Claims Canada June-July 2011

www.claimscanada.ca

June/July 2011

Official Journal of the Canadian Indeépendent Adjusters’ Association

Facing the Flood Industry on the ready in Manitoba

A BUSINESS INFORMATION GROUP PUBLICATION Publications Mail Sales Agreement #40069240

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

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Cover Feature 12 Facing the Flood Manitoba is currently bracing against the threat of flooding. That threat continues to be reduced in part due to flood prevention methods the province has established. The increase in water-related claims also brings the issue of overland flooding to the forefront.

BY LAURA KUPCIS

Spotlight 20 Quality Claims Service The key to success at Prince Edward Claims Services, Inc. is efficient claims handling and quality service.

BY LAURA KUPCIS

Education Forum

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36 Adjusting to SABS The adjuster’s role in Ontario auto accident claims has changed as a result of the new Statutory Accident Benefits Schedule in Ontario. Adjusters now have more authority to make decisions and a little more time to investigate the validity of a treatment plan.

News Features 22 55 and Older When it comes to clients aged 55 and older, file management needs to be tailored to suit the unique needs of this group.

BY JUDY FARRIMOND and ANGELA VERI

24 Taking a Bite Out of Theft

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Vehicle theft costs insurers and the public a substantial amount of money and time.

BY ANTHONY MANNELLA

26 A Tale of Two Cars In two different cases, someone was injured while riding a machine on wheels. Are they considered an automobile?

BY DANIEL STRIGBERGER

28 Clarified The limitation date for declatory judgment is clarified in an Alberta Court decision.

Departments

BY DON MCGARVEY and ANTHONY ESPEJO

4 First Notice

30 Building Defects

38 On The Scene

Claims for moisture penetration in new buildings continues to rise.

Columns

BY STEPHEN BLANEY and JOHN MCGLONE

32 Drinking Water Flows Again

36 Education Forum

The drinking water in a Northern Ontario Reserve was compromised after vandals threw homemade explosives into the treatment facility.

BY KAREN SCHMIDT

34 No-Fault In British Columbia, no-fault benefits are only deducted where at least one defendant is covered under an auto insurance policy.

BY BARBARA DEVLIN and GREGORY PUN

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• first notice F4 tornado in downtown Toronto would cause $4 billion in losses If an F4 tornado — which packs wind speeds of between 333 km-h and 418 km-h — ripped through downtown Toronto, it could potentially cause up to $4 billion in losses, said Matthew Nielsen, senior product marketing manager of natural catastrophe and portfolio solutions at RMS. Nielsen made the observation at a seminar on convective storm models for the Canadian market at RMS’s Canadian catastrophe model seminar in Toronto on May 24, 2011.

Nielsen based his estimate in part on damage caused by large-scale tornadoes in Tuscaloosa, Ala. on Apr. 27, 2011 and Joplin, Miss. on May 22, 2011. He described these as catastrophic events causing “billions” in losses.

“Tuscaloosa is a city with a population of approximately 100,000, and Joplin was about 50,000,” he said.

“Compare that to the types of exposures you have in Toronto, and the number of people you have here [approximately 2.5 million], and it can be a very, very different loss.”

For an F4 tornado in Toronto, RMS predicts about $4 billion in damage.

“This is one example of what could happen from a large event,” he said. “We haven’t seen this type of event before. But, it’s similar to what we say for earthquakes: ‘Just because you haven’t seen an event, doesn’t mean we shouldn’t think about these potential events’.” ●

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Ontario Divisional Court sets aside FSCO director delegate ruling in Pastore The Ontario Divisional Court ruled in Aviva v. Pastore that the determination of a Class 4 (marked) or Class 5 (extreme) psychological impairment under subsection (g) cannot include consideration for pain associated with physical injuries.

The decision reverses a Financial Services Commission of Ontario (FSCO) Appeal decision.

In Aviva and Pastore, a FSCO director delegate ruled there is no inconsistency in defining an auto injury victim as “catastrophically impaired,” even though she suffered only a single Class 4 impairment, and her physical and psychological injuries fell well below the 55 per cent threshold for a person to be classified as catastrophically impaired under s.2(1.1)(f) of the province’s Statutory Accident Benefits Schedule (SABS).

The Divisional Court, in a 2-1 split, also found that FSCO’s interpretation of the SABS cannot be supported. Rather, the SABS, AMA Guides and the Superintendent’s Guidelines, make it clear that all four areas of function are to be accounted for in an assessment of catastrophic impairment.

The Divisional Court majority set aside the decision of the FSCO director’s delegate without prejudice to the matter being re-heard by a different director’s delegate or, if appropriate, Anna Pastore could make a fresh catastrophic impairment application.

In an email, Kadey B.J. Schultz, a partner at Hughes Amys LLP, outlined Pastore’s options moving forward. These options include: • to have her claim reheard

by Director’s Delegate David Evans; • to appeal this ruling to the Ontario Court of Appeal; • to re-submit an OCF-19, “but any such application would quite possibly be barred by the two year limitation period,” Schultz said; or • accept the ruling of the Divisional Court.

“It will be interesting to watch this case to see if a further appeal will be made to the Ontario Court of Appeal,” Schultz wrote. “In the meantime, the Court of Appeal will consider the Kusnierz matter and perhaps that decision will render any further appeal moot.” l

Backflow valves highly effective in reducing sewer backup damage: Saskatoon utility manager Backflow valves are 85 per cent effective in eliminating sewer backup, according to Galen Heinrichs, stormwater utility manager with the City of Saskatoon.

Moreover, in that 15 per cent of instances in which a home experienced some sewer backup despite having a backflow valve, the backflow valve was nevertheless 96% effective in reducing damage from the event, said Heinrichs.

Heinrichs spoke at the Institute for Catastrophic Loss Reduction’s Basement Flooding Symposium held May 26 in Toronto.

Beginning in 2003, the City of Saskatoon implemented a bylaw requiring all new homes to have a backwater valve.

Around the same time, the city implemented a flood protection program to help mitigate basement flooding and sewer-backup issues in high-risk homes.

Homes deemed to be at risk were

given an opportunity to upgrade their plumbing with a sump pit and a backwater valve; the city reimbursed the homeowner 100 per cent of the cost. The program was offered three times.

In 2005 and 2007, the city paid a maximum reimbursement cost of $2,500. In 2010, the limit was increased to $3,000.

Roughly 50 per cent of the at-risk homes participated in the program, which accounted for about 700 homes, Heinrichs said.

When Heinrichs’ department conducted a survey to determine why the other 50 per cent had not participated, there was no overarching reason. Individual responses included that the backup was a random event, the problem rested with the city and not with the homeowner, and that the homeowner did not want to deal with the mess that would result from installation. l www.claimscanada.ca

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• first notice FN Canadian insurers, adjusters pour into Slave Lake, Alberta to aid in wildfire recovery efforts Insurance company and independent adjusters continue to pour into the area of the Town of Slave Lake, Alta to aid displaced residents and help in recovery efforts, after wildfires have consumed much of the of the town since before May 15.

Roughly 7,000 residents in Slave Lake have been ordered to evacuate. Alberta put up $50 million on May 18 to assist evacuees in finding find temporary lodging, since the area remains unsafe.

As of May 18, approximately 87 wildfires were burning in Alberta, 23 of which were out of control. Seventeen of the outof-control wildfires raged in the Lesser Slave Lake Area.

The Slave Lake wildfire has burned about 2,000 hectares of land. A second wildfire along the south shore of Lesser Slave Lake is out of control and has burned approximately 30,000 hectares of land.

In total, active wildfires in Alberta have burned 191,000 hectares of land — more than the area burned over Alberta’s entire 2010 wildfire season. More than 1,000 firefighters have been dispatched to douse the flames.

The damage in Slave Lake is already being compared to the record-setting damage caused by a 2003 wildfire in Kelowna, B.C., which cost insurers about $200 million.

In a statement to the media on May 17, Slave Lake Mayor Karina Pillay-Kinnee estimated “hundreds of homes and businesses have been damaged or destroyed by the fire.” In addition, critical infrastructure like water, power, gas, telecommunications and health services are not yet in place for residents to return.

Intact Insurance opened three mobile claims centres in Athabasca, Westlock and Edmonton as early as May 17.

The three centres, located south-east of Slave Lake, are staffed with community response teams to help customers begin the claims process and start to get their lives back on track.

“Intact Insurance is handing out emergency funds for accommodation, food and clothing and providing comfort kits filled with everything from colouring books to pet food,” the company notes in a press release.

Three independent adjusting firms have all deployed catastrophe response teams to the area.

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McLarens Canada deployed claims adjusters from its Calgary and Edmonton branches to the town of Slave Lake.

They are coordinating with insurers and their brokers to respond to their clients’ losses, which include major commercial losses, homes, automobiles, and contents as well as smoke and wind damage, boat, RV and multiple other types of losses.

Crawford & Company (Canada) Inc. announced on May 19 that it had secured a temporary office location in Slave Lake.

This will accommodate the adjusters deployed to the area to assist with the damage and devastation being caused by the wildfires.

“Once we receive safety clearance, we will move our adjusters into the temporary office location, and will maintain possession of this site for as long as necessary,” said Crawford & Company (Canada) CEO John Sharoun. “We continue to monitor the situation and deploy adjusters to the area as required. We are also responding quickly to the many claims we have already received.”

Cunningham Lindsey also has adjusters standing ready for deployment to Slave Lake. “We have initiated our CAT response plan to respond to the events in Alberta and to ensure adequate adjusting resources are available to meet the needs of our customers,” said Cunningham Lindsey’s national CAT coordinator Mike Morris. “Furthermore, we’ve

appointed Lisa McCabe as regional CAT coordinator to coordinate efforts on the ground in Slave Lake in addition to providing a single point of contact for our customers.

“In compliance with the Alberta Superintendent of Insurance, we have submitted the names of our adjusters who will be part of the initial response team.

Should additional resources be required, we have a number of other adjusters from within our organization that can and will be deployed.”

Meanwhile RSA Canada’s mobile claims response vehicle and claims representatives are on the ground near the Athabasca Regional Multiplex in Athabasca, Alberta, where many evacuated families from Slave Lake are currently residing.

RSA is encouraging families and business owners from Slave Lake to start taking an inventory of their homes, cars and businesses.

“As insurance experts, we come into people’s lives at the worst possible times, and our job is to get them back on their feet,” says Irene Bianchi, senior vice president of RSA Canada. “One of the best ways to get back to normal is to start making lists as soon as you are able - this is central to getting the claims process going. And don’t forget the small things! Many people forget things like bedding, vacuum cleaners and hairdryers.” l

www.claimscanada.ca

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1/26/11 6:09 PM

• first notice FN Supreme Court of Canada agrees to hear case of a rotten tree killing a young man seated in a parked car The Supreme Court of Canada has granted leave to appeal the decision of the Quebec Court of Appeal in Ville de Westmount c. Richard Rossy et autres.

Gabriel Rossy was killed in 2006 when a rotten tree fell on top of the parked car in which he was seated.

The Rossy family attempted to sue the City of Westmount for $1.3 million, arguing the city had failed to maintain the tree, which it owned, and that it was liable on that basis.

Lloyd’s of London, the city’s insurer, moved to dismiss the action, arguing an automobile had caused the damage. Since an automobile was involved, the insurer argued, no fault compensation was available under the Automobile Insurance Act and responsibility for payment therefore fell to the Société de l’assurance automobile du Québec.

The Superior Court dismissed the Rossy family’s action, noting that no fault benefits were available under the Automobile Insurance Act. But the Court of Appeal overturned this finding, saying the death was causally connected to the tree falling, not to Rossy’s sitting in the car when it happened.

The fact that Rossy was sitting in an automobile when the tree fell was not connected to his death, the Appeal Court ruled, arguing the tree might well have killed him if he had been walking along the sidewalk, outside of the car.

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

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

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

A bi-monthly magazine (6x per year), Claims Canada is published by BIG Magazines LP, a div. of Glacier BIG Holdings Company Ltd. Business Information Group is located at: 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

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Lloyd’s of London sought leave to appeal the decision to the Supreme Court of Canada.

“Lloyd’s of London is of the view that the Court of Appeal failed to apply the proper causality test and that the Automobile Insurance Act must be given a wide and generous interpretation in order to ensure that victims of car accidents be compensated without having to hire lawyers to sue potentially insolvent wrongdoers,” Lloyd’s wrote in a January 2011 press release. l

Claims Canada

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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 MARY CHARMAN

The Canadian Independent Adjusters’ Association (CIAA) applauds the Canadian Council of Insurance Regulator’s (CCIR) new strategic priorities and initiatives as they relate to the development of solutions to common regulatory issues and the promotion of a harmonized insurance regulatory system. CIAA and CCIR share the same common goal for consumer protection and believe seamless licensing administration is a winwin for regulators, independent adjusters, insurers and, most importantly, the public. CIAA, in collaboration with insurance industry colleagues, is reaching out to industry stakeholders to attain collective support of our appeal for CCIR’s assistance in developing a solution to the complexity of deploying adjusters quickly into disaster areas. It is anticipated with the combination of strong industry support and CCIR’s current mandate we can successfully achieve an effective and efficient process for seamless mobility of adjusters for the protection of the consumer.

CIAA recently announced its ability to respond to insurers’ CAT preparedness requirements. With the increased frequency and severity of extreme weather events, any excess capacity to respond is already strained as it is and the association’s CAT Response Resource is an insurer’s gateway to CIAA professional members able to respond in the event of an emergency.

As we have reported previously, the agreement on Internal Trade Labour Mobility (TLM) excluded occupations that were either licensed and/or regulated by the financial sector regulators of provincial governments.

The premiers reviewed this matter in 2010 and agreed to remove the unnecessary protectionist barriers and improve full labour mobility of qualified Canadian professionals without additional training, testing or assessment. In theory, the TLM is a document that evidences the provinces’ agreement to lower hurdles for licensed professionals to have “portability” of their licenses between the provinces. Implementation takes effect Jul. 1, 2011 and will now include independent adjusters as one of the regulated professions to be covered and no longer exempt from the benefits. All Canadian independent adjusters meet national standards of qualification requirements and education programs sufficient to protect the 10 Claims Canada

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L’Association canadienne des experts indépendants (ACEI) approuve sans réserve les nouvelles priorités et initiatives stratégiques du Conseil canadien des responsables de la réglementation d’assurance (CCRRA) qui visent à trouver des solutions aux questions de réglementation courantes et à harmoniser les pratiques des autorités de réglementation d’assurance.

L’ACEI et le CCRRA ont tous deux pour objectif la protection des consommateurs et sont convaincus que l’administration continue des permis d’exercer est gagnant-gagnant pour les responsables de la réglementation, les experts indépendants, les assureurs et surtout pour le public. L’ACEI, en collaboration avec ses collègues de l’industrie de l’assurance, cherche à convaincre les parties prenantes de l’industrie pour qu’ensemble elles obtiennent l’appui du CCRRA et trouvent une solution au problème complexe du déploiement rapide des experts dans les zones sinistrées. Nous prévoyons que grâce à l’appui massif de l’industrie et au mandat actuel du CCRRA, nous pouvons obtenir, pour la protection des consommateurs, un pouvoir réglementaire efficace sur la mobilité continue des experts.

L’ACEI a annoncé récemment qu’elle était en mesure de satisfaire aux exigences des assureurs quant à sa capacité de réaction rapide en cas de catastrophe. En raison de la fréquence accrue et de la gravité des catastrophes climatiques extrêmes, toute demande excessive d’aide met déjà le service à rude épreuve et la disponibilité des ressources d’intervention de l’association en cas de catastrophe constitue pour l’assureur un accès rapide aux membres professionnels de l’ACEI pouvant réagir en cas d’urgence.

Comme nous l’avons précédemment mentionné, le chapitre de l’Entente sur le commerce intérieur (ECI) qui porte sur la mobilité de la main-d’oeuvre excluait les emplois préalablement autorisés et (ou) réglementés par les responsables de la réglementation du secteur financier des gouvernements provinciaux. Après avoir étudié la question en 2010, les premiers ministres ont convenu de supprimer les barrières protectionnistes inutiles et d’améliorer la mobilité de l’ensemble des professionnels canadiens qualifiés, sans exiger de formation, d’examen ou d’évaluation supplémentaire. En théorie, l’ECI est un document qui sanctionne l’entente interprovinciale visant à diminuer les obstacles pour les professionnels détenteurs de permis et à faciliter la «transférabilité» de l’autorisation d’exercer entre les provinces. Cette entente entrera en vigueur le 1er juillet 2011 et intégrera le travail des experts indépendants en tant que profession réglementée, travail qui sera inclus et non exclu des bénéfices de possibilités d’emploi. Tous les experts indépendants canadiens satisfont pleinement aux normes nationales de qualification et aux programmes de formation axés sur la protection www.claimscanada.ca

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public interest and indeed the time has come for mutual recognition whereby those who are deemed competent to practice independent loss adjusting in one jurisdiction should be deemed competent to practice in other jurisdictions as well.

CIAA maintains a strong position on the issue of unlicensed adjusting activity and reports instances of misconduct to the appropriate regulating body. Currently there is a very broad range in the severity of penalties imposed by the various jurisdictions and CIAA would like to see implementation of more effective deterrents and consequences. Independent adjusters must meet regulators’ demanding competency, knowledge, skills and experience requirements mandatory in attaining their licence and in order to protect the consumer, regulators have to have the ability to adequately penalize all breaches of the Insurance Act. We are extremely fortunate to have such dedicated volunteers working unconditionally for the good of the entire membership and I thank them all for their unwavering support. If an association’s stature depended solely on the experience, wisdom and selflessness of its volunteers, CIAA would be ranked at the top.

Enjoy a safe and happy summer season! n

des intérêts du public. De fait, cette reconnaissance mutuelle vient à point nommé, ce qui veut dire que la compétence des experts indépendants reconnue dans une partie du pays doit être reconnue et prise en considération dans les autres parties du pays.

La position de l’ACEI reste ferme sur la question des activités d’expertise par des personnes qui n’ont pas l’autorisation d’exercer et dénonce les cas de faute professionnelle aux instances appropriées. Actuellement, la sévérité des sanctions imposées diffère grandement selon les régions et l’ACEI souhaiterait introduire des pénalités et de conséquences plus strictes.

Les experts indépendants doivent satisfaire aux demandes de compétences, de connaissances, de capacités et d’expériences jugées obligatoires par les responsables de la réglementation avant d’obtenir un permis d’exercer et, pour protéger les consommateurs, ces responsables doivent avoir le pouvoir de pénaliser adéquatement toute infraction à la Loi sur les assurances.

Nous sommes extrêmement chanceux de pouvoir compter sur des bénévoles très motivés qui travaillent sans condition pour le bien de tous nos membres et je les remercie pour leur appui inconditionnel. Si l’envergure d’une association reposait uniquement sur l’expérience, la sagesse et le dévouement de ses bénévoles, l’ACEI serait à sa tête!

Passez un bel été et soyez prudent! n Translation provided by Henry Arcache, Themis Translations, Montreal, Que.

NATIONAL EXECUTIVE 2010-2011 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

SECRETARY Marie C. Gallagher, FCIP, CRM McLarens Canada 71 King Street, Suite 204 St. Catharines, ON L2R 3H7 Phone: (905) 984-8282 Fax: (905) 984-8290 E-mail: marie.gallagher@mclarens.ca

1ST VICE-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

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 Delores Thorbourne, BA, FCIP McLarens Canada Suite 103 Greystone VII 4208 - 97 Street Edmonton, AB T6E 5Z9 Phone: (780) 442-3077 Fax: (780) 466-0325 E-mail: delores.thorbourne@mclarens.ca

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PAST-PRESIDENT Patti M. Kernaghan, FCIP, CRM Kernaghan Adjusters Limited 300-1575 West Georgia Street Vancouver, BC V6G 2V3 Phone: 1-800-387-5677 Fax: 1-800-387-5644 E-mail: pkernaghan@kernaghan.com

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 McLarens Canada Suite 300, 5915 Airport Road Mississauga, ON L4V 1T1 Phone: (905) 671-3164 Fax: (905) 671-1889 E-mail: john.jones@mclarens.ca

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Facing the Flood

Manitoba is currently bracing against the threat of flooding.

That threat continues to be reduced in part due to flood prevention methods the province has established. The increase in water-related claims also brings the issue of overland flooding to the forefront.

BY LAURA KUPCIS

The volume of water flowing through the Assiniboine River in Brandon, M.B. reached record levels this spring, causing further pressure in a province where the water tables were already filled to capacity last fall. News reports across the country focused on an incredible amount of water rushing through the waterways in the province. At times, when aerial shots pan over the province, it seems no dry land is left.

Social media is rife with tales of evacuations — both as a precautionary measure and due to actual flooding. One rural community sandbagged their homes and evacuated because they were living in an area intended to be flooded. Flooding their community was seen to be a means to save another larger, more densely populated community — sacrificial lambs, as it were.

Despite this alarming level of water, insurance claims in the area remain (as of press time) nearly nonexistent. The inability to purchase overland flood insurance for residential properties plays some part in the infrequency of claims. However, just as important are the preventive measures the province and the residents have taken to mitigate damage. This is a prepared province; there are no rookies here when it comes to flooding and flood prevention. www.claimscanada.ca

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Bird’s eye view As of press time, adjusters, insurers and residents continue to wait with bated breath. One heavy rainstorm could take the province from a situation in which it gets through the spring relatively unscathed, to a position in which it helps rebuild basements for quite some time. “With the combination of saturated ground and high snow levels, we expect to see flooding again this spring,” said Gord Mansfield, vice president of claims with the Western division of Intact Insurance.

The flooding is more pronounced this year in the Assiniboine River Watershed, with the flooding heaviest in the western parts of the province and in the central interlake area as well.

Many seasonal residences have been destroyed by the high flood waters and the related wave action from early season storms on Lake Manitoba. In the Interlake, most of the farms are pasturelands; many are now under water. The livestock have been moved to other parts of the province. But how the pastures will fare remains to be seen, said Miles Barber, principal of Network Adjusters.

The City of Winnipeg itself isn’t at a terrible risk of overland flooding, although preventing sewer backup is a trickier issue. But when you leave the city, water covers a swath rough-

ly 50 miles wide, said Larry French, president of J.P. Hamilton Adjusters.

Highway 75, the principle link to the United States, was closed due to water overrunning the highway. The issue there lies with the cost of re-routing the trucks. “Winnipeg is a major destination and centre for trucks,” he said. “We’ve got huge truck fleets operating out of Winnipeg, most of which flow south. And the truckers, as a consequence, have to take different routes.”

Rivers normally 100 metres wide are now a kilometer wide, said Russ Malkoske owner of QA Adjusting Company. And although the water seemingly runs on forever, it is thankfully not very deep.

The biggest issue this year is the increased water levels in the Assiniboine River and its tributaries. The watershed is a huge area and it runs right into Winnipeg. There is a diversion west of the city, around Portage la Prairie, but that has reached capacity this year. “If anywhere is going to cause issues in the city, that’s going to be it this year,” said Grant Rerie, Manitoba regional manager for Kernaghan Adjusters.

(As of press time, flows were being released into the La Salle River watershed in a controlled release through the Assiniboine River dikes.

The controlled release was an effort to June/July 2011

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minimize the potential for an uncontrolled breach that might affect 850 homes. The controlled release, on the other hand, could potentially affect 150 homes.)

The threat of sewer backup For now, the industry sits and waits. “If the water goes over the banks, if we had a rainfall, it would be a horrendous problem, because the surplus water in almost all of the urban sewer systems is dumped into the rivers, which are at capacity,” Malkoske said. “When we’ve had the sewer backup issues, it’s been this type of condition.”

When it comes to flooding, sewer backup would be the main insured risk under a personal property homeowner policy. “While flood damage is covered for some commercial properties, in residential properties flood is not insured,” said Lindsay Olson, vice president for the regions of British Columbia, Saskatchewan and Manitoba at the Insurance Bureau of Canada (IBC). “However, sewer backup is, so it is going to be interesting to wait and see what kind damage occurs.”

As noted above, commercial — including farming — policies have flood coverage. This is in addition to the potential for business interruption claims if the water does not recede.

For example, in Brandon, if the dike breaks and the water spills over, a large business section — filled with big box stores — might be catastrophically affected, said Paul Balabanski, principal of Westman Claims Adjusters Ltd. (As of press time, the dike had not yet broken. However, a civil evacuation order for homes and businesses in an area around the river created a few business interruption losses).

But when it comes to Manitoba’s flood waters, all eyes in the industry are on sewer backup losses. If the heavy rains come, there will be sewer backups, sump pump failures and sump pit overflows, Barber said.

“Most of the infrastructure in the older part of Winnipeg operates with a combined sewer system,” he said.

“If we get a heavy rain, the question is going to be: ‘Can the sewer system handle the run off?’” Newer areas 14 Claims Canada

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have separate systems for live sewers and storm sewers, which means those areas will likely fare better, he adds.

Typically saturated conditions mean a higher probability of having sewer backup occurrences. This not only affects live sewer lines, but also septic fields and septic tanks. A higher probability of sump pit failure exists because high water tables lend to the risk of sump pump burnout and float failure. All sorts of combinations can occur. When sump pump failure occurs, there is an overflow from the sump pit — which is included within sewer backup-style coverage, Barber said.

Areas identifiable as high risk lack the infrastructure to satisfy the accumulation of water and inevitably sewer backups occur.

It might seem Manitoba is at a high risk for water-related claims, but this is not necessarily true. “What’s happened is, of course, flood is not covered in any Canadian policy for personal lines. So even though there is a lot of publicity out there about these rising rivers and the floods, there is no coverage for it,” said Wayne Ross,

vice president of national property claims with Aviva Canada. “As a consequence, they are having to go to the government for relief.”

It can be tricky to link the frequency of sewer backup claims directly to the flooding. But in the event of a huge influx of claims, most insurers will set up a major event record on their system. Last May, Winnipeg saw 100 mm of rainfall over two days at the end of the month, overwhelming the drainage system and resulting in high river levels. The Co-operators received 231 sewer-backup claims as a result, totaling $3.6 million. This was the highest total of sewer backup claims related to a single claim event The Co-operators faced last year.

Throughout Canada, water-related claims account for 40 per cent of all claims in the country. In Winnipeg, they only account for 19 per cent, Ross points out.

Last year, significant rain compounded problems caused by high river levels, resulting in a lot of sewer backups, Ross said. Areas identifiable as high risk lack the infrastructure to satisfy the accumulation of water and inevitably sewer backups occur.

However, many carriers will not offer sewer backup coverage without limits. And they often require the provision of having a backwater valve.

This combination results in fewer claims in the area, Ross said. This is a change from when French and his office were tasked with adjusting 1,200 sewer backup claims in 1993 — a time when there was no limitation on sewer backup. “It was hell on wheels,” French said.

Are we prepared?

Preparedness also helps to keep the claims numbers down. Manitoba is extremely well-prepared for spring thaws and the seemingly constant threat of flooding. After sustaining millions of dollars in damage due to a flood in 1950, the province began construction on the Red River Floodway.

This was completed in 1968 and has, according to the Manitoba Floodway Authority, saved the province more than $30 billion in flood losses. Following the 1997 flood, better known www.claimscanada.ca

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as the ‘Flood of the Century’ — which came close to reaching the capacity of the floodway, thereby leaving Winnipeg at risk — the province further reviewed its flood exposure. If the area experienced another flood similar to the one in 1997, the flood protection infrastructure around Winnipeg was likely to fail, according to the Manitoba Floodway Authority. At that time, it was recommended immediate action be taken to protect Winnipeg. This resulted in what is now known as the Red River Floodway Expansion Project. The project is intended to increase flood protection to more than 450,000 Manitobans, 140,000 homes and 8,000 businesses.

Ultimately, it is expected to prevent more than $12 billion in damages to the provincial economy in the event of a 1-in-700-year flood. The project is scheduled for completion this year, but the 1-in-700-year flood protection was achieved by 2009.

The province has also built dikes, which are elevated as needed, and piled sandbags to add further pro-

tection throughout the province.

“The rural individuals, farmers and acreage owners are fairly proactive in moving snow or protecting their properties from a fast flood,” James Barnett, principal at Westman Claims Adjusters Ltd. said. “In a lot of cases, we don’t see [any claims] because they are fairly proactive and have the equipment or the ability to move snow as necessary or dike it.”

But no matter how prepared, the possibility for damage still exists.

In the event of a flood, adjusters and insurers are ready to get to work.

The degree of predictability of such an event has afforded the adjusters the opportunity to clear off their desks in anticipation of a claims influx. “If an insured event happens, you want to make sure you’ve got your resources in place, that everything is set to go,” Barber said. “So when the claims start coming in, you are able to hit the ground running with your rubber boots on.”

A few years back, The Co-operators set up a Western storm team.

Members of the team were asked to traveling the Western provinces to handle the influx of storm claims that seem to hit every summer, said Glen Oxford, national property claims manager with The Co-operators.

They are not the only ones.

“We have a dedicated catastrophe team we are able to mobilize and dispatch immediately to help customers get back on track,” Mansfield said.

“Once calls come in, the catastrophe team works together with our standard claims team to quickly begin supporting brokers and customers through the claims process.”

Crawford & Company (Canada) Inc. also has a catastrophe team at the ready, and can call in additional adjusters not only from across the country, but North America.

In addition, Crawford has an “office in a box.” It includes wireless capability and everything required to set up in a hotel, office building or wherever they can find a place to sit. The company has on-the-ground logistics pre-arranged with hotels, fa-

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Claims Canada 15

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cilities and rental companies so in the event of a disaster, there is no need to scramble.

The presence of social media also adds to preparedness. With the increased prevalence of social media, there is no need to sit around blind and wait for someone to report back on a situation. The networks are filled with up-to-date personal accounts and constant alerts.

This information pipeline can be a double-edged sword. Although it provides the industry a continuous flow of information and a medium through which to communicate, it can create mounting public pressure on adjusters, depending on the way policyholders use the sites. For example, if one policyholder has received a favourable response from his or her insurer, and others on the street have not yet heard from their company, this is now a viral issue that an insurer must face. In the past, a perceived lack of responsiveness might have been more of a contained, local issue, said Pat Van Bakel, senior vice president of operations with Crawford & Company (Canada) Inc.

Handling claims If the homeowner has sewer backup coverage on the policy, which is available in various increments of coverage value in Manitoba, the next task is to determine how much of the damage, if any, is caused by sewer backup or, alternatively, how much of it is attributable to foundation seepage or leakage or overland flooding.

The majority of homes in the province carry only $5,000 in coverage, Barber said. This is sufficient to have the damage stabilized, cleaned, properly disinfected and dried. There is usually a small balance left over for the homeowner to put towards a minor degree of reconstruction.

Working with Government Members of the Canadian Independent Adjusters’ Association (CIAA) are always poised to help the government in times of need. The CIAA has formed a partnership with the Government of Manitoba’s Emergency Measures Organization (EMO) 16 Claims Canada

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department, making adjusters available to help solve certain issues on behalf of the government. The partnership started back in the spring of 1997 after Manitoba was inundated with the flood of the century. “CIAA identified that there was going to be a need for the province in addressing the disaster financial assistance claims,” Barber said. “We contacted EMO and started discussions and established a mechanism. We provided 99 adjusters for a couple of weeks once the flood

The project is intended to increase flood protection to more than

450,000

Manitobans,

140,000

homes and

8,000

businesses. had subsided to assist in administering the claims. Once things got under control, then we dwindled that number down. Ever since, when EMO needed outside resources to supplement their staff, we’ve been the go-to organization.”

The idea is that CIAA will supplement existing EMO staff to work on specific programs so that the core staff is not being too divested.

Senior adjusters will go out in the field to investigate and adjust a program, for example. They might also work backup by assuming an office position. This would mean handling the paperwork while internal staff is out in the field or meeting with applicants.

“We’ve used them specifically in relation to flood compensation,” said Lee Spencer, director of recovery with the Manitoba Emergency Measures Organization. This covers instances in which the province is forced to store water on resident land. Other situations may include the operation of the floodway, when artificial flooding occurs. The CIAA is used in these types of circumstances because of their experience in determining eligibility and compensation, he said.

“They understand how to calculate loss of income and revenue and other types of approaches that we are not normally engaged in here,” Spencer said.

Flood claims may not be numerous, but they are usually very complex and sensitive — something adjusters are accustomed to handling. “They fill a nice role for us,” Spencer said.

Independent adjusters are tasked with determining an appropriate settlement for the damages incurred and settling with the client. The EMO will tell the adjusters where it believes the affected residents are, what type of effects they believe have occurred and then the adjuster will head out to work with the client to determine the impact on livelihoods and property. The adjuster would then provide EMO with a recommendation on the amount of compensation necessary based on general insurance adjuster practices, Spencer said.

“This particular organization provides very professional service that focuses both on the client’s needs and on the public’s needs,” Spencer said.

“Everything that they have done for us has been done to a very high standard and certainly with everybody’s best interest at heart.”

A subsection in The Red River Floodway Act, registered in 2009, now dictates: “Whenever possible, the Emergency Measures Organization www.claimscanada.ca

20/06/11 2:51 PM

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must use independent licensed insurance adjusters to evaluate compensation claims.”

Looking overland Canada is the only G8 country that currently does not have some form of overland flooding insurance — be it government-funded, industry-funded or a partnership between those two entities. The suggestion to bring some form of overland coverage to Canada has been met with reservation, in part because of a principle called ‘anti-selection.’ Basically, the concern is that only those at risk would buy the coverage, and therefore the risk wouldn’t be spread widely enough to keep the premiums from being prohibitively expensive.

However, the Institute for Catastrophic Loss Reduction (ICLR), after extensive research into overland flood insurance programs, has come to the conclusion that bundling overland flooding with the standard policy would be an appealing option, said Glenn McGillivray, managing director of the ICLR. Swiss Re supported the ICLR research, culminating in a report presented in November 2010, Making flood insurable for Canadian homeowners.

McGillivray is quick to add that while many attribute flooding to living beside a body of water, this is not the only situation in which flooding poses a problem. “Flooding from rainstorm is a huge problem now and it’s only going to get worse with climate change and the condition of our infrastructure,” he said. “Water claims have surpassed fire claims as proportion of claims. There isn’t a city in this country that isn’t getting whacked by basement flooding from rainstorms.”

Quebec is the only province in the country to offer coverage for infiltration of water, where seepage that comes through the cracks in the foundation is a covered peril, McGillivray said. The insurers in Quebec seem to be interested in pursuing the idea of flood coverage, he added, noting that the province is more advanced with respect to flood mapping than other areas of the country. This puts them 18 Claims Canada

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in a good position to implement this additional peril.

The ICLR researched flood insurance regimes in other countries. After looking at historical floods in Canada, and the loss costs associated with another flood, the ICLR concluded a modification of the current flood program in the United Kingdom would be the best suited for Canada. In the U.K., the insurance industry, through the Association of British Insurers, has a formal written agreement with

Currently, the insurance industry in Canada is looking into the possibility, and the IBC recognizes other jurisdictions do offer overland flood insurance.

But at this time, an underwriting challenge still exists. the government that says each will be responsible for certain tasks. If the government performs tasks A, B, C and D — which includes keeping flood mapping up to date, working on flood defense and prohibiting new construction in floodplains — the insurance industry will offer a product at a fair price with a low deductible.

Additionally, the product is bundled in the U.K.

When it comes to bringing the model to Canada, the ICLR uses the U.K. example as a launching pad. But instead of just two parties to an agreement, the ICLR recommends adding homeowners to the equation. Under this model, homeowners would be required to defend against flood on their own property through means such as landscaping, ensuring a solid foundation, watertight windows, backwater valves, sump pumps, sump pits, etc.

As in the U.K., the government would be responsible for flood mapping, flood defense construction, etc.

Canada has a Flood Damage Reduction Program in place. However, McGillivray said the program hasn’t received funding in quite some time, and it’s effectively become an empty shell.

And so when can Canadian homeowners expect to see overland flood insurance? “This wouldn’t happen tomorrow,” McGillivray said. “It wouldn’t probably happen in a couple of years. We can’t just have one of those three groups do their thing.

All three have to do it together.”

The ICLR is suggesting that all water damage be covered, no matter the source. But the IBC says insurers would then face the challenge of how to provide coverage to homeowners at a reasonable price. “For the folks who would need it, who are in those areas who would want it, it would be prohibitively expensive,” said Mark Klein, manager of media relations at IBC. “For folks who don’t want it, such as myself, we wouldn’t pay for it at all.”

Currently, the insurance industry in Canada is looking into the possibility, and the IBC recognizes other jurisdictions do offer overland flood insurance. But at this time, an underwriting challenge still exists, Klein said.

“We are looking into this and, given the increase in extreme weather situations, it is something we look at and will be continuing to look at,” Klein said. “We understand the seriousness and complexity of the issue. It is something on our radar that we will continue to look into, as a way to help consumers.” 

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• spotlight S

Quality Claims Service

The key to success at Prince Edward Claims Services, Inc. is efficient claims handling and quality service

BY LAURA KUPCIS

T

he establishment of Prince Edward Claims Services Inc., (PECS) defied conventional wisdom. “Many of our industry peers questioned how a new company with three senior adjusters could survive in a smaller province where a number of firms were already situated,” Randy Driscoll, a founding partner said. “ We were convinced that providing quality claims service would make PECS an obvious choice for insurers.”

R. Driscoll, Richard Arsenault and Wade Driscoll launched PECS on May 15, 2000 after several months of meetings. They brought with them a combined 40 years of experience and a loyal following of clients. Despite the odds, PECS is still going strong after more than 11 years.

When it came to choosing a name, the three founding partners wanted something that was easy to remember and quickly associated with Prince Edward Island. Prince Edward Claims Services, Inc. — or PECS as it’s better known — was chosen. “We wondered if the general public would confuse us for a local gym” because of the acronym, laughs R. Driscoll. “People quickly realized after seeing us that our business wasn’t a fitness facility named after our pecs!”

Ups and downs As with most independents across the country, PECS has experienced the ups and downs that come with a cyclical industry. Mergers and acquisitions in the industry have also left fewer sources for business. However, evolving technology has made it easier for smaller independent offices, such as PECS, to 20 Claims Canada

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compete with the larger national firms.

The firm is able to offer comparable accessibility and online services that the competition offers. “We believe insurers are recognizing that bigger isn’t always better when it comes to providing service and efficient claims handling,” R. Driscoll said. “Insurers recognize that the size of our company does not hinder the level of quality service provided.

We anticipate growth in our business as a result of the respect earned among our peers.”

And if the upward trend noted over the last few years continues, PECS will increase its staff count accordingly.

At this time, the firm has three fulltime staff. Three years ago, W. Driscoll sold his shares in the company to R. Driscoll and Arsenault. He continues to work as a field adjuster on a contract basis. There is only one official office, but R. Driscoll jokes that their wives might say the family homes serve as satellite offices on the weekends and holidays.

Office environment The office, centrally located in Charlottetown, is a place where both family and a sense of humour are top priority. “Mutual respect and friendship make the office run like a welloiled machine,” R. Driscoll said. “We realize that a successfully managed office is beneficial to us and our clients.”

The office manager, Gloria MacWilliams, recognizes how important her role is in keeping the day-to-day operations running smoothly. She is, “the brains of the operation,” R. Driscoll said. And the decisions surrounding the day-to-day operations are deter-

mined by collaborative input from all staff. “There is flexibility in our office that wouldn’t be available in most others,” he added.

A further benefit to being a small firm is the ability to make changes quickly. The individual protocols and needs of a client can be implemented and tailored with ease. “Clients know that we are very approachable and that we want and encourage feedback in order to improve our business,” R. Driscoll said. “Being a smaller firm enables us to connect with clients on a more personal level because they know we are the company.”

The perfect storm But with all the benefits, also come challenges. One of the biggest of these is competing with larger firms for national contracts with insurers. “We have lost great clients as a result of national deals in the past, but most have eventually returned and continue to be clients today,” R. Driscoll said. “Our clients realize that we will go above and beyond to provide top-notch service in order to obtain and retain business.”

R. Driscoll describes the firm’s greatest challenge to date, something he refers to as ‘the perfect storm.’ The residency clause for obtaining an adjusting license was retracted by the provincial government, so adjusters residing elsewhere in Canada could handle claims in P.E.I. The change in legislation tripled the number of adjusting licenses issued. That same year, the minor injury cap for automobile claims came into effect, which drastically reduced the number of assignments for claims, R. Driscoll said. To www.claimscanada.ca

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“Our clients realize that we will go above and beyond to provide top-notch service in order to obtain and retain business.” boot, P.E.I. experienced a mild winter, which resulted in fewer weatherrelated claims. “Despite these factors, PECS continued to thrive by providing timely and quality service,” R. Driscoll said.

Maintaining a membership in the CIAA has allowed this smaller firm to leverage a large national body of similar firms. Being a member of the Canadian Independent Adjusters’ Association allows the firm a connection to a large national body. This provides the opportunity to interact with other companies, particularly similar smaller firms, to discuss the unique issues and challenges they face, and how they overcome them.

Exceeding expectations The firm has always operated under the mindset that is has to exceed the competition in terms of response, efwww.claimscanada.ca

p20,21 SPOTLIGHT.indd 21

ficiency and expertise in order to set themselves apart from the large national firms.

“We don’t have a marketing person visiting insurers looking for business,” R. Driscoll said. “We believe that our quality service is our marketing tool. We also have strong support from brokers as they are familiar with the level of service and expertise that we can provide to their clients.”

The firm’s partners say they believe their inter-personal skills help them stand out among the competition. Being able to relate with claimants in a professional manner during a stressful situation is imperative. “Our experience has enabled us to become very effective communicators,” R. Driscoll said. “Knowing what to say and when to say it goes a long way with most people.

“Having a claimant thank you for listening, caring and being profession-

al is always satisfying, especially after having to tell someone that their policy unfortunately doesn’t cover their loss.”

PECS would like to continue growing its operation within P.E.I. The challenge, although, not dissimilar from the challenge facing others in the industry is finding people interested in pursuing a career in adjusting. “We have to show that this is interesting and challenging work that is everchanging,” R. Driscoll said. “Every day is different. We believe this appeals to certain individuals who want to be challenged. The key is to locate them.”

But they will have time, because PECS has no plans on going anywhere. As R. Driscoll laughs, “We expect to continue offering quality claims service for many more years to come, since a lack of talent has prevented us from becoming professional golfers.”  June/July 2011

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55 and Older

Tailoring file management to address the unique issues facing clients 55 years of age and over

BY JUDY FARRIMOND AND ANGELA VERI

Although we like to think of 60 as the new 40 and 40 as the new 20, the reality is that time marches on — especially regarding physiology.

With common issues such as extended healing timeframes, susceptibility to secondary infections and mobility problems, motor vehicle accident (MVA) clients who are 55 and older benefit from a specialized approach to rehabilitation.

Treating them as if they are from a younger population group does not address their unique needs and, as a result, decreases effectiveness.

Age increase = unique medical history issues There is just no avoiding it: With longevity comes history. Consequently, although medical history is important for all clients, it is especially relevant regarding those 55 and older.

Common medical histories for those 55 and older include: • Previous hip or knee pathology/dislocation (affecting prior mobility and conditioning) • Degenerative changes in lumbar and cervical spine (causing pain in the neck, shoulders and lower back) • Diabetes mellitus (a contributing factor to numbness and tingling) • Decreased healing properties of tissue due to previous pathology or systemic disease • Depression (anti-depressants may cause motor dysfunction, visual im22 Claims Canada

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pairment, and cognitive and attention decline)

Age increases = unique physiological issues Younger population groups are not yet affected by a range of physiological changes and barriers that are common for those 55 and older. As we age, common physiological changes include: • Decreased skin sensation, larger adhesions and tissue shortening due to diminished extensibility of muscles • Susceptibility to secondary infections • Extended healing timeframes • Memory issues. A 2001 Statistics Canada survey notes, “Activity limitations related to memory problems are often associated with aging.

Among adults aged 65 and over, 153,000 persons reported being limited by memory problems or periods of confusion, representing 4.3 per cent of Canadian seniors.”1 A consequence of the unique medical history and physiology of the 55 and older population is that they have a range of specialized needs. In addition, this age group often has a range of unique lifestyle issues that also translate into a variety of distinct needs.

Age increases = unique lifestyle issues Increasingly the 55 and older population aims to live independently as long as possible. This goal is becoming a reality for many, making access to community support networks more important than ever.

In addition, a focus on support is also important. Although people are working longer and living indepen-

dently longer, as people age there is still a trend toward social isolation. This is due to a range of factors like mobility, geography, and longevity of family and peers. “While seniors generally have good social support networks, compared to other Canadians, they are more likely to be socially isolated: 8% of seniors reported having no close relatives; 14% having no close friends; and 13% having no “other” friends,” according to Seniors in Canada 2006 Report Card.2 Trends also reveal that many people are now working into their seventies often in work arrangements that include contract and part-time work assignments.

As a result, vocational planning may also be a requirement of the rehabilitation plan. However, any vocational planning must address this population’s unique issues. Standard return-to-work programs and functional abilities evaluations must carefully monitor any pre-existing limitations and modifications that were present prior to the motor vehicle accident.

Tailoring rehabilitation to meet specialized needs To help guide file management, there are a number of questions to consider when working with a client who is 55 and older. If any of the following issues are present, consider an approach specialized for this age group.

Medical history and physiology: Does the 55 and older client: • have extensive pre-MVA medical history? Before initiating treatment, it is www.claimscanada.ca

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especially relevant to address medical history for those 55 and older.

• Show signs of pre-MVA de-conditioning? According to a Health Canada report, “More than four out of five seniors living at home suffer from a chronic health condition, this proportion being slightly higher among senior women than senior men. The most common chronic health problems reported by seniors are arthritis and rheumatism, followed by high blood pressure, allergies, back problems, chronic heart problems,” making assessment of prior de-conditioning critical as it may negatively impact recovery.3 • Have pre-existing mobility issues?

According to a Statistics Canada 2001 survey, 23.3 per cent of adults aged 65 to 74 reported mobility problems with the rate climbing to 42.9 per cent for those 75 and older, making comprehensive assessment of pre-accident mobility status critical.4 • Suffer from complex or multiple injuries? Expertise of professionals experienced with this population to ensure the use of assessment tools especially relevant for this population.

Lifestyle: Does the 55 and older client: • Require assistance with re-integration to home and community through discharge planning and other support services? Longer healing

timeframes and range of pre-existing conditions makes early intervention critical.

• Have responsibilities as a primary caregiver? The client could be the primary caregiver for a partner aged 55 and older. Or perhaps has the dual responsibility of caring for elderly parents as well as children, making the need to assess additional assistance requirements increasingly important.

• Live in a remote geographic location? Early intervention is especially critical for this age group. However, remote locations often don’t have immediate access to the range of healthcare professionals that may be required.

• Lack medical, family, and/or community support? Trend toward living independently as long as possible makes the assessment of community, social and medical support increasingly relevant for this age group.

• Show signs of psychosocial changes since the MVA? Addressing psychosocial functioning pre- and postMVA, and relating the information to an overall rehabilitation plan facilitates timely recovery.

• Needs vocational issues assessed?

Vocational assessment may be required since the largest percentage of today’s workforce is 45 years or older.

• Resides in a convalescent or adult living environment? Issues like trans-

portation and disruption of regular routine may need to be taken into consideration.

Specialize the approach A range of unique issues related to everything from medical history to physiology to lifestyle, makes early intervention especially critical for the 55 and older population. Recognizing that this population has special needs — and matching these needs with a rehabilitation approach that is tailored to these needs — is the best way to make sure that your 55 and older clients receive intervention as early as possible.

This will consequently mean the client will receive the best start toward maximum recovery.  Judi Farrimond is the supervisor of complex and catastrophic services and Angela Veri is the national director of customer relations at Sibley & Associates LP. 1. A Profile of Disability in Canada, Stats Canada, 2001 2. Seniors in Canada 2006 Report Card, National Advisory Council on Aging, Government of Canada, 2006 3. Canada’s Aging Population, A report prepared by Health Canada in collaboration with the Interdepartmental Committee on Aging and Seniors Issues, 2002 4. A Profile of Disability in Canada, Stats Canada, 2001

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Taking a

bite theft out of

Vehicle theft is the number two claim insurers have to face today

BY ANTHONY MANNELLA

Car theft costs Canadians about $1.2 billion a year, including health care expenses, court policing, legal and out of pocket costs such as deductibles, according to the Insurance Bureau of Canada. The average auto claim in Toronto is $34,858 (outside of the Greater Toronto Area, this figure drops to $11,067), Moneyville reports.1 These losses are made up through insurance premiums, costing each Canadian policyholder. Factor in other vehicle thefts, such as cargo and heavy equipment and you start to get a clearer picture of a potential epidemic.

So why is vehicle theft so rampant in Ontario? It has a lot to do with in24 Claims Canada

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sufficient legislation and ineffective current laws. Car thieves know their penalty is merely a slap on the wrist.

They are charged under the Criminal Code with possession of stolen property over $5,000 or with theft over $5,000. Repeat offenders and those charged with multiple thefts rarely face jail time. In fact, police often arrest the same miscreants who are the front line for a more clandestine group which operate behind the scenes. Until Nov 5, 2010, border and customs officials had no power to inspect and seize suspicious shipping containers of vehicles leaving the country. However, the implementation of Bill S-9 provides tough action on property crime, including the serious crimes of auto theft and trafficking in property that is obtained by crime. This is

a great first step in stopping vehicles from leaving the country. The bigger challenge is: How do we prevent vehicles from being stolen in the first place? Consumer education has helped by encouraging common sense behaviours such as locking doors and not leaving the car running while unattended, to name a few. Standard 114, under the Motor Vehicle Safety Act, mandates that all vehicles under 4,536 kg GVWR manufactured after Sept. 1 2007 must be outfitted with an electronic immobilizer. These measures have helped by stopping the petty or quick and easy theft. It has done nothing for theft as a result of organized crime.

There is a misconception that vehicle theft is a victimless crime. However, there are plenty of reports and www.claimscanada.ca

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examples contradicting this misjudgment.

Through vehicle theft, terrorists fund their operation. Home invasions and business break and enters typically occur with a stolen vehicle.

Bomb deployments in other parts of the world have been often a result of a plated North American car packed with explosives.

Of course, I have just identified the theft as a pure claim item from an insurer’s standpoint. What is not clear and harder to define is the sundry costs to vehicle theft. The figure of $1.2 billion could be substantially larger when miscellaneous costs are considered. For example, medical costs due to mental or physical trauma. These costs are shouldered by taxpayers and through accident benefits of insurers. A theft always requires additional support from police and possible emergency services. These costs are paid by the taxpayer. Business break and enters could leave a business inoperable for weeks, thereby putting people out of work. This leads to business interruption claims.

In some cases, insurance could be inadequate which could lead to noncompensable losses. Almost everyone can consider scenarios where the spin off from vehicle theft has far-ranging ramifications. Of course, no one can put a price on loss of life as the result of vehicle theft.

Although there has been a noble attempt to eliminate the problem, it still exists. Although harsher penalties are needed, a more permanent fix is required. The governing bodies have the power to implement change, however they first need to embrace current world-class initiatives and solutions.

Car manufacturers have built-in anti-theft technology, which is inadequate for a seasoned thief. A properly installed three circuit immobilizer has been identified as an almost foolproof deterrent, as reported in other parts of the world where theft is a much greater issue. With the proper technology installed, thefts decrease and a subsequent reduction in claims.

This scenario already exists in Manitoba. The provincial government, as www.claimscanada.ca

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an insurer, enforced electronic immobilization in September 2007 and has reaped the rewards of its action.

The city of Winnipeg has recorded up to a 75 per cent reduction in car thefts alone. By 2014, the province estimates a savings of up to $157,324,000 due to the immobilizer program. To date, the province has saved $31,586,000 due to enforcement of proper immobilization. These numbers are purely based on theft claims for cars and does not take into account cargo and

heavy equipment theft, as well as associated sundry costs.  Anthony Mannella is a corporate sales consultant with Ontario Security Solutions.

1. http://www.moneyville.ca/ article/846694--toronto-auto-insurance-claims-average-cost-34-858

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2

A Tale of

2

Two Cars

BY DANIEL STRIGBERGER

“I know a lot about cars, man. I can look at any car’s headlights and tell you exactly which way it’s coming.”

— Mitch Hedberg, comedian The Financial Services Commission of Ontario (FSCO) has decided that 2011 will be the “Year of the Automobile.” Herein is a tale of two incidents involving two very different types of machines on wheels. In both cases, people were injured while riding on such machines. They each applied to different automobile insurers for accident benefits. Their claims were denied, as accident benefits are meant for victims of automobile accidents. Both insurers decided that their respective claimants were not involved in automobile accidents — or so they thought.

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How to make an automobile The Ontario Court of Appeal held in Adams v. Pineland Amusements that the following three-part test must be used to determine whether a vehicle is an automobile: (i) Is the vehicle an automobile in ordinary parlance? (ii) If not, is the vehicle defined as an automobile in the wording of the insurance policy? (iii) If not, does the vehicle fall within any enlarged definition of “automobile” in any relevant statute?

With respect to the third part, section 224(1) of the Insurance Act provides the following definition for the word automobile: ““automobile” includes, (a) a motor vehicle required under any Act to be insured under a motor vehicle liability policy, and (b) a vehicle prescribed by regulation to be an automobile.”

Therefore, where a vehicle isn’t an automobile in ordinary parlance and is otherwise not defined as an automobile in the policy, it can become an automobile if it meets the criteria in section 224(1) of the Insurance Act: Either it is prescribed by regulation to be an automobile or it is a “motor vehicle” required under

any other Act to be insured under an auto policy. Of course, the Insurance Act does not define motor vehicle, but the Highway Traffic Act does.

With some exceptions, the definition of motor vehicle includes any vehicle propelled or driven otherwise than by muscular power.

So a motor vehicle that is required by law to be insured is considered to be an automobile for the purpose of automobile insurance in Ontario. With that in mind, our tale begins:

An automobile by any other name: Buckle v. MVACF Wilhelmina Margaret Buckle was injured when she fell off a moving golf cart. By all accounts, at the time of the accident the golf cart was being operated on a public highway illegally: It was unlicensed, unregistered and uninsured. The parties agreed that the golf cart was neither an automobile in ordinary parlance nor defined as an automobile in the policy. The arbitrator found that the golf cart was a motor vehicle, as it was self-propelled.

Therefore, the arbitrator had to decide whether the golf cart was required to be insured at the time of the accident.

The arbitrator found that because www.claimscanada.ca

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the golf cart was a motor vehicle, under the Compulsory Automobile Insurance Act it was required to be insured at the time of the accident because it was travelling on a highway when the accident occurred. Therefore, pursuant to the definition of automobile under section 224(1) of the Insurance Act, the golf cart was an automobile at the time of the accident.

We can assume that the golf cart returned to being a non-automobile once it left the highway.

Arbitrator pulls automobile from pocket: Bouchard v.

Motors Cassondra Bouchard had a friend named Kristin Stratton, who owned a couple of pocket bikes (described as gas powered miniature motorcycles).

Stratton would ride the bikes on his own property and on a friend’s property.

On Jan. 13, 2008, Bouchard was riding one of the pocket bikes on Kristin’s property, when she collided with one of Kristin’s other pocket bikes and sustained injuries.

Working with an agreed statement of facts, the arbitrator determined that the issue was whether the pocket bike was required to be insured under a motor vehicle liability policy. First, she found that the pocket bike was an offroad vehicle under the Off Road Vehicles Act. Next, she noted that pursuant to section 15 of the Act, the pocket bike was required to be insured under a motor vehicle liability policy unless it was driven on land occupied by the owner (Stratton) of the bike.

Even though the accident happened on Stratton’s land, the arbitrator found that it was nevertheless required to be insured. Her decision apparently turned on the evidence that Stratton would drive his pocket bikes at a friend’s house. She stated, “[c]learly the legislature intended that off-road vehicles be insured unless they were used solely on lands occupied by the owner.” [emphasis added].

In other words, according to this decision it appears that once the owner of an off-road vehicle uses the vehicle on lands not occupied by them, the off-road vehicle transforms into an www.claimscanada.ca

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automobile forever. There’s no turning back.

Would you insure my threeyear-old?

At this rate, it seems that the “ordinary parlance” test has gone out the window (of a moving automobile).

Suppose my three-year-old drives his Power Wheel Diego Jeep Wrangler on the road. It would likely meet the definition of motor vehicle under the Highway Traffic Act because it is a “ve-

hicle propelled or driven otherwise than by muscular power.” Therefore, while on the road it would also require auto insurance, pursuant to the Compulsory Automobile Insurance Act, and, accordingly, it would be considered to be an automobile under the Insurance Act. Go Diego Go!  Daniel Strigberger is a partner in the insurance litigation group in the Waterloo office of Miller Thomson LLP.

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June/July 2011

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Clarified

The Alberta Court Clarifies Limitation Date for Declaratory Judgment

BY DON MCGARVEY AND ANTHONY ESPEJO

In a recent Alberta Court of Queen’s Bench decision, the interplay between policy provisions that stipulate a limitation date for the commencement of an action on the policy and legislated limitation dates was recently examined, leading to a result that will be of interest across the country.

In Schroeder Transport v. Lloyd’s Underwriters, Justice June Ross was called upon to consider whether a contractual limitation period in an insurance policy was paramount to a conflicting limitation period in the Limitations Act, R.S.A. 2000, c. L-12 (the Act).

The facts In Schroeder Transport, a truck driver for the plaintiff company was transporting electrical cable from Quebec to Alberta. During this trip, he stopped at a truck stop to shower and eat. The driver locked the doors of the truck and left the keys under the floor mat in the cab. When the driver returned, the truck, trailers and cargo were gone. The insurer denied coverage relying on exclusions contained in the policy.

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The loss occurred on Mar. 1, 2006. The insurer denied coverage on Apr. 28, 2006. The plaintiff’s Statement of Claim was filed on Apr. 25, 2008, which was more than two years from the date of loss, but less than two years from the denial of coverage by the insurer.

The policy contained a condition that required any action against the insurer for coverage be commenced within 24 months of the date of “discovery by the Insured of the occurrence which gives rise to the loss . . . ”.

This is to be contrasted with s. 3(1) of the Act, which requires an action to have been commenced within two years of the date the insured knew or ought to have known that the conduct attributable to the insurer (the denial), occurred that warranted bringing a proceeding.

To further complicate matters, the Court was also required to consider s. 7(2) of the Act, which states that “an agreement that purports to provide for the reduction of a limitation period provided by this Act is not valid.”

In attempting to demonstrate it commenced its action for a declaration of coverage in time, the plaintiff argued the claim was brought within the limitation period as specified by the Act. The Court reviewed case law as well as the Alberta Law Reform Institute’s Final Report No. 90, Limiwww.claimscanada.ca

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tations Act: Standardizing Limitation Periods for Actions on solutely barred unless commenced within one year next Insurance Contracts (August 2003), which expressed a firm after the loss or damage occurs.” This wording is different view that this limitation period would run from the date from that of s. 3(1) of the Limitations Act, whereby injury coverage was denied. was taken to mean the date when the claim was denied. The The plaintiff argued that s. 7(2) of the Act operated to re- above decision can likely be distinguished in the context of move this condition. The defendant argued that s. 7(2) does a fire insurance policy, where the clock begins to run from not apply in this case because this section was not in force the occurrence of a loss or damage. when the loss occurred. The Court noted that while s. 7(2) However, if Schroeder Transport is indicative of a trend was not in force when the loss occurred, it was in force when that our courts are willing and likely to accept the recomthe defendant denied coverage and when mendations of the Alberta Law Reform the plaintiff’s action was commenced.

Institute, then it should be noted that the Therefore, it was a “legal situation that was Institute’s recommendations in Final Reongoing at the time the Limitations Act port No. 90 were as follows: was being modified, so that this was not a 1. The limitation periods for acsituation of retroactive effect, but immeditions on all types of insurance contracts ate effect . . .” should be standardized; Ross stated at paragraph 43: “The inter2. Insurance contracts should be subpretation of the Plaintiff and the Alberta ject to the limitation periods in the LimiLaw Reform Institute best reflects the lantations Act; guage of s. 3(1), and means that the limi3. The limitation periods for all insurtation period runs from the date that the ance should be centralized in the Limitainsured knew or ought to have known that tions Act; and, coverage was denied.” Hence, the plain4. Limitation periods for actions tiff’s claim was not statute-barred. against insurers should commence in acThe Court stated that the limitation pecordance with s. 3 of the Limitations Act. riod commences from the date the insured In its report, the Institute stated, “ . . . knew or ought to have known that coverdifferent limitation periods for each type age was denied. At paragraph 13, the Court of peril creates confusion . . . This conaccepted the plaintiff had made a similar fusion would be minimized if the limiThe Court stated claim under a previous insurance policy tation periods for actions on all types of with identical wording in 2005. In that acinsurance policies were standardized. that the limitation tion the defendant denied the claim, noneStandardizing the limitation periods is a period commences theless, the suit was eventually settled. rational reform as there are no principled from the date the It was open for the defendant to argue reasons for having different limitation the plaintiff “ought to have known” cov- insured knew or ought periods for different types of insurance.” erage was denied the instant the Proof The above rationale echoes the sentito have known of Loss was filed (Mar. 2, 2006) based on ment expressed by Madame Chief Justice that coverage prior experience in a seemingly analogous McLachlin in the Supreme Court of Cansituation. Had the limitation clock started ada decision of KP Pacific Holdings Ltd. was denied. running from that time, the plaintiff’s acv. Guardian Insurance Co. of Canada. In tion would have been statute-barred. that decision, the Court made reference to the insurance statutes in Canada and how they are outImplications and observations dated. She called upon the legislatures to revisit the proviThis decision will serve as a precedent for the proposi- sions, but commented that in the meantime, resolution of tion that the term “injury,” under s. 3(1) of the Act, refers to these issues will fall to the courts.1 Whether this means that when the insurer denies coverage not when the initial loss courts will be attracted to the rationale of the Institute’s recoccurred. ommendations remains to be seen but it certainly appears Further, this case suggests a policy of insurance that to be trending in that direction.  has any provision which might affect limitation periods, as set out in the Act, may be held to violate s. 7(2) of the Act Don McGarvey is a partner with McLennan Ross LLP prac(depending on the dates involved) and any such limitation ticing commercial litigation and commercial insurance. Anclause as set out in the contract of insurance may be invalid. thony Espejo is an articling student with McLennan Ross LLP. This decision should not be blindly applied in every case McLennan Ross LLP is a member of the ARC Group Canada where there is a limitation issue. For example, in the context Inc. of fire insurance, under the Insurance Act, R.S.A. c. I-3, Part 5, Subpart 3, Statutory Condition 14 provides: “��������� Every ac- 1. See para 5. tion or proceeding against the insurer for the recovery of any claim under or by virtue of this contract shall be abwww.claimscanada.ca

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Building Defects Claims for moisture penetration in new buildings continues to rise

BY STEPHEN BLANEY AND JOHN MCGLONE

The performance of modern buildings is an increasingly complex subject. However, there are several fundamentals that can be applied to defects, patterns of defects and adequately managing risk.

Due to varying site conditions, almost all buildings are essentially “one-off prototypes” and, in many ways, it is understandable very few are delivered in perfect condition with no apparent or unnoticed defects. Construction defects occur when finished or partially completed buildings fail to perform as required by applicable contract documents or established standards or codes.

Modern structures, especially with the wide range of climactic conditions we experience in Canada, are extremely expensive. In cases where they fail to function as intended — or demonstrate defects — there are also legal and financial implications that can be significant.

There are a number of issues involved with moisture penetration and/ or accumulation within the building envelope (walls, windows and roofing systems), which have risen dramatically over the past 20 years.

Increasing construction cost The cost of construction, operation and maintenance of buildings will continue to increase over time. As a result, 30 Claims Canada

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the general trend towards seeking legal recourse regarding building defects will likely accelerate in tandem. These are both serious concerns for the both the insurance industry and the construction sector as a whole. The costs involved in rectifying defects in new and existing construction involve the interests of risk managers, brokers, adjusters and insurance companies.

Catastrophic failure In most cases, projects that experience catastrophic failure receive much greater attention than buildings that experience routine claims for defective construction. Take, for example, the estimated 50,000 condominium units that experienced severe water leakage in British Columbia. These have been identified as catastrophic failures due to water penetration. The cost to repair the defects related to drainage ranges from $40,000 to $60,000 per unit on average.

At the present time, however, Canada, and a number of other countries, are actively investigating ways and means to improve the overall performance of their construction industries on an on-going basis.

Unintended deviations Unintended deviations from standardized building practice have a significant impact on quality control and are often not identified until the project is underway or completed. In addition, many buildings have defects that may not be immediately apparent when they are put into service, as was

the case of the condominiums in British Columbia.

In many cases, inadequate understanding of the building code, lack of knowledge and experience regarding good building practice(s) have been identified as concerns. Another cause that leads to cost and time overruns related to repair of construction defects is rework.

On some projects, cost overruns or defects can be traced to lack of communication between the client, designer and the end-user.

The failure to properly commission the building is also a common omission.

Time is money In the construction sector the concept that time means money is a fact of life. As a result, over the past 20 years there has been a significant compression of design and construction schedules. This compression results in overlap of activities and increases the chances of time and cost overruns, which magnifies the potential for the occurrence of defective construction.

Construction defects Claims for deficiencies in the building envelope systems (primarily related to moisture penetration or accumulation within walls, windows, roofing and foundations) have increased dramatically and now comprise approximately 70 per cent of all identified defects. Moisture damage of this nature is considered to be one of the most problematic issues in the industry. www.claimscanada.ca

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However, in spite of the fact that there are ways to prevent these moisture problems, measures to prevent moisture damage have not been widely adopted. This is primarily because of cost-cutting and failure to undertake design reviews, mock-up testing and adequate on-site quality control.

Many building professionals also believe the failure to apply well-established building science principles before and during construction also leads to non-conforming construction and defects. In many cases, the defects are either not noticed or overlooked, leaving insurance professionals at risk for repairs that become apparent at some point in the future.

Modern building envelope construction Unlike the solid robust masonry walls that were used in construction in the past, modern building enclosures now often consist of multiple layers of lightweight construction materials. As a rule, each layer serves a very specific function.

In order to avoid or eliminate water penetration or absorption, careful detailing and construction is essential to ensure adequate performance. These items must also take into account the complexity of using these principles for the wide range of climate conditions in Canada.

When undertaking detailed inspection, a lack of continuity is observed.

This results typically from using four different layers and because there are numerous interruptions, transitions or penetrations at wall/window intersections. The ‘interface’ of materials is always prone for error.

Many modern buildings use sealants around such penetrations (face seal construction) and sealants do not reliably or adequately accommodate differential movement over the required service life of the assemblies.

Risk and cost reduced Building science and engineering professionals estimate the cost of defects in new construction represents approximately 10 per cent of building value. There is general agreement that www.claimscanada.ca

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the potential exposure (if claimed) could be greatly reduced by utilizing a combination of accepted techniques.

These would include application of accepted building science principles, (including adequate on-site quality control measures) and enforcing existing building code regulations.

Defects could also be prevented by undertaking much closer review of the design and schedule during the building permit application process.

In our experience, the insurance industry can guard against losses due to repairing defects in new and existing construction by anticipating the pattern of defects, adequately managing their risk and by thoroughly evaluating claims for defects to let the fault lie where it may.  Stephen Blaney is president and John McGlone is a principal engineer at Kleinfeldt Consulting Limited (KCL).

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20/06/11 3:23 PM

Drinking Water Flows Again

Homemade explosive renders drinking water unsafe for consumption

BY KAREN SCHMIDT

When the Lac La Croix First Nation Reserve in Northern Ontario had a homemade explosive thrown into its water treatment facility by vandals, it not only caused extensive fire damage, but created unsafe drinking water for the residents. Bottled water had to be trucked in from Fort Frances — 190 kilometers away.

Flames were drawn under the door and ignited flammables inside the building, causing extensive fire and smoke damage. The building’s internal structure, finishes and the water treatment mechanicals were severely affected. Soot and smoke residue covered the interior of the facility and melted materials were hanging precariously over the water treatment beds. The drinking water supply was immediately shut down. Plant operators and Health Canada had further concerns about the contamination of the non-potable water supply. Keeping the water treatment facility operational for uses other than consumption was necessary. But, falling debris during the restoration process could further pollute the reservoir. A simultaneous remediation and restoration project would need to take place.

There were two main sections in the building. One area contained the two filter beds, with the second area housing the pump and supporting mechanical systems. Adjacent to the mechanical room was a combination control room, office and utility closet.

The concrete floor, block walls, metal panel ceiling, insulated attic and a wood truss roof had all been damaged.

It was determined the most prudent course of remediation was to utilize a dry ice blasting system to remove soot from surfaces in the building, including electrical and pumping systems.

There is virtually no fallout associated 32 Claims Canada

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with the use of this system, and it is the quickest and most efficient method to remove heavy soot. A supported temporary floor served a dual purpose: the protection of the non-potable water and as a platform to allow access to overhead space and to the far end of the filter beds. The floor restricted the maintenance of water production, depleting the community’s water source by 50 per cent. All electrical components throughout the building were replaced, in addition to the damaged door, ceiling materials and insulation, along with smoke sealing and painting of all surfaces. Tasks were often conducted simultaneously for cost efficiencies and a speedy reconnection to the Reserve’s drinking water. Several sub-contractors, including mechanics and electricians, were recruited to provide specialized services within their areas of expertise. It was vitally important to forecast and pro-actively plan for potential stumbling blocks that would impair the work schedule.

Located approximately 350km south west of Thunder Bay, the final 90 kilometers to the Reserve is unpaved logging roads. The remoteness of the location presented a number of unique challenges: accessible lodging and food, limited supplies, limited number of local sub-contractors, wildlife, sharing the road with logging trucks, communication (cell phone service was sporadic at best, and there were issues with reliable internet and email access), and no access to gas or diesel on the Reserve.

To ensure the safety of workers and protect time and cost efficiencies, all of these challenges needed to be addressed. Accommodation and food was arranged with a fishing camp located across the lake from the water treatment facility. A water taxi carried workers to and from the job site. Staff was scheduled on two-weeks-on and one-week-off shifts to allow for time to

rejuvenate and spend time with families. Wildlife safety concerns were addressed by providing information and tips on wildlife behaviour and what to do if confronted by an animal in the wild. The buddy system was utilized whenever possible. Local residents, with experience in navigating gravellogging roads, were hired to transport workers. When cell phone and landlines failed, short wave radios provided two-way communication. Management of staff, including team-building exercises, kept workers engaged and motivated.

A team, consisting of a project manager, independent adjuster, insurance company, reserve band manager, Health Canada and sub-contractors, worked diligently together to ensure success by recognizing roadblocks and potential obstacles before they happened. The Lac La Croix claim presented an excellent opportunity to acquire new skills and best practices that may be utilized for future opportunities in isolated areas within Canada.

This unique and very rewarding project was successfully completed in only eight weeks and clean drinking water was once again flowing from the facility to the residents of the Reserve.  Karen Schmidt is a senior project manager with Strone. www.claimscanada.ca

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CICMA A.C.D.S.A. Canadian Insurance Claims Managers’ Association

ANNUAL GENERAL MEETING September 19, 2011

The Ontario Chapter (Toronto) of the C.I.C.M.A. is honoured to host this years AGM, welcoming delegates from across the country. This year’s program will be a panel of senior claims executives focusing on claims issues of National interest.

Annual General Meeting: 10:00 • Claims Executive Panel: 11:00 Lunch: Noon CICMA MEMBERS FREE – On a first come basis Guest $50.00 (if space permits) The International Centre 6900 Airport Road Mississauga, Ontario Northeast corner of Airport Road and Derry Road. www.internationalcentre.com Members are encouraged to join us!

Please e-mail you intention to attend to Vita Bulovas, vbulovas@ibc.ca Space is limited so act quickly to reserve your spot.

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No-Fault

Deduction of No-Fault (Part 7) Benefits from Motor Vehicle Accident Damages Awards in British Columbia

BY BARBARA L DEVLIN AND GREGORY S. PUN

If a window from your building falls and injures a driver of a vehicle, can your insurer deduct no-fault benefits paid to the driver?

Insurers and adjusters who deal with insureds in British Columbia may wish to note an interesting and difficult nuance in damages law in motor vehicle accident cases.

While the obvious situations involve insureds who are motor vehicle accident defendants with automobile insurance coverage (with B.C. or non-B.C. motor vehicle insurers), the problem arises in those occasional cases involving insureds who are not motor vehicle operators and who are, accordingly, looking to CGL or other non-automobile coverage.

The paradigm situation, which raises no particular difficulty, is where a plaintiff is injured in a motor vehicle accident by a defendant also driving a vehicle and covered by an automobile policy. In B.C., the defendant’s coverage is usually with ICBC, but coverage could be with any automobile insurer (e.g. where the defendant is from out of province).

In such cases, the no-fault benefits (called “Part 7 benefits” in B.C., and sometimes called “Section B benefits” in other provinces) received by the plaintiff from ICBC (under the plaintiff’s first party coverage) are deducted from the tort award of damages and judgment is entered for the balance of damages awarded.

No deduction is made But consider another example, less common but entirely plausible: A plaintiff (owner/driver) is injured because, and only because, a plate glass window falls off a building onto the plaintiff’s car. The plaintiff likely receives no-fault benefits from ICBC. No other defendant is in play. Obviously, the building owner is not covered for this situation under an automobile policy; rather, the building owner calls on its CGL coverage. It might be thought, especially by the build34 Claims Canada

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ing owner and its insurer, that the plaintiff’s no-fault benefits should be deducted from the tort award, as is usually done. But actually, in this circumstance, the deduction is not made.

In short, the deduction of no-fault benefits is only made where there is at least one defendant covered under an automobile insurance policy. In the hypothetical above, as there is no defendant covered by automobile insurance, no deduction would be made for the Part 7 benefits received by the plaintiff.

Court decisions The usual deduction of no-fault benefits is based on Insurance (Vehicle) Act, R.S.B.C. 1996, c. 231, s. 83 (before June 2007, this was the Insurance (Motor Vehicle) Act, R.S.B.C. 1996, c. 231, s. 25). Although the wording of s. 83 appears to be substantially different than its predecessor, the meaning and effect is virtually identical. The well-recognized legislative intent of the deduction is: (1) to shift responsibility from the tortfeasor to the no-fault insurer, and (2) to prevent double recovery; Fisher v. Wabischewich; Baart v. Kumar. The wording of s. 83 (and earlier, s. 25) is not crystal clear that the deduction applies only where the defendant is covered by an automobile policy. However, it has been expressly held that deduction only applies in cases involving a defendant insured by an automobile policy. At the same time, it has been held that the deduction applies not only to defendants insured by ICBC, but to any defendant insured by any automobile insurer. This is the effect of the B.C. Court of Appeal decision in Ruckheim v. Robinson, where it was said (emphasis added): “I think it is clear that the purpose of [what is now s. 83] was to continue to provide that benefits were only deductible where the tortfeasor was insured under a contract of automobile insurance. . . . and does not apply where the tortfeasor is not so insured . . . www.claimscanada.ca

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I respectfully agree [that the deduction applies to those] Although the current Insurance (Vehicle) Act s. 83 is who are insured by a policy of automobile insurance. In so rather differently worded, its overall tenor is similar to its stating, however, I would not limit the protection afforded by legislative predecessors. Accordingly, it is most likely that, the section to I.C.B.C., but extend it to any if faced with the question again in light of automobile insurer.” the wording of s. 83, a court today would One final nuance of This conclusion stemmed not so much follow Ruckheim. note is that the from the clear words of the section (then One final nuance of note is that the s. 24), but from the nature and purpose deduction applies so long as at least one deduction applies of the legislation overall. The Court in defendant is insured by an automobile so long as at least Ruckheim started by looking at the origipolicy. In a multi-party motor vehicle one defendant is nal automobile insurance legislation (enlawsuit, it is highly likely that at least one acted in 1973) and held in part (emphasis defendant will be covered by automobile insured by added): “Similarly, s.-s. (5) was concerned insurance (either ICBC or other insurer). an automobile with the liability of the tortfeasor whose liAccordingly, the s. 83 deduction will be policy. ability … was reduced to the extent of the made, to the benefit of all the defendants payment of the no-fault benefits. Again, (even those not insured under automobile that subsection applied only where the tortinsurance). This is the result of the decision in Brennan v. Singh. (Incidentally, feasor was insured under a contract of auon appeal, the Court of Appeal expressly tomobile insurance.” refused to consider this part of the trial The Court noted that the 1977 replaceCourt’s reasons and dismissed the appeal ment legislation, which was very differently worded, was to the same effect on other grounds.)  (emphasis added): “This scheme of making no-fault benefits deductible only where the tortfeasor was insured under a conBarbara Devlin is a partner with Alexander Holburn and tract of automobile insurance was continued in 1977.”

Gregory Pun is the director of research and head of the appeals The Court then came to the same view about the legislation practice advisory team at Alexander Holburn. They are both as it stood in the case at bar in 1995 (in para. 63, quoted above). members of Canadian Defence Lawyers.

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EF

• education forum

A SERIES OF ARTICLES PROVIDED BY THE INSURANCE INSTITUTE OF CANADA

Adjusting to

SABS: Getting a Grip on Serious Injuries

A

s a result of Ontario’s new Statutory Accident Benefits Schedule (SABS), which came into effect last September, the adjuster’s role in Ontario auto accident claims has changed. In this issue of Education Forum, we look at some of the knowledge and skills adjusters will now need to bring to these claims.

Under the new SABS, adjusters have more authority to make decisions on a file and a little more time to investigate the validity of a treatment plan. And the lower limit for medical rehabilitation coverage for minor injuries, coupled with the insurer’s duty to keep claimants informed about how that money is being spent, means that adjusters will need to be thorough in determining benefit entitlement and the reasonableness of expenses.

Adjusters now need to develop a broader understanding of serious injuries and how the various facets of injury, assessment, treatment options and coverage fit together.

Knowing major from minor Adjusting claims under the new SABS first requires understanding the classification of injuries, and in particular the categories of minor and catastrophic injuries.

According to the Minor Injury Guideline (MIG), minor injuries include “sprain, strain, whiplash associated disorder, contusion, abrasion, laceration or subluxation and . . . any clinically associated sequelae to such an injury.” In general, a claimant who has sustained these kinds of injuries is subject to a limit of $3,500 for medical and rehabilitation benefits.

However, if the insured person has a pre-existing medical condition that would prevent the person from achieving maximal recovery from the minor injury if subject to that limit (and if this is supported by compelling evidence from a health practitioner), then the MIG does not apply.

At the other end of the SABS injury classification scale, catastrophic impairments include paraplegia or quadriplegia, the amputation or permanent loss of use of a limb, the total loss of vision in both eyes, certain specified levels of brain impairment, an impairment or combination of impairments resulting in a 55 per cent or more impairment 36 Claims Canada

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of the whole person, and a class 4 or 5 impairment due to mental or behavioural disorders. Catastrophic impairments are eligible for up to $1 million in coverage.

Although the “cat” category is clearly defined, injuries initially designated under other categories sometimes subsequently develop into conditions that fit the cat definitions.

When handling a claim file, all medical information should be gathered and monitored closely, even if the person is not deemed catastrophic at the outset. During the recovery period, psychological and physiological factors can develop that may result in the insured being redefined as catastrophically impaired.

Another important distinction is between an impairment and a disability. An impairment is a physical or psychological effect on a person, whereas a disability is a limit to a person’s social or personal function. Injuries in the cat category lead to impairments that often result in permanent disabilities. Injuries in other categories such as the MIG may not lead to impairments but can result in disabilities.

Tools of the trade Understanding whether or not a claim legitimately fits within a given injury classification requires understanding basic human anatomy and a range of medical terminology. Where the cat category is concerned, familiarity with guidelines such as the Glasgow Coma Scale, the Glasgow Outcome Scale and the American Medical Association’s Guides to the Evaluation of Permanent Impairment is helpful as well.

Adjusters also need to be familiar with the elements of various medical reports, such as ambulance call reports, clinical notes and records, disability certificates, treatment plans and assessment reports. All medical reports have specific information that must be captured. Knowing the roles of these reports in effective injury management and case resolution will help adjusters to determine whether treatment and rehabilitation expenses incurred are reasonable.

The various medical reports in a claims file should present a clear picture of the claimant’s injuries and impairments, the effect of these on the person’s life, the plan to return the www.claimscanada.ca

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person to maximum function, and the benefits the person is eligible to receive.

Where medical reports present conflicting opinions, adjusters need to be prepared to explain why one opinion is preferred over another. This, in turn, may involve asking follow-up questions of health practitioners or medical legal experts.

Examining further If the medical information on a claim is insufficient and facts need to be confirmed in order to make a decision on a file, an insurer may request an insurer’s examination. For example, if an injury is initially classified as minor but the medical practitioner subsequently decides that it is more serious and requires additional treatment, an insurer’s examination may be set up to verify the revised diagnosis.

Under the new SABS, adjusters have discretion in deciding whether or not an insurer examination is warranted — which means they need to understand what kind of information is required to support decisions in various kinds of injury situations. Adjusters also need to know how to choose the appropriate medical assessor, distinguishing between physiatrists and physiotherapists, psychiatrists and psychologists, neuropsychologists and neurologists — among others.

Looking ahead Determining benefit entitlement is not just a matter of assessing a claimant’s condition at a given point in time;

it also requires looking to the future. For serious injuries, especially catastrophic ones, adjusters need to differentiate between acute and chronic injuries. They must integrate medical information with other actuarial information to establish an appropriate course of action for future rehabilitation.

As they bring all these new medical management skills to bear on a claim, adjusters will need to maintain a focus on understanding the injury and how it affects the person.

They will need to develop skills for dealing appropriately with their own emotional reactions to others’ pain and trauma. And finally, throughout the process, they must also maintain the usual good claims-handling practices: gathering all relevant information, handling correspondence carefully, advising the claimant about the process and about the benefits they may be eligible for, and so on.

In the next issue of Claims Canada, Education Forum looks at some of the other knowledge and skills that adjusters working under the new SABS now need.  This article is based on excerpts from the study material in the Understanding Serious Injury series of workshops — a new supplementary training program launching later this year, developed specifically for adjusters by the Insurance Institute of Ontario and the Ontario Insurance Adjusters Association.

Disaster Restoration Services

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• on the scene OTS Region Spotlight: Ontario

Regional president: Richard Swierczynski, AZ Claims Services Inc., president, phone: 905-825-0027, fax: 905-8255543 First vice president and chair of sick & vigil committee: Teresa Mitchell; Crawford Global Technical Services, senior adjuster, phone: 705-728-5597, fax: 705-728-2167 Treasurer and chair of convention committee: Dorothy Lowry, Crawford & Company (Canada), senior accident benefits adjuster, phone: 705-728-5597, fax: 705-728-2167 Secretary: Steve Del Greco, Crawford & Company (Canada), branch manager, Toronto West, phone: 416-620-7700, fax: 416-620-7511 Director of northern region: David Marshall, Crawford & Company (Canada), branch manager, phone: 705-9421300, Fax: 705-942-3060

Canpro Global Services Inc. and King-Reed & Associates LP have amalgamated to create the largest full-service risk mitigation and investigation company in Canada.

Canpro Global Services Inc., headquartered in Vancouver, has 11 offices throughout Western Canada. With more than 300 employees, it produces risk mitigation services through its five subsidiaries — investigations, HR services, risk solutions, training resources and labour risk management.

King-Reed & Associates LP is an investigations firm headquartered in Toronto with a staff of more than 170. Since 1984, King-Reed has served the corporate, legal, insurance and financial markets, providing investigations in the areas of fraud, intellectual property, due diligence, surveillance, pre-employment screening, intelligence gathering services and threat risk assessments.

The new organization, Canpro King-Reed LP, will have combined annual revenues in excess of $40 million.

Client sectors include government, corporate, financial, legal, extractive and insurance industries. Client services include investigations, security and risk consulting, preemployment screening, occupational health and safety and labour risk management.

The combined firm will deliver uniform reporting and methodology and a single point of contact for national coverage. Clients will now have access to expanded technology, geographic coverage, resources and industry specialists across Canada and in some international locations.

The merger is the result of the private equity investment in both firms by Granite Global Solutions.

“Granite Global Solutions is proud to have facilitated bringing together these two great Canadian success stories that complement each other perfectly and can seamlessly continue to grow and develop in new and existing markets.” said Murray Wallace, president and CEO of Granite Global Solutions. l

Director of central region: Scott Clements, Pinnacle Adjusters Group, president, phone: 416-362-0800, fax: 416-362-1608 Chair of education committee: Kelly Stevens, Crawford & Company (Canada), assistant branch manager, phone: 416-620-7700, fax: 416-620-7511 Chair of licensing committee: Edgar J. Lethbridge, Lethbridge Adjusting Ltd., president, phone: 905-275-4904, fax: 905-275-4909 Director of eastern region: Pat O’Shaughnessy, PCA Adjusters Ltd., senior adjuster, 613-962-9556, fax: 613-9629596

Raymond Smith

Grant King, president of the Canadian Independent Adjusters’ Association’s Nova Scotia region, presents Gilberte Theriault of the Insurance Women’s Association of Nova Scotia with a $500 donation to Women in Insurance Cancer Crusade. l

Director of western region: Spencer Baily, McLarens Canada, branch manager, phone: 519-858-8888, fax: 519858-2588 Chair of membership: Maria Joshua, McLarens Canada, branch manager, accident benefits. phone: 905-740-0034, fax: 905-671-1889 Chair of editorial committee and chair of industry liaison committee: Georgiana Chen, ProFormance Adjusting Solutions Inc., account executive, phone: 905-420-3111, fax: 905-420-3118. l 38 Claims Canada

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Raymond Smith joined Kernaghan Adjusters’ Toronto branch as the vice president of marketing and as an executive adjuster.

He has more than 45 years of experience in the insurance industry with valuable knowledge in bodily injury claims, property claims, tort losses, errors & omissions, environmental claims and large liability losses. l

Grant King and Gilberte Theriault

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National Standing Committees 2010-2011 ADVISORY Greg G. Merrithew, CIP, FIFAA Arctic West Adjusters Ltd. 401 – 5204 – 50 Ave. Yellowknife, NT X1A 1E2 Phone: (867) 920-2212 Fax: (867) 873-2244 E-mail: gregm@arcticwest.ca Delores Thorbourne, BA, FCIP McLarens Canada Suite 103 Greystone VII 4208 - 97 Street Edmonton, AB T6E 5Z9 Phone: (780) 442-3077 Fax: (780) 466-0325 E-mail: delores.thorbourne@mclarens.ca Patti M. Kernaghan, FCIP, CRM Kernaghan Adjusters Limited 300 - 1575 West Georgia Street Vancouver, BC V6G 2V3 Phone: 1-800-387-5677 Fax: 1-800-387-5644 E-mail: pkernaghan@kernaghan.com 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 McLarens Canada Suite 300, 5915 Airport Road Mississauga, ON L4V 1T1 Phone: (905) 671-3164 Fax: (905) 671-1889 E-mail: john.jones@mclarens.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 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 Craig J. Walker, CIP, FCIAA, FIFAA Maltman Group International 3550 Victoria Park Avenue, Suite 301 Toronto, ON M2H 2N5 Phone: (416) 492-4411 Fax: (416) 492-5657 E-mail: cwalker@maltmans.com 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 CONSTITUTION & RULES John Jones, BA McLarens Canada Suite 300, 5915 Airport Road Mississauga, ON L4V 1T1 Phone: (905) 671-3164 Fax: (905) 671-1889 E-mail: john.jones@mclarens.ca CONVENTION Marie Gallagher, FCIP, CRM McLarens Canada 71 King Street Suite 204 St. Catharines, ON L2R 3H7 Phone (905) 984-8282 Fax (905) 984-8290 E-mail: marie.gallagher@mclarens.ca DESIGNATION Paul Hancock, B.Sc., CIP Crawford & Company (Canada) Inc. 300 – 123 Front Street West Toronto, ON M5J 2M2 Phone: (416) 867-1188 Fax: (416) 867-1925 E-mail: Paul.Hancock@crawco.ca

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E. Brian Gough, FCIP, CLA, FCIAA Marsh Adjustment Bureau Limited 1550 Bedford Highway, Suite 711 Bedford, NS B4A 1E6 Phone: (902) 469-3537 Fax: (902) 469-2396 E-mail: ebgough@marshadj.com Robert V. Pearson, CLA, FCIAA AAL Alberta Ltd. 600 – 2424 4th Street S.W. Calgary, AB T2S 2T4 Phone: (403) 452-2195 Fax: (403) 452-3568 E-mail: rvp@aaladjusters.com Craig J. Walker, CIP, FCIAA, FIFAA Maltman Group International 3550 Victoria Park Avenue, Suite 301 Toronto, ON M2H 2N5 Phone: (416) 492-4411 Fax: (416) 492-5657 E-mail: cwalker@maltmans.com John L. Taylor, BBA, FCIP, CLA Ontario Mutual Insurance Association 350 Pinebush Road, PO Box 3187 Cambridge, ON N3H 4S6 Phone: (519) 622-9220 Fax: (519) 622-9227 E-mail: jtaylor@omia.com DISCIPLINE Patti M. Kernaghan, FCIP, CRM Kernaghan Adjusters Limited 300 – 1575 West Georgia St. Vancouver, BC V6G 2V3 Phone: 1-800-387-5677 Fax: 1-800-387-5644 E-mail: pkernaghan@kernaghan.com EDITORIAL Fred Silvestri, BA, CIP NCRS 6725 Airport Road, Suite 300 Mississauga, ON L4V 1V2 Phone: (905) 293-7715 Fax: (866) 278-0310 E-mail: fred.silvestri@srsconnect.com John M. Sharoun, FIIC, CFE, FCIAA Crawford & Company (Canada) Inc. 300 – 123 Front Street West Toronto, ON M5J 2M2 Phone: (416) 867-1188 Fax: (416) 867-1925 E-mail: John.Sharoun@crawco.ca 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 EDUCATION Gary A. Ellis, BBA, FCIP, RF, FCIAA, CLA, FIFAA Crawford & Company (Canada) Inc. 18 Great George Street Charlottetown, PE C1A 4J6 Phone: (902) 566-1011 Fax: (902) 894-3044 E-mail: Gary.Ellis@crawco.ca W.E. (Ted) Baker, BA, CFE, FCIAA BBCG Claim Services Limited 3660 Hurontario St., Suite 601 Mississauga, ON L5B 3C4 Phone: (905) 279-8880 Fax: (905) 279-5338 E-mail: webaker@bbcg.ca EMERGENCY MEASURES Richard Van Horne Action Investigations Inc. 2 Catelina Court Dartmouth, NS B2X 3G9 Phone: (902) 462- 1222 Fax: (902) 462-3688 E-mail: richardvanhorne@actioninvestigations.ca FINANCE 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

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 Patti M. Kernaghan, FCIP, CRM Kernaghan Adjusters Limited 300 - 1575 West Georgia Street Vancouver, BC V6G 2V3 Phone: 1-800-387-5677 Fax: 1-800-387-5644 E-mail: pkernaghan@kernaghan.com IBC: LIAISON, LEGISLATIVE & FORMS David McKeon, CIP McKeon & Associates Adjusting Company 2120 Rathburn Road East, Suite 91 Mississauga, ON L4W 2S8 Phone: (905) 602-0321 Fax: (905) 602-4025 E-mail: david@maaac.ca LICENSING J. Miles O. Barber, B.Comm.

(Hons.), FCIP, CRM Network Adjusters Ltd. 67 Folkestone Blvd.

Winnipeg, MB R3P 0B4 Phone: (204) 897-5793 Fax: (204) 897-5797 E-mail: mbarber@mts.net MEMBERSHIP & QUALIFICATIONS Santo Carbone, CRM, FCIAA Crawford & Company (Canada) Inc. 300-123 Front Street West Toronto, ON M5J 2M2 Phone: (416) 364-6341 Fax: (416) 435-0546 E-mail: santo.carbone@crawco.ca NOMINATING Patti M. Kernaghan, FCIP, CRM Kernaghan Adjusters Limited 300 – 1575 West Georgia St. Vancouver, BC V6G 2V3 Phone: 1-800-387-5677 Fax: 1-800-387-5644 E-mail: pkernaghan@kernaghan.com Mary Charman, CIP Crawford & Company (Canada) Inc. 1 – 120 Mulock Drive Newmarket, ON L3Y 7C5 Phone: (905) 898-0008 Fax: (905) 898-1705 E-mail: Mary.Charman@crawco.ca 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 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 PRIVACY James B. Eso, BA, CIP Crawford & Company (Canada) Inc. 539 Riverbend Drive Kitchener, ON N2K 3S3 Phone: (519) 578-5540 Fax: (519) 578-2868 E-mail: Jim.Eso@crawco.ca Keith P. Edwards, FCILA, CLA, FUEDI-ELAE CIAA Honorary Life Member c/o CIAA National Office 5401 Eglinton Ave. W., Suite 100 Etobicoke, ON M9C 5K6 Phone: (416) 621-6222 Fax: (416) 621-7776 E-mail: info@ciaa-adjusters.ca

CIAA REGIONAL PRESIDENTS 2010 – 2011 NEWFOUNDLAND & LABRADOR Marcel Pitcher, CIP, CRM Crawford & Company (Canada) Inc. 300 – 44 Torbay Road St. John’s, NL AlA 2G4 Phone: (709) 753-6351 Fax: (709) 753-6129 E-mail: Marcel.Pitcher@crawco.ca NOVA SCOTIA E. Grant King, BA, B.Ed., CIP Crawford & Company (Canada) Inc. 120 – 237 Brownlow Avenue Dartmouth, NS B3B 2C7 Phone: (902) 468-7787 Fax: (902) 468-5822 E-mail: Grant.King@crawco.ca NEW BRUNSWICK & PRINCE EDWARD ISLAND Luc Aucoin, BBA, FCIP Plant Hope Adjusters Ltd. 85 Englehart Street Dieppe, NB E1A 8K2 Phone: (506) 853-8500 Fax: (506) 853-8501 E-mail: laucoin@planthope.com QUEBEC/AESIQ Elaine Savard, LL.B., FPAA Les Expertises Richard Racette 1090, rue Principale Sainte-Agathe des Monts, PQ J8C 1L6 Phone: (819) 326-0012 Fax: (819) 326-2023 E-mail: elaine.savard@exprr.ca ONTARIO 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 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 FirstOnSite Restoration has expanded its presence in Quebec and Alberta. The emergency restoration company opened a branch in Quebec City, which will be lead by Daniel Jean, a 25-year veteran in the construction and restoration industry.

“FirstOnSite has already been active in the province with several jobs in the last year, including recently rebuilding parts of Bishop’s University after serious flooding,” said Bruce Derraugh, FirstOnSite’s chief operating officer. “We’ve also already responded to jobs in Quebec City, including Laval University after a fire and after a devastating fire at the Complexe de la Capitale.”

In the West, FirstOnSite launched a branch in Medicine Hat, Alberta - an area facing a high flood risk, a FirstOnSite release says.

Jamie Mackie will lead the team in the new locale as territory manager. l The Canadian Independent Adjusters’ Association’s Nova Scotia Region hosted an education session in Dartmouth on May 5, 2011. The seminar focused on the bodily injury cap regulatory changes. l From left: Grant King, Nova Scotia region president; Tipper McEwan, presenter; Jamie Chipman, presenter; Carol Messervey, education chair; Jane Richardson, CIAA Nova Scotia; Candice Colwell, CIAA Nova Scotia; Richard Van Horne, CIAA Nova Scotia; Graham Campell, CIAA Nova Scotia.

The Nova Scotia Canadian Independent Adjusters’ Association/ Canadian Insurance Claims Managers’ Association will host a joint seminar at Digby Pines in Digby, N.S. June 22 to June 24. l Greg Merrithew, first vice president of the Canadian Independent Adjusters’ Association presents a prize to Mark Kemaldean of Western Financial Group during the Insurance Brokers Association of Alberta’s 2011 Convention. l The Canadian Independent Adjusters’ Association’s Ontario Region hosted an education seminar on May 13, 2011.

The seminar looked at accident benefits and bodily injury claims. l From left: Richard Swierczynski, president Ontario region; Kadey B.J. Schultz, partner at Hughes Amys LLP; Jason Frost, associate at Hughes Amys LLP; Dr. Arthur Ameis, physiatrist and founder of the Multidisciplinary Disciplinary Assessment Centre.

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The National Association of Independent Insurance Adjusters (NAIIA) held its 74th Annual Conference, at the Grand Marriott Resort Golf Club & Spa, in Point Clear (Mobile), Al from May 8-11, 2011. Pat Battle, executive director, Mary Charman, president, and Fred Plant, past president, attended the event on behalf of the Canadian Independent Adjusters’ Association (CIAA). 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

CIAA New Members — March 2011 CORPORATE MEMBERSHIP Hanselman Claims Inc. — Milton, ON INDIVIDUAL MEMBERSHIP Advance Claims Service Ltd. Donald L. Abney Penticton, BC

Level 3

Arctic West Adjusters Ltd. Amy Bowden

Level 3

Yellowknife, NT

Claridge Insurance Adjusters Inc. Craig Ryther Barrie, ON

Level 2

Crawford & Company (Canada) Inc. Mary Lynn Coulas North Bay, ON Debbie Watson Toronto, ON Robert Rutherford Dartmouth, NS Erin Stroud Dartmouth, NS Brian Billard St. John’s, NL

Level 3 Level 1 Level 1 Level 1 Level 3

Hanselman Claims Inc. Kevin C. Hanselman

Level 3

Milton, ON

North Country Adjusters Inc. Chris Matheson Fort Frances, ON

Level 3

Plant Hope Adjusters Ltd. Robert Corbett

Fredericton, NB

Level 3

PRM Claim Services Ltd. Chris Staeger

Grand Bend, ON

Level 2

ProFormance Adjusting Solutions Inc. Marta Kurek-Brady Markham, ON Renee Reeves Markham, ON Leslie Rogers Markham, ON Nurisha Wright Markham, ON Niki McConnell Mississauga, ON Garfield Adamson Pickering, ON Shannon Crawford Pickering, ON Calin Lau Pickering, ON Raymond Proctor Pickering, ON

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

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CSN Collision and Glass hosted their 2nd annual Date Night on Apr. 5. There was food, cocktails and a private screening of The Lincoln Lawyer starring Matthew McConaughey. The CSN Team and its members invited insurance adjusters for a night out. The evening started at Jack Astor’s where everyone enjoyed an after-work cocktail great food before moving on to the Mississauga Coliseum for the private screening. l

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• on the scene OTS ProFormance Adjusting Solutions Inc. hosted a Corporate Launch & Charity Wine Tasting Event. The evening, held at the Drake Hotel on Apr. 28, included a silent auction, a 50/50 draw and great raffle prizes, including a weekend getaway, with proceeds going to the Jennifer Ashleigh Children’s Charity. Wine tasting and hors d’oeuvres were available throughout the evening, which was emceed by Jennifer Valentyne of Breakfast Television. l

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• on the scene OTS The Honourable Order of the Blue Goose International, Ontario Pond held its 11th annual Scotch Nosing on Apr. 27 at the One King West Hotel & Residence.

The evening started with cocktails in The Vault, followed by dinner in the Grand Banking Hall. A record number of ganders and guests attended the event, enjoying an evening of fine dining, camaraderie and rare scotch samplings sponsored by Glenfiddich. The evening raised close to $20,000 to be donated to Women In Insurance Cancer Crusade and the Starlight Children’s Foundation. The evening was sponsored by Blouin, Dunn LLP, Vista Disability Management Inc., Masterclean Contracting and Cleaning, Modern Salvage Consultants, Giffin Koerth. Thanks to the hard work of Laurel DiMaso, Jamie Dunn and Anna Galanter, along with all those who attended, the evening was a great success. l

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Vancouver was host to the RIMS 2011 Annual Conference & Exhibition May 1– 5. The risk and insurance industry community took advantage of the exceptional beauty of the city and surroundings to hold and attend numerous receptions, special events, dinners and networking gatherings. l

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• on the scene OTS WICC Ontario held its 15th annual gala dinner, ICONIC, on Apr. 13, 2011 at The Westin Harbour Castle Hotel in Toronto. WICC dinner co-chairs and evening emcees Michael Butler and Marian Adamson introduced WICC cochairs Carolyn Horan and Jean Faulkner to present Martin Kabat, CEO of the Ontario division of the Canadian Cancer Society, with a cheque from WICC for $825,000.

Gold Flame Awards, recognizing significant contributions to WICC, went to the Insurance Brokers Association of Ontario, Risk Management Counsel of Canada, SIMAC Canada Inc. and Worden Insurance & Financial Services Ltd. Nancy Thorne and Debbie Cyr were 2010 WICC ‘Hall of Flame’ Award inductees. Lyna Newman, who was the executive director, board member and secretary of WICC Ontario for more than a decade, received the Lew Dunn Memorial Award. Marilyn Horrick, past dinner chair, introduced WICC Relay for Life co-chairs Paul Martin and Carla Smith, who spoke about the industry’s commitment to the event and 2011 Relay for Life plans and goals. Since WICC’s inception in 1996, the P&C industry has raised more than $5 million. l

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CIAA

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