Claims Canada November 2011

www.claimscanada.ca

October/November 2011

Official Journal of the Canadian Indeépendent Adjusters’ Association

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Finding Solutions for Basement Flooding

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Contents OCTOBER/NOVEMBER 2011 • VOLUME 5 • NUMBER

5

Cover Feature

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12 Staying Dry Reducing the risk of basement flooding is a priority for both insurance companies and municipalities. A recent Institute for Catastrophic Loss seminar allowed both parties to come together to discuss individual concerns and solutions.

BY LAURA KUPCIS

Spotlight 18 Filling a Void Seeing a need in the industry for specialized services, ProFormance Adjusting Group of companies is busy filling that niche.

BY LAURA KUPCIS

Education Forum

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38 Managing Injury Conceptual models can influence disability management and service delivery, preventing or minimizing the impact of impairment on a person’s ability to work or function.

News Features 20 The Claims Loop It is essential for independent adjusters to keep everyone involved in the claims process: The insured, the insurer and the broker.

BY LAURA KUPCIS

24 Large Loss When handling large loss claims, an adjuster must ensure they are not making promises that cannot be kept.

BY LAURA KUPCIS

26 Fraud and other Faux-pas

30 Containing the Quantum There is little mention on the investigation, assessment, quantification and scrutinization of third party properrty damage investigations in training material, leaving a potential void.

32 Green Energy There are a number of questions that arise with respect to green energy claims — an emerging issue for insurance professionals.

BY ALLISON KLYMYSHYN

Identity theft, homemade trailers and small claims settlement take centre stage at an educational seminar.

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BY JAMES GIFFEN

34 Red Flags

BY DAVID GAMBRILL

When there are unanswered questions and inconsistencies on a particular file, red flags arise.

28 Adjusters in the Field

BY DEBBRA MACDONALD and THE BOARD OF DIRECTORS OF CASIU

The increased enforcement of safety legislation is affecting the duties and responsibilities of the independent adjuster.

36 Travel Risk Management

BY GREG MERRITHEW

There are a number of scenarios to consider when staff are travelling regionally, nationally or internationally to ensure their safety.

Departments 4 First Notice 40 On The Scene

Columns 38 Education Forum

BY MARK LALONDE

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• first notice FN Fitness club not automatically liable for injury sustained in a rush for dumbbells A fitness club with limited dumbbells for exercising was not responsible for a patron fracturing her wrist while participating in a “frenzy” to grab the available weights, the Ontario Superior Court ruled in an April 2011 Occupiers’ Liability Act case.

Dutton Brock, in its publication ECounsel, cited the court’s judgment in Soares v. Premier Fitness Clubs, noting “occupiers are not automatically liable for any injuries suffered by persons on their premises and are not meant to be insurers of such persons.”

In rendering its decision, the court noted the plaintiff was “well aware” of the rush to get available weights when there was a shortage.

“It would appear that this was the usual state of affairs,” the court said of the “frenzy” in its decision.

The aerobics teacher at the time of the incident did not give any oral directives on how class participants were to get the weights.

“He also stated he thought he was working with sensible people,” the court decision states. “He said, ‘Thought dealing with adults not children.’”

The court added the premises were “reasonably safe” and there was no evidence a similar accident had occurred at the club.

The plaintiff in the case acknowledged participating in a race to get to the weights.

She had bent down to collect a second dumbbell, she testified, when one she was carrying fell on her forearm and rolled down towards her right hand, fracturing her wrist.

She was off work for about six weeks and received some disability payments. ●

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Ontario courts expand interpretation of “ordinary drivers”: RIMS panelist The interpretation of ‘ordinary driver’ in Ontario’s courts has expanded to include those drivers who “sometimes make mistakes,” and has thus increased municipalities’ exposure to liability for not keeping safe roads.

Steven Stieber, a managing partner at Stieber Burlach LLP, spoke as a panel member during ‘The Rising Cost of BI Claims: Why You Should Be Concerned,’ at the RIMS Canada 2011 Conference in Ottawa.

Stieber referenced the 2010 Ontario Superior Court of Justice case Deering v Scugog. In this case, a novice driver was driving a group of friends down a rural road at night to see a movie. As she drove up over the crest of a hill (10 km-h faster than the speed limit), the headlights of an oncoming vehicle appeared to be in her lane. She swerved and lost control of the vehicle.

Both she and her sister, a passenger in the car at the time, were left quadriplegic.

Both sisters sued the municipality of Oshawa and Scugog. They alleged the municipality had failed to keep the road safe because no speed limit was posted and the road had no painted centre line at the time of the accident.

Citing the written decision from the case, Stieber said the court ruled: “The ordinary motorist includes those of average range of driving ability — not simply the perfect, the prescient or the especially perceptive driver or one with exceptionally fast reflexes but the ordinary driver who is of average intelligence, pays attention, uses caution when conditions warrant, but is human and sometimes makes mistakes.”

“So we have to protect that driver, although there was some degree of contributory negligence,” said Stieber.

“That is a very, very difficult standard to meet. Apart from the [issue of the] resources available to meet it, the costs make it very difficult to meet it.” l

Proof of mental anguish enough to sustain third party actions in privacy breach Victims of a privacy breach may no longer have to rely on proving economic loss as a result of the privacy breach to sustain a third party action. They can also show the breach caused mental anguish.

Aaron Konarsky, director of risk management and integrated controls at Canada Lands Co., spoke as a panel member during the Risk and Insurance Management Society (RIMS) Canada’s Annual Conference in Ottawa on Sept. 20. The theme of the seminar was, ‘Privacy Update: Hot Issues for Risk Professionals.’

“Traditionally, in a third party action against an organization, you have to prove that the loss of information would result in economic loss of the individual,” Konarsky told delegates. “So basically, someone took your information, they put a bogus mortgage on your property or they used your identity to borrow — those are economic losses that would generally sustain a third party action.”

October/November 2011

But now the tide has turned, Konarsky noted. U.S. caselaw is on the books suggesting that victims need only prove the breach caused them mental anguish.

In the United States a few years ago, the Department of Veteran Affairs accidentally released medical records of their veterans. The case eventually settled for $20 million.

But the case was not about those records being used for economic advance.

“The case was around these veterans’ personal medical information being out there, and the mental anguish they suffered worried about what would happen to it,” said Konarsky. “Would they be embarrassed? and whose hands would that information fall into?

“There is the blueprint for what we see going forward as far as civil exposure for organizations. You don’t have to prove economic loss. If you suffered mental anguish, that’s actionable as a third party loss.”l

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• first notice FN Man injured while repairing a truck was not involved in an “accident”: Ontario arbitrator A man who sustained a head injury while repairing a truck is not eligible for accident benefits because repairing a vehicle does not constitute “the use” of a vehicle, and hence the man was not involved in a motor vehicle “accident,” an Ontario arbitrator has ruled.

In John Earl Olesiuk and Kingsway General Insurance Company, John Olesiuk started to fix a drinking water delivery truck that had been inoperable for a long time after it was involved in an accident (Olesiuk was not the operator in the accident.).

The truck’s transmission required repair. The commercial owner of the truck asked Olesiuk, who did some driving for the company, if he would undertake some of the repairs while they waited for the transmission to be fixed. Olesiuk agreed.

Olesiuk’s last memory was climbing on the hood of the truck so he could reach the cab of the truck. He was found the next morning lying on the concrete floor with a pool of blood around his head.

Olesiuk claimed accident benefits, arguing that his injuries directly resulted from the use of a motor vehicle. But the

insurer disputed his eligibility, arguing that repairs on a vehicle are not part of the use of a vehicle, and thus Olesiuk was not involved in a motor vehicle “accident,” as defined by the Statutory Accident Benefits Schedule (SABS).

Financial Services Commission of Ontario (FSCO) arbitrator Richard Feldman ultimately sided with the insurer.

“Vehicles are used primarily to transport people and things from one place to another,” Feldman wrote in his decision.

“They can also be used to store goods.

They can be used to tow another vehicle or a trailer.

“Some vehicles are intended to be used as a temporary place in which to sleep. As vehicles and technologies change, the types of uses to which vehicles may be put will no doubt expand.

“When one is repairing a vehicle, how-

ever, he or she is not actually using the vehicle. While repairs and maintenance may be integral to one’s ability to safely use and operate a vehicle, such activities are not, in and of themselves, a use of the vehicle.”

Feldman did note that repairs undertaken on a vehicle while on a trip — i.e. stopping at the side of a road to fix a flat — may be the product of a chain of events caused by the “use” of a vehicle and thus “might constitute” an accident. l

Injured insureds in Ontario worse off after auto insurance reforms, alliance of health care providers say Insureds injured in motor vehicle accidents are now worse off as a result of Ontario’s auto insurance reforms, according The Alliance of Community Medical and Rehabilitation Providers.

The Alliance has 80 member companies and represents 3,500 health care providers, including physiotherapists, occupational therapists, speech language pathologists, chiropractors, psychologists, rehabilitation therapists, social workers, personal support workers and case managers.

The Alliance conducted an informal survey of 45 rehab practices across the province. The results, it says, uncovered a number of troubling developments in the way accident victims are now being handled.

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For example, the survey found a significant increase in the number of accident victims who are running out of benefits before they are fully recovered. “A majority of providers say at least half of their clients will now run out of benefits (vs. 10 per cent or fewer of their clients a year ago),” the Alliance said in a press release.

Also, the survey found: • More than twothirds of providers say insurers are now denying 30 per cent or more of assessment and treatment plan requests, versus a denial rate of 10 per cent or less a year ago.

• About two-thirds of providers surveyed said between 10 per cent and 50

October/November 2011

per cent of claimants are now not being assessed because of a cap on assessment fees, which includes travel expenses to assess certain claimants, particularly in rural areas.

• A “vast majority” of providers reported their clients are now waiting two months or more to receive treatment and services, versus a wait of a month or less a year ago.

“We were shocked by how quickly these negative trends have worked through the system and the degree to which services and benefits have eroded,” said Alliance president Nick Gurevich. “The survey of 45 rehab practices across the province is not scientific, but it does uncover some disturbing evidence that points to a breakdown in consumer protection.”

The Alliance’s recommendations would effectively roll back most of the auto insurance reforms introduced by the Ontario government in September 2010. l

www.claimscanada.ca

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• first notice FN Ontario court criticizes insurer for not inspecting fine art collection prior to binding coverage in fire case The Ontario Superior Court of Justice ruled against awarding punitive damages against Chubb Insurance Company of Canada in a case involving the destruction of a high-end art collection in a 1997 fire.

In doing so, however, the court ruling took the insurer to task for accepting and binding the risk without conducting an inspection of the art collection, valued at approximately $10 million (although this number was under dispute).

Ontario’s Court of Appeal directed the new trial in 2009 to consider a number of questions in Sagl v. Chubb Insurance Company of Canada. Among them, the Ontario Superior Court was asked to consider whether or not Bridgette Sagl’s $2-million insurance policy on her fine art collection was void because, as Chubb argued, Sagl had materially misrepresented the value of her collection.

On the advice of her broker, sometime between 1995 and 1997, Sagl had started to take photos of the art and catalogue the photos for insurance purposes. She had completed this process for approximately $1-million worth of her collection before a 1997 fire destroyed the entire collection.

Chubb denied coverage in part because the insurer suspected arson. The court found Chubb was incorrect about its suspicion, but did not award punitive damages because Chubb’s suspicion was “reasonable,” based on information it received from the Ontario Fire Marshal.

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A bi-monthly magazine (6x per year), Claims Canada is published by BIG Magazines LP, a div. of Glacier BIG Holdings Company Ltd. Business Information Group is located at: 12 Concorde Place Suite 800, Toronto, ON, M3C 4J2.

Claims Canada magazine is the Official Publication of the Canadian Independent Adjusters’ Association [CIAA] and through its editorial content and circulation brings together the ‘entire property & casualty insurance claims market nationally’ with information and insight into the profession, business and people of insurance claims and loss adjusting.

All key claims process stakeholders are reached as part of our readership community – including: both CIAA member and non-member independent claims adjusting firms; insurance and reinsurance company executive, claims management

8

But the court found the insurer did not conduct a thorough inspection of the art collection before it bound the coverage, leading to issues in determining its value.

“Chubb’s practices with respect to the acceptance of this risk deserve to be criticized,” Ontario Superior Court Justice Frank Marrocco wrote. “In the eleven weeks between issuance of the binder of insurance and the date of the fire, Chubb never attended at 2415 Doulton Drive to inspect Ms. Sagl’s fine arts collection.

“One only has to contrast the jewelry claim [for the same 1997 fire] and the fine arts claim to see that Chubb’s practices caused some of the problems in this case. The jewelry [valued at roughly $1 million] was insured as scheduled articles; there has been virtually no controversy about the value of the jewelry.”

Marrocco observed Sagl had started to catalogue the art, and circumstances after the fire made it difficult for the insured to access her records and complete the task. For these and other reasons, the court found Sagl could not be faulted for “intentional misrepresentation” of the art collection’s value.

Marrocco elected not to award punitive damages to emphasize the court’s criticisms of Chubb’s underwriting practices.

The full case is available at: http://www.canlii.org/en/on/onsc/doc/2011/2011onsc 5233/2011onsc5233.html l

Claims Canada

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October/November 2011

Gary White Production Manager (416) 510-6760

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

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

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Message from the President La Plume du Président GREG MERRITHEW

I am certainly looking forward to the year ahead as national president of CIAA. Friends and colleagues have asked me if I am nervous about taking on this important position. Quite frankly, I am not. In fact I am excited.

Mainly because of the great executive team we have leading the CIAA. First and foremost, Pat Battle, our executive director. Pat is so organized! Within minutes of taking on the position, Pat is passing me notes and “suggested” directions on what needs to be done. As past president Reno Daigle always says, “she is awesome!” As is the rest of our executive: Delores Thorbourne, John Seyler, Marie Gallagher, Randy LaBrash, Jim Eso, John Jones and David Porter.

The CIAA 2011 annual conference in Muskoka was a resounding success. Marie Gallagher and her team did a fabulous job in the organization and coordination. My wife Liz and I started attending the CIAA conventions in the early 1990s and we have not been disappointed yet.

What a venue! The JW Marriott Rousseau Resort has got to be one of the finest venues we have had the pleasure of utilizing for our conventions in the last 27 years.

I strongly recommend all members consider attending future conventions. The contacts you make will have a positive impact on your profession and your business for many years. Keep Aug 23 to 26, 2012 open for next year’s convention and AGM in Yellowknife, NWT. Karen Kuronen and her convention committee are already hard at work.

The chairs of our 2011/2012 standing committees have been appointed and will be in need of committee members to assist in their important work. Areas we are concentrating on this year include education, our new CLA designation, membership organic growth and higher profile branding of the CIAA. If you are interested in helping on a CIAA committee, give Pat Battle a call.

Our editorial committee — Fred Silvestri, John Sharoun and Mary Charman — produced an excellent brochure/handout for members to provide to policyholders. The brochure details the role of an independent adjuster in the claim process. It is entitled “CIAA Independent Adjusters Make a Difference.” Order forms are being sent out to member firms and are also available 10 Claims Canada

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October/November 2011

C’est certainement avec plaisir que j’envisage de passer l’année comme président national de l’ACEI. Mes amis et mes collègues me demandent si je suis nerveux à l’idée d’occuper ce poste important. Je réponds en toute franchise que je ne le suis pas. En fait, je suis ravi. Principalement, quand je pense à la formidable équipe de direction qui gère l’ACEI. D’abord et avant tout, il y a Pat Battle, notre directrice générale. Pat a un tel sens de l’organisation! Quelques minutes à peine après ma nomination, Pat m’a remis des résumés et des orientations ‘suggérées’ sur ce qu’il y a lieu de faire. L’ancien président, Reno Daigle, disait toujours que Pat ‘était impressionnante.’ Tout comme le sont les autres membres de l’exécutif: Dolores Thorbourne, John Seyler, Marie Gallagher, Randy LeBrash, Jim Eso, John Jones, et David Porter.

La conférence annuelle 2011 de l’ACEI a connu un succès retentissant. Marie Gallagher et son équipe ont remarquablement fait preuve d’organisation et de coordination. Ma femme Liz et moi assistons aux congrès de l’ACEI depuis les années 90 et, jusqu’ici, nous n’avons jamais été déçus. Quel bel endroit! Le JW Marriott Rousseau Resort est, à mon avis, l’un des lieux les plus raffinés où nous avons eu le plaisir de tenir un congrès ces 27 dernières années. Je conseille fortement à tous nos membres d’assister à nos futurs congrès. Les relations professionnelles que vous y créerez auront un impact bénéfique à long terme sur votre profession et vos affaires. Réservez les 23 au 26 août prochains pour le congrès et l’assemblée générale annuelle de 2012 qui se tiendront à Yellowknife, T.-N.-O. Karen Kuronen et le Comité des congrès sont déjà à l’œuvre.

Les présidents de nos comités permanents ont été nommés et devront compter sur les membres de leurs comités pour les aider à remplir leur mandat. Nos domaines d’intérêt pour cette année sont, entre autres la formation, la nouvelle désignation ESA, l’accroissement du nombre d’adhérents et la bonification du profil de l’ACEI. Si vous voulez siéger sur l’un des comités de l’ACEI, appelez Pat Battle.

Notre comité de la rédaction — Fred Silvestri, John Sharoun et Mary Charman — a produit une excellente brochure/prospectus que les membres pourront remettre aux titulaires de polices. Cette brochure explique en détail le rôle de l’expert en sinistres lors de l’estimation des inwww.claimscanada.ca

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on our website at www.CIAA-adjusters.ca. Please submit your orders to CIAA national office.

Mary Charman, our immediate past president, put her heart and soul into our association over the last year.

She worked hard in pushing forward our objectives in promoting a harmonized insurance regulatory system, preparing CIAA’s CAT Response Resource, as well as enabling our National Insurance Industry Advisory Board.

Mary also continued on with the strategic plan objectives and ensured CIAA kept up a national profile as the voice of independent adjusters in Canada. Mary, on behalf of the membership, I thank you for all your good work and commitment to continue giving back to our organization in the years ahead.

I will be attending the RIMS Canada conference in Ottawa, Sept. 18 to 23 and hope to meet up with members that are in attendance.

Remember, look after your health, look after yourself and be safe. n

demnités. Elle a pour titre «CIAA Independent Adjusters Make a Difference». Les sociétés membres recevront des bons de commande et les brochures sont aussi disponibles sur notre site web www.ciaa-adjusters.ca. Vous pouvez également en commander au bureau national de l’ACEI. Mary Charman, à qui je succède en tant que président, s’est dépensée corps et âme pour notre association au cours de son mandat. Elle a fait avancer nos objectifs en encourageant la création d’un système de réglementation pour l’assurance harmonisée, préparant les ressources de l’ACEI pour une réaction rapide en cas de catastrophe et en facilitant la création du Conseil consultatif national de l’industrie de l’assurance. Mary a aussi poursuivi les objectifs du plan stratégique et a vu à ce que l’ACEI maintienne un profil national en tant que représentante des experts indépendants au Canada. Mary, au nom de tous nos membres, je vous remercie pour votre excellent travail et pour votre engagement de poursuivre votre contribution à l’organisation.

J’assisterai à la conférence de la RIMS qui se tiendra à Ottawa du 18 au 23 septembre et j’espère y rencontrer les membres de l’ACEI qui s’y rendront.

N’oubliez pas de prendre soin de votre santé, de prendre soin de vous et d’être prudent! n Translation provided by Henry Arcache, Themis Translations, Montreal, Que.

NATIONAL EXECUTIVE 2011-2012 2010-2011 PRESIDENT Greg G. Merrithew, CIP, FIFAA Arctic West Adjusters Ltd. 401 – 5204 – 50 Ave. Yellowknife, NT X1A 1E2 Phone: (867) 920-2212 Fax: (867) 873-2244 E-mail: gregm@arcticwest.ca

SECRETARY Marie C. Gallagher, FCIP, CRM Granite Claims Solutions 71 King Street, Suite 204 St. Catharines, ON L2R 3H7 Phone: (905) 984-8282 Fax: (905) 984-8290 E-mail: marie.gallagher@graniteclaims.com

1ST VICE-PRESIDENT Delores Thorbourne, BA, FCIP Granite Claims Solutions Suite 103 Greystone VII 4208 - 97 Street Edmonton, AB T6E 5Z9 Phone: (780) 442-3077 Fax: (780) 466-0325 E-mail: delores.thorbourne@graniteclaims.com

TREASURER Randy P. LaBrash, CIP, CFE, CFEI Crawford & Company (Canada) Inc. 300 – 191 Lombard Avenue Winnipeg, MB R3B 0X1 Phone: (204) 947-2340 Fax: (204) 943-9168 E-mail: Randy.Labrash@crawco.ca

2ND VICE-PRESIDENT John D. Seyler, AIIC ProFormance Group 2 Robert Speck Parkway, Suite 700 Mississauga, ON L4Z 1H8 Phone: (905) 270-1723 Fax: (905) 272-7486 E-mail: jseyler@prospecialty.ca

PAST PRESIDENT Mary Charman, CIP Crawford & Company (Canada) Inc. 1 – 120 Mulock Drive Newmarket, ON L3Y 7C5 Phone: (905) 898-0008 Fax: (905) 898-1705 E-mail: Mary.Charman@crawco.ca

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EXECUTIVE DIRECTOR Patricia M. Battle Canadian Independent Adjusters’ Association/ L’Association Canadienne des Experts Indépendants Centennial Centre, 5401 Eglinton Avenue West, Suite 100 Etobicoke, ON M9C 5K6 Phone: (416) 621-6222 Toll Free: 1-877-255-5589 Fax: (416) 621-7776 E-mail: pbattle@ciaa-adjusters.ca

DIRECTOR David Porter, LL.B., FCIP, CRM Advance Claims Service Ltd. 206 - 2323 Boundary Road Vancouver, BC V5M 4V8 Phone: (604) 642-0660 Fax: 1-888-452-5246 E-mail: davidp@advanceclaims.com

DIRECTOR James B. Eso, BA, CIP Crawford & Company (Canada) Inc. 539 Riverbend Drive Kitchener, ON N2K 3S3 Phone: (519) 578-5540 Fax: (519) 578-2868 E-mail: Jim.Eso@crawco.ca DIRECTOR John Jones, BA Granite Claims Solutions Suite 300, 5915 Airport Road Mississauga, ON L4V 1T1 Phone: (905) 671-3164 Fax: (905) 671-1889 E-mail: john.jones@graniteclaims.com

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• cover story

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Reducing the risk of basement flooding is a priority for both insurance companies and municipalities.

BY LAURA KUPCIS

B

asement flooding is still a learning experience for everybody involved and the appreciation of risk is still relatively new.

For insurance companies, part of the learning curve includes acquiring better data about sewer backup risk.

Companies can then be more realistic about what they offer in terms of pricing and consequently more confident in providing the product, said Kevin Smart, assistant vice president of person lines underwriting policy with Aviva Canada.

Smart was speaking at the Institute for Catastrophic Loss Reduction’s (ICLR) Basement Flooding Symposium in Toronto in May 2011. Insurance industry and municipal representatives, along with experts from ICLR, joined him in discussing how to prevent water from entering into and damaging homes. For municipalities, this includes determining the best way, through both public and private solutions, to minimize the risk of water infiltration.

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“Water is the most contentious peril we deal with and the least understood,” said Carol Jardine, senior vice president of claims services with TD Insurance. “Hopefully by creating this dialogue between municipalities and the insurers, we will actually create a dialogue in society.”

Water is the new fire risk for the insurance company, said Grant Kelly, director of climate change adaptation projects at the ICLR. He said an insurance policy is in fact a fire policy with other coverages added on. But from an insurance point of view, water has now overtaken fire in terms of importance.

Today, water claims comprise roughly 40 per cent of the total claims in Canada.

Water claims grew by 34 per cent over the past five years — from more than $1.2 billion in 2005 to more than $1.6 billion in 2009, according to the Insurance Bureau of Canada.

These claims include losses due to sewer backup, broken pipes and wa-

October/November 2011

ter that entered a home through a window or wall broken open by an insured peril.

Whether or not overland flood insurance becomes an insured peril in Canada still remains to be seen. “It’s very difficult in light of all the catastrophes around the world right now to get an increased appetite for flood insurance,” Jardine said. “It doesn’t say it won’t happen; I’m not pinning all my hopes on it.” ICLR has been instrumental in funding research in this area. Also, global (re)insurer Swiss Re is championing the cause.

But as of this time, the federal government does not license insurers in Canada to underwrite residential overflow of water from another body of water. “The federal government has decided — for federally licensed insurance companies — it would be too big a risk for an insurance company to bear,” Jardine said.

In the interim, discussion continues about how municipalities, insurwww.claimscanada.ca

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ance companies and homeowners can mitigate the occurrence and severity of water damage into a home.

Homeowner uncertainty When it comes to insurance coverage for sewer backup and flooding, research shows homeowners are uncertain about what is covered and what isn’t, says Dan Sandink, manager of resilient communities and research for the ICLR. “A 2007 study of homeowners in Toronto and Edmonton revealed that 33 per cent of respondents from Edmonton and 38 per cent of residents from Toronto who had experienced sewer backup in the past did not know whether or not they had insurance coverage for sewer backup,” Sandink writes in Involving Homeowners in Urban Flood and Risk Reduction: A Case Study of the Sherwood Forest Neighbourhood, London, Ontario.

This uncertainty also appears in a study of residents living in the Sherwood Forest neighbourhood of London, Ont. These residents experienced flooding on May 28, 2009, after 83mm of precipitation fell during a five-hour period. Forty-five per cent of the 674 respondents did not know whether or not they had sewer backup coverage, the research paper notes. Twentythree per cent of the 52 respondents who reported sewage flooding did not know if they had insurance coverage.

Of those who reported clean water flooding, 45 per cent could not identify whether coverage existed.

Forty-one per cent of the 75 respondents who did not have insurance coverage for sewer backup said they chose not to purchase the coverage. Twenty-five per cent did not know the coverage was available. A further 17 per cent indicated their sewer backup coverage was cancelled, Sandink wrote.

Policyholders will frequently call up insurers assuming that they are covered for overland flooding, only to become livid when they realize their claim will be denied, Jardine said.

Further complicating the issue, insureds do not understand why their home insurance rates are continuing to rise even though they have never www.claimscanada.ca

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reported a claim. “I think both of us (insurers and municipality representatives) must have the conversation with society that it is a spread of risk,” she added. “That allows us to offer this infrastructure from a municipality perspective or this insurance from an insurance perspective. It’s not an easy conversation to have when people are standing in three feet of water.”

Insurer stance Water damage claims tend to bring out the insurance companies’ most vocal critics, Jardine pointed out. “I have been on more Twitter accounts and Facebook accounts in the last year than I have in my entire career, and it’s people complaining and swearing and saying nasty things about us,” she said. Frequently the cause of the complaint is that the claimant has a coverage limit. Either that, or the claimant was not aware that the municipality covers the damage, not the insurer.

Many insurance companies are providing credits to insureds who install a backwater valve in their homes.

Unfortunately, people often expect to receive more from that credit than the insurer is able to provide, Jardine said.

Furthermore, there are restrictions on obtaining sewer backup coverage.

In a high-risk area, coverage limits will be lower. If a client wants to access a higher limit, they will have to pay a much higher price. “It’s all vetted by the limits that are available, the risks we perceive in your area and whether you’ve taken any risk mitigation,” Smart said.

Municipalities’ efforts to mitigate flooding would also factor into underwriting the risk. Communities that do not have fire stations, or that have volunteer stations, pay a higher premium than those staffed with career firefighters or a municipally owned fire station. Insurers’ are looking to obtain similar data as it pertains to water: Which municipality is undertaking efforts to protect their communities and citizens from flood damage? Over time, insurers hope to collect enough data to show which communities invested in infrastructure (resulting in lower risk and ultimately lower premium) and which

did not invest (elevating the risk and premium for their residents).

Municipality input Toronto After eight separate incidents of extreme weather in the past 20 years overwhelmed the city’s aging infrastructure, Toronto undertook an engineering review of the system. Council subsequently approved an adaptive management approach.

The review showed there was nothing wrong with the sewer system — it performed exactly as it was designed to do. But the system was designed for minor storms: one-intwo-year storms, or one-in-five-year storms. During extreme storms, the sanitary sewer system completely overloaded, resulting in widespread flooding, including flooding onto private property, said Michael D’Andrea, director of water infrastructure management of Toronto Water. The storm water industry has evolved over time; now, the city’s corporate and major storm systems are designed to handle one-in-onehundred-year storms.

With respect to surface flooding, many low points around the city have no water outlets, causing “ponding” during extreme conditions. But now, when a new subdivision is built a major system design is incorporated that channels the water (via the road network) out to a low point, typically a storm water pond, before the water is released into a watercourse or lake.

None of the new subdivisions using this system have experienced chronic flooding, D’Andrea said. City council advocated and approved an adaptive management approach in April 2006.

Thirty-two areas were deemed to be basement flooding-prone zones which were then identified as priority study areas. Council then approved upgrading existing storm drainage systems in high risk areas to standards set for new subdivisions, meaning a one-in100-year storm.

No downspouts are connected to the sanitary sewer system in Toronto.

But in many areas in the city, they are connected to the storm sewer system.

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Council mandated the disconnection of all downspouts in the city, with the higher risk areas to be disconnected by 2013.

The city has also launched a basement flooding protection subsidy program, which provides up to $3,200 in financial incentives for the installation of a backwater valve, sump pump and pipe severance and capping.

The municipality is also looking at restricting flow that actually enters the storm sewer system. “The caveat being that flow running on the road surface needs to be intercepted and captured in order to make this an effective measure,” D’Andrea said. City officials are looking at diverting overland flow to underground storage systems or storm water ponds.

The preferred option is to install storm water ponds. Where this is not a viable option, the municipality will have to take a more expensive route and look into tanks or oversized pipes to reduce damage.

The cost of the upgraded infrastructure is $272 million for only four of the 32 study areas. Only $20 million of that represents upgrades to the sanitary sewer system; the rest is for storm drainage system upgrades.

Sanitary sewer system improvements are the city’s first priority.

With respect to storm drainage system improvements, these have been prioritized from the highest to lowest number of benefiting properties. The cost per benefiting property is capped at $25,000.

Furthermore, the mandatory downspout disconnection program has been extended to the affected areas. Bylaws have been amended so that backwater valves must be installed with all new developments. The construction of reverse-slope driveways has been banned.

London In an effort to reduce the impact of basement flooding, the City of London is looking into mandatory weeping tile disconnections. In many of the “problem areas,” weeping tiles are connected directly to the sanitary sewer system. At least, this was true prior to 1985. Subsequently, weeping 14 Claims Canada

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tile was connected to a sump pit that directed the discharge overland. This worked until 1995, at which point all sump pump discharge in new developments was directed to a new storm sewer private drain connection (PDC). In a PDC, an individual homeowner sanitary lateral runs from the house to the sewer mainline, explained Kyle Chambers, wastewater and drainage engineering division with the City of London.

London’s Sherwood Forest subdivision, built between the late 1970s to early 1980s, is a chronic basement

Water claims grew by 34 per cent from more than $1.2 billion in 2005 to more than $1.6 billion in 2009, according to the Insurance Bureau of Canada. flooding problem area in the city. It is a separated system with no combined sewers and no catch basin connected to the sanitary system. On May 28, 2009, the area was flooded with more than 80mm of rain in a five-hour period. Flow monitors in the subdivision’s sanitary sewers showed an increase of flow between a normal level of 2L/sec to 5L/sec during dry weather to more than 40L/sec during the rainstorm.

October/November 2011

The subdivision is built on clay soil, which, when combined with lot grading issues and zero lot line homes (a large number of homes built close together with very little green space), means the water falls onto the ground and shifts directly to the house, down into the weeping tile and out into the sanitary sewer, Chambers said.

Following the May 2009 event, the municipality engaged a consultant, analyzed all the flow monitor available and built and calibrated an inflow works computer model to look at the flows and determine the best way to mitigate basement flooding. Two different alternatives were explored, one for the city and one for homeowners.

The city alternative would look at increasing the pipe size to try and accommodate the flow. For a cost of $10 million, pipe upsizing would include an additional 2.3 km, an additional 1,400 cubic meters of inline storage and a 2,200 diameter underground pipe.

This solution comes with a number of issue. First, a pipe can only be designed to a certain size event. The next, bigger pipeline can ruin the system and there’s basement flooding again. Second, a bigger pipe only accommodates the inflow and infiltration (I/I), it doesn’t actually remove it, Chambers explained.

However, on the homeowner side of things, by disconnecting the weeping tile from the sanitary laterals, the I/I doesn’t have a chance to make it into the sanitary sewer. Disconnecting these, which would cost $2 million for 160 homes, would remove an adequate level of I/I to bring the load down and protect basements up to and beyond a 25-year design event.

This would be done in addition to weeping tile disconnection, sump pump and backwater valve installation, dedicated storm PDC for sump pump discharge, and road resurfacing for those 160 residences.

Additionally, the city offers a 75 per cent grant program to all homeowners in basement flooding-prone areas to cover the cost of disconnecting the weeping tile from the sanitary sewer and installing a backwater valve.

However, as is the case in many other www.claimscanada.ca

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municipalities, there is very poor uptake on this offer. The municipality is currently trying to move to a mandatory solution, which would bump up the funding to 100 per cent in the problem areas. Currently, a council report is being drafted, with the ultimate goal of having council buy in to this program, Chambers said.

Saskatoon Saskatoon has always had two sewer systems: a storm sewer system and a sanitary sewer system. No household sewage is connected to the storm sewer systems and no roof or downspout leaders and no catch basins are connected to the sanitary sewer systems, said Galen Heinrichs, stormwater utility manager for the City of Saskatoon.

As a means to reduce the risk of flooding in the city, some small-scale solutions and some large-scale solutions have been, or are in the process of being, implemented.

Beginning in 2003, new homes were designed so that water would go

through the weeping tile straight into a sump pit and then be pumped out.

“It’s very important, if you are ever involved in this, to make sure that when they are pumping out the water, they extend the lead past the backfill zone,” Heinrichs cautioned. “If you don’t, you’ve just got this vicious circle: When you are pumping water out, it goes through the back fill zone and then continues on.”

All new homes are required to be built with a backwater valve installed.

Furthermore, any home with a demonstrated risk of sanitary sewer backup that was not built up to the Jan. 1, 2004 standard could take part of the flood protection program. Funded 100 per cent by the city, the program offered residents up to $2,500 to upgrade their plumbing with a backwater valve and sump pit.

The program ran three times, once in 2005 and again in 2007. It offered the program in 2010 with the cap raised to $3,000. “Coincidentally plumbing prices went up by $500,” Heinrichs mused. “Our participa-

tion rate in these programs was pretty consistent all around the 50 per cent level,” he said. “So, we only had about 700 homes that actually took us up on the program.”

Heinrichs and his team concluded the backflow valve was 85 per cent effective in eliminating sewer backup.

After flood events, in areas in which flooding would have been expected again they would go back to the homes that had completed the plumbing upgrade to note the damage. Sewer backup was eliminated in 85 per cent of the instances; in the 15 per cent of homes that did experience damage, 96 per cent of the time the damage had been reduced.

With respect to large-scale infrastructure solutions, the municipality has gone the route of super pipes. It is not as simple as building bigger pipes, however, Heinrichs pointed out. “The primary purpose of the sanitary sewer system is conveying domestic sewage,” he said. “And when you start altering the design of that you create problems. Sanitary sewers have to run

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at minimum flow speeds in order to convey the solids that are inherent in that sanitary sewer.”

Furthermore, they have to be selfcleaning. In larger pipes, the flow will be less, due to a drop in slope. Solids will simply accumulate at the bottom and eventually capacity is reduced.

The pipes must be deep enough to prevent freezing, but not so deep that they cannot be maintained or built.

In addition, they cannot be designed for extreme events because in many situations there is an actual physical limitation to what can be done with sanitary sewer. It has to both convey the rainwater from weeping tile and convey sewage from the home, which is its primary purpose.

With the Saskatoon super pipe concept, the idea is to build a tank and to build it lower than the lowest basement in the area. Then, when the water needs somewhere to go, it goes into the tank and not into the basements.

After a rainstorm, the tank will either self-drain or someone will have to go and manually pump out the water. Currently, the municipality is in the process of switching these manual pumps over to an automated system which will drain the tank immediately after a heavy rainfall, Heinrichs said.

Two pipes were installed in 2008, two more in 2009 and two more in 2010. Another one is currently being built, with two more planned for 2012 and one more for 2013. The city has currently spent $10.2 million on superpipes. The total projected cost is $19.3 million by the time the project is completed.

Stratford For the city of Stratford, a massive rain event on July 28, 2002 and a subsequent class action lawsuit motivated the municipality to take action.

The Norfolk and Elgin area was known to be problematic. In a normal area, storm sewers are designed to take water away and the road system removes the rest of the water. But that did not happen in this basin. After the rain on July 28, residents could canoe between the properties. The municipality was already planning 16 Claims Canada

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to fix this area, but the July 28 storm changed everything, said Ron Shaw, chief administrative office for the city of Stratford.

Immediately following the event, two emergency council meetings were held and an emergency aid program was initiated. The program offered up to $5,000 per household after insurance, including $1,000 for lost wages.

Within a month, four people initiated a class action lawsuit against the city for $210 million. The case was recent-

Any home with a demonstrated risk of sanitary sewer backup, that was not built up to the Jan. 1, 2004 standard, could take part of the flood protection program.

ly settled out of court for $7.7 million, with no admission of liability on the part of the city, Shaw said.

A sanitary sewer master plan was initiated prior to the flood of July 28.

The plan was to analyze the sanitary collection system in problem areas and to identify solutions. The goal was to evaluate existing conditions, taking into account future development. The

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plan identified $35 million in priority projects for the sanitary system and $16.5 million in strategic projects.

Following the July 28 flood, council demonstrated a strong will to proceed with these recommendations, Shaw said.

A storm master plan was intended as a follow-up to the sanitary plan.

The goal of the storm master plan was to prepare a comprehensive action plan for the planning and implementation of the required changes and/ or improvements to the storm system infrastructure to meet current and future needs.

It was found that a lot of the rural drainage system flowed into the city through a number of drains into the Lorne Avenue pipe, Shaw said. The city was legally obliged to deal with that and came up with a solution. The capital works project proposed for this outlet system will cost $50 million or more.

The storm master plan recommended three categories: • Capital works: the proposed Lorne Avenue outlet system would cost more than $50 million. A Collegiate Arch system would cost more than $15 million. Other projects would amount to more than $5 million. It was also determined that a five-year inspection and maintenance program needed to be implemented.

This has been done and continues to be done, Shaw said.

• Programs: These include monitoring identified problem areas; flow reduction areas; and PDC Isolation.

• Policy measures.

“Our priority has been on the capital project,” Shaw said. “Given the situation, it is an area that we needed to address.” Council has agreed to implement a 250-year level for stormwater management. Five storm ponds have been completed and some storm sewers are in place in the city.

Understanding what municipalities are doing is important to the insurance industry, said Glenn Matheson, program manager for property losses at Gore Mutual. By bringing all parties together, those involved are able to learn more about water claims.  www.claimscanada.ca

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• spotlight S

Filling a Void

Seeing a need in the industry for specialized services, ProFormance Adjusting Group of Companies is busy filling that niche.

BY LAURA KUPCIS

S

eeing a need for specialized services for accident benefits (AB) and bodily injury (BI) handling, Tammie Norn set out to fill that gap.

Taking her experience as an AB and BI adjuster, Norn launched ProFormance Adjusting Solutions Inc in November of 2008, a member of the ProFormance Group of Companies.

“I wanted to be able to provide the industry with expertise, and really develop the quality piece of it — be accountable to quality,” Norn said. “It was about having controls in place in order to ensure quality work is being provided and also if there are opportunity areas, then there is the ability to identify those early on, rectify the issues and still provide the client with a quality product.”

After spending the first six months of her new venture as an in-house contract, by April of 2009 Norn had her first contract for the outsourcing of full handle claims. Things have only continued to grow since then, with Norn’s three-year business plan being fulfilled in less than one.

Being able to say to a client, “We know how to handle these claims, we understand the legislation and the nuances of the auto product so your indemnity spend is going to be less,” is a huge key to the company’s success.

“Because of our knowledge of this business, we are able to close files on a timely basis, we know what we are doing, we are able to control the indemnity piece of it, which is, in turn, going to decrease your overall loss ratio,” Norn tells her clients. By implement18 Claims Canada

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ing these few, yet critical, steps and offerings into her claims handling, Norn has increased the company’s book of business exponentially.

Growing quickly The first company to contract ProFormance Adjusting Solutions had such a need that it simply kept sending more work and Norn had to start building her firm sooner than she’d anticipated. “Other clients came on as soon as word started to spread that there was a specialist,” Norn said.

“The feedback that I was getting was that it was just such a great idea, that the industry really did need this specialty service.”

By the end of 2009, ProFormance Adjusting had 12 adjusters and an office in Markham. By January of 2010, the company had expanded, and opened a second office in Mississauga.

By October of 2010 the company expanded further and opened its third office in Pickering and had ballooned to 27 staff before the year was out.

The key to success is not simply making early contact on new claims or heading out to taka statement. It’s about understanding what’s required to investigate and evaluate a claim and providing the client with the information they need, Norn said. “One of the things that I have always believed as an independent is that we’ve got to mimic the insurance companies,” she said.

“They are our customer, they are our client, and we need to be able to provide them with what they want, expect and deserve. And what they want is for

October/November 2011

us to provide them with superior quality. Part of how this is achieved is by having the appropriate levels of supervision and support in place similar to that of the company, providing ongoing training so the staff are fully conversant with the ever changing product and going above and beyond when it comes to servicing their insureds.

Diversifying the lines While ProFormance Adjusting Solutions continues to specialize in AB claims, the company also offers mediation work, training and settlement solutions.

From the get-go the goal has always been to diversify the group’s portfolio of services. The intention of the group has always been to do a good job, develop relationships and provide a quality product; these are the things that will sustain a company, Norn said.

“But you’re always thinking of other ways to diversify, expand and increase your market share.”

The obvious solution for Norn and her company was to take on a new partner and diversify her lines of business.

She approached John Seyler in early June 2011 and by August 2011 ProFormance Specialty Claims Inc was launched. ProFormance Specialty Claims specializes in commercial auto, transportation, casualty, E&O and D&O claims handling.

“We formed ProFormance Specialty Claims to service a niche and not to compete with what [the Group] had already established.” www.claimscanada.ca

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Photo by Marshall Seyler

“Our goal is to have a national presence, but it’s not going to be at the expense of the client where we don’t have the right people in the right places”

The vision for ProFormance Specialty Claims is to be able to replicate the basis that ProFormance Adjusting Solutions has established and carry it right across the country. Not to be in every town across Canada, but for the model to be available to serve clients right across the country.

Offering exceptional service “Our goal is to have a national presence, but it’s not going to be at the expense of the client where we don’t have the right people in the right places” Seyler said. “This growth is going to be fostered by finding the right people to grow with us.”

Currently, there are five staff focused on the development of ProFormance Specialty Claims, but given that the first contract came in 15 minutes after the doors had officially opened, it won’t be long before this number will be on the rise. “It’s indicative of a need in the industry for somebody who is going to provide quality services at a reasonable price,” Seyler said of that immediate first call.

“I can’t tell you the number of times I have been told at client meetings, www.claimscanada.ca

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‘Price is not important, do the work and provide us with a quality product,’” Norn pointed out. “It’s not a justification to increase your price, but it just goes to show you the mind set is different on a specialized service.”

“Insurers and self-insured clients have really reached the point where they are tired of bracing themselves to expect substandard quality,” Seyler added.

Giving back But at the end of the day, a corporation is only as strong as its people — it’s about quality of life and balance. And for the staff at ProFormance Group of Companies, part of this balance means giving back — and not just monetarily.

The company and its staff spends most of its volunteer time focused on the Jennifer Ashley Children’s Charity. The rest is spent involved in industry-related charities, including sitting on the Women in Insurance Cancer Crusade Gala Committee, the Starlight Committee and participating in Relay for Life. Norn and Seyler are also heavily involved in both the Ontario Insurance Adjusters Association (OIAA) and the

Canadian Independent Adjusters’ Association (CIAA). Seyler is currently second vice president on the CIAA’s national executive, having previously served as president of the Ontario region. Norn is currently the second vice president on the OIAA senior executive, is heavily involved with the Insurance Institute of Ontario developing a Serious Injury Training Program for adjusters and sits on the CIP Society’s National Counsel.

The members of the CIAA are all like-minded companies and individuals who believe in and abide by the Code of Ethics. “We know they provide a valuable service to the public and believe in being held accountable,” Seyler said.

“When we get assignments that are nationally-based, if I go to a CIAA member that is qualified to handle the type of claim that I have, I know they are going to be like us,” he said.

“We can use the network of CIAA members that are qualified to do the work,” Norn added. “We can capitalize on our resources by using CIAA members knowing they will get the job done.” 

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CIAA 27th Annual General Meeting and Conference, Muskoka, Ontario

The Claims Loop

It is essential for independent adjusters to keep everyone involved in the claims process: The insured, the insurer and the broker

BY LAURA KUPCIS

N

erves start to get rattled for an insurer if they are not able to capture what is involved financially with a claim.

“When you get those really odd claims, coverage issues are a really big issue,” said Sharon Clark, casualty claim manager with CAA Insurance Company.

Clark was speaking at the education forum during the Canadian Independent Adjusters’ Association’s (CIAA) annual general meeting in Muskoka, Ont. on Aug. 26, 2011.

Insurance companies immediately need a cost estimate on a claim so they are better able to plan.

For the run of the mill claim, most independent adjusters send in a little fact sheet via email or mail, which is perfectly fine, Clark said. But, for more complicated claims — or ones where there is suspected fraud — the information that an adjuster sends in is extremely important because it provides the insurer the opportunity to very quickly capture the essence of the claim and know what its exposures are, she added.

What to note Issues that should be addressed: • Are there any policy violations?

• Are there any exclusions?

• Is there adequate insurance?

• Is there a co-insurance issue?

• Is the insurer actually insuring what it believes it is insuring?

• What are the insurer’s exposures?

• What are the facts of the loss?

• Who are the other parties?

• Is the insurer exposed to liability?

• What are the damages?

• Is there a priority dispute in the case of an accident benefits claim?

• Is it a loss transfer?

• Are there other accident benefits claimants?

• Are there subrogation possibilities?

• Is there mitigation to be dealt with?

• Do goods need to be protected from further damage?

• Do additional living arrangements need to be made?

• Does a case worker need to be assigned in the event of an accident benefits claim?

• Is there a suspicion of fraud?

• Is there a social media nightmare brewing?

“It sounds like a lot, but it’s amazing what you can cover off pretty quickly,” Clark said. “If you are starting to get that gut instinct, or something specific has come up and you go, ‘Wow, this is a serious loss’ or you’ve got one those problems 20 Claims Canada

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described, great idea to just pick up the phone [and call the insurer].”

Service standards In many cases, an insurer simply wants to guarantee that its service standards are being met, said Mark Stewardson, claims manager, property/casualty subrogation with RSA. In some instances, the claim originates directly within the organization and in-house adjusters are held accountable to the company’s initial service standards. However, in instances where the claim is assigned from the broker to an independent adjuster, the insurer needs to know immediately who is working on the claim. “If we don’t have the information up front, it looks pretty bad on an insurance company when we don’t know who was assigned in the individual office and what initial promise was made,” he said. “Immediately try and give feedback to the insurance company as to who is handling the claim and what your initial plan is by way of services standards and contact.”

He went on to note that in his company, there are financial implications if service standards are not met. Deductibles and other dollar values are put back in the pocket of the insured if these standards are not met. Through customer surveys, the company has learned that for the insured, the initial contact is the most important; it is the peace of mind that somebody is listening and has answered that initial concern as to what’s involved in the process. “As long as you transfer that information to [the insurer] to put our minds at ease, so we know if a problem exists, we know exactly how to act upon it” Stewardson said. “It’s that basic information given to us, so we are all communicating on the same page right out of the gate.”

The broker Part of that essential communication is keeping the broker in the loop. “It’s really helpful for the brokers to know very early on that there is something going on,” said Justin MacGregor, chairman of the Insurance Brokers Association of Canada said. “I have seen countless situations where it’s days before the brokers knows that a customer of his has had a problem or even had a claim. That’s not a good reflection of us or any service provider.”

Make sure the broker is in the loop; at the end of the day, it’s the broker’s customer, he said. By speaking to the broker, the adjuster can learn what the business approach is for that broker with respect to their clients. This includes what the obligations are in the event of a claim. “The sooner the broker is aware, the sooner they are able to start answering a lot of those questions that an insured is going to have,” www.claimscanada.ca

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rio

MacGregor said. The broker needs the opportunity to speak with the insured to explain the process and who will be involved in the claims handling. “We don’t need to know a huge amount, because obviously if we’ve got a relationship with the client, that’s who we are going to go and talk to,” he added. What the broker does need to know is that the promise the broker has sold — the policy — is being upheld. “We get to realize that the insurance company is going to provide the benefit to the insured,” MacGregor said. “We want to see that that happens in an effective manner.” The broker will not take over, but they do need to be in the loop to act as an advocate for their client as required.

Communication For Bob Grouchy, avp at Allianz Global, that initial phone to the client — immediately upon receipt of the claim — is key. “You are going to state that you’ve done that,” he said. “Or you are going to state that you’ve tried, because there’s nothing worse than a client sitting there who doesn’t know what he is doing and waiting.”

Send that notice to both the insurer and the broker and include the cell number of the adjuster. Those involved must be able to reach adjuster. “One of the things that I advocate, and this came out of one of the conferences some years back, is that when the adjuster does the initial meeting with the client, he says who he is acting for, writes it on a piece

CIAA National Executive 2011 - 2012: Patricia Battle, executive director; Randy LaBrash, treasurer; Delores Thorbourne, first vice president; Greg Merrithew, president; Mary Charman, immediate past president; Marie Gallagher, secretary; Jim Eso, director. Absent: John Seyler, second vice-president; David Porter, director; John Jones, director. l

of paper and gives it to [the insured],” Grouchy said. The insurance company the adjuster is representing, the claim number and the contact information should be included so that the insured has a contact base. Follow that up with the steps that will take place throughout the claim, so that the client is informed.

With respect to passing information along to the insurance company — Grouchy says letting the insurer know that you have been on scene or spoken to the insured and indicate whether it is a major or a minor loss. Advise the insurer that you will have more information as to the nature of the loss within seven days.

Contact with the insured must be made as early as three hours after the loss (ideal) up to 24 hours after a loss (on the outside), Grouchy says, adding it would be ideal if an adjuster made in-person contact with the insured within three hours, but does realize that is not always possible. “I want you out there as promptly as you can,” he said. “That’s what I am paying you for. You are my eyes and you are going to hear what’s going on.“ And he definitely wants something substantial within seven days. With all the blanks that need to be filled in, the insurer needs to know a ballpark figure for the claim. “Do not hesitate to pick up the phone and call the company if you sense there’s an issue or there’s a problem,” Grouchy said. “If you’ve got some concerns or there’s some delays . . . let us know.” 

CIAA Past Presidents: Carol Messervey, 2004/2005; Jim Eso, 2003/2004; Craig Walker, 2005/2006; Russ Malkoske, 1998/1999; Fred Plant, 2007/2008; Reno Daigle, 2008/2009; Mary Charman, 2010/2011. l

David F. Mehren, executive vice president of the National Association of Independent Insurance Adjusters (NAIIA) for the past 35 years, was awarded the Honourary Membership of the Canadian Independent Adjusters’ Association (CIAA) at the annual general meeting in Muskoka, Ont. “Affectionately known as the Karaoke Kid, Dave will be retiring next year, and with the sun setting on his remarkable career, CIAA members want to express their admiration and appreciation of his long standing alliance and loyal support of our association,” Pat Battle, CIAA’s executive director, said during the presentation.

“Not only is this a great personal tribute that I treasure, it speaks to the long-standing relationship between CIAA and the NAIIA,” Mehren said in a thank you to the CIAA. “These roots go back many years and continue to prosper. Without exaggseration, NAIIA holds CIAA in the highest esteem.” l www.claimscanada.ca

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CIAA 27th Annual General Meeting and Conference, Muskoka, Ontario

The Canadian Independent Adjusters’ Association (CIAA) held its 27th Annual General Meeting and Conference at the JW Mariott The Rosseau Muskoka Resort & Spa August 24 to 28. More than 60 delegates joined together for a trade show, a day of education, a dinner cruise and a member meeting. The weekend was rounded out with the President’s Banquet & Ball where Greg Merrithew took over the reins as president of the association for the 2011-2012 year from outgoing president Mary Charman. l

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Large Loss

When handling large losses, an adjuster must ensure they are not making promises that later cannot be kept

BY LAURA KUPCIS

T

read carefully when adjusting a large loss property claim so as to not make any commitments to the insured that cannot be kept.

For instance, when at a fire scene, until it can be determined whether the fire was accidental or not, do not make any promises to the insured, said Ian Daunt, executive general adjuster with Crawford & Company (Canada) Inc.’s global technical services division. “The insurers can’t rely on an arson defense if you, as the adjuster via company or independent have done something that basically gave the impression there was no issues with corroboration and the company was covering this loss.”

Daunt was speaking at the ASAP Education and Training Resources Seminar in Toronto on Jun. 7, 2011.

Using a claim he worked on at a pork and meat plant in Ontario as an example, Daunt explained the process of adjusting tricky large property losses. In this claim, two separate fires had occurred just over three hours apart.

After the fire department put out the first fire and cleared the scene, a second fire broke out in the cooler room, which developed into a five-alarm fire.

It took 24 hours to put out the second fire and another five days before the fire marshal would release the building back to the insured.

Talk to observers Despite not being able to enter the building to investigate, an adjuster can still do a lot of work outside. Part of this includes retaining the right people, including a cause and origin expert and, in this case, counsel. In this particular instance, in part because the gas lines in the boiler room had been disconnected, which could have created a massive explosion, the police were also called in because it was a crime scene.

Talk to people around the scene, including the fire marshal, and, more importantly, the insured. This might be the only opportunity to speak with 24 Claims Canada

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the insured. For Daunt, a three-hour conversation at a local Starbucks while the building was still burning was the only time in five years he had the opportunity to speak with the insured.

Right after that, a lawyer was retained.

“When you go to a fire scene you can never spend too much time there, but, more importantly, spend time with the insured and do it early,” Daunt said. “If the guy will stay with you for 10 hours, stay with him for 10 hours until you get all the information. You might get one shot and one shot only.”

Don’t commit Despite not being able to get inside the building, the expectation still existed that Daunt and the insurance company would remove a consignment of beef which was being housed inside the plant. The meat inside the building was becoming a health hazard, but the building was structurally damaged and it wasn’t safe to enter.

The insurer was being asked to get the meat out, pay for it and sort everything out with the insured later. “We told them until we can get in to do an investigation, we can’t make any commitments,” he said. To boot, the building was burning in an urban area and the police and fire department want it secured — they wanted it fenced and boarded up. “I was under a lot of pressure to basically make commitments.”

To get the process started, Daunt determined the best way to get the meat out of the building. First up was to determine if it was spoiled (most likely) and the second step was to determine where to take this meat (be it to a rendering company or to the dump). Daunt connected the insured with a company who could remove the meat and bring it to the dump. He explained to the insured that until he could get in to do a thorough investigation, the insurer could not commit to paying for the removal and disposal of the meat. The insured would need to retain the company to remove the meat and take it to the dump, along

October/November 2011

with a special license required to dispose of the meat. An accounting firm was brought in to weigh and document all the meat that was removed from the building, so there was a record in case the claim ended up going to appraisal on the quantum end.

On the fourth day after the fire, with 20 trucks lined up along a busy street in Toronto in the middle of rush-hour traffic, the insured initially did not show up as arranged. When he finally did, he explained the bank was “pulling the plug” and he would not be paying for the removal of the meat, Daunt said. It was decided by the Ontario fire marshal that the city would have the meat removed and the cost would be charged to the owner’s property taxes. Again, the expectation was that the insurer would pay for the limited demolition required to make it safe to enter the building to remove the meat – again Daunt had to explain the insurer could not make any commitments of the sort until an investigation could determine the cause of the fire.

“If I had committed to any one of those things, it would have ended up that the insurer, if they turned around and said this is an arson and we can prove the insured did it, it could have been estopped,” Daunt said, explaining again the need to remain noncommittal (but still being polite!) until an investigation can be completed.

“You’ve got to be strong down there, because you will be kicked all over the place and you’ve got to stick by your principles and say: ‘Look, I’m sorry, I don’t like giving this message.’”

Handling hiccups On the fifth day, the fire marshal told Daunt the investigation would likely be complete, and he would release the building back to the insured.

However, because Daunt didn’t have a non-waiver agreement, the lawyer for the insurer wrote a reservation of rights letter to the insured explaining Daunt and the experts would be going into the building to do an inwww.claimscanada.ca

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vestigation and that the insurers were not waiving any rights. However, when the fire marshal released the scene and agreed to walk the insurer’s cause and origin engineer through the building the insured would not agree unless he too could walk through the scene.

The fire marshal would not agree to this, and after five days of waiting, Daunt and the other experts were being denied the one opportunity to start an investigation. In an attempt to ensure his expert could get in, Daunt suggested the insured’s expert be allowed to go in, as well. Unfortunately, this would have to wait until after the weekend — another two days lost.

At this point, the fire marshal has been on scene for five days and Daunt has not received any information about the site or what evidence has been removed. To get the process going, the cause and origin expert must focus on the incident: document the two fires and document the boiler room where the gas lines were cut or disconnected.

From there, structural engineers need to go in to determine whether it is safe and the extent of the damage. Is it a total loss? A rebuild? Once a scope is defined, a price can be set. Cleaning companies and environmental engineers needed to be brought in to determine whether the smoke could be cleaned, what’s economical and what needs to be done to clean it to Canadian Food Inspection Agency (CFIA) standards?

Coverage issues There were also coverage issues on the file. Three separate companies were named under one policy: a landlord (owner) for the building, an operating tenant (the pork and meat plant) who had leasehold improvements and equipments and a smaller house on the property with another tenant. The tenant operating company was placed in receivership by the bank, to add insult to injury. “Receivership makes a huge difference because the receiver is looking to get huge money from the bank,” Daunt said. “They are going to be claiming for whatever they believe is their property and they are going to be arguing it’s not the landlord’s, it’s theirs.”

Both the tenant and the landlord claimed ownership of more than $2 million in leasehold improvement, plus additional claims for business interruption. The receiver went back through 10 years of financials for the www.claimscanada.ca

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operating company and the landlord finding the landlord had spent roughly $5,000 on leasehold improvements, whereas the operating company had spent several million. “The receiver claimed the operating company paid for this and as a result it’s the operating companies,” Daunt said. “The public adjuster argued [on behalf of the landlord] otherwise.”

Appraisal If the two parties could not agree, it would need to go to appraisal. Right

before appraisal some progress was made in terms of who owned what.

During appraisal, damages were agreed upon and the money was divvied up between the landlord and the tenant. In the end, $1.4 million was paid on the building for the mortgage clause; the landlord received $1.7 million, and the receiver was paid $1.6 million for leasehold improvements and an additional $500,000 for business interruption and payroll. 

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18/10/11 9:32 AM

Fraud and other Faux-pas

Identity theft, homemade trailers and small claims settlement take centre stage at educational seminar.

BY DAVID GAMBRILL

I

dentity theft of health care practitioners, taking advantage of an insurer’s desire to settle small claims quickly and theft of ATVs, “homemade” trailers and marine craft were all the subject of discussion at an ISB-U Education Series Event held in London, Ont. on July 26.

The seminar focused on industry efforts to identify auto insurance fraud trends, ‘red flags’ and successful efforts in combating auto insurance fraud.

Identity fraud and HCAI Representatives of the Insurance Bureau of Canada (IBC) and the Ontario Provincial Police (OPP) expressed concern at the conference that fraudsters are using identity theft to gain access to the province’s new electronic claims administration system, Health Claims for Auto Insurance (HCAI).

Ontario’s insurance regulator, the Financial Services Commission of Ontario (FSCO), requires that all of the province’s health care providers submit their OCF treatment plans to insurers through HCAI. As HCAI notes on its web site, the Ontario government commented in its 2011-12 budget that the province and its insurers could use HCAI as a tool for identifying potentially fraudulent claims activity in the system.

But HCAI itself may be the target of fraud, according to conference speakers representing IBC and the OPP. Kathy Metzger, an investigator for the Ontario injury rings unit of the IBC investigative services, said fraudsters have already tried to gain access to the HCAI system in order to submit fraudulent treatment plans. The key is obtaining a health care practitioner’s name and call-to-registration number.

Under the old regime, in which doctors submitted paper OCF treatment plans to insurers, the health care practitioner’s signature was required, Metzger said. “With HCAI, they don’t even need that signature anymore,” Metzger said. “Everything is done electronically. So the invoices, the treatment plans, the requests for assessments and the invoices are all submitted to the insurance companies electronically and all [fraudsters] need is a name and call-to-registration number.

And they can get that anywhere. They can get it from a report they happen to read, they can get it from a résumé that’s come into the clinic if someone has applied for a job.”

Metzger said a health care provider must sign a signature agreement in order to access the HCAI system. But she said evidence exists that fraudsters have attempted to forge doctors’ signatures in these agreements.

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“Last year alone, we interviewed over 40 health care practitioners who were victims of identity theft,” Metzger said. “Not all of them decided to pursue it, because they were afraid for their safety.”

Doctors can be victims of extortion in efforts to obtain their registration numbers, observed Sergeant Stephen Boyd of the OPP’s organized crime enforcement bureau.

“How else do I get a doctor’s registration number and license number?” Boyd asked. “I go to Club Supersexe in Montreal, call some doctors, and send the two prettiest girls from Quebec to the ugliest doctor in the bar. And he thinks, ‘Wow, this is . . . ’ Probably looks like a Casino Rama commercial, right? ‘How can I be so lucky?’ She prostitutes the doctor, making out in the hotel room, and then says to the doctor, ‘I want your registration number, your name, your clinic and everything from you. If you don’t, there’s a video that’s going to go on YouTube.’ What does the doctor do?

Lose the house in [Toronto’s] Rosedale [neighbourhood] and the BMW? He’s going to give them what they want. Extortion.”

Taking advantage: Settling small claims without investigation Insurance companies settling small claims (under $10,000) without any investigation may in fact be emboldening fraudsters to commit more serious forms of fraud in the future, a claims investigator warned.

Jordan Legg of Cunningham Lindsey spoke about the ongoing debate all insurers face related to the enormous cost and time required to prove fraudulent claims.

Legg said most vehicle claims are anywhere between $10,000 and $15,000. “Countless times,” he said, insurers are opting to pay out claims worth $10,000 or less rather than rack up the time and money required to undertake a thorough investigation.

“One of the biggest debates we have is the ethics and economics (debate),” Legg said. “The question always is, ‘How much do we pay before paying out?’ Is it more economical just to pay the $10,000 rather than incur investigation expenses?

“What we say is, what you pay now, you get later. Because criminals start at a low level, a couple of $10,000 thefts.

They realize they can get away with it, they see how easy it is to pull an insurance fraud and they start to do bigger things. Basically it’s just a snowball in the industry. People www.claimscanada.ca

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just continue to perpetrate these frauds, and then they get bigger and bigger, because insurance companies are paying out with no investigation.”

Legg recommended insurers proceed with a staged approach to claims investigations. He suggested insurers allow investigators to do some preliminary work on a file, say four to five hours, which is “not going to cost you a lot.” This initial investigation would at least determine whether or not there are any ‘red flag’ indicators of fraud.

“If there are any indicators, if there is any indication of discrepancies, you will be able to make that assessment at that time and proceed accordingly,” he said.

Emerging trends in fraud Car theft may be grabbing headlines these days, but frauds involving other types of vehicles have emerged recently on the radar screens of Ontario police.

These include insured ‘homemade’ trailers, watercraft and all-terrain vehicles (ATVs).

“Homemade trailers, this is probably the hottest thing going on right now in the province [of Ontario],” said Boyd.

“Do you know how many how many homemade trailers are registered in the province each year? We have had over 400,000 homemade trailers [registered] in Ontario over the last five years.

“All of these trailers are ‘homemade.’ Do they look homemade?”

Boyd’s rhetorical question accompanied a slide presentation of ‘homemade’ trailers, some of which were clearly commercially manufactured trailers. He noted people obtain licenses for the trailers, obtain insurance for them, report them stolen and then re-register for a new homemade trailer license.

“We’ve lost 11,000 already in our jurisdiction [in 2011],” Boyd noted, adding that up to $300,000 to $400,000 worth of other property can easily go missing along with the trailer. One trailer, for example, went missing along with an expensive watercraft.

Speaking of watercraft, marina chop shops are coming into vogue, Boyd observed. As in scams involving auto chop shops, boats are reported stolen, an insurance claim is made, and the ‘stolen’ boat is actually carted to a marina, where the boat is stripped for parts that are re-sold.

ATV thefts are also an emerging trend. “ATVs are the number one stolen [item] in OPP jurisdictions” across the province, Boyd said.

One group of thieves stole a number of ATVs, sold them, and then stole them from the buyers to whom they had just sold them. They proceeded to re-sell them a second time for $1,000 per ATV. “That was entrepreneurial,” Boyd said caustically.  David Gambrill is the editor of Canadian Underwriter magazine.

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Adjusters in the Field Workplace safety and the role of the adjuster

BY GREG MERRITHEW

Workplace safety is becoming a very hot topic nationally with occupational health and safety regulators. Safety legislation has been lawfully in force for many years. Recently, safety inspectors are becoming more proactive on enforcing the intent of the existing legislation found in most jurisdictions in Canada.

This increased enforcement of safety legislation affects the duties and responsibilities of the independent adjuster in a number of provincial and territorial jurisdictions. For the most part, but not exclusively, the types of claims that are affected by this issue are property losses. Although reportedly only experienced to date by independent adjusters, the insurance company staff adjuster is potentially exposed to this issue as well. Also, arguably, an in-house examiner who provides direction to the employees of service providers can have exposure to the regulations respecting work site safety. For the purpose of this article, we will only address the issue as to how this increased enforcement has affected independent adjusters to date.

In the normal course of a property claim, an independent adjuster is most often the first professional to give assistance to the building owner (Insured) affected by a claimable event, (fire/water escape etc). The building owner relies heavily on the advice and guidance of the independent adjuster in the investigation, mitigation and repair of the damage.

On initial attendance to a loss site, the independent adjuster may be required to make arrangements to retain employees of other employers, such as origin & cause experts, engineers, disaster restoration contractors, etc. When these other employees are engaged at the loss site, the regulatory authority might identify the independent adjuster as being the responsible party for work site safety. Safety inspectors in some jurisdictions have already deemed independent adjuster as the agent of the owner in charge of the site, and, therefore, responsible for site safety.

This view may be solidified by how courts have perceived the actions of the independent adjuster, triggering the “election to repair” provision of property policies. An election to repair can be found by conduct. The actions of the independent adjuster, acting under the authority of the insurers in negotiating prices and terms for labour and materials and in dealing directly with the contractor on payments, could 28 Claims Canada

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support a conclusion that there is a contract of repair. Accordingly, it is reasonable to believe regulatory authorities would follow the same logic of the courts. The logic being that the independent adjuster, if not the contracting authority is, at the very least, the controlling authority.

On a review of the legislation of some jurisdictions across Canada, enabling legislation has the following intentions:

Ontario The Occupational Health & Safety Act states a general contractor (GC) is responsible for on-site safety. The general contractor must file a Notice of Project with the Ministry of Labour. Also, the general contractor is responsible to ensure all workers on-site are registered with the Workplace Safety & Insurance Board. The general contractor is responsible for all individuals working on-site.

Safety officers have previously stated that independent adjuster’s are the contractor in the absence of an identifiable general contractor. Therefore, the independent adjuster is responsible for work site safety Prince Edward Island The defining word in P.E.I. safety legislation is “constructor.” The definition includes a person who “undertakes work on a project as an owner.” Obligations in the Act placed upon the constructor include ensuring that “every reasonable precaution is taken to protect the occupational health and safety of persons at or near a project.”

It is probable, if the issue was ever raised, the independent adjuster would be responsible for workplace safety as the owner’s agent in the absence of others specifically identified to undertake responsibility for site safety.

Manitoba Legislation in Manitoba is different than in other jurisdictions. There does not appear to be the same onus on-site safety on a preliminary review of Manitoba legislation. Independent adjuster’s contacted in Manitoba said this has not been raised as an issue by Safe Work inspectors in their province. Of interest, independent adjuster’s in Manitoba are excluded from Workers Compensation Board of Manitoba coverage.

Nova Scotia Nova Scotia legislation for workplace safety states on work sites someone must have ultimate responsibility for www.claimscanada.ca

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site safety. It appears to be left to regulatory authorities to deem who that person may be.

“Owner” in Nova Scotia includes “a person who acts for, or on behalf of, an owner as an agent or delegate.” This certainly could include an independent adjuster, from the regulator’s perspective, during an independent adjuster’s normal course of duties on a typical property loss.

Northwest Territories and Nunavut “Employer” includes owner, agent, principal contractor, subcontractor, manager or other authorized person having charge of an establishment in which one or more workers are engaged in work. If two or more employers have charge of an establishment, the principal contractor or, if there is no principal contractor, the owner of the establishment or their agent, shall coordinate the activities of the employers in the establishment to ensure the health and safety of persons in the establishment.

In the NWT, safety officers have already made it clear that when two or more employers have employees on a job site where an independent adjuster is providing the owner with guidance, instruction and making recommendations on the scope of work and payments, then, in the absence of a general contractor, the independent adjuster is deemed to be the “employer” having responsibility for safety.

British Columbia In B.C., the “prime contractor” on a work site is responsible for the safety of workers on that site. The legislation states, “Every employer must ensure the health and safety of all workers working for that employer, and any other workers present at a workplace at which that employer’s work is being carried out.” Work Safe officers in B.C. take the position that independent adjuster’s are ultimately responsible for the safety of every worker on the site in the absence of others being appointed, where the independent adjuster is adjusting a property loss.

B.C. regulators agree employers other than the independent adjuster can be identified as the prime contractor responsible for work site safety, but only when a written agreement is in place to confirm this obligation.

Recommendations Independent adjuster’s should ensure they address workplace safety as one of their initial priorities on attendance to a loss site. In the absence of any other employees on a site, it is still the obligation of the independent adjuster’s employer to ensure the safety of their own employees.

1. When outside experts such as origin & cause, engineers, disaster restoration technicians, quantity surveyors are retained, a site safety meeting should be placed on the agenda as one of the first matters to be dealt with by the independent adjuster.

• Site conditions, hazards and necessary safety equipment should be discussed. All employees traveling to remote sites should be forewarned of the need for safety equipment. This includes hard hats, eye protection, appropriate footwear and safety clothing, reflective vests and respiratory protection. www.claimscanada.ca

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• A site “tailgate” meeting should be conducted with on-site employees to ensure all safety issues are discussed. Minutes of the meeting should be kept and distributed to all on-site employees as soon as possible.

• Where necessary, site hazard warnings should be posted on a safety bulletin board at the entrance to the work site.

• Structural integrity of buildings should be assessed by a qualified engineer prior to entry when the structure has been compromised, especially due to fire.

• Where required, air quality tests should be undertaken if there is evidence of potential airborne hazards (asbestos, vapour borne contaminants, mould).

2. Once contractors have been retained to undertake repairs, the person responsible for site safety should be identified and a Certificate of Compliance should be drafted and signed by that individual. This person normally would be the general contractor’s site superintendent or his designate.

3. The requirement for site safety and compliance should be included within the scope of work prepared by the independent adjuster or the quantity surveyor.

4. Independent adjusting firms must ensure that employees of their firms are provided training in workplace safety as it relates to their duties. This includes, but is not limited to: • WHMIS; • ladder use; • fall arrest systems; • enclosed spaces; • asbestos contaminated work sites; • mould remediation; and • personal protection equipment

Conclusion Independent adjuster’s across Canada must ensure they are aware of the appropriate safety legislation in their jurisdiction and the obligations placed upon them for the safety of others. Regulators are prepared to take legal action against employers who fail to fulfill their responsibility under the laws of the jurisdiction in which they work. This can expose independent adjusting firms to fines and, in some cases, civil action in the event of an injury to an employee due to employer’s failure to fulfill their obligations under the safety laws in place.

Independent adjuster’s have for years entered unsafe work sites with minimal or no safety training, inadequate safety equipment as well as entering buildings with suspect atmospheres full of contaminants with little or no thought to the long term effects on their respiratory health. Independent adjuster’s have an obligation to promote on-site safety to other contracted employees in the course of claims adjusting. We should embrace work place safety and be proactive in providing site safety information to assist others in ensuring a work safe site.  Greg Merrithew is the managing director of Arctic West Adjusters Ltd. and the president of the Canadian Independent Adjusters’ Association.

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Containing the Quantum The other half of the property damage liability loss

BY JAMES GIFFEN

An examination of most industry training material on the adjusting of property damage claims under a casualty policy show an interesting pattern: The focus is almost exclusively on the negligence investigation. There tends to be scant mention on the investigation, assessment, quantification and scrutinization of the third party property damage component.

The industry has developed highly skilled adjusters capable of thoughtful and detailed negligence investigations and assessment of the liability apportionment.

Can the same be said on the property damage assessment side?

In an industry where claims professionals are more and more specialized in a particular area, less become proficient in both property and casualty.

Something might be lost in this technical narrowing.

If a thorough liability investigation allows for a reduction of 25 per cent exposure on a $100,000.00 or $1 million loss, and an equally detailed analysis and presentation of the damage component increasing the reduction by even 10 per cent, it will have a significant impact on the bottom line.

In conjunction with examining liability and policy coverage in the investigation, also consider focusing on the following:

Request access It is common for the liability adjuster to be granted access to the involved property, product or equipment for examination by their own cause and origin expert. Consider also engag30 Claims Canada

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ing and involving your own property experts for early and on-site examinations of damages to building, contents, equipment or stock. The involvement of such experts throughout the claim process can often result in valuable information on the other side’s weaknesses when it comes to settlement.

Betterment/ACV assessments When granted access to the damaged property, the liability adjuster and their property assessment experts should not only focus on the areas of damage, but examine and photograph all areas to be used in the actual cash value (ACV) analysis. This could reveal areas of substandard construction or bylaw upgrades, which may exacerbate the damage claim.

Often the first party property adjuster is not focusing on the age and condition of the damaged property, particularly with contents and equipment, as they are most often dealing with replacement cost policies. A more detailed examination by the liability adjuster can be a persuasive tool down the road.

Question costs and reasonableness The first party property adjuster will often settle the damages, taking a liberal view to the policyholder’s benefit as a paying customer. This can include such things as allowing an insured to have their own contrac-

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tor undertake emergency cleanup and drying work with little control on costs or documentation. It can also result in replacement being allowed where repair may have been suitable. A well documented casualty adjuster file will assist in negotiating reductions.

Request source documents Particularly on larger property losses involving both building, contents and stock losses there is an opportunity to request significantly more source documents than initially provided by the plaintiff or first party adjuster.

Don’t be afraid to ask for more.

What may be considered acceptable documentation to support a first party claim may not be adequate for the tort claim. Often the first party claim will rely on a “sampling” of supporting documents. This may not satisfy the third party adjuster who wants to dig deeper.

Business interruption/extra expense and time lines When dealing with a commercial third party, attempt to work with the first party adjuster in determining business interruption and extra expense exposures. This will include confirming first party coverage and adequate limits, as well as monitoring the length of a downtime and the financial impact to the business. Examine whether everything has been done from a first party perspective to mitigate a loss of revenue while ensurwww.claimscanada.ca

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Negotiate liability apportionment first Where possible, try and resolve the negligence aspect with the involved www.claimscanada.ca

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Ontario

PDS of Brampton/ Guelph 905-796-6100 PDS of Brantford/ Woodstock 519-751-1900

PDS of Chatham-Kent 519-352-7700 PDS of Cornwall 613-936-1818 PDS of Durham 905-666-7744 PDS of Etobicoke 416-626-7371 PDS of Halton/ Hamilton-Wentworth 905-333-9288 PDS of Huron-Perth 519-482-7371 PDS of Kingston 613-531-7962 PDS of KitchenerWaterloo Inc. 519-570-0438 PDS of Lanark 613-253-7500 PDS of London 519-685-9595 PDS of Mississauga 905-270-3399 PDS of Muskoka 705-645-5745 PDS of Niagara/ Haldimand 905-892-3456 PDS of North Bay & Nipissing 705-494-1000 PDS of Northumberland & PE County 613-475-3338 PDS of Orillia 705-325-8003 PDS of Ottawa 613-822-2734 PDS of Owen Sound 519-376-8022

negotiated first in a manner in which the other side finds reductions more significant than they had anticipated.

An increased focus on training, exposure and experience on the property damage side of a liability loss can lead to real reductions under casualty policies. The industry will benefit from a more versatile adjuster. 

James Giffen is a commercial/industrial adjuster and partner with the adjusting firm MGB Claims Consultants Inc.

PDS of Peterborough & Kawartha Lakes 705-799-7777 PDS of Renfrew County 613-732-2335 PDS of Sarnia/Lambton 519-336-2000 PDS of Sault Ste. Marie 705-949-9631 PDS of Simcoe County 705-458-8001 PDS of Sudbury Manitoulin 705-522-3312 PDS of Thunder Bay 807-344-7566 PDS of Timmins & the Claybelt 705-360-1124 PDS of Toronto 905-856-5737 PDS of Windsor & Essex County 519-776-4567 PDS of York Region 905-856-5737

British Columbia PDS of Greater Vancouver 604-501-9992

Alberta

PDS of Calgary 403-293-2200 PDS of Edmonton 780-454-4047 PDS of Red Deer 403-342-4666 PDS of Grande Prairie 780-538-3300

Saskatchewan

PDS of Saskatoon 306-374-7000

Manitoba

PDS of Winnipeg 204-586-1684

Québec

SPD de Lanaudiere 450-932-3597 SPD Laurentides 450-226-8484 SPD de Laval Inc. 450-434-5858 SPD de L’Outaouais 819-772-4040 SPD Mauricie 418-365-5786 SPD Montreal (Est) 514-644-9955 SPD de Quebec Nord-Est 418-653-6666 SDP du Sud-Ouest 450-829-3700 SPD de Vaudreuil Solange 450-510-5559

Maritimes

PDS of Cape Breton 902-567-3377 PDS of Cumberland/ Colchester 902-893-7260 PDS of Fredericton 506-457-9074 PDS of Halifax/ Dartmouth 902-481-0874 PDS of Moncton 506-382-8285 PDS of New Glasgow 902-695-3223 PDS of Northeast New Brunswick 506-826-3688 PDS of Northwest New Brunswick Tel: 506-473-4555 PDS of Saint John Tel: 506-633-1108 PDS of Eastern Newfoundland 709-747-2648 PDS of Western Newfoundland 709-686-0726

SPD de Brossard 450-659-3333

a

Examine market value/income approach on total losses In the event of total losses of commercial properties, construction ACV is often the most common approach to settlement between the first party and third party policies.

Particularly in the case of larger losses or more unique building circumstances, such as older properties or properties where the benefit of their location has significantly altered, the market value or income approach may reveal a value less than that calculated by a construction ACV evaluation.

There are numerous, well qualified real estate appraisers throughout the country capable of undertaking such an assessment at a reasonable cost.

PDS Canada Head Office

Experience the PDS difference

PDS_Network_Ad_Island_4.5x7.25_Sep2011.indd 1

pds .c

Spread it all out One of the most effective ways to be successful in negotiating reductions on the property damage is to be more thorough and organized than the other side. A properly compiled package outlining the damage assessment can go a long way in achieving your position.

One of the best tools is an Excel spreadsheet based on a thorough review of the damage documentation provided.

Such a review and organization of documents can often reveal flaws in the plaintiff’s claim, such as invoices, which predate the loss, included inadvertently, as well as giving rise to additional questions and inquiries of the plaintiff’s claim.

parties prior to the quantum.

It is not unusual to find the focus of settlement discussions revolve around the liability apportionment. If the casualty adjuster has done a thorough and detailed quantum analysis, they can find they are able to negotiate significant concessions with persuasive arguments from the other side. If the liability has already been agreed upon, then the other side does not have the ability to take, what could become, an otherwise rigid stand if the quantum is

Paul Davis Systems Network

ing that any extra expense paid is realizing an equal to, or better reduction in revenue loss.

Early scene examinations will also determine whether there is potentially obsolete stock or equipment, which was affected and may be considered under the first party policy. However, its exclusion may be raised under the casualty policy.

Consider the early involvement of a forensic accounting firm to assist in the monitoring and examination of the anticipated time element and extra expense claim.

24-HOUR NATIONAL RESPONSE CENTRE

October/November 2011

800-661-5975

11-09-14 11:18 AM

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18/10/11 9:41 AM

Green Energy

An Emerging Insurance Issue

BY ALLISON KLYMYSHYN

In today’s rapidly changing world, it is critical that insurance professionals stay abreast of new developments and remain prepared to respond when issues arise. One such issue is green energy: What type of claims can arise because of renewable energy installations? What implications are there on coverage under typical forms of insurance policies?

Through the Ontario Power Authority Feed-in Tariff (FIT) program, large renewable energy producers offer guaranteed prices for long-term contracts.1 Under the smaller microFIT program, homeowners, farmers and small business owners have the opportunity to develop renewable energy projects that are 10 kW or less in size. Pursuant to government-guaranteed contracts, the microFIT participants receive payments for the energy their project produces for 20 years.

Anticipated coverage issues There are many coverage questions which could arise as a result of lawsuits brought against renewable energy producers. The legal decisions suggest policyholders may be seeking insurance funded legal defenses, as well as coverage, for their own claims.

Many insurers have responded to the microFIT program by offering a floater or rider to an existing homeowner policy. It extends the liability and property coverage of the main policy to the equipment used in an approved program.

Those who have not purchased a floater for their policy may find they do not have adequate coverage.

Business exclusion The Ontario microFIT program permits homeowners to become part of the provincial energy grid. Homeowners who use their roofs for installation of solar panels sell the resulting energy to the province. These homeowners will make insurance claims when damage is sustained to the panels or their homes. The intent of the program is to provide a steady income stream to the homeowner.

Is this resulting income stream business income? Losses related to a business are typically excluded under the homeowner policy. For the most part, as long as a venture is undertaken for financial gain, provides regular remuneration and is required to be reported as taxable income, that venture is a business. Therefore, any loss to or arising from the solar panels may be excluded under the homeowner’s policy because it relates to a business.

Injunctive relief One early reported court decisions relating to renewable energy involved wind energy in New Jersey. Rose v. Chaikin.2 32 Claims Canada

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October/November 2011

The 1982 decision was based on allegations by residents that a neighbouring windmill created excessive noise, was a public nuisance and caused nervousness, dizziness, loss of sleep and fatigue. The court found the windmill violated noise ordinances and constituted an actionable nuisance. Accordingly, it was held the property owners were entitled to an injunction prohibiting operation of the windmill.

Claims for purely injunctive relief are not covered under a CGL policy. Many court actions will seek injunctions to halt the construction of renewable energy facilities. Unless the parties constructing the energy facilities are properly insured they will not be entitled to a defense/indemnity under CGL policies with respect to defending the claims for injunctions.

Economic loss CGL policies do not respond to claims for pure economic loss. While economic losses, such as loss of income, are not subject to significant challenge, claims of diminished property value are the subject of frequent litigation and are normally denied by insurers on the basis that they constitute pure economic loss. The key issue in the diminished value claims is whether there has been physical injury or loss of use to the property. If there has been no physical or tangible injury, neither a defense nor indemnity will be owed by the insurer.

The renewable energy case law reviewed contains allegations relating to diminished property values. The diminished value arises from the changed landscape, and noise and light pollution. It is unlikely that as the law stands, these claims would be covered under a typical CGL policy.

Nuisance Nuisance is focused on the effects of the activities of property owners on their neighbours. Nuisance is defined as “unreasonable and substantial interference with another’s reasonable use and enjoyment of his or her property.” In the context of renewable energy installations, claimants/neighbours are concerned with the aesthetics of their property, as well as noise and unnatural light patterns from the movement of wind turbines.

With respect to duty to defend and indemnity for a nuisance lawsuit, the definition of personal injury should be reviewed. Some definitions of personal injury include the torts of nuisance and trespass. One of the offenses listed within the definition of personal injury in a CGL policy is “wrongful entry into, or eviction of a person from, a room, dwelling or premises that the person occupies.” Some CGL policies also include the second phrase “or other invasion of the right of private occupancy.” It is this second phrase in www.claimscanada.ca

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the coverage definition that could give rise to coverage for nuisance claims.

A Texas decision considered the construction/operation of a wind farm.4 The applicants’ claims were founded in nuisance and relied upon the negative visual impact the wind farm would have on the applicants’ property. The court noted that successful nuisance actions typically involve an invasion of the neighbours’ property by “light, sound, odor, or foreign substance.” An example given was that of noisy air-conditioners which interfered with conversation in a neighbouring backyard. The air-conditioners were held to constitute a nuisance. The applicant argued aesthetics may be considered as one of the conditions that create a nuisance.

They contended the jury was entitled to consider the wind farm’s visual impact together with other conditions such as “the turbines’ blinking lights, the shadow flicker effect they created early in the morning and late at night, and their operational annoyances.” The applicants argued that nuisance law is dynamic, fact specific, evolving and should not be blindly followed without considering societal changes.

Despite the applicants’ persuasive arguments, the court ruled aesthetic impact was not to be considered in deciding whether the wind farm constituted a nuisance. The court noted conflicting interests are balanced by limiting nuisance actions to circumstances in which the activity resulted in some invasion of the neighbour’s property and not I HIRE JOB DONE horiz 2 5/11/09 1:41 PM Page 1 emotional reaction alone. It is anticipated Canadian plain-

tiffs will be creative in how they craft their objections to wind farms, when much of that objection will be related to the appearance of the turbines.

Whether the owners of the windmill in the Rose v. Chaikin case above, or the company erecting the wind farm in the Texas decision would have been entitled to an insurance funded defense as a result of the claims of nuisance is questionable. The courts have held that for a claim arising out of interference with private occupancy to be covered under a CGL policy, there must be physical interference with an interest in real property. Mere interference with a legal right is not sufficient.5 It is a well understood principle that there is no legal right to an unobstructed view. It will be necessary to consider coverage cases alleging nuisance from renewable energy installations individually on their facts.

Conclusion As additional wind farms, solar installations and other forms of renewable energy are constructed, increasing claims and lawsuits are likely. For insurers, the claims will raise questions about whether the allegations fall within the terms of the standard policy. It is anticipated that this will be an evolving area of law for some time.  Allison Klymyshyn is a senior associate with Kelly Santini LLP. Kelly Santini is a member group of the Risk Management Counsel of Canada.

Get the job.

Done.

TM

FOUND MY JOB AT

www.claimscanada.ca

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Red Flags

BY DEBBRA MACDONALD AND THE BOARD OF DIRECTORS OF CASIU

Each insurer has its individual threshold that provides the reason to hire an investigator. Inconsistencies, red flags and missing pieces of the puzzle are recorded and outlined on each suspicious file. When there are unanswered questions, red flags arise. Making reference to these factors when assigning a file to an investigator means the file has been assigned with careful consideration and in the least invasive way possible.

Adjusters recognize red flags based on the inconsistencies in a particular file. These red flags enable the adjuster to instruct the investigator to direct attention to problem areas for background checks or surveillance. The resulting investigation becomes an invaluable tool to determining accuracy of information and activities because it is done without the claimant’s awareness, meaning the evidence has been collected in a natural state.

To effectively and efficiently complete an investigation, it is important for the adjuster to ensure the information provided to the investigator has been confirmed as accurate. Such accuracy can save thousands of dollars when it comes to surveillance.

Preliminary background searches can confirm starting information, can assist in the direction of surveillance and lead to other areas of investigation that will assist in successfully settling a claim.

It is a sign of the times that growing numbers of adjusters carry large case loads. So assigning files to an investigator can appear to be tedious work for an adjuster. It is important to realize there are many options to identify34 Claims Canada

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ing the focus of investigative requirements. Moreover, the adjuster must be aware an assignment can be completed much more successfully if the investigator is provided with as much information as possible about the claim. A postal code when reversed may lead to a different address than provided; small details may provide great insight. Even if the file is inundated with paperwork, the investigator, for his part, should review it and become very familiar with the claim.

A recent trend of a trail of little white lies that hide the claimant’s address and personal information can lead to uneventful investigations. This trend has come and gone over the years, and has great influence where surveillance is concerned. Preliminary background inquiries should be utilized as the starting point. When the insurance adjuster has determined the red flags and purpose of the investigation, the resulting background inquiries can identify and confirm the claimant’s address, employment and activities in order to conduct surveillance in its natural form.

The Internet has provided new leads that were not available to the gumshoes of yore. There is a wealth of public information that can be obtained through research and background.

Public documents are still available, as long as they are accessed through proper channels. The flow of online documents has provided investigators with great avenues to search, unlike the old city directories at libraries. A preliminary background investigation can provide leads for surveillance, social media including photos, activities and relationships. This ensures a higher level of successful investigation in a cost effective manner.

October/November 2011

Insurance claims consist of an abundance of forms and invoices from service providers that can be overwhelming at times. Background investigation has become a valuable and cost effective tool that can provide great insight into the legitimacy of clinics, employers and transportation carriers. In recent months, a number of new medical specialties, including allergy testing, have provided invoices to insurers. Such specialty clinics are emerging and evolving every month.

With each development, we must find a way to verify, validate or reject new invoice types.

Due diligence has come to the fore in the matter of evaluating new invoice types. Relationships between representatives, clinics and transportation providers may link to auto repair shops, tow truck drivers and companies connected to a fraudulent ring.

A simple due diligence investigation on such services can provide adjusters with the evidence and insight needed to validate or dismiss the invoices at hand.

With the ever-growing number of injury claims, despite fewer accidents being reported in Ontario, investigations have become necessary to deter and fight fraud in the insurance industry. Through identifying the red flags and carrying out effective investigations, the industry can send a clear message to those who breach insurance contracts and make false claims.  The Canadian Association of Special Investigation Units (CASIU) is a low-profile association whose members come from the claims side of the P&C industry.

www.claimscanada.ca

18/10/11 9:45 AM

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12/01/11 12:02 PM

Travel Risk Management Enhancing staff safety and organizational success

BY MARK LALONDE

As part of risk mitigation, travel risk management has become a popular topic in the past few years. The approach to identifying and managing risk for many is limited to checking the Government of Canada travel advisory web site and keeping hotel room doors locked, cash and credit cards tucked away and ensuring there is Imodium in the toiletry kit. Some companies assume the client in the destination country will be provided a full bubble of protection on arrival. Risks associated with travel, and employers duty to protect are much more complex than this.

As a risk manager, if staff within your organization travel regionally, nationally or internationally, take a moment and consider the following: • After leaving a late afternoon meeting, a manager is driving through far northern Ontario to another town for a meeting the next day. It is January; there is no mobile phone coverage in the area. The car hits ice, skids off the road and down an embankment. The car is out of sight of the road and the driver is knocked unconscious. How long will it be before the manager is missed and a search is initiated? Will anyone know what route to search?

• A fabric buyer is sent to a South East Asian country to source local suppliers. While in a rural area, the buyer encounters large crowds celebrating an important national anniversary that often results in significant street disturbances. Was this anniversary known prior to the trip? If so, what personal safety measures were put in place prior to leaving Canada?

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• An engineer is sent on a three-week assignment in the Ukraine. Sunday morning, while crossing a local street he/she is struck by a car and severely injured. Unconscious, an ambulance takes your employee to a local hospital. Does the engineer have a bilingual wallet card listing emergency contacts, medical history and drug allergies? If he/she does have such a card, who will authorities contact when it is Saturday late night at your office? What will be your response plan?

There are many risks associated with travel, both in and out of Canada. Weather, traffic, political unrest, disease and food-borne illness are but a few. Threats may arise based on the location, the nature of the trip, the business of the company or the profile of the traveler. Overly confident travelers pose risks, just as naïve travelers might. Personal characteristics of the traveller may mitigate or attract risk in specific locales and circumstances.

Duty to protect Employers have a duty to protect workers no matter where they are. This is typically accomplished through policy, procedure and training.

Part of a comprehensive corporate approach to travel risk management includes: • Identifying a line in the sand. In what circumstances will travel be prohibited?

• Basing travel decisions on a thorough assessment of threats and the resultant risks to both the corporation and the traveler.

• Categorizing levels of procedural response pre-trip, durwww.claimscanada.ca

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ing the trip and post-trip based.

• Building corporate response capacity – including out of hours incident response.

• Desktop testing of policy, procedures and response capacity.

Technology now offers multiple avenues for monitoring travelers in real time including ways for travelers to periodically check in and stay in contact with the office regardless of where they are. Data sources abound for researching local threats to travelers.

• upcoming events of significance (election, politically charged anniversary, protest); • history of foreigners/tourists or western interests being targeted; • road safety; • environmental concerns; • public health concerns; and • specific activities and locale planned for visit.

As one example, based on an examination of the above points for a specific location, it may be determined that in a five-point scale, the destination is a level three country.

Challenges to consider Based on this, policy and procedure may require the traveler Challenges to effective travel risk management include to check in daily by phone, text or e-mail, stay in approved corporate capacity to monitor and respond to traveler needs secure accommodations, not go out after dark alone and and events. Identifying threats, and appropriate mitigation only use approved drivers. The traveler is provided local, strategies in advance can also be a challenge. All too often, pre-vetted emergency points of a contact, as well as a depre-trip planning is restricted to checking a government tailed safety briefing specific to the location prior to departravel advisory web site and possibly seeing a travel doctor if ture. A personal safety plan is created and tested. it is an overseas trip. In such cases, a wealth of opportunities Prior to departure to a level three country, detailed reto identify and address risk is missed. search is done to identify such things Overseas travel presents many of the as important upcoming dates (i.e. ansame risks as travel within Canada. Street niversary of national tragedy, uprising crime, natural disaster, fire and traffic acor religious festival), how to recognize a cidents can impact travelers regardless of legitimate taxi outside the airport or howhere they are. It is incumbent upon mantel, areas to avoid in the destination city, agers to look beyond these more obvious numbers used to call emergency service risks and identify local, specific threats and providers (police, fire, ambulance), the their relative likelihood of occurrence.

Technology now offers contact details for a locally available phyIn testing online data sources for travel multiple avenues for sician trained to an international stanrisk, an interesting starting point is to see dard, and how to make both local and inmonitoring travelers ternational calls using a locally purchased what others say about Canada. One Commonwealth country advises its citizens in real time including mobile phone SIM card. planning a trip to Canada to beware of During the trip to the level three counways for travelers to the possibility of random terrorist attacks. try, 24 hours a day, 7 days a week remote periodically check in monitoring/emergency call centre servicOthers point to flooding, forest fire and earthquake dangers in specific parts of es are offered, complete with plans that and stay in contact Canada. While all are true, they provide an are flexible enough to address events such with the office interesting perspective on the depth and as a medical emergency, natural disaster, utility of government travel advisories. regardless of where local/regional instability or the arrest/detention of the traveler. they are.

Five point scale Post-trip, the ideal is for some form One approach to travel risk manageof debriefing including assessment of ment provides a five point scale for ranking country risk strengths and weaknesses of the plan and resources in the (low to extreme) and a graduated approach to risk manage- face of the reality of the trip and application within policy ment commensurate with identified risks. The score could and procedure of lessons learned. be based on an examination of the following threat indiFor some, travel risk management goes further. There cators (allowing for variations of a score within parts of a are concerns over brand management and reputation procountry): tection, safeguarding of intellectual property and physical • Capacity of local institutions, such as police, health, pub- assets. All require mitigation measures unique to the deslic transport; tination, nature of the threat, purpose and form of the trip.

• aspects and strength of rule of law, including government A robust, holistic approach to travel risk management and state institution transparency, corruption; is not only an employer’s duty, it can save money, enhance • government stability; business continuity and in some cases – save lives.  • presence/recent history of terrorism (includes freedom fighters, liberation groups, politically motivated entities); Mark LaLonde is a senior manager with Canpro King Reed • crime (street, organized, targeted); Global. He travels and works extensively in challenging envi• public safety issues such as prevalence/access to firearms; ronments helping companies enhance human safety and se• recent history of civil unrest; curity. www.claimscanada.ca

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EF

• education forum

A SERIES OF ARTICLES PROVIDED BY THE INSURANCE INSTITUTE OF CANADA

Managing Injury: Conceptual Models that Guide Practice

D

isability management is the overall process of preventing or minimizing the impact of impairment on a person’s ability to work or function. In this article, we look at conceptual models that influence disability management and service delivery.

A person who has been injured in an accident may require a range of medical and rehabilitation services and supplies to facilitate their recovery and minimize disability – for example, prescriptions, assistive devices, home or vehicle modifications, chiropractic treatment, psychological treatment or counselling, vocational counselling, training, workplace modifications and so on.

A medical healthcare provider will provide a diagnosis, recommend and provide treatment, and provide information on the person’s medical restrictions. An occupational therapist may be involved in assessing the person’s functional ability and arranging assistive devices; and a psychologist may be brought in to provide counselling or psychological testing connected with vocational rehabilitation. Depending on the circumstances, other service providers may also be called upon, such as ergonomists, physiotherapists, kinesiologists, employment counselors or labour market analysts.

To coordinate the supply of and payment for the various services, a case manager may be recommended.

Disability management models The overall process of minimizing the impact of an impairment on a person’s ability to function is known as disability management. There are a number of models that guide professional practice in disability management, but the three main ones are the 38 Claims Canada

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medical model, the environmental/social model, and the functional model.

It is generally accepted that a combination of these three approaches is needed to address disability effectively.

In the medical model, the focus is on how the illness or disability resulting from a physical condition may reduce a person’s quality of life and cause them a clear disadvantage. Impairment is measured objectively based on clear medical criteria, and the goal is to identify the disability from an in-depth clinical perspective and invest resources in improving function.

Although determinations made under this model tend to be defensible because of the objective and measurable criteria used, the model takes no account of the person’s ability to actively influence his or her own rehabilitation, or of the potential impact of the person’s environment on his or her recovery.

In the environmental/social model, practitioners see a person with a disability, not a disabled person. This model takes account of the positive and negative impacts of a person’s environment on their disability. Factors that may be considered include access to services and support networks, access to suitable transportation, and barriers such as inaccessible buildings. These sorts of factors are considered for their potential impact (positive or negative) on the person’s rehabilitation.

Although this model takes a more comprehensive view of the factors that can affect rehabilitation, its emphasis on numerous and changing environmental factors can lead to uncertainty as rehabilitation goals become moving targets. In addition, the injured person may see the environmental factors as beyond their control, and may play a

October/November 2011

reduced role in their own rehabilitation as a result.

In the functional model, disability is viewed in relation to the person’s life roles: it arises from a mismatch between the person’s biological condition and functional capacities on the one hand, and his or her environmental and situational factors on the other. For instance, an inability to walk would affect an athlete differently than it would a clerk.

With its focus on the individual’s ability to work or to perform the activities of daily living, this model tends to emphasize treatment through services and supports aimed at making the person as functional as possible. This involves compensation rather than cure: The aim is for the individual to adapt and fit within the system, not for the system to accommodate the individual.

In its focus on the individual’s ability to function in his or her work and life circumstances, the functional model provides a tailored approach. Efforts can be focused upon those interventions with the greatest potential impact upon that particular individual’s actual functioning in daily life.

However, there is a tendency to focus on functioning that is directly rel-

Cost Containment Whatever the disability management model involved in a claim, basic cost containment strategies include • avoiding duplication of services • ensuring the appropriate distribution of services by lining up the right professionals • arranging early intervention, before a claimant’s situation deteriorates further • conducting cost-benefit analyses

www.claimscanada.ca

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evant to earning capacity – performing essential job tasks, activities that permit the person to get to work, etc. But not all factors influencing rehabilitation are economic in nature. Psychosocial barriers, for example, can significantly impact rehabilitation outcomes.

Service delivery models Just as conceptual models influence overall disability management, there are also models that influence how treatment and recovery services are delivered.

In the traditional model of service delivery, the treating physician leads the way in rehabilitation planning. As with the medical model of disability, this approach emphasizes objective medical diagnosis and tends to ignore environmental, functional and other factors.

Active rehabilitation may be delayed in favour of waiting for a “full recovery.”

The job-matching model involves comparing an individual’s measured functional abilities with a job demands analysis to determine if there is a match. Measurable values are assigned to occupational factors such as required aptitudes, skills, educational requirements, physical requirements and tolerances, etc. A match can signal a viable option, whereas a mismatch can flag a poor choice or potential barrier.

However, this approach can lead to cookie-cutter solutions that are not individualized to the person. People and disabilities vary, and there is no onesize-fits-all solution.

Under the managed-care model, the client’s diagnosis is referenced against expected durations and other guidelines gleaned from medical research and insurance statistics. Reasonable estimates can be made about expectations for injury and disability, making time and cost projections possible. If a claimant’s disability experience significantly diverges from expectations, that may indicate that another factor, previously unaccounted for, is at play and impacting recovery.

On the other hand, individuals and therefore their disability experience can be unique. When the experience and duration of a claimant’s disability differs from what was expected, his or her case should be examined on its individual merits to determine next steps.

In the direct case management model, key stakeholders such as the employee and employer work together www.claimscanada.ca

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in the rehabilitation process, such as by developing a return-to-work plan.

This multidisciplinary, multi-stakeholder model respects the privacy of the individual and the expertise of each stakeholder. It has a greater likelihood of resulting in a comprehensive rehabilitation plan that foresees and mitigates barriers from multiple perspectives. The case management approach ensures that the plan remains targeted and goal-focused.

This approach requires active case management, a role that is all too often left to a stakeholder who already holds

another key role in the process or who may not necessarily be qualified to assume this responsibility. For the model to work, the role of each stakeholder must be clear to all parties, especially the injured individual.  This article is based on excerpts from the study material in the Understanding Serious Injury: Adjuster Training and Education program – a new program launching in November, developed by the Insurance Institute of Ontario in partnership with the Ontario Insurance Adjusters Association.

THIS IS MORE THAN A HURRICANE. To business owners who have tirelessly committed themselves, it’s the loss of their dream and livelihood. To insurance professionals, it’s the challenge to fairly and accurately quantify what their loss is worth. When disasters strike, trust the firm that provides an expert, objective opinion and quality resources. BDO. More than you think.

Business Interruption | IRB Calculations | Personal Injury Claims Forensic Investigations | Inventory Losses | Fidelity & Surety Bonds VANCOUVER | CALGARY | EDMONTON | WINNIPEG TORONTO | MONTREAL | HALIFAX ASSURANCE | ACCOUNTING | TAXATION | ADVISORY SERVICES Greg Hocking ghocking@bdo.ca 416 775 7800

Jeffrey C. Smith jsmith@bdo.ca 416 775 7801

www.bdo.ca/advisory

BDO Canada LLP, a Canadian limited liability partnership, is a member of BDO International Limited, a UK company limited by guarantee, and forms part of the international BDO network of independent member firms. BDO is the brand name for the BDO network and for each of the BDO Member Firms.

October/November 2011

Claims Canada 39

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• on the scene OTS FirstOnSite has expanded its Ontario management team with three new appointments. Steve Gregg is now district manager of the GTA. In this role, he will oversee the operations and service delivery of several FirstOnSite locations across Southern Ontario. Jim Mandeville is now branch manager of Toronto East. Mandeville will draw on his eight years of experience in the construction and restoration industry to lead this location. Len Perdic has accepted the title of project manager in Hamilton. Perdic has established trusted relationships with the insurance industry in Hamilton and the surrounding area and will continue to respect those relationships and foster new ones in his new role, the company says in a release. l

Steve Gregg

Jim Mandeville

Len Perdic

On behalf of the Canadian Independent Adjusters’ Association New Brunswick/Prince Edward Island, regional president, Luc Aucoin presented CIAA national with a $10,000 donation at the Association’s Annual General Meeting in August. National treasurer, Randy LaBrash, national executive members and the CIAA membership as a whole, express a heartfelt thank you to the region for their extremely generous contribution.

Sincere congratulations are extended to CIAA NB/ PEI’s regional executive for their tremendous dedication and commitment in coordinating the province’s Emergency Measures Organization work for the benefit of the CIAA membership.

“CIAA members across the country certainly appreciated CIAA New Brunswick’s “Call for Adjusters” last year and took advantage of the opportunity to assist,” Pat Battle said in a letter to the region’s president, Luc Aucoin.

“Your region does an exemplary job in also providing valuable education and networking opportunities to the benefit of all your members and we are grateful for the support, cooperation and courtesies extended by the NB/PEI Region’s members over the years.” l

Claims Canada Wants You!

Claims Canada magazine wants you to send us your company news, appointments and event photos for possible inclusion within our ‘On the Scene’ department.

Please help us share your items with the claims industry across the country. For more information, please email: laura@claimscanada.ca

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Granite Global Solutions and Rochon Engineering announced the renewal of a long-term contract with Mike Rochon and Vince Rochon, founders and co-CEOs of Rochon, to continue to lead the division.

Rochon Engineering announced on Sept. 13 that Mike and Vince Rochon would be stepping down from the position in October 2011. Since then, they have decided to stay on and lead the division.

“We are delighted that Mike and Vince Rochon have committed enthusiastically to a long-term agreement to lead this expert team of forensic engineers well into the future,” said Murray Wallace, CEO of Granite Global.

“We have had excellent discussions about the exciting and promising future for Rochon Engineering as part of Canada’s fastest growing network of risk management and insurance services at Granite Global.” l

October/November 2011

Brad Meekin

FirstOnSite Restoration has appointed Brad Meekin to head up its new healthcare and government services business unit.

Through FirstOnSite’s Priority Response Emergency Plan (PREP) program, Meekin will assist organizations in the healthcare and government sectors - including hospitals, retirement residences, long-term care and medical facilities - with business continuity and emergency response planning. l

McLarens Canada has been renamed Granite Claims Solutions.

McLarens Canada began 35 years ago in Toronto as Ponton Coleshill Insurance Adjusters. Since then, the company has grown to over 500 employees and provides claims services across Canada from almost 50 branch offices.

“Our new name provides an opportunity to position ourselves as Canada’s leading independent adjusting firm,” says Granite Claims Solutions president Michael Holden.

“While our re-branding reflects a change for us, we remain dedicated to being the same great company that was founded 35 years ago. As we continue to grow and evolve the one thing that remains constant is our commitment to our clients.”

The organization has also teamed up with international adjusting alliance VRS Adjusters, which enables Granite Claims Solutions to service its clients internationally.

Since 1976, Granite Claims Solutions has provided claims handling, risk management and third-party administration services to local, national and international insurance markets, risk managers, brokers and public entities.

Headquartered in Toronto, Ont., Granite offers a national presence to the domestic property and casualty insurance industry. It has more than 300 specialty claims adjusters, marine surveyors and third party administrators coast to coast in Canada. l

www.claimscanada.ca

18/10/11 9:55 AM

National Standing Committees 2011-2012 ADVISORY Delores Thorbourne, BA, FCIP Granite Claims Solutions Suite 103 Greystone VII 4208 - 97 Street Edmonton, AB T6E 5Z9 Phone: (780) 442-3077 Fax: (780) 466-0325 E-mail: delores.thorbourne@graniteclaims.com John D. Seyler, AIIC ProFormance Group 2 Robert Speck Parkway, Suite 700 Mississauga, ON L4Z 1H8 Phone: (905) 270-1723 Fax: (905) 272-7486 E-mail: jseyler@prospecialty.ca Mary Charman, CIP Crawford & Company (Canada) Inc. 1 – 120 Mulock Drive Newmarket, ON L3Y 7C5 Phone: (905) 898-0008 Fax: (905) 898-1705 E-mail: Mary.Charman@crawco.ca James B. Eso, BA, CIP Crawford & Company (Canada) Inc. 539 Riverbend Drive Kitchener, ON N2K 3S3 Phone: (519) 578-5540 Fax: (519) 578-2868 E-mail: Jim.Eso@crawco.ca John Jones, BA Granite Claims Solutions Suite 300, 5915 Airport Road Mississauga, ON L4V 1T1 Phone: (905) 671-3164 Fax: (905) 671-1889 E-mail: john.jones@graniteclaims.com David Porter, LL.B., FCIP, CRM Advance Claims Service Ltd. 206 - 2323 Boundary Road Vancouver, BC V5M 4V8 Phone: (604) 642-0660 Fax: 1-888-452-5246 E-mail: davidp@advanceclaims.com CAREER RECRUITMENT PLANNING Richard Swierczynski, BA, CIP AZ Claims Services Inc. 1500 Upper Middle Rd., Unit #3 P.O. Box 76041 Oakville, ON L6M 3G3 Phone: (905) 825-0027 Fax: (905) 825-5543 E-mail: Richard@azclaims.ca COMMUNICATIONS Teresa Mitchell, FCIP, CRM, FCLA, FCIAA, FIFAA Crawford & Company (Canada) Inc. 14 – 431 Bayview Drive Barrie, ON L4N 8Y2 Phone: (705) 728-5597 Fax: (705) 728-2167 E-mail: Teresa.Mitchell@crawco.ca CONSTITUTION & RULES John Jones, BA Granite Claims Solutions Suite 300, 5915 Airport Road Mississauga, ON L4V 1T1 Phone: (905) 671-3164 Fax: (905) 671-1889 E-mail: john.jones@graniteclaims.com CONVENTION Karen Kuronen, CIP, Dip. Mech. Eng. Arctic West Adjusters Ltd. 401 – 5204 – 50 Ave. Yellowknife, NT X1A 1E2 Phone: (867) 920-2212 Fax: (867) 873-2244 E-mail: kkuronen@arcticwest.ca

www.claimscanada.ca

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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

MEMBERSHIP & QUALIFICATIONS Santo Carbone, CRM, FCIAA Crawford & Company (Canada) Inc. 300-123 Front Street West Toronto, ON M5J 2M2 Phone: (416) 364-6341 Fax: (416) 435-0546 E-mail: Santo.Carbone@crawco.ca

DISCIPLINE Mary Charman, CIP Crawford & Company (Canada) Inc. 1 – 120 Mulock Drive Newmarket, ON L3Y 7C5 Phone: (905) 898-0008 Fax: (905) 898-1705 E-mail: Mary.Charman@crawco.ca

NOMINATING Mary Charman, CIP Crawford & Company (Canada) Inc. 1 – 120 Mulock Drive Newmarket, ON L3Y 7C5 Phone: (905) 898-0008 Fax: (905) 898-1705 E-mail: Mary.Charman@crawco.ca

EDITORIAL Fred Silvestri, BA, CIP Sedgwick CMS Canada Inc. 6725 Airport Road, Suite 300 Mississauga, ON L4V 1V2 Phone: (905) 293-7715 Fax: (877) 863-5678 E-mail: fred.silvestri@sedgwickcms.ca

Greg G. Merrithew, CIP, FIFAA Arctic West Adjusters Ltd. 401 – 5204 – 50 Ave. Yellowknife, NT X1A 1E2 Phone: (867) 920-2212 Fax: (867) 873-2244 E-mail: gregm@arcticwest.ca

EDUCATION David Porter, LL.B., FCIP, CRM Advance Claims Service Ltd. 206 - 2323 Boundary Road Vancouver, BC V5M 4V8 Phone: (604) 642-0660 Fax: 1-888-452-5246 E-mail: davidp@advanceclaims.com EMERGENCY MEASURES Richard Van Horne Action Investigations Inc. 2 Catelina Court Dartmouth, NS B2X 3G9 Phone: (902) 462- 1222 Fax: (902) 462-3688 E-mail: richardvanhorne@actioninvestigations.ca FINANCE Randy P. LaBrash, CIP, CFE, CFEI Crawford & Company (Canada) Inc. 300 – 191 Lombard Avenue Winnipeg, MB R3B 0X1 Phone: (204) 947-2340 Fax: (204) 943-9168 E-mail: Randy.Labrash@crawco.ca Greg G. Merrithew, CIP, FIFAA Arctic West Adjusters Ltd. 401 – 5204 – 50 Ave. Yellowknife, NT X1A 1E2 Phone: (867) 920-2212 Fax: (867) 873-2244 E-mail: gregm@arcticwest.ca Mary Charman, CIP Crawford & Company (Canada) Inc. 1 – 120 Mulock Drive Newmarket, ON L3Y 7C5 Phone: (905) 898-0008 Fax: (905) 898-1705 E-mail: Mary.Charman@crawco.ca IBC: LIAISON, LEGISLATIVE & FORMS Paul Hancock, B.Sc., CIP Crawford & Company (Canada) Inc. 300 – 123 Front Street West Toronto, ON M5J 2M2 Phone: (416) 867-1188 Fax: (416) 867-1925 E-mail: Paul.Hancock@crawco.ca LICENSING J. Miles O. Barber, B.Comm. (Hons.), FCIP, CRM Network Adjusters Ltd. 67 Folkestone Blvd.

Winnipeg, MB R3P 0B4 Phone: (204) 897-5793 Fax: (204) 897-5797 E-mail: mbarber@mts.net

CIAA REGIONAL PRESIDENTS 2011 – 2012 NEWFOUNDLAND & LABRADOR Marcel Pitcher, CIP, CRM Crawford & Company (Canada) Inc. 300 – 44 Torbay Road St. John’s, NL AlA 2G4 Phone: (709) 753-6351 Fax: (709) 753-6129 E-mail: Marcel.Pitcher@crawco.ca NOVA SCOTIA E. Grant King, BA, B.Ed., CIP Crawford & Company (Canada) Inc. 120 – 237 Brownlow Avenue Dartmouth, NS B3B 2C7 Phone: (902) 468-7787 Fax: (902) 468-5822 E-mail: Grant.King@crawco.ca NEW BRUNSWICK & PRINCE EDWARD ISLAND Luc Aucoin, BBA, FCIP Plant Hope Adjusters Ltd. 85 Englehart Street Dieppe, NB E1A 8K2 Phone: (506) 853-8500 Fax: (506) 853-8501 E-mail: laucoin@planthope.com

James B. Eso, BA, CIP Crawford & Company (Canada) Inc. 539 Riverbend Drive Kitchener, ON N2K 3S3 Phone: (519) 578-5540 Fax: (519) 578-2868 E-mail: Jim.Eso@crawco.ca

QUEBEC/AESIQ Elaine Savard, LL.B., FPAA Les Expertises Richard Racette 1090, rue Principale Sainte-Agathe des Monts, PQ J8C 1L6 Phone: (819) 326-0012 Fax: (819) 326-2023 E-mail: elaine.savard@exprr.ca

David Porter, LL.B., FCIP, CRM Advance Claims Service Ltd. 206 - 2323 Boundary Road Vancouver, BC V5M 4V8 Phone: (604) 642-0660 Fax: 1-888-452-5246 E-mail: davidp@advanceclaims.com

ONTARIO Teresa Mitchell, FCIP, CRM, FCLA, FCIAA, FIFAA Crawford & Company (Canada) Inc. 14 – 431 Bayview Drive Barrie, ON L4N 8Y2 Phone: (705) 728-5597 Fax: (705) 728-2167 E-mail: Teresa.Mitchell@crawco.ca

PRIVACY James B. Eso, BA, CIP Crawford & Company (Canada) Inc. 539 Riverbend Drive Kitchener, ON N2K 3S3 Phone: (519) 578-5540 Fax: (519) 578-2868 E-mail: Jim.Eso@crawco.ca Keith P. Edwards, FCILA, CLA, FUEDI-ELAE CIAA Honorary Life Member c/o CIAA National Office 5401 Eglinton Ave. W., Suite 100 Etobicoke, ON M9C 5K6 Phone: (416) 621-6222 Fax: (416) 621-7776 E-mail: info@ciaa-adjusters.ca

MANITOBA Timothy W. Bromley J.P. Hamilton Adjusters Ltd. 125 Enfield Crescent Winnipeg, MB R2H 1A8 Phone: (204) 944-1057 Fax: (204) 944-1606 E-mail: tbromley@mts.net SASKATCHEWAN Lee Dixon Crawford & Company (Canada) Inc. 210 – 227 Primrose Drive Saskatoon, SK S7K 5E4 Phone: (306) 931-1999 Fax: (306) 931-2212 E-mail: Lee.Dixon@crawco.ca WESTERN Bea Boutcher, CIP Horizon Adjusters Ltd. #207, 9814 – 97 Street Grande Prairie, AB T8V 8H5 Phone: (780) 402-8383 Fax: (780) 402-7888 E-mail: bea.boutcher@horizonadjusters.com PACIFIC David Porter, LL.B., FCIP, CRM Advance Claims Service Ltd. 206 - 2323 Boundary Road Vancouver, BC V5M 4V8 Phone: (604) 642-0660 Fax: 1-888-452-5246 E-mail: davidp@advanceclaims.com

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• on the scene OTS Michael McLeod has been promoted to branch manager of Crawford & Company (Canada)’s Toronto West office.

McLeod will be responsible for the daily operations of the branch office, maintaining relationships and leading a team of more than 40 professionals and administrative staff.

Jennifer Tims has been named branch manager of operations for the company on Vancouver Island.

Tims has been with Crawford for more than 10 years, previously working with the company’s Edmonton claims Craig Wilkinson Jennifer Tims operation. l

Granite Claims Solutions acquired Toronto-based BBCG Claim Services Limited.

BBCG will continue to operate under the BBCG name.

It is a niche-market adjusting firm specializing in surety and fidelity bonds, builders’ risk, course of construction, professional errors and omissions and trade credit claims.

The BBCG team is led by William E. (Ted) Baker, and has offices in Ontario, British Columbia and Quebec. l

CIAA New Members — August 2011 CORPORATE MEMBERSHIP Absolute Claims Adjusters – Regina, SK District Insurance Adjusters – Regina, SK INDIVIDUAL MEMBERSHIP Absolute Claims Adjusters Bev Wright Regina, SK C. Keith Wright Regina, SK

Level 1 Level 3

AZ Claims Services Inc. Sean Adamson, CIP

Oakville, ON

Level 2

Crawford & Company (Canada) Inc. Vance Somerton Toronto, ON

Level 1

District Insurance Adjusters Gordon King, CIP Regina, SK

Level 2

Marsh Adjustment Bureau Limited Edward Valiant, CIP Bedford, NS Scott Lynds, CIP Truro, NS

Level 3 Level 3

Plant Hope Adjusters Ltd. Sylvie Roy, CIP Cinthia Richard, CIP Paul Forestell

Bathurst, NB Dieppe, NB Fredericton, NB

Level 3 Level 2 Level 1

ProFormance Group John Seyler, CIP

Mississauga, On

Level 3

we assess all kinds of risk Liability Risk - Risk Reduction - Risk Control - Coverage Analysis - Litigation Defence Risk Management Counsel of Canada is a national association of independent law firms with expertise in providing legal advice and representation to insurers, insureds, brokers and companies with self-insured or high SIR liability exposures.

Swim with the experts. Please visit our website for more information. www.rmc-agr.com

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www.claimscanada.ca

18/10/11 9:55 AM

“CIAA is dedicated to fair practice and integrity on all claims-related services” To contact the member firms below go to www.ciaa-adjusters.ca/find.asp NOVA SCOTIA

NEW BRUNSWICK

Action Investigations Incorporated Dartmouth ASAP Claims Adjusting Limited Sydney Audas Consulting Ltd. Hammonds Plains Crawford & Company (Canada) Inc. Dartmouth Kentville Stellarton Sydney Fundy Adjustment Bureau Ltd. Arcadia Granite Claims Solutions Halifax Sydney Kernaghan Adjusters Limited Halifax Sydney Marsh Adjustment Bureau Limited Antigonish Bedford Bridgewater Kentville Lawrencetown Sydney Truro Yarmouth G.E. Morgan Adjusters Limited Bedford N.S. TASKS Ltd. Truro

Brunswick Claims Services Ltd. Bathurst Crawford & Company (Canada) Inc. Bathurst Fredericton Grand Falls Miramichi Moncton Saint John East Coast Claim Services Inc. Moncton Granite Claims Solutions Bathurst Moncton Greater Moncton Adjustment Bureau Inc. Dieppe C. Landry Adjustment Ltd. Caraquet Lawrence & Associates Ltd. Fredericton Plant Hope Adjusters Ltd. Bathurst Campbellton Dieppe Edmundston Fredericton Grand Falls Miramichi Saint John Young’s Claim Service Moncton

PRINCE EDWARD ISLAND CKS Holdings Inc. Charlottetown Crawford & Company (Canada) Inc. Charlottetown DeLong & Associates Inc. Charlottetown Summerside Granite Claims Solutions Summerside Prince Edward Claims Services Inc. Charlottetown NEWFOUNDLAND Colonial Adjusting & Appraisal Services St. John’s Crawford & Company (Canada) Inc. St. John’s Granite Claims Solutions St. John’s Newfoundland & Labrador Claims Services Inc. Corner Brook Penninsula Adjusting Services Ltd. Creston North Pike and Associates Adjusting Ltd. Holyrood

For more information about membership in CIAA, our professional standards or our goals and objectives, please call one of our Regional Officers….

NS President – Grant King • 902-468-7787 • Grant.King@crawco.ca NB/PEI President – Luc Aucoin • 506-853-8500 • laucoin@planthope.com NL President – Marcel Pitcher • 709-753-6351 • Marcel.Pitcher@crawco.ca 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

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APPOINTMENT

• on the scene OTS More than 220 golfers attended the 12th annual WICC Ontario Golf Tournament on July 11 at Angus Glen Golf Club in Markham, Ont. Attendees enjoyed a barbeque lunch, silent auction, raffle and dinner. A WICC cheque for $250,000 was presented to the Canadian Cancer Society. l

Meral Kesebi

Blouin Dunn is pleased to announce that Meral Kesebi has joined the firm as an associate lawyer. Meral was called to the Ontario Bar in 2003 and has had experience practicing in well known insurance boutique firms as well as in an in-house legal department of a large insurer prior to joining Blouin Dunn LLP. Meral’s areas of practice include: Automobile insurance (Tort & Accident Benefits), Occupiers’ Liability, Commercial Insurance, General Liability, Insurance Coverage Issues, Fire & Casualty, Subrogation, Products Liability, and Municipal Liability, and Professional Negligence.

Blouin Dunn LLP is one of Ontario’s leading insurance defence firms whose members have been providing quality legal support to the insurance community for over 30 years.

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

www.blouindunn.com

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ciaa conf ad 2011 final

10/14/11

3:16 PM

Page 1

Canadian Insurance Claims Managers’ Association / Canadian Independent Adjusters’ Association United & Committed Leadership through - Education • Professionalism • Communication

CICMA/CIAA Ontario Chapters’ 45th Annual Joint Conference Tuesday, February 7, 2012 Metro Toronto Convention Centre, Toronto, Ontario Registration 8:00 a.m. • Seminar 9:00 a.m.

Reception and Lunch 12:30 p.m.

AUTO REFORM… DID IT PERFORM? Price: $195.00 — CICMA/CIAA Members Price: $245.00 — Non-Members Register early - Space is limited Tickets will not be sold at the door.

Guest Speakers TBA from various provinces to speak on their recent auto reforms and results to date with particular focus on AB/BI CICMA

NAME:____________________________________________________ COMPANY: ________________________________________________ ADDRESS: ________________________________________________ CITY: ___________________________POSTAL CODE: _____________

Please send registration to: Ray Schostak Global Reinsurance Company, 1016B Sutton Drive, Suite 204, Burlington, ON L7L 6B8 RETURN WITH CHEQUE PAYABLE TO: CICMA/CIAA JOINT CONFERENCE

EMAIL: ___________________________________________________ PHONE: (_________) ________________________________________ FAX: (_________)___________________________________________

Please Indicate affiliation: CICMA ❏ CIAA ❏ Other ❏

APPOINTMENT

• on the scene OTS More than 150 guests boarded the Yankee Lady III for a four-hour tour of the Toronto harbour. The third annual event, co-sponsored by Winmar Toronto/ Brampton and Gilbertson Davis Emerson LLP, raised $5,000 for Kerry’s Place Autism Services. The cruise, held August 18, provided guests not only the opportunity to raise money for a valuable cause, but mix and mingle with insurance professionals, friends and colleagues over lunch and cocktails. l

Miriam Tepperman

Blouin Dunn is pleased to announce that Miriam Tepperman has joined the firm as an associate lawyer. Miriam was called to the Ontario Bar in 2003 and has exclusively practiced insurance defence litigation in both private and in-house practice. Miriam has extensive experience in a wide range of matters, including: motor vehicle accident; personal injury; occupiers liability; products liability; property damage claims; and professional negligence.

Miriam has argued cases before all levels of Court in Ontario including the Ontario Superior Court of Justice and the Ontario Court of Appeal. She has also successfully appeared before the Workplace Safety and Insurance Appeals tribunal.

Blouin Dunn LLP is one of Ontario’s leading insurance defence firms whose members have been providing quality legal support to the insurance community for over 30 years.

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

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Every file is different

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In addition to natural case differences, regional rules and nuances often come to bear and shape outcomes.

ARC Group Canada is a national network of independent law firms providing legal and risk-related services to Canada’s insurance and risk management communities. Each member firm within ARC Group intimately understands and is connected with its local market – providing you with national expertise at a regional level.

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