Claims Canada June/July 2013

www.claimscanada.ca

Official Journal of the Canadian Indeépendent Adjusters’ Association

June/July 2013

It’s not a question of if, but when a cyber-breach will occur

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4 Claims Canada June/July 2013 www.claimscanada.ca

FN• first notice

The Ontario Liberal government’s budget outlines poten-tial changes to the rate filing process, the return-on-equity benchmark for insurers and measures aimed at addressing fraud — all part of the larger target of a 15 per cent aver-age reduction in auto insurance premiums. It was released on May 2.

Earlier in the week, the government announced it would introduce legislation and amendments aimed at making the 15 per cent average reduction for Ontario drivers, using a fig-ure the provincial NDP said the government would need to meet to have its budget supported and avoid an elec-tion.

The budget included more details on how the government plans to meet that target, with Finance Minister Charles Sousa calling high costs in the auto insurance system “a drag on our economy.”

The timeline for premium cut is still unclear, with the budget document citing the change will be made “within a period of time to be prescribed by regulation,” which would be set out in the government’s future legisla-tion.

In a press conference, Sousa said the timeline is dependent upon how quickly the budget measures are passed, but that changes would begin within a year.

If the government’s legislation is passed, insurers would be required to offer lower premiums to drivers with safe driving records, but the budget didn’t include specifics on how much lower the premiums would need to be, or when insurers would have to make their changes.

Budgetmeasureswould“giveFSCOsometeeth”:Sousa

If passed, the government’s plan would also see the Su-perintendent of Financial Institutions having the authority to call on insurers to file their rates, rather than having to wait for insurers to come forward to propose changes to their rates.

The government also said its legislation would “call on” the Financial Services Commission of Ontario (FSCO) to reduce

the return-on-equity (ROE) benchmark used for rate filings, which currently stands at 12 per cent. The government has not yet said how much lower the benchmark should be or the timeline for the change.

New“expert”reportsoncosts,disputeresolutionsystem

Citing the goal of increasing accountability and transpar-ency, the budget calls for “a new independent annual report by outside experts” to examine the effect previous reforms have had on costs and premiums. The report would also look

at industry costs and premiums and would need to include recommendations for further steps needed to

meet the 15 per cent average reduction tar-get. It isn’t clear yet when the report would be expected.

The government’s plan would also see FSCO consolidating its statutory

auto insurance reviews. Current-ly, FSCO conducts a two-year review of the Statutory Accident

Benefits Schedule (SABS), a three-year review of the rates and classifications system and a five-year review of the auto

insurance system generally. The change outlined in the budget would see FSCO providing

one consolidated review, although the period for the reviews to be conducted hasn’t yet been outlined.

In terms of dispute resolution (the mediation and arbitra-tion backlog), the government said it plans to appoint an “ex-pert” to review the system and propose amendments this fall, although it wasn’t specific about who that expert would be.

The government’s plan would also call on the regulator to provide an interim report this year on the progress of the Mi-nor Injury Treatment Protocol project.

Regulationcomingforhealthclinics?

Unsurprisingly, the budget document also included anti-fraud provisions, including expanding the Superintendent’s “investigation and enforcement authority” over fraud preven-tion, a recommendation made in the Auto Insurance Anti-Fraud Task Force’s final report last November.

If passed, the government’s legislation would allow FSCO to regulate health clinics and other practitioners that invoice auto insurers, also a recommendation originally laid out in the task force’s report.

“Further study” will be conducted for CAT impairment,towingindustrychanges

The budget did not include specifics on amending the catastrophic impairment definition in the SABS, or a plan to potentially regulate the towing industry, both controversial aspects of Ontario’s auto insurance system. Rather, the gov-ernment said it will “conduct further study and consultation” on those issues and other potential cost-reducing initiatives.

The Auto Insurance Anti-Fraud Task Force’s report did call for more regulation of the towing industry, and the issue was touched on during recent hearings on auto insurance held by the Standing Committee on General Government, which in-cludes members of provincial parliament from all parties. l

Ontariobudgetproposeschangestorate-filingprocess,regulationtoreach15percentreductiontarget

p4,6,8 FIRST NOTICE.indd 4 13-06-25 12:30 PM


http://www.dsbclaims.com

Winmar Franchise Corp., a London, Ontario-based independently owned and operated property restora-tion company with over 85 offices across Canada, is pleased to announce that they have signed a multi-year agreement to integrate Symbil-ity Solutions Inc. ® (TSX.V: SY; OTCQX: ATBEF), a provider of cloud-based smartphone/tab-let-enabled claims technology that uses one of the most com-prehensive data for the property and casualty insurance industry into its daily operations.

“It is with great pleasure that we welcome Winmar, one of the leaders in the restoration industry in Canada, and their franchise owners to our valued and growing client base,” said James Swayze, CEO, Symbility Solu-tions. “Symbility is committed to supporting contractor networks and restoration companies and we are proud

to be one of the estimating platforms that Winmar has chosen for their large network of offices across the country.”

“Winmar has been in business since 1977, with offices span-ning from St. John’s, New-foundland to Victoria, British Columbia. Our partnership with Symbility enables our fran-chises to collaborate on the most innovative cloud-based platform in the market and will enable us to provide our valued customers an alterna-

tive choice in the software we use to estimate their claims,” comments John White, President/Founder, Winmar Franchise Corp. “We look forward to a suc-cessful, long-term relationship with Symbility Solu-tions as we continue to expand the way we service our customers.”

Left to right: Paul Wormith - Winmar Co-Founder & CEO, John Burega - Symbility Sr. VP Sales & Marketing, John White - Winmar Co-Founder & President, James R. Swayze - Symbility CEO, Lyne Mercier - Symbility Regional VP Sales Canada, Tom Brodhurst - Winmar Executive Vice President, Glenn Woolfrey - Winmar Executive VP Corporate Operations

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FN• first notice

The pain and suffering damages cap for people suffering minor per-sonal injuries in auto collisions in New Brunswick will be increased this sum-mer.

The new cap of $7,500 (up from $2,500) will take effect on July 1, the province’s Justice Minister and Attorney General Marie-Claude Blais announced in the legislative assembly on May 8.

Beginning Jan. 1, 2015 the maximum amount will increase annually in accor-dance with the Consumer Price Index for New Brunswick.

Along with those changes, the defi-nition of “minor personal injury” has also been updated in the province’s In-surance Act.

Insurance Bureau of Canada (IBC)said the industry is committed to work-ing with the provincial government on implementing the changes. “IBC will work with the government and the in-surance industry to ensure smooth

implementation of the changes to the minor injury damages cap for New Brunswickers,” IBC said.

“A sustainable and stable auto insur-ance system must strike a balance be-tween providing adequate benefits for the few people who make claims and affordable premiums for everyone who drives,” Steve Olmstead, manager of government rela-tions with IBC, commented.

“The government’s deci-sion to increase the minor injury cap changes that bal-ance to provide more ben-efits that we hope will serve to benefit New Brunswick driv-ers,” he added. “We know that caps can work, and that caps are a fair and reasonable way to control claims costs and deliver affordable premiums for consumers.”

The previous $2,500 cap was imple-mented in 2003. An Auto Insurance

Working Group was formed in 2011 to address the cap on personal injury awards, and in November of that year, the group released its final report. Its recommendations included proposed changes to the minor personal injury definition and increasing the personal

injury award cap to between $4,000 and $6,000.

The provincial govern-ment tabled its own rec-ommendations, in June 2012, based on the work-ing group’s report. It pro-posed increasing the cap

to $7,500, more than the working group’s proposal,

but on par with the cap in Nova Scotia.The government also asked for pub-

lic and stakeholder feedback on the amendments following its proposed changes in June 2012, and again earlier this year. l

It is imperative that a company has a social media policy to reference when con-ducting investigations, stresses Constable Richard Gadreau, social media officer with the Niagara Regional Police Service.

More than one-third of insurance com-panies who use social media in any capacity don’t have a social media strategy, he said, speaking at the 2013 Ontario Insurance Adjusters Association’s Provincial Conference, held by the group’s Niagara Falls chapter.

The reason for not having a policy in place is two-fold, Gadreau said: top management doesn’t support its usage, and there is a lack of skill or know-how.

“They don’t have boundaries, they don’t have policies and pro-cedures and how-tos for their com-pany,” Gadreau said. “That’s a bit of a red flag for me, because if you don’t have something that sets out ‘this is how we are going to operate,’ you are setting yourself up for more criticism.”

Social media can play a large role dur-ing an investigation, but if the information is not credible, and the case ends up in court, it could be worth nothing.

On the flip side, if a company has a so-cial media policy in place, including a meth-

od for gathering information from various social media sites, the information can be very advantageous.

“Define the framework by which you are going to conduct your investigations, and how social media is going to be used,” Ga-dreau noted.

Going through the investigation pro-cess, companies must be as transparent

as possible, he said. “Open is bet-ter,” he added. “If you are not only using it to gather information, but you are also using it to share infor-mation, it helps your credibility if you come across as being trans-parent: ‘I will tell you what we do, this is how we conduct our investigations’.”

He also urged his audi-ence not to forget that social media is all about informa-tion sharing and to use that

to their advantage. Connect with companies, investigators and

clients to widen the social network — and by default the availability of information, he said.

The top two network sites to join, Gadreau said, are Facebook and Twit-ter. Unlike with Facebook, one does not need to be accepted as a friend to view

Tweets — which are often posted in real time.

Gadreau offered up some other tips when conducting investigations using so-cial media: • Don’t expect a smoking gun. Some-

times it’s more often what a person isn’t saying, than what they are saying.

• Look at a person’s digital shadow (any bit of information about a person found online). What are they putting out there? Who are their friends, contacts and associations?

• Look at friends and family members. The person being investigated might not be saying much, but friends and family might offer up clues.

• Think about who the source of information might be. A neighbour? A coworker?“Information solves crimes,” Gadreau

said. “The information is out there for us to put together and sometimes the important part is not what you see as a total, but the ability to connect the dots.”

“Remember too: little things, little com-ments might not be significant at the time, but collect that information . . . it might be important down the road,” he said. “Keep good quality notes and quality reports. You need to be able to define how you are do-ing social media investigations.” l

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p4,6,8 FIRST NOTICE.indd 6 13-06-25 9:25 AM


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FN• first notice


Paul AquinoPublisher

(416) [email protected]

Laura KupcisEditor


Michael ChimientiArt Director

[email protected]

Steve Wilson Senior Publisher (416) 510-6800

[email protected]

Phyllis Wright Print Production Manager

Subscription inquiries(416) 442-5600 • 1-800-668-2374

Fax: (416) 442-2191

Christine GiovisAdvertising Sales Representative


Mike WellsAccount Manager


Gary WhiteProduction Manager

(416) 510-6760

A bi-monthly magazine (6x per year), Claims Canada is published by BIG Magazines LP, a div. of Glacier BIG Holdings Company Ltd. Business Information Group is located at: 80 Valleybrook Drive, Toronto, ON, M3B 2S9. Claims Canada magazine is the Official Publication of the Canadian Independent Adjusters’ Association [CIAA] and through its editorial content and circulation brings together the ‘entire property & casualty insurance claims market nationally’ with information and insight into the profession, business and people of insurance claims and loss adjusting. All key claims process stakeholders are reached as part of our readership community – including: both CIAA member and non-member independent claims adjusting firms; insurance and reinsurance company executive, claims management

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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Implementing standard pricing for assistive devices could save the insur-ance industry a substantial amount of money, suggests Constable Glen Mo-rash of the Major Fraud Bureau with Peel Regional Police.

Morash was speaking at ISB Cana-da’s ISB-U Education Series event, in Milton, Ont. on April 11.

While investing MVA clinics during a fraud investigation, he said he noticed a number of patients were receiving household assistive devices paid for by the insurance companies. The devices were all standard items that claims ad-justers see regularly, including light-weight vacuums, shoehorns, ergody-namic devices.

However, when Morash looked into it further, he found that clinics were charging insurers $149 for a lightweight vacuum, which in reality was a Swiffer that retails for $34.99. To boot, the clin-ics would be getting the “vacuum” at a

wholesale cost, making the profit even higher for them.

Long shoe horns were being billed at $29.99, with a wholesale cost of $2.99, hot and cold packs were being billed for $20, when they cost $1.99 retail, and so forth.

“You do that with over 60 patients in one clinic in a six month pe-riod and it becomes a large dollar fraud,” he said. “But I can’t even re-ally call it fraud because it is accepted by the indus-try.”

“If the clinic is willing to charge you that and you are willing to pay it, then it is your loss,” Morash said. “We can’t even charge them with fraud for that, un-less they come out and tell you it’s something else.”

The description of the product in question is so vague that there was

nothing the fraud department could do. “It is all just pure profit

for the clinic at a cost to you guys,” he said.

The industry is not look-ing into these charges be-cause they fall under the threshold of care for the industry — and they are

small ticket items that ap-pear once per claimant. The

concern is higher price point items, which are claimed fre-quently over a number of visits over a longer period. “When you start adding it up over and over again, it is a lot of money to them, when it could be a sav-

ings to you guys,” Morash said. He suggested that the industry

should implement a standard pricing on these devices to help save costs. l

Over-inflatedchargesforassistivedevicescostinginsuranceindustry

p4,6,8 FIRST NOTICE.indd 8 13-06-25 9:25 AM


mailto:[email protected]







“You’re hired.”Two words

that can changesomeone’s life

forever.

CRDN - Certified Restoration Drycleaning Network is challenging insurance professionals

in the GTA to donate gently-used clothing and business attire, in support of Dress for Success

Toronto, to benefit disadvantaged womenseeking gainful employment.

How you can help...

To promote this year’s clothing and suit

drive in your office, contact CRDN of GreaterToronto prior to August 1 to request a

donation bag and information kit.

(416) 533-2736 | [email protected]

In recognition of your valued support, all participating companies will be published in Claims Canada Magazine and Canadian Underwriter Magazine after the event.

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This year’s event will take place

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JOHN D. SEYLER

I was in New Brunswick to visit our Maritime membership in May. The educational day included an excellent presentation by Charles Foster and his colleagues of Foster & Company. It was great to see New Brunswick/PEI CIAA Regional President Luc Aucoin and Nova Scotia President Grant King. In addition to being industry leaders, I count them amongst my friends. At these events I am often asked to say a few remarks. Those that know me well, know I am rarely lost for words, but this particu-lar morning I was ready to impress! I was fresh out of the public speaking course at the Ontario Insurance Adjusters Association provincial conference. I was prepared to connect to my audi-ence: I was going to use my hands, I wasn’t going to hold eye contact with some poor attendee to the point of being mistaken for a serial killer, I was going to deliver a compelling message of member benefit and the importance of education. But an hour before arriving, I saw an article about the driverless car by Google and threw my notes out.

The article got me thinking: Do adjusters do enough to keep pace with the advancing technology at the same pace as other professions? For those that haven’t heard of the Google navi-gated driverless car, it was first revealed in 2010. The technol-ogy has now advanced to the point of reliability that three states have passed legislation approving their operation. Five manu-facturers, including Mercedes Benz, Audi and Volkswagen will have a driverless car in production in five years.

With the flick of a switch, the car takes over and miraculous-ly responds to rapidly changing traffic conditions. Ironically, the first driverless car crash occurred in August 2011 when it was in manual mode with the human in control at the time of the crash. I asked the group to reflect on the societal and techno-logical changes involving many of us. For example, I recall the choice of smoking or non-smoking on a flight, and the miracle of my first cell phone, which was half the size of my head. I real-ize that as an adjuster, I had best be open to change and continue to try and advance my craft, or I expect I will be replaced by a smarter, younger version of me.

The driverless car speech posed the question as to how would this affect our industry? The car’s safety systems are said to be foolproof. It easily responds to the car that cuts in front of it by gradually slowing to a safe distance. It responds with robotic efficiency when faced with a hazard in its path. If collisions are reduced by two-thirds or half, what effect can we expect in the claims industry. If the car operates like my laptop or iPhone, I

En mai, j’étais au Nouveau-Brunswick pour rendre visite à nos membres des Maritimes. La journée de formation incluait une ex-cellente présentation par Charles Foster et ses collègues de Foster & Company. Il était agréable de rencontrer Luc Aucoin, président régional de l’ACEI du Nouveau-Brunswick et de l’Île-du-Prince-Édouard, et Grant King, président de l’ACEI de la Nouvelle-Écosse. En plus de les considérer comme chefs de file de l’industrie, je les compte parmi mes amis. Lors de ces événements, on me de-mande souvent de dire quelques mots. Ceux qui me connaissent bien savent que les mots me manquent rarement. Mais ce matin-là, j’étais prêt à impressionner la galerie. Je venais tout juste de partici-per à une formation sur la communication orale lors de la réunion à l’extérieur de l’Ontario Insurance Adjusters Association. J’étais prêt à établir un contact avec l’auditoire. J’allais utiliser mes mains. Je n’allais pas maintenir le contact visuel avec un pauvre partici-pant jusqu’au point où on allait me prendre pour un tueur en série. J’allais livrer un message convaincant sur les avantages pour les membres et l’importance de l’éducation, mais une heure avant mon arrivée, j’ai lu un article sur la voiture sans conducteur de Google et j’ai jeté mes notes.

L’article m’a fait réfléchir. Est-ce que les experts en sinistres en font suffisamment pour maintenir le pas avec les avancées technologiques au même rythme que les autres professions? Pour ceux qui n’en ont pas entendu parler, la voiture autonome sans con-ducteur de Google a été dévoilée en 2010. La technologie est main-tenant rendue fiable à un tel point que trois états ont adopté des lois qui autorisent son utilisation. Cinq fabricants, incluant Mercedes Benz, Audi et Volkswagen, auront des voitures sans conducteur en production dans cinq ans.

En appuyant simplement sur un bouton, le véhicule prend le contrôle et répond miraculeusement aux variations rapides des conditions routières. Ironiquement, le premier accident de voiture sans conducteur a eu lieu en août 2011. Une personne conduisait le véhicule en mode manuel au moment de l’impact. J’ai deman-dé au groupe de réfléchir sur les changements sociétaux et tech-nologiques qui touchent beaucoup d’entre nous. Par exemple, je me souviens d’avoir eu à choisir entre un vol fumeur ou non-fumeur et du miracle de mon premier téléphone cellulaire, qui devait faire la moitié de la taille de ma tête. Je réalise que, en tant qu’expert en sinistres, il vaut mieux être ouvert au changement et continuer d’améliorer mon art. Sinon, je dois m’attendre à être remplacé par une personne plus jeune et plus intelligente que moi.

La question de la voiture sans conducteur amène à se demander quelle incidence elle aura sur l’industrie. On dit que les systèmes de sécurité du véhicule sont infaillibles. La voiture réagit facile-ment à un véhicule qui coupe devant elle en ralentissant gradu-ellement jusqu’à atteindre une distance sécuritaire. Elle répond avec l’efficacité d’un robot lorsqu’un danger surgit sur sa route. Si le nombre de collisions diminue de deux tiers ou de la moitié,

Message from the PresidentLa Plume du Président

p10,11 presidents message.indd 10 13-06-25 9:44 AM


www.claimscanada.ca June/July 2013 Claims Canada 11

am sure those driver-related collisions would be replaced by the inevitable computer crash or freeze up. How will the auto policy respond to “no one” driving? Statutory regulations in place will have to provide some protection against manufacturers who will rapidly become a target for litigation for every routine col-lision.

Keeping up with technology is a costly venture. Knowing where to invest financial resources is a challenge for our na-tional members as well as small member firms. No one wants to get stuck with the proverbial Beta VCR. We can always improve systems and look for efficiencies, but fundamentally we are in a customer service industry, which should never seek to eliminate the personal contact for an app or process.

At the CIAA National convention in September 2013, at the Banff Springs Hotel in Banff, the keynote speaker will be Jeff Mowat, who will focus on the customer service aspect of our business while the education program will address the technical side. The balanced approach is not unlike my personal approach to the advancing technology. Embrace it, utilize it, but in har-mony with customer service. Honestly, I can’t wait until the day when I can snooze on the way to the office or tell Siri where my appointment is and let her do the driving. n

quels effets pouvons-nous nous attendre d’observer sur l’industrie des assurances? Si la voiture fonctionne comme mon ordinateur portable ou mon iPhone, je suis persuadé que les collisions pro-voquées par les conducteurs cèderont la place aux inévitables cas d’ordinateurs qui plantent ou qui gèlent. Comment la politique en matière d’automobiles répondra-t-elle à la conduite « sans con-ducteur »? Les règlements en place devront fournir une certaine protection contre les fabricants, qui deviendront rapidement la cible de litige pour chaque collision de routine.

Maintenir le rythme de l’évolution de la technologie est une aventure coûteuse. Savoir où investir ses ressources financières est un défi pour nos membres à l’échelle nationale, ainsi que pour les petits cabinets membres. Personne ne veut se retrouver coincé avec ce bon vieux magnétoscope à cassettes Beta. Nous pouvons tou-jours améliorer les systèmes et tenter d’accroître l’efficacité, mais fondamentalement, nous appartenons à une industrie de service à la clientèle qui ne doit jamais chercher à éliminer les contacts per-sonnels au profit d’une application ou d’un processus.

À l’occasion du congrès national de l’ACEI, qui aura lieu en septembre 2013 à l’hôtel Banff Springs à Banff, le conférencier d’honneur sera Jeff Mowat. Il abordera l’aspect service à la clientèle de notre industrie. Pour sa part, le programme de formation aura pour thème le côté technique de l’industrie. En matière de progrès technologiques, mon approche personnelle vise l’équilibre. Adoptez et utilisez la technologie, mais faites-le en harmonie avec le service à la clientèle. En toute honnêteté, j’attends avec impatience le jour où je pourrai faire une sieste sur le chemin du bureau ou dire à Siri où est mon rendez-vous et la laisser conduire. n

NATIONAL EXECUTIVE 2011-2011NATIONAL EXECUTIVE 2012-2013PRESIDENTJohn D. Seyler, CIPProFormance Group Inc.5080 Timberlea Blvd., Suite 214Mississauga, ON L4W 4M2Phone: (905) 238-4985 • Fax: (905) 238-2735E-mail: [email protected]

1ST VICE-PRESIDENTMarie C. Gallagher, FCIP, CRMGranite Claims Solutions71 King Street, Suite 204St. Catharines, ON L2R 3H7Phone: (905) 984-8282 • Fax: (905) 984-8290E-mail: [email protected]

2ND VICE-PRESIDENTE. Grant King, BA, B.Ed., CIPCrawford & Company (Canada) Inc.120 – 237 Brownlow AvenueDartmouth, NS B3B 2C7Phone: (902) 468-7787 • Fax: (902) 468-5822E-mail: [email protected]

SECRETARYPaul Hancock, B.Sc., CIPCrawford & Company (Canada) Inc.300 – 123 Front Street WestToronto, ON M5J 2M2Phone: (416) 867-1188Fax: (416) 867-1925E-mail: [email protected]

TREASURERRussell Fitzgerald, CIPKernaghan Adjusters Limited203 – 4246 97 Street N.W.Edmonton, AB T6E 5Z9Phone: (780) 488-2371Fax: (780) 488-0243E-mail: [email protected]

PAST-PRESIDENTGreg G. Merrithew, CIP, FIFAAArctic West Adjusters Ltd.201 – 5204 – 50 Ave.Yellowknife, NT X1A 1E2Phone: (867) 920-2212Fax: (867) 873-2244E-mail: [email protected]

EXECUTIVE DIRECTORPatricia M. BattleCanadian Independent Adjusters’ Association/L’Association Canadienne des Experts IndépendantsCentennial Centre,5401 Eglinton Avenue West, Suite 100Etobicoke, ON M9C 5K6Phone: (416) 621-6222Toll Free: 1-877-255-5589Fax: (416) 621-7776 E-mail: [email protected]

DIRECTORJames B. Eso, BA, CIP Crawford & Company (Canada) Inc.539 Riverbend DriveKitchener, ON N2K 3S3Phone: (519) 578-5540 Fax: (519) 578-2868E-mail: [email protected] DIRECTORJohn Jones, BAGranite Claims SolutionsSuite 300, 5915 Airport Road Mississauga, ON L4V 1T1 Phone: (905) 671-3164Fax: (905) 671-1889E-mail: [email protected]

DIRECTORCraig J. Walker, CIP, FCIAA, FIFAAMaltman Group International3550 Victoria Park Ave., Suite 301Toronto, ON M2H 2N5Phone: (416) 492-4411Fax: (416) 492-5657E-mail: [email protected]

p10,11 presidents message.indd 11 13-06-25 9:44 AM













Cyber Specter

CS• cover story

p12-18 COVER STORY.indd 12 13-06-25 9:48 AM


BY LAURA KUPCIS

When it comes to cyber attacks, it is not a question of if, but when, a breach will occur. The acceptance of cyber insurance as necessary coverage is likely to increase, as more companies realize it is an essential component to the cyber security solution.

Cyber Specter


As the frequency of targeted at-tacks continues to rise, there might be a misplaced confi-dence in IT departments to be

able to protect businesses against cy-ber attacks.

“I suspect that if you were to survey businesses that had made a decision not to either put their mind to the risk exposure, try to quantify it and try to manage it, or as part of that analysis purchase insurance, a large number of them would suggest that the rea-son they haven’t done so is they have confidence in their IT,” Mario Fiori-no, senior counsel with Insurance Bureau of Canada, said. “They have confidence that their IT controls are robust enough and that they are not vulnerable to penetration or to being attacked. I think there is a confidence, maybe a misplaced confidence or overconfidence, in their IT controls.”

But, the evidence has shown, no matter how robust IT security is, there are still vulnerabilities that can result in a loss, Kevin Kalinich, global prac-tice leader for cyber insurance with Aon Risk Solutions, said.

There was a 42 per cent surge last year alone in targeted attacks as com-pared to 2011, according to Symantec Corp.’s Internet Security Threat Report, Volume 18. A whopping 31 per cent of these attacks were on small businesses with fewer than 250 employees — a sector that may feel immune to target-ed attacks, Symantec reports. Symantec has established comprehensive sources of internet threat data through the Sy-mantec Global Intelligence Network, which is comprised of roughly 69 mil-lion attack sensors and records thou-sands of events per second. The net-work monitors threat activity in more than 157 countries and territories.




Small businesses seem to assume that they are immune to attacks, based on surveys conducted by Sy-mantec. However, this is not the case. Any business, no matter the size, is a potential target for attackers. “Money stolen from a small business is as easy to spend as money stolen from a large business,” Symantec writes in its re-port. “And while small businesses may assume that they have nothing a targeted attacker would want to steal, they forget that they retain customer information, create intellectual prop-erty, and keep money in the bank. While it can be argued that the re-wards of attacking a small business are less than what can be gained from a large enterprise, this is more than compensated by the fact that many small companies are typically less careful in their cyberdefenses. Crimi-nal activity is often driven by crimes of opportunity. With cybercrimes, that opportunity appears to be with small business.”

In fact, the threat caused by a small business’ lack of adequate security practices affects everyone. Hackers who can’t breach the defenses of a larger business will attack a smaller business that has a relationship with the real target, using it as a way to get into the larger one, Symantec reports.

Interestingly, while many would assume that the financial and govern-ment sectors would be the most tar-geted for a cyber attack, it is, in fact, the manufacturing sector, according to Symantec. In 2012, the manufac-turing sector saw 24 per cent of all targeted attacks, up from 15 per cent in 2011. The government and public sector organizations saw a drop in attacks in 2012, from 25 per cent in 2011, to 12 per cent last year.

“The targets of cyber risk really include everyone — the attacks are, more often than not, indiscriminat-ing and random,” Pat Van Bakel, COO at Crawford & Company (Canada) Inc., said. “The methods of attack are

dynamic and evolving and therefore the mitigation and defense strategies need to keep pace.”

While it is imperative to have mul-tiple layers and multiple walls, and to have confidence in a company’s IT system, the reality of it is, just like a burglary, if someone is determined to get in, they are going to get in, there is no way to completely prevent that, Dale Avis, CIO, Crawford & Compa-ny (Canada) Inc. said. The key is to ensure that in the event of a breach, there is a plan in place to handle that.

Available insurance coverage“Cyber insurance is probably the

fastest growing area of availability of insurance coverage in Canada and North America, if not the world,” Mike Petersen, communications, me-dia and technology practice leader with Marsh Canada Ltd., said. “What began as an offering with a small number of underwriters in 1999-2000 in and around Y2K has reached

While it is imperative to have multiple layers and multiple walls, and to have confidence in a company’s IT system, the reality of it is, just like a burglary, if someone is determined to get in, they are going to get in, there is no way to completely prevent that.



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the point where here in Canada there are in excess of 25 underwriters with a stated theoretical capacity of over $300 million for Canadian admitted paper.”

Coverage is available in the Cana-dian marketplace in varying degrees. Some markets have produced sepa-rate standalone cyber policies cover-ing a wide range of exposures, such as privacy or data breach consulting services, notification expense reim-bursement, forensic investigation ex-penses, crisis management services, etc., Dave MacDonald, assistant vice president, ProFin, global specialty lines with RSA, said. Many other markets created cyber endorsements, which provide a more limited scope of cyber coverage, attaching it to a D&O and/or an E&O policy.

As global awareness of cyber risks becomes more evident, Canadian markets are gearing up in establishing their coverage solutions to meet their client’s local and foreign needs.

Petersen notes that at his firm, they break network security and privacy into seven different items:

1. privacy liability 2. network security liability 3. cyber extortion4. regulatory defense5. crisis management6. property loss 7. business interruption Typically the coverage includes

various first party losses, including the loss of a business’ own data or a business interruption loss, and third party liability.

The difficulty, however, is that there is no uniformity in the wording or in the coverage, because it is such an emerging area. “Consumers will have to be very careful working with their respected advisors to make sure that they have the appropriate cover-age,” Fiorino said.

Cyber exposures are, at best, not well understood by most people, MacDonald said. “There very well could be an understanding or mis-understanding that they’re fully protected from cyber attacks within their other insurance policies, such as CGL, D&O, and E&O,” he added. “To

some extent, certain cyber exposures could be partially protected through these other liability policies, depend-ing on the cyber circumstances and the actual coverage within these other policies. But for sure they would not be fully covered for all types of cyber issues.”

While Sean Forgie, executive gen-eral adjuster, national director of ca-sualty/liability with the commercial risk division at Cunningham Lindsey, hasn’t handled a large volume of cy-ber claims, he says he has dealt with

a number of claims on a CGL-type basis, where the gap in coverage is exposed. “Something has happened, information has gotten out there, and you are realizing there isn’t coverage for this under the normal insurance program.

“These claims can be very complex to handle, and if you don’t have un-derlying coverage under your general liability policy, paying the appropri-ate experts to handle this could be as large as the potential exposure of the claim,” Forgie addes.

Current take-upBecause many entities had the mis-

taken belief they had coverage under their property or general liability pol-icies, there was little take-up on cyber insurance.

“What happens is the legacy poli-cies might not have specifically ex-cluded the coverage for cyber ex-posures, but they didn’t specifically include it, because they just didn’t think about it,” Kalinich said. “We didn’t have social media, we didn’t have mobile devices, we didn’t have ‘bring your own device to work,’ we didn’t have cloud computing, we didn’t have big data just five or 10 years ago, so we didn’t have those ex-posures accounted for in the policies.”

Despite the increase in cyber at-tacks, many companies still feel they are immune.

“Some companies are going to take the approach that our internal secu-rity is good enough, that we don’t feel that we have a risk there that we are willing to pay the cost to the insur-ance,” Avis said. “Other ones are go-ing to say that there is a huge poten-tial risk there, that if there is a breach we need some coverage. You can get into a strategy where a business would only insure a high end, like an excess liability type coverage, then self-in-sure the smaller stuff. Then, if there was a huge breach, a business would have the high end covered off through insurance and transferring of risk strategy, especially around the low frequency, high severity and impact type claims.”

Large international companies, es-pecially those with US exposures, are more apt to consider buying a cyber policy for their company, MacDonald points out. “They understand they’re exposed to many kinds of cyber at-tacks which could decimate their brand/image and financially destroy their company,” he said. The dilem-ma in Canada is that there are only a handful of high profile cases hitting the various media venues, which truly suppresses the need to protect a com-pany and its employees with a cyber policy. “Corporate executives, for the most part, do agree that their compa-


Those companies most at risk,

such as those with valuable IP,

financial data, ecommerce

requirement, etc are likely to have

great interest in the cyber security

product.




nies are exposed to various forms of cyber attack, but until they, or their corporate neighbours, encounter an actual cyber intrusion, many busi-nesses are resisting and taking their chances using the old cliché ‘it’ll nev-er happen to us’,” he added.

As the threat to Canadian business increases, the appetite for risk man-agement solutions, including insur-ance, will increase, John Proctor, vice president of security services with CGI, said. “Generally, Canada lags slightly compared to other countries, but this is true across the whole cyber security/risk mitigation portfolio.” Those companies most at risk, such as those with valuable IP, financial data, ecommerce requirement, etc are like-ly to have great interest in the cyber security product.

“Most Canadian companies sim-ply don’t see the need to spend their limited insurance budget dollars on cyber insurance,” MacDonald said. “Unfortunately, most of these compa-nies will experience some form of cy-ber attack within the near future, but will be uninsured. It will be a serious wake-up call.”

Claims As with any new product, it takes

some time for enough policies to be in force to actually result in any sig-nificant volume of claims. “The ex-posures are certainly real and are occurring virtually every day,” Van Bakel said. “It ranges from mali-cious attacks like phishing, malware and spyware that can bring an entire company to its knees in an instant, to more unintentional events like an employee losing a mobile device or a memory stick.”

The risks are two-fold: First party and third party. First party exposures are reputational risk, business conti-nuity, customer retention, as well as direct costs of computer forensics, legal and public relations. Mass data breaches would also create exposure to class action litigation. Third party risks are, for the most part, a result of data breaches, but there are certainly other exposures, such as contract ful-fillment and, depending on the nature of the business, could even be prop-

erty damage and supply chain risks. There are a number of different

ways a company can be targeted in a cyber risk claim. The most common is denial of service, where a hacker will, basically, take possession of hundreds of thousands of computers across the world and attempt to access the same website at the same time. This shuts the website down, because too many people are trying to access

it at once, John Valeriote, executive general adjuster at Granite Claims So-lutions, said. This results in a loss of income, because the business is rely-ing on the website to generate income. There are also viruses, where a hacker will break into a computer and place a virus, which will allow them to break in and steal information. They might steal information and sell it or hold a business hostage for ransom. Finally



http://www.bdo.ca/advisory


there is theft of information, where it might not be actual theft of a busi-ness’ information, but the client’s in-formation, including credit card in-formation, transaction numbers, etc. “These are the types of risk that the policies are contemplating,” Valeriote said, “and those are the claims that are evolving out of this.”

One of the key changes is coming to understand the complexity of the risk in a non-traditional insurance area. Actually processing the claim usually requires technical support and advice for the claimant and then deep technical support to assess the reality and the impact of the inci-dent, Proctor said. The challenge in conducting the technical forensics and assessing the claim is not only discovering what happened and what was lost, but assessing the intan-gibles, such as brand and reputation value, future value of IP, financial impact of a data breach or e-com-merce outage. At the same time, the process used for the forensics analy-sis may have to be legally defensible requiring the technical team to un-derstand chain of evidence and chain of custody requirements.

When adjusting a claim, Valeri-ote and his team would immediately bring in a law firm to deal with le-gal issues relating to any stolen in-formation. A public relations firm is brought in to handle any dialogue with the media, which helps clients to feel secure. Finally, an IT firm is brought in to figure out what exactly transpired. “We don’t use the in-sureds IT people, because they may be in on it,” he said. “When I commu-nicate initially, I never communicate by email, I always call, because I don’t know who has access to the system now; it’s clearly been breached.” The IT firm is brought in to determine how someone was able to access the system, what they did and ultimately assess the damage and determine the best way to repair the breach. Then another IT firm is brought it to actu-ally handle the repair, to ensure that a company is not over-paying for the repair. Throughout the entire pro-cess, the independent adjusters would

be overseeing all the activity and, at the same time, determining what cov-erage is available and what would be indemnified to the policyholder.

As an adjuster, be aware that you have to plan very early on what you are going to look for as to the cause of the damage and what you are go-ing to do about, Valeriote warns. If a company’s own internal staff starts trying to fix the issue, you are never going to find out the answer. It is not dissimilar from a fire claim, where the location is sealed off and nobody is al-lowed in until the expert determines

a cause. But, most people understand why they cannot enter the location of a fire; they do not always appreci-ate why they can’t begin rebuilding immediately after a cyber attack. All they recognize is that their business has been compromised and they want to get it back up and running, which could mean deleting files, checking discs, stopping entry. “What I re-ally need to say is ‘don’t do anything for a minute, let me have my expert

come in and see everything and save it and freeze that moment in time to see what has happened’,” Valeriote said. “That communication between you and the insured is vital to explain this has to happen before you contin-ue doing what you are doing because they might delete everything that shows there was a breach, in which case there is no coverage.”

Increasing awareness“I think we will see consumers

becoming aware of this issue, both because of the increase in frequency and severity as being reported by the media, and secondly the necessity of the availability of the coverage and its foreseeable consequences will drive brokers to counsel their clients about this particular exposure,” Fiorino said.

Those businesses that do suffer a cyber incident are most likely unin-sured and are now very motivated to purchase some form of cyber insur-ance protection, MacDonald said. Companies that thought they were insulated from cyber attack or simply didn’t have an exposure, are coming to the realization how widespread cyber risk truly is. “Virtually every company and business is exposed to some for of cyber attack,” he said.

Brokers need to be well armed with what cyber products and cov-erages exist in Canada in order to better serve their clients, MacDon-ald stressed. “Clients, with the assis-tance of their insurance broker, need to better identify where they may be exposed to cyber liabilities and how they can transfer those risks to insur-ance companies through purchasing a cyber insurance product which meets their needs.”

Like many risk strategies, some-times the best model is a blended solution, Proctor said. In assessing the required protection, it will be im-portant for the insurance provider to be able to understand the risks as-sociated with cyber coverage, what a reasonable amount of security the in-sured should have and the constantly changing threat of the cyber environ-ment.

The challenge in conducting the technical forensics and assessing

the claim is not only discovering what

happened and what was lost, but assessing the intangibles, such as brand and reputation value, future value of

IP, financial impact of a data breach or

e-commerce outage.



®

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http://www.servicemasterrestore.ca


S• spotlight

Like many independent adjusters reaching a certain stage in life, Dennis Bymak is at a crossroads:

to carry on adjusting or to retire. While we seemingly spend our entire careers talking about the freedom of retirement, when push comes to shove, walking away from an indus-try you have been a part of your en-tire life, and a career you love, is not an easy task. And this is why Bymak, the principal of All Task Adjust-ers in Calgary, Alta, is having such a tough time deciding the next step. Having been in the adjusting world for more than 40 years, Bymak is certainly entrenched in the industry.

Bymak opened All Task Adjusters in 2005, but he is not new to business ownership. He was the principle share-holder of Bymak & Associates, along with two other minor shareholders, in Yorkton, Sask. for 20 years. The company also had a branch office in Dauphin, Man. He sold the company and moved back to Calgary in 1997, at which time he started working for Kernaghan Adjusters. In 2004, the opportunity to do some catastrophe work arose in the Grand Cayman and he jumped at the chance, having ben-efited from two prior CAT experiences in Kauai, HI and St. Thomas, USVI. Six months later, he returned to Cal-gary and for the first time in 35 years, he actually took a break from insur-ance adjusting. For about five months, Bymak could be found doing safety

work in the oil patch, until a local in-surer pulled him back into the fold. In the spring of 2005, there was a large flood south of Calgary in the High River and Okotoks areas of Alberta, at which time Bymak launched All Task Adjusters. “A local (insurer) had called me and said ‘what are you doing’ and I said I was playing around,” Bymak laughs. “He said you’d better put your adjusting cap on because we are re-ally busy, would you like some work. That’s how All Task started.”

Busier than everAfter the 2005 storm-work influx,

All Task continued at a pace that suit-ed Bymak’s semi-retirement percep-tions. He was billing 700-800 hours a year, enjoying the continuity of a long-standing career, but also with enough free time to enjoy travelling and his other hobbies. Then, in July 2010, Cal-gary and parts of southern Alberta were pummeled with golf ball-sized hail, resulting in a record amount of insured damage from hailstorms in Canada. Following the storm, which resulted in nearly $400 million in in-sured damages, Bymak — and All Task Adjusters — saw the two busiest years of his entire career.

At that time, Bymak considered selling All Task Adjusters, but just as he was inundated with claims, so was every other independent adjusting firm that would be interested in ac-quiring his business. There are always

peaks and valleys in this business, By-mak said, and at that point, no other company had the time to add on the workload of another small business.

Sure enough, the valley came. He has parted ways with one of his main clients, and while he is still in a part-nership with another niche client, the availability of claims has diminished.

ChoicesSo here he — and All Task Adjust-

ers — stands: at a crossroad. If Bymak decides it’s ultimately not

time to retire just yet, then he sees his future unfolding in two ways: either ramping up his domestic work or per-haps heading back into catastrophe work again.

As a member of the Canadian In-dependent Adjusters’ Association (CIAA), he has expressed interest in signing up for the association’s Catas-trophe Response Resource (CRR).

The CRR is a way for members of the CIAA to become a part of an insur-er’s strategy for catastrophe prepared-ness. If an insurer does not have a plan in place — or the existing plan is not meeting the insurer’s needs during a catastrophe — they can count on the CIAA to send a call to its members for catastrophe adjusters. Bymak is confi-dent he has the expertise and knowl-edge to handle any catastrophe claim situation thrown his way.

If All Task Adjusters decides to take on more domestic files, then it

CrossroadsDennis Bymak, principal of All Task Adjusters, has had a flourishing career in independent adjusting. He now has the luxury of deciding whether to continue pursuing claims or retiring.

BY LAURA KUPCIS

Dennis Bymak, principal of All Task Adjusters — at a crossroads: to carry on adjusting or retire.

p20-21 SPOTLIGHT copy.indd 20 13-06-25 9:56 AM



is a matter of going back to market-ing the business and taking on new clients. This is a task that shouldn’t prove to be difficult for Bymak, who has a solid reputation in the adjust-ing field.

He admits, however, that the draw of catastrophe work is stronger right now and his current passion lies with CAT claims. The reason is simply a

matter of time. CAT work, which has a potentially shorter time commitment, is more conducive to semi-retirement than servicing domestic claims, which requires a commitment year-round.

Making it work

These are just some of the chal-lenges — but also positives — to being a one-person operation. On a positive

note, Bymak has the opportunity to make all of the important decisions on which direction he wants to take All Task Adjusters. But at the same time, it is a challenge to do everything alone. “You are kind of isolated when you are not in an office where there are a dozen claims people talking about new developments in the industry over cof-fee,” Bymak said. To combat the iso-lation he is a member of the CIAA, giving some availability to networking with other adjusters at various events, including the CIAA/Canadian Insur-ance Claims Managers’ Association joint conference.

Taking a vacation can also be tricky, but Bymak has such a cred-ible reputation in the field, that he was able to assure his clients that all open files were in very good condi-tion. While at times he was able to find another independent adjuster in the city to handle new business and work in progress, at other times Bymak would simply have to tell his clients he couldn’t take on any new files while he was out of town. “They were good enough to work with that, so bless their hearts.”

Perhaps it is that All Task Adjust-ers handles claims in a more personal, service-oriented way. Bymak is always reachable — relying very little on voice mail. This leads clients and insurance claimant’s to feel connected and cared for. Whatever the reasons, it has clearly worked for Bymak, who has been able to run not one, but two successful in-dependent adjusting firms during his accomplished career.

If he decides to continue working in the field of independent adjusting, Bymak and All Task Adjusters will undoubtedly continue providing top-notch, personalized claims handling to its clients.

Dennis Bymak, principal of All Task Adjusters — at a crossroads: to carry on adjusting or retire.

p20-21 SPOTLIGHT copy.indd 21 13-06-25 9:56 AM



The Saskatchewan Court of Queen’s Bench made history when Justice Murray Acton assessed one of the largest punitive damage awards against an insurer in Canadian history this March.

Acton awarded the plaintiff $3,000,000 in punitive damages against Zurich Life In-surance Company Ltd.

and a further $1,500,000 against AIG, after the insurers denied the plaintiff ’s long-term disability and regular benefit payments for more than nine years.

As he concluded his lengthy judg-ment, Acton stated he hoped the award would garner the attention of the in-surance industry:

“The industry must recognize the destruction and devastation that their actions cause in failing to honour their contractual policy commitments to the individuals insured.”

The decision, which is being ap-pealed, condemned the insurers’ “pro-tracted,” “outrageous,” “reprehensible” and “abhorrent” management of the plaintiff ’s claim in the decade preced-ing the trial.

The plaintiff, Luciano Branco, worked as a welder for a subsidiary of a Saskatchewan company in Kyrgyzstan. He injured his foot in the course of his employment in December 1999, with a re-injury in March 2000. Branco ul-timately reported his injury to his em-ployer in June 2000.

AIG was obligated to provide ben-efits to Branco for his work-related injuries based on Workers’ Compen-

sation Board benefits payable in Sas-katchewan. Zurich was responsible for his long-term disability.

The Court concluded that both Zu-rich and AIG’s policies were “peace of mind” contracts, the object of which was to secure a psychological benefit. On this basis, the Court concluded the plaintiff ’s mental distress, caused by a breach of these contracts, was within the reasonable expectation of the parties.

The Court confirmed the goal of punitive damages is deterrence. The blameworthiness of AIG and Zurich’s conduct, and their liability for punitive damages, was assessed against the fac-tors identified by the Supreme Court of Canada in Whiten v. Pilot Insurance Co., when considering awards for pu-nitive and aggravated damages. These factors include:• Whether the conduct was planned

and deliberate;• The intent and motive of the defen-

dant;• Whether the defendant persisted

in the outrageous conduct over a lengthy period of time;

• Whether the defendant concealed or attempted to cover up its miscon-duct;

• The defendant’s awareness of what he or she was doing wrong;

• Whether the defendant profited from the misconduct; and

• Whether the interest violated by the misconduct was known to be deeply personal to the plaintiff or a thing that was irreplaceable.

The case against AIGAIG failed to pay benefits when due,

but for some erratic payments to Bran-co over several years, until the benefits

were discontinued entirely in Decem-ber 2004.

The Court found AIG’s failure to pay benefits in a prompt and reason-able manner was a breach of duty of good faith and fair dealing. The Court recognized that the purpose of month-ly benefits is to enable those who are disabled to meet the monthly expenses of living. It found AIG’s failure to pay benefits for months or years on end was “malicious and designed to lever-age a reduced settlement”.

The Court was exceptionally criti-cal of AIG given the case of Sarchuk v. Alto Construction Ltd. In Sarchuk, the Court awarded punitive damages against AIG in the amount of $60,000 based on the reprehensible actions of the adjuster. Acton recognized the same adjuster in Sarchuk was involved in the plaintiff ’s case and employed the “same technique” to the Branco’s claim. Noting this, the Court felt the punitive damage award in Sarchuk was “not sufficient to prevent an immedi-ate reoccurrence of the unacceptable technique.”

In this case, the Court found AIG was aware of how deeply their actions were affecting the well-being of Bran-co, that the dispute had continued for over nine years, and that Branco’s de-termination for a fair resolution was the only thing preventing the insurer from profiting from its misconduct.

The Court awarded Branco $1,500,000 in punitive damages against AIG on the basis that:

“The goal of punitive damages is deterrence. Insurers must discontinue exploiting the vulnerability of insureds in times of disaster. The court must also consider the fact that previous

History in the Making Canada’slargestawardofpunitivedamagesagainstinsurers

BYDONMCGARVEYANDTARAARGENT

p22-23 ARC.indd 22 13-06-25 9:59 AM


http://www.isbc.ca


The potential haz-ards to human health resulting from direct exposure to fire and smoke are obvious to us all, but responsible insurance claims pro-

fessionals should be aware that many other environmental, health and safety concerns don’t arise until after the fire is put out and the assessment and restora-tion work begins. Specifically, we must be aware of potential concerns regard-ing indoor air quality for safe work and future occupancy, contamination of firefighting water and resultant impacts to the environment, identification of designated substances and hazardous materials, proper waste disposal and assessment of soot migration to deter-mine the actual extent of damages.

Indoor air qualityWith fires that affect industrial or

commercial facilities, or any buildings which may have a variety of chemicals stored at the property, the potential ex-ists for a hazardous atmosphere to be created as a result of the fire. Although such atmospheric hazards are most pronounced during and shortly follow-ing the fire, off-gassing of remaining chemical contaminants and evapora-tion from wet materials can result in

lingering air quality impacts. In order to evaluate the level of hazard associ-ated with the indoor atmosphere, a prudent claims professional should require that some level of indoor air quality (IAQ) assessment be complet-ed within the subject building shortly after the scene is released by the Fire Marshall’s office, or sometimes even before, depending on the Fire Mar-shall’s direction. This would generally involve the use of handheld air moni-toring devices to obtain real-time spot measurements of various air quality indicator parameters, such as oxygen, carbon dioxide and monoxide levels, suspended particulate matter, and total volatile organic compounds (TVOCs, among others). The IAQ assessment would confirm whether additional ven-tilation measures may be required, or whether there may be a contamination source that needs to be addressed (e.g. spilled chemicals) prior to restoration work proceeding or future occupancy. In addition, the IAQ assessment would assist in the determination of the ap-propriate level of personal protective equipment required for any personnel entering the structure during the early post-fire stage. Such IAQ monitoring can continue throughout the restora-tion process in order to identify when personnel protective measures can be

downgraded to avoid unnecessary cost and restrictions.

Contamination of firefighting water

In instances where a potential source of contamination is known to be pres-ent or was identified on the subject property during the initial scene assess-ment (e.g. spilled chemicals or the rem-nants of chemical containers damaged by the fire), it follows that the firefight-ing water may also end up contaminat-ed as a result. When this water becomes surface runoff and enters the sewer sys-tems or flows overland onto adjacent properties, significant environmen-tal impacts can result. Consideration should be given to the site drainage and sewer infrastructure that could be af-fected and the potential for off-site mi-gration of contamination as a result of the fire and firefighting activities. Cer-tain storm sewer systems also discharge to nearby watercourses, which could have even more pronounced effects if aquatic life is put at risk as a result. This might involve assessing the water with-in local catch basins for visual or olfac-tory evidence of contamination and/or laboratory analysis of water samples to verify concentrations of contaminants of concern in comparison with regula-tory standards (e.g. sewer use by-laws).

Varied Facets of

a Fire LossThe key

environmental, health and safety

considerations in the event of a

property fire claim

BY KEITH STEPHEN

p24-26 GK FIRE.indd 24 13-06-25 10:06 AM



In instances where contamination is identified, further investigation may be warranted to identify the extents of contamination, particularly if the con-tamination has migrated off the subject property, or it may be appropriate to undertake some level of remediation (e.g. containment and offsite disposal at an approved facility of any residual contaminated water within the subject property and/or catch basins using a vacuum truck). Addressing these con-cerns early on would ensure that the insurance parties are doing their part to mitigate potential offsite contami-nation issues on behalf of the insured, and would help to appease regulatory officials (e.g. Ministry of the Environ-ment) and demonstrate due diligence in these regards.

Designated substances and hazardous materials

Prior to any demolition or restora-tion activities in any Canadian province or territory, it is mandatory that the presence of hazardous materials in gen-

eral (and in most jurisdictions, asbes-tos in particular) be identified so that appropriate safety and waste handling precautions can be taken.1-13 Generally, it is required that the regulated materi-als (the specific list of hazardous sub-stances varies by jurisdiction) present within a project area be identified for the purpose of communicating the re-lated hazards to workers and occupants in advance of construction or demoli-tion that may disturb such materials. Commonly with older buildings, the most significant concern is the pres-ence of asbestos, which was historically used in numerous building materials including floor tiles, window caulk-ing, and plaster. Certain construction materials and finishes for sale are still asbestos-containing today, such as floor tiles and concrete pipes, etc. making it difficult to gauge the risk based on the age of a building alone. In all Canadian jurisdictions, there are provincial/terri-torial regulations, guidelines, or codes of practice pertaining to the assessment and abatement of asbestos.14-25 Some

jurisdictions require written notifica-tion to the regulatory authority prior to undertaking asbestos abatement, and in most jurisdictions, the regulatory authority may conduct surprise inspec-tions of the asbestos abatement work being undertaken. Failure to carry out the abatement work in a safe manner (e.g. in accordance with the applicable regulation, guideline, or code of prac-tice for a given jurisdiction) could re-sult in the demolition/restoration work being suspended (i.e. think costly con-struction delay) or, even worse, result-ing in fines to the project owner and/or contractor. Ironically, the project own-er may, in fact, be interpreted as being the adjuster or insurer given that most property owners, especially in residen-tial situations, are unaware of these pre-restoration regulatory requirements.

Waste disposalThe various types of waste that may

be generated during the demolition/restoration activities would have to be classified and handled in accordance

p24-26 GK FIRE.indd 25 13-06-25 10:06 AM


http://www.firstgeneral.ca


with applicable guidelines or regulatory requirements for each jurisdiction.26-37 These regulations or guidelines may include special waste handling require-ments for asbestos waste and other hazardous wastes (like leachable lead in old paint, etc.), and generally provide definitions of the various waste types and testing requirements to determine appropriate disposal measures. Claims professionals responding to a fire loss must ensure that the selected restora-tion contractor is properly managing wastes in accordance with the applica-ble regulatory requirements, including confirmation that waste haulers and waste disposal locations are appropri-ate and have the necessary provincial approvals, licenses and permits. The discovery that waste has been mishan-dled after it has already been dumped at a landfill may have costly repercussions in terms of recovering it for proper dis-posal.

Soot deposition and migration in structures

Soot is a product of incomplete combustion, which occurs when there is insufficient oxygen present to al-low a fuel to react without produc-ing by-products. Whereas the charred materials affected by a fire can be eas-ily visually identified, the identification of the presence of loss-related soot on the surfaces of building materials or building contents may require closer examination. To this end, claims pro-fessionals would be wise to have a soot migration assessment undertaken in order to better understand the extents of the area affected by loss-related soot deposition, and to most efficiently plan restoration activities. The assess-ment would help to avoid unnecessary tear-out and cleaning or, even worse, to avoid missing hidden impacts that may require additional work after a claim is resolved. Such an assessment would involve the collection of surface wipe samples for microscopic analysis. When viewed under a microscope, sur-face samples containing soot are read-ily discernible from samples containing dust and other particulate matter due to the differences in particulate colour, morphology and size. In addition, lab-oratory testing could be conducted in

order to identify the “chemical finger-print” of the subject fire to allow for the differentiation of loss-related impacts from other impacts related to normal operations at the subject property or other pre-existing conditions. This ad-ditional testing can be pivotal in avoid-ing unnecessary remedial measures and costs in buildings with high back-ground (pre-existing) soot contamina-tion.

SummaryThough it may seem like a daunting

task to effectively address these various potential environmental, health and safety concerns, an effective insurance claims professional can manage these duties easily by quickly identifying the key concerns and ensuring that the right resources are brought in early on. Experience shows a basic assess-ment at the outset of a loss can avoid a multitude of complications and sur-prise costs later on in the restoration process.

Keith Stephen, B.A.Sc., M.Eng., P.Eng., is an environmental engineer with the forensic engineering firm Giffin Koerth Inc., and has successfully man-aged dozens of environmental site as-sessments and site remediation projects, including several for insurers.

1. Section 20.112 of BC Occupational Health and Safety Regulation

2. Sections 34 and 417 of Alberta Occupa-tional Health and Safety Code, 2009

3. Sections 334(1) and 381(1)(a) of Sas-katchewan Occupational Health and Safety Regulations, 1996

4. Section 33.4(1)(a)(ii) of Manitoba Work-place Safety and Health Regulation

5. Section 30 of Ontario Occupational Health and Safety Act and Ontario Regu-lation 490/09 – Designated Substances

6. Section 3.23.3.2 of Quebec Safety Code for the construction industry

7. Section 398(a) of Newfoundland and Labrador Occupational Health and Safety Regulations, 2009

8. Section 157(2) of Nova Scotia Oc-cupational Health and Safety General Regulations

9. Section 157(2) of New Brunswick Oc-cupational Health and Safety General Regulations

10. Section 49.10 of PEI Occupational Health and Safety Act – General Regula-tions

11. Section 10.56(a) of Yukon Occupational

Health and Safety Regulations

12. Section 2.3 of NWT Guideline for the Management of Waste Asbestos and Sec-tion 5 of Asbestos Safety Regulations

13. Section 5 of Nunavut Asbestos Safety Regulations

14. Guideline G6.8 – Procedures for abate-ment of asbestos materials during house and building renovation of BC Occupa-tional Health and Safety Regulation

15. Alberta Asbestos Abatement Manual, Oct 2012

16. Saskatchewan Guidelines for Managing Asbestos in Buildings

17. Manitoba Guideline for Working with Asbestos

18. Ontario Regulation 278/05 – Designated Substance – Asbestos on Construction Projects and in Building and Repair Operations

19. Section 3.23.7 of Quebec Safety Code for the construction industry

20. Newfoundland and Labrador Asbestos Abatement Regulations, 1998

21. Nova Scotia Code of Practice for Re-moval of Friable Asbestos-Containing Materials

22. Code of Practice for Working with Materials Containing Asbestos in New Brunswick

23. Section 49 of General Regulations of PEI Occupational Health and Safety Act

24. Section 34 of Yukon Occupational Health Regulations

25. NWT and Nunavut Codes of Practice for Asbestos Abatement

26. BC Regulation 63/88 – Hazardous Waste Regulation

27. Alberta Regulation 192/1996 – Waste Control Regulation

28. The Hazardous Substances and Waste Dangerous Goods Regulation for Sas-katchewan

29. Manitoba Regulation 282/87 Classifica-tion Criteria for Products, Substances, and Organisms Regulation

30. Ontario Regulation 347/90 – Waste Management

31. Newfoundland and Labrador Guidance Document for Asbestos Waste Disposal and Newfoundland and Labrador Guid-ance Document for Leachable Toxic Waste, Testing and Disposal

32. Nova Scotia Regulation 56/95 – Danger-ous Goods Management Regulation

33. New Brunswick Regulation 2008-54 – Designated Materials Regulation – Clean Environment Act

34. PEI Waste Resource Management Regu-lations

35. Yukon Special Waste Regulations

36. Guideline for the General Management of Hazardous Waste in NWT

37. Guideline for the General Management of Hazardous Waste in Nunavut

p24-26 GK FIRE.indd 26 13-06-25 10:06 AM


NAVIGATE YOUR WAY TO VICTORIA BC ON OCT 6–9 2013 TO DISCOVER THE FUTURE OF RISK MANAGEMENT.

The BC Chapter is excited to invite you to a city proud of its rich heritage, historic downtown, gorgeous gardens and parks, and scenic Inner Harbour. It’s the perfect backdrop for this voyage of discovery, chart your course for 2013 RIMS Canada Conference in Victoria, BC.

The organizing committee has its sails fully furled as it navigates past the buoys marking the final months. Our program committee is putting together an exciting nautical map with ports of call at ERM, Claims, Legal and Insurance, with 25 concurrent sessions over 6 blocks.

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

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

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

Join other risk and insurance professionals on a voyage of Discovery at the 39th Annual

RIMS Canada Conference.

OCTOBER 6–9, 2013 The Victoria Conference Centre


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Accountants are frequently retained in ca-sualty/bodily injury/personal injury matters to quantify potential income losses. Often the quantification exercise is based on limited in-formation provided by the plaintiff or plain-tiff ’s counsel. When the assessment of poten-tial losses of income needs to be made, there is

information that should be requested from the plaintiff. Each situation is unique, however, and the information is intended to be general and may not be applicable to every situation.

Before getting into the specifics, it is important to note there are two distinct types of individuals as it relates to personal in-jury matters: employed individuals and self-employed business owners. The information that needs to be obtained from each type of plaintiff is different.

Employee In terms of employees, a typical information request listing

would look as follows:1. Personal Income Tax Returns (T1), complete with all in-

come related slips including: a. T4 Statement of Remuneration Paid b. T4A Statement of Pension, Retirement, Annuity

and Other Income c. T4A(P) Statement of Canada Pension Plan Benefits d. T4A (OAS) Statement of Old Age Security e. T4E Statement of Employment Insurance and Other Benefits

2. Notice of Assessment as provided by the Canada Revenue Agency (CRA)

3. Information Tax Return Information – Regular4. Pay stubs for where no income tax return has been pro-

vided 5. Current union agreement (if employee is unionized)6. Pension guide (if employee is part of a pension program)7. Benefit guide (if employee received benefits from their em-

ployer)8. Employment files9. Disability benefit file (private disability benefits or CPP

Disability Benefits)10. Documentation supporting any Income Replacement Ben-

efits receivedTypically, this information should be requested for the five

years prior to the accident, this would be dependent on the specifics of each case.

Much of what is detailed above is straightforward; however, further discussion is warranted with respect to the first 3 items. Generally speaking, it is preferable to receive the detailed and completed income tax returns (#1) as opposed to the printouts

that are provided by the Canada Revenue Agency (CRA) (#3), as it can be difficult to pinpoint specific sources of income with only the CRA printouts. However, if the detailed tax returns are provided, it is imperative the corresponding Notice of Assess-ment (#2) is provided as well. The Notice of Assessment serves to confirm that the information contained in the income tax return has been filed with CRA; if the Notice of Assessment (or the CRA printout) is not available, this may be an indica-tion that the income tax return was not actually filed and may not be accurate. Furthermore, the Notice of Assessment will indicate when the assessment occurred, which will confirm the approximate time when the tax return was filed. If it is noticed that the requested pre-accident tax returns were all filed fol-lowing the accident, this may represent a red flag and further investigation would be warranted.

Self-employed Self-employed individuals present an additional layer of

complexity. A self-employed person generally owns a busi-ness and can draw money from their business, either as a divi-dend, a salary and/or benefits. Ultimately how business owners choose to pay themselves is a matter of tax or financial plan-ning, and does necessarily speak to their economic earnings from the business. It is the results of the company that should be assessed, and not how the owner chooses to transfer money from the business bank accounts to its personal bank account.

When dealing with a self-employed individual there are key questions that need to be addressed which will dictate what information is required:1. Is the business incorporated or not? If the business is not

incorporated, the results of the business will be reported on the T2125 Statement of Business or Professional Activi-ties within the individual’s personal income tax returns. No corporate income tax returns will exist. If the business is incorporated, you will require records of the individual and records of the corporation.

2. How much of the business does the individual own? Fre-quently, self-employed individuals will own a business jointly with other individuals and, therefore, would only be entitled to the portion of losses related to their portion of ownership. Ownership of the business is outlined on the T2125 Statement of Business or Professional Activities for unincorporated businesses (within the personal income tax return) or Schedule 50 Shareholder Information for incor-porated business (within the corporate income tax return).

3. How does the incorporated business owner get paid? The salary drawn or dividends paid by a corporation to the owner is not in itself a measure of the income available to

Quantifying Income Loss BY MATT MULHOLLAND

p28-29 MD&D.indd 28 13-06-25 10:10 AM



the owner from the business, but it does assist in making that determination. Ultimately, the income available to the business owner is the net income earned by the business, plus any salary withdrawn and any other personal expenses that were recorded as corporate expenses.In terms of self-employed plaintiffs, a typical information

request listing would look as follows:1. Personal Income Tax Returns (T1), complete with all in-

come related slips including:a. T4 Statement of Remuneration Paidb. T4A Statement of Pension, Retirement, Annuity and

Other Incomec. T4A(P) Statement of Canada Pension Plan Benefitsd. T4A (OAS) Statement of Old Age Securitye. T4E Statement of Employment Insurance and Other

Benefitsf. T2125 Statement of Business or Professional Activities

2. Information Tax Return Information – Regular (Personal)3. Corporate Income Tax Return (T2), complete with all sup-

porting schedules including:a. Schedule 50 – Shareholder Informationb. Schedule 125 – Income Statement Information

4. Notice of Assessment as provided by the Canada Revenue Agency (Corporate and Personal)

5. Financial statements (including the Income Statement, Bal-ance Sheet and Cash Flow Statement)

6. Monthly revenue summary/Monthly revenue summary by customer

7. Payroll journal including a copy of all T4 Statement of Re-muneration Paid slips issued

8. GST/HST Remittances9. General ledger10. Bank statements11. Sales invoices12. Disability benefit file (private disability benefits or CPP

Disability Benefits)

13. Documentation supporting any Income Replacement Ben-efits receivedWith respect to specific documents from this list, the

monthly revenue summary/monthly revenue summary by customer (#6) is often overlooked. This information is useful in determining when a decline in revenues commenced, or if the decline in revenues relates to the loss of a specific customer that may indicate the decline in income was not accident-re-lated.

GST/HST Remittances (#8) are also useful documents as they serve to validate the sales reported in the income state-ments of the business. Once again, if the GST/HST Remittanc-es do not reconcile to the income statements, further investiga-tion would be required.

The general ledger (#9) is a listing of all accounting transac-tions, which occurred over a specific period of time (usually the fiscal year). This document is helpful if further examina-tion of the business expenses is required, such as in cases where significant expense fluctuations occur following the accident.

Bank statements (#10) and sales invoices (#11) are generally requests of last resort, but may be required should other docu-mentation not be available or its review warrants that more detailed review and investigation is required.

Conclusion Different documents are required when dealing with

plaintiffs who are employees versus those who are self-em-ployed business owners. A proper analysis of a business own-er’s claim for lost income is generally much more complex and document-intensive. The sooner in the litigation process this information is received, the better the likelihood that a fair resolution of the claim can be achieved.

Matt Mulholland is a vice president with Matson, Driscoll & Damico Ltd. (MDD) in Toronto, Ontario. Matt has been in-volved in a wide variety of commercial insurance and litigation matters and has testified before the Superior Court of Ontario.

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Arbitrator John Wilson, of the Financial Services Commission of Ontario (FSCO), released the first decision in consideration of the Minor Injury Guideline (MIG) on Mar. 26, 2013.

Before we consider this decision, howev-er, it is warranted to take a quick look back on what led us to Scarlett. On Sept. 1, 2010, the Statutory Accident Benefits Schedule (SABS) was amended replacing reference to the previous Pre-Approved Framework (PAF) with the MIG. Concerns were imme-diately raised within the industry question-ing the breadth, scope and application of the MIG. Importantly, we must accept that the MIG is a guideline, noting that the leg-islature did not amend the SABS or Insur-ance Act itself to incorporate the provisions of that guideline, but have made the MIG an aid to the SABs.

By the fall of 2012, it had become clear that even in spite of a lack of clarity as to when the MIG should apply, the financial results for auto insurance in On-tario had turned from a significant loss ratio to a satisfac-tory profit. From the beginning, the MIG (and removal/reduction of various benefits from the standard package of coverage) was intended to create “cost certainty” by posi-tioning insurers to have a financially viable product based on the approved premiums.

Absent case law to guide the way, each insurer has had little choice but to handle this Guideline in its own way, all the while asking: Are we doing this right? What does “pre-dominantly minor” mean? How long can this last?

Has Scarlett rendered the MIG gone with the wind?

Facts Lenworth Scarlett suffered soft tissue injuries in a rear-

end collision on Sept. 18, 2010. He was a passenger in a Belair vehicle that was struck from behind. He was also a recent arrival to Canada, with no OHIP coverage or per-

mit to work. Any funding available to him to treat injuries sustained in this loss would have to flow from Belair under the accident benefits coverage. The Belair policy had yet to renew, so the “old” benefits were in place (housekeeping, $100,000 for medical and rehabilitation, $72,000 for atten-dant care and cost of examinations, which, if funded, would not come out of his med/rehab limits).

Scarlett produced three main reports, all from different specialists, in support of his claim that he suffered injuries that did not fall within the MIG. One was a medical report from dental surgeon Dr. Lewandowski who diagnosed tem-poro-mandibular joint syndrome (TMJ). The next was a report from Dr. F. Tavazzani, orthopaedic specialist, which indicated that Scarlett demonstrated “depressed affect” and that Scarlett had restricted lumbar range of motion and dif-ficulty transferring positions from standing to sitting and from sitting to standing. Additionally, he produced a report from Dr. Pilowsky, psychologist, who found that Scarlett was suffering from pain disorder, severe depressive symp-toms, and chronic symptoms of posttraumatic stress dis-order and driver anxiety. Apparently, there was a follow up report from Dr. Pilowsky which responded to the insurer’s own psychological report.

In what appears to be an effort to comply with the re-quirements of the MIG, to ensure that the evidence provid-ed in support of Scarlett’s claims were “compelling”, Belair arranged for several insurer’s examinations. The conclusion of the assessors was that Scarlett’s injuries fell within the scope of the minor injury definition and the MIG.

Belair relied first upon a paper review report from Dr. Crescenzi, a chiropractor, responding to a treatment plan. This assessor concluded that Scarlett’s injuries fell within the MIG on the basis that he sustained soft tissue injuries and there was no evidence of any neurological sequelae.

Next, Scarlett was examined by Dr. Mor, a psychologist. In the resulting report it was noted that Scarlett reported that he was independent with respect to personal care and denied depression or cognitive difficulties. Scarlett did not

GONE WITH THE WIND?The Impact of Scarlett on the MIG

BY KADEY B.J. SCHULTZ, JASON FROST, AND JOY STOTHERS

p30-31 SCHULTZ.indd 30 13-06-25 10:12 AM



express the need for psychological treatment. Although the details of the reports are not apparent from the decision, it seems that Dr. Pilowsky, Scarlett’s treating psychologist, responded to that report challenging the comments and conclusions. As discussed below, it also raised an issue of concern for Wilson that a statement made by Scarlett was subsequently used against him.

Belair also arranged for a paper review report from a dentist, Dr. Ouanounou, who concluded that the file docu-mentation did not provide “compelling substantive objec-tive evidence or subjective claimant complaints to suggest” that the claimant had ongoing concerns regarding TMJ. Wilson’s lack of confidence in paper reviews and the opin-ions flowing from there is palpable.

DiscussionWilson concluded that the MIG is a “non-binding inter-

pretive aid” and that “compelling medical evidence” must be convincing, on a balance of probabilities.

In essence, the decision found that Belair had not proven on a balance of probabilities that the claimant’s soft tissue whiplash injuries, and other complaints were minor in na-ture, and stated:

While there is no doubt that Mr. Scarlett suffered soft tissue injuries, it is not at all clear that he also did not suffer from any other conditions that were neither soft tissue inju-ries nor the sequelae thereof, or that the sum of his injuries from the accident were minor in nature.

The reports of chronic pain from Dr. Tavazzani are evi-dence of symptoms separate from Mr. Scarlett’s soft tissue injuries, presenting as psychological, neurolocognitive and emotional impairment.

Dr. Pilowsky’s reports, taken with the comments of Dr. Tavazzani, provide credible evidence that Mr. Scarlett suf-fered serious depressive symptoms and PTSD consequent to the accident.

While the Insurer’s reports may disagree with that con-clusion, that is the very sort of conflict that is meant to be resolved in court or by arbitration, on the issue of reason-ableness of the particular treatment proposed, not by a uni-lateral veto of benefits by the Insurer.An intriguing issue that has arisen relates to Wilson’s

reference to section 233 of the Insurance Act. This section deals with insurance contracts – the information provided to insurers by applicants to form the basis of the policy and premium determination. It appears, from Wilson’s com-ments, that in his opinion, based on section 233 of the Act, an insurer could not rely on statements made by an insured claimant to assessors. His reference to section 233 was in the context of whether Scarlett advised Dr. Mor that he was independent with respect to personal care, denied depres-sion or cognitive difficulties, and did not express the need for psychological treatment. Without saying it clearly, one can infer from the decision that Wilson gave little weight to that report and the reported comments of the claimant, preferring to rely on the treating psychologist’s earlier and subsequent reports supporting ongoing psychological se-quelae and treatment needs.

The concern that naturally arises from this line of com-mentary is whether other FSCO arbitrators and decision makers will read this to restrict an insurer’s ability to rely on statements made by the claimant to s. 25 and 44 asses-sors, evidence obtained through examinations under oath, clinical notes and records and even surveillance. If read narrowly, Wilson’s commentary would mean that the only information the insurer can rely upon is the signed OCF-1, OCF-3 and/or the original copies of the OCF-18s or OCF-23s.

In review of s. 233(3) we note that it only applies to the “application for a contract” and the other portions of s. 233 only apply when the applicant or insured makes a false claim, misrepresents a material fact or contravenes a term of the contract. None of these requirements are present in this case.

Conclusion Our recommendation is for insurers to continue to con-

sider all relevant information in the file when providing the “medical and any other reasons” for approval, partial ap-proval, or denial of a benefit, keeping in mind the consumer protection intent of this legislation and Wilson’s approach in Scarlett.

Ultimately, he concluded that jaw pain, chronic pain and psychological impairments are “separate and distinct from the soft tissue injuries” and the MIG exclusion did not ap-ply. While many insurers have taken the approach that one must consider whether the impairments as a whole were predominantly minor in nature or whether the sequelae complained of (in Scarlett: jaw pain, chronic pain and de-pression) flowed from the predominantly minor injuries, this was not Wilson’s approach. The MIG is only a guide-line, and before it can be considered all insurers must first look at the language of the medical and rehabilitation bene-fits sections of the SABS – pay benefits for injuries sustained as a result of the accident.

There is no word yet on whether the decision will be ap-pealed. One might suggest that an appeal of this decision is not in the interest of insurers. As it stands right now, Scar-lett is not binding. It is an arbitration decision based on a specific set of facts and evidence. No viva voce evidence was presented. It was a preliminary issue hearing to determine whether Scarlett was precluded from receiving housekeep-ing, attendant care and other benefits as a result of falling within the MIG. It might be best to let this decision sit, and to continue to develop the case law based on different facts, different experts and a complete hearing.

Some aspects of the decision are both surprising and troubling, while others are as we would, and should, have anticipated. While we now have “the first word” on the MIG, there will be many more words before we are in a position to know whether the MIG is gone with the wind.

Kadey B.J. Schultz, LL.B., L.L.M., is a partner, Jason Frost, LL.B., is an associate and Joy Stothers, LL.B., LL.M., is an as-sociate with Hughes Amys LLP.

p30-31 SCHULTZ.indd 31 13-06-25 10:12 AM



For motor vehicle accident (MVA) cli-ents, an essential as-pect of achieving an independent lifestyle is a safe and func-tional home envi-

ronment that facilitates maximum mobility. While this might seem obvi-ous, depending on a client’s specific post-accident condition, the barriers to independence in their home can be anything but obvious. In most cases, it is necessary to structurally modify the home to remove any barriers that impede mobility and safety — and to add structural enhancements to pro-mote mobility and safety. But in On-tario, how best to meet the Statutory Accident Benefits Schedule (SABS) re-quirements that home modifications and associated costs be “reasonable and necessary”? The answer is teamwork.

As the Statutory Accident Benefits ScheduleSection 16, sub-sections 16.3(i), 16.4 (b) and 16.4(c) stipulates that “an as-sessment must be completed upon the catastrophically-impaired client’s home in order to establish a quantum value for home modifications. The extent of the home modifications, as well as the as-sociated costs to complete the modifica-tions must be reasonable and necessary.”

There’s no going it aloneTo effectively assess potential modi-

fications to the pre-accident home requires a long-term view of what is necessary to meet a client’s and their family’s present and future needs. Whether these modifications can be achieved by renovating the existing home, or by investigating alterna-tive housing options is a central issue. However, in all cases, the difference between assessing home modifications versus other types of assessments is that it requires a team approach because it requires diverse skill sets. The exper-tise required to provide a client with a comprehensive assessment doesn’t exist in just one type of professional—it re-

quires the combined skills of an occu-pational therapist and a housing expert.

One professional’s assessment (oc-cupational therapist) without the other professional’s assessment (housing ex-pert) can result in recommendations that are not “reasonable and necessary” — plus there is the potential for signifi-cant liability issues. Working in isola-tion, each professional is not qualified to provide the type of recommenda-tions required to ensure that a client’s specific housing needs are effectively addressed and in keeping with SABS requirements.

A Home Modifications Assessment of the pre-accident or existing residence identifies the adaptive modifications that should be considered, as well as the associated costing to complete the same. The resulting Home Modifications Report is the basis for making the decision regarding whether to renovate the pre-accident/existing home or, alternatively, to explore other housing options.

The occupational therapistBefore it’s possible for a client’s

home modification needs to be deter-mined, first an occupational therapist (OT) must assess the client’s physical and cognitive abilities and limitations. The OT scope of practice enables them to determine a client’s post-accident functional status: • An OT is qualified to assess a client to

determine what is “necessary” from a functional abilities perspective.

• An OT is not qualified to recommend specific home modifications or asso-ciated costing. OT’s are only qualified to provide general recommendations regarding accessibility.

OTs are not qualified to assess struc-tural limitations of a client’s home because they are not trained in ar-chitectural design and construction principles (i.e., feasibility of structural modifications, cost estimates, etc.). In addition, OTs are not trained in design standards or building code require-ments. If an OT provides structural recommendations, the recommenda-

tions are not necessarily “reasonable and necessary” and there is also liability risk. Overall, the OT, while weighing in on recommendations from a functional perspective, should defer all design and costing to the housing expert.

Do: It is within the OT scope of practice to comment that, for example, “If provided with an appropriate bathroom design, Mr. X will have the functional ability to independently conduct his daily self-care routine.”

Don’t:It is outside the OT scope of practice to recommend specific structural details like “To maximize Mr. X’s functional abilities within the bathroom, consideration should be given to the construction of a second story addition off the home’s rear elevation.”

The housing expert Based on the OT’s functional as-

sessment, which provides a clear un-derstanding of what a can and can’t do, the housing expert can now determine what structural modifications are nec-essary to maximize function and limit the “can’t do” aspects of a client’s post-accident functional status: • The housing expert is qualified to

assess the structural aspects a client’s post-accident home to determine what is “reasonable” from a design, construction, and cost perspective based on the OT’s functional assess-ment.

• The housing expert is not qualified to assess a client’s functional ability.

Using the OT functional assessment as the foundation, the housing expert — trained in barrier-free design — now assesses to what degree the struc-tural aspects of the home impede or

Team ApproachBY DAVID BORTHWICK

p32-33 SIBLEY.indd 32 13-06-25 10:29 AM



enhance a client’s functional status. Where the pre-residence structure now poses barriers post-accident, it is up to the housing expert to pro-vide detailed architectural solutions to overcoming these barriers through recommendations that focus on structurally modifying the residence.

Do: It is within the housing expert scope of practice to recommend structural specifications and associated costing, for example, “Based on the functional information provided it appears that Mr. X would benefit from the inclusion of a fully accessible en-suite bathroom. The proposed bathroom design would include a wheel-in shower enclosure, an open ac-cess vanity with off-set covered plumbing and a height-adjusted raised toilet.”

Don’t:It is outside the housing expert scope of practice to comment on functional abili-ties like “Mr. X was observed to experi-ence cognitive fatigue and appears to have deficits that affect his tolerance and ability to perform certain activities.”

No part to play on the team: unqualified professionals

To provide a client with the best assessment possible—plus ensure a defensible report and avoid liability risk—assemble a team with these two distinct skill sets: • Check that the OT is registered with

the College of Occupational Thera-pists of Ontario (COTO). As COTO describes, “registration with the Col-lege qualifies occupational therapists to use the title ‘Occupational Thera-pists’ or ‘O.T.’, and the designation ‘OT Reg. (Ont.)’. Registration indi-cates to the public that their occu-pational therapist has met entry-to-practice requirements, and meets the College’s standards of practice and quality assurance requirements. In addition, it provides the public with a means of recourse, should they re-ceive occupational therapy treatment they feel does not meet professional standards.” (http://www.coto.org/registration/default.asp)

• Housing expert: look for certifica-tion as a registered architect or con-struction engineering professional

specialized in barrier-free design and cost estimating. This not only ensures that the housing expert is qualified regarding accessible design, but also that they carry the right type of liability insurance.

Don’t settle for one without the other

Combined skills is the only way to meeting SABS requirements. The team approach ensures that home modifications and associated costs are

“reasonable and necessary.” And ulti-mately, teamwork ensures that a client maximizes post-accident abilities in a safe and accessible living environment — while avoiding potential liability risks.

David Borthwick is the president of Accessible Solutions Inc. (ASI): specialists in barrier-free home assessments, design, and construction management for insur-ers with MVA clients who have suffered mobility and/or cognitive impairments.

Claims Canada Magazine is the only national claims

publication COVERING the Canadian market


Reaching Over 8,500 Insurance Claims Professionals from

Coast-to-Coast!

www.claimscanada.ca

For advertising space information, please contact Paul Aquino, Publisher: [email protected]

p32-33 SIBLEY.indd 33 13-06-25 10:29 AM


http://www.coto.org/registration/default.asp

http://www.coto.org/registration/default.asp




The particular activity of the child will also play a role in determining the standard of care. When a child engages in an adult activity, such as driving a car, dirt biking, or snowmobiling, that child will be judged by the purely ob-jective standard that applies to adults. In McErlean, Justice Robins of the On-tario Court of Appeal stated, [A]s a general rule in determining

negligence, children are not requiredtoconformtothestandardofconductwhich may reasonably be expected ofadults.Theirconduct is judgedby thestandard tobe expectedof childrenoflike age, intelligence and experience.This is essentially a subjective testwhichrecognizesthatthecapacitiesofchildrenare infinitelyvariousandac-cordinglytreatsthemonanindividualbasis and, out of a public interest intheirwelfareandprotection,inamorelenient manner than adults …Thereare,however,exceptionstothisgeneralrule. Where a child engages in whatmay be classified as an adult activity,he or she will not be accorded specialtreatment, and no allowance will bemade for his or her immaturity. Inthosecircumstances,theminorwillbeheldtothesamestandardofcareasanadultengagedinthesameactivity.

Recognizing the distinct legal stan-dards which apply to the subsets of children is key to effective early inves-tigation of the case. If you are dealing with a tortfeasor or claimant of tender age, considerations of culpability in negligence or contributory negligence will not apply.

If you are dealing with a situation, however, that falls within the grey zone, it is essential to fully canvass both the subjective and objective ele-ments at play at the time of the occur-rence. Failure to do so may rob you of a potentially effective defence. By the time a claim is advanced to the stage of litigation, and then to trial, several years will likely have passed. Limita-tion acts in the common law provinces allow for postponement of the limita-tion period while the plaintiff is a mi-nor. In cases where the claimant is a child, it could be over a decade before an action is even commenced. For this reason, decisive early investigation of

the circumstances of the occurrence which specifically includes investiga-tion of the characteristics of the child or children in question, is key to a potentially successful defence of the claim.

Christine practices civil litigationwiththelawfirmLindsayLLP,primarilyintheareasofpersonalinjury,motorve-hicleaccidents,fire lossesandoccupiers’liability.MaxR.S.HuftonisabarristerwiththelawfirmLindsayLLP,primar-

ily involved in the defence of casualtyclaims.TheyarebothmembersofCana-dianDefenceLawyers.

1.McErleanv.Sarel,1987CarswellOnt762(ONCA),atpara.53

2.[1966]O.J.No.1082,[1967]1O.R.203(H.C.J.)(perGrantJ.)

3.[1956]S.C.R.787at793,6D.L.R.(2d)1(S.C.C.)

4.2006CarswellOnt8695(OntarioSup.Ct.Justice)

5.2013BCSC607

6.McErlean,atpara.53

p34-35 CDL.indd 35 13-06-25 10:34 AM




A SERIES OF ARTICLES PROVIDED BY THE INSURANCE INSTITUTE OF CANADAEF• education forum

As you’ve likely heard, demo-graphic factors pose an im-minent challenge to Canadian

businesses. Most industries are expect-ed to feel a staffing pinch as the large “boomer” segment of the population retires from the workforce. Strategic workforce planning can help indepen-dent adjusting firms prepare to face this challenge.

Demographic research from the Insurance Institute of Canada sug-gests that the labour pinch may be felt strongly in the p&c sector, where up to a maximum of 28 per cent of the cur-rent industry workforce – and up to 43 per cent of those at management level – could potentially retire by 2022. The Institute’s latest research report, A Demographic Analysis of the P&C In-dustry in Canada 2012–2022, draws on surveys conducted in 2011 and 2012 with employers, employees and HR professionals across Canada’s p&c in-dustry.

The industry’s overall entry-to-exit ratios remain poor: for every person who can potentially leave the industry through retirement, less than one new person enters it. At the same time, de-mand for the industry’s products and services is expected to increase, result-ing in additional pressure to recruit and retain staff.

Claims crunchThe research findings suggest that

independent adjusting firms will be in the thick of the coming workforce challenges. About one in three of the industry’s employees work in claims

overall; similarly, one in three of the employees who retired between 2007 and 2012 worked in claims. In addi-tion, some of the highest median ages are seen in claims roles, pointing to a high potential for further retirements over the next 10 years. Based on these trends, the report projects a maximum potential reduction of 29 per cent in claims occupations nationally by 2022.

Claims roles are already facing chal-lenges in both recruitment and reten-tion. From the employers’ perspective, claims staff are among the most difficult and urgent roles to recruit. Roles such as accident benefits adjuster and claims adjuster/examiner tend to require ex-perience, and survey respondents in-dicated there are too few qualified can-didates available. Compensation levels can also be a hindrance in recruiting, as can failing to accommodate work-life balance issues.

Management roles at all levels are another area of concern. Across the industry, front-line managers have a median age of 44; middle managers, 47; senior/executive managers, 50; and the average retirement age is 60. These data point to a high potential for retirement

over the next ten years – one in five em-ployees who retired between 2007 and 2012 were managers.

Among HR professionals surveyed, those employed by independent adjust-ing firms ranked retention as their most important human resource manage-ment issue. Accident benefit adjusters, claims adjusters/examiners and casu-alty adjusters are all perceived as dif-ficult roles to retain. At the same time, the need to retain people in these roles was perceived as urgent. A high degree of worker mobility within the indus-try, uncompetitive compensation lev-els, and poor fit with corporate culture were the most-frequently cited factors making retention difficult in the p&c sector.

Talent tacticsUnder these circumstances, man-

aging the talent pool will be a critical strategic issue for leaders of indepen-dent adjusting firms in coming years. Leaders will need to be clear about their firms’ strategic talent requirements; and firms will need to focus on recruit-ing new people to the industry and on retaining and developing current work-

Additional research findings

• The industry may see higher levels of retirement over the next ten years as all members of the baby-boomer cohort move past the age of 55.

• Across the industry overall, two-thirds of senior managers are men; and two-thirds of senior managers (both male and female) are baby-boomers.

• Claims adjusters have a more balanced age profile and sex profile than other claims roles.

• Casualty adjusters have an older age profile than other claims roles.

Counting Heads: Demographics and the Adjuster

p36-37 EDUCATION FORUM.indd 36 13-06-25 10:42 AM



ers. Managing performance effectively will be key.

According to the Institute’s research, flexible work arrangements and ac-commodation of work/life balance are among the top five aspects of an ideal job for employees of all age groups (though with differing definitions at different life stages), so these two fac-tors should be considered when de-signing both recruitment and retention programs.

When human resources are scarce, it becomes particularly important to distinguish between talent (people who are good at what they do) and stra-tegic talent (people who are good at doing things that are strategically im-portant for the organization). This re-quires clarity about the firm’s strategy, about the specific capabilities needed for the strategy, and about which jobs express or support those capabilities. An adjusting firm facing numerous imminent retirements can identify key positions and prioritize its efforts in recruitment, retention, and succession planning according to the strategic val-ue of the positions.

Motivation and retentionMotivation and retention are closely

linked: motivated employees are more likely to stay with the firm. One clus-ter of motivational approaches involves making jobs more interesting and satis-fying. A few examples:• Analyze the career aspirations and

training needs of part-time employ-ees (a group in which turnover tends to be high) and then create more attractive employment options for them.

• Explore younger employees’ reasons for leaving and incentives for staying, and adjust practices accordingly. For example, if younger workers are eager for advancement, involving them in project work or stretch assignments can give them an opportunity to learn and grow.

• Restructure positions to accommo-date work-life balance issues and offer more flexible employment pat-terns, such as job sharing and phased retirement plans. These options can particularly appeal to employees with family responsibilities and to older

workers looking to transition gradu-ally out of the workforce.

• Establish cross-training and mentor-ing roles to transfer knowledge from mature workers to younger ones, so that knowledge is retained within the firm even after the mature worker re-tires.

As with recruitment and selection, retention efforts can be approached strategically. Employees who are per-forming well and hold strategically valuable positions are particularly im-portant to retain. Other employees might need training or coaching, cross training and redeployment, or replace-ment with stronger performers.

In the current demographic climate, retention programs should target two key cohorts: workers in their 30s, who are the most likely to leave an organiza-tion through voluntary or involuntary means; and mature workers, who are the most likely to leave through retire-ment. For workers in their 30s, train-ing and development, cross-training and mentorship opportunities may be effective motivators. For mature work-ers – many of whom expressed a pref-erence in the surveys for continuing to work on a part-time basis – consider creating phased-retirement options and post-retirement roles that will al-low them to share their experience by mentoring younger managers.

Succession planningAcross the industry as a whole,

the results of the survey of human resource management profession-als show increased use of four tools associated with strategic workforce planning: retirement forecasts, demo-graphic profiling, exit interviews and succession planning. Independent ad-justers reported being less likely to use succession planning than most other types of companies.

As a component of performance management, succession planning is about trying to maintain a steady supply of qualified strategic talent throughout the organization, not just in the upper management ranks. Like other components of performance management, it can be aligned with strategy and reflect an understanding of the competencies the firm wants to maintain and develop. Elements in-clude• focusing on the longer term, not just

on immediate needs• identifying key positions and the

knowledge and skills they require• identifying employees with potential

for those positions; creating develop-ment plans; and providing training, coaching, mentoring, and job assign-ments accordingly

Large organizations often make succession planning an ongoing part of their performance management ac-tivities. When an organization of any size expects to face hiring and reten-tion challenges – as many independent adjusting firms do today – succession planning can be a valuable comple-ment to other workforce management initiatives.

This article is based on the Insurance Institute’s Demographic Analysis of the P&C Industry in Canada 2012–2022, the third in a series of research studies produced in response to industry con-cerns about human capital issues such as recruitment, retention, succession planning, and training; and on mate-rial used in F510 Strategy in the P&C Insurance Sector, the first course in the Institute’s FCIP program for current and future insurance leaders.

When human resources are scarce,

it becomes particularly important to distinguish

between talent (people who are good at

what they do) and strategic talent

(people who are good at doing things that are

strategically important for the organization).

p36-37 EDUCATION FORUM.indd 37 13-06-25 10:42 AM



OTS• on the scene

Winmar Franchise Corp. has signed a multi-year agree-ment to integrate Symbility Solutions Inc., a provider of cloud-based smart phone/tablet-enabled claims technology that uses one of the most comprehensive data for the prop-erty and casualty insurance industry into its daily operations. “It is with great pleasure that we wel-come Winmar, one of the leaders in the restoration industry in Canada, and their franchise owners to our val-ued and growing client base,” James Swayze, CEO, Symbility Solutions, said. “Symbility is committed to sup-porting contractor networks and res-toration companies and we are proud to be one of the estimating platforms that Winmar has chosen for their large network of offices across the country.” “Winmar has been in business since 1977, with offices spanning from St. John’s, Nfld. to Victoria, BC. Our partnership with Symbility enables our franchises to collaborate on the most innovative cloud-based platform in the market and will enable us to pro-vide our valued customers an alternative choice in the soft-

ware we use to estimate their claims,” John White, president/founder, Winmar Franchise Corp., said. “We look forward to a successful, long-term relationship with Symbility Solutions as we continue to expand the way we service our customers.” The multi-year agreement will see Winmar implement Sym-

bility’s Claims Connect, an innovative property and casualty claims workflow management software that will stream-line the claims estimating process by reducing cycle time and increasing accuracy in all aspects of the claims handling process. Winmar will also use Symbility Mobile Claims, one of the industry’s most intuitive smart phone and tablet-enabled field estimating solution in enhancing adjuster and third-party contractor productivity. Mo-bile Claims will enable Winmar staff to quickly and easily generate accurate

estimates, improve efficiencies and shorten the claims es-timating process. With no hardware to install or software to maintain, Winmar will continue to provide their valued policy-holders a better claims experience. l

The Canadian Independent Adjuster’s Association’s New Brunswick/Prince Edward Island Region hosted an educational seminar and luncheon in Moncton, NB on May

16. Charles Forster, QC of Foster & Company, and Kev-in Quigley of Burchells LLP spoke on a number of high profile issues for adjusters: How to react when denial of coverage is likely — reserva-tion of rights letters and non-waiver agreements; Accident or arson? The importance of causation in insurance claims; Above the influence? Section B payments for im-paired drivers. l

Jodi Payne has been appointed as branch manager in Calgary with Ker-naghan Adjusters. Payne has worked in the adjusting field for more than 14 years and is an active member of the Alberta Association of Insurance Adjusters Board of Directors.

Her expertise includes personal and commercial liability, auto prop-erty, automotive injury and municipal liability. lJodi Payne

Stephanie Wood joined Ker-naghan Adjusters as an adjuster in the Edmonton office. Wood has 11 years experience in the insurance industry, 10 of which she has spent as a claims representative. She specializes in both auto and prop-erty claims. Wood obtained her CIP designation in 2005 and remains active within the insurance industry. lStephanie Wood

John White & James R. Swayze

Kernaghan Adjusters has opened a new branch in Castlegar, British Co-lumbia.

The office opened on Mar. 1 and services: Castlegar, Nelson, Trail, Creston, and Grand Forks. Mason Norman, who joined Kernaghan Ad-justers in July 2012 at the Revel-stoke branch, has been appointed adjuster in charge at the new loca-tion. His areas of expertise include personal property and liability claims

of varying complexities, including marine claims on pleasure crafts, and commercial property and liability claims. Ann Stalinski has joined Kernaghan Adjusters as the administra-tive assistant at the Castlegar branch. l

Mason Norman

Environmental Solutions Remediation Services (ESRS) is now EFI Global. “For over ten years, we’ve served the Canadian insurance industry with superior environmental response services namely in relation to transportation spills and other similar commercial releases,” Gary Dal-ton, senior vice president & executive director. “Our new name reflects our continued commitment in this special-ized field, but with the addition to introducing two new ser-vices: forensic engineering and fire investigation. It also aligns us here in Canada, with the services offered by our sister company, EFI Global, Inc. in the United States.” l Fred Plant

p38 OTS.indd 38 13-06-25 10:43 AM


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

29th Annual General Meeting and ConferenceSeptember 12-15, 2013

Banff, Alberta

Come and enjoy the exquisiteness!

Few hotels in the world can rival the majesty, hospitality, scenery and the grandeur of The Fairmont Banff Springs. Its unique blend of opulence and seclusion has been a symbol of Rocky Mountain magnificence for more than a century. Styled after a Scottish baronial castle, The Fairmont Banff Springs Hotel, a National Historical site of Canada, offers stunning vistas, championship golf courses, unparalleled skiing, classic cuisine and Willow Stream, a world class European-style spa.

Experience timeless beauty and luxurious comfort in a pristine wilderness.

SAVE THE DATE – Further details available soon



Banff, Alberta







Banff, Alberta







OTS• on the scene

Crawford & Company (Canada) Inc. has become the newest pledging partner of the Regional Carbon Initiative, run by Sustainable Waterloo Region. Crawford, which has been involved in the initiative for a year, has committed to a 20 per cent reduction target.

Sustainable Waterloo Region is a non-for-profit organiza-tion that is focused on advancing the environmental sus-tainability and operations of companies and organizations across the region of Waterloo, Ont. The Regional Carbon Initiative was implemented with the aim to reduce green-house gas emissions and has become the organization’s flagship program.

“We are extremely proud to be recognized as a member organization and are committed to improving our local com-munities through involvement with projects such as this,” John Sharoun, chief executive officer of Crawford & Com-pany (Canada) Inc., said. l

E.A. “Ted” Bishop passed quietly of ALS in Toronto on Friday, April 26, 2013. He was the beloved husband of Pamela for 68 years. Born April 29, 1925 in Montreal, Ted grew up in Toronto. After joining the RCAF at 17, Ted drove a taxi to support his family while earning his BA at the University of Toronto. He then be-gan an extremely successful career in the Insurance adjusting profes-sion, starting with the Underwriters

Adjustment Bureau in the early 50s, then with Angell & Townson Ltd. in the 60s. Ted then formed E.A. Bishop & Associates, one of Canada’s leading insurance adjusting firms, later consulting and offering expert testimony. He did not close his last file until he was 78.

He will be truly missed by his loving family and many friends. l

Ted Bishop

Grant King, on behalf of the Canadian Independent Adjuster’s Association’s Nova Scotia region, presented a cheque to Gilberte Theriault of the Nova Scotia Can-cer Society. l

Grant King and Gilberte Theriault

CIAA New Members — April 2013CORPORATE MEMBERSHIPClaims Tech (Canada) Inc. Mississauga, ONINDIVIDUAL MEMBERSHIPCrawford & CompanyCarolle Vieville Winnipeg, MB Level 1

Cunningham Lindsey Canada Claims Services Ltd.Jack Downey Cranbrook, BC Level 3Daphne Chan Port Moody, BC Level 1Anthony Esposito Vancouver, BC Level 1Rodney Ahlskog Edmonton, AB Level 3Robert Keith Edmonton, AB Level 3Robert Queen Windsor, ON Level 2Gerald Mallet Dartmouth, NS Level 3Angela Stiles-Bodkin Vancouver, BC Level 3Joseph Poset Mississauga, ON Level 3Paul Lin Port Moody, BC Level 2Wilson Hunter St. Catharines, ON Level 3Jeff Shurtleff Richmond Hill, ON Level 3

Claims Tech (Canada) Inc. Mississauga, ONBalu Naidu Mississauga, ON Level 3

Correction:Steve Scullion is a senior adjuster/ branch manager with Granite Claims Solutions. His position and the company he works for was incorrectly listed in the April/May 2013 issue on page 52.

The grand re-opening of CARSTAR St. Catharines includ-ed a life changing moment for the MacKenzies. The Niagara-region family of eight in need of a boost was surprised with the keys to a fully restored 2010 Dodge Caravan.

Jim and Maureen MacKenzie were one of 40 families that had submitted an application to Community Care, and were selected as the winning family.

“Giving back to local communities that our franchises serve is at the core of CARSTAR’s values,” Jeff Moriarty, CAR-STAR’s regional development manager, said. “CARSTAR St. Catharines, and the commitment that owner Steve Sytchouk has made to support the Niagara community at his grand re-opening exemplifies CARSTAR’s community-minded spirit.”

In addition to the fully-restored vehicle, the $20,000 prize also included a lifetime warranty on repairs from CARSTAR Collision & Glass, a gift certificate for one-year of insurance from Youngs Insurance Brokers Inc., a $500 service and maintenance gift certificate from Hope & Harder/QMAX NAPA Auto and a $300 Canadian Tire gas card.

This life-changing gift for the MacKenzies was the result of strong community partnerships. When approached by the CARSTAR team, Youngs Insurance Brokers jumped at the opportunity to support a local family.

“We recognize that people in our own community can benefit from businesses coming together to help,” Marie Fucile, VP personal lines, Youngs Insurance, said. “Youngs Insurance is committed to helping families in need and we wish the MacKenzie family safe travels in their new vehicle.”

Community Care assists an average of 1,850 house-holds per month in St. Catharines and Thorold, with over 4,000 pounds of food distributed daily. The not-for-profit organization has been serving local families in need since 1919 and has seen the number of families using their ser-vices rise in recent years.

“At Community Care, we encourage our families to be-come self-sufficient one step at a time,” Betty-Lou Souter, Community Care C.E.O, said. “What CARSTAR and its busi-ness partners have done for the Mackenzie family goes way beyond one step; they’ve provided a staircase toward inde-pendence.” l

p40-41 OTS.indd 40 13-06-25 10:46 AM



Granite Claims Solutions has acquired HR Leiher Insur-ance Adjusters.

HR Leiher Insurance Adjusters, based out of Colling-wood, Ont., was formed in 1991 and has since serviced Simcoe County and surrounding areas handling all classes of insurance claims. The company’s founder and principal, Harold Leiher, started his claims career for a national in-surer in 1976 and has been an independent adjuster since 1980.

“As a firm, they have always impressed us and been on our radar for quite some time as a potential partner due to their dedication to high-quality claims adjusting and their client-focused approach,” Michael Holden, president and CEO of Granite Claims Solutions, said. “They very much mirror the standards set out by Granite Claims.”

In addition to increased coverage in the Collingwood area, the acquisition of HR Leiher provides a substantial increase in Granite’s municipal claims skill set.

“I believe the merger between our companies is mutu-ally beneficial,” Leiher said. “In particular, our existing cli-ents will greatly benefit from Granite’s technology and the depth of talent on the Granite team. As well, their quality program is a model we will fit into very nicely.” l

The Canadian Insurance Adjusters’ Association (CIAA) Nova Scotia Region, the Canadian Insurance Claims Man-agers’ Association (CICMA) Nova Scotia Region and the Canadian Defence Lawyers (CDL) hosted a joint confer-ence on April 11.

Approximately 75 people attended to learn about the ‘CGL Claim’ and ‘That Thing Called Facebook.’

L to R - Lucie LaBoissonniere , presenter, CDL, Len Costello, presenter, CIAA • Wendy Johnston, presenter, CDL • Paul Ross, presenter, CICMA • David Graves, moderator, CDL • Grant King, committee, CIAA • Carol Messervey, com-mittee, CIAA

p40-41 OTS.indd 41 13-06-25 10:46 AM



http://www.harmonie.org

http://www.dacbeachcroft.com

http://www.clcnow.com


ADVISORYMarie C. Gallagher, FCIP, CRMGranite Claims Solutions71 King Street, Suite 204St. Catharines, ON L2R 3H7Phone: (905) 984-8282Fax: (905) 984-8290E-mail: [email protected]

E. Grant King, BA, B.Ed., CIPCrawford & Company (Canada) Inc.120 – 237 Brownlow AvenueDartmouth, NS B3B 2C7Phone: (902) 468-7787Fax: (902) 468-5822E-mail: [email protected]

Greg G. Merrithew, CIP, FIFAAArctic West Adjusters Ltd.201 – 5204 – 50 Ave.Yellowknife, NT X1A 1E2Phone: (867) 920-2212Fax: (867) 873-2244E-mail: [email protected]

James B. Eso, BA, CIP Crawford & Company (Canada) Inc.539 Riverbend DriveKitchener, ON N2K 3S3Phone: (519) 578-5540 Fax: (519) 578-2868E-mail: [email protected]

John Jones, BAGranite Claims SolutionsSuite 300, 5915 Airport Road Mississauga, ON L4V 1T1 Phone: (905) 671-3164Fax: (905) 671-1889E-mail: [email protected]

Craig J. Walker, CIP, FCIAA, FIFAAMaltman Group International3550 Victoria Park Ave., Suite 301Toronto, ON M2H 2N5Phone: (416) 492-4411Fax: (416) 492-5657E-mail: [email protected]

CIAA NATIONAL INSURANCE INDUSTRY ADVISORY BOARD Patti M. Kernaghan, FCIP, CRMKernaghan Adjusters Limited300 - 1575 West Georgia StreetVancouver, BC V6G 2V3Phone: 1-800-387-5677Fax: 1-800-387-5644E-mail: [email protected]

John D. Seyler, CIPProFormance Group5080 Timberlea Blvd., Suite 214Mississauga, ON L4W 4M2Phone: (905) 238-4985Fax: (905) 238-2735E-mail: [email protected]

Marie C. Gallagher, FCIP, CRMGranite Claims Solutions71 King Street, Suite 204St. Catharines, ON L2R 3H7Phone: (905) 984-8282Fax: (905) 984-8290E-mail: [email protected]



Patricia M. BattleCanadian Independent Adjusters’ Association/L’Association Cana-dienne des Experts Indépendants5401 Eglinton Ave. West, Suite 100Etobicoke, ON M9C 5K6Phone: (416) 621-6222Toll Free: 1-877-255-5589Fax: (416) 621-7776 E-mail: [email protected]

John M. Sharoun, FIIC, CFE, FCIAACrawford & Company (Canada) Inc.300 – 123 Front Street WestToronto, ON M5J 2M2Phone: (416) 867-1188Fax: (416) 867-1925E-mail: [email protected]

Dennis N. Schembri, CIP, CFEIGranite Global Solutions133 King Street East, 3rd FloorToronto, ON M5C 1G6 Phone: (647) 789-2438Fax: (647) 789-2449E-mail: [email protected]

Jo-Ann Eccleston, CIPAviva Canada Inc.2206 Eglinton Ave. EastToronto, ON M1L 4S8Phone: (416) 689-3328Fax: 1-866-805-8585 E-mail: [email protected]

Bob Grouchy, BA, FCIP, CRMAllianz Global 1600 – 130 Adelaide Street WestToronto, ON M5H 3P5Phone: (416) 915-4247Fax: (416) 849-4555E-mail: [email protected]

Carol Jardine, FCIP, CRMTD Insurance 2161 Yonge Street, 4th FloorToronto, ON M4S 3A6Phone: (416) 486-2507Fax: (416) 545-6022E-mail: [email protected]

Justin MacGregorAvec Insurance Managers - Inc.25 Toronto Street, Suite 200 Toronto, ON M5C 2R1Phone: (416) 862-9527Fax: (416) 862-9388E-mail: [email protected]

Mark Stewardson, FCIPRoyal & SunAlliance2225 Erin Mills Parkway, Suite 1000Mississauga, ON L5K 2S9Phone: (905) 403-2333Fax: (905) 403-2326E-mail: [email protected]

Mark WeirIntact Financial Corporation700 University Avenue, 13th FloorToronto, ON M5G 0A1Phone: (416) 341-1464Fax: (416) 217-0562E-mail: [email protected]

Peggy Wong, CIPThe Economical Insurance Group111 Westmount Road SouthWaterloo, ON N2J 4S4Phone: (519) 570-8500Fax: (519) 570-8690E-mail: [email protected]

CAREER RECRUITMENT PLANNINGRichard Swierczynski, BA, CIPAZ Claims Services Inc.1500 Upper Middle Rd., Unit #3P.O. Box 76041Oakville, ON L6M 3G3Phone: (905) 825-0027Fax: (905) 825-5543E-mail: [email protected]

COMMUNICATIONSTeresa Mitchell, FCIP, CRM, FCLA, FCIAA, FIFAACrawford & Company (Canada) Inc.14 – 431 Bayview DriveBarrie, ON L4N 8Y2Phone: (705) 728-5597Fax: (705) 728-2167E-mail: [email protected]

CONSTITUTION & RULESJohn Jones, BAGranite Claims SolutionsSuite 300, 5915 Airport RoadMississauga, ON L4V 1T1Phone: (905) 671-3164Fax: (905) 671-1889E-mail: [email protected]

CONVENTIONDavid S. Riddell, FCIP, CRMCanadian Claims Services17958 – 106 AvenueEdmonton, AB T5S 1V4Phone: (780) 443-1185Fax: (780) 443-1893E-mail: [email protected]

DESIGNATION Paul W. Greening, CLA, FCIAAGreening Aviation Claims Inc.26C Palliser Park, Box 190 River-hurst, SK S0H 3P0Phone: (306) 353-2000Fax: (306) 353-2200E-mail: [email protected]

E. Brian Gough, FCIP, CLA, FCIAAMarsh Adjustment Limited1550 Bedford Highway, Suite 711Bedford, NS B4A 1E6Phone: (902) 469-3537Fax: (902) 469-2396E-mail: [email protected]

Robert V. Pearson, CLA, FCIAAHansen Labelle Adjusters Ltd.1328 17th Avenue N.W.Calgary, AB T2M 0R1Phone: (403) 284-2211 Fax: (403) 284-2299E-mail: [email protected]

DISCIPLINEGreg G. Merrithew, CIP, FIFAAArctic West Adjusters Ltd.201 – 5204 – 50 Ave.Yellowknife, NT X1A 1E2Phone: (867) 920-2212Fax: (867) 873-2244E-mail: [email protected]

EDITORIALMary Charman, CIPCrawford & Company (Canada) Inc.14 & 15 – 431 Bayview DriveBarrie, ON L4N 8Y2Phone: (705) 728-5597Fax: (705) 728-2167E-mail: [email protected]

John M. Sharoun, FIIC, CFE, FCIAACrawford & Company (Canada) Inc.300 – 123 Front Street WestToronto, ON M5J 2M2Phone: (416) 867-1188Fax: (416) 867-1925E-mail: [email protected]

EDUCATIONSanto Carbone, CRM, FCIAACrawford & Company (Canada) Inc.300-123 Front Street WestToronto, ON M5J 2M2Phone: (416) 364-6341Fax: (416) 435-0546E-mail: [email protected]

EMERGENCY MEASURES Richard Van HorneAction Investigations Inc.2 Catelina CourtDartmouth, NS B2X 3G9Phone: (902) 462- 1222Fax: (902) 462-3688E-mail: [email protected]

FINANCERussell Fitzgerald, CIPKernaghan Adjusters Limited203 – 4246 97 Street N.W.Edmonton, AB T6E 5Z9Phone: (780) 488-2371Fax: (780) 488-0243E-mail: [email protected]

John D. Seyler, CIPProFormance Group Inc.5080 Timberlea Blvd., Suite 214Mississauga, ON L4W 4M2Phone: (905) 238-4985Fax: (905) 238-2735E-mail: [email protected]


IBC: LIAISON, LEGISLATIVE & FORMSPaul Hancock, B.Sc., CIP Crawford & Company (Canada) Inc.300 – 123 Front Street WestToronto, ON M5J 2M2Phone: (416) 867-1188Fax: (416) 867-1925E-mail: [email protected]

LICENSINGJ. Miles O. Barber, B.Comm. (Hons.), FCIP, CRMNetwork Adjusters Ltd.67 Folkestone Blvd.Winnipeg, MB R3P 0B4Phone: (204) 897-5793Fax: (204) 897-5797E-mail: [email protected]

MEMBERSHIP & QUALIFICATIONSGeorgiana Chen, CIPProFormance Group Inc.1101 Kingston Rd., Suite 280Pickering, ON L1V 1B5Phone: (877) 539-3111Fax: (905) 554-3776E-mail: [email protected]

NOMINATINGGreg G. Merrithew, CIP, FIFAAArctic West Adjusters Ltd.201 – 5204 – 50 Ave.Yellowknife, NT X1A 1E2Phone: (867) 920-2212Fax: (867) 873-2244E-mail: [email protected]

John D. Seyler, CIPProFormance Group Inc.5080 Timberlea Blvd., Suite 214Mississauga, ON L4W 4M2Phone: (905) 238-4985Fax: (905) 238-2735E-mail: [email protected]

James B. Eso, BA, CIPCrawford & Company (Canada) Inc.539 Riverbend DriveKitchener, ON N2K 3S3Phone: (519) 578-5540 Fax: (519) 578-2868E-mail: [email protected]


PRIVACYJames B. Eso, BA, CIPCrawford & Company (Canada) Inc.539 Riverbend DriveKitchener, ON N2K 3S3Phone: (519) 578-5540 Fax: (519) 578-2868E-mail: [email protected]

Keith P. Edwards, FCILA, CLA, FUEDI-ELAECIAA Honorary Life Memberc/o CIAA National Office5401 Eglinton Ave. W., Suite 100Etobicoke, ON M9C 5K6Phone: (416) 621-6222Fax: (416) 621-7776E-mail: [email protected]

National Standing Committees 2012-2013NEWFOUNDLAND & LABRADORChristopher GoodwinCrawford & Company (Canada) Inc.96 Clyde Avenue, Suite 100Mount Pearl, NL A1N 4S2 Phone: (709) 753-6351Fax: (709) 753-6129E-mail: [email protected]

NOVA SCOTIAE. Grant King, BA, B.Ed., CIPCrawford & Company (Canada) Inc.120 – 237 Brownlow AvenueDartmouth, NS B3B 2C7Phone: (902) 468-7787Fax: (902) 468-5822E-mail: [email protected]

NEW BRUNSWICK & PRINCE EDWARD ISLANDLuc Aucoin, BBA, FCIPPlant Hope Adjusters Ltd.85 Englehart StreetDieppe, NB E1A 8K2Phone: (506) 853-8500Fax: (506) 853-8501E-mail: [email protected]

QUEBEC/AESIQClaude NadeauCunningham Lindsey1250 Guy Street #1000Montreal, QC H3H 2T4Phone: (514) 939-1570Fax: (514) 938-5445E-mail: [email protected]

ONTARIOTeresa Mitchell, FCIP, CRM, FCLA, FCIAA, FIFAACrawford & Company (Canada) Inc.14 – 431 Bayview DriveBarrie, ON L4N 8Y2Phone: (705) 728-5597Fax: (705) 728-2167E-mail: [email protected]

MANITOBATimothy W. BromleyJ.P. Hamilton Adjusters Ltd.125 Enfield CrescentWinnipeg, MB R2H 1A8Phone: (204) 944-1057Fax: (204) 944-1606E-mail: [email protected]

SASKATCHEWAN Cheryl HansonCrawford & Company (Canada) Inc.210 – 227 Primrose DriveSaskatoon, SK S7K 5E4Phone: (306) 931-1999 Fax: (306) 931-2212E-mail: [email protected]

WESTERNRussell Fitzgerald, CIP Kernaghan Adjusters Limited203 – 4246 97 Street N.W.Edmonton, AB T6E 5Z9Phone: (780) 488-2371Fax: (780) 488-0243E-mail: [email protected]

PACIFICDavid Porter, LL.B., FCIP, CRMGranite Claims Solutions400-4370 Dominion StreetBurnaby, BC V5G 4L7Phone: (604) 699-6550 Fax: (604) 659-6570E-mail: [email protected]

CIAA REGIONAL PRESIDENTS2012 – 2013

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ProFormance Group Inc. hosted its 2nd Annual Wine Tasting & Charity Event on Apr. 19. The evening, held at the Drake Hotel in Toronto, included a silent auction, a 50/50 draw and great raffle prizes, including a weekend getaway. More than $6,600 was raised and went to the Jennifer Ashleigh Children’s Charity - These funds will go to help approximately 10 families with children that have serious illnesses “when love is not enough”. Wine tasting and hors d’oeuvres were available throughout the evening. Jennifer Valentyne of Breakfast Television emceed the event. l

OTS• on the scene

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OTS• on the scene

Canadian delegates of the 2013 RIMS Conference and Exhibition in Los Angeles gathered with their U.S. and foreign friends at Canada Night on Apr. 23, sponsored by SCM Insurance Services and the Canadian Litigation Counsel. The event provided a chance to catch up and share stories to the benefit of the William H. McGannon Foundation. RIMS Canada Council Chair Betty Clarke, on behalf of the RIMS Canada Council, presented a donation of $10,000 to McGannon Foundation president and director Joe Restoule. l

p44 on the scene.indd 44 13-06-25 10:54 AM


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17338 CRDN Ad-ClaimsCanada_July2012.indd 1 7/10/12 4:01 PM


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OTS• on the scene

The 13th annual Ontario Pond Blue Goose Scotch Nosing took place on Apr. 25 at the Shangri-La Hotel (Toronto) in their beautiful Queen’s Park Ballroom. More than 200 Ganders and guests attended raising funds in support of Camp Oochigeas - A Camp for Children With Cancer. Once again, Ed Patrick, president and founder of the International Order of the Companions of the Quaich Whisky Appreciation Society, presided over the nosing and led the tastings. l

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Kernaghan Adjusters held its 60th Anniversary Celebration on May 1, at the University Club of To-ronto. In honour of this milestone, President and CEO Patti Kernaghan thanked all who attended and shared in the celebration, as well as all those within the industry for their support over the years. l

THE PROPERTY RESTORATION SPECIALISTS WITH OVER 85 SERVICE LOCATIONS ACROSS CANADA24 HOUR ASSIGNMENT/EMERGENCY RESPONSE TOLL FREE 1-866-4-WINMAR (494-6627)

For more information visit www.winmar.ca Proud to be Canadian owned and operated.

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OTS• on the scene

Winmar Toronto/Brampton hosted their annual “Spring Fling” on May 2, at the Watermark Irish Pub in Toronto. The event was created as a way to increase awareness for brain injury research and also served as a fundraiser for St. Michael’s Hospital. $15,000 was raised and a cheque was later presented to Dr. Michael Cusimano of St. Michael’s Hospital. 250+ industry friends were entertained by guest singer “Roxanna” and everyone enjoyed an evening of good food and beverages. l

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A record turnout of 200+ industry representatives attended the 54th Annual Reception of the Quarter Century Club on May 23 at the Albany Club in Toronto. The event was a roast for claims industry vet-eran James Giffen, owner/director of Malik, Giffen & Burnett (MGB) Claims Consultants Inc. James has been a loss adjuster since 1987 and was previously the Director of Technical Services Canada for Craw-ford & Company in Toronto. In May 2010 (along with partners Shawn Malik and Shawn Burnett) launched MGB Claims Consultants Inc. l

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OTS• on the scene

Friends, colleagues and guests gathered on May 29 within the historic Distillery District in Toronto (once the renowned Gooderham & Worts whiskey distillery) to celebrate ServiceMaster’s 60th Anni-versary in Canada. Held at Archeo Restaurant, one and all gathered together to celebrate the six de-cades of restoration excellence by enjoying an eve-ning of wine, food and good conversation. l

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KG SERVICESYour environmental remediation specialist.

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Claims Canada June/July 2013

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Transcript of Claims Canada June/July 2013