future adjusters’ association thiners · growth vs controlling expense. claims canada asked...

www.claimscanada.ca February/March 2016

PM40063170

Official Journal of the Canadian Indeépendent Adjusters’ AssociationFuture Thinkers

Adjusters ready to take on new claims environment

http://www.claimscanada.ca

Forensic Engineering

Loss Mitigation /Remediation

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ContentsCover Feature12 Future ThinkersIndependent adjusters across Canada face a wide range of issues in the coming year. Those developments fall into familiar themes: consolidation; the role of technology; a possible decrease in auto claims; how to manage peaks and valleys; and, revenue growth vs controlling expense. Claims Canada asked leading adjusters at top-ranked firms across the country what trends and developments they expect to unfold in 2016. How should claims professionals and their firms best prepare?

BY ANGELA STELMAKOWICH

Spotlight20 Changing the EnvironmentSocial justice drives Pieter Heydenrych’s practice in his Halifax-based specialist firm Emergency & Environmental Claims Management (EECM Ltd.).

BY EMILY ATKINS

News Features22 Top Ten Insurance DecisionsThis was an active year at the provincial appellate court level, with two issues dominating the insurance coverage landscape.

BY CHRISTOPHER R. DUNN AND JOSIAH T. MACQUARRIE

26 Nudging ClaimantsThe field of behavioural economics could have potential applications in insurance claims, fraud deterrence, injury management, driver safety and client service, experts contend.

BY CRAIG HARRIS

28 Monk v. Farmers’ Mutual Insurance Co. (Lindsay) Further Lessons in Policy Language and Interpretation

BY MICHAEL S. TEITELBAUM

26

12

Departments

4 First Notice

30 On The Scene

Columns

10 President’s Message

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4 Claims Canada February/March 2016 www.claimscanada.ca

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The flooding in southern Alberta in 2013 has left claims executives better prepared for another major catastrophe, speakers suggested at the inaugural Canadian Catastrophe Conference.

“You think you are ready, but you’re never quite ready for what was to unfold,” Mathieu Lamy, senior vice president of claims at Intact Financial Corp., said. “I don’t think we were quite ready to handle that from an adjusting standpoint.”

There was a lot of learning from that event, Lamy added. “Calgary was challenging,” he conceded. “We never prepared as much as we should have for water. I think now we’d be in a better place to do that.”

Preparing in advance for such events can help mitigate losses when they do occur and improve claims experience, speakers suggested at the conference.

“We incorporate a process of what we call a ‘pre-mortem,’” Pat Van Bakel, president and CEO of Crawford and Company (Canada) Inc. said.

“Before the event happens, and before anybody is going to get blamed for anything, frankly, you can sit in a room and throw scenarios at the wall of what could go wrong, what are all of the things that might happen here that might cause us a problem?” Van Bakel said. “And that gives you the forward-looking opportunity to build mitigation strategies to hopefully prevent some of those failures when they happen.”

Lamy noted that Intact spent “quite a bit of time” to establish what it called a ‘coverage guide’ for the 2013 floods.

As well, the company wanted a solid guide for anybody who would help adjust, either from Intact, from other regions or outside partners.

“That ended up being, I think for us, a saving grace,” Lamy said. ●

Preparation key to reducing losses from cats

Adjusters will need new skills for tech claimsThe face of claims is changing and will continue to do so

with rapidly unfolding technology. There are several areas “where the risk and expertise re-

quired is new,” says Paul Hancock, national director of global technical services at Crawford & Company.

Hancock explained to attendees at the 49th Annual Ca-nadian Insurance Claims Managers Association/ Canadian Independent Adjusters’ Association Ontario Chapter Joint Conference that drones, for example, are a new technology that could lead to more claims given the current environment, but also clearly illustrate the need for a fresh breed of adjuster equipped with a different skill set.

“Due to obstacles like the skills of operators, lack of training, untested technology and the liability as-sociated with drones in crowded areas, I think there’s going to be more collisions, accidents, injuries and property damage,” Hancock predicted.

“Do we have the skilled adjusters that understand the regu-lation, the technology, that are able to handle the claims?” he asked.

There is a “growing need for more and different complex loss adjusters. The future of adjusting will be engineering, IT professionals, data analysts, lawyers, accountants, quantifica-tion experts doing their thing, for the most part, 24/7, 365, remotely and virtually,” Hancock suggested.

Along with drones, he said driverless cars will challenge the adjustment process. Who will be responsible when a driverless car gets into an accident? There are many parties it could be, from the vehicle manufacturer, to the software maker, the city,

the town, or the province that had to create the infrastructure to support the driverless car.

“Claims adjudication will not be a human response based on witnesses,” Hancock said. It will purely be based on technology.

For the most part, new technologies like drones, the Internet of Things, telematics and driverless cars offer the promise of helping to reduce the number of claims, Hancock said. His company has recently purchased a

drone that can serve as the “eye of adjusters,” for example.“Drones are going to offer us the ability to improve the ef-

ficiency and the effectiveness of a variety of claims-handling and risk management tasks that otherwise may be tedious, difficult and even dangerous to the people who do them,” he said. ●

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FNCanada was hit with six severe-weather catastrophes, each

causing more than $25 million in damage in 2015, and all but one affected the West.

“2015 was the year all hail broke loose,” said Carolyn Ren-nie, director of catastrophic loss analysis for Catastrophe Indi-ces and Quantification Inc. (CatIQ), at the company’s Canadian Catastrophe Conference in Toronto.

CatIQ—a sister company to Toronto-based MSA Re-search Inc.—tracked six catastrophic events and 10 “notable” events last year, Rennie added. A “no-table” event is one with losses between $10 million and $25 million.

The most expensive was on July 21, when a severe convective thunderstorm in Alberta caused $260 million in insured losses. There was tennis-ball-sized hail and wind gusts up to 110 kilometres per hour, Rennie noted. This caused damage to roof shingles, siding and “extensive auto damage,” she said.

“Alberta incurred the majority of losses from catastrophes” in 2015, she said.

The second most expensive event was Aug. 4-5. Golf ball-sized hail affected Calgary. That storm, with losses estimated at $165 million, packed winds near 80 km/h.

On June 12 a storm hit the Prairies with gusts up to 119 km/h and golf ball-sized hail in places. Losses were estimated at more than $70 million, with the “majority of the damage” occurring in Alberta.

On July 22, a cold front passed through Alberta, with a tornado touching down near Calgary. Overall losses from that storm were estimated at $51 million.

The last catastrophe occurred Aug. 29, when a windstorm smashed British Columbia. That storm, which caused about $33 million in damage, caused trees to fall, cutting power to more than 530,000 people.

In Ontario, severe thunderstorms the night of June 22 caused losses estimated at $32 million.

Balz Grollimund, head of earthquake for Swiss Re-insurance Company also spoke at the conference.

Grollimund suggested the experience in Christ-church, New Zealand—which was hit by a series

of earthquakes five years ago—provides les-sons if a major tremor hits British Columbia. The cost of those quakes is now about $36 billion.

The main quake in Christchurch was 6.3 on the Richter scale, but it hit “the wrong place,” Grollimund said.

Grollimund referred to a report from AIR Worldwide that modelled the effects of two

hypothetical earthquakes affecting Canada. The report, commissioned by Insurance Bureau

of Canada and released in October 2013, predicted the effects—including economic and insured losses—of a

magnitude 9.0 temblor off the West Coast and a magnitude 7.1 quake northeast of Quebec City.

Large parts of suburban Vancouver would be affected by liquefaction—which also affected areas of Christchurch in 2011, said Grollimund.

“That’s the ground underneath the buildings, becoming not solid but liquid,” he said.

The threat of an earthquake in B.C. should have reinsurers checking policy terms carefully, he added. ●

Western Canada hit hardest by 2015 catastrophes

Zurich has released a mobile app—designed for qualified customers throughout North America in industries that deal with hazardous materials—meant to help them speed up re-sponse to spills requiring emergency environmental clean-up.

The Zurich Environmental Emergency Response (ZEER) app is designed for industries, including transportation and manufacturing, where hazardous materials spills can lead to environmental contamina-tion at or beyond a company’s facilities, notes a statement from the global multi-line insurer.

Originally developed for Zurich’s environ-mental underwriting and claims professionals—in collaboration with environmental response company Spill Center, Inc.—ZEER offers cus-tomers the ability to report spills from a mo-bile device immediately at the scene of an in-cident. Among other things, the app can do or be used to do the following:

for environmental spill consultation;

meet regulatory requirements to reduce liability expo-sures and possible penalties;

management communications;

clean-up via customer’s mobile device; and,

report, such as insurance policy information and spill location.

“An accidental spill that results in an envi-ronmental hazard is, for most businesses, an extraordinary occurrence,” Steve Hatch, chief claims officer for Zurich North America, notes in the company statement. That said, every business should be prepared, Hatch empha-sizes, adding the new app “can help customers mitigate damages and reduce potential liabil-ity associated with spills.”

For Android, Blackberry and Apple devic-es, the mobile app is available for use in both

English and French.Noting that the world is experiencing a huge increase in

innovation of various kinds, “Zurich is incorporating new tech-nology into its own efforts to increase efficiency and profitabil-ity and, in turn, improve the quality of products and services we provide to our customers,” the statement adds. ●

App for quicker environmental spill response



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

“With over 1600 Independent Adjusters committed to professionalism in 400 offices throughout Canada…

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

For more information about membership in CIAA, our professional standards, goals and objectives,

Canadian Independent Adjusters’ Association5401 Eglinton Avenue West, Suite 100, Etobicoke, ON M9C 5K6Phone: (416) 621-6222 Fax: (416) 621-7776E-mail: [email protected] Website: www.ciaa-adjusters.ca

NOVA SCOTIAAction Investigations IncorporatedDartmouth

AMG Claims Inc.Halifax

ASAP Claims Adjusting LimitedSydney

ClaimsProAntigonishColdbrookDartmouthNew GlasgowSydney

Crawford & Company (Canada) Inc.DartmouthKentvilleStellartonSydneyYarmouth

Cunningham Lindsey Canada Claim Services Ltd.DartmouthKentvilleNew Glasgow

Integral-AdjusterNewport

Kernaghan Adjusters LimitedHalifaxSydney

Marsh Adjustment LimitedAntigonishBedfordBridgewaterKentvilleLawrencetownSydneyTruroYarmouth

G.E. Morgan Adjusters LimitedBedford

N.S. TASKS Ltd.Truro

NEW BRUNSWICK AMG Claims Inc.Fredericton

ClaimsProBathurstCampbelltonDieppeEdmundstonHanwellFrederictonGrand FallsMiramichiMonctonSaint John

Crawford & Company (Canada) Inc.BathurstFrederictonMonctonSaint John

Cunningham Lindsey Canada LimitedCaraquetDieppeEdmundstonSaint John

Greater Moncton Adjustment Bureau Inc.Dieppe

C. Landry Adjustment Ltd.Caraquet

Réclamation Marsh AdjustmentBathurstMoncton

Robichaud Claims ServicesCocagne

Young’s Claim ServiceMoncton

PRINCE EDWARD ISLANDAMG Claims Inc.Charlottetown

CKS Holdings Inc.Charlottetown

ClaimsProMount Stewart

Crawford & Company (Canada) Inc.Charlottetown

DeLong & Associates Inc.CharlottetownSummerside

Prince Edward Claims Services Inc.Charlottetown

NEWFOUNDLANDClaimsProClarenvilleCorner BrookGanderGrand Falls-WindsorSt. John’s

Colonial Adjusting & Appraisal ServicesSt. John’s

Crawford & Company (Canada) Inc.Mount Pearl

Cunningham Lindsey Canada Claim Services Ltd.Corner BrookGrand FallsSt. John’s

Insurance Consulting and Mediation Services Ltd.St. John’s

Peninsula Adjusting Services Ltd.Marystown

Pike and Associates Adjusting Ltd.Holyrood

ATLANTIC - CIAA.indd 1 16-02-29 9:54 AM

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A bi-monthly magazine (6x per year), Claims Canada is published by NEWCOM Business Media Inc. 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.

Produced by the publishers of Canadian Underwriter magazine

Offering incentives to municipalities to invest in addressing risk and improving resilience is a dialogue that deserves more attention.

“We want to move to dialogue that can help provide clear incentives for cities that invest in improving and addressing risk, and encourage other stakeholders in investing in ad-dressing risk and improving resilience,” said Matthew Lynch, vice president of global partnerships and initiatives with the Toronto-based World Council on City Data, speaking at the Canadian Catastrophe Conference in early February.

Lynch used the example of the National Flood Insurance Program’s community rating system, “where if communities take certain levels of actions, it feeds back into the premiums they are offering.”

“We’re looking at those linkages—standardized indicators that can help broker those linkages between risk resilience and insurability,” Lynch added. “When you start looking at the city-level performance…there are a number of things that greatly influence that risk base, be it planning controls, design and implementation of building codes, performance and infra-structure, emergency response capabilities,” he said, adding that dialogue between insurers and municipalities in Canada is “already happening a lot anyway, but I think there’s always room for more.”

Ewa Jackson, manager of ICLEI Canada, a Toronto-based association for urban sustainability, pointed to a climate change-related incentive for municipalities, introduced by the

government of Nova Scotia. “It said that in order to access your gas tax funding, we require you to create and submit to us a municipal climate change action plan (MCAP),” Jackson said at the conference.

“The MCAPs essentially provide a roadmap that each and every municipality in Nova Scotia is going to follow to get more climate ready, and that’s both on the mitigation and ad-aptation side,” she said, adding that implementation funding for these action plans will be the next step. “Climate change has really amplified existing risks.”

Barb Szychta, vice president of risk management services with Princeton, Ont.-based Frank Cowan Company, a provider of specialized insurance programs, including risk management and claims services to municipalities and other organizations, also spoke. She said the company sees climate change as a “very significant emerging risk” for municipalities because it impacts a vast variety of local services.

“Municipalities have to identify how does climate change [affect] their operations,” Szychta said. “It’s identifying your vulnerabilities, your funding sources, resources, categorizing your risk, where should I go first? Where does my money go first? What can I do in five years? What can I do in 10 years?” ●

Incentives could improve municipal risk management

Paul AquinoPublisher

(416) [email protected]

Emily AtkinsEditor


Michael ChimientiArt Director

[email protected]

Steve Wilson Senior Publisher (416) 510-6800

[email protected]

Karen Samuels

[email protected]

Subscription inquiries(416) 614-5831

Christine GiovisAccount Manager


Mike Wells

[email protected]

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www.claimscanada.ca February/March 2016 Claims Canada 9

ADVISORYHeather Matthews, CIP, CRMCrawford & Company (Canada) Inc.539 Riverbend Dr.Kitchener, ON N2K 3S3Phone: (519) 578-5540Fax: (519) 578-2868E-mail: [email protected]

Gary Ellis, BBA, FCIP, RF, FCLA, FCIAA, FIFAAAMG Claims Inc.P.O. Box 20102 SherwoodCharlottetown, PE C1A 9E3Phone: (902) 628-9091Fax: (902) 628-9093E-mail: [email protected]

Albert Poon, CIPCunningham Lindsey CanadaClaims Services Ltd.1102 – 50 Burnhamthorpe Rd. W.Mississauga, ON L5B 3C2Phone: (905) 896-8181Fax: (905) 896-3485E-mail: [email protected]

Paul Féron, FCIP, CRMClaimsPro210 – 746 Baseline Rd. EastLondon, ON N6C 5Z2Phone: (519) 645-6500Fax: (519) 645-2250E-mail: [email protected]

Lorri FrederickClaimsPro120 Adelaide St. W., Suite 2401Toronto, ON M5H 1T1Phone: (905) 308-6292Fax: (416) 360-7335E-mail: [email protected]

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

John Jones, BACunningham Lindsey CanadaClaims Services Ltd.1102 – 50 Burnhamthorpe Rd. W.Mississauga, ON L5B 3C2Phone: (905) 896-8181Fax: (905) 896-3485E-mail: [email protected]


Marie C. Gallagher, FCIP, CRMKernaghan Adjusters Limited602 – 1 St. Paul StreetSt. Catharines, ON L2R 7L3Phone: (289) 786-1074Fax: (289) 723-1979E-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]

Fred R. Plant, AIICClaimsPro85 Englehart StreetDieppe, NB E1A 8K2Phone: (506) 853-8507Fax: (506) 853-8501E-mail: [email protected]

Heather Matthews, CIP, CRMCrawford & Company (Canada) Inc.539 Riverbend Dr.Kitchener, ON N2K 3S3Phone: (519) 578-5540Fax: (519) 578-2868E-mail: [email protected]

Monica Kuzyk, FCIP, CRMCuro Claims Services125 Northfield Dr. W., P.O. Box 218Waterloo, ON N2J 3Z9Phone: (866) 952-2876Fax: (519) 888-9704E-mail: [email protected]


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

Marie C. Gallagher, FCIP, CRMKernaghan Adjusters Limited602 – 1 St. Paul StreetSt. Catharines, ON L2R 7L3Phone: (289) 786-1074Fax: (289) 723-1979E-mail: [email protected]


Sasha AlexanderUniversity of GuelphAlexander Hall50 Stone Road EastGuelph, ON N1G 2W2Phone: (519) 824-4120Fax: (519) 824-0364E-mail: [email protected]

Ian Frost, FCIPWawanesa Mutual Insurance Company191 BroadwayWinnipeg, MB R3C 3P1Phone: (204) 985-3886Fax: (204) 942-7724E-mail: [email protected]

Tim GuernseyRSA Canada18 York Street, Suite 800Toronto, ON M5J 2T8Phone: (416) 366-7511Fax: (416) 367-9869E-mail: [email protected]

Peter HohmanInsurance Institute of Canada18 King Street East, 6th Floor Toronto, ON M5C 1C4Phone: (416) 362-8586Fax: (416) 362-1126E-mail: [email protected]

Glen HopkinsonXL Insurance Company SE100 Yonge Street, Suite 1200Toronto, ON M5C 2W1Tel: (647) 277-8650E-mail: [email protected]

Dan Langer E-mail: [email protected]

Justin MacGregorHighgate Insurance Brokers Inc.151 Rose Glen Rd.Port Hope, ON L1A 3V6Phone: (905) 885-1551E-mail: [email protected]

Alex Walker, CIPAviva Canada211 Pritchard Road, Unit #4, Hamilton, Ontario L8J 0G5Phone: (905) 330-7752E-mail: [email protected]

Mark WeirE-mail: [email protected]

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

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

John D. Seyler, CIPIntegrated Insurance Resources5080 Timberlea Blvd., Suite 214Mississauga, ON L4W 4M2Phone: (905) 238-4985Fax: (905) 238-2735E-mail: [email protected]


CONSTITUTION & RULESPaul Féron, FCIP, CRMClaimsPro210 – 746 Baseline Rd. EastLondon, ON N6C 5Z2Phone: (519) 645-6500Fax: (519) 645-2250E-mail: [email protected]

CONVENTIONTBA

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

Robert V. Pearson, CLA, FCIAACIAA Honorary Life Memberc/o CIAA National Office5401 Eglinton Ave. W., Suite 100Etobicoke, ON M9C 5K6Phone: (416) 621-6222Fax: (416) 621-7776E-mail: [email protected]

EDITORIALMary Charman, CIPCrawford & Company (Canada) Inc.1 – 120 Mulock Dr.Newmarket, ON L3Y 7C5Phone: (905) 898-0008Fax: (905) 898-1705E-mail: [email protected]

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

EDUCATIONGary Ellis, BBA, FCIP, RF, FCLA, FCIAA, FIFAAAMG Claims Inc.P.O. Box 20102 SherwoodCharlottetown, PE C1A 9E3Phone: (902) 628-9091Fax: (902) 628-9093E-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]

FINANCEJohn D. Seyler, CIPIntegrated Insurance Resources5080 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 & QUALIFICATIONSMarie C. Gallagher, FCIP, CRMKernaghan Adjusters Limited602 – 1 St. Paul StreetSt. Catharines, ON L2R 7L3Phone: (289) 786-1074Fax: (289) 723-1979E-mail: [email protected]

NOMINATINGAlbert Poon, CIPCunningham Lindsey CanadaClaims Services Ltd.1102 – 50 Burnhamthorpe Rd. W.Mississauga, ON L5B 3C2Phone: (905) 896-8181Fax: (905) 896-3485E-mail: [email protected]


Lorri FrederickClaimsPro120 Adelaide St. W., Suite 2401Toronto, ON M5H 1T1Phone: (905) 308-6292Fax: (416) 360-7335E-mail: [email protected]

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


PRIVACYJames B. Eso, CIP, CIOPCrawford & 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-ELAEClaimsPro 120 Adelaide St. W., Suite 2401Toronto, ON M5H 1T1Phone: (416) 777-4479Fax: (416) 360-7335E-mail: [email protected]

PROFESSIONAL PRACTICESAlbert Poon, CIPCunningham Lindsey CanadaClaims Services Ltd.1102 – 50 Burnhamthorpe Rd. W.Mississauga, ON L5B 3C2Phone: (905) 896-8181Fax: (905) 896-3485E-mail: [email protected]

National Standing Committees 2015-2016NEWFOUNDLAND & LABRADORTBA

NOVA SCOTIA Michael Connolly, BA, CFEI, CIP ClaimsPro30 Damascus Rd., Suite 220Halifax, NS B4A 0C1Phone: (902) 835-5065Fax: (902) 835-0848E-mail: [email protected]

NEW BRUNSWICK & PRINCE EDWARD ISLANDGreg Potten, BPE, CIP, CFEIAMG Claims Inc. 212 Queen Street, Unit 308Fredericton, NB E3B 1A8Phone: (506) 458-9000Fax: (506) 458-9595E-mail: [email protected]

QUEBEC/AESIQDenis DuchesneCunningham Lindsey Canada Claims Services Ltd.1250 rue Guy, bureau 1000Montreal, QC H3H 2T4Phone: (514) 938-5400 Fax: (514) 938-5445E-mail: [email protected]

ONTARIOMaria Joshua, FCIPSedgwick CMS Canada Inc.21 Four Seasons Place, Suite 100Toronto, ON M9B 6J8Phone: (416) 695-5100Fax: (416) 695-5120E-mail: [email protected]

MANITOBACraig Shanks, BA, CIPNetwork Adjusters Ltd.64 Regent Cres.Brandon, MB R7B 2W9Phone: (204) 725-7436Fax: (204) 725-7437E-mail: [email protected]

SASKATCHEWANJustin Braaten, FCIP, CRM, XATCapital Claims Adjusters Limited3500 – 13th AvenueRegina, SK S4T 1P9Phone: 1 866 550-0516 Fax: 1 866 725-4794E-mail: [email protected]

WESTERN M. Doreen Lennon, CIPTownsend & Leedham Adjusters Ltd.200, 4245 - 97 StreetEdmonton, AB T6E 5Y7Phone: (780) 463-7776Fax: (780) 462-1280E-mail: [email protected]

PACIFICBlair McGregor, CIP, ClaimsPro#400, 4370 Dominion StreetBurnaby, BC, V5G 4L7Phone: (604) 659-6550Fax:1-888-452-5246 E-mail: [email protected]

CIAA REGIONAL PRESIDENTS2015 – 2016

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FRED PLANT

Ours is a noble profession and you should be proud of the

important work you do, every day - delivering the product of

the Property & Casualty Insurance Industry in Canada.

The Ontario Chapter of the Canadian Independent Adjust-

ers’ Association (CIAA) and The Canadian Insurance Claims

Managers Association (CICMA) recently collaborated on their

49th annual joint conference which was held in Toronto during

the first week of February. These organizations put on collab-

orative seminars across Canada to promote professional devel-

opment and encourage contact between Insurers’ claims staff

and CIAA-member Independent Adjusters.

This year’s theme was “Technology Bytes Insurance” and

focused on disruptive technologies and potential new expo-

sures affecting the P&C Industry. The term disruptive technol-

ogy was coined approximately 20 years ago and refers to tech-

nological change that displaces an established technology and

shakes up the industry. Change. There’s that word again.

Those in attendance heard from a distinguished panel of

P&C claims and underwriting veterans speculating on what

impact technological change will have on the P&C Insurance

Industry and what claims people might reasonably expect do

to be prepared for what is coming our way.

The difficulty with all of this, as was really driven home by

the day’s keynote speaker, well-known CBC journalist Jesse

Hirsh who is described, among other things, as an internet

evangelist, is that no one really knows what will come our way

or even what has already come our way and the impact it will

have on our businesses.

Since 1688 the Property and Casualty Insurance Industry

has been evolving. Much has changed in the world over the last

328 years and while, admittedly, more has happened in the last

58 years than happened in the first 270 of those years, the fact

is the insurance industry has adapted to changing technologies

and so too will it adapt to what is now before us and is to come.

I am not so optimistic that governments and the legal sys-

tem will be as proactive and adaptive to the rush of change we

are experiencing, however the insurance industry has a pretty

good record of identifying and filling needs and opportunities.

The subject of overland flooding is a recent example of such

adaptation. Forever, such coverage was just not offered as there

was no demand. However, when the profile of the coverage

gap was elevated, the industry responded and that coverage is

available today.

Notre profession est une profession noble; vous devriez être fiers du

travail important que vous accomplissez chaque jour, c’est-à-dire d’offrir

le produit du secteur de l’assurance de dommages au Canada.

La section de l’Ontario de l’Association Canadienne des Experts

Indépendants (ACEI) et l’Association Canadienne des Directeurs de

Sinistres d’Assurance (ACDSA) ont récemment collaboré dans le cadre

de leur 49e congrès conjoint annuel qui a eu lieu à Toronto pendant la

première semaine de février. Ces organisations tiennent des séminaires

collaboratifs dans l’ensemble du Canada en vue de promouvoir le per-

fectionnement professionnel et d’encourager le contact entre le person-

nel chargé des sinistres chez les assureurs et les experts indépendants

membres de l’ACEI.

Le thème de cette année était « Technology Bytes Insurance » (tech-

nologie, octets, assurance); il mettait l’accent sur les technologies per-

turbatrices et les nouvelles expositions potentielles touchant le secteur

de l’assurance de dommages. Le terme « technologie perturbatrice » a

été formulé il y a environ 20 ans et fait référence à un changement tech-

nologique qui supplante une technologie établie et bouleverse le secteur.

Changement. Voilà encore ce terme.

Les gens présents ont écouté un panel de vétérans distingués en ma-

tière de sinistres de dommages et de souscription faire des suppositions

concernant l’incidence du changement technologique sur notre secteur

de l’assurance de dommages et ce à quoi les personnes chargées des si-

nistres pourraient raisonnablement s’attendre à l’avenir.

La difficulté dans tout cela comme l’a souligné le conférencier

d’honneur, le renommé Jesse Hirsh, journaliste de la CBC qui est, entre

autres, décrit comme un évangéliste du Web, c’est que personne ne sait

ce qui nous arrivera, ou même, ce qui nous est déjà arrivé, et l’incidence

que cela aura sur nos affaires.

Le secteur de l’assurance de dommages évolue depuis 1688. Il y a eu

beaucoup de changements dans le monde au cours des 328 dernières

années, et bien qu’il faut avouer que plus de choses se sont produites au

cours des 58 dernières années que pendant les 270 premières, le fait est

que le secteur de l’assurance s’est adapté à l’évolution des technologies et

continuera à s’adapter à ce qui est maintenant devant nous et à ce que

l’avenir nous réserve.

Je ne crois pas avec autant d’optimisme que les gouvernements et

le système juridique seront aussi proactifs et capables de s’adapter au

rythme des changements auxquels nous faisons face. Toutefois, le sec-

teur de l’assurance a de bonnes références en ce qui concerne le fait de

déterminer les besoins et les occasions et d’y donner suite. Le sujet des

inondations de surface est un exemple récent d’une telle adaptation.

Depuis toujours, une telle protection n’avait simplement jamais été

offerte, puisqu’il n’y avait aucune demande. Toutefois, lorsque le profil

de la lacune en matière de protection a été élargi, le secteur a réagi et

Message from the PresidentLa Plume du Président

p10,11 presidents message.indd 10 16-03-01 2:37 PM



We traveled a long way on that in a relatively short time

span. There was also a time when there was no automobile in-

surance.

As needs develop and coverages are written to fill those

needs, the process of fine-tuning the coverage will be accom-

plished through experience. There are risks out there covered

by policies that were never designed to cover those risks; and

we do not even know what the risks are and won’t know until

the claim notices start flowing. That’s where the skilled claim

professional comes in. These disruptive technologies should be

viewed as tremendous opportunities for Independent Adjust-

ers to put to use their skills in completing detailed investiga-

tions and understanding the implications of events in relation

to coverage.

There will be many tests of coverage that will shape the

policies that get designed to cover the risks that emerge with

evolving technologies. There will be great uncertainty and cool

heads will prevail. Overall, these so-called disruptive technologies

are really a new name on what our industry has been dealing

with for over three centuries. We thrive on this stuff. Opportu-

nity is knocking. Seize the opportunity.

Members of CIAA from across Canada will be meeting at

the CIAA National Convention to be held in beautiful Saint

Andrews, New Brunswick, September 22-25, 2016. Mark those

dates in your calendar and start planning to attend. We are at

a turning point in our profession. Be part of steering us in the

right direction. ■

cette protection est offerte de nos jours. Nous avons parcouru un long

chemin pendant une période relativement courte. Autrefois, il n’y avait

aucune assurance automobile.

Au fur et à mesure que les besoins évoluent et que les protections

sont souscrites pour combler ces besoins, le processus d’ajustement des

protections sera accompli grâce à l’expérience. Il existe des risques qui

sont couverts par des polices qui n’avaient jamais été conçues pour cou-

vrir de tels risques, nous ne savons même pas quels sont ces risques et

nous ne le saurons pas avant que les avis de sinistres ne commencent

à affluer. C’est là où le professionnel chevronné en matière de sinistres

entre en jeu. Ces technologies perturbatrices doivent être considérées

comme des occasions énormes pour les experts indépendants de mettre

en pratique leurs compétences, en effectuant des enquêtes détaillées et

en comprenant les conséquences des événements liés à la protection.

Il y aura plusieurs épreuves pour les protections qui viendront façon-

ner les polices conçues pour couvrir les risques découlant de l’évolution

des technologies. Il y aura une grande incertitude et ceux qui garderont

la tête froide réussiront. Dans l’ensemble, ces technologies perturbatrices

sont en réalité un nouveau nom pour les situations auxquelles notre sec-

teur fait face depuis plus de trois siècles. Nous prospérons grâce à ces

situations. Des occasions se présentent à nous. Saisissez-les.

Les membres de l’ACEI provenant de l’ensemble du Canada se

rencontreront à l’occasion du congrès national de l’ACEI qui aura lieu

dans la magnifique ville de Saint Andrews, au Nouveau-Brunswick,

du 22 au 25 septembre 2016. Inscrivez ces dates à votre calendrier et

commencez à planifier votre participation. Nous sommes à un moment

décisif dans notre profession. Contribuez à nous orienter dans la bonne

direction. ■

NATIONAL EXECUTIVE 2014 - 2015NATIONAL EXECUTIVE 2015 - 2016PRESIDENTFred R. Plant, AIICClaimsPro85 Englehart StreetDieppe, NB E1A 8K2Phone: (506) 853-8507Fax: (506) 853-8501E-mail: [email protected]

1ST VICE-PRESIDENTHeather Matthews, CIP, CRMCrawford & Company (Canada) Inc.539 Riverbend Dr.Kitchener, ON N2K 3S3Phone: (519) 578-5540Fax: (519) 578-2868E-mail: [email protected]

2ND VICE-PRESIDENTGary Ellis, BBA, FCIP, RF, FCLA, FCIAA, FIFAAAMG Claims Inc.P.O. Box 20102 SherwoodCharlottetown, PE C1A 9E3Phone: (902) 628-9091Fax: (902) 628-9093E-mail: [email protected]

SECRETARYMonica Kuzyk, FCIP, CRMCuro Claims Services125 Northfield Dr. W., P.O. Box 218Waterloo, ON N2J 3Z9Phone: (866) 952-2876Fax: (519) 888-9704E-mail: [email protected]

TREASURERJohn D. Seyler, CIPIntegrated Insurance Resources5080 Timberlea Blvd., Suite 214Mississauga, ON L4W 4M2Phone: (905) 238-4985Fax: (905) 238-2735E-mail: [email protected]

PAST-PRESIDENT Albert Poon, CIPCunningham Lindsey CanadaClaims Services Ltd.1102 – 50 Burnhamthorpe Rd. W.Mississauga, ON L5B 3C2Phone: (905) 896-8181Fax: (905) 896-3485E-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]

DIRECTORPaul Féron, FCIP, CRMClaimsPro210 – 746 Baseline Rd. EastLondon, ON N6C 5Z2Phone: (519) 645-6500Fax: (519) 645-2250E-mail: [email protected]

DIRECTORLorri FrederickClaimsPro120 Adelaide St. W., Suite 2401Toronto, ON M5H 1T1Phone: (905) 308-6292Fax: (416) 360-7335E-mail: [email protected]

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

DIRECTORE. 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]

DIRECTORJohn Jones, BACunningham Lindsey CanadaClaims Services Ltd.1102 – 50 Burnhamthorpe Rd. W.Mississauga, ON L5B 3C2Phone: (905) 896-8181Fax: (905) 896-3485E-mail: [email protected]

DIRECTORAlbert Poon, CIPCunningham Lindsey CanadaClaims Services Ltd.1102 – 50 Burnhamthorpe Rd. W.Mississauga, ON L5B 3C2Phone: (905) 896-8181Fax: (905) 896-3485E-mail: [email protected]

DIRECTORMarie C. Gallagher, FCIP, CRMKernaghan Adjusters Limited602 – 1 St. Paul StreetSt. Catharines, ON L2R 7L3Ph: (289) 786-1074 Fax: (289) 723-1979E-mail: [email protected] DIRECTORCraig J. Walker, CIP, FCIAA, FIFAAMaltman Group International3550 Victoria Park Ave., Suite 301Toronto, ON M2H 2N5Ph: (416) 492-4411 Fax: (416) 492-5657E-mail: [email protected]

p10,11 presidents message.indd 11 16-03-01 2:38 PM

















CS

Adjusters ready to take on new claims environment Change, it seems, is the only constant

p12-18 COVER STORY.indd 12 16-02-29 11:04 AM


Independent adjusters across Canada can expect to face a wide range of issues over the coming year. Those anticipated developments, though, fall under some familiar themes: the effect of consolidation, not only among IA firms, but among insurers as well; the need to attract talent to ensure the sector remains healthy and sustainable; the role of technology

to make the claims-handling process as efficient and customer-friendly as possible; the effect of a possible decrease in auto claims resulting from improved technology; how best to manage peaks and valleys to adapt to current conditions; identifying the balance between producing revenue and controlling expense; and determining how to address fluctuating claims volumes.

Claims Canada asked leading adjusters at top-ranked firms across the country what trends and developments they expect to unfold in 2016. How should claims professionals and their firms best prepare? Read on to find out what those leaders had to say, presented in alphabeti-cal order by last name. ➜ BY ANGELA STELMAKOWICH

How will consolidation impact Can-

ada’s independent claims adjusting land-

scape?

In all, 59% of surveyed Canadian exec-

utives plan to actively pursue acquisitions

in the next 12 months, placing mergers and

acquisitions (M&A) appetite at a six-year

high, according to EY’s 2015 Canadian

Capital Confidence Barometer. While this

statistic reflects business in general, the

insurance industry is following the trend.

Supporting that view are findings from

a 2014 survey by Towers Watson that 86%

of North American insurance executive

respondents expected to see an increase

in M&A activity in the next three years,

and 78% were actively considering acqui-

sitions. But M&A activity is not involving

just insurance companies and brokers.

Consolidation is also happening among

vendors, including tech companies, claims

adjusters and restoration firms, which are

buying companies to help expand their

Dara Banga, FCIP, CFEIPresident & Chief Adjusting Officer,

DSB Claims Solutions Inc.



http://www.winmar.ca

14 Claims Canada February/March 2016 www.claimscanada.

Ross Betteridge, CPA, CAPresident,

ClaimsPro

service offerings and broaden their reach.

Recent insurance M&A examples in-

clude ACE Limited’s acquisition of The

Chubb Corporation; the Towers Watson

and Willis Group Holdings merger; Hub

International’s acquisition of two home

warranty companies; and SCM Insurance

Services’ acquisition of Granite Claims.

What does all this M&A activity mean

for independent claims adjusting services?

Two words: buyer beware.

While acquisitions may yield posi-

tive results five years down the road, the

transition period — while two companies

struggle to integrate goals, people, systems

and processes — can be nothing short of

chaos. And the biggest losers during the

transition period tend to be clients. Just

ask Comcast/Time Warner Cable custom-

ers following their failed merger. Customer

satisfaction scores dropped 10% and 9%,

respectively.

In the serious and time-sensitive busi-

ness of claims management, there’s simply

no room for error or ambiguity. People’s

lives, assets and futures are at stake. In-

sureds trust that the policies they’ve dili-

gently paid for will deliver in spades when

they need them most. They are 100% reli-

ant on an adjuster’s rapid response, investi-

gation, reporting and action.

Then, there’s the bottom line to consid-

er. Insurers and self-insured organizations

rely on adjusters to defend their profits and

reputations with quality claims services —

keeping policyholder retention levels high

and fraud and claims leakage low. These

goals may be difficult to achieve with an

adjusting partner who is in the midst of

merger chaos.

Independent adjusters need to take

charge of change.

Smaller North American brokerages

outperform larger ones in overall satisfac-

tion according to J.D. Power’s 2015 Large

Commercial Insurance Study. Smaller bro-

kers received higher satisfaction ratings in

three key areas: quality of advice, guidance

provided and reasonableness of fees, Cana-

dian Underwriter recently reported.

Likewise, if policyholder satisfaction

and profitability are important goals, in-

surers and self-insured organizations may

want to choose smaller, service-driven

adjusting firms rather than larger firms in

transition.

They should look for adjusting firms

that are focused on clients and the crises

at hand, that aren’t burdened by satisfying

shareholders’ expectations. They should

insist on adjusters who aren’t inhibited by

big-company bureaucracy or unclear pro-

tocols, who can respond to changing needs

with speed and agility.

Taking charge of change is necessary to

prevent change from taking charge of orga-

nizations’ claims results. ●

2016, holds many opportunities and a

few challenges for the independent adjust-

ing industry.

The industry has just finished one of the

most benign weather years in recent mem-

ory and, with that, came a significant drop

in frequency of property-related claims.

This is far different from the 2013/2014 pe-

riod, which saw Canada experience some

of the most catastrophic weather in recent

memory.

In both of these scenarios, however, a

key success driver of independent adjust-

ing (IA) firms is borne by its people, its

financial strength and the flexibility to pro-

vide the service that our clients need, when

they need it.

Helping our clients deliver at the “mo-

ment of truth,” in a manner that meets all

stakeholders’ needs, is a key challenge to

which independent adjusting companies

must respond. Insurers are increasingly

measuring their own success in this regard,

through key performance indicators such

as handling costs, cycle times and net pro-

moter scores (NPS).

Delivering cost-efficient claims han-

dling will require IA firms to invest in tech-

nology that not only reduces the adminis-

trative burden of claims handling on the

adjuster, but allows IA firms to seamlessly

connect with insurers’ claims management

systems. Our adjusters’ professional expe-

rience, training and opportunity to inter-

act on-site with the end-customer, when

required, will be important to delivering

the excellent customer experience that

translates into positive NPS scores.

With consolidation expected to con-

tinue among property and casualty (P&C)

insurers, IA firms will need to ensure they

have the scale and presence to not only

serve clients across the entire country, but

also to deliver the breadth of specialty ser-

vices increasingly called upon by clients. In

order to successfully grow and meet these

scale and skill set needs, IA firms must in-

vest in robust succession planning facilitat-

ed by strong recruiting and retention pro-

grams, training and mentoring, and clarity

of career path options.

Due to the regulated nature of the in-

dustry, P&C insurers are increasingly faced

with strict governance requirements. This,

in turn, puts additional pressure on IA

firms to ensure they, too, have the appro-

priate control environment in place as they

act in partnership as a true extension of the

insurer/customer relationship. Education,

monitoring and reporting on compliance

will also be important to provide our cli-

ents with the confidence to fully use our

services.

ClaimsPro has recently joined the Ca-

nadian Independent Adjusters Association

(CIAA) and is excited to be working with

all members in prioritizing the industry’s

goals for 2016. These goals include work-

ing with provincial regulators to gain sup-

port for relaxing restrictive legislation that

requires adjusters to hold a license from a

province in order to adjust claims in that

territory. This will dramatically improve

our ability to respond and help Canadians

during catastrophic events.

Other priorities include further sup-

port for education and training, as well as

better promotion of the profession and the

career opportunities it provides.

While no one can predict what Mother

Nature will bring in the coming months,

IA firms, including everyone at ClaimsPro,

are prepared and eager to respond to meet

the needs of our clients! ●

2016 started with a soft market and low

interest rates. Both have an effect on the

use of independent adjusters, as insurers

not only look to tighten their underwrit-

ing practices, but also to streamline their

claims practices.

One positive development is that the

industry is very strong on leveraging tech-

nology. This is important since consumer

expectations are very high around the use

of technology. If one can use Craig’s List

to buy and sell items and transact im-

mediate payments using e-transfer tech-

nology, can the insurance industry har-

ness better technology processes to keep

insureds happy during the adjustment of

their claim?

Workflow issues could be solved

through increased use of technology.

Patti Kernaghan, FCIP, CRMPresident & Chief Executive Officer,

Kernaghan Adjusters


http://www.claimscanada


Consumers will drive that change and in-

dependent adjusters must be ready to em-

brace new ways of using technology.

Independent adjusters will need to

keep current not only with what they

themselves are doing, but also with how

they can be affected by what others are do-

ing. For example, one of Canada’s larger

insurers was recently quoted as saying it

is developing a “once and done” claims

service for customers, and that its new

platform will include self-service claims

for very quick settlements.

Where does this leave IAs? Will they

need to incorporate new technology pro-

cesses to reduce their cycle times? This is

an opportunity for independent adjust-

ing firms to differentiate their service by

creating workflow efficiencies for their

adjusters.

Catastrophic events are the biggest

unknown in the industry. Typically, the

industry waits for an event and then

decides on a course of action accord-

ing to the event’s location and severity.

Overall, 2015 was slower than usual for

storm claims. However, weather events

come in cycles and adjusters cannot afford

to be complacent.

In 2016, we need to prepare ourselves

and undertake more training, develop

new processes to shorten storm claim

cycle time, and be prepared to increase

the size of our storm teams — thereby

allowing us to respond to weather events

with fast on-the-ground service, using

fully licensed professionals, to control the

claims. ●

The world of independent adjusting has

undergone plenty of changes over the past

number of years and continues to evolve at

a rapid pace. There is something to be said

for consistency and stability, but in this day

and age, if an adjuster is not continuing to

develop, change and grow in concert with

society, technology and industry trends,

then it will be difficult to continue to oper-

ate a sustainable business.

Small independents rely largely on spe-

cialization, relationships and the ability to

be agile and responsive to change, whereas

nationals have an advantage due to the

size, breadth and scope of coverage they

can provide. I believe the industry needs

both nationals and the boutique firms to

respond to various needs.

From a personal lines perspective, I an-

ticipate the industry will see a decrease in

claims throughout 2016 and ongoing into

the future, largely due to technological

advances in society such as smart homes,

autonomous vehicles and telematics. Our

homes are safer because of the security and

monitoring systems consumers are pur-

chasing, as well as the apps and programs

that can alert homeowners to smoke and

intruders in real time.

On the roads, many drivers choose to

install telematics devices into their vehicles

for purposes of reducing their insurance

rates. This not only provides the insurer

with data on the driver’s behaviour, but

also serves to curtail poor driving habits.

Drivers tend to consciously attempt to im-

prove their habits to reduce their insurance

rates, which, ultimately, leads to fewer ac-

cidents.

Accident avoidance systems have been

around for many years and can be as sim-

ple as a light on the side-view mirror that

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flashes if a vehicle in the next lane is in the

driver’s “danger zone”, or as complex as au-

tomatic braking features if the car senses

the driver is too close to an object in front

of the vehicle.

All new cars these days come with some

form of safety features that help reduce

driver error and resulting accidents. Let’s

take this one step further and look at au-

tonomous cars.

Ontario will be the first province in

Canada to allow the testing of self-driving

cars. Testing was to start in January 2016

at the University of Waterloo, which is

home to a lab dedicated to self-driving

vehicles. By 2040, the Institute of Electri-

cal and Electronics Engineers reports that

it expects 75% of all cars on the road will

be automated to some extent. The experts

further believe that this change will come

quicker than we think. There are already

almost 100 companies in Ontario working

on technology in this field.

These are all great transformations

for society and insurers. However, some

experts anticipate as much as an 80% re-

duction of car accidents within the next

decade, which will have a significant im-

pact on the independents who deal with

personal lines claims.

As an optimist, I like to see the oppor-

tunity in every challenge and choose to

believe that this considerable reduction, if

realized, may lead insurers to rethink their

business models and outsource personal

lines claim departments all together.

Furthermore, independent adjusters

are often used for their expertise in a cer-

tain field. With so much change and in-

novation, there will be a shift in liability

from personal lines to commercial prod-

ucts.

It is an opportune time for IAs to fur-

ther develop investigation skills to adjudi-

cate claims involving disruptive technolo-

gies such as drones, autonomous vehicles,

smart homes and 3D printing. As special-

ists in these fields, IAs will be able to co-

ordinate experts, investigate and evaluate

at a superior level than that of a general

adjuster. ●

The independent adjusting business

is coming off a year of lower claims out-

source volumes due to a lack of weather-

related events. The outlook for 2016 does

not appear to be any different, as long as

the weather remains benign.

As in the past, this mild environment

represents a challenge for the industry. IA

firms are continually faced with the need

to right size their organizations for the

current conditions, while also ensuring

resources are available to meet customer

needs, especially should claim volumes

spike.

Managing peaks and valleys has — and

will continue to be — a primary challenge

for any independent adjusting firm and

this is not expected to change.

What has evolved is how IAs manage

resourcing when major events do occur. As

global expansion continues in the industry,

it affords access to resources from other

parts of the global community. Sharing

adjusting resourcing and expertise from

within Cunningham Lindsey’s worldwide

operations, for example, has become an ef-

fective way of quickly bringing in trained

and knowledgeable people.

Technology is also a key area to support

major loss events. The IA industry is look-

ing at a wide range of ways to leverage in-

novation — everything from smartphones

to tablets, video adjusting and drone tech-

nology — to better manage catastrophe

events.

Our operation in the United Kingdom,

for example, has been using drone technol-

ogy for several years now in a variety of

scenarios. When a major event occurs, a

drone is deployed to survey the area and

build a picture of the general area to de-

termine how many people need to be de-

ployed in a certain area. This helps separate

Albert PoonChief Operating Officer,

Cunningham Lindsey Canada

By 2040, the Institute of Electrical and Electronics Engineers reports that it expects 75% of all cars on the road will be automated to some extent.




fact from fiction in terms of where to send

people and resources.

Technology is definitely changing how

independent adjusters do business. Data

and analytics are now fundamental to

service offerings. Providing meaningful

claims experience data can significantly

assist corporations with their risk manage-

ment programs. And, for insurers, it means

claims can be paid more quickly, which fits

into the “customer experience” mantra that

is echoing throughout the industry.

Greater innovation through process

improvement and technology will help to

deliver a better service model.

Low insurance premium rates have led

to record levels of mergers and acquisitions

activity in the industry and insurers are

looking to achieve savings through these

deals, often through in-sourcing claims.

Faced with this challenge, independent ad-

justers understand they can play a key role

as a provider of specialty services. Cun-

ningham Lindsey anticipates the need for

increased expertise in specialty lines to re-

main core to our business, and the strategy

remains to grow in large loss and specialty

lines capabilities through recruitment and

organic growth.

While the IA industry has and will con-

tinue to change, it brings with it new op-

portunities. 2016 should be viewed with

great optimism and excitement. ●

In 2011, there was an article in Claims

Canada written by my friend and col-

league, Terri Mitchell. In that article, she

said, “Unfortunately, I have heard rum-

blings throughout the independent ad-

justing community about us being a dying

breed.” It seems we have been falling out of

style for years.

From the perspective of a small adjust-

ing firm owner, these firms do face chal-

lenges that are not unique to small business

in Canada. The bureaucracy of govern-

ment and administration of businesses big

and small detract from our ability to focus

on serving our clients and, specifically, the

insuring public.

In conversations with fellow adjusters, a

common lament is, “I just need to find time

to deal with the issues of my company like

payroll, benefits and human resources.”

I think every business owner simply

wants to be free to handle files and mar-

ket clients. Let’s face it. Producing revenue

may be the easy way to succeed, but con-

trolling rising expenses is where the long-

term success lies. It is apparent that the re-

sulting pressures facing small IAs has led to

consolidation of the industry and demise

of the independent operator.

As is the case with property and casu-

alty insurer consolidation — where the

bigger-is-better philosophy prevails — that

this trend will continue to extend into the

claims industry. With the implementation

of restrictive vendor lists as opposed to the

model of using the best vendor in a mar-

ket, the small general adjusting firm may

be a thing of the past. It seems the idea of

a thorough investigation by insurers is dis-

appearing.

Combine these issues with the advan-

tage that a national firm has thanks to

economies of scale and access to national

vendor managers, this can make any small

operator jealous.

Yes, I can hear three or four national

CEOs bemoaning my comments, point-

ing out that I haven’t walked in their

shoes, but little is more distressing than

finding out how little big operations pay

for office supplies, insurance and equip-

ment in comparison to a small volume

purchaser.

With all that said, I believe that while

the general claims business is fading for

small independent adjusters (IAs), we still

have a lot to offer the industry. So, Terri, I

would say that in 2016 the rumours of our

death have been greatly exaggerated, but

do offer food for thought.

Like vendors large and small, IAs need

to keep investing in technology and keep

searching for the niche market where our

intellectual property has value to insurers.

Unless you operate in a remote location

and are the only game in town, it is neces-

sary to handle the type of claims the com-

petition doesn’t, or to do it better.

Small independent adjusters looking

to compete with a national independent

company or the company adjuster must

provide a better product. It is essential to

constantly add value in exchange for the

use of your firm. Having niche capabilities

can overcome the restrictions of the exclu-

sionary vendor list.

There are many problems facing inde-

pendent adjusters in general. In-sourcing

by insurers is a key factor. This only makes

proving our value proposition every day

— without creating an hourly rate race to

the bottom between competitors — all the

more important.

Automation of the claims process

looms and the interface of technology with

our clients is inevitable, but at what cost?

With the addition of ClaimsPro to the

CIAA, this coming together provides an

excellent opportunity to make our single

voice heard. The opportunity to be heard

by insurers and regulators as a true nation-

al representation cannot be squandered.

However, capitalizing on the opportu-

nity means we need to develop — first at a

grass-roots level — pride and enthusiasm

in the IA profession. It seems we have an

industry-wide self-esteem issue.

Building confidence and strength starts

with every adjuster being proud to hold a

license. Whether grinding through mun-

dane physical damage claims or an indus-

try leader working a multi-million-dollar

loss, adjusters deserve the recognition by

principals of large and small firms alike.

The work of the independent adjuster

is changing as a result of an ever-changing

environment. I, for one, plan to scuttle the

rumours and adapt to a new reality where

IAs can continue to offer insight and value

to clientele. ●

It is the time of year where everyone

is looking into their crystal balls and try-

ing to predict what the year ahead will de-

liver — in the way of both challenges and

opportunities. The same applies to the

claims industry and the role of the inde-

pendent adjuster.

It seems nearly impossible to go a full

day where there are not multiple headlines

highlighting the profound changes that

have taken place or are about to come into

effect, all of which lead to significant and

irreversible effects on the independent ad-

justing industry.

Throughout 2015, we witnessed con-

siderable merger and acquisition activity

within the insurance industry. The 2016

large-scale acquisition of RBC General

Insurance Company by Aviva Canada sig-

nifies that mergers and acquisitions may

continue to play a significant role in shap-

ing the landscape of the insurance market.

With a single transaction, a carrier can

significantly increase both its market share

John Seyler, CIPPresident,

Integated Insurance Resources Inc.

Pat Van Bakel, BA, CIPPresident & Chief Executive Officer,

Crawford & Company (Canada) Inc.




and competitive advantage. The ripple ef-

fect of such a transaction has considerable

impacts on supporting service providers

and business partners, such as IA firms.

Within a split second, two of your larg-

er clients can become your largest client.

The reverse could also be true, whereby

you lose a large client as a result of an

acquisition and are left with a significant

loss within your business portfolio.

Adaptability within an ever-changing

landscape is key to the success of an IA

firm. Being flexible in terms of altering

short and long-term strategies to adapt

to current conditions, as well as the needs

and expectations of your client base, is

vital. The diversification of clients and

service offerings is one way in which a

successful IA firm counteracts the risks

associated with M&A activities.

The insurance industry is in the midst

of a digital transformation. From brokers

to carriers to IA firms, we are all striving

to use technology to drive improved pro-

cesses and create efficiency gains, better

manage our businesses, increase engage-

ment with clients, enhance the insured’s

experience, and better interact with our

business partners.

Carriers are rapidly shedding legacy

systems, unlocking the potential for more

agile, strategic and integrated partner-

ships with IAs. This serves to solidify the

business partnership between the two, as

IA firms become the true variable exten-

sion of a carrier’s internal capabilities,

with both service and data being closely

integrated.

These factors will impact our industry

in a significant way. But so, too, will the

advancements in technology and devel-

opments in insurance products currently

being tested in research and development

labs across the globe in areas like autono-

mous cars, drones or unmanned aerial

vehicles, the Internet of Things, cyber

risk, data analytics, self-service and video

streaming, telematics and usage-based

insurance, and the emergence of sharing

economies.

Through these advancements, it is

almost possible to peer into the future,

which upon first glance, bears little to no

resemblance to the past.

Parallel to this is the increased indus-

try demand placed on IA firms to develop

first-class talent in these new disciplines

so that carriers and risk managers have

the confidence to underwrite or confront

these risks.

As an industry, we are always trying to

define the “new norm”. At a macro level,

we look at the “claims economy” and the

fact that it is in an extended period of be-

nign weather in Canada with low claim

frequency. This presents an opportunity

for carriers to strengthen their solutions

with IA partners and prepare for the in-

evitable return to higher claims frequency

or catastrophe events.

The timing is ideal for carriers to work

with IAs to redefine their field service

strategy, be more prescribed with respect

to service proposition and segmentation,

implement effective triage practices, le-

verage best-response resources, develop

strategies on how to use technology to

deliver a more cost-effective and service-

oriented approach to claims, and obtain

alignment on what the expectations of

that service proposition will be in the

short and long term.

As IAs, we need to be culturally and

operationally aligned with the chang-

ing competitive dynamics of our clients,

who are facing rapidly evolving service

expectations from personal and commer-

cial policyholders alike. Technical skills

in claims investigations and coverage

analysis are as critical as ever, but are now

overlaid with an equal focus and priority

around customer experience and more

predictable service outcomes.

Ultimately, IAs need to be students

of the industry, rethinking corporate

orientations from the inside-out to the

outside-in. It has never been more im-

portant to stay on top of emerging trends

and products as we face unprecedent-

ed changes in core property and auto

products.

Whether it is rapidly changing prop-

erty coverages in response to demand

for flood cover, or yet again more regula-

tory changes on the horizon for Ontario

automobile insurance, IAs need to keep

abreast of these evolutions and assist cli-

ents in their quests to adapt to new land-

scapes. �

From brokers to carriers to IA firms, we are all striving to use technology to drive improved processes and create efficiency gains, better manage our businesses, increase engagement with clients, enhance the insured’s experience, and better interact with our business partners.



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“My passion in life is social enter-

prise. That’s what I want; that’s what I

love,” says Pieter Heydenrych, CIP.

Thanks to that overarching phi-

losophy, his company, Halifax-based

Emergency & Environmental Claims

Management (EECM Ltd.), is more

than an adjusting firm. Not only does

the company provide claims services

and environmental consulting servic-

es, it also has a strong commitment to

social responsibility.

Heydenrych started EECM in 2014

with partner Torgny Vigerstad, PhD,

who operates under the title of Science

Director.

The company handles primarily

property losses and liability stemming

from environmental losses.

“It’s always complicated and pain-

ful,” Heydenrych says, adding he pre-

fers to solve complex problems, and

ones that involve a lot of the human

element.

“Inevitably there are 101 people

involved with every environmental

claim,” he says, tongue firmly in cheek.

“Everybody’s got a different interest,

everybody’s got a different need, and

to make them all work together is chal-

lenging, exciting and fun to do. I like

the challenge of sorting it all out; find-

ing a solution that makes people happy

at the end of the day.”

To understand his social justice fo-

cus, a little background about Heyden-

rych helps.

He started his insurance career in

1994 in South Africa as a sales rep.

That led quickly to an ownership stake

in a brokerage firm focused on com-

mercial and marine insurance.

It was a serendipitous conversation

with a claims manager he placed busi-

ness with that led to his career in ad-

justing.

“Believe it or not, I wasn’t planning

a career in claims,” he says.

The claims manager lamented the

lack of expertise available to deal with

claims related to computers and engi-

neering. When Heydenrych admitted

to a little IT knowledge, having trained

as a technician and knowing program-

ming, he was granted an interview and

got a new job on the spot.

It was August 1997, and he imme-

diately established his first adjusting

company. He sold his stake in the bro-

kerage, as the adjusting side seemed a

better option. It was electronic equip-

ment and data losses claims at first,

but another chance meeting resulted

in taking on a cargo loss file, and from

there he spent nine years specializing

in cargo losses—local, international

and mostly dockside.

“It was fascinating work, and pain-

ful work, and fun work,” he says. “But

fascinating especially because I’ve had

opportunities to work claims deal-

ing with everything from McDonald's

buns to sulfuric acid. If it’s been on a

truck somewhere, I’ve probably had a

claim on it.”

In 2006 Heydenrych decided to

leave South Africa permanently and

sold the business, which by that time

had expanded to include a network of

adjusters who could respond to cargo

claims from the very southern tip of

the continent right up to Zambia in a

matter of hours.

After a couple years working in Eu-

rope he got a work permit and came to

Canada, ultimately moving to Halifax

in 2010 once he received his perma-

nent resident status.

Starting his career in South Africa

gives Heydenrych a different perspec-

tive on doing business in Canada. The

differences in insurance industry cul-

ture between here and there are as vast

as the oceans that separate us.

“The guy with the biggest lawyer

in South Africa is the guy that wins

the case,” he laughs. “The South

African insurance industry is very

wild, wild West. Canada is very civi-

lized and pleasant. You can really

make a difference here as an adjust-

er by following the rules as they are

laid out.”


SChanging theEnvironment

BY EMILY ATKINS

“

“

p20-21 SPOTLIGHT.indd 20 16-02-29 11:17 AM


Coming out of secondary school

Heydenrych was told he had a seven

percent chance of finding a job in

South Africa—a statistic that has since

dropped to five percent, he says.

“Canada doesn’t have the same lev-

el of challenge in this arena, although

the environment we are living in has

become very capitalist-driven with no

real regard for people. That distresses

me personally greatly because I’ve seen

what that does to a place.”

This fuels his drive to help others

succeed. Heydenrych volunteers as an

advisor for the Junior Achievement

program, among other social respon-

sibility projects he’s working on.

“I am very passionate about social

enterprise and in doing things that

make it possible for people to make

their own lives better. I have a lot of

experience as an entrepreneur, as a

businessperson, and if I can teach one

person one thing that makes their life

better then it was worth it. It’s some-

thing that’s seriously lacking in our

industry.”

As a new member of the CIAA,

Heydenrych says he is sure he hasn’t

even begun to tap the full potential of

his membership, but he values the op-

portunity that it gives him as a smaller

adjusting firm.

“I do like that there are a fair num-

ber of smaller firms,” he says. “It makes

it easy to connect with other firms. It

also adds a level of credibility for me

when dealing with other companies.”

As a small company, EECM may

well need the association’s support.

Heydenrych says it himself: the ad-

justing business in Canada is facing a

near-perfect storm, especially as it per-

tains to smaller adjusting firms.

“There’s been a significant move by

larger insurance companies to follow

procurement processes which…seem

designed to exclude the smaller firms.

They are losing ground at a rate that is

completely frightening,” he says.

“We’re about to lose a dramatic

number of very skilled adjusters to re-

tirement. There’s no succession plan-

ning; they’re just taking less work…

That brain trust is being lost at this

time.”

His concern is it’s making it diffi-

cult for young, new adjusters starting

out to find a place to learn and grow.

“Entrepreneurship in our industry is

dying completely.

As a new entrant to the market my-

self, I find it very frightening.”

His advice to those starting out:

“It’s hard. Get ready to grind your

teeth, there’s no shortcuts, you need to

just get in there and do what needs to

be done.”

As for his own future, having been

successful in South Africa’s hostile

business environment “has given me

staying power,” Heydenrych says. “I’m

going to be around for a while.”

Plans for EECM’s future develop-

ment will depend on the opportuni-

ties that arise, he says. “I’m not afraid

to take the risk to take advantage of an

opportunity. I’ve created a vehicle here

for people with an entrepreneurial flair

[to join us]. It’s more of a collaboration

than a partnership.” �


Pieter Heydenrych

p20-21 SPOTLIGHT.indd 21 16-02-29 11:17 AM


This was an active

year at the provincial

appellate court level,

with two issues domi-

nating the insurance

coverage landscape.

The first was the “faulty

workmanship” vs. “re-

sultant damage” debate,

which was addressed by

three separate appellate

courts and is headed to

the Supreme Court in

2016. The other is the

application of the Su-

preme Court of Canada’s decision in Sat-

tva Capital to standard-form insurance

policies.

While 2015 saw little activity from the

Supreme Court of Canada, 2016 is shap-

ing up to be much more interesting, with

at least one major appeal set to be heard by

the top court, and several other decisions

seeking leave. Here’s the top 10…

Ledcor Construction Limited v Northbridge Indemnity Insurance Company, 2015 ABCA 121; leave to appeal to SCC granted September 24, 2015 (Builders’ Risk - Poor Work-manship vs. Resultant Damage)

Ledcor dealt with the

line-drawing exercise be-

tween faulty workman-

ship and resultant damage.

A window cleaner damaged

the windows of a commercial

building. The owner sought

indemnity from its builder’s

risk insurer, Northbridge,

for the cost to replace the

windows. Northbridge

denied the claim, tak-

ing the position that the

loss was caused by faulty

workmanship, and was therefore

excluded. The trial judge initially found

in favour of the insured, but the Alberta

Court of Appeal disagreed, holding that

the cleaning service was “workmanship”,

and the cost to repair the cleaner’s faulty

work was not “resultant damage”, but in-

stead, a direct result of the faulty work.

The court confirmed builder’s risk

coverage is not intended to pro-

vide a construction warranty,

in spite of fact that the policy

covers “all-risks”.

The court also suggested

that the deference standard of ap-

pellate review established by the

Supreme Court in Sattva Capital

may not be applicable in insurance

cases where standard form language is

used.

Leave to appeal was granted by the

Supreme Court of Canada in September,

which is helpful, given the starkly differ-

ing approach taken in the next decision

on our list.

Acciona Infrastructure Canada Inc. v. Allianz Global Risks US Insurance Co., 2015 BCCA 347; leave to appeal to SCC filed October 21, 2015 (Course of Construction Policy – Defects exclusion)

The trial decision in Acciona made last

year’s Top 10 list, a decision which has

now been upheld by the B.C. Court of

Appeal. Acciona involved

wide-spread cracking

of concrete during the

construction of a large

hospital. The concrete

failed to set properly

due to improper form-

work and re-shoring.

The trial judge held

that, while the im-

proper formwork

and shoring was

faulty workman-

ship, the subsequent

cracking of the con-

crete was “resultant damage”, and

therefore outside the scope of the faulty

workmanship exclusion. The BC Court of

Appeal looked to the purpose of the faulty

workmanship exclusion in deciding that

there was coverage for this loss. The court

found that the purpose of the exclusion

was to prevent recovery for negli-

gent work, but not the damage

resulting from negligent

work.

This is a completely dif-

ferent approach than that

seen in Ledcor, and reconciling

these two different approaches

will be a challenge left to the

Supreme Court of Canada, hope-

fully in 2016. Leave to appeal was filed

on October 21, 2015.

Precision Plating Ltd. v. Axa Pacific Insurance Company, 2015 BCCA 277; leave to appeal to Supreme Court of Canada dismissed January 14, 2016 (CGL Policy – Pollution Exclusion)

Precision Plating is another case that

we covered in 2014 that has now gone to

appeal. Precision Plating was sued by a

third party after a fire triggered the sprin-

kler system at its property, resulting in

the overflow of dangerous chemicals. Axa

denied coverage under its liability policy,

relying on the absolute pollution exclu-

sion. Although the claim alleged concur-

rent causes of damage from the fire and

pollutants, the court found no possibility

that the insurer would be obligated to in-

demnify the insured. Ultimately, the pur-

pose of the absolute pollution exclusion is

to exclude damage caused by the escape of

pollutants, however caused. The fact that

the escape of pollutants resulted from an

insured peril (fire) did not nullify that

purpose.

Similar to the Alberta Court of Ap-

peal in Ledcor, the Court openly ques-

tioned whether the deference standard

of appellate review from Sattva Capital

applies to boilerplate insurance con-

tracts.

The Supreme Court of Canada refused

leave to appeal on January 16, 2016.


Insurance Decisions A review of the ten most important insurance coverage cases of 2015

BY CHRISTOPHER R. DUNN AND JOSIAH T. MACQUARRIE

22-24 TOP TEN.indd 22 16-02-29 11:19 AM


Allstate Insurance Company of Canada v. Aftab, 2015 ONCA 349 (Homeowner’s Policy – Exclusion for claims arising out of bodily injury to member of household)

The Ontario Court of Appeal has now

clarified its earlier decision in Bawden v.

Wawanesa Mutual Insurance Company,

which refused to enforce the standard ex-

clusion in homeowner’s liability policies

for claims of bodily injury to members of

the insured household.

Ms. Atfab sued a third party for in-

juries suffered by her young son while

he was exiting a vehicle. The third party

counterclaimed against Atfab for fail-

ure to supervise her child. Atfab sought

coverage from her homeowner’s insurer

Allstate. The application judge, relying

on the Ontario Court of Appeal decision

in Bawden, held that there was a duty to

defend in spite of her son being a “mem-

ber of the household”. Allstate success-

fully appealed based on the wording of

its policy. The Court of Appeal distin-

guished Bawden, as the policy wording

in Bawden excluded claims “for” injury

to any person in the household, while

the Aftab policy excluded coverage for

claims “arising out of” an injury to a

member of the household. This broader

exclusionary language was sufficient to

preclude coverage.

Unifund Assurance Company v. D.E., 2015 ONCA 423; C.S. v. TD Home and Auto Insurance Company, 2015 ONCA 424; leave to appeal to SCC filed September 29, 2015 (Homeowner’s Policy – coverage for bullying claims)

These companion decisions addressed

coverage for claims arising out of bul-

lying. The homeowner’s policies at issue

contained typical language indicating

that the insurer would pay all sums to

which the insured becomes legally liable

for unintentional bodily injury or proper-

ty damage, but excluding claims resulting

from intentional acts. An abuse exclusion

sought to negate coverage for any failure

to prevent sexual, physical, psychological

or emotional abuse.

The insureds argued that the claims

against them were based in negligent fail-

ure to supervise their children,

not intentional acts. The in-

surers argued that such

claims were derivative of

the underlying claim of bul-

lying, which was expressly

excluded. The application

judge held that the policies

did not clearly exclude a “negligent” fail-

ure to prevent abuse, finding in favour of

coverage. Unifund and TD successfully

appealed. The Ontario Court of Appeal

agreed that, regardless of the

degree of intention, the only

way to find liability on the

parents was to find that

they failed to prevent the

bullying from happening,

thus falling squarely within

the abuse exclusion.


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Onex Corporation v. American Home Assurance Company, 2015 ONCA 573; leave to appeal filed October 13, 2015 (D&O Policy – coverage for defence costs)

This is the second trip to the Court of Ap-

peal for Onex v. American Home, a coverage

dispute between Onex and American Home

under both D&O and Run-Off policies. The

2015 appeal results from the Court of Appeal

originally sending the case back to the

Superior Court for a determination of

coverage.

The new issue involved the in-

terpretation of the term “Claim”.

After finding that the full $15

million policy limit was

available to Onex, the

case made its way back

to the Court of Appeal.

The Court of Appeal

agreed that the trial judge

correctly used extrinsic evidence to re-

solve the ambiguity of the term “Claim”

in Endorsement 14. The court pointed to

the fact that the trial judge was not tasked

with interpreting the policy afresh, but

rather with using extrinsic evidence to

resolve a specific ambiguity that had al-

ready been found. The Court agreed with

the trial judge’s interpretation of Endorse-

ment 16, holding that “Claim” was not

used in isolation, but rather was part of

the phrase “claim under this policy”, thus

applying to claims under the Run-Off

policy, which would not include claims

under the Onex policy.

Leave to appeal to the Supreme Court

of Canada was sought on October 13,

2015.

MacDonald v. Chicago Title Insurance Company of Canada, 2015 ONCA 842 (Modifying the Sattva Capital test for standard form contracts).

MacDonald represents the Ontario

Court of Appeal’s opportunity

to weigh in on Sattva Capital,

and the standard of review

on appeal as it applies to

insurance contracts. In

MacDonald, the Ontario

Court of Appeal held that

the Sattva Capital decision

heightening the standard of

appellate review does not

apply in the case of standard-

form contracts. Given the impor-

tance of appellate review in the case

of standard form contracts, the standard

of review must remain one of “correct-

ness”. This allows appellate courts to step

in more readily in any case where a trial

judge has incorrectly interpreted a stan-

dard form insurance contract.

Daverne v. John Switzer Fuels Ltd., 2015 ONCA 919 (CGL Policy – Limitation Periods)

M&W was sued over a fuel tank

leak, and tendered the claim to its

liability insurer, Federated, which

denied coverage on April 9, 2010.

M&W sued Federated for cov-

erage on March 11, 2012,

almost two years later.

On a summary judgment

motion, Federated argued that

the one-year limitation period

set out in the policy, running

from the insured suffering “loss

or damage”, barred M&W’s claim.

While the motion’s judge held in favour

of coverage, the Ontario Court of Appeal

agreed with Federated, hold-

ing that the one-year limi-

tation period barred the

claim. The Court held

that the insured suffers

“loss or damage” on

the date of the insurer’s

refusal to defend. Impor-

tantly, M&W’s claim was

barred only with respect

to defence costs, as the is-

sue of indemnity hadn’t crystallized, as

the action remained ongoing.

The finding that there can be two

separate limitation periods for defence

costs and indemnity represents a sig-

nificant shift from the historic approach

taken under commercial liability policies,

where the limitation period for both de-

fence costs and indemnity generally ran

from the date of settlement or judgment.

Of course, the policy language is para-

mount.

Monk v. Farmer’s Mutual Insurance Company (Lindsay), 2015 ONCA 911 (Homeowner’s Policy – exclusion for repair of

faulty workmanship)

Monk put in a claim under

his homeowner’s policy after

existing property in the home was

damaged by a contractor. Farmer’s Mu-

tual denied the claim on the basis of the

faulty workmanship exclusion. Monk

sued for coverage. The court held that

the claim was not for faulty workman-

ship, but rather “resultant damage”. The

“faulty workmanship” exclusion was

to be interpreted narrowly, while the

grant of coverage in the “all-risks” policy

should be interpreted broadly. The faulty

workmanship exclusion was in conflict

with the “property being worked on”

exclusion, which expressly preserved

coverage for resulting damage to other

insured property. (For a detailed review

of this case, see page 28.)

Ontario Society for the Prevention of Cruelty to Animals v. Sovereign General Insurance Co., 2015 ONCA 702 (CGL Policy – fortuity principle)

The OSPCA was sued for malicious

prosecution and defamation, claims argu-

ably involving intentional conduct. When

OSPCA’s liability carrier, Sovereign Gen-

eral, denied coverage, the OSPCA sued.

While Sovereign admitted that

certain claims were covered

by the policies, it nonethe-

less denied on the basis

of certain exclusions in

addition to the claims

not being “fortuitous”.

The Ontario Court of Ap-

peal rejected Sovereign’s

argument. The alleged

damages were fortuitous, as

there were no allegations that the OSPCA

intended the harm that resulted from its

actions. There is also no general insur-

ance ‘rule’ that non-fortuitous claims are

automatically excluded.The Court noted

that the policy expressly covered several

non-fortuitous acts such as malicious

prosecution. It is only in circumstances

where an intentional act accomplishes

an intentional result that coverage will be

unavailable. �

Chris Dunn is a partner and Josiah

MacQuarrie is an associate with Dutton

Brock LLP. Both specialize in insurance

litigation. Dutton Brock LLP is a member

of Canadian Defence Lawyers (CDL), the

only national organization representing

the interests of civil defence lawyers. It

offers broad opportunities to unite the

defence bar over common issues, as well

as providing accredited continuing legal

education.


1. For a detailed review of this case, see page 28.

22-24 TOP TEN.indd 24 16-02-29 11:20 AM


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The field of behavioural economics could

have potential applications in insurance claims,

fraud deterrence, injury management, driver

safety and client service, some experts contend.

Led by academics such as Richard Thaler, Cass

Sunstein and Dan Ariely, behavioural economics

holds that psychological bias or irrationality of-

ten pushes people to make decisions contrary to

their best interests. The concept of nudging is based on research that

shows it is possible to guide e to socially ethical or utilitarian ends

by presenting choices in different, often simplified ways.

“Nudge theory” in particular was popularized in the 2008

book, Nudge: Improving Decisions About Health, Wealth, and Hap-

piness by Thaler and Sunstein. The book explores the potential for

behavioural economics to improve the effectiveness of govern-

ment (and other) programs by better understanding social norms

and human behaviour, especially related to ethics in the decision-

making process.

Far from an abstract theory, nudge has been put into practice

in government and policy settings around the world (interestingly,

Sunstein was Administrator of the U.S. White House Office of In-

formation and Regulatory Affairs from 2009-2012).

The concept really took hold in the United Kingdom in 2010

when Prime Minister David Cameron set up a Behavioural In-

sights Team (BIT), dubbed the “nudge unit.” The team examined

a wide range of policies in diverse areas—everything from taxa-

tion to pensions to police diversity—before it was spun off from

government in 2014 to become a private company. More recently,

the U.S. government formed a nudge unit called the Social and

Behavioural Sciences Team.

One interesting project from BIT involved testing whether a

new tax reminder letter to recipients informing them that most of

their neighbours had already paid (social norm) would increase

payments. The unit claimed that it nudged forward £30 million ($62

million) per year in income tax for HM Revenue and Customs.

“A number of governments are setting up think tanks to spe-

cifically focus on behavioural science,” notes Keith Walter, joint

leader of the actuarial, reward and analytics team at Deloitte in

Canada. “It is a huge public policy issue and a big theme right now

in government in Canada, particularly regarding evidence-based

decision making linked with behavioural insights.”

So what does this have to do with property and casualty insur-

ance? Potentially, a great deal, according to Deloitte Consulting’s

chief data scientist, James Guszcza.

“Advertising has effectively done this behavioural nudging for

years, and now you are seeing its use for more efficient govern-

ment, better policies and improved social outcomes,” he says. “I

think nudges can be used in other pro-social ways, and the insur-

ance claims process is a great example.”

Identifying AbuseFor instance, Deloitte worked with the unemployment insur-

ance agency of a U.S. state to test low-cost methods of identifying

and curbing fraud amongst claimants. Deloitte did not release the

name of the state. Guszcza notes that his firm used sophisticated

analytics capabilities —including predictive modeling, machine

learning, anomaly detections, and analysis of behavioral patterns—

to identify likely abuse early so preventative action could be taken.

Coupling predictive analytics with behavioral nudge tactics,

claimants were given helpful information at key moments in the

application and certification process. The UI agency has seen sub-

stantial improvement in the accuracy of initial claim filings and

weekly certifications, according to Guszcza.

“It was a ‘Eureka’ moment for us that showed this actually can

and does work,” he says. “We have floated these and other results

to insurance companies and the interest has been very strong.

There is little downside risk to experimenting and there is a lot of

upside potential that has a positive social effect.”

An obvious example in p&c insurance is fraud detection, es-

pecially the “soft” or opportunistic variety (honesty-prompting

nudges would have little effect on organized, premeditated activ-

ity, Guszcza notes).

“The issue around opportunistic fraud is one that gets people’s

attention,” says Walter. “There is a general recognition that bring-

ing behavioural science into managing the claims process around

soft fraud is a key issue. There is a lot of interest in how you actu-

ally influence behaviour so that the claimant is less likely to exag-

gerate or pad the claim.”

Nudge tactics “offer a ‘soft touch’ approach that is well suited to

the ambiguous nature of much fraud detection work,” Guszcza notes.

There are extrinsic or external factors involved in soft fraud, which

can be addressed through what Guszcza calls “judiciously worded let-

ters” that include specific details about the claim and remind claim-

ants about fraud detection policies. Letters could also refer to random

or “lottery” fraud investigations that may have a “sentinel effect” on

exaggeration of embellishment, according to Guszcza.

However, insurers could also appeal to the individual’s intrinsic

reward system as well. Research in behavioural economics sug-

Nudging ClaimantsThe concept of behavioural nudging is gaining interest among insurance professionals looking for ways of influencing the behaviour of claimants

BY CRAIG HARRIS, FREELANCE WRITER

p26-27 HARRIS.indd 26 16-02-29 11:24 AM


gests that a small amount of cheating flies beneath the radar of

people’s internal ethical codes, according to Guszcza. Behavioural

economist Dan Ariely coined the term “personal fudge factor” to

describe this tendency.

“Such nudge tactics as priming people to think about ethical

codes of honour and contrasting their actual behaviour with their

(honest) self-images are non-economic levers for promoting hon-

est behaviour,” Guszcza notes in a recent article he wrote in the

January 2015 issue of Deloitte Review called The Last Mile Prob-

lem: How Data Science and Behavioural Science can Work Together.

Behavioural economics is not restricted to fraud detection.

Guszcza observes that the applicability could extend to return-

to-work or pre-accident level of functioning for injured insurance

claimants. In fact, it is here that the confluence between data ana-

lytics and behavioural science is most evident.

“We can run predictive models and all sorts of analytics about

the rates of return to work or normal living for certain types of

claimants,” Guszcza observes. “But it is when you combine this

with behavioural insights that it really gets interesting. If you are

able to inform an individual that 90 percent of the people with the

same injury go back to work within three weeks, I suspect it will

give that person something to work towards. It might provide an

unconscious motivator. It is a pro-social outcome,” he adds.

Driving BehaviorThe use of telematics in tracking driving statistics is another

potential example of the use of behavioural insights for economic

and social purposes. Here, the interest is not just offering premium

discounts, but improving driver safety.

“There is certainly a behavioural impact when it comes to

telematics,” says Walter. “As that whole process is developing, I

see more interest in the discussion around the behavioural side of

interacting with customers—from a claims prevention approach

rather than claims management standpoint.”

Telematics is not only valuable for underwriting but also “for

pro-social nudges,” Guszcza adds. “You can give people a report

card on their driving, how they compare with a survey of their

peers. It gives insurance companies a way of increasing positive

touch points and giving people a data service to help them under-

stand their risk better.”

Other key elements of behavioural economics are the inter-

linked concepts of “choice architecture” and “design thinking.”

When it comes to choices in complex areas, such as insurance cov-

erages, this means that options are simplified based on how people

actually think and respond.

“Rather than design products or programs based on perfect

rationality, we should go with the grain of human psychology,”

Guszcza comments. ‘’So if an insurance company is going to offer

a choice of coverage options, rather than this complicated menu

of 40 possibilities, why don’t we use what we know about people-

centric design and give fewer but more intuitive choices.”

Guszcza adds that the same approach can be used in various as-

pects of the insurance lifecycle—such as using social media behav-

ioural profiles based on “digital breadcrumbs” for contact/channel

preferences, claims triage, self-service options and so on.

Last Mile“A lot of this stuff is just coming online. It is early days, but

there are all these innovative and tangible ways in which insurance

companies can be more customer centric,” Guszcza notes. “That

should be the motivation—if you can provide unique services in

a way that people find agreeable, you are offering a different kind

of value that goes beyond just products and commodities. “With

the power of suggestion and the appeal to social norms, some say

that behavioural nudging could cross a line sometimes called the

“creep factor.” Is it a positive force for ethical decisions or an intru-

sive form of social engineering?

“I think if you do all of this stuff from a product centric per-

spective, then it could be creepy,” Guszcza says. “If you are trying

to think in terms of empathy, customer needs, what would help

them in their daily lives, then it is beneficial. It actually gives peo-

ple prioritized choices. You can call that paternalistic; I frame it as

choice architecture and design thinking.”

Finding the exact point where data analytics meets behavioural

science could be a challenge for an insurance industry that is not

accustomed to being on the leading edge of innovation. This chal-

lenge is what Guszcza refers to as the “last mile problem.” Never-

theless, there are parallels in other industries—ranging from en-

ergy conservation to financial management—that show the power

of behavioural insights and the proper use of data can be a potent

combination.

“You can use understanding of human psychology to create

little interventions that have disproportionate effects,” Guszcza

concludes. “It is an almost cost-free experiment that can result in

millions of dollars in savings and the achievement of a positive

social outcome.” �

Craig Harris is a freelance journalist who specializes in

Insurance (P&C + life), Financial Services, including investing

and wealth management.


p26-27 HARRIS.indd 27 16-02-29 11:24 AM



IntroductionIn Monk v. Farmers’

Mutual Insurance Co.

(Lindsay), [2015] ONCA

911, the Court of Appeal

reversed the motion

judge’s decision1 that the

“faulty workmanship” exclusion applied

to both direct and indirect damages. The

Court ruled that the motion judge’s inter-

pretation of the exclusion was overly broad

and that the damage to the insured’s prop-

erty was covered by the policy, whether

or not the damage constituted resulting

damage from faulty workmanship.

FactsThe action arose when the insured re-

tained a contractor, Pleasantview Resto-

ration Systems (“Pleasantview”), to per-

form restoration work on the exterior of

her home. At the conclusion of the work,

the insured discovered deficiencies in the

work done by Pleasantview; namely, stains

on the windows, light fixtures, and the car-

peting, scratches and marks on the win-

dows, and damage to the wooden window

frames.

The home was insured by Farmers’

Mutual Insurance Company (“Farmers’

Mutual”) with the insured purchasing a

homeowner’s insurance policy through

Muskoka Insurance Brokers (“Muskoka

Insurance”).

The policy covered perils subject to the

specified exclusions, two of which are rel-

evant to the case at hand. The first, under

the heading “Losses Excluded”, provided:

We do not insure:

2. the cost of making good faulty material

or workmanship;

The second exclusion, under the heading

“Property Excluded”, stated:

We do not insure loss or damage to:

4. property

(ii) while being worked on, where the

damage results from such process or work

(but resulting damage to other insured

property is covered);

The insured allegedly went to Mus-

koka Insurance when she discovered the

aforesaid damage, and was informed that

her policy did not cover work done by an

independent contractor, and that the con-

tractor hired would be responsible for the

damage. Muskoka Insurance denied this.

The insured subsequently sued Farm-

ers’ Mutual under her policy and Muskoka

Insurance based on an alleged breach of

Muskoka Insurance’s contractual and fi-

duciary duty to her by failing to advise her

in a timely way that she had a valid claim

against Farmers’ Mutual.

Parties PositionFarmers’ Mutual and Muskoka Insur-

ance brought motions for summary judg-

ment for dismissal based on the argument

that the insured’s claim constituted costs

of repairing faulty workmanship caused

by Pleasantview, and thus was specifically

excluded by the policy. They argued the

“faulty workmanship” exclusion is an un-

qualified exclusion, and does not contain

an exception for “resulting damage”.

The insured argued that the “faulty

workmanship” exclusion should apply

only to restoration work Pleasantview

was contracted to perform and that the

incidental or corollary damage from that

workmanship should not be excluded.

In addition, the insured argued that her

damages constituted damage to “property

while being worked on” and that the “re-

sulting damage” exception in the exclu-

sion ought to extend coverage regardless

of the wording in the “faulty workman-

ship” exclusion.

Decision of the Motion JudgeThe motion judge disagreed with the

insured’s arguments. The motion judge ap-

plied a plain and simple reading of the pol-

icy’s “faulty workmanship” exclusion and

ruled that coverage for direct and indirect

damage arising from faulty workmanship

was excluded. Furthermore, the motion

judge found that coverage afforded by an

exception to the “property being worked

on” exclusion did not provide coverage

because the faulty workmanship exclusion

trumped the exception.

The insured appealed the decision.

Issue on AppealThe main issue on appeal was whether

the motion judge erred in concluding that

the “faulty workmanship” exclusion also

excluded resulting damage.

The Appeal DecisionThe Court ruled that the “faulty work-

manship” exclusion should not be inter-

preted so broadly as to deny coverage for

damages that an “all-risks” policy would

otherwise provide. The Court noted that

if an insurer wanted to exclude particu-

lar coverage, such as resulting damage, it

should do so specifically.

The Court held that an interpretation

of the “faulty workmanship” exclusion that

denies coverage for resulting damage is an

overly broad interpretation of the exclusion

clause. The Court interpreted the exclusion

narrowly as excluding coverage from direct

damage only and not the resulting damage

from faulty workmanship. This was not a

matter of reading an exception into that

exclusion, but interpreting it narrowly in

accordance with established principle.

The Court observed that if the “faulty

workmanship” exclusion was interpreted

as excluding resulting damage in the case at

bar, the two exclusion clauses at issue would

be in conflict. The “faulty workmanship”

exclusion would exclude damage to prop-

erty caused by faulty workmanship includ-

ing resulting damage. On the other hand,

the “property being worked on” exclusion

would specifically preserve coverage for re-

sulting damage to “other insured property.”

The Court found that the motion judge

erred in saying the “faulty workmanship”

exclusion trumped the “property being

worked on” exclusion because the ex-

ception to that exclusion only preserved

resulting damage coverage for a narrow

range of events unrelated to faulty work-

manship, such as damage caused by acci-

dent. This was an overly narrow interpreta-

tion of the resulting damage exception. In

effect, the Court indicated that the excep-

tion to the “property being worked on” ex-

clusion, which is to be construed broadly,

should not be interpreted narrowly, so that

Monk v. Farmers’ Mutual Insurance Co. (Lindsay): Further Lessons in Policy Language and Interpretation

BY MICHAEL S. TEITELBAUM

1. The motion judge’s decision, [2014] O.J. No. 3509, was discussed in the December 2014 issue of Claims Canada.

p28-29 ARC.indd 28 16-02-29 11:25 AM



the “faulty workmanship” exclusion can be

interpreted broadly, when the principle is it

should be interpreted narrowly.

The Court noted that the motion judge

considered it significant that “faulty work-

manship” exclusions in insurance policies

typically include an exception for result-

ing damage, which is not the case in the

insured’s policy. However, the Court found

that this consideration was irrelevant to the

interpretation of the policy at hand.

The Court went on to find that the mo-

tion judge’s suggestion that the absence of

an exception for resulting damage from the

“faulty workmanship” exclusion is reflec-

tive of the insurer’s intention not to provide

coverage for such damage is misplaced. The

Court stated that an insurer’s unilateral in-

tention is irrelevant to the interpretation of

the insurance contract. And, it is not ap-

propriate to interpret the “property being

worked on” exclusion in a manner that nar-

rows the coverage it preserves by its excep-

tion in order to interpret the “faulty work-

manship” exclusion as broadly as possible.

The Court therefore concluded that

resulting damage to insured property is

covered by the policy whether or not that

damage is the result of faulty workmanship.

The Court also indicated that following

its recent decision of MacDonald v. Chica-

go Title Insurance Co., 2015 ONCA 842, the

standard of review to be applied was “cor-

rectness” because this was a standard form

insurance contract. Although the “faulty

workmanship” exclusion was not standard

across the insurance industry, it is stan-

dard to Farmers’ Mutual’s customers, and

should be interpreted consistently.

The action was remitted to the motion

judge to decide the question of whether the

action is limitation-barred which was not

previously addressed because of his deci-

sion there was no coverage.

CommentaryThe Court addressed the conundrum

posed by the “faulty workmanship” exclu-

sion being worded differently from other

homeowners’ policies by saying that this

does not matter, what matters is what this

policy provides.

And, then, reading the policy as a

whole, the Court found that to give the

subject exclusions meaning, the fact the

faulty workmanship exclusion has no ex-

ception means it should be read without

one, and interpreted narrowly.

It is arguable that by doing so the Court

gave a similar meaning to the two exclu-

sions by holding that both do not exclude

resulting damage, one dealing with prop-

erty being worked on, and the other for

faulty workmanship generally. Can it be

said this was the intention of the parties?

The Court’s reasoning suggests it was

not; rather, it was only the insurer’s inten-

tion. Ultimately, the Court indicated that

Farmers’ Mutual’s attempt to exclude re-

sulting damage by not including an excep-

tion in the “faulty workmanship” exclusion

was insufficient. The wording used must

specifically state there is no coverage for

resulting damage in that context.

Thus, the Court of Appeal in Monk

has indicated the importance of insurers

clearly identifying and articulating areas of

excluded coverage so as to ensure that they

are providing the type of coverage they

wish to provide. �

Michael S. Teitelbaum is a partner with

Hughes Amys LLP. Ashley Peacock, an as-

sociate with Hughes Amys, assisted with this

article. Hughes Amys is a member firm of

The ARC Group of Canada, a network of in-

dependent law firms across Canada.

OBJECTIVETo assist with funding needed to further education of Canadian students entered in an insurance claims related discipline.

VALUEminimu o o $1000.0 awar annually.

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p28-29 ARC.indd 29 16-02-29 11:25 AM




OTS

Patti M. Kernaghan FCIP, CRM, FIFAAPresident & CEO of Kernaghan Adjustersis pleased to announce the appointmentof Dennis Schembri as VP OntarioOperations and a new member of ourCorporate Senior Management Team.

Dennis is a well known and highlyrespected contributor to the insuranceindustry. He has over 35 years ofexperience in the independent adjustingfield.

He founded Vanler Insurance AdjustersLtd in 1993, which spanned acrossOntario with over 50 employees. As theManaging Director for McLarens Canada,Dennis was involved in seniormanagement level marketing, sales andoperations. Dennis was appointedExecutive Vice President, ClientManagement in 2011 for all divisions ofGranite Global Solutions.

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K e r n a g h a n . c o m

ANNOUNCEMENT

The Alberta government has accepted several recommendations in relation to

an independent review of the province’s response to the floods that occurred in

the summer of 2013. The report, prepared by MNP LLP, makes 16 recommen-

dations to enhance and improve the province’s emergency response and recov-

ery procedures. “Work on implementing these is under way,” Alberta Municipal

Affairs noted in a press release. One recommendation was the development of a

new provincial operations centre, which could either be a purpose-built facility or

constructed in an existing government building. ●

A national working group should be established to address the problem of dis-

tracted driving, the Traffic Injury Research Foundation (TIRF) suggests in a recent

report announced by The Co-operators Group Ltd. The Co-operators reported this

past December that it plans to provide funding to TIRF to establish a working group

on distracted driving. “Because distracted driving is still an emerging issue, and

one that falls under provincial jurisdiction, bringing together stakeholders to help

develop a strategic plan at a national level will be very valuable work,” says Kathy

Bardswick, president and chief executive officer of The Co-operators, in a state-

ment. TIRF’s report is titled Distracted Driving in Canada: Making Progress, Taking

Action. TIRF plans to work with Drop It And Drive — a British Columbia-based dis-

tracted driving educational campaign — to form the working group. ●

Insurers that contract with the United States National Flood Insurance Pro-

gram (NFIP) should be allowed to write their own polices, Marsh & McLennan

Companies Inc. suggests. Insurers are permitted to market, sell and service

NFIP policies “under their own name in exchange for an administrative allow-

ance from the NFIP,” Marsh & McLennan states in the report, “Reforming the

National Flood Insurance Program” released December 9, 2015. Those policies

are dubbed write-your-own (WYO). “Any claims payments that are made by WYO

companies are reimbursed by the NFIP,” notes Marsh & McLennan, adding that

NFIP should share risk with private industry. “By opening up private market par-

ticipation, the NFIP can help improve the program’s sustainability by providing

expertise and market stability.” ●

The median annual base salary for Canadian risk management profession-

als responding to the RIMS Risk Management Compensation Survey 2015 was

$104,000 as of June 1, 2015. Base salaries varied by job title. For Canadian

respondents indicating their roles and responsibilities most closely matched

chief risk officer or vice president of risk management, the median salary was

$174,000. For respondents who function as claims managers or workers compen-

sation claims managers, the median salary was $72,500. The survey, released in

December 2015 by RIMS, was based on 1,145 respondents (999 of whom were

employed as risk management professionals in the U.S. as of June 1, and 146 of

whom were Canadians in the same occupation). The margin of error for the 95%

confidence level is 2.8 percentage points for U.S. respondents and 7.5 points for

Canadians. ●

SCM Risk Management Services (RMS) has launched a Canadian solution for

property inspection replacement cost valuations. Called rmsPrecise, the property

replacement cost inspection valuation tool is designed to be responsive to the

detail and customization of specific and unique features of a building captured

during the inspection process, thereby helping to accurately gather the diverse

characteristics on expected loss costs. The tool is imbedded in RMS’s residential

inspection process. ●

ClaimsPro will continue to expand its coverage in Western Canada with the

opening of a new branch in Fort St. John, B.C. Located in Northeastern B.C., ap-

proximately 90 minutes from the Alberta border, Fort St. John serves as a hub for

many other communities in the north. This new branch services communities along

the Alaska Highway including Dawson Creek, Fort Nelson, Chetwynd, and Hudson’s

Hope. At present, ClaimsPro has more than 30 offices in British Columbia. ●

p30-31 OTS.indd 30 16-02-29 11:27 AM


http://www.kernaghan.com


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Julie Van Dusen Kamloops, BC Level 2

Tom Rixon Kamloops, BC Level 1

Gary McAvena Kamloops, BC Level 1

Brett McAvena Kelowna, BC Level 1

Dale Campbell Kelowna, BC Level 1

J. Brady Ives Kelowna, BC Level 2

Ross Stenmark Kelowna, BC Level 2

Trent Buchanan Kelowna, BC Level 1

Kelly Lewis Kelowna, BC Level 1

Michael Montpetit Kelowna, BC Level 1

Luke Moilliet Nanaimo, BC Level 1

Nettie Wagner Nanaimo, BC Level 1

Sarah Klassen Nanaimo, BC Level 2

Nancy Johnston Nanaimo, BC Level 1

Courtenay Stewart Nelson, BC Level 1

Leona Ashcroft Nelson, BC Level 2

Robert Phillips Nelson, BC Level 1

Carson Fong New Westminster, BC Level 2

Cheryl Martin New Westminster, BC Level 1

Craig Segaric New Westminster, BC Level 1

Jaime Kallstrom New Westminster, BC Level 1

Kathy Kwan New Westminster, BC Level 2

Kelly Brewer New Westminster, BC Level 1

Mark Misirlis New Westminster, BC Level 2

Michael Parsons New Westminster, BC Level 2

Ramona Nobert New Westminster, BC Level 1

Christine Leung New Westminster, BC Level 1

Martin Moon New Westminster, BC Level 1

Susan Durnin New Westminster, BC Level 1

Brent Serediak New Westminster, BC Level 2

Ashley Parsons Penticton, BC Level 1

Donald Abney Penticton, BC Level 1

Tammy R. Virr Penticton, BC Level 1

Cindy Heard Port Alberni, BC Level 1

Darlene Tomkinson Prince George, BC Level 1

Ken Bielert Prince George, BC Level 1

Shanna Carmichael Prince George, BC Level 1

Jacqueline Linke Revelstoke, BC Level 1

Robert Stanhope Sechelt, BC Level 1

Alan Sloman Surrey,BC Level 2

Andrew Joubert Surrey, BC Level 1

Andrew Mitchell Surrey, BC Level 2

Beata Bulic Surrey, BC Level 1

Bob Sidhu Surrey, BC Level 2

Douglas Miller Surrey, BC Level 1

Eric O`Dell Surrey, BC Level 1

Holly Laderoute Surrey, BC Level 1

James Godfrey Surrey, BC Level 1

Jo Kinasewich Surrey, BC Level 1

Mark Thomas Surrey, BC Level 1

Pierre Chavigny Surrey, BC Level 1

Robert Donay Surrey, BC Level 1

Russell Sorsdahl Surrey, BC Level 1

Teena Molson Surrey, BC Level 1

William Cole Surrey, BC Level 1

Emily Schollen Surrey, BC Level 1

Martin Clingwall Surrey North, BC Level 1

To be continued in the April May 2016 issue of Claims Canada.

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OTS

Giffin Koerth co-founder and senior principal, Ron Ko-

erth, has relinquished his role in the day-to-day manage-

ment and operations of the firm, and the existing sharehold-

ers have purchased his ownership interest in the company.

Ron will continue to serve as a consultant with the firm on

forensic and remediation projects. Said chairman and CEO,

Chris Giffin, “Ron’s contributions to Giffin Koerth since its

inception have been immeasurable; whether in assisting in

growing the firm, bringing engineering excellence to our cli-

ents, or serving as a mentor to our staff, the organization

has benefitted greatly over the years. As the firm continues

to build the centre of excellence in forensic engineering and

sciences, our current leadership team, principals and staff

look forward to working with Ron in his new role.” Headquar-

tered in Toronto, the firm serves clients around the globe. ●

Specialized Property Evaluation Control Services Lim-

ited (SPECS) unveiled a new logo; and bid a fond farewell

to the visual identity that has served the firm well for more

than two decades. The new logo marks the beginning of

a corporate identity refresh. “SPECS has undergone an

impressive 20-year evolution. We knew it was time to up-

date our corporate identity to better reflect what we had

become, as well as how we plan to grow in the future.

We wanted a polished, modern logo that represents our

sophisticated and often layered services in a simple, ef-

fective way,” said SPECS director of sales and marketing,

Lucy Railton. “SPECS may have a new logo but; our in-

dependent, impartial approach to property, contents, and

complex loss appraisals and consulting services remains

unchanged,” she added. ●

Crawford & Company (Canada) Inc.’s Greg Smith and Gary Gardner have

taken on new responsibilities. Smith, former senior vice president of key ac-

count management, is the company’s new senior vice president of administra-

tion, while Gardner, senior vice president of global client development, will over-

see the key account management team and sales and marketing department.

With 19 years of service at Crawford & Company Canada, Smith will oversee

many of the claims management provider’s head office departments that sup-

port business operations across the country, including information and commu-

nication technology, human resources and administration services. Gardner,

with the company for more than two decades, will use his extensive knowledge

and insight of the independent adjusting and insurance industry, as well as his

strong relationships with key clients, in carrying out his new duties. ●

CARSTAR Automotive Canada Inc., a network of independently owned colli-

sion and glass centres, has been acquired by Driven Brands Inc. of Charlotte,

North Carolina, which previously acquired CARSTAR’s operations in the United

States. The Canadian operation of CARSTAR will remain under the current

management, with Sam Mercanti, chief executive officer of CARSTAR Canada,

serving as chairman and Michael Macaluso continuing as president. CAR-

STAR Canada’s three staff members, Larry Jefferies, Lisa Mercanti-Ladd and

Dennis Concordia, have decided ‘’this was the right time for them personally

to step aside in order to provide opportunities for the existing team to thrive,”

Mercanti says. ●

Greg Smith

Sam Mercanti

Gary Gardner

Michael Macaluso

IN MEMORIAMIt is with a great sense of sadness and

sense of loss that the Canadian Independent Adjusters’ Association (CIAA) announces the

passing of E. Brian Gough, FIIC, FCLA, FCIAA on February 5, 2016. Brian gave generously of his time and expertise serving the association unconditionally in a wide variety of roles and re-sponsibilities at all levels of the organization.

Brian served as CIAA National President 1996/97 and was recently granted the presti-gious Honourary Life Member award in recog-nition of his tireless efforts in furthering the objectives of the association on behalf of the Independent Adjusting fraternity and the industry at large.

A true statesman in the P&C industry, Bri-an began his distinguished insurance adjust-ing career with Marsh Adjustment Bureau in Halifax in 1974, serving as its President from 1995 – 2015.

Known for his honesty, loyalty and utmost integrity, Brian merited the admiration and re-spect of all who had the privilege of working with him.

Please join us in a moment of reflection to honour the memories and influence of this true gentleman to our Industry and the many people touched personally and professionally

by his wonderful legacy. ●Brian Gough

p32-33 OTS.indd 32 16-02-29 11:30 AM



DKI Canada announced the addition of Golden Triangle Restoration DKI to

the organization. Golden Triangle Restoration has provided property restora-

tion services in Cambridge, Kitchener/Waterloo and surrounding areas for al-

most 10 years. Adam Wood, president of Golden Triangle Restoration stated,

“We are proud to service the Cambridge, Kitchener/Waterloo and surrounding

areas for all their restoration needs. We look forward to growing as a business

with a beneficial partnership with DKI Canada.” “We are very excited at DKI

Canada with Golden Triangle joining our group, they are a great organization

that will strengthen our team in Southern Ontario,” said Adam Tzarik, direc-

tor - Central Region. ●

One of Crawford & Company (Canada) Inc.’s long-standing and most valu-

able executive leaders, John Sharoun, has been appointed to the position of

executive general adjuster/senior consultant. After working with the aviation,

energy, forensic accounting and Global Technical Services (GTS) teams in an ex-

ecutive management role across the Americas since July 2013, John has decid-

ed to return to the Canadian marketplace. He will pursue his interests in major

and complex loss management but will still be involved with Crawford projects

across the Americas. John will work closely with the Canadian executive leader-

ship team and the Canadian GTS team, and will be based in the Toronto office. ●

ClaimsPro/IndemniPro has acquired one of Quebec’s leading loss adjusting

firms, Allen & Fugère Inc. Allen & Fugère has been providing adjusting ser-

vices for more than 55 years. The company boasts an impressive roster of

10 preeminent insurance professionals and has developed a stellar reputation

across Quebec for its Special Investigations Unit. The Unit works to identify

and investigate fraudulent claims through preliminary interview and statement-

taking techniques. This capability both complements and enhances ClaimsPro/

IndemniPro’s existing service offering, and positions ClaimsPro/IndemniPro as

an expanded presence in Trois-Rivières while increasing its geographical foot-

print within Quebec. The addition of the Allen & Fugère team means ClaimsPro/

IndemniPro now has 140 Adjusters working throughout the province. René Paillé

and Ghyslain Morinville, senior adjusters and presidents of Allen & Fugère, will

continue to provide the expert services their clients have come to know. René

will still lead the Special Investigations Unit in Quebec and report to Suzie God-

mer, ClaimsPro/IndemniPro’s senior vice president, Quebec. Ghyslain will serve

as Branch Manager in Trois-Rivières and report to Pierre Boulianne, ClaimsPro/

IndemniPro’s regional district manager, Quebec. ●

Maeve Davis is bringing her 25 years of insurance ex-

perience to Insurance Search Bureau of Canada, which

supplies source documents and retrieval services to the

property and casualty claim industry. She will serve as

ISB Canada’s new vice president of client services. ●

Maeve Davis

Claims Canada Wants You!Claims Canada magazine wants you to send us your company

news, appointments and event photos for possible inclusion within our

‘On the Scene’ department. Please help us share your items with the

claims industry across the country. For more information, please email:

[email protected]

APPOINTMENT

Emily Atkins

Emily Atkins is the new editor of Claims Canada magazine.

A professional journalist, Atkins has been editor of MM&D, Canada’s Sup-ply Chain Magazine for 13 years, and continues in that role.

She is also a freelance automotive review-er with work frequently published in the Toronto Star’s Wheels section.

Atkins is an accomplished writer, in-terviewer and researcher, and is experi-enced moderating panels and roundta-bles, as well as writing whitepapers, blogs and marketing material for her corporate clients.

Most recently she was awarded the Betty Jo Turner prize for making Ontario’s own Provinz magazine the best in the Porsche Club of America. Atkins was the volun-teer editor of Provinz for three years.

She got her start in journalism at the Kingston Whig Standard, with a brief detour into the federal government and non-for-profit sector. She worked over-seas in both Hong Kong and Saudi Ara-bia, as a journalist and in corporate com-munications.

Atkins holds a Masters degree in interna-tional relations with an award-winning thesis, and a BA in political science.

In her spare time, Atkins is a successful amateur racecar driver. She can be found most summer weekends at a racetrack somewhere in southern Ontario or Que-bec, racing her 1982 Porsche 911 against other beautiful vintage automobiles.

She looks forward to hearing from you. [email protected]

www.claimscanada.ca

p32-33 OTS.indd 33 16-02-29 11:30 AM






OTSORIMS (Ontario Chapter of RIMS) held its Christmas

Luncheon on December 10, 2015 at the Westin Harbour

Castle in Toronto. With more than 700 guests in atten-

dance, ORIMS continued with the spirit of giving by rais-

ing funds for The Daily Bread Food Bank. In all, $10,000

and more than 230 pounds of non-perishable food plus

gift cards was collected to help the food bank in its fight

to eliminate hunger in and around Toronto. ●

p34-35 OTS.indd 34 16-02-29 11:32 AM


Indemnipro (the name for ClaimsPro in

Quebec) welcomed approximately 140 clients

and partners from across the insurance and

claims industries on November 27, 2015 at

the Hotel Gault in Old Montreal for a festive

and friendly event – its 2nd annual holiday

client cocktail – to ring in the holiday season.

●

p34-35 OTS.indd 35 16-02-29 11:32 AM




OTSHundreds of insurance claims industry

guests attended the 10th Annual Post

CICMA/CIAA Joint Conference Cocktail

on February 2, 2016. Entitled The Big

Mingle, the event is hosted by Giffin

Koerth Forensic Engineering and Blouin

Dunn LLP and is held at The Fifth Social

Club in Toronto. ●

p36-37 OTS.indd 36 16-02-29 11:34 AM



p36-37 OTS.indd 37 16-02-29 11:34 AM



OTSMore than 150 exhibitors from across

Canada showcased their works at the

Ontario Insurance Adjusters’ Association’s

(OIAA) Professional Development and

Claims Conference in Toronto on February

3, 2016. The event featured a trade show

and seminars covering a wide variety of

timely claims topics. ●

p38 OTS.indd 38 16-02-29 11:36 AM


Wednesday, May 11th, 2016

The Albany Club91 King Street EastToronto, ON, M5C 1G3

Reception – 12:00 p.m.Cost - $75.00

p

57th AnnualReception Committee:John Cherrie - 416-737-7525John Sharoun - 416-957-5001Ford Blow - 416-457-7072

Send Contact Info and ChequePayable to (or VISA, provide exp. date):John Sharoun

Quarter Century Clubc/o Crawford & Company (Canada) Ltd.123 Front St, Suite 300Toronto M5J 2M2Email: [email protected]: 416-957-5001

Once again this year, the Quarter Century Club plans to continue to make a donation to theInsurance Institute Scholarship Fund, in memory of our claims colleagues

Design and Space Compliments of:

Featuring…‘The Roasting of

Brad Ebel’

nouncing theAAAnnnn

QUARTER CENTURY CLUB 57 th Annual Reception

Thank you for the support of these generous event sponsors:

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