (it was parked).

The judge noted: “A parking spot at one’s residence is typically where a car is put when there is no intent to use it.”

He also found that the causation test was not met. He found that the car’s use had ended without injury. The trip-and-fall was an intervening act.

So how then do we apply the law to the facts?

It is apparent in the case law that each case is fact specific. When presented with an unusual claim, insurers should investigate the incident early in the claims process and collect as much information as possible about how the incident occurred.

It is important to remember that not every slip and fall in a parking lot will be considered to be an “accident.”

Not every explosion in a garage will be considered to be an “accident.” And hopefully not every incident involving a limousine stripper pole will be considered an “accident.”

Answers: A – No accident -- Khan v. Certas Direct Insurance Co., [2008] O.F.S.C.D. No. 120 (FSCO Arb.) B – Accident -- Umer and (Lloyd’s) Non-Marine Underwriters, [2003] O.F.S.C.I.D. No. 52 (FSCO Arb.) C – Accident -- Saad v. Federation Insurance Co. of Canada, 2004 CarswellOnt 6040 (FSCO App.) D – No accident -- Nickerson v. Security National Insurance Co., 2012 CarswellOnt 15737 (FSCO Arb.) E – Accident -- DiMarco v. Chubb Insurance Co. of Canada, 2012 CarswellOnt 1946 (FSCO Arb.) Daniel Strigberger is a partner in the insurance litigation group in the Waterloo office of Miller Thomson LLP.  April/May 2013

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13-04-19 3:46 PM

The Other Side of the Fence

One lawyer argues that Independent Medical Exams are often unnecessary

BY DARCY MERKUR

It happens way too often. A person is seriously injured in an auto accident and needs ample care and rehabilitation. Thankfully, and with effective legal representation, you navigate through all the red tape, leap over all of the hurdles the accident benefit insurer puts in your way and things run smoothly until, finally, the insurer secures a game-changing highly contentious Independent Medical Examination (IME) report that leads to crucial treatment and care denials.

The report, often by someone specializing in Independent Medical Examinations, rather than treatment, concludes that the treatment or care recommended by the treating health practitioner is unnecessary and unreasonable.

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What do you do?

You try to persuade the insurance adjuster to reconsider their denial by providing additional medical support for the request and by explaining how the report is sloppy and riddled with numerous factual errors, but the insurer maintains their denial.

Now what?

You know that any means of disputing the denial could take years to resolve.

You imagine explaining to your client the dispute process – that you will have to file for mediation with the Financial Services Commission of

Ontario, that you won’t be able to get a mediation date anytime soon so you will either have to wait until you get a mediation date or wait 60 days and rely on the now accepted deemed failed mediation rule, and only then do you have the privilege of filing for Arbitration or litigating in the Courts.

If you take the shorter Arbitration route, you can expect to wait more than a year given the longer than normal lineups resulting from reliance on the deemed failed mediation rule and then you have to wait an uncertain length for the results of the Arbitration, all the while knowing that you

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ANNOUNCEMENT are waiting for a decision from an Arbitration you argued more than 6 months ago and that any decision is still subject to appeal.

You consider options to expedite the process or move for interim relief, but are conscious of the fact that almost everyone in the dispute queue, including a large number of your clients, have similarly time sensitive complaints.

The accident benefit dispute process makes no sense.

The premise of no-fault benefits is immediate access to necessary benefits.

A lengthy dispute process to resolve claims for immediate benefits is absurd.

Meanwhile, while the dispute is pending, your client suffers without the treatment (and the insurer doesn’t suffer at all).

You can threaten claims for bad faith, mental anguish, special damages, punitive damages, but the accident benefit insurer isn’t worried since their denial is supported by an Independent Medical Examination report.

What we need is a better dispute process – a more efficient one, a more timely one – one that can be accessed without delays that impede a claimant’s recovery.

Developing a new process and gaining support for it will be a challenge and will take time. In the meantime, we need to make Independent Medical Examiners more accountable for sloppy or biased reports, and we need to make insurers more accountable for relying on them. 

Peter Sutton

Hamilton Hospitals Assessment Centre (“HHAC”), one of Ontario’s leading, hospital-based providers of independent medical evaluation services, has announced that Peter Sutton has been appointed to lead its business development and quality control initiatives. In this role he will be responsible for expanding and strengthening relationships between insurance company personnel and the HHAC team of medical evaluation professionals.

HHAC manager Christine Pook said, “Peter brings a unique combination of expertise and understanding to this role. He is widely recognized within the auto insurance sector for his expertise as an accident benefit and bodily injury claims adjuster and for the services he provided as part of a team that successfully built and operated an IME business. Peter’s link with that business ended two years ago when he sold his share.”

According to Pook, “the industry-wide slow-down in IME referrals since the introduction of new legislation in 2010 has not diminished HHAC’s focus on expanding its share of the entire Ontario independent medical evaluation market. Our goal has been and remains the delivery of defensible, highquality medical evaluation services and standards of reporting provincewide. We work with an impressive roster of credentialed clinicians and we have achieved one of the lowest no-show levels in our industry.”

Peter can be contacted at Tel: 905-388-1035 or 1-800-663-0423 email: sutton@hhac.on.ca About Hamilton Hospitals Assessment Centre Since being formed in 1990, the Hamilton Hospitals Assessment Centre (HHAC) has provided credible, defensible and high quality medical assessment services to auto and disability insurance companies, the Workplace Safety and Insurance Board, public and private employers, and the legal profession. Clients are provided a reliable framework for determining the right benefit, at the right time, and for the right cost.

HHAC’s team of leading clinical specialists and its commitment to bestin-class assessment techniques makes its operation unique within the IME sector. Its services include quick access to timely specialty testing, diagnostic services, and complex assessment procedures. A unique aspect of their operation is that revenues generated from its services are reinvested into the public hospital system to support patient care and research. www.hhac.on.ca

Darcy Merkur is a partner at Thomson, Rogers in Toronto practicing plaintiff ’s personal injury litigation, including plaintiff ’s motor vehicle litigation.

www.claimscanada.ca

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EF

• education forum

A SERIES OF ARTICLES PROVIDED BY THE INSURANCE INSTITUTE OF CANADA

Testing the Waters: The Challenges of Environmental Insurance

Beginning in the 1990s, governments around the world began to focus their attention on the problem of environmental pollution. In Canada, legislation at both the federal and provincial levels prohibits activity that may cause damage to the environment, and regulations continue to be updated. Environmental insurance is continuously adapting to this changing regulatory environment.

At the federal level, the Canadian Environmental Protection Act makes individuals, corporations, corporate officers and directors subject to prosecution for environmental offences and, if convicted, liable for fines and/ or prison terms.

Environmental insurance has been available in Canada since the mid-1980s.

Carriers usually offer “sudden and accidental pollution coverage” under a casualty policy, but this cover can contain gaps and uncertainties. Separate pollution products typically offer cover for pollution conditions that occur gradually over a period of time (no time-period reporting requirements). Often, the coverage is for pollution that is created by a company’s own operations.

As part of the underwriting process for an environmental policy, insurers have to understand how insureds are managing their risks. Applications for environmental insurance are detailed.

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many insureds find they can address an insurer’s questions by providing copies of documents they’ve already developed, such as risk management procedures and operating plans.

Lines of liability For insurers and claims adjusters active in this market, the definition of environmental liability can be a challenging issue.

For a start, there is liability imposed by government regulation. This level of liability is continuing to evolve and remains subject to change. For example, several provincial regulators have recently instituted revised soil and groundwater contaminant concentration criteria, making standards more stringent.

Regulatory issues aside, liability can arise when one party tries to sell a contaminated site to another party.

This type of liability is a fairly recent development.

Liability can also arise in relation to a third party, such as when a contaminant is released into a waterway and a claim is brought for damages.

CGL policy puzzles In cases of liability to a specific party, courts have fastened on the regulatory principle of “polluter pays” and have imposed penalties. However, the collective direction of these decisions is unclear in some areas, particularly in connection with coverage under commercial general liability (CGL) policies.

Responding to change Apart from offering environmental policies per se, some insurance companies are responding to the increased consensus on climate change by introducing new products geared to other environmentally friendly practices, addressing exposures that come with issues like carbon trading, corporate disclosure and directors’ and officers’ insurance. Many of these insurance products focus on areas of energy efficiency, including clean-air energy, hybrid vehicles or pay-as-you-go programs, and green-certified buildings.

In fact, while much of the focus of environmentalism has been on cars and transportation, a significant proportion of the greenhouse gas emissions in Canada come from buildings and associated construction activities. Green construction standards are an attempt to reduce this impact.

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Many CGL policies specify a 120hour window within which the insured must report the pollution incident to the insurer in order to trigger coverage. But conflicting court decisions have left adjusters and insurers – and insureds – uncertain as to whether the 120 hours begin when the incident occurs or when it is discovered.

Room to grow Commercial insurance has been in a soft market for the past few years, so many insureds have been saving on insurance. This has created increased interest in more specific environmental insurance policies as insureds seek to reduce their uncertainty, broaden their insurance programs and address pollution gaps in their CGL policies.

Environmental insurance is still an unfamiliar area for many brokers and insureds, so carriers spend significant time educating the marketplace about the cover and benefits associated with a pollution policy.

In the oil and gas sector, large companies tend to self-insure their environmental pollution risks but smaller companies are increasingly interested in pollution cover. Environmental impairment liability (EIL) policies include coverage for bodily injury liability, property damage liability, cleanup (both on-site and off), business interruption, contracted liability, loss of value of a third-party property from contamination, and legal defence costs. For smaller oil and gas companies, a coverage package like this can make good sense. This is a growing area of business for Canadian insurers.

In other sectors, large companies have traditionally been the main purchasers of pollution coverage. But again, small-to-medium-size enterprises are beginning to see value in environmental policies. Stimulus spending has launched many public-private partnership (P3) projects in Canada in recent years, making environmental coverage of contractors and construction projects a particularly active area.

Open questions Increasing government scrutiny of environmental risks is leading to www.claimscanada.ca

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more-stringent regulation and harsher penalties. In addition, high-profile events such as the deaths of 1600 ducks in a Syncrude tailings pond in Alberta and the Deepwater Horizon oil spill off the US Gulf coast are likely to have long-lasting repercussions. In the wake of Deepwater, for instance, the policy cap on consequential damages may now be irrelevant – there will always be political pressure to break the cap and make the operator liable for all costs of containment pol-

In the oil and gas sector, large companies tend to self-insure their environmental pollution risks but smaller companies are increasingly interested in pollution cover. lution cleanup and business interruption. This kind of increased regulation and oversight will affect the insurance industry as potential first- and thirdparty exposures become even more uncertain.

Ongoing technological developments are another source of uncertainty. Determining environmental liability can be particularly challenging when new technologies are involved.

In general, the less-tested a technology is, the greater the risk it poses.

For example, new processes of carbon capture and storage could theoretically mitigate the effects of fossil fuel emissions. But the UN’s International Panel on Climate Change (IPCC) has acknowledged that safe and permanent storage of CO2 cannot be guaranteed and that even very low leakage rates could potentially undermine any climate mitigation benefits.

For adjusters and insurers dealing with environmental coverage for large-scale facilities such as power plants, such evolving technological recommendations can further complicate liability issues.

Climate change raises yet another set of liability issues. Setting aside any questions about the extent to which human activity has contributed to the problem, enterprises increasingly view climate change as a business risk they need to manage. And a changing climate poses risks not only to property and health but to businesses and governments through liability. Potential exposures range from mass tort claims against regulators or companies for not enforcing or meeting emission standards, to shareholder lawsuits against corporations for not disclosing environmental risks. Adjusters and insurers may find themselves dealing with environment-related claims brought under D&O policies, as well as the ones made under environmental policies.

For adjusters and insurers alike, the environmental insurance market remains one to watch as it continues to evolve in response to both new information and new regulatory pressures.  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 16,000 graduates of the Insurance Institute’s Fellow Chartered Insurance Professional (FCIP) and Chartered Insurance Professional (CIP) programs.

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QUEBEC APPOINTMENT

Cunningham Lindsey Canada Claims Services Ltd. (Cunningham Lindsey) President and CEO Rob Seal is pleased to announce the firm’s 90th anniversary in Canada. “March 2013 marks Cunningham Lindsey’s 90th anniversary in Canada, an amazing milestone in our firm’s history,” said Rob Seal. “90 years is a very long time and a huge accomplishment for any business. I attribute this success and longevity to our employees and customers for their support and commitment that has enabled us to grow and diversify into a leading claims solutions provider here in Canada and around the world.” l Benoit Guay Customer Relationship Manager

Craig Smith, Vice President, Sales and Marketing of ISB Canada is pleased to introduce Benoit Guay as the Customer Relationship Manager for the Province of Quebec.

Benoit gained experience in the insurance industry working for an independent adjusting firm, and he is the driving force behind ISB Canada’s Quebec operation. He has previously shown his leadership and communication skills as a Strategic Consultant, promoting business development in both Quebec and France.

Benoit can be reached in Montreal at 438-863-3588 bguay@isbc.ca ISB Canada is your trusted partner for source document retrieval. Documents such as Police Reports, Driver Insurance Histories, Statement of Claim Searches, Land Title Searches, Lien Information and much more are all available. Spend your time analyzing information, not looking for it.

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Kia Moser and Mike Connolly

Plant Hope Adjusters is proud to announce the opening of its 9th office in Atlantic Canada. The flagship Nova Scotia office is located at Bedford within the Halifax Regional Municipality giving efficient access to all points within the province. Senior Adjuster Mike Connolly will be the principal adjuster in the Bedford office where he will be very capably assisted by Kia Moser and supported by the entire Plant Hope team. Contact information for the Nova Scotia office is: Plant Hope Adjusters Ltd. 30 Damascus Road, Suite 220 (Halifax) Bedford, NS, B4A 0C1 Toll Free: 1-855-835-5065 Fax:(902) 835-0848 e-mail: info@planthope.com l

Stewart Ponton, Chairman and Founding Partner of Granite Claims Solutions, is pleased to announce that 37 years ago today he and Bryan Coleshill opened the doors of Ponton Coleshill & Associates, now Granite Claims Solutions. What started as a small, four-person operation working out of a small office in downtown Toronto has blossomed into one of the largest independent adjusting firms in Canada. “What has impressed me each and every day is how we have grown from that small office to a large national firm and still retained our focus on our clients and providing them with the highest quality independent adjusting services,” says Ponton. “We owe all our successes to each and every employee at Granite.” l In other company news, Granite Claims Solutions recently announced its acquisition of Subrogation Group Limited. “I am pleased to announce that Granite Claims Solutions has acquired Burlington-based Subrogation Group,” says Michael Holden, President and CEO of Granite Claims Solutions. “As a great resource on the recovery side of claims adjusting, their focus on providing the highest quality service for their client fits right in line and is a perfect compliment with our product offering.” l Michael Holden, President and CEO of Granite Claims Solutions, is also pleased to announce that Jean-Marc Laurin has joined the GCS team as Senior Vice President – Quebec and Atlantic Canada. Jean-Marc has over 30 years of experience in the insurance industry, having held senior claims and leadership roles.

Most recently he held a senior operations role with a large national independent adjusting firm. l Catastrophe modelling firm AIR Worldwide has announced a new consulting service for the public sector. Public Risk Services is a new consulting service for “public sector institutions and stakeholders charged with managing catastrophe risk,” the Boston-based firm announced Tuesday. l www.claimscanada.ca

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Ian Elliot

Murray Wallace, CEO of Granite Global Solutions, announced that Ian Elliott has been promoted to President of Granite Health Solutions (GHS) effective April 1, 2013.

He has been Chief Operating Officer of GHS since October 2012. Granite Health Solutions is Granite Global Solutions’ Health and Disability Management Division. GHS operates in the marketplace under the separate Sibley, TRM, and MDAC brands. l

The National Post recently announced that STRONE, emergency restoration and remediation professionals, are 2012 winners of Canada’s 50 Best Managed Companies program. Established in 1993, this national awards program recognizes Canadian companies who implement world-class business practices and create value in innovative ways. l

Ross Totten

Peter Sutton

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H. Ross Totten, longtime president and CEO of Totten Insurance Group, most recently the company’s chairman and chief sales officer, will be retiring June 30, after 43 years as an insurance intermediary. “It is time for me to move on to the next stage of my life, after having had the privilege of helping to build, and lead, Totten Group in it’s first decade of service to our industry,” Totten said in his message to his colleagues. l Hamilton Hospitals Assessment Centre (“HHAC”), one of Ontario’s leading, hospital-based providers of independent medical evaluation services, has announced that Peter Sutton has been appointed to lead its business development and quality control initiatives. In this role he will be responsible for expanding and strengthening relationships between insurance company personnel and the HHAC team of medical evaluation professionals. l April/May 2013

FirstOnSite was recently named as one of Canada’s Best Managed Companies for 2012 – a national awards program from Deloitte that recognizes Canadian companies that have implemented world-class business practices and created value in innovative ways. “We are thrilled to be named one of the Best Managed Companies in Canada,” said Dave Demos, Chief Executive Officer of FirstOnSite.

“Over the years we have strived to meet our commitment to excellence in customer service, employee engagement and innovation at every touch point. At FirstOnSite our core strength is our team and this prestigious award is testament to all their hard work.” l

Itech Environmental Services is pleased to welcome Kevin Spiers to the role of Business Development Manager. Kevin brings over 20 years of experience as a recognized and respected service provider to the insurance industry, with the personal goal of always delivering at or above customer expectations. l Kevin Spiers

Chris Schmidt

DKI Canada is pleased to announce the appointment of Chris Schmidt as Vice President at the company. In his new role, Mr. Schmidt will oversee the strategic sales and marketing plan, as well as lead and manage business development activity. He will also direct product development, including the rollout of new products and services. l

Disaster Kleenup Canada Ltd. (DKC) announced in early April that it has completed its company name change to DKI Canada, effective immediately. This is a move that solidifies the strong relationship that the company has with its counter-part in the US. The move to rebrand as DKI Canada will assist in unifying the company message among DKI members as well as sending a unified message to the marketplace, according to the company. l Spectius Underwriting Solutions will now operate as Canadian Reports, the company announced. The name change is the result of a new partnership with leading U.S.based underwriting services provider, US-Reports that offers the Canadian company a unique opportunity to expand its operations while establishing a national footprint for underwriting services in Canada. By operating together, the companies will be able to meet customer demands for a fully integrated North American solution for underwriting services. l www.claimscanada.ca

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Canadian Independent Adjusters’ Association Ontario Region

AGM/Elections Education Seminar Golf and Spa

June 13-15, 2013

Oakwood Resort, Grand Bend, Ontario

Thursday June 13 9:00 am – 10:00 am Registration 10:00 am – 11:30 am Annual General Meeting & Elections (CIAA members only) 11:30 am – 12:30 pm Lunch, Mix & Mingle (local Insurers & Brokers invited) 12:30 pm – 02:30 pm Seminar – being finalized 3:00 pm – 05:00 pm CIAA National Executive Committee meeting (CIAA members only) 6:00 pm – 08:00 pm Casual Dinner, The Oakwood Pub 8:00 pm Hospitality Suite Friday June 14 7:00 am – 09:00 am Breakfast 9:30 am – 10:30 am Golf Lessons with Golf Pro 11:00 am – 05:00 pm Golf or Spa – includes lunch 6:30 pm – 08:30 pm President’s Dinner – Semi-formal / Business Attire 9:00 pm The Oakwood Pub, Live Entertainment Saturday June 15 7:00 am – 9:00 am Farewell Breakfast

REGISTRATION $225.00 – single $325.00 – double (Colleagues / Guests welcome) Includes – Meetings, Meals, Seminar, Golf/Spa, Hospitality Suite, Entertainment Excludes - Lodging Remit with payment to: CIAA Ontario Region c/o CIAA National Office 100 – 5401 Eglinton Avenue West Etobicoke ON M9C 5K6 Committee Chair : Matt Allan, Granite Claims – 905-740-0048

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• on the scene OTS Rob Reynolds, President of rcvMobile Claims Support Services Ltd, is pleased to announce an innovative property claim support service. The newly formed enterprise was created in response to the insurance claim professionals need for precise, accurate and timely on site information to support the process of settling a property loss. The professional on site assessment accurately provides the client with the origin of the loss, scope of damage and a detailed valuation of the repairs. l Paul Davis Systems Canada (PDSC) welcomes Tim Breau and Jody Dunnett to the Paul Davis Systems franchise network. As new franchisees, Tim and Jody will be operating the Paul Davis Systems of Moncton franchise location and providing restoration services to the Moncton community and surrounding area. l Claims technology provider Symbility Solutions announced in March that its Symbility Mobile Claims app is now available for Android devices. The app aims to improve efficiency, customer service and speed during the estimation process. The app is now compatible with more devices, adding to the user experience, the company said. It also allows customers more flexibility in the property claim process, it noted. l A new slate of maximum fees and disbursements payable for services, activities or functions under Nova Scotia’s Automobile Insurance Diagnostic and Treatment Protocols Regulations will take effect on April 1. A bulletin issued in late March by the Nova Scotia’s Finance Department details the service and fee The revised diagnostic and treatment protocols for minor injuries are among the changes flowing from Nova Scotia’s Auto Insurance Reforms 2011. A fact sheet on the reforms notes the limit on pain and suffering awards for minor injuries was increased, and the definition of “minor injury” was narrowed to include only sprains, strains and certain types of whiplash-associated disorders. An independent automobile insurance review commissioned by the provincial government recommended adopting diagnostic and treatment protocols for minor injuries, based on Alberta’s model, in place since 2004, and regarded as working well. l Droughts are increasingly becoming one of the most destructive of natural catastrophes worldwide, with the number of loss-producing droughts doubling since the 1980s, but it remains an underestimated risk, notes a new report from Munich Re. Still, droughts remain an underestimated risk, notes the company’s new publication, Topics Geo 2012. Droughts are especially catastrophic because they often create conditions for wildfires, disruption of waterway traffic and can have a negative impact on the power generation industry. Although droughts seem less “spectacular” than tornadoes, hurricanes or other such catastrophes, the impact can also be longer lasting, in terms of things like food prices and often famine, the report states. Population growth worldwide also exacerbates the negative effects of drought, Munich Re notes. l 48 Claims Canada

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CIAA New Members — March 2013 CORPORATE MEMBERSHIP Integral-Adjuster

Priddle & Associates Adjusters

Pembroke, NS St. Albert, AB

INDIVIDUAL MEMBERSHIP Canadian Claims Services Inc. Mark Sherwood Vancouver, BC Lee-Ann Case Calgary, AB Carley Matson Calgary, AB Jaye Bewley Edmonton, AB Christine Mlynarchuk Edmonton, AB Candice Tipper Edmonton, AB Reid Townsend Edmonton, AB Steve Bulmer Calgary, AB Aaron Suggett Calgary, AB

Level 3 Level 3 Level 1 Level 1 Level 1 Level 3 Level 3 Level 3 Level 1

Crawford & Company Catherine Dussault Mikhail Serov Neil Patel Karen Bernard Robert Kirby

Level 1 Level 2 Level 1 Level 1 Level 3

Surrey, BC Vancouver, BC Hamilton, ON Charlottetown, PE Mount Pearl, NL

Cunningham Lindsey Canada Claims Services Ltd. Angus Lawrence St. Paul, AB Michael Lamb Mississauga, ON Robert Seal Mississauga, ON Brian Samec North Bay, ON Dave Hildred St. Catharines, ON Timothy Williamson Cranbrook, BC Troy Nevens Port Moody, BC Janice Carruthers Vancouver, BC Lisa McCabe Vancouver, BC Brad Suchecki Brantford, ON Joan Jones Kitchener, ON

Level 2 Level 3 Level 3 Level 3 Level 3 Level 1 Level 3 Level 3 Level 3 Level 3 Level 3

Granite Claims Solutions Balu Naidu

Level 3

Toronto, ON

Kernaghan Adjusters Limited Jodi Payne Calgary, AB Werner de Jager Thompson, MB

Level 2 Level 1

Sedgwick CMS Canada Inc. Ian Encarnacion Toronto, ON Maria Joshua Toronto, ON

Level 2 Level 3

T.C. Insurance Adjusters Ltd. Donna Marry London, ON

Level 1

Townsend & Leedham Adjusters Ltd. Katelin Foster Edmonton, AB

Level 1

Integral-Adjuster Jim Coolen

Pembroke, NS

Level 3

Bedford, NS

Level 1

Plant Hope Adjusters Michael Connolly

Priddle & Associates Adjusters

Mike Priddle St. Albert, AB Phil Gibbs St. Albert, AB Franz Scharfenberger St. Albert, AB

Level 3 Level 3 Level 3

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APPOINTMENT

The Saskatchewan government has set out $198.3 million for crop insurance in its 2013-14 budget, which it says is the largest amount set aside in the program’s history. Coverage levels under the new budget will be $194 per acre on average, the government said in a release, noting the figure is double the average in 2007. It also includes funding for the province’s share of private reinsurance. The budget also sets out $27.7 million for agricultural research, including $3 million for the Global Institute for Food Security. l The federal and Manitoba governments have lent their support to the recently created Guy Carpenter Professorship in Agriculture Risk Management and Insurance, citing the importance of advancing risk management in agriculture, which serves as economic driver in the province and across the country. “We are proud of this endeavour that has governments and industry groups, the academic community and the private sector working together to develop new risk management tools for our hardworking farmers,” federal agriculture minister Gerry Ritz said. l Forecast services company ImpactWeather has released a prediction for this year’s hurricane season, suggesting that 2013 will have a series of storms more severe than last year. Based on “averages of past seasons, ocean temperature trends, and the absence of an El Nino influence from the Tropical Pacific,” the company’s senior meteorologist Chris Hebert said this year could have between 16 and 20 named storms. Last year saw 19 named storms, 10 of which were hurricanes. Hebert has predicted seven to nine hurricanes for this year, but two to four “intense” hurricanes, or those that reach categories three, four or five. Last year saw only one such storm, according to ImpactWeather. l One in four deaths on the road can be attributed to distracted driving, according to Manitoba Public Insurance. The public insurer says that more than 160 road deaths have been linked to distracted driving since 2005, which translates to an average of 25 per year. “Cell phones don’t cause crashes, distracted drivers do,” MaryAnn Kempe, vice president of community and corporate relations for MPI, said. l Lloyd’s released its financial results for 2012, reporting a profit of £2.77 billion despite billions in claims from damage resulting from Hurricane Sandy. Lloyd’s, which lost £516 million in 2011, said in March that its gross written premium income in 2012 was £25.5 billion while total net incurred claims were £10.1 billion, down from £12.9 billion in 2011. “In marked contrast to 2011 there was a low level of major catastrophe activity until the impact of Superstorm Sandy in late October,” Lloyd’s stated in its annual report. l Ninety percent of Canadians say they believe an extreme weather-related disaster is possible in their community, but few are prepared for the consequences that excess water from such events can have on their homes, notes a new report from Royal Bank of Canada. Paved surfaces, overloaded infrastructure and severe weather conditions all create challenges for managing excess water, notes the 2013 RBC Canadian Water Attitudes Study, an online survey of 2,282 Canadians administered by GlobeScan between Jan. 23 and Feb. 1. l

Hue Nguyen Claude Blouin and Jamie Dunn, Partners at Blouin Dunn LLP, are extremely pleased to announce that Hue Nguyen has joined the firm as an associate lawyer.

Hue received her Bachelor of Arts (Honours) degree in History from Queen’s University in 2007 and obtained her Juris Doctor at Osgoode Hall Law School in 2010. She was called to the Ontario Bar in 2011 Hue’s practice focuses on several areas of insurance litigation including personal injury, occupiers’ liability and disability insurance. Prior to joining Blouin Dunn, Hue practiced at a Toronto personal injury law firm where she gained valuable insight and experience in personal injury litigation.

Hue is currently a member in good standing of the Law Society of Upper Canada, the Advocates’ Society, the Ontario Bar Association, the Canadian Bar Association, Canadian Defence Lawyers and the Federation of Asian Canadian Lawyers.

Outside of work, Hue enjoys travelling, hot yoga, spinning, volleyball and trying new restaurants.

Hue’s contact information is: hnguyen@blouindunn.com (416) 365-7888 ext. 163 Blouin Dunn is one of Ontario’s leading insurance defence firms whose members have been providing quality legal support to the insurance community for over 30 years.

We offer services in Ontario to property and casualty insurers throughout North America, at all levels of experience, at appropriate and competitive rates.

Claims Canada Wants You! Claims Canada magazine wants you to send us your company news, appointments and event photos for possible inclusion within our ‘On the Scene’ department. Please help us share your items with the claims industry across the country. For more information, please email: craig@editinsight.com

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April/May 2013

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• on the scene OTS Murray Wallace, CEO of Granite Global Solutions, is pleased to announce the appointment of Doug Tremblay as Managing Partner of Rochon Engineering effective April 1, 2013. Doug is a Licensed Professional Engineer who has been with the firm since 2007 and Chief Operating Officer since June 2012.

He completed his Baccalaureate of Technology in Mechanical EngineerDoug Tremblay ing at Ryerson University and his accreditation program through the University of Toronto. He is currently completing his MBA at the Queen’s School of Business. l

Les Telch

Claridge Insurance Adjusters Inc. is pleased to announce that Les Telch, B.A., CIP has joined our team. Les brings with him over 20 years of adjusting experience specializing in Accident Benefits, Bodily Injury, Fraud Investigation and Liability claims. Les’ territory includes the GTA and Barrie/Simcoe County.

Les is also a seasonal resident of the Muskoka region servicing the needs of Ontario’s Cottage Country and surrounding areas including Sudbury and North Bay. l

On February 21, 2013, AESIQ held their 9th annual Sugar Shack event at the Cabane à sucre Constantin in St-Eustache, Quebec. A record breaking 361 guests registered for this now very popular event in the Quebec insurance industry. CIAA National President, John Seyler was among special guests in attendance. AESIQ’s President, Claude Nadeau, presented President Seyler with a basket full of maple goodies and he went on to win another in a prize drawing from one of the many sponsors. The “Sugar Shack” is one of three fundraising events held annually by AESIQ. l

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More than 400 repairers, insurers and suppliers representing the insurance claims and collision repair industries attended the Canadian Collision Industry Forum (CCIF) meeting on Saturday January 25 in Toronto. A panel discussing top CCIF action items included: Flavio Battilana, CSN Collision & Glass/ Carrossier ProColor, Canada; David Low, Wolf Collision, Halifax; Michael Macaluso, CARSTAR Automotive, Canada; Kevin Machell- Cox, Craftsman Collision, Vancouver; Sam Piercey, Budd’s Collision, Oakville, Ontario; and Paul Prochilo, Prochilo Brothers, Toronto.l

Claims Canada Magazine is the only national claims publication COVERING the Canadian market

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For advertising space information, please contact Paul Aquino, Publisher: paul@canadianunderwriter.ca

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April/May 2013

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Official Journal of the Canadian Indeépendent Adjusters’ Association

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• on the scene OTS The CICMA/CIAA Ontario Chapter’s 46th Annual Joint Conference was held on Feb. 5, 2013 at the Metro Toronto Convention Centre. The theme of the conference was ‘Can We Talk? Customer Service: the Good, the Bad and the Ugly’. Guest speakers were Brian Maltman, executive director, General Insurance OmbudService; Stephen Scullion, director professional development, Crawford & Company (Canada) Inc.; and keynote speakers Carl Van, president and CEO, International Insurance Institute, Inc. l

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SAVE THE DATE –– Further details available soon SAVE THE DATE Further details available SAVE THE DATE – Further details available soon soon

Canadian Independent Adjusters’ Association/ Canadian Independent Adjusters’ Association/ Canadian Independent Adjusters’ L’Association Canadienne des ExpertsAssociation/ Indépendants L’Association Canadienne des Experts Indépendants L’Association Canadienne des Experts Indépendants

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• on the scene OTS Hundreds of insurance claims industry guests attended the 7th Annual Post CICMA/CIAA Joint Conference Cocktail on Feb. 5, 2013. Entitled The Big Mingle, the event featured a Big-Top theme. Giffin Koerth Forensic Engineering and Blouin Dunn LLP hosted the event, held at the Maison Mercer in Toronto. l

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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. 6, 2013. The event featured a trade show and seminars covering a wide variety of timely claims topics. l

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Property & Casualty Insurance Newswire

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McCague Borlack LLP hosted its seventh annual ski day event on Feb. 21 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

Canadian Insurance Claims Education Benevolent Foundation OBJECTIVE • To assist with funding needed to further education of Canadian students entered in an insurance claims related discipline.

• Applications must be received at the CIAA National Office by July 31st annually.

• Awards will be announced at the CIAA Annual General Meeting in August.

VALUE • A minimum of one $1000.00 award annually.

DONORS • Canadian Independent Adjusters’ Association • Canadian Federation of Insurance Claims Associations

SUBMISSION • Applications are available at the Canadian Independent Adjusters’ Association National Office: CIAA Centennial Centre, 5401 Eglinton Ave. W., Suite 100 Etobicoke, ON M9C 5K6 Tel: (416) 621-6222 Fax: (416) 621-7776 E-mail: info@ciaa-adjusters.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. 21. More than 1,200 guests attended the association’s annual signature event. l

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Canadian Independent Adjusters’ Association l’Association Canadienne des Experts Indépendants

Presenting…

Online Education

for CIAA Members and Insurers!

CIAA is pleased to announce their online training platform is now available to Insurance Company Claims Personnel.

Offering quality claims specific education through an online educational program, Members and now Insurers can drastically reduce the time and costs associated with training and regulated Continuing Education compliance.

CIAA's online learning program provides claims professionals with a full stream of quality training at basic, intermediate and advanced levels. The curriculum includes technical property courses, adjuster skill and knowledge courses as well as basic legal concept courses in contract law and tort law.

Pricing per Person: $125 annually provides full access to all courses. Currently there are 30 courses available with more being added as they are developed.

Visit www.ciaa-adjusters.ca for a complete course listing and program registration.

CIAA - proudly providing Members and Insurers with continuing training, education and professional development opportunities!

www.ciaa-adjusters.ca

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