Claims Canada June/July 2015

www.claimscanada.ca

June/July 2015

Official Journal of the Canadian Indeépendent Adjusters’ Association

Capitalizing

on Claims Data

How analytics can work for insurers and adjusters

PM40069240

p1 CLAIMS COVER FINAL.indd 1

15-06-29 9:40 AM

GK_Ad_ClaimsCanada.pdf

1

11-11-03

2:51 PM

Exceptional expertise

• Forensic Engineering • Loss Mitigation / Remediation • Engineering Risk Management

416.368.1700 giffinkoerth.com

ad right size.indd 1

15-06-24 3:57 PM

12

Contents J U N E / J U LY 2 0 1 5 • V O L U M E 9 • N U M B E R

3

Cover Feature 12 Capitalizing on Claims Data After initially focusing on underwriting and pricing, many insurance companies have expanded their view of data analytics to loss management. The claims handling process represents a rich area for data modeling tools that can provide better insight into in everything from adjuster assignment to operational efficiency to fraud detection and subrogation. How does data analytics fit into the claims management process for insurers – and adjusters?

22

BY CRAIG HARRIS

Spotlight 20 Pinnacle Position Ray Proctor says that Toronto-based Pinnacle Adjusters Group’s business model stems from a simple promise – “exceptional adjusting at a reasonable rate.”

BY CRAIG HARRIS

Education Forum 30 Cats and Dogs

28

Although many Canadian households include a dog or a cat, only a fraction of them currently have pet insurance.

News Features 22 The Additional Insured An oil spill case shows the consequences of not naming an additional insured on a policy.

BY MICHAEL S. TEITELBAUM

26 Risky Real Estate Negligent disclosure of natural hazard risks can pose future liability.

BY JOANNA KYRIAZIS and LAURA ZIZZO

28 The State of Summary Judgement

Departments

A national overview of personal injury cases.

BY ERIN H. DURANT

4 First Notice 32 On The Scene

Columns 10 President’s Message 30 Education Forum

26 p3 contents.indd 1

15-06-25 4:41 PM

• first notice FN Cyber risk protection should be strengthened: IIC Canadian property and casualty insurance organizations should bolster the defences of their organizations and those of their clients against cyber threats by developing a culture of cyber security, recommends a new research report issued recently by the Insurance Institute of Canada (IIC).

“Insurance organizations are encouraged to build a corporate culture of cyber security that includes actions to address technological threats and security training for employees,” notes an IIC statement announcing the release of Cyber Risks: Implications for the Insurance Industry in Canada, which assesses cyber risk from the perspective of the Canadian p&c insurance industry.

The research report cites a study by Intel’s McAfee and the Center for Strategic and International Studies, Net Losses: Estimating the Global Cost of Cybercrime, which estimates the global cost of cyber crime in 2013 at US$375 billion to US$575 billion. “The global impact of cyber crime is similar to estimates by the United Nations of the international production, trafficking and sales of illicit drugs (US$400 billion) and the worldwide damage resulting from vehicle collisions (US$518 billion),” states the report.

According to the report, the most common forms of cyber attacks were theft and other data attacks, malware (phishing

and pharming) and mechanisms to infect computers (viruses, worms, Trojan horses). The report notes that in 2013, the 3,700 clients of IBM’s Managed Security Services experienced seven or eight cyber incidents each month, on average. About half of those attacks - including scams to steal credit card information, website vandalism, corporate espionage and denial-of-service attacks - were directed at the manufacturing (27%) and financial services (21%) industries.

The largest source of loss from cyber crime involves the theft of trade secrets or other intellectual property, the report says, followed by theft of funds, theft of confidential information and opportunity cost (confidence eroded in the Internet as a trusted place for commerce and communications).

In a separate study, the Ponemon Institute reported that the average consolidated total cost of a data breach in Canada was $5.32 million. Released in late May, the inaugural 2015 Cost of Data Breach Study: Canada found that the average cost per lost or stolen record was $250 and 52% of data breaches involved malicious or criminal attacks. The study examined the costs incurred by 21 Canadian companies from 11 different industry sectors “following the loss or theft of protected personal data and the notification of breach victims as required by various laws.” l

Number of wildfires doubled from last year There has been double the amount of wildfires nationally and almost nine times as many hectares burned so far in 2015 over the same time period last year, said a speaker at the sixth annual Canadian Insurance Financial Forum May 27.

“The hot and dry weather in the West coupled with human interaction and lightning has sparked over 2,220 fires as of (late May), which have burned over 133,000 hectares of forest,” Carolyn Rennie, director of catastrophic loss analysis with Catastrophe Indices and Quantification Inc. (CatIQ), said.

“From this, we know that we are going to be watching forest fires for a while this year,” she noted during the Review of Industry Results and Outlook presentation at the Metro Toronto Convention Centre.

Of particular concern was the Little Bobtail Lake fire, about 70 kilometres southwest of Prince George, British Columbia, which burned over 25,000 hectares of forest before it was contained. In Alberta, an estimated 5,000 people were evacuated and a local state of emergency remains in effect for the Municipal District of Lesser Slake Lake. On May 25, the province of Alberta issued a province-wide fire ban and other provinces are following suit. “[Forest fires] are already becoming more frequent due to above-average temperatures and a dry climate,” Rennie said. “This is one peril to keep a close eye on.” l 4

Claims Canada

p4,6,8 FIRST NOTICE.indd 4

June/July 2015

www.claimscanada.ca

15-06-25 4:46 PM

WHEN THE UNEXPECTED HAPPENS,

WE’RE WE’RE READY

WHEN THE UNEXPECTED HAPPENS,

READY

WE ARE EQUIPPED TO RESPOND TO YOUR NEEDS 24/7.

We are the single-source solution with the expertise and resources to mitigate damages and minimize losses with superior results. You can depend on us to handle every aspect of the property repair efficiently, effectively and with care. Call the brand you can trust to deliver all your We are the single-source solution with the expertise and resources to mitigate damages needs. andrestoration minimize losses with superior results. You can depend on us to handle every aspect

WE ARE EQUIPPED TO RESPOND TO YOUR NEEDS 24/7.

We are the single-source solution with the expertise and resources to

of the property repair efficiently, effectively and with care. Call the brand you can trust to mitigate damages andneeds. minimize losses with superior results. You can deliver all your restoration

depend on us to handle every aspect of the property repair efficiently, effectively and with care. Call the brand you can trust to deliver all your restoration needs.

1-800-RESPOND servicemasterrestore.ca

ad right size copy.indd 1 ad right size.indd 1

15-01-19 9:21 AM 15-06-24 4:03 PM

• first notice FN Air bag inflator recall largest in history In what’s being called the “largest and most complex product recall” in United States history, Takata Corporation, a Tokyo, Japan-based supplier of automotive safety systems, announced the recall of nearly 34 million defective air bag inflators.

U.S. Transportation Secretary Anthony Foxx announced the recall in May, saying that “at the [Department of Transportation’s (DOT)] insistence, air bag manufacturer Takata has acknowledged that a defect exists in its air bag inflators.” Takata has agreed to a national recall of certain types of driver and passenger side air bag inflators, which were made with a propellant that can degrade over time and has led to ruptures that have been blamed for six deaths worldwide, the DOT said in a statement.

The DOT’s National Highway Traffic Safety Administration (NHTSA) has also issued to a consent order to Takata, requiring the company to “cooperate in all future regulatory actions that NHTSA undertakes in its ongoing investigation and oversight of Takata.” In addition, NHTSA an-

nounced its intent to begin a formal legal process to organize and prioritize the replacement of defective Takata inflators under the agency’s legal authority.

“The Department of Transportation is taking the proactive steps necessary to ensure that defective inflators are replaced with safe ones as quickly as possible, and that the highest risks are addressed first,” Foxx said in the statement. “We will not stop our work until every air bag is replaced.”

In late May, Transport Canada released a detailed list of vehicles being recalled in Canada due to faulty airbags made by Japan’s Takata Corp., saying 1.2 million vehicles in this country are part of the worldwide recall. The list of affected vehicles was posted online and includes the Honda Civic, Accord, and CR-V, Chrysler products, including the Dodge Ram and the Chrysler 300, BMW sedans and the X5, and Ford’s Ranger and Mustang.

The majority of the affected models are from the 2001 to 2011 model years, although more recent Ford Mustang models are also affected. l

Below-average season for Atlantic hurricanes predicted

Claimspro acquires Plant Hope Adjusters

The National Oceanic and Atmospheric Administration (NOAA) in the United States recently reported that the 2015 Atlantic hurricane season will likely be below-normal.

For the hurricane season, which officially runs from June 1 to Nov. 30, NOAA is predicting a 70% likelihood of six to 11 named storms (winds of 39 miles per hour (mph) or higher)), of which three to six could become hurricanes (winds of 74 mph or higher), including zero to two major hurricanes (Category 3, 4 or 5; winds of 111 mph or higher).

While there is a 70% chance of a below-normal season, there is also a 20% chance of a near-normal season and a 10% chance of an above-normal season, the NOAA’s Climate Prediction Center said in a press release.

“A below-normal season doesn’t mean we’re off the hook,” NOAA administrator Kathryn Sullivan said in the release. “As we’ve seen before, below-normal seasons can still produce catastrophic impacts to communities, she said, referring to the 1992 season in which only seven named storms formed, yet the first was Andrew – a Category 5 major hurricane that devastated South Florida.

“The main factor expected to suppress the hurricane season this year is El Niño, which is already affecting wind and pressure patterns, and is forecast to last through the hurricane season,” added Gerry Bell, lead seasonal hurricane forecaster with NOAA’s Climate Prediction Center.

“El Niño may also intensify as the season progresses, and is expected to have its greatest influence during the peak months of the season. We also expect sea surface temperatures in the tropical Atlantic to be close to normal, whereas warmer waters would have supported storm development.” l

Independent adjusting and claims management company ClaimsPro announced in late May that it has acquired Atlantic Canada adjusting service Plant Hope Adjusters Ltd. Fred Plant, formerly president of Plant Hope Adjusters Ltd., will serve as senior vice president, operations, Atlantic Canada, with ClaimsPro and will work alongside Wayne Guy, ClaimsPro’s vice president, Atlantic Canada.

ClaimsPro, a company of SCM Insurance Services, noted in a press release that Plant Hope Adjusters is the largest employeeowned regional independent adjusting service in Atlantic Canada, with 11 offices and 42 adjusters operating in the Maritime provinces. Plant Hope provides services in complete loss investigation, marine surveying and claims management to insurers.

Led by president Fred Plant , an associate of the Insurance Institute of Canada and previously the president of the Canadian Independent Adjusters’ Association (CIAA), Plant Hope “exemplifies the type of strategic acquisition ClaimsPro strives to make in providing the best possible service and geographical coverage to its clients,” the release said.

“We are excited about this new alliance,” Plant said. “When we looked at our philosophy and ClaimsPro’s business strategy, we found significant alignment centered on our people and our commitment to delivering the best service to our clients.”

Ross Betteridge, president of ClaimsPro, said in the release that the company identified Plant Hope as one that “shares our corporate values and philosophy” and that the “alliance gives us important regional scale. This merger means a great deal for us,” Betteridge said. l

6

Claims Canada

p4,6,8 FIRST NOTICE.indd 6

June/July 2015

www.claimscanada.ca

15-06-25 4:47 PM

When critically injured people need help‌ who provides support?

Let’s recognize the best. The choice is yours.

The Ontario Brain Injury Association is pleased to announce that the annual Awards of Excellence in Brain Injury Rehabilitation will now include an Award of Excellence for the Insurance Company of the Year.

This award is meant to recognize the insurance company that consistently acts responsibly and compassionately in assisting brain injury claimants. The recipient will be a company that continues to provide support to the brain injury community and is dedicated to raising public awareness of brain injury.

Online nominations for the Awards of Excellence will take place from June 1st to July 17th, 2015 Online voting for the selected nominees will take place from August 4th to August 28th, 2015 The Awards of Excellence will be presented by the Ontario Brain Injury Association at the Back to School Conference on September 10th, 2015 at the Four Seasons Hotel in Toronto.

Please encourage voting. To vote or for more information, visit OBIA.ca

ad right size.indd 1

15-06-25 3:10 PM

• first notice FN The Co-Operators launches overland flood coverage in Alberta The Co-operators General Insurance Company announced in May that it has introduced insurance coverage for overland flooding in Alberta.

The coverage, which is available throughout the province, is an “inclusive and flexible solution” designed to protect homes against the most common causes of water damage – flooding caused by an overflow from a body of water, sewer/water backup and accumulation of surface water caused by heavy rain, The Co-operators said in a press release.

The coverage is available as an endorsement to Co-operators General Insurance Company homeowners’ insurance policies in Alberta, the release said. It is available for purchase as of Monday, and will be added to existing policies that currently have coverage for sewer/water backup, upon renewal. Planning is currently underway to make the product available across the country, the Co-operators reported.

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

Steve Wilson Senior Publisher (416) 510-6800 steve@canadianunderwriter.ca

Elliot Ford Account Manager eford@canadianunderwriter.ca (416) 510-5117

Craig Harris Editor (905) 873-7691 craig@editinsight.com

Gary White Production Manager • (416) 510-6760

Christine Giovis Account Manager (416) 510-5114 christine@canadianunderwriter.ca

Michael Chimienti Art Director mchimienti@annexnewcom.ca

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 b i-monthly m agazine ( 6x p er y ear), C laims C anada i s p ublished b y N EWCOM B usiness M edia I nc. i s l ocated a t: 80 Valleybrook Drive, Toronto, ON, M3B 2S9.

Claims C anada m agazine is t he O fficial P ublication o f t he C anadian I ndependent A djusters’ A ssociation [ CIAA] a nd through i ts editorial c ontent and c irculation b rings t ogether the ‘ entire property & casualty i nsurance c laims m arket 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

8

“As a co-operative, we seek to address unmet needs, and there is clearly a need to provide Canadian homeowners with better protection against flooding,” said Kathy Bardswick, president and CEO of The Co-operators, in the release.

“Our coverage is available to homeowners throughout the province – not just those who have a low risk of flooding or sewer backup.”

The announcement comes after a study on flood preparedness that The Co-operators released earlier in May. The report, written by Dr. Blair Feltmate, an associate professor in the Faculty of Environment at the University of Waterloo, assessed the level of preparedness of 15 major Canadian cities to limit flood damage. Ottawa leads the pack in flood preparedness (with a grade score of A-), while the remaining cities received a score from B+ to D: Winnipeg, Calgary, St. Johns, Toronto, Montreal, Mississauga, Ont., Edmonton, Fredericton, Whitehorse, Charlottetown, Quebec City, Regina, Vancouver and Halifax. l

Claims Canada

p4,6,8 FIRST NOTICE.indd 8

June/July 2015

Mike Wells Account Manager • (416) 510-5122 mike@canadianunderwriter.ca

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.

www.claimscanada.ca

15-06-25 4:47 PM

Being a member of CIAA has its benefits‌ Introducing new insurance enhancements available exclusively for members of the Canadian Independent Adjuster’s Association PRIVACY BREACH EXPENSE COVERAGE: LMS PROLINK in partnership with Berkley Canada is pleased to announce complimentary Privacy Breach coverage for members of CIAA who subscribe to the Insurance program.

Traditional Insurance policies have not kept up with the evolving landscape of privacy breaches and the exposure adjusting firms encounter when handling private and confidential client information.

Any Adjuster or Adjusting Firm that handles or stores private business, customer, or employee information is at risk of a privacy breach.

CIAA CYBER.indd 1

WHAT CAN YOU DO? Join CIAA now and benefit from the extensive protection offered by this unique program.

Limits Provided

(subject to minimal underwriting information):

- Personal Identity Limit: - Administrative Expensive Limit: - Identity Event Service Limit:

$50,000 per claim $25,000 per claim $25,000 per claim

Coverage Includes: - Administrative Expenses: Defense and investigation to determine whether a breach occurred.

- Crisis Management: Time saving professional forensic investigation service in handling a privacy breach.

Assistance from public relations expert and crisis management expenses paid.

- Notification Costs: Recommendations on remediation services for impacted clients and credit file monitoring - Damages: Compensation Damages as a result of a Privacy Breach Claim.

Higher limits are available upon request for an additional premium.

15-06-24 1:35 PM

Message from the President La Plume du Président ALBERT POON

Wearable te chnology. D riverless c ars. H ome s ystems (heating, a ir c onditioning o r l ocks) r emotely c ontrolled b y sensors. I t’s g etting m ore a nd m ore c hallenging t o k eep u p with the pace of modern technology. Many veteran adjusters may r emember s uch a ntiquated p rocesses a s h and-written notes, faxes a nd pay phones. Mention t hese t hings to a M illennial and you will likely get a quizzical look and maybe even a patronizing smile. The digital generation has grown up with twitter, instagram and apps – this is their new normal.

It’s c lear t hat t oday’s h i-tech w orld o ffers a g reat d eal o f opportunities for adjusters and the claims handling process.

Now, we have mobile technology, tablets, wireless communications, connected systems between adjusting firms a nd clients and a whole host of tools that mean the “field” has become the adjuster’s de facto office. We c an communicate far more quickly when it comes to first notice of loss, site visits and ongoing correspondence back to insurers.

It is not just adjusters communicating with insurance companies; some customers are now taking photos or videos and sharing them directly with their insurers. The trend towards “self-servicing” o f c laims t hrough m obile a pps o r p ortals i s one that independent adjusters have to take notice of and understand.

Much o f the te chnology t oday is g enerating e normous amounts of data – a lot of it is so-called “big data.” This is not the traditional kind of information stored in insurance policy administration or c laims s ystems. S o i t i s b eyond a ctuarial, underwriting o r e ven l oss d ata. T his c ould b e i nformation collected from third-party sources, video or audio, data from remote sensors (like telematics i n vehicles or a larm systems in homes). When it comes to big data, the three “Vs” rule: volume, velocity and variety of information.

Data a nalytics i s q uickly b ecoming t he n orm f or l eading insurance companies seeking to improve operational performance, g lean b etter i nsights f rom i nformation a nd m anage risks or exposures more effectively. A s adjusters, we have to know what these new processes mean to us – will it allow for more timely assignment to losses? Will adjuster expertise be more closely matched by type of claim? Will new technologies, 10 Claims Canada

p10,11 presidents message.indd 10

June/July 2015

En r aison d es t echnologies v estimentaires, d es v oitures s ans conducteur et des systèmes domestiques (comme le chauffage, l’air conditionné et les serrures) commandés à d istance par l ’entremise de c apteurs, le r ythme d ifficile à s uivre de la technologie moderne représente u n p roblème g randissant. C ertains e xperts e n s inistres chevronnés se rappelleront les procédés archaïques comme les notes manuscrites, l es t élécopieurs e t l es t éléphones p ublics. L e si mple fait de mentionner ces objets à une personne issue du présent millénaire entraînera probablement un air perplexe et peut-être même un sourire c ondescendant. L a génération du numérique a g randi avec Twitter, Instagram et des applications; voilà ce qui a modelé sa conception de cette nouvelle normalité.

De n os j ours, i l a ppert q ue l e m onde h autement t echnologique offre un grand éventail de possibilités en ce qui a trait aux experts en sinistres et au processus de traitement des réclamations. Nous avons aujourd’hui la technologie mobile, les tablettes, les communications sans fil, les systèmes reliés entre firmes d ’experts en sinistres ainsi que les clients. Nous disposons d’une vaste gamme d’outils qui font en sorte que le « terrain » est, dans les faits, devenu le lieu de travail de l’expert en sinistres. Nous pouvons communiquer bien plus rapidement avec les entreprises d’assurance en ce qui a trait au premier avis de sinistre, à l a visite sur les lieux et à l a correspondance continue.

Il n’y a p as que les experts en sinistres qui communiquent avec les entreprises d’assurance; certains clients prennent désormais des photos ou enregistrent des vidéos et les partagent directement avec leurs assureurs. Les experts en sinistres doivent prendre en compte et comprendre la tendance en faveur de « l’autogestion » des sinistres par l’entremise d’applications mobiles ou de portails.

De nos jours, la plupart des appareils technologiques génèrent des quantités énormes de données dont la majeure partie se nomme soidisant les « mégadonnées ». Il ne s’agit pas du type de renseignement traditionnel emmagasiné au sein des systèmes d ’administration de polices d ’assurance ou de réclamations. Elle va par conséquent audelà des données actuarielles, de production, voire les pertes. C ela pourrait s ’avérer d es re nseignements r ecueillis d e s ources t ierces, de contenu audio ou vidéo, de données provenant de senseurs à distance (comme la télématique contenue dans les véhicules ou dans les systèmes d’alarme domestiques). Les trois dimensions liées aux mégadonnées sont représentées par la règle des trois « V » : le volume, la vitesse et la variété.

L’analyse d es d onnées d evient r apidement l a n orme p our l es principales e ntreprises d ’assurance q ui c herchent à a méliorer l e rendement opérationnel, concevoir de meilleures idées à p artir des renseignements et gérer les risques et les expositions plus efficacement. À t itre d’experts en sinistres, nous nous devons de connaître l’importance que revêtent pour nous ces nouveaux procédés. Cela www.claimscanada.ca

15-06-26 8:41 AM

such as drones and micro or nano satellites, allow us to get a better picture of catastrophic loss events – a nd thus respond more quickly?

With a ll t hese t rends i n te chnology, i t’s e asy t o get overwhelmed. In fact, one might get the impression that automation w ill make t he role of t he i ndependent adjuster obsolete.

Nothing could be further from the truth, from my perspective.

The p rocess o f a djudication – e nsuring t hat t he c laim pa yment is commensurate w ith t he terms of t he policy – is a nd will a lways b e necessary i n t he i nsurance i ndustry. A nd t he independent adjuster is the standard-bearer for this primary function.

Technology w ill n ot b e a ble t o r eplace s ound j udgement, analysis and investigative skills of the trained, well-qualified independent a djuster. Moreover, te chnology c annot r eplace the patience and understanding shown by empathic adjusters to customers who have experienced a m ajor, u nsettling loss.

There is no “app” for that. I don’t think there ever will be.

What I t hink w e s hould b e striving f or is e nhancement of t he adjuster profession w ith t he tools of technology. What forms of automation will allow us to gather information quicker, expedite decision-making and and respond to clients more effectively? How can we marry our skills as a profession with hi-tech tools that allow us to do our jobs better? That is a tech talk well worth having. n

nous permettra-t-il de gérer les pertes d ans les délais? L e savoir-faire des e xperts e n si nistres c orrespondra-t-il p lus fidèlement a u t ype d e réclamation? Les nouvelles technologies, comme les drones, ainsi que les m icrosatellites o u l es n anosatellites, n ous o ffriront-elles l a p ossibilité d’obtenir un meilleur portrait en cas de sinistre catastrophique, et donc, d’intervenir plus rapidement?

Il est facile d’être submergé par toutes ces tendances technologiques.

En fait, on pourrait avoir l’impression que l’automatisation entraînera la désuétude du rôle de l’expert en sinistres. Selon moi, rien ne pourrait être plus l oin d e l a vérité. L e processus d e d écision – s ’assurer q ue l e paiement de la réclamation est effectué en fonction des modalités de la politique – est et restera toujours nécessaire à l’industrie de l’assurance.

L’expert e n si nistres i ndépendant e st é galement l e p orte-étendard d e cette fonction primordiale.

La t echnologie n e s era p as e n m esure d e r emplacer l es a ptitudes à émettre u n jugement éclairé, d ’analyses et d ’enquêtes de l ’expert en sinistres indépendant qualifié et formé. De plus, la technologie ne peut pas remplacer la patience et la compréhension démontrées par des experts en sinistre empathiques auprès de clients ayant éprouvé des pertes majeures e t t roublantes. I l n’existe p as d ’application p our ç a. Je c rois qu’il n’y en aura jamais.

Je c rois q ue n ous d evrions a spirer à l ’amélioration d e l a p rofession d’experts en sinistres au moyen des outils technologiques. Quelles formes d ’automatisation n ous p ermettront-elles d e c ueillir d es re nseignements p lus r apidement, d ’accélérer l e p rocessus d écisionnel e t d’intervenir auprès de clients plus rapidement? Comment pouvonsnous agencer nos aptitudes professionnelles aux outils de hautes technologies, nous permettant ainsi de mieux accomplir notre travail? Voilà une discussion sur les technologies qu’il vaut la peine d’entamer. n

NATIONAL EXECUTIVE 2014 - 2015 President Albert Poon, CIP Cunningham Lindsey Canada Claims Services Ltd. 1102 – 50 Burnhamthorpe Rd. W. Mississauga, ON L5B 3C2 Phone: (905) 896-8181 Fax: (905) 896-3485 E-mail: apoon@cl-na.com 1st Vice-President Gary Ellis, BBA, FCIP, RF, FCLA, FCIAA, FIFAA AMG Claims Inc. 535 North River Road, Unit 3 Charlottetown, PE C1E 1J6 Phone: (902) 628-9091 Fax: (902) 628-9093 E-mail: gary.ellis@amgclaims.ca S ecret ar y Monica Kuzyk, FCIP, CRM Curo Claims Services 125 Northfield Dr. W., P.O. Box 218 Waterloo, ON N2J 3Z9 Phone: (866) 952-2876 Fax: (519) 888-9704 E-mail: mkuzyk@curocanada.com

www.claimscanada.ca

p10,11 presidents message.indd 11

T reasurer John D. Seyler, CIP Integrated Insurance Resources 5080 Timberlea Blvd., Suite 214 Mississauga, ON L4W 4M2 Phone: (905) 238-4985 Fax: (905) 238-2735 E-mail: jseyler@integrated-ins.ca Past -President Marie C. Gallagher, FCIP, CRM Kernaghan Adjusters Limited 602 – 1 St. Paul Street St. Catharines, ON L2R 7L3 Phone: (289) 786-1074 Fax: (289) 723-1979 E-mail: mgallagher@kernaghan.com Executi ve D irector 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

D irector James B. Eso, CIP, CIOP 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 D irector John Jones, BA Cunningham Lindsey Canada Claims Services Ltd. 1102 – 50 Burnhamthorpe Rd. W. Mississauga, ON L5B 3C2 Phone: (905) 896-8181 Fax: (905) 896-3485 E-mail: jjones@cl-na.com D irector 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

June/July 2015

Claims Canada 11

15-06-26 8:42 AM

CS

• cover story

Capitalizing

on Claims Data

After initially focusing on underwriting and pricing, many insurance companies have expanded their view of data analytics to loss management. The claims handling process represents a rich area for data modeling tools that can provide better insight into everything from adjuster assignment and operational efficiency to fraud detection and subrogation. How does data analytics fit into the claims management process for insurers – and adjusters?

By CRAIG HARRIS

p12-18 COVER STORY.indd 12

15-06-26 8:45 AM

I

f “data is the new oil,” as some contend, then analytics represents the internal combustion engine of business intelligence. Insurance companies are using various types of data analysis and predictive modeling techniques in areas such as underwriting, pricing and, increasingly, claims management.

Deloitte Canada recently surveyed Canadian insurance companies across underwriting, risk management and claims departments to ask how important data analytics was to their operations.

“Thirty per cent said it was important and 70 per cent said it was absolutely critical,” comments Keith Walter, senior advisor, insurance consulting practice, Deloitte Canada. “The top 20 property and casualty (p&c) insurance companies in Canada are either in development or in testing phase with data analytic models and concentrating on certain areas. Number one is loss cost management, through fraud and subrogation; and number two is operational efficiency, or how to manage resources against claims in an efficient way.”

www.claimscanada.ca

p12-18 COVER STORY.indd 13

The jockeying for position in data analytics has led to an arms race for insurers seeking to harness the power of structured and unstructured (or big) data for business insights into the claims handling process.

“If we measure the data, we have an opportunity to manage the data,” says Patti Kernaghan, president of Kernaghan Adjusters Ltd. “If we spend the time creatively accessing the data, and the possible decision making opportunities coming out of the data collected at the claims front line, we’ll be better equipped to see patterns that are otherwise hard to pinpoint.”

Scientific Evidence Kernaghan adds that “in the past decisions were often made on gut instinct. Data analytics provides the scientific evidence that will help us make better decisions for claims management and ultimately better underwriting and better insurance products that suit the needs of the insuring public.”

A 2014 Towers Watson survey of U.S. and Canadian insurers found that company priorities in data analytics primarily involved underwriting/risk selection (57 per cent use or plan to use), but claims functions figured predominantly in the list. Specifically, loss control (49 per cent), claims triage (37 per cent) and evaluation of fraud potential (36 per cent) emerged as key areas of focus for insurers – particularly as “plan to use” in the near future.

To get there, insurers will have to make sense of the dizzying array of information available in today’s digital society: the so-called three “Vs” of big data – volume, velocity and variety. According to an IBM white paper, each day more than 2.5 quintillion bytes of data are created. Velocity often refers to “real-time” or streaming data and the need to incorporate that information into business processes and decision-making. And then there is the variety of data: structured, semi-structured and unstructured information. This could involve text, sensor data, audio, video, radio-frequency identification (RFID), click streams, log files, twitter, Facebook posts

June/July 2015

Claims Canada 13

15-06-26 8:45 AM

– essentially, any type of measurable data.

“I see more emphasis on leveraging outside data sources and unstructured data sources to increase efficiencies and cost containment in the claims management process, and provide more robust and inclusive risk management analytics,” notes Patrick Bossey, manager business intelligence unit, Crawford & Company (Canada) Inc.

Unstructured Data “We have already seen this trend starting to take off with respect to the infrastructure for some of the fraud detection solutions out in the market, and this will only continue as the underlying technologies and abilities to manage and mine big data mature,” he adds.

In a recently released Canadian study, Property and Cas ualty Insurance Reimagined: 2025 , Deloitte notes that insurers will face a learning curve on “how to collect, store and take action on structured – and especially unstructured – data. While much of the data insurers will need will be highly organized, consistent and structured, far more data will be ‘unstructured’ NEWTRON-GROUP-CLAIMS-CANADA-JUNE-JULY-DHPS-V3.pdf 1 – an anarchic collection of social posts,

tweets, claims photos and more. Carriers will need to determine how they’ll monitor and make sense of it all.”

Indeed, a recent research report spearheaded by the UK Chartered Institute of Loss Adjusters, in conjunction with Ordnance Survey, found that 82 per cent of

A 2014 Towers Watson survey of U.S. and Canadian insurers found that company priorities in data analytics primarily involved underwriting/risk selection (57 per cent use or plan to use), but claims functions figured predominantly in the list. those questioned believed that insurers that do not capture the potential of big data will become uncompetitive. Another recent study from IBM found that 74 per cent of insurance companies surveyed re2015-05-22 2:40:46 PM port that the use of information (includ-

0

p12-18 COVER STORY.indd 14

5

ing big data) and analytics is creating a competitive advantage for their organizations.

Those insurers with the capability to turn raw data into useful information and then business-driven insights will gain strong footholds in various facets of the claims lifecycle – from FNOL to resolution.

More insurance companies are using, or contemplating, data analytics and predictive modeling to better identify claim patterns. Insurers have invested in software and tools such as link analysis, text mining, social media analytics, location intelligence and network visualization Predictive analytics, which involves the use of regression models and advanced techniques such as neural networks, helps to quickly and more accurately determine the complexity of the claim and whether it needs further investigation.

These techniques can apply to various types of data or information. A good example is the use of text mining to search for specific words or “tags” in adjusters’ notes.

“Text mining can help carriers identify, understand, and measure the root

10

15

20

15-06-26 8:45 AM

causes behind losses to enable smarter underwriting. ‘Water damage’ is a great example, because often a claim possesses that descriptor and has no further detail in a claims system,” states Karthik Balakrishnan, an analytics specialist formerly with Verisk/ISO. “Using appropriate text mining on claim adjuster notes can reveal whether the claim was the result of a ‘burst pipe’ or a ‘weather-related event.’

Applying that granular insight to identify and quantify trends can lead to development of smarter underwriting criteria and establishment of stronger loss control and prevention mechanisms.”

Driving Insight So, how is data analytics driving insight into key parts of the claims management process? There are several areas cited by sources. One is the identification of loss patterns and the opportunity for reductions in claims. Bossey explains that Crawford & Company (Canada) uses geocoding, time lapsing and benchmarking to analyze loss data and identify trends for its clients.

“We work with our clients to establish and monitor action plans, minimize loss

p12-18 COVER STORY.indd 15

exposures, and provide them with the ‘full picture’ of their loss activities,” Bossey notes. “For example, in one such case we identified specific neighbourhoods in major cities, which, over multiple years, had concentrations of break and enter claims.

This information was synthesized into

“Today with the increased availability of tracking data inexpensively, scientific evidenced based decisions are becoming even more available and important to risk managers when making business decisions.” clear and concise formats, and was shared with key stakeholders to prompt appropriate action.”

Kernaghan agrees that data analytics can drive major changes in risk exposures and opportunities. “A primary way of us-

ing data analytics is for cost saving purposes,” she states. “The claim results help inform the underwriters when coverages need to be reviewed, deductibles increased or even new products developed such as flood insurance, that is just now being offered in Canada by two companies.”

It is not just insurance companies that want this information – but risk managers as well. “Our risk management clients tend to use high-level analytics – they are looking for trends and benchmarks,” Bossey says. “They want to know how to reduce claims, but also want to gauge themselves against prior years and similar types of risks. Mostly commonly, they are looking for cost trending and comparisons, financial ratios, litigation ratios and the frequencies of certain types of losses. “ Kernaghan notes that “front-line claims data collection is particularly important to risk managers, especially in large corporations that have long understood and applied data analytics to their specific operations. Today with the increased availability of tracking data inexpensively, scientific evidenced based decisions are becoming even more available

15-06-26 8:45 AM

Data analytics can represent a better technique to catch fraudsters than traditional fraud detection measures, such as red-flag indicators, random file reviews or automated business rules. and important to risk managers when making business decisions,” she says.

Fraud detection is another critical area for data analytics and claims, particularly for insurance companies exposed to various forms of organized, premeditated and opportunistic fraud. Insurers are using various methods, including link analysis, location intelligence/analytics and network visualization, to more quickly identify suspicious claims.

Fraud Detection “A key question is how claims organizations are better equipping themselves to identify both hard and soft fraud,” says Alex Watson a manager in the insurance consulting practice for Deloitte Canada.

“And then how do they use that information to better allocate investigation resources, whether that is through a dedicated fraud investigation team that is going out into the field or using social media tools.”

Data analytics can represent a better technique to catch fraudsters than traditional fraud detection measures, such as red-flag indicators, random file reviews or automated business rules.

“Most fraud solutions on the market today are rules-based,” notes Stuart Rose, a global marketing principal at SAS in a report, Six Ways Big D ata Analytic Can Improve Insurance Claims P rocessing. “Unfortunately, it is too easy for fraudsters to manipulate and get around the rules. Predictive analysis, on the other hand, uses a combination of rules, modeling, text mining, database searches and exception re16 Claims Canada

p12-18 COVER STORY.indd 16

June/July 2015

porting to identify fraud sooner and more effectively at each stage of the claims cycle.”

Bossey observes that there are interesting developments with data in identifying opportunistic fraud and claims leakage.

“An exciting area of opportunity is applying analytics to contain leakage,” he says.

“Similar to building a fraud detection solution that identifies red flags, if we can develop algorithms to flag potential leakage and refine these algorithms with audits and real-life use, we can work towards building more robust models.”

Subrogation represents a prime area for increased efficiencies in data analytics, according to sources.

“Many insurers are asking: ‘how do we pinpoint subrogation opportunities earlier in the claims lifecycle? What are the key triggers in data analytics or the adjuster’s ability to identify subrogation potential?’”

Watson notes. “This can then be passed to a more specialized unit who can investigate and recover money sooner rather than later. There are a lot of subrogation dollars left on the table, either because they are recognized too late in the claims lifecycle or not recognized at all.”

One of the key drivers for data analytics in the claims management process is enhanced operational efficiency – or making the claim hand-off process as smooth and quick as possible. There’s room for improvement, for example, in the adjuster assignment process, according to sources.

Operational Efficiency “Adjuster assignment segmentation is a heavily manualized process that is prob-

ably documented on some sort of Excel spreadsheet by a claims supervisor,” Watson observes. “For insurers, however, once they are able to capture the right amount of personal and loss information, they are better able to segment those claims to the right people. The real opportunity for data is really its use as a workforce management tool – to get more sophisticated in assignment and segmentation.”

The allocation of resource capacity in large catastrophic events is another important claims consideration for insurers and adjusters, according to Watson.

“We have seen a lot of insurers still struggling with how they prepare for CAT events, even though we are getting to the point of anticipating and even knowing the risks beforehand within a generally defined range,” he says.

“For example, with hurricane season, we know that in the south Atlantic, the season is between July and December, but the peak months tend to be October-November. So how do insurers use data analytics to build up capacity in the affected areas? Or how do they alleviate capacity restraints in those areas? Can they offload some of the claims onto areas that may have less capacity?” Watson notes.

For independent adjusters themselves, many of the features of data analytics have revolved around key performance indicators (KPIs) set out by insurance companies.

“One of the primary ways data analytics are used today is . . . tracking various KPIs to include a series of firsts: 1) Contact with the insured; 2) Claim site visit; www.claimscanada.ca

15-06-26 8:46 AM

When some things can’t Wait ...

We’re All

The power of an international Network.

The personalized attention of a local Partner.

When disaster hits home and families are displaced, basic needs become a priority.

That’s why we have developed the CRDN Immediate Needs Service.

CRDN provides up to two weeks of clothing and other textiles families need to go to work, to school and continue their lives as normally as possible. We also securely store these and other textiles until the family can have them delivered.

• Two weeks worth of clothing and comfort items are restored and returned within 24 hours • Secure, insured and climate controlled storage • Local storage provides convenient homeowner access to their belongings

One call brings immediate response.

866-897-CRDN (2736) 24-Hour Claim Assignment Line or visit crdn.ca Find out how CRDN’s new mobile app 2.0 can make your job easier.

Download it now

ad right size.indd 1

15-06-24 3:47 PM

3) Report to the principal; 4) Reserves; and 5) Cycle time,” Kernaghan comments.

“These basic data elements provide an overview of the performance on an individual claim and once rolled up to the entire portfolio level, they can provide management with tools to assess the adjuster’s performance and the progress of the entire claims portfolio.”

Bossey notes that most of these performance measurements are aligned with cost containment. “In terms of cost containment, our focus has been on measuring key performance indicators and targets set forth by our clients and

by Crawford standards, and establishing secondary metrics to proactively strive towards set KPIs and targets,” he says.

“One way we monitor costs is by monitoring claim shelf life. We have worked in conjunction with our claims team to understand key milestones during the life of a file and have established measures to track our progress against the established KPIs and targets. This allows for the early identification of files that require additional attention and allows us to direct our resources accordingly to shorten the life cycle of the claim,” Bossey adds.

However, an overly narrow focus on metrics and performance targets may take away from the real value of data analytics, according to some sources.

Performance Targets “Adjusters are using analytics at a claims level; however, there is a lot of untapped potential,” Bossey notes. “I feel the main reason for this is that in a world of KPIs, target and benchmarks, most of the claims level analytics thus far have been tailored to the examiner, vendor manager and/or risk manager audience, and are usually performance management based.

This means we have been primarily using analytics to track and measure the claims process, rather than augment and support it.”

To truly reap the rewards of data analytics, Bossey says “the next steps are to work closely with adjusters and operations to intimately understand processes and workflows, with the ultimate goal of automating more functions, and tailoring information to support their specific needs and facilitate their workflow.”

The technology investment in data analytics has to be accompanied by an equal emphasis on people and process in claims management functions, according to Watson. “It is critical for the claims or-

18 Claims Canada

p12-18 COVER STORY.indd 18

June/July 2015

ganization to get the people and process part right,” he says. “Traditionally, insurance companies’ systems haven’t allowed them to capture the richness of data that they require in a structured format. So we are seeing the need for insurers to implement the right processes, and measure the right KPIs to incent the appropriate behaviours.”

Watson adds “that is a move away from, ‘let’s just capture the entire claim in an unstructured notes section.’ Instead, it’s ‘let’s better use the technology we have and capture all of the information we are going to require.’ Insurers know this will

“The future of data analytics in the p&c industry for claims and risk managers is a stronger and stronger reliance on the increasingly cheaper ways to gather scientific evidence based data.” eventually drive lower loss adjustment expenses, allow them to predict losses or be better able to assign and select claims to the right adjuster the first time. And ultimately, it will provide better customer service.”

There are many challenges to the full adoption of data analytics and several reasons why some insurers have yet to pursue “end-to-end implementations,” according to Deloitte’s Walter.

“The two biggest challenges in data analytics are people and costs,” says Walter.

“There is a relatively small pool of people who are knowledgeable and capable of dealing with advanced data analytics. The second issue is the total cost of what we would call end-to-end implementation.

It is one thing to build a model in a lab somewhere; it is another thing to actually implement it into a live system so it is delivering value when needed.”

For adjusters, one of the main obstacles to data analytics is the quality of the data itself. “The main challenges we see are inconsistent or incomplete data,” says Bossey. “Insurance Bureau of Canada (IBC) has provided excellent guidance and frameworks for statistical models and coding. For the analytics side of the industry on the whole, there is great opportunity to establish consistency in terminology and measurements – particularly for common terms, such as shelf-life and claim.”

Quality of Data Bossey adds that “data sharing is problematic because each organization structures their data to match their unique operational needs, and calculates measures based on their own evidence of activities.

If we can get to a place where some of the key terminology and pieces of data can be locked down across the board, the whole industry could benefit.”

Kernaghan says that one of the most obvious obstacles to data analytics is data integrity. “Can you rely on the source? Is it timely? Is it accurate? Have your naming conventions been clearly articulated and agreed upon?” she asks. “If you are confident in all areas, your evidence based results will help provide a sound analysis for making business decisions.”

While cumbersome, these challenges will not likely stop the progress of data analytics in the p&c insurance marketplace, according to sources.

For claims, Bossey believes the future will see “an ongoing validation and refinement of fraud detection models. In addition, there will be a continued focus on identifying further efficiencies in the claims handling process through predictive modeling, and a move to using analytics to reinvent the claimant experience after a loss.”

Kernaghan observes that “we are operating in a world of evidence based information. The issue is effectively reading the data collected to ensure we make the right decisions. The future of data analytics in the p&c industry for claims and risk managers is a stronger and stronger reliance on the increasingly cheaper ways to gather scientific evidence based data,” she adds.

“We are very quickly getting to the point where it is not a shortage of data, but rather whether insurance companies can take full advantage of the data they have,” Watson concludes. “It is a race to turn that data into real value, and unlock the value that is already there.”  www.claimscanada.ca

15-06-26 8:46 AM

A New View

WALLS: EagleView® wall measurement reports utilize the same patented technology that drives EagleView’s proven roof reports.

Experience the quality and accuracy needed to close exterior claims faster and more efficiently than ever before.

To learn how to add walls to your EagleView Reports call 866.447.3741 or vist www.eagleview.com/insurance © 2015 EagleView Technologies, Inc.

ad right size.indd 1

15-06-24 3:42 PM

• spotlight S

Pinnacle Position

Ray Proctor says that Toronto-based Pinnacle Adjusters Group’s business model stems from a simple promise – “exceptional adjusting at a reasonable rate.”

By Cr a ig Ha rris

W

hen asked about his adjusting firm’s approach to business, Pinnacle Adjusters Group’s managing partner Ray Proctor cites an adage from Ronald Reagan: Trust, b ut verify.

“We treat our client’s customers with respect and offer professional service, but we still verify and validate,” says Proctor.

“You can conduct a thorough fraud investigation, but still treat the person with fairness and courtesy.”

Pinnacle Adjusters Group has existed in its current form since 2005, when it was rebranded from Sobel Adamson Clements; however, it has roots in Adamsons Limited that date back to 1897. Marc Newburgh, who joined the firm in 1995, continues in his role as principal owner, but dedicates much of his time to community service. Day-to-day management of the company rests with Proctor, who took on the role of chief operating officer in 2013.

Today, Proctor heads up a team of three veteran adjusters – Chris Gullison, Michael Lander and John Scott – and two longstanding support staff – Sue Lewis and Mina Pallotta – at Pinnacle Adjusters Group.

“As a boutique adjuster, we do a lot of CGL claims, especially personal injury with general liability exposure, and we are also specialists in Auto AB/BI,” says Proctor, who adds that Pinnacle was one of a select few adjusters accredited to handle claims for the upcoming Pan Am Games, July 10-26, and the Parapan Am Games, August 7-15, in Toronto.

For Proctor, the success of the firm comes down to the quality of the staff he manages. “If you look at our team of adjusters, we are diversified and well-versed 20 Claims Canada

p20-21 SPOTLIGHT final.indd 20

June/July 2015

in many areas, particularly personal injury, coverage issues, investigations and litigation issues,” Proctor comments of the firm, which services the GTA and other regions in Ontario on demand. “We have more than 100 years of combined experience between our adjusters and principals and because of that we are often called on to handle unique or complex losses.

And we have a team of support staff who are the heartbeat of the company. People know what they are getting when they call us.”

“

We have loyal clients who know our philosophy and value our experience.

I don’t expect that to change.

”

Proctor understands this first-hand.

As a former director of claims operations for a large p&c insurance company, he used to rely on Pinnacle Adjusters Group as a preferred vendor for independent adjusting services.

In fact, Proctor’s career in claims dates back to 1993, when he moved into personal and commercial claims handling for some of the country’s top insurers.

For close to two decades, he developed extensive experience in accident benefits, bodily injury, general liability and commercial property claims, serving in several senior claims management positions. He made the transition to the in-

dependent adjusting side of the business in 2010, and opened his own firm, which was amalgamated with Pinnacle Adjusters Group in 2013.

“There was something about the dynamics of claims that I found interesting,” Proctor notes. “More than 20 years later, I still find it so –sometimes the nature of this job can frustrate you, but it is never boring.”

Curiosity and knowledge about diverse industries and professions are key parts of what makes an independent adjuster’s life stimulating, according to Proctor. “As an adjuster you need to know a bit about everything – from legal to medical to engineering. When you get to a loss site, you have to get up to speed pretty quickly.”

This widespread interest certainly applies to Proctor himself, who, in addition to experience in commercial/personal property, liability and auto claims, also has expertise in alternative dispute resolution and fraud detection. He is accredited with a handful of convictions, one of which was an industry adjuster. However, he believes his role as a litigation specialist stands out.

“You learn so much when you are subject to discovery or when you are cross examined as a witness,” he says. “You understand why you are being asked certain questions by a lawyer, and you can relate that back to why you need to gather certain information and ask questions in your investigation that must be answered in your loss report. It really ties it back to what you have to learn and uncover in your role as an adjuster.”

Pinnacle’s business approach is to provide a wide array of adjusting services in return for reasonable fees. “We don’t have a desire to be the cheapest adjuster,” www.claimscanada.ca

15-06-26 8:55 AM

From left to right: Chris Gullison, Mina Pallotta, Sue Lewis, Michael Lander, John Scott, Ray Proctor. Absent is Marc Newburgh.

Proctor observes. “As someone who has worked on the company and independent side, I have seen how the low rate adjusting fee competition can erode the quality of claims handling.”

The balance between quality and cost has to be struck by every insurance company and client, Proctor acknowledges.

But he adds that an excessive emphasis on productivity targets, short-term financial goals and efficiency measurements can have unintended consequences on loss payouts.

“Claims examiners are relying on an adjuster’s expertise and ability to gather information and deliver an accurate report,” he says. “What if there is a coverage issue or other information not picked up on due to a lack of experience? That could unnecessarily add tens of thousands of dollars to the loss payout? Is that worth saving a few dollars on an eight-hour assignment? If you think hiring a professional is expensive, try going with an amateur.”

“If it is all about getting as much productivity out of people for the lowest cost, I suggest that comes at a price,” Proctor adds. “Insurers may save on the expense side, but they are sure to be losing far more than those savings in loss payments.”

As an expert in reviewing files and conducting claims audits, Proctor has an interesting vantage point on how an inexperienced investigation can sometimes fall short of the mark. www.claimscanada.ca

p20-21 SPOTLIGHT final.indd 21

“I have done thousands of audits and I see it all the time,” he says. “There is hard leakage that is easy to find, such as ‘this invoice was overpaid.’ But leakage from overlooked opportunities that only experience catches is usually about much more significant loss dollars. For example, look at loss transfer, subrogation, priority, change in coverage or possible misrepresentation. These are the things that have a greater likelihood of getting overlooked by the inexperience that low-rate adjusting fees often buy. They only get picked up in audits after the fact.”

“The gap in industry experience is a concern to me; there aren’t as many companies willing to make the investment in training young adjusters anymore. We are soon to lose a number of experienced veterans to retirement,” he says. “There are a lot of junior adjusters who are eager to learn, however it seems like the approach now is training by fire – ‘here are a bunch of files, go to it.”

Proctor adds that “if you don’t invest in training and your people don’t get the experience, it can affect corporate governance, corporate responsibility and bad faith claims – it all ties together.”

A prime antidote to the training gap is the role of industry associations like the OIAA and CIAA, where Proctor says likeminded adjusters can gather for seminars, discussions and continuing education.

“That is one of the reasons why our associations are so important, they can

provide some of that training – that is the mandate,” notes Proctor, who is the OIAA Kawartha/Durham Chapter delegate for the provincial OIAA Executive.

“I have met so many people through the association that I would not have if I was only behind my desk or out on the road.”

For Proctor, this type of informal networking and information gathering is critical, and may become even more significant in the years ahead.

“You can ask them (fellow adjusters): how do they approach certain issues in the market? What are the hot topics? Who can organize a good seminar or training session on a key issue? That is the real value you get out of it. Ultimately, we learn from each other,” he observes.

For Pinnacle Adjusters Group, Proctor says the firm will stay the course and stick to its fundamental premise of thorough, quality adjusting services for fair rates. This is a chosen business model in the face of consolidation, trends to inhouse adjusting and more national flatfee contracts for independent adjusting services.

“We have a broad spectrum of clients, including insurance companies and corporate clients,” Proctor concludes. “In the past couple of years, we have been able to keep very busy, even in times of general industry downturns. We have loyal clients who know our philosophy and value our experience. I don’t expect that to change.”  June/July 2015

Claims Canada 21

15-06-26 8:55 AM

The Additional Insured

An oil spill case shows the consequences of not naming an additional insured on a policy.

By M ic h ael S . Teitel bau m

In Amello v Bluewave Energy L imited P artnership (2014 ONSC 4040), Justice Perell of the Ontario Superior Court of Justice addressed the breach of a covenant to insure. The court held that an oil transport company should not be able to circumvent its obligation to maintain liability insurance and have its oil supplier added as an additional insured in its liability policy. The Court applied a 50% split of defence costs incurred to date and into the future between these two parties.

Amello provides a helpful review of the requirements of withdrawing admissions made in a Response to a Request to Admit.

The decision also serves as a reminder that despite the existence of a Pierringer Agreement, a co-defendant is still potentially liable with respect to possible Crossclaims.

Background Facts On September 17, 2009, oil escaped from a leak in the plaintiffs’ tank maintained by Bluewave, a division of the defendant, Parkland Income Fund. Bluewave was an oil supplier. Extensive damage was caused. The plaintiffs sued Daniel Charles Transport (“Daniel Charles”), a transport company, and Bluewave. Bluewave had subcontracted the oil delivery to Daniel Charles. Parkland was also sued.

A Trucking Services Agreement was entered into by the Plaintiffs and Daniel Charles on October 31, 2008. Daniel Charles would, amongst other things, hold harmless and indemnify Bluewave for costs and legal fees arising from an oil spill. Under the agreement, Daniel Charles was obligated to take out liability insurance naming Bluewave as an additional insured.

Daniel Charles took out liability insurance for itself but failed to add Bluewave as a 22 Claims Canada

p22-23 ARC.indd 22

June/July 2015

co-insured. The defendants crossclaimed against one another.

Bluewave had its own liability insurance, which responded to the plaintiffs’ claims against Bluewave. Bluewave’s insurer wanted the costs of the defence paid by Daniel Charles; it brought a motion for partial summary judgment seeking such an order.

Daniel Charles brought a cross-motion to dismiss Bluewave’s crossclaim, relying on a Pierringer Agreement. Daniel Charles also sought to withdraw admissions made in a Response to Request to Admit. The court refused to permit Daniel Charles to withdraw its admissions as it had failed to satisfy the requirements for leave to do so.

The motion to dismiss Bluewave’s crossclaim was dismissed.

The court granted Bluewave’s partial summary judgment for 50% of the costs of its defence of the Plaintiffs’ claim to date as well as a declaration that Daniel Charles was liable to pay 50% of Bluewave’s future defence costs.

Issues There were three main issues in Amello.

First, the court had to determine whether Daniel Charles could obtain leave to withdraw admissions made in a Response to a Request to Admit. Second, it had to address the motion brought by Daniel Charles to have Bluewave’s crossclaim dismissed pursuant to a Pierringer Agreement. Lastly, the court had to decide how to rule on the motion for a partial summary judgment brought by Bluewave for an order requiring Daniel Charles to pay the costs of its defence.

Withdrawal of Admissions Although not a central issue in this decision, the court denied Daniel Charles’ motion for an order withdrawing admissions made in a Response to a Request to

Admit. In it, Daniel Charles had admitted it breached its covenant to maintain Commercial General Liability insurance with Bluewave as a named insured.

Bluewave did not consent to the withdrawal of the admissions The court declined to grant leave to have the admissions withdrawn as the requirements under rule 51.05 were not met. Daniel Charles was unable to meet the second and third requirements under rule 51.05; namely, it did not provide a reasonable explanation or justification for withdrawing the admissions nor did it establish that the withdrawal would not result in non-compensable prejudice.

Pierringer Agreement On March 17, 2014, the Plaintiffs entered into a Pierringer Agreement where they agreed to settle their claim against Daniel Charles. Under this agreement, the plaintiffs also agreed to be responsible for the costs of Bluewave’s defence, and the Plaintiffs would limit their remaining claims against Bluewave to individual or several liability of Bluewave. Based on the terms of the Pierringer Agreement, Daniel Charles argued Bluewave’s Crossclaim should be dismissed.

The court found that Daniel Charles’ argument in this regard was “fallacious” as it disregarded that Bluewave’s Crossclaim was based on Daniel Charles’ liability to indemnify Bluewave for its own liability.

As a result, the Perringer Agreement did not operate in the manner contended by Daniel Charles, i.e., to render the Crossclaim “meaningless.” The court explained the effect of the Pierringer Agreement as permitting the plaintiffs to pursue their claim against Bluewave. If the Plaintiffs were successful and obtained a judgment against Bluewave, Bluewave would be able to advance their Crossclaim in order to enforce the Trucking Agreement. www.claimscanada.ca

15-06-26 8:58 AM

Defence Costs Bluewave brought a summary judgment motion regarding Daniel Charles’ failure to maintain liability insurance for Bluewave. The motion for summary judgment only focussed on damages arising from Daniel Charles’ failure to satisfy the terms of the Trucking Agreement. Under this agreement, coverage would have been obtained to cover the cost of Bluewave’s defence of the plaintiffs’ action.

Daniel Charles made three arguments in this regard. First, it argued the Trucking Agreement was not enforceable. Second, if the agreement was found enforceable, Daniel Charles argued it does not require it to pay for a defence or indemnify Bluewave for its own negligence or mistakes (Daniel Charles alleged Bluewave failed to maintain the Plaintiffs’ oil tank).

The third argument advanced by Daniel Charles was that if it is liable to pay for a defence, its liability to Bluewave should be reduced because Bluewave’s defence were being shared by Parkland and its claim for defence costs was privy to equitable contribution between insurers who cover the same risk.

In its analysis, the court acknowledged that as set out in Papapetrou v. 1054422 Ontario Ltd. (2012 ONCA 506) when a party has failed to insure pursuant to a covenant, that party is liable to the party it promised to insure. In this case, the damages award would reflect what should have been obtained under the insurance policy, had the insurance been obtained. The court clarified that this award would include the recoverable defence costs under the liability policy.

In determining what is recoverable, the Court held that the damages in Amello considered the decision in Papapetrou. As outlined in Papapetrou, the quantum of damages in this situation is the amount the insurer of the party who was supposed to become a named insured (party A), is required to spend in defending a claim that the breaching party’s insurer would have been obligated to defend on party A’s behalf.

The court concluded that Daniel Charles was 50% liable for the defence costs incurred to date and 50% of those going forward. In so deciding, the basic principles of contract law were relied on in that the court put Bluewave in the position it would have been in had the contract been performed Justice Perell rejected the argument regarding sharing of defence costs because the costs of defending Bluewww.claimscanada.ca

p22-23 ARC.indd 23

wave had not been increased by the joint defence.

Comment Justice Perell’s decision is helpful in illustrating how the Papapetrou decision can be applied – by having the party that failed to secure insurance essentially act as if it were the insurer.

In arriving at the 50/50 equitable allocation, no analysis was done by the court of the “other insurance” clauses to see if they negate each other, thereby resulting in

equal contribution, or one policy might be considered excess to the other so that the other would be fully responsible for the defence costs. Ultimately, it appears the court was of the view that a 50/50 sharing of costs was appropriate in the circumstances.  Michael S. Teitelbaum is a p artner with Hughes Amys LLP. Ashley Peacock, an associate w ith H ughes Amys, assist ed w ith this article. H ughes Amys is a me mber firm o f The Arc Group of Canada, a network of independent law firms across Canada.

BDO HELPS WHEN DISASTER STRIKES To business owners who have tirelessly committed themselves, disaster is the loss of their dreams and livelihood. To insurance professionals, it’s the challenge to fairly and accurately quantify what their loss is worth. When disaster strikes, trust the firm that provides expert, objective opinions and quality resources.

• • •

Business interruptions Personal injury claims Inventory losses

• • •

Income replacement benefit calculations Forensic investigations Fidelity and surety bonds

Vancouver | Calgary | Edmonton | Winnipeg | Toronto | Montreal | Halifax People who know, know BDO.SM Assurance | Accounting | Tax | Advisory Greg Hocking 416 775 7800 ghocking@bdo.ca

Andrew Bourne 416 775 7802 abourne@bdo.ca

www.bdo.ca/advisory

June/July 2015

Claims Canada 23

15-06-26 8:58 AM

“With over 1000 Independent Adjusters committed to professionalism in 300 offices throughout Canada‌ ONTARIO A T & W Insurance Adjusters Aurora Adjusters SSA Limited Cobalt North Bay Algom Insurance Adjusters Elliot Lake Espanola Ally Adjusters Ltd. Hamilton Arthur Adjusters Inc. Newmarket AZ Claims Services Inc. Oakville Bannatyne & Company General Insurance Adjusters Ltd. Hamilton Bussell Adjusters Inc. Toronto Capital Claims Adjusters Limited Toronto Chenier and Associates Insurance Adjusting Inc. Timmins Claim Xperts Inc. Peterborough Claims Tech (Canada) Inc. Mississauga Comiskey Insurance Adjusters Inc. Chatham Cormier Adjusting Limited Huntsville Crawford & Company (Canada) Inc. Barrie Belleville Brantford

ONTARIO- CIAA.indd 1

Brockville Hamilton Huntsville Kapuskasing Kingston Kitchener London Mississauga New Liskeard Newmarket North Bay Orangeville Ottawa Owensound Peterborough Pickering Sarnia Sault Ste. Marie St. Catharines Sudbury Thunder Bay Timmins Toronto Waterloo Windsor Cunningham Lindsey Canada Claims Services Ltd. Barrie Belleville Brampton Brantford Burlington Chatham Cornwall Guelph Hamilton Kitchener Kingston London Milton Mississauga North Bay Oshawa Ottawa Owen Sound

Peterborough Richmond Hill Sault Ste. Marie St. Catharines Sudbury Stratford Thunder Bay Timmins Windsor Woodstock Curo Claims Services Waterloo Doerr Claims Services Inc. Barrie DSB Claims Solutions Inc. Brampton Kitchener Oshawa D-Tek Corporation (North) Aurora Uxbridge Fahey & Associates Insurance Adjusters Ltd. Ottawa Georgian Claim Services Inc. Barrie Giannini Group Ltd. Toronto Hanselman Claims Inc. Milton Paris Integrated Insurance Resources Mississauga E.R. Jones General Insurance Adjusters Ltd. Thunder Bay Kellow & Associates Inc. Claims Consultants & Insurance Adjusters Mississauga Orangeville

15-06-25 11:48 AM

CIAA Members are dedicated to fair practice and integrity on all claims-related services”

Kernaghan Adjusters Limited Kenora Orangeville Oshawa St. Catherines Toronto Lander-Spiers Insurance Adjusters Ltd. Richmond Hill Leading Edge Claims Services Inc. Fonthill Lennox & Company Insurance Adjusters Inc. Burlington Lethbridge Adjusting Limited Mississauga Maltman Group International Toronto Maximum Insurance Adjusters Inc. Mississauga McKeon & Associates Adjusting Company Mississauga MGB Claims Consultants Inc. Toronto NSA Claims Inc. Mississauga OZA Adjusting Ltd. Grimsby Patterson Insurance Adjusters Inc. Collingwood P.C.A. Adjusters Limited Belleville Kingston Ottawa R. Ian Pepper Insurance Adjusters Inc. Lindsay Picano Claims Adjusters Fort Erie

Pinnacle Adjusters Group Inc. Toronto Whitby ProFormance Group Insurance Solutions Inc. Mississauga Pickering Resource Adjusters Group Toronto G. Rocca & Associates Consulting Inc. Sudbury David A. Roy Adjusters Ltd. Ottawa SCS Insurance Adjusters Ltd. North Bay Sault Ste. Marie Sudbury Thunder Bay Timmins Sedgwick CMS Canada Inc. Toronto D.R. Siegel Insurance Adjusters Limited Pembroke G.R. South & Associates Insurance Adjusters Inc. Orillia TC Insurance Adjusters Ltd. Exeter London Thomson Insurance Adjusters Inc. Collingwood Orangeville Toronto Upright Claims Services Ltd. Ottawa Williams Adjusting Inc. Sunderland

For more information about membership in CIAA, our professional standards, goals and objectives: Canadian Independent Adjusters’ Association 5401 Eglinton Avenue West, Suite 100, Etobicoke, ON M9C 5K6 Phone: (416) 621-6222 Fax: (416) 621-7776 E-mail: info@ciaa-adjusters.ca Website: www.ciaa-adjusters.ca

For a complete listing of all CIAA Professional Members – www.ciaa-adjusters.ca/find.asp

ONTARIO- CIAA.indd 2

15-06-25 11:48 AM

Risky Real Estate

Negligent disclosure of natural hazard risks can pose future liability.

By J o a nna K y r ia z is & L a u r a Z iz z o

Property sellers could be exposed to significant legal liability for not warning buyers about past damage and potential risks to their property relating to natural hazards. In a recent case, the Ontario Superior Court of Justice found sellers of a home and their real estate agent liable for tens of thousands of dollars in damages for failing to disclose past flooding and other water-related problems to the buyer (Fors v O veracker, 2014 ONSC 3084).

In 2008, Vance and Dorothy Overacker listed their Thunder Bay home for sale. Prior to selling, they experienced significant water problems for the three years that they owned their home. In 2005, the Overackers’ basement flooded, costing their insurance company $35,000 in repairs. From 26 Claims Canada

p26-27 ZIZZO.indd 26

June/July 2015

2005-2008, the Overackers also experienced problems with their sumppump system and septic field. The Overackers sold their house to Daniel Fors for $392,000. Prior to closing, their real estate agent Jack Mallon assisted the Overackers in completing a Seller Property Information Statement (SPIS) for the buyer—a form that is not required by law but that must be completed honestly and accurately if the seller opts to fill it out (see also Krawchuck v Scherbak, 2011 ONCA 352).

When completing the SPIS, Mallon advised the Overackers that they were not required to disclose problems that had already been addressed, such as the 2005 flood. Following this advice, the Overackers did not disclose the 2005 basement flood or subsequent problems they experienced with the sump pump system, the septic field, moisture in the basement or leakage from the skylight.

After the close of sale, Fors, the buyer, experienced similar water-relat-

ed problems in the house. Having not been informed of these issues prior to purchase, Fors sued the Overackers for negligent misrepresentation in completing the SPIS, alleging that certain of the answers the Overackers provided on the SPIS form were false. The Overackers, in turn, brought a third party claim against Mallon, their real estate agent, for providing them with poor advice. The Court awarded Fors $117,830.50 in damages (representing about 30% of the purchase price of the house) against the Overackers, finding that the Overackers acted negligently in completing the SPIS form.

The Court also allowed the third party claim against Mallon, granting the Overackers $42,459.75 in damages relating to Mallon’s negligent advice.

The Fors case is one of many litigations concerning seller liability relating to disclosure of property defects (see also Costa v W imalasekera, 2012 ONSC 6056, 2012). Often the defects at issue relate to past flooding or water problems, which, in light of climate www.claimscanada.ca

15-06-26 9:01 AM

change, will only become more prevalent. Particularly in the face of rising sea levels and increased storm surges, cases like this raise some interesting questions regarding what type of property information should be disclosed by sellers of property and their agents.

For instance, should it be mandatory to disclose whether a property has been subject flooding or other natural hazards in the past? Similarly, should there be disclosure requirements concerning whether a property is at risk of experiencing hazards in the future?

In Ontario the concept of “buyer beware” generally applies to real estate transactions (Robb-Sim v Solomes, 2013 CarswellOnt 9432). That is, absent fraud, mistake or misrepresentation, a buyer takes an existing property as he or she found it. However, there is a growing trend toward greater disclosure by home sellers to prospective buyers—both in Ontario and in other jurisdictions. For instance, buyers are increasingly asking sellers to complete SPISs in Ontario real estate transactions. The SPIS asks questions such as: • Is the property subject to flooding?

• Are you aware of any moisture and/ or water problems?

• Are you aware of any damage due to wind, fire, water, insects, termites, rodents, pets or wood rot?

• Are you aware of any problems with the plumbing system?

If a seller elects to fill out a SPIS he or she must complete it accurately and honestly, or face potential legal liability for misrepresentation (see Krawchuk).

Other jurisdictions have made disclosure of certain property risks mandatory. For instance, under California’s Natural Hazards Disclosure Act, sellers of real property and their agents are required to disclose when property being sold is located within flood hazard zones, fire hazard zones and earthquake fault zones, among others (Cal. Civ. Code, section 1103 c). This information is provided in a “Natural Hazard Disclosure Statement.” A study conducted by the California Policy Research Center suggests that the disclosure requirements under this www.claimscanada.ca

Act have been well adhered to and, at least in some cases, have had a noticeable effect on property prices (Austin Troy & Jeff Romm, “An Assessment of the 1998 California Natural Hazard Disclosure Law (AB 1195)” (2006), online: California Policy Research Center <http://www.uvm.edu/~atroy/ cprctroy.pdf> at vii-viii).

In light of these developments, sellers would be wise to carefully consider any disclosures made in order to en-

sure the information provided does not negligently mislead prospective buyers. As climate change intensifies and flooding becomes more common, these disclosures promise to be more important to both buyers and sellers and will be an interesting area to watch as risks increase.  Joanna Kyriazis and Laura Zizzo are members o f Z izzo A llan D eMarco L LP in Toronto.

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

Reaching Over 8,500 Insurance Claims Professionals from Coast-to-Coast!

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

www.claimscanada.ca June/July 2015

Claims Canada 27

Official Journal of the Canadian Indeépendent Adjusters’ Association

p26-27 ZIZZO.indd 27

15-06-26 9:01 AM

The State of

Summary Judgement A national overview of personal injury cases.

By E RIN H. DURANT

The Supreme Court’s decision in Hryniak v.

Mauldin broadened the availability of summary judgment across Canada as the court focused its attention on access to justice and proportionality in litigation (2014 SCC 7, 1 S.C.R. 87]. The opening words of Hryniak demonstrate why the court did so: “Ensuring access to justice is the greatest challenge to the rule of law in Canada today. Trials have become increasingly expensive and protracted. Most Canadians cannot afford to sue when they are wronged or defend themselves when they are sued, and cannot afford to go to trial.”

Insurance adjusters and defence counsel should now consider summary judgment in their personal injury cases. A review of the law since Hryniak across Canada reveals that summary judgment can be used to benefit innocent defendants in the right case. What are the circumstances where summary judgment has been granted in personal injury cases to dismiss unmeritorious actions against defendants?

Occupiers’ Liability Justice Scherman in Saskatchewan granted summary judgment in Morozoff v. Fitness Focus Health where the plaintiff sued a gym after falling on icy stairs outside the gym (2015 SKQB 89). The gym argued that it was not an occupier of the stairs, which were not part of its leased premises. The lease showed that the gym occupied the inside of the building; occupation and control of the outside stairs at issue was held by the owner/landlord. The landlord had sole responsibility over the stairs, including ice removal, in the lease.

The claim against the gym was dismissed.

28 Claims Canada

p28-29 CDL.indd 28

June/July 2015

A court may also grant summary judgment in a trip and fall case if there is no evidence regarding the state of an occupier’s premises. In Nandlal v. Toronto Transit Commission, the plaintiff claimed she fell on slippery and debris-strewn steps owned by the Toronto Transit Commission (2015 ONCA 166). The plaintiff ’s evidence was that she did not “see any debris on the tile at the location where she fell.” Instead she stated that she had seen debris in the station on prior occasions and elsewhere on the floor that day. The TTC produced evidence that the tiles were non-slip and that they were not defective or in need of repair at the relevant time,. Justice Perell accepted that evidence and granted the TTC’s motion dismissing the action. The Court of Appeal agreed.

Summary judgment was also granted in a case where a snow removal company was not responsible for the area where the plaintiff slipped and fell in Wiseman v. C arleton P lace O il. The defendants Carlton Place Oil [“Carleton”] and Reid Gardens Landscaping & Garden [“Reid”] brought summary judgment motions (2014 ONSC 1987). Reid was responsible for removing snow from a parking lot and Carlton was the owner of the property where the accident occurred – a Tim Horton’s. On her way to the entrance, the plaintiff slipped and fell when stepping over the curb due to ice build up. Justice Pedlar granted summary judgment to Reid because it met contractual obligations by plowing the parking lot earlier that day. The contract did not require Reid to shovel the curbs.

The Rear-End Collision Defendants have also brought successful summary judgment motions in motor vehicle accident cases involving rear-end

collisions. An interesting example in a case that did contain conflicting evidence is Swain v. Gorman (2014 ONSC 4686).

In Swain Justice Healey granted summary judgment in favour of Gorman – even though Gorman’s evidence was not helpful to her case. The accounts of the accident were as follows: 1. Motor V ehicle Accident Report: showed an unidentified vehicle first, followed by the defendant Go rman’s vehicle, followed by the plaintiff ’s vehicle, and then the defendant Ross vehicle. The plaintiff had a similar recollection of the accident. She asserted that she applied her brakes when she saw the Gorman v ehicle st opped in front of her. She was then hit behind by Ross and pushed into Gorman.

2. The De fendant R oss: the unidentified car stopped to make a left hand turn and after it had turned the Gorman vehicle started to move when the plaintiff ’s vehicle moved forward and hit the Gorman vehicle and, apparently, “bounced” backwards and hit the Ross vehicle.

3. The Defendant Gorman: Gorman’s vehicle was behind the plaintiff ’s vehicle and in front of the Ross vehicle. Gorman’s e vidence was that she was r ear ended by the Ross vehicle and pushed into the plaintiff.

Justice Healey had enough evidence to reject the evidence of Gorman of how the accident happened because (a) there was no evidence of damage to the front of the Gorman vehicle, (b) the description she provided of the vehicle in front of her did not match any of the vehicles involved in the accident, and (c) it was contradicted by the motor vehicle accident report. The court was left with two competing versions of the accident and in each of these www.claimscanada.ca

15-06-26 9:04 AM

versions, the plaintiff ’s vehicle struck the Gorman vehicle from behind.

The law of rear-end collisions is wellsettled: “when one car runs into another from behind, the fault is in the driving of the rear car, and the driver of the rear car must satisfy the court that the collision did not occur as a result of his negligence” (Beaumont v. Ruddy [1932] O.R. 441). Justice Healey held that Gorman was not negligent as the duty was on the plaintiff to ensure that a collision did not occur and there was no evidence that Gorman breached the standard of care that is to be expected of an ordinary, reasonable and prudent person in the same circumstances. The Court of Appeal agreed with Justice Healey.

Summary Not all injury cases are appropriate for summary judgment. In most cases involving conf licting facts, numerous parties, several witnesses and complex issues, a summary judgment motion may not resolve the case and would only add unnecessary delay and expense to the litigation. Summary judgment motions are expensive and should only be brought after careful consideration with defence counsel. The above case law, however, shows that the Courts

since Hryniak are willing to grant summary judgment dismissing actions against innocent defendants in personal injury cases.  Erin D urant i s a l awyer a t D ooley Lucenti Barristers & S olicitors in Ontario acting f or i nsurers i n p rofessional n egligence, title insurance, wrongful dismissal, personal i njury a nd i nsurance c overage claims. She is a member of the CDL Young Lawyers Committee.

Expert Reports The law is settled that an expert report is required to prove a medical professional is negligent in the professional’s care of a patient. In the Nova Scotia case of Chan v. White, Justice Coady granted summary judgment to defendant doctors when the plaintiff had no expert evidence to prove the doctors breached the required standard of care (2014 NSSC 383).

The plaintiff in Chan was the estate of a deceased cancer patient. The allegation was that Chan’s treating physicians’ negligence resulted in his death. The allegations did not relate to negligent cancer care, but rather their actions during his resuscitation in the face of respiratory arrest. The court agreed with the defendants that the plaintiff ’s case could not be established without expert evidence. The court found no genuine issue requiring a trial and dismissed the action against the doctors.

The Limitation Period Defence Defendants commonly bring motions for summary judgment in personal injury cases where there is a limitation period defence, such as the recent example of Seif v.

City of Toronto ( 2014 ONSC 2983).

In Seif, the plaintiff tripped on a Toronto sidewalk fracturing her wrist. Notice was given to the city 4 months after the fall – well past the statutory 10 day notice period. The issue on the motion was if the plaintiff could meet the exception in the legislation that extended the limitation period if there was a reasonable excuse for the delay and no prejudice to the city in its defence. The plaintiff ’s excuse was that she “gave no thought, and had no intention to commence a lawsuit regarding the accident” in the immediate time period after the accident. This was no excuse and summary judgment was granted. www.claimscanada.ca

p28-29 CDL.indd 29

June/July 2015

Claims Canada 29

15-06-26 9:04 AM

EF

• education forum

A SERIES OF ARTICLES PROVIDED BY THE INSURANCE INSTITUTE OF CANADA

The Truth about

Cats & Dogs Pet insurance explained

A

lthough many Canadian households include a dog or a cat, only a fraction of them currently have pet insurance. This market is expected to grow, so it’s worth taking a closer look at this insurance product.

According to a survey conducted by Ipsos-Reid for the Canadian Veterinary Medical Association, 56% of Canadian households had at least one dog or cat in 2008, but only 4% of dog owners and 2% of cat owners had purchased pet insurance.* Pet insurance has been available in Canada only since the late 1980s. By contrast, in countries where the product has been available for longer, usage of pet insurance is more common: about a quarter to a third of pet owners in the UK have pet insurance, which has been available there since the 1950s; and almost half of pet owners in Sweden, where pet insurance has been available for over 100 years.

Uptake in Canada is expected to increase as pet owners become more familiar with the product – and more sensitive to the costs of veterinary care for pets.

Types of pet coverage The most common coverages available for dogs and cats are accident coverage, and combined accident and illness coverage. Some companies also offer products for preventive care, such as payment plans designed to help smooth out the costs of routine veterinary services. Although pet insurance is a form of property insurance, it includes some features that are more common in health insurance, such as co-pays.

Accident coverage Accident coverage generally pays the costs associated with medically neces30 Claims Canada

p30-31 EDUCATION FORUM.indd 30

June/July 2015

sary veterinary services provided to treat a pet for injuries caused by an accident.

Depending on the policy, this may include the cost of examination, diagnostic procedures, hospitalization, treatment, surgery, prescription medicines required as a result of the accident, and some alternative therapies. Accident coverage does not cover illness, non-essential services, or routine or elective procedures.

Most accident policies have a co-pay or co-insurance amount, which means the pet owner pays a portion of the covered costs – typically 10–30%. There is usually an annual deductible as well.

Policies also state a maximum coverage amount. On some accident policies this is a per-year amount, while on others it is a per-accident amount.

Some policies offer additional benefits, such as coverage for cremation or burial expenses, the cost of advertising and rewards to recover a lost pet, or costs for boarding a pet if the owner is hospitalized.

Illness coverage Illness coverage is not available on its own; it is always combined with accident coverage. It targets expenses related to treatment for sickness, disease and injuries. Pre-existing conditions are not covered.

Most policies have a separate maximum for illness coverage, which can be on a per-illness basis per year, or simply a maximum amount per year regardless of the number of illnesses the pet is treated for.

Like accident coverage, illness coverage is subject to a co-pay and a deductible. When a pet hits certain age thresholds, the deductible typically increases.

Pets are more likely to experience illness as they age, so the insurance risk increases with age as well. Some companies apply a claims risk management practice that can result in an adjustment to the premium based on the claims history, which in turn can be affected by the animal’s age.

Exclusions The approach to exclusions for certain conditions varies. Some insurers assess the risk at the point when they extend coverage, asking for the pet’s veterinary records up front to determine whether there are any pre-existing conditions or exclusions. Under other policies, the assessment of whether a particular condition is excluded takes place only when a claim is actually made. Under these poli-

Pets & premiums For accident-only pet insurance, premiums are typically a flat amount that differs only by species (dog vs. cat).

• For illness insurance, underwriters consider a wider range of factors: • species (cat or dog – dogs are typically more expensive to treat) • breed • location (which influences veterinary costs) • claims history (for older pets) For either type of insurance, premiums are also influenced by the co-pay and deductible chosen.

www.claimscanada.ca

15-06-26 9:06 AM

Pet Policies Most pet insurance policies have a relatively short waiting period before coverage takes effect – for example, 48 hours for accident coverage and 14 days for illness coverage. Dogs and cats can be insured at any age, but most policyholders take out the coverage when the pet is young. cies, the insured is asked to provide the veterinary records as part of the claims process.

Exemptions for pre-existing conditions can be temporary (if the condition is one the pet can recover from) or permanent. If the insurer deems a pre-existing condition temporary, the insurer might set an exclusion period – for example, 6–12 months. At the end of the period, after a review of the medical history during the exclusion period, the exclusion may be lifted. Adjusters facing a pet insurance claim will need to take care to ensure they have complete and up-to-date information on such exclusions.

Pet insurance policies also commonly carry exclusions for things like nuclear incidents and war, as well as risky activities the insured did not disclose at the time of application – for example, using the animal for commercial guarding or organized fighting.

members of the family and seeking highquality care when medical issues arise. As owners deal with the costs of sophisticated veterinary diagnostics, interventions and therapies, their usage of pet insurance is likely to increase. The combination of property and health insurance policy features are an interesting aspect of claims under these policies.

ance Professionals’ (CIP) Society. The CIP Society i s th e p rofessional o rganization representing m ore t han 1 5,000 g raduates of t he I nsurance I nstitute’s F ellow C hartered I nsurance Pr ofessional ( FCIP) an d Chartered Insurance Professional (CIP) programs. 

If you’re in Manitoba, this is considered an automobile.

This a rticle i s b ased o n e xcerpts f rom ADVANTAGE Monthly, a s eries of topical papers on emerging trends and issues provided to m embers of the C hartered Insur-

* T . P errin, “ The B usiness o f U rban Animals S urvey: T he f acts a nd s tatistics on c ompanion a nimals i n C anada.” C an Vet J. 2 009 J an; 5 0(1): 4 8–52. A ccessed at w ww.ncbi.nlm.nih.gov/pmc/articles/ PMC2603652/

Surprised? ARC isn’t.

Your customer has a list of the vehicles that are covered by your fleet policy. You have a list of the vehicles that are covered by ARC Group Canada is a national that policy. network of independent law firms, And your lists aren’t theintimately same. each connected to their local market.

When the one vehicle that is involved in Insurance risk appear management an accident is the one thatand doesn’t on experts.

Regionalnext? strength. both lists, do you know what happens National scope.

ARC does.

That is the ARC Group.

If yo Manitoba, conside autom

Surprise

ARC Group Canada is network of independent each intimately con their loc

Insurance and risk ma experts. Regiona Natio That is the A

Go to AskA

Go to AskARC.com

Additional coverages Dental care issues are fairly common with pets, and the cost of canine and feline dental care can be high. Insurance coverage is available for certain types of pet dental care. It is usually offered as an optional extension, although some policies automatically include coverage for dental care up to a limit.

As with human health care, many other special treatments and therapies are available. Most illness policies will cover some prescribed “alternative therapies”, such as hydrotherapy, chiropractic, massage, acupuncture and homeopathy; and certain “behavioural therapies” used to treat behavioural problems that result from an underlying medical condition.

There is usually a separate annual limit for each category of therapy.

In addition, the costs of medical devices prescribed by a vet are often covered to a specific amount.

Although pet insurance has not yet A National of Independent Law Firms been widelyNetwork adopted in Canada, pet owners are increasingly viewing their pets as

ARC Group Canada is a national network of independent law firms, each intimately connected to their local market.

Insurance and risk management experts. Regional strength.

National scope. Go to AskARC.com

The ARC Legal Reporter Winter Issue – Article #1 A National Network of Independent Law Firms

When is a medical examination considered a second examination under Rule 36 of the New Brunswick Rules of Court?

The ARC Legal Reporter v. Crowther and Kelly Case: Winter IssueReported – Article #1 Blyth 2009 NBCA 80 Citation: At Issue:

When is a medical examination considered a second examination 36 of the New Brunswick Rules of The Court?

Court:

www.claimscanada.ca under Rule

ARC_Fleet ad_1/2 page.indd 1

Reported Case: Citation: At Issue:

p30-31 EDUCATION FORUM.indd 31

Judgment Rendered: Factual Summary:

When both the plaintiff’s physical and mental condition are in issue in an action, and the plaintiff undergoes a physical examination, will a subsequent application for a psychiatric examination be considered an application for a second medical examination?

Should medical examinations that are ordered as part of the discovery process be characterized as ‘independent’ examinations?

June/July 2015 medical Claims Canada 31 Court of Appeal of New Brunswick October 13, 2009 (Reasons delivered November 2015-02-14 26, 2009) 1:05 PM The plaintiff suffered injuries in a motor vehicle accident and commenced an action seeking damages. Both the plaintiff’s physical state and mental state were in issue in the action. The plaintiff submitted to a physical examination by the defendant’s expert, but subsequently refused to submit to a psychiatric examination.

Blyth v. Crowther and Kelly 2009 NBCA 80 When both the plaintiff’s physical and mental condition are in issue in an action, and 15-06-26 9:07 AM The adefendant made a motion requesting an order that the plaintiff submit to the the plaintiff undergoes a physical examination, will a subsequent application for

• on the scene OTS IN MEMORIAM May 2, 2015 our friend and fellow insurance professional, became the CIAA.) True to his roots, Dennis held his con vention in Jasper, Alberta. It was a resounding success.

Dennis A. Leonard, passed away at the age of 80.

Dennis was also extremely active in the Kinsmen and K40.

Dennis w as a l eader i n b oth t he A lberta a nd t he C anadian insurance industry. His accomplishments and influ- He ser ved on the National Council and in 1969 he attended ences are many. However, like so many great an international meeting in India. This was during the time of the India / Bangladesh conflict. people he came from humble roots and will be r emembered m ost f or h is p ersonal a ttriWhile on this trip to India he met with Mother butes.

Teresa and assisted with one of her projects to Dennis w as bor n in Saskatche wan but supply pillows to the poor. moved at a young age to Mountain Park, AlberIn addition to his role as President of Leonta. At age eleven, Dennis and his family moved ard, Hir st, and Miller , Dennis w as instr umental to Edson, Alber ta where he gre w up. After a in for ming the first independent drive-in auto short tenure as a salesman, Dennis entered appraisal center in Western Canada. He served the insurance industr y as the Edson adjuster on the Alberta Insurance Council and was active for Richard S. Holmes. Dennis soon became in the Alber ta Insurance Adjuster’s Association, a partner and the firm was called Holmes and where he co-authored the Association’s By-Laws.

Leonard. In 1966, Michael Hirst joined the firm In 1991 Dennis left the adjusting profession Dennis (Tubby) A. Leonard and it became Holmes, Leonard, and Hir st. but he did not leave the insurance industry. He When in 1967 Dick Holmes left to go to law school, Roy Miller served for seventeen years on the Board of Peace Hills Insurjoined the firm and it became Leonard, Hirst, and Miller. A firm ance. He also established the Edmonton office of Canadian whose name, that for o ver thir ty five years, was synonymous Dispute Resolutions Inc., retiring from that position in 1996.

In addition to all of this Dennis was a loving family man, an with integrity.

In 1974/1975 Dennis served as National President of the avid sportsman, and a great friend to everyone that knew him.

He will be sadly missed. l Canadian Independent Adjuster s’ Conference (The CIA C later

CIAA New Members — April 2015 CORPORATE MEMBERSHIP Ally Adjusters Ltd. Hamilton, ON

Mark Thompson

Joseph Trudeau

Jason Trudeau

Pat V an B akel, P resident a nd C hief E xecutive O fficer of Crawford & C ompany ( Canada) I nc. a nnounced t he addition o f Mark T hompson, Joseph T rudeau a nd Jason Trudeau to t he C ompany’s G lobal T echnical S ervices (GTS®) team. The appointment of these well-established, industry-recognized p rofessionals e nhances t he C ompany’s marine services capabilities within the domestic and Lloyd’s markets. l

Dennis Quinlan

32 Claims Canada

p32-33 OTS.indd 32

Dennis Q uinlan, Q C ( QA L aw), of Vancouver, British Columbia was named the 14th recipient of the Lee Samis Award of Excellence. The award w as n amed f or t he f ounding P resident o f C DL t o r ecognize exceptional c ontributions a nd/or achievements b y m embers o f C DL to t he l egal p rofession a nd j urisprudence in Canada on the law of insurance. l June/July 2015

INDIVIDUAL MEMBERSHIP Ally Adjusters Ltd. Wilson Igwe, CIP, CRM Hamilton, ON Canadian Claims Services J. Scott Jordan, CIP Kelowna, BC Larisa Grace, CAIB Vancouver, BC Kenna Freeman, CIP Edmonton, AB Kerry Reid Edmonton, AB Prabjot Gill Edmonton, AB Dan Falk, BA, HCRI Red Deer, AB Capital Claims Adjusters Limited Jennifer Meshka, CIP Regina, SK Crawford & Company (Canada) Inc. Hanna Butler Dartmouth, NS Chelsea Wong Calgary, AB Rachel Lopez Winnipeg, MB Caryl McKay, CIP Winnipeg, MB Jacqueline Desrochers, CIP Winnipeg, MB Nancee Pilih-Wilmott Hamilton, ON Terence O’Brien, CIP Kitchener, ON Zehra Qazi Mississauga, ON Reamtie Rooplal-Barrios Mississauga, ON Sloane Hillis, CIP Pickering, ON Townsend & Leedham Adjusters Ltd. Guillermo Valle, FCIP, CRM Edmonton, AB

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

www.claimscanada.ca

15-06-26 9:11 AM

Mike Alwyn, Vice President, Major Loss Services, a Division of Cunningham L indsey, a nnounced t he appointment o f Darren B erg, EG A, as t he n ew D irector, Q uality A ssurance & Training. l

Darren Berg

Justin Sharp

Ken Tucker, CEO of DKI Canada, recently a nnounced t he a ppointment o f Frank S parfel t o t he p osition of Director of C ommercial S ervices. l

Frank Sparfel FirstOnSite Re storation, Cana da’s largest independent disaster restoration compan y, recently an nounced the appointment of Justin Sharp as President and Chief Operating Officer. In other company news, John Stephenson was promoted to Senior Vice President, Commercial Accounts, and Nathan B elcher was appointed Vice President of Information Technology. l

CEP F orensic E ngineering I nc. announced t hat Brian L i, P . E ng., has j oined i ts T oronto o ffice. E ng is a s tructural/civil e ngineer w ith a strong ba ckground in s tructural d esign and analysis with experience in building envelope issues. l

Brian Li

APPOINTMENT

Contrast Engineering Limited’s Grant Rhyno, Frank Lockyer and Sarah Murphy recently held a presentation for the Canadian Insurance Claims Manager Association’s (CICMA) Blue Nose Chapter about winter damage in Eastern Canada, including d amage c aused b y t he w eight o f i ce a nd s now. T hey d iscussed t he typical c auses o f r oof/building f ailures, s ome c ontributing f actors, t he i mportance of inspecting buildings as a preventative measure and finally some subrogation tips. First photo is Frank Lockyer presenting; second photo is (from left): Grant Rhyno, Sara Murphy, CICMA’s Michael Bennett and Frank Lockyer. l Konrad Berg, General Manager Southern Ontario based Bachly Construction is pleased to announce the opening of its Calgary, Alberta branch. Specializing in residential, commercial, industrial and institutional restoration, Bachly Construction is excited to expand its operations into Calgary.

Cunningham Lindsey Canada Claims Services Ltd. (“Cunningham Lindsey”) is pleased to introduce its recently enhanced claims management system,which has been rebranded as eConnect 2.0. “With these recent enhancements to our exist ing eConnect system, clients will now ha ve even more efficient and effective reporting capabilities,” said Rob Seal, President and CEO of Cunningham Lindsey. l SPECS Limited, a provider of independent property damage and consulting services, has several announcements, including Greig Boyle as the new Director of Operations. In his new role, Greig will oversee all aspects of the Appraisal Operations for SPECS Limited nationally. The company also appointed Stewart Tarrant to the role of Program Development Manager, working out of the Vancouver Island (Sidney) office to assist all offices nationally. SPECS also announced that Graham Cochrane has been promoted to Branch Manager of the SPECS London, Ontario office, while Calumn McKay has joined SPECS as an Appraiser in its London of fice. Thurston White has joined as a new Appraiser in the Ottawa, Ontario region.

SPECS also announced the opening of a new office location in Quebec City. l www.claimscanada.ca

p32-33 OTS.indd 33

Konrad Berg will be overseeing the daily operations as the branch’s General Manager.

Konrad brings over 15 years of experience working within the Insurance community.

Most notably, Konrad was the President of Koverra Consulting Inc., An independent insurance appraisal firm. Konrad also has 6 years’ experience as a project manager.

Bachly Construction is a multi-divisional construction company specializing in Custom Home & Cottage Build, Commercial Build and Property Mitigation & Restoration Services.

Service excellence since 1962

www.bachly.com June/July 2015

Claims Canada 33

15-06-26 9:11 AM

CIAA REGIONAL PRESIDENTS 2014 – 2015 Newfoundland & Labrador TBA

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 Denis Duchesne Cunningham Lindsey Canada Claims Services Ltd. 1250 rue Guy, bureau 1000 Montreal, QC H3H 2T4 Phone: (514) 938-5400 Fax: (514) 938-5445 E-mail: dduchesne@cl-na.com

Ontario Dorothy Lowry, FCIP Crawford & Company (Canada) Inc. 11 - 431 Bayview Drive Barrie, ON L4N 8Y2 Phone: (705) 728-5597 Fax: (705) 728-2167 E-mail: Dorothy.Lowry@crawco.ca

Manitoba Craig Shanks, BA, CIP Network Adjusters Ltd. 64 Regent Cres.

Brandon, MB R7B 2W9 Phone: (204) 725-7436 Fax: (204) 725-7437 E-mail: craig.shanks@mymts.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 M. Doreen Lennon, CIP Townsend & Leedham Adjusters Ltd. 200, 4245 - 97 Street Edmonton, AB T6E 5Y7 Phone: (780) 463-7776 Fax: (780) 462-1280 E-mail: dlennon@tladjusters.com

PACIFIC TBA

34 Claims Canada

p34 CIAA NSC.indd 34

June/July 2015

National Standing Committees 2014-2015 ADVISORY Gary Ellis, BBA, FCIP, RF, FCLA, FCIAA, FIFAA AMG Claims Inc. 535 North River Road, Unit 3 Charlottetown, PE C1E 1J6 Phone: (902) 628-9091 Fax: (902) 628-9093 E-mail: gary.ellis@amgclaims.ca Marie C. Gallagher, FCIP, CRM Kernaghan Adjusters Limited 602 – 1 St. Paul Street St. Catharines, ON L2R 7L3 Phone: (289) 786-1074 Fax: (289) 723-1979 E-mail: mgallagher@kernaghan.com James B. Eso, CIP, CIOP 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 Cunningham Lindsey Canada Claims Services Ltd. 1102 – 50 Burnhamthorpe Rd. W. Mississauga, ON L5B 3C2 Phone: (905) 896-8181 Fax: (905) 896-3485 E-mail: jjones@cl-na.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 Albert Poon, CIP Cunningham Lindsey Canada Claims Services Ltd. 1102 – 50 Burnhamthorpe Rd. W. Mississauga, ON L5B 3C2 Phone: (905) 896-8181 Fax: (905) 896-3485 E-mail: apoon@cl-na.com Gary Ellis, BBA, FCIP, RF, FCLA, FCIAA, FIFAA AMG Claims Inc. 535 North River Road, Unit 3 Charlottetown, PE C1E 1J6 Phone: (902) 628-9091 Fax: (902) 628-9093 E-mail: gary.ellis@amgclaims.ca Monica Kuzyk, FCIP, CRM Curo Claims Services 125 Northfield Dr. W., P.O. Box 218 Waterloo, ON N2J 3Z9 Phone: (866) 952-2876 Fax: (519) 888-9704 E-mail: mkuzyk@curocanada.com Marie C. Gallagher, FCIP, CRM Kernaghan Adjusters Limited 602 – 1 St. Paul Street St. Catharines, ON L2R 7L3 Phone: (289) 786-1074 Fax: (289) 723-1979 E-mail: mgallagher@kernaghan.com Patricia M. Battle Canadian Independent Adjusters’ Association/L’Association Canadienne des Experts Indépendants Centennial Centre, 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 James B. Eso, CIP, CIOP 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 Cunningham Lindsey Canada Claims Services Ltd. 1102 – 50 Burnhamthorpe Rd. W. Mississauga, ON L5B 3C2 Phone: (905) 896-8181 Fax: (905) 896-3485 E-mail: jjones@cl-na.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 Sasha Alexander University of Guelph Alexander Hall 50 Stone Road East Guelph, ON N1G 2W2 Phone: (519) 824-4120 Fax: (519) 824-0364 E-mail: sasha@uoguelph.ca Jo-Ann Eccleston, CIP Aviva Canada Inc. 2206 Eglinton Ave. East Toronto, ON M1L 4S8 Phone: (416) 689-3328 Fax: 1-866-805-8585 E-mail: jo-ann_eccleston@avivacanada.com Bob Grouchy, BA, FCIP, CRM Allianz Global 1600 – 130 Adelaide Street West Toronto, ON M5H 3P5 Phone: (416) 915-4247 Fax: (416) 849-4555 E-mail: bob.grouchy@agr.allianz.ca Tim Guernsey RSA Canada 18 York Street, Suite 800 Toronto, ON M5J 2T8 Phone: (416) 366-7511 Fax: (416) 367-9869 E-mail: tim.guernsey@rsagroup.ca Paul Hicks, FCIP, CRM TD Insurance 2161 Yonge Street, 4th Floor Toronto, ON M4S 3A6 Phone: (416) 486-2507 Fax: (416) 545-6022 E-mail: Paul.Hicks@tdinsurance.com Peter Hohman Insurance Institute of Canada 18 King Street East, 6th Floor Toronto, ON M5C 1C4 Phone: Fax: E-mail: phohman@insuranceinstitute.ca Justin MacGregor Highgate Insurance Brokers Inc. 151 Rose Glen Rd. Port Hope, ON L1A 3V6 Phone: (905) 885-1551 E-mail: justinmacgregor@highgateinsurance.com 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 Alex Walker, CIP Royal & Sun Alliance 2225 Erin Mills Parkway, Suite 1000 Mississauga, ON L5K 2S9 Phone: (905) 412-1397 Fax: (905) 403-2328 E-mail: Alex.Walker@rsagroup.ca 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 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

John D. Seyler, CIP Integrated Insurance Resources 5080 Timberlea Blvd., Suite 214 Mississauga, ON L4W 4M2 Phone: (905) 238-4985 Fax: (905) 238-2735 E-mail: jseyler@integrated-ins.ca Fred R. Plant, AIIC Plant Hope Adjusters Ltd. 85 Englehart Street Dieppe, NB E1A 8K2 Phone: (506) 853-8500 Fax: (506) 853-8501 E-mail: fplant@planthope.com CONSTITUTION & RULES John Jones, BA Cunningham Lindsey Canada Claims Services Ltd. 1102 – 50 Burnhamthorpe Rd. W. Mississauga, ON L5B 3C2 Phone: (905) 896-8181 Fax: (905) 896-3485 E-mail: jjones@cl-na.com CONVENTION Krystine Wolochatiuk Cunningham Lindsey Canada Claims Services Ltd. 74 Cedar Pointe Drive, Suite 1001 Barrie, ON L4N 5R7 Phone: (705) 728-8398 Fax: (705) 734-0559 E-mail: kwolochatiuk@cl-na.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 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 EDITORIAL Mary Charman, CIP Crawford & Company (Canada) Inc. 1 – 120 Mulock Dr. Newmarket, ON L3Y 7C5 Phone: (905) 898-0008 Fax: (905) 898-1705 E-mail: Mary.Charman@crawco.ca John M. Sharoun, FCIP, FCIAA, CRM 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 Gary Ellis, BBA, FCIP, RF, FCLA, FCIAA, FIFAA AMG Claims Inc. 535 North River Road, Unit 3 Charlottetown, PE C1E 1J6 Phone: (902) 628-9091 Fax: (902) 628-9093 E-mail: gary.ellis@amgclaims.ca

Albert Poon, CIP Cunningham Lindsey Canada Claims Services Ltd. 1102 – 50 Burnhamthorpe Rd. W. Mississauga, ON L5B 3C2 Phone: (905) 896-8181 Fax: (905) 896-3485 E-mail: apoon@cl-na.com Marie C. Gallagher, FCIP, CRM Kernaghan Adjusters Limited 602 – 1 St. Paul Street St. Catharines, ON L2R 7L3 Phone: (289) 786-1074 Fax: (289) 723-1979 E-mail: mgallagher@kernaghan.com 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 Marie C. Gallagher, FCIP, CRM Kernaghan Adjusters Limited 602 – 1 St. Paul Street St. Catharines, ON L2R 7L3 Phone: (289) 786-1074 Fax: (289) 723-1979 E-mail: mgallagher@kernaghan.com NOMINATING Marie C. Gallagher, FCIP, CRM Kernaghan Adjusters Limited 602 – 1 St. Paul Street St. Catharines, ON L2R 7L3 Phone: (289) 786-1074 Fax: (289) 723-1979 E-mail: mgallagher@kernaghan.com Albert Poon, CIP Cunningham Lindsey Canada Claims Services Ltd. 1102 – 50 Burnhamthorpe Rd. W. Mississauga, ON L5B 3C2 Phone: (905) 896-8181 Fax: (905) 896-3485 E-mail: apoon@cl-na.com James B. Eso, CIP, CIOP 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, CIP, CIOP 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

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

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

FINANCE John D. Seyler, CIP Integrated Insurance Resources 5080 Timberlea Blvd., Suite 214 Mississauga, ON L4W 4M2 Phone: (905) 238-4985 Fax: (905) 238-2735 E-mail: jseyler@integrated-ins.ca

PROFESSIONAL PRACTICES Marie C. Gallagher, FCIP, CRM Kernaghan Adjusters Limited 602 – 1 St. Paul Street St. Catharines, ON L2R 7L3 Phone: (289) 786-1074 Fax: (289) 723-1979 E-mail: mgallagher@kernaghan.com

www.claimscanada.ca

15-06-26 9:13 AM

• on the scene OTS Crawford & Company (Canada) offered their guests at the 2015 R IMS ( Risk a nd I nsurance M anagement Society) New Orleans Conference a taste of histor y on April 25. Located within the hear t of the French Quarter, historic Antoine’s Restaurant provided the quintessential backdrop for guests to ha ve a tr ue New Orleans experience as they sampled hor s d’ouvres and cocktails on a private balcony. The evening also provided a private din ing experience. l

www.claimscanada.ca

p35 OTS.indd 35

June/July 2015

Claims Canada 35

15-06-26 9:16 AM

â&#x20AC;˘ on the scene OTS More t han 4 00 e xhibitors filled t he Exhibit Hall a t t he RIMS 2 015 Ann ual C onference & Exhibition April 26-29 in New Orleans. Held at the New Orleans Ernest N. Morial Convention Center, the show floor bustled with thousands of delegates from t hroughout N orth A merica a nd a round t he globe. The booths offered unlimited opportunities for learning, networking and sharing. l

36 Claims Canada

p36 OTS.indd 36

June/July 2015

www.claimscanada.ca

15-06-26 9:17 AM

41 st

SEPT. 27-30, 2015

THERE IS NO BETTER PLACE TO ...

Meet and network than at the 2015 RIMS Canada Conference in Quebec City !

Gain perspective and broaden your horizons in Quebec City, a Unesco World Heritage site.

Choose from more than thirty educational concurrent sessions with various focus areas like cyber liability, new trends and developments in traditional areas like D&O liability.

Continue to build and enhance your business relationships and boost your brand at the Conference Exhibitors marketplace.

FOR MORE INFO

ad right size.indd 1

www.rimscanadaconference.ca | LinkedIn/RIMS in Canada | Twitter/@RCC_Quebec2015 15-06-25 10:49 AM

â&#x20AC;˘ on the scene OTS Canadian delegates of the 2015 R IMS Conference and Exhibition in New Orleans gathered with their U.S. and inter national friends at Canada Night on April 28, hosted

by SCM Insurance Services and the Canadian Litigation Counsel. The e vent pro vided delegates to catch up and share stories while enjoying fine food and drinks. l

38 Claims Canada

p38 OTS.indd 38

June/July 2015

www.claimscanada.ca

15-06-26 9:19 AM

FOR

THANK YOU TO OUR CANADIAN NETWORK MEETING OUR 2014 KPI OBJECTIVES. Michael, Lou, Frank & Randy The Executive Team

With over 80 offices across North America We’re here to help www.fgsna.ca | 1-877-888-9111

FIRST GENERAL right size.indd 1

15-06-24 3:35 PM

ad right size.indd 1

15-06-25 10:59 AM