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!

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

 

New Vice President Announcement

Jim Cameron is pleased to announce the promotion of Brian Grieve to Vice President of Cameron & Associates Insurance Consultants.

Brian has been invaluable to us since joining Cameron in the role of Operations Manager. He is a key contributor to our past successes and will continue to monitor and manage our anticipated rapid growth in the exciting times ahead.

Congratulations, Brian!

Mediation Assistance Program for Insurers

At Cameron & Associates, we are pleased to announce our new Mediation Assistance Program (M.A.P.) for Insurers.

Are you ready?

FSCO has recently initiated a project to clear the backlog of over 30,000 mediation requests.

Implications for insurers:

  • Your AB team will receive an influx of mediation scheduling requests
  • Your ADR team and claims handlers will experience a dramatic workload increase to prepare for mediations
  • Your senior claims handlers will be preparing for mediations, spending less time on active files

At Cameron & Associates, our M.A.P. team is ready and available now for claims handling while your team readies for mediations.  Our highly skilled Accident Benefits team provides on-site assistance to insurers on long and short-term contracts.

What our M.A.P. Team can do:

  • Full AB file handling from Med./Rehab. to Catastrophic Claims
  • Mediation brief preparation

Help with individual tasks within the AB department:

  • Respond to incoming forms & mail
  • Make initial calls & return calls on AB claims
  • Identify red flags indicating possible fraud
  • Reserve worksheets
  • Processing & requesting payments
  • Correspondence to claimants
  • HCAI notification clearance

Please let us know how our team can support you.

Brian Grieve, Operations Manager via phone: 416-350-7359 or email: *protected email*

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