Winter Subrogation

What are some common situations for subrogation in winter?  There are a few!

1.  Potholes

With the temperature fluctuating, our streets become riddled with potholes.  Driving over these can often cause significant damage to vehicles.  Who is responsible for maintaining roads?  It’s likely the city or municipality.  It is important to send notice to the city or municipality immediately after the damage occurs.  This is important for two reasons.  One is that the city will attempt to repair the pot hole, preventing further damage.  The other reason is that the notification for most cities is needed within 7-15 days if there’s any chance of subrogation recovery.  It is important to follow up on these notices, and to thoroughly document loss details.

2.  Snow Plows

Most often, when vehicles are parked on the side of a road, and a plow goes by after a heavy snow, there is a chance for damage to the parked vehicle.  Snow plows long gone though, right?  Maybe not.  Ensure that photos and a cause of the damage to the vehicle are documented as soon as possible.  If the damage is consistent with being hit by a plow, there is a chance of recovery.  Find out what time the damage occurred, if there were any other vehicles damaged, and who was responsible for the snow removal.  Not always easy, but worth a shot!

3.  Snow Birds

Lucky folks will get out of the snow for winter, and head south to the U.S.  Almost all states are tort for recovery.  This means that you go to the at-fault party for recovery of damage.  If one vehicle does not have collision coverage, that driver has to go directly to the other insurance company for their damage.  It’s important to ensure adequate reserving for these losses, as the at-fault company has an exposure to third party property damage, as well as injury claims.

The important keys for pursuing subrogation successfully is to recognize the opportunities early, and to get complete details of the loss, and documentation to support damage and payments.  Attempting recovery too late often leads to failure.

Insurance Certificates & Commercial Policy Basics

Susan Saksida, CIP, CRM, RMCO *protected email*

This past Tuesday, Susan Saksida, Risk Management & Insurance Consultant with Cameron & Associates, delivered a building blocks session for the Ontario Risk and Insurance Management Society.

This presentation included:

  • Introduction to Commercial Insurance Policies
  • Parts of the policy
  • Exclusions
  • Endorsements
  • Certificates of Insurance
  • Misconceptions & meanings

The presentation was delivered to a group of new to senior risk managers and sparked some great discussions on what to look for in policies and endorsements, and what information is necessary for the insurer’s protection on Certificates of Insurance.

Seminars like this are great to share information and help further everyone’s expertise.  Keep an eye out for ORIMS’ next professional development sessions.

We have included links to pdf versions of our presentations for further reference in the links below.

Need help with Risk Management, Training or  Certificates of Insurance?  We have the expertise and experience to assist!

Let us know how we can help.

Introduction to Commercial Insurance Policies Presentation

Certificates of Insurance Presentation

 

Are You Ready for the AB Mediation Backlog “Fix”?

On May 23, 2012, Tom Golfetto, Executive Director of the FSCO Dispute Resolution Group, issued a letter updating stake holders on the progress of DRS initiatives. The RFP procurement process in nearing completion and he expects that the first set of files will flow to the outsource vendors at the beginning of July. They expect that outsource vendors will be able to handle 2000 mediations per month and 500 arbitrations. This is in addition to the 2,793 mediations being handled per month by FSCO DRG staff. It was conspicuous that Tom’s letter did not give the number of cases currently in backlog but that was estimated at 30,000 (see our previous blog entry)

The problem with the math is that it does not account for the estimated 3,000 new cases coming in per month. If this number stays constant, FSCO staff can only keep up with the new ones and the backlog will be reduced at the rate of 2,000 per month over the next 18 months to 2 years.

The letter is available here.

In any event, the “warning” to be ready for the onslaught echoes my article “When the Dam Bursts”, FSCO warns: “please ensure that you retain additional staff as necessary, so that there are no scheduling delays due to unavailability of your staff”.

Cameron & Associates would be pleased to assist Insurers to resolve this challenge on a long and short term basis. Contact us for more details.

Thank you,

Jim Cameron & Team

Coaching and Mentoring Program (C.A.M.P.)

With the summer fast approaching, we got to thinking of C.A.M.P.!  Even though this C.A.M.P. doesn’t involve mosquitoes and campfires, we’re still very excited.

This program is specifically tailored to your needs.  We offer one-on-one coaching and mentoring both in-person and on the phone.

Who this program suits:

  • Small claims departments
  • Claims handlers who need focussed and specific training
  • New adjusters
  • Adjusters transitioning to handle a new line of claims (e.g. from Auto Physical Damage to Bodily Injury or Accident Benefits or from Personal Lines to Commercial)
  • Brokerages who handle claims in-house

This is a suggested program:

  • One on one mentoring with an experienced claims professional
  • In-person & telephone mentoring
  • Technical assistance on coverage and procedural issues
  • Assistance with file action plans, including investigation
  • Call observations, and feedback
  • Assistance with correspondence response
  • Reserve recommendations
  • Exposure identification
  • Negotiation best practices
  • Statement taking basics, observation & feedback
  • Coaching on the Litigation process

In a nutshell, this program provides you with immediate technical expertise, coaching and training to further hone your claims handling skills.

Program Delivery and Timelines:

Month one: One to two days per week of side-by-side coaching (can be full or half days), followed by as-needed phone consultations, charged hourly

Month two: One to two days every two weeks of side-by-side coaching, followed by as-needed phone consultations, charged hourly

Ongoing: Phone consultations, with one day per month of side-by-side coaching and follow-up after month 2

Contact Us

If you have specific claims training requirements for an individual or small group, we can design this program for you.

We’d love to chat more about our C.A.M.P., let us know how we can help!

Nicole Langley, Training & Business Development:  *protected email* or 416-306-2857

Brian Grieve, Vice President: *protected email* or 416-350-7359

Medical Rehabilitation Limits after September 1, 2010 (Part I)

This entry is by Nick White, AB Consultant with Cameron & Associates.

Nick began his career in insurance in 2007 and quickly moved into Accident Benefits where he continues to handle all levels of injury claims. He has championed settlement and dispute resolution projects as well as many training initiatives.

Medical Rehabilitation Limits after September 1, 2010 (Part I)

With the reforms to Bill 198 now comfortably (so to speak) in place both insurers and plaintiffs have developed their own strategies and styles for handling medical rehabilitation limits and the Minor Injury Guideline.   It was no surprise that plaintiff lawyers were quick to chime in on the pitfalls of the new regulations – and that insurers were quick to point out the need for reform to control exploding premiums – but what about claim handlers?

We have all heard and (if you drive in Ontario) experienced your standard policy non-catastrophic medical rehabilitation limit lower from $100,000.00 to $50,000.00 with your premium remaining the same or increasing.  This disparity is the first battle cry of any plaintiff lawyer arguing the reform is flawed, and frankly if you pay premium in this province, you may be inclined to bang the drum with them.

The second complaint regarding medical rehabilitation from any plaintiff lawyer (and possibly claimant) is likely going to be the combining of the insured’s cost of examinations with their scheduled medical rehabilitation limits.  Cost of examinations prior to the reform were not capped, and became a huge bone of contention between insurers, lawyers and other stake holders because of escalating out of control costs and insurance fraud.  Clinics could in essence propose anything and ultimately it was no threat to the claimant’s medical rehabilitation or other scheduled limits.  It also allowed for the tort file to be built on the backs of accident benefits so to speak.  I’m not a litigator, but clearly there is a trend of some plaintiffs (and defence) to simply amass mountains of medical reports in an attempt to sway an arbitrator, judge, jury and so on.

What is a claimant to do?  How does a claimant manage their medical rehabilitation and substantiate their on going disability?

Carefully.   Not only does the plaintiff lawyer or claimant have to monitor these limits, but the insurer too needs to look at the facts of every file and do something that has been lost in recent years: Call claimant, call the lawyer, call the doctor.

If Mrs. Insured has had a severe accident, and right now has to wait two years to determine she may or may not have sustained a catastrophic impairment. Mrs. Insured (and her lawyer) must work with the insurer and visa versa.  The lawyer cannot send her to a gamut of assessments only to find that $20,000.00 in medical rehabilitation limits have been squandered.

The adjuster cannot blanket approve all treatment only to be left with a badly impaired claimant collecting specified benefits, such are IRB or CareGiver, long after her treatment dollars are gone.  The two need to call each other. The adjuster must always keep in mind that we are seeking to lessen the effects of disability to help the claimant recover and reduce the duration of the claim.   It cannot be done by aggressively denying treatment nor can it be done by blindly approving every proposal that crosses the desk.

Mediation Skills Workshop

We are excited to announce that we have expanded our “Mediation Assistance Program” to include a Mediation Skills Workshop.

In this one-day workshop, you will receive tips & coaching in Mediation Best Practices through examples, demonstrations & role-plays.  We will help you to effectively prepare for & participate in mediations.

Topics discussed:

  • File & strategy preparation
  • Challenges in file management
  • Information on relevant regulations, practice notes & forms
  • Mediation process & goals
  • Mediation behaviour & etiquette
  • Communication skills
  • Settlement practice tips

Stay tuned for our next scheduled session, or let us know how we can tailor this workshop to meet your specific needs.

Contact Us

Nicole Langley, Training & Business Development:  *protected email* or 416-306-2857

Brian Grieve, Vice President: *protected email* or 416-350-7359

Toronto Commercial Arbitration Society Membership

We’re pleased to announce that the President of Cameron & Associates, Jim Cameron, has been accepted as a member of the Toronto Commercial Arbitration Society.

Jim is honoured to be part of such a great group of arbitrators.

From the Toronto Commercial Arbitration Society’s website:

TCAS mission statement

To promote and develop in Toronto a world centre for arbitration excellence to resolve international and domestic disputes by providing

  • qualified arbitrators,
  • exceptional facilities,
  • experienced counsel,
  • innovative research, and
  • a supportive legal environment regardless of the location of the parties or their systems of law.

And to promote the use of arbitration to resolve commercial disputes by

  • developing alliances with other arbitral organizations and centres of learning,
  • sponsoring international conferences featuring preeminent practitioners as speakers,
  • advocating supportive international and domestic legislation, and
  • providing a forum and network for the exchange of ideas on all aspects of international and domestic arbitration
  • promoting and understanding of available rules and arbitral institutions to facilitate commercial arbitration.

Congratulations, Jim!

AB Mediation Backlog

35,000 cases and counting.  What happens when the dam bursts?

Under the current Ontario Insurance Act, if you have a dispute with an Insurer involving the payment of accident benefits under the SABS (Statutory Accident Benefits Schedule), you must file for mediation with the Dispute Resolution Practice Group (DRPG) at FSCO (Financial Services Commission Of Ontario). This mediation must take place before the claimant can proceed to the courts through a law suit or by arbitration (again to be filed with the Dispute Resolution Practice Group).

The Act provides that such mediation shall take place within 60 days of the filing date with FSCO.  FSCO have found themselves facing some staffing issues and an unusual volume of cases being presented which resulted in a backlog of about 35,000 mediations.

The Auditor General of Ontario commented on this situation and FSCO has posted an RFP for outside services to assist in aggressively attacking the backlog.  One of the problems may be, however, what happens when the case is not settled at mediation.  If only 60% settle, 40% of these or 14,000 new cases will appear before the courts or at arbitration within the next few years.  Are we ready?

A great article in the Law Times talks a bit more on this subject.

We can help Insurers to get ready for mediations, and coach on mediation best practices.

Let us know if we can help! 

Thanks for reading,

Jim Cameron

Understanding Accident Benefits: A Primer for Brokers & other Insurance Professionals

We’re excited to announce that we will be delivering an Intro. to AB workshop on May 2nd at the Insurance Institute in Toronto.

We would love to see you there!  Our last courses on this topic were a big hit.

This one-day course is meant for someone with little-to-no claims experience, and will give a general overview of what benefits are, and some claims handling procedures.

Check out the Institute’s website for more information and registration.

Arbitration Advocacy Presentation

I attended the Arbitration Advocacy presentation by the Advocates Society on March 27th.

This was the first such session presented by the Advocates Society and included a review of the myriad legislation existing both in Canada and Internationally on Commercial Arbitrations. Experienced practitioners discussed cultural and legal system differences that were highlighted by some fascinating tales of intrigue and hijackings of witnesses. It did, as a questioner pointed out, reinforce the value of arbitration in international off shore contractual disputes instead of having to resort to the local courts.

Great session.  I recommend you keep an eye out for more like this.  If you have any questions, please call or email me directly: *protected email* or 416-350-5823

Thanks for reading,

Jim Cameron