for Medical Marijuana - Canadian Underwriter · Boston, Massachusetts-based Novarica provided an overview of how payment gateways allow insurers to respond to cus- tomer needs, as

The Evolution of Insurance Coverage

for Medical Marijuana

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PM40063170

August/September 2017

The Times They Are A Changin – ' -

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21

ContentsA u g u s t / S e p t e m b e r 2 0 1 7 • V O L U M E 1 1 • N U M B E R 4

Cover Feature10 The times they are a-changing The evolution of Canada’s medical marijuana regime means changes for insurance BY HELEN D.K. FRIEDMAN AND EVAN BAWKS

Spotlight18 Exit interviewHeather Matthews reflects on the claims industry and her year as CIAA presidentBY EMILY ATKINS

News Features21 Tech advances reshaping insurable privacy risk BY DAVID MACKENZIE

25 How to weather a disaster with customer satisfaction intact BY DARA BANGA, FCIP, CFEI

28 Recovery for psychological injuriesBY TODD DAVIES AND JENNIFER GROENEWOLD

31 Alberta court issues Canada’s first cyber coverage decision in The Brick v. Chubb BY ANNE JUNTUNEN

10

Departments

4 First Notice

34 On the Scene

Columns

7 President’s Message

28

FN• first notice

4 Claims Canada August/September 2017 www.claimscanada.ca

Report suggests reforms for BC auto insurance

As consumer expectations change, insurance carriers are moving towards fully digitizing more processes, including payment gateway technology, research and advisory firm No-varica said recently.

In a new executive brief, Payment Gateways in Insurance, Boston, Massachusetts-based Novarica provided an overview of how payment gateways allow insurers to respond to cus-tomer needs, as well as trends, changes and evolution of the vendor landscape.

Payment gateways enable insurers to simplify their pay plan structures, ensure PCI (payment card industry) compli-ance and shield themselves from changes in the payment landscape, while providing a seamless and secure experi-ence for consumers. In the executive brief, Novarica includes profiles of providers of payment gateway solutions, including both traditional payment processors and newer providers.

“Payment gateways can serve a vital role in meeting cus-tomer expectations and providing secure services,” said Chuck Ruzicka, vice president of research and consulting at Novarica, who co-authored the brief with Novarica associ-ate Christina Choi.

“They offer the ability to enhance consumer-facing ser-vices, improve IT’s response to market changes while reduc-ing its complexity, reduce carrier risk and reduce costs,” he suggested. “Carriers who are evaluating their digital capa-bilities should consider how they provide billing services and how they can best leverage the capabilities of payment portal service providers to address their challenges.” ●

A huge divide exists between consumer expectations of their digital service experience and what is being delivered, with three-quarters of recently polled consumers in Australia reporting they will stop trying a digital app or service within a minute if it stops working or slows down.

Findings in State of Digital Operations: Australia, clearly show “a disconnect between consumers’ high expec-tations of their digital service experience and how quickly IT organiza-tions can adapt to the rise of digital service offerings and resolve customer-impacting in-cidents,” according to PagerDuty, digital operations management firm with regional offices in Toronto and Sydney. Findings are based on a survey of 300-plus consumers in Australia.

The lack of consumer satisfaction has some big potential costs attached. The study shows that one hour of IT downtime costs companies between AU$500,000 to more than AU$10 million. As well, resolving consumer-impacting incidents takes IT teams more than five times longer than the amount of time consumers are willing to wait for a service that is not perform-ing properly. ●

Insurers increasing reliance on digital payments

Consumers won’t tolerate slow apps

British Columbia’s auto insurance system “has structural problems” and its mandatory Basic Autoplan product needs to be redesigned, suggested Ernst & Young LLP (EY) in a re-port released July 24.

“In BC today, claimants receive less than 60 percent of their premiums as benefits, with the remainder going to scheme costs including legal costs and disbursements,” EY said in the report, Affordable and Effective Auto Insurance – a New Road Forward for British Columbia, which was commissioned by In-surance Corporation of BC, the crown corporation that runs Autoplan as a monopoly and sells optional additional auto coverage in competition with the private sector.

“Best-in-class schemes around the world return approxi-mately 80 percent of premiums as benefits to claimants,” EY said in the report.

In BC, the Basic Autoplan had loss ratios of 106.5 percent in 2014, 115.6 percent in 2015 and 110.3 percent in 2016, EY reported, adding that ICBC had net losses, on basic mandatory auto insurance, of $257 mil-lion in 2015 and $280 million in 2016.

EY included details on auto insurance schemes elsewhere in Canada, and not-ed: “Ontario has one of the least effec-tive insurance systems in Canada. It is

filled with disputes and inefficiencies, and a very high percent-age of premiums is going to experts and lawyers rather than directly to claimants.”

In 2015, Ontario appointed David Marshall, former presi-dent of the Workplace Safety and Insurance Board (WSIB), to review and make recommendations on auto coverage. EY not-ed that the Marshall report (Fair Benefits Fairly Delivered, April 2017) contains useful lessons for BC in terms of opportunit ies for creating a better and more efficient system.

In Ontario, Marshall suggested that insurers “are incented to close their liability with as little cash cost as possible and, hence, they introduce the practice of negotiating cash settle-ments with claimants in lieu of medical treatment, future wage and other future benefits” under the Statutory Accident Ben-efits Schedule.

Ontario should change its regulations “to include only broad principles and entitlements” for auto accident benefits and

should establish an “arms-length regulator with a skills-based board” to oversee auto insurance, Marshall wrote.

“Fundamentally, auto insurance in BC has structural problems and requires major re-

form to resolve these issues,” EY said. “Very similar” to Marshall’s observa-tions in Ontario, “these issues in BC

www.claimscanada.ca August/September 2017 Claims Canada 5

FN• first notice

Approved rate increases for auto insurance in Ontario were an average of 0.76 percent in the second quarter of 2017, the Financial Services Commission of Ontario (FSCO) reported re-cently. This compares to an increase of 1.24 percent on aver-age for the first quarter of 2017.

In Ontario, insurers must submit proposed rate changes, along with actuarial data, to FSCO for approval. It approved rates for 22 insurers representing just over half of the market, based on premium.

Four years ago, the province changed the Ontario Automo-bile Insurance Rate Stabilization Act to establish an “industry-wide target reduction” by 15 percent, by 2015.

That mandated reduction did not hap-pen. “It got to around seven

percent and they realized that there were a lot of issues around this that the industry and the regulators have to work together on,” said Joel Silverthorn, senior financial analyst at A.M. Best Company Inc, at a late 2016 briefing.

The 15-percent reduction was meant to be of the average of the authorized rates that may be charged by insurers for private passenger auto in Ontario. ●

Saskatchewan Government Insurance (SGI Canada) report-ed a consolidated loss ratio of 60.4 percent for the year end-ing March 31, 2017, while 77 percent of all eligible homeowner policies have optional water protection coverage that was in-troduced last October.

“Flood insurance is still a fairly new product in the Canadian insurance market, but when offered to SGI Canada homeown-ers, the coverage was applied to 77 percent of eligible po-lies,” wrote Andrew Cartmell, SGI’s CEO, in its annual report released July 20.

Coverage for losses from overland flood was generally not available on Canadian home insurance poli-

cies until 2015, the year The Co-operators and Aviva announced residential flood

coverage. Other home insurers have since followed suit with their own flood coverage for homeowners.

“Storm claim losses totalled $51.6 million in 2016-17, with a sub-

stantial number of claims streaming in following powerful weather events,” Cartmell wrote in the annual report. “In Saskatchewan, these included a pound-

ing hailstorm that hit Moose Jaw and heavy rains that caused flash flooding in Estevan; and in Alberta, two significant sum-mer storms—all in July of 2016.” ●

Changing climate patterns are putting additional strain on both power generation and transmission, and presenting another risk factor for natural disaster mitigation and recov-ery in North America’s Pacific Northwest region, suggests a new study from Swiss Re and the Johns Hopkins University School of Advanced International Studies.

The report, Lights out: The risks of climate and natural disaster related disruption to the electrical grid, explores how extreme weather and other natural catastrophes are evolving in the Pacific Northwest, including implications for reliability of the system and potential economic dis-ruption. The region is prone not only to high-frequen-cy, low-intensity natural disasters such as droughts and flooding, but is also at risk of catastrophes like the Cas-cadian Subduction Zone event, an “earthquake-tsunami combination that is expected to devastate the coastline from northern California to southern British Columbia,” the report explained.

Climate change is causing more severe and frequent nat-ural disasters, meaning power systems face increased strain from catastrophes. As well, the economic implications are challenging governments and energy providers: not only do they require pre-disaster financing provided by insurance, they must address how to make their systems more resilient to future flooding, droughts and earthquakes.

The report suggested state governments and local com-munities should explore ways to leverage limited public re-sources through partnerships with the private sector. “Gov-ernments in the Pacific Northwest have become regional and national leaders in the development of risk mitigation and resilience strategies.”

The report not-ed that unlike the Federal Emergency Management Agen-cy (FEMA) in the US, Public Safety Canada is not as well capital-ized, and therefore unable to provide as much financial assis-tance to communi-ties devastated by

natural disasters. “Post-disaster financial recovery in Cana-da is further complicated by the large discrepancy between the Canadian insurance industry’s capacity to pay out insur-ance claims and the expected value of the damage from a potential catastrophe, which the Canadian federal govern-ment does not cover,” the report said.

In March 2016, Prime Minister Justin Trudeau and then-US President Barack Obama issued the US-Canada Joint Statement on Climate, Energy, and Arctic Leadership, in which the two countries pledged to “develop strategies to strengthen the security and resilience of the North America electricity grid, and to work together to fight against climate change impacts,” the report said. ●

Ontario auto premium increases slow in Q2

Climate change stressing electrical infrastructure

Majority of Saskatchewan home-owners opt for flood coverage

continued on page 6...

FN• first notice


Illegal rental suites common: surveySeventeen percent of rental suites in

detached houses in Ontario, Alberta and British Columbia are considered illegal, a new survey from Vancouver-based Square One Insurance Services Inc. has found.

The study involved a survey of more than 5,500 homeowners in the three provinces and revealed that 11 percent of house owners rent out a portion of their home to non-family members. Al-berta had the highest percentage at 14 percent, followed by BC at 13 percent and Ontario at nine percent.

“We wanted to conduct this survey for two reasons,” said Daniel Mirkovic, Square One’s president. “We’re noticing an in-crease in inquiries by house owners that are renting a portion of their home to non-family members. We wanted to understand what was driving this increase. We also wanted to understand how house owners are coping with municipal laws relating to rental suites in single-family homes.”

Overall, 17 percent of rental suites in detached houses are considered illegal, the survey found. Ontario has the highest percentage at 21 percent, followed by BC at 15 percent, and Alberta at 14 percent. “The actual percentage is likely to be considerably higher as residents may be reluctant to disclose illegal rental suites,” Square One suggested.

According to the survey, the top three reasons why homeowners have rental suites are: for extra income, to help with a mortgage and for companionship. “While mortgage-helpers are well, helpful, there are many mu-nicipal regulations that house owners need to be aware of,” Square One stressed.

For example, Vancouver and Toronto have capped the number of rental suites

allowed per single-family house to just one. Other regulations, which vary by municipal-

ity, usually include: zoning restrictions; building code compliance; unit size restrictions; minimum parking re-quirements; and inspection and licensing compliance.

“Most municipal regulations for secondary suites ensure residents have adequate and safe housing options,” Mirkov-ic said. “But some, like the one rental suite per single-family house, are just outdated. It’s hard to understand why cities ad-vocating for more affordable housing options would continue to enforce this outdated regulation,” he contended.

Ontario has more than 233,000 secondary rental units, BC more than 155,000 and Alberta more than 125,000, according to the Canadian Mortgage and Housing Corporation. Second-ary rental units tend to be more affordable than apartment suites. The average cost in Metro Vancouver of a two-bedroom secondary suite is $1,390 per month, while a two-bedroom apartment is $1,450 a month. ●

...continued from page 5

www.claimscanada.ca

PM40063170

February/March 2017

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evolving threats to business

www.claimscanada.ca

PM40063170

June/July 2017

Watch and wait

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 Insti-tute 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

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HEATHER MATTHEWS

The profession of loss adjusting came into being after the

Great Fire of London in 1666. With the introduction of prop-

erty fire insurance, independent surveyors began using their

expertise to evaluate and settle claims.

351 years later, how much has really changed? The funda-

mentals of determining the cause of loss, the scope and quan-

tum, determining liability and negotiating and settling a claims

are not dramatically different today than they were in 1666.

Sure, we have paperless files, claims systems, digital photog-

raphy, drones, cell phones that fit into your pocket and not a car

bag, but the fundamentals have not changed. We help people.

We are there when the public needs us. We were there for

Fort Mac, handling 60 percent of the total value of commercial

and residential insured losses. We were there when Toronto

flooded and tens of thousands of claims came in within hours.

We are there for any category hurricane, tornadoes, hail and

wind damage, as well as evolving new claim types such as mass

tort and cyber.

Although fundamentally the profession has not changed,

we must continue to evolve the professional adjuster. We need

to push for change to stay relevant and add

value.

We, as a collective group of independent

adjusters, have an immense store of data,

intelligence and expertise. We need to con-

tinue to mine the data, educate and train

our staff and be compensated fairly for the

expertise that we bring to the table.

CIAA has conducted a rate survey

through an independent firm and has re-

cently shared a summary with the asso-

ciation executive and will be issuing a rate

guideline in the near future. As an associa-

tion we cannot set rates or even discuss them,

and are required to stay within the regu-

lations set out in the “Competition Law

Orientation for Directors of Non-Profit

Organizations”.

What we can do, though, is issue a guide-

line of recommended rates by line of cover.

We cannot enforce members to charge

the rates within the guideline but we, as

an association, can provide that sugges-

tion. I strongly encourage you to review the

guideline with your staff and clients when it

arrives.

Le métier d’expert en sinistres est né après le grand incendie de Londres en

1666. Avec l’avènement de l’assurance incendie habitation, les experts indépendants ont

commencé à utiliser leur expertise pour évaluer et régler les réclamations.

351 ans plus tard, qu’est-ce qui a réellement changé? Les bases servant à déter-

miner la cause, la portée et le montant de la perte, la détermination de la respon-

sabilité, la négociation et le règlement d’une réclamation ne sont pas radicalement

différentes aujourd’hui de ce qu’elles étaient en 1666.

Bien sûr, nous avons des fichiers sans papier, des systèmes de réclamations,

des photographies numériques, des drones et des téléphones cellulaires qui se

rangent dans votre poche et non dans une mallette, mais la base n’a pas changé.

Nous aidons les gens.

Nous sommes là quand les gens ont besoin de nous. Nous étions là pour Fort

Mac, gérant 60 pour cent de la valeur totale des pertes commerciales et résiden-

tielles assurées. Nous étions là quand Toronto a été inondée et que des dizaines de

milliers de réclamations sont arrivées en quelques heures. Nous sommes là pour

toutes les catégories d’ouragans, de tornades, de grêle et de dommages causés par

le vent, ainsi que pour les nouveaux types de réclamations comme les litiges de

masse et cybernétiques.

Bien que, fondamentalement, la profession n’ait pas changé, nous devons

continuer à évoluer en tant qu’experts en sinistres. Nous devons évoluer pour de-

meurer pertinents et ajouter de la valeur.

Nous, en tant que collectif d’experts indé-

pendants, disposons d’une immense quantité de

données, de renseignements et de compétences.

Nous devons continuer à exploiter les données, à

éduquer et à former notre personnel et à être ré-

munérés équitablement pour l’expertise que nous

apportons.

L’ACEI a mandaté un cabinet indépendant pour

effectuer un sondage sur les taux et a récemment par-

tagé un résumé avec la direction de l’association, la-

quelle publiera prochainement sa ligne directrice sur

les taux. En tant qu’association, nous ne pouvons pas

fixer de taux ni même en discuter, et nous devons res-

pecter les règlements énoncés dans les orientations

du droit de la concurrence pour les administrateurs

d’organismes à but non lucratif.

Ce que nous pouvons faire, cependant, c’est

d’émettre une ligne directrice sur les taux recom-

mandés par ligne de couverture. Nous ne pouvons

pas obliger les membres à facturer les tarifs dans la

ligne directrice, mais nous, en tant qu’association,

pouvons fournir cette suggestion. Je vous encou-

rage vivement à passer en revue la ligne directrice

avec votre personnel et vos clients lorsqu’elle sera

publiée.


Message from the PresidentLa Plume du président

The profession of claims adjusting got its start after the great

Fire of London in 1666


Not only do we need to push the profession to stay rel-

evant and add value, we need to push our association as well.

We need to be a collective voice to continue to promote our

services and illustrate the benefits to our clients. We need to

continue to drive government bodies on licensing require-

ments both for business as usual and for catastrophic situa-

tions. We need to continue to make available to our members

all forms of education and training. We need to have a forum

to talk to our clients in a very open, honest and transparent

fashion about current issues and future challenges. We need

member engagement and participation to make that happen.

Apathy can be the cancer to an association. I encourage

members to sit up to the table, speak up and out and work to

not only preserve, but also heighten your profession.

I was honoured to have served as your president in 2016/17

and thank all of those on the executive and all of those that

I have met for your support, participation and comradery.

I wish Monica Kuzyk all of the best in 2017/18 and can

assure everyone that you are in good hands with Monica as

your president. ■

Sincerely,

Heather Matthews

NATIONAL EXECUTIVE 2016 - 2017NATIONAL EXECUTIVE 2016 - 2017PRESIDENTHeather Matthews, CIP, CRM, CIOPCrawford & Company (Canada) Inc.539 Riverbend Dr.Kitchener, ON N2K 3S3Phone: (519) 578-5540Fax: (519) 578-2868E-mail: [email protected]

1ST VICE-PRESIDENTMonica Kuzyk, FCIP, CRMCuro Claims Services125 Northfield Dr. W., P.O. Box 218Waterloo, ON N2J 3Z9Phone: (866) 952-2876Fax: (519) 888-9704E-mail: [email protected]

2ND VICE-PRESIDENTLee PowellVericlaim Canada5915 Airport Road, Suite 201Mississauga, ON L4V 1T1Phone: (905) 671-7834Fax: (905) 671-7819E-mail: [email protected]

SECRETARYJeff Edge, CIP, CFEI Leading Edge Claims Services Inc.P.O. Box 1399, 78 Highway 20 WestFonthill, ON L0S 1E0Phone: (289) 897-8676Fax: (289) 897-8677E-mail: [email protected]

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

PAST-PRESIDENT Fred R. Plant, AIICClaimsPro85 Englehart StreetDieppe, NB E1A 8K2Phone: (506) 853-8507 Fax: (506) 853-8501E-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 5Z2

Phone: (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]

DIRECTORAlbert Poon, CIPCunningham Lindsey CanadaClaims Services Ltd.1102 – 50 Burnhamthorpe Rd. W.Mississauga, ON L5B 3C2


DIRECTORMarie C. Gallagher, FCIP, CRM

Kernaghan Adjusters Limited

602 – 1 St. Paul Street

St. Catharines, ON L2R 7L3

Phone: (289) 786-1074

Fax: (289) 723-1979

E-mail: [email protected]

DIRECTORCraig J. Walker, CIP, FCIAA, FIFAA

Maltman Group International

2001 Sheppard Ave. East, Suite 810

Toronto, ON M2J 4Z8

Phone: (416) 492-4411

Fax: (416) 492-5657


DIRECTORGary Ellis, BBA, FCIP, RF, FCLA, FCIAA,

FIFAA

AMG Claims Inc.

P.O. Box 20102 Sherwood

Charlottetown, PE C1A 9E3

Phone: (902) 628-9091

Fax: (902) 628-9093


Non seulement nous devons faire en sorte que le métier demeure pertinent

et ajoute de la valeur, mais nous devons également faire avancer notre associa-

tion. Nous devons, d’une voix commune, continuer à promouvoir nos services

et en montrer les avantages à nos clients. Nous devons continuer à presser les

organismes gouvernementaux pour nous assurer que les exigences en matière

de permis répondent aux besoins de l’industrie en situations normales comme

en situations de crise. Nous devons continuer de mettre à la disposition de nos

membres toutes les formes d’éducation et de formation possibles. Nous devons

avoir un forum pour parler à nos clients de manière très ouverte, honnête et

transparente à propos des problèmes actuels et des défis futurs. Nous avons be-

soin de l’engagement et de la participation des membres pour que cela se produise.

L’apathie peut être le cancer d’une association. J’encourage les membres à

s’asseoir ensemble, à se parler et à travailler non seulement à préserver, mais

aussi à faire grandir votre profession.

Ce fut un honneur d’être votre présidente en 2016-2017. Je remercie de leur

appui, de leur participation et de leur camaraderie tous les membres de la direc-

tion et tous les gens que j’ai rencontrés.

Je souhaite tous mes vœux de succès à Monica Kuzyk pour 2017-2018.

Je peux vous assurer que vous êtes entre bonnes mains avec Monica comme

présidente. ■

Salutations,

Heather Matthews



National Standing Committees 2016-2017NEWFOUNDLAND & LABRADORGejapathy Gopal, CRMClaimsPro27 Duffy Place,P.O. Box 8686, Station ASt. John’s, NL A1B 3T1Phone: (866) 726-7815Fax: (709) 726-6106E-mail: [email protected]

NOVA SCOTIA Michael Connolly, BA, CFEI, CIP ClaimsPro238 Brownlow Avenue, Suite 300Dartmouth, NS B3B 1Y2Phone: (877) 514-6269Fax: (902) 425-9918E-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/AESIQ Michel Lacelle, PAA/CIPClaimsPro255 Crémazie Est, 2e étageMontréal, QC H2M 1M2Phone: (514) 340-8959 Fax: (514) 342-5474E-mail: [email protected]

ONTARIONiki McConnell, BA (Hons.), CIP, CRM TC Insurance Adjusters Ltd.6-2400 Dundas Street West, Suite 388Mississauga, ON L5K 2R8Phone: (877) 663-0701Fax: (905) 916-0242E-mail: [email protected]

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

SASKATCHEWAN Lee Dixon, B. Comm., CIP Midwest Claims Services#7 – 1622 Ontario Ave.Saskatoon, SK S7K 1S8Phone: (306) 668-0870Fax: (306) 249-4114E-mail: [email protected]

WESTERNJody Schmidt, B. Comm., CIP Crawford & Company (Canada) Inc.600, 10709 Jasper Ave.Edmonton, AB T5J 3N3Phone: (780) 486-8024Fax: (780) 486-9001E-mail: [email protected]

PACIFICStacy Phillips, B.Comm., CRM, FCIPClaimsPro600, 1111 Melville StreetVancouver, BC V6E 3V6Phone: (888) 681-6331 Fax: (604) 681-6388E-mail: [email protected]

CIAA REGIONAL PRESIDENTS2016 – 2017

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

Lee PowellVericlaim Canada5915 Airport Road, Suite 201Mississauga, ON L4V 1T1Phone: (905) 671-7834Fax: (905) 671-7819E-mail: [email protected]

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

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]

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 International2001 Sheppard Ave. East, Suite 810Toronto, ON M2J 4Z8Phone: (416) 492-4411Fax: (416) 492-5657E-mail: [email protected]

CIAA NATIONAL INSURANCE INDUSTRY ADVISORY BOARD Patti M. Kernaghan, FCIP, CRMKernaghan Adjusters Limited300 - 1445 West Georgia StreetVancouver, BC V6G 2T3Phone: 1-800-387-5677Fax: 1-800-387-5644E-mail: [email protected]

Heather Matthews, CIP, CRM, CIOPCrawford & 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]

Fred R. Plant, AIICClaimsPro85 Englehart StreetDieppe, NB E1A 8K2


Patricia M. BattleCanadian Independent Adjusters’ Association/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]

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]

Marie C. Gallagher, FCIP, CRMKernaghan Adjusters Limited602 – 1 St. Paul StreetSt. Catharines, ON L2R 7L3Phone: (289) 786-1074Fax: (289) 723-1979E-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 FloorToronto, ON M5C 1C4Phone: (416) 362-8586Fax: (416) 362-1126E-mail: [email protected]

Glen HopkinsonXL Insurance Company SE100 Yonge Street, Suite 1200Toronto, ON M5C 2W1Phone: (647) 277-8650E-mail: [email protected]

Dan LangerCICMA Ontario Chapter Presidentc/o CIAA5401 Eglinton Ave. W., Suite 100Etobicoke, ON M9C 5K6Phone : (416) 621-6222Fax : (416) 621-7776E-mail: [email protected]

Justin MacGregorGovernor, IBAC151 Rose Glen Rd.Port Hope, ON L1A 3V6Phone: (905) 885-1551E-mail: [email protected]

Penny McCuneSGI Canada2260 11th AvenueRegina, SK S4P 0J9Phone : 844 855-2744E-mail : [email protected]

Alex Walker, CIPAviva Canada2206 Eglinton Ave. E.Toronto, ON M1L 4S8Phone: (866) 692-8482E-mail: [email protected]

Tina Gardiner, B.Sc.,CRM, CIPThe Regional Municipality of York17250 Yonge StreetNewmarket, ON L3Y 6Z1 Phone: 1-877-464-9675E-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]

CONVENTIONPaul 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]

DESIGNATION/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]

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]

Lorne Montgomery, CIP, FCIAA, FCLACrawford & Company (Canada) Inc.300-123 Front St. W.Toronto, ON M5J 2M2Telephone: 416-867-1188Fax: 416-867-1925E-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]

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) 238-2735




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, CRM, RFNetwork 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]

NOMINATINGFred R. Plant, AIICClaimsPro85 Englehart StreetDieppe, NB E1A 8K2Phone: (506) 853-8507Fax: (506) 853-8501E-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 3S3Ph: (519) 578-5540 Fax: (519) 578-2868E-mail: [email protected]

Keith P. Edwards, FCILA, CLA, FUEDI-ELAE — ClaimsPro 120 Adelaide St. W., Suite 2401Toronto, ON M5H 1T1Ph: (416) 777-4479 Fax: (416) 360-7335E-mail: [email protected]

PROFESSIONAL PRACTICESFred R. Plant, AIIC — ClaimsPro85 Englehart StreetDieppe, NB E1A 8K2Phone: (506) 853-8507Fax: (506) 853-8501E-mail: [email protected]

ByHelen D.K. Friedman

andEvan Bawks

The Evolution of Insurance Coverage

for Medical Marijuana

The Times They Are A Changin – ' -


As we celebrate the 50th Anniver-

sary of the Summer of Love (1967-

2017), listening to vinyl/download

versions of Jefferson Airplane,

Janis Joplin and the Grateful Dead, it is clear

some aspects of counter-culture have become

mainstream.

With the advent of new Health Canada Regula-

tions in 2015, following the Supreme Court’s ruling

that users of medical marijuana should be permitted to

consume the product in more varied forms than smoking dried

buds, the demand for insurers to cover medical marijuana

under benefit plans has increased exponentially. At the same

time, the current retreat from opioid prescription has left a gap

in products available to treat chronic pain. These factors are

shifting the landscape and mindset of employers, insurers and

adjudicators towards coverage extension. Most recently, the

food giant Loblaws extended coverage for medical marijuana

to its approximately 45,000 employees under policies managed

by Manulife and Great-West Life.

It is possible that Loblaws’ extension of coverage is simply

a supply chain support to the Shoppers Drug Mart application

to Health Canada for the license required to sell medical mari-

juana. (Loblaws attributes the extension to evolving clinical

evidence for use as treatment for specific medical conditions).

Setting supply chain innovation aside, extension of coverage

under insurance plans and by statutory tribunals has been well

underway for years. Adjudicators, employers and insurers are

tuning in, turning on (the benefits coverage) and dropping out

(of coverage denials).

Background – Regulatory Scheme for Medical Marijuana

In R. v. Parker, 2000 CanLII 5762 (ONCA), the Ontario

Court of Appeal considered the impact of medical marijuana

in the context of a criminal proceeding under the Controlled

Drugs and Substances Act (CDSA). The accused Parker was suf-

fering from epilepsy and found smoking marijuana substan-

tially reduced instances of seizure. Since he had no legal source

of marijuana, he cultivated it for himself, which led to him be-

ing charged under the CDSA. The Court of Appeal held the lack

of a viable medical exemption from the enforcement provisions

under CDSA violated the accused’s constitutional right to life,

liberty and security of the person pursuant to section 7 of the

Charter of Rights and Freedoms, as it would force individuals to

choose between their liberty and their health.

Parker eventually led the federal government to establish

the Marihuana Medical Access Regulations (MMAR) which

set out a framework for an individual, with appropriate autho-

rization from a medical practitioner, to access marijuana for

medical purposes. Pursuant to the MMAR, an individual with

appropriate authorization could purchase marijuana from

Health Canada sources of supply or, upon

approval from Health Canada, was permitted

to cultivate marijuana for his or her own use.

(Note that the federal statutes and regula-

tions all use the spelling “Marihuana” instead

of the more common “Marijuana”).

In 2013, the federal government revised

the guidelines for access to medical marijuana

through the Marihuana for Medical Purposes

Regulations (or MMPR), which made some changes

to the MMAR and sought to restrict possession limits and

licences for the providers of medical marijuana.

Originally, only dried marijuana was permissible for use

under the regulations. In June 2015, in R. v. Smith, 2015 SCC

34, the Supreme Court of Canada broadened the available

forms of marijuana to be used for medical purposes to include

cannabis oil and fresh marijuana buds and leaves, in addition

to dried marijuana.

The MMPR stipulated that the MMAR would phase out and

be fully repealed by March 31, 2014. As a result of the prohi-

bition on issuing licences and lowering possession amounts

under the MMPR, an injunction was sought in the Feder-

al Court (in Canada v. Allard, 2014 FC 280), to preserve the

MMPR and to limit the provisions of the MMPR. Injunctive

relief was granted and was upheld by the Federal Court of Ap-

peal (2014 FCA 298). The full case on the merits was heard in

2016, with the Federal Court declaring that the entire MMPR

was unconstitutional and leaving a period of time for Parliament

to pass appropriate remedial regulations (2016 FC 236 & 237).

As a result, the Access to Cannabis for Medical Purpos-

es Regulations (ACMPR) came into force in February 2017.

This regulation replaces the MMPR and MMAR and is the

central mechanism for controlling medical marijuana in

Canada. The Narcotic Control Regulations, CRC c. 1041, al-

lows medical practitioners to prescribe marijuana despite the

provisions of the CDSA, while the ACMPR (and previous

MMAR and MMPR) dictates the circumstances under which

the exemption could be exercised.

Under the ACMPR, consumers of medical marijuana can

access cannabis from a licenced producer by first becoming a

client of the producer, which requires filing an application with

the client’s information and obtaining a “medical document”,

a term defined by the regulations.

Applicants may, in lieu of providing a medical document,

obtain a registration certificate issued by the Minister (which

also requires a medical document). The registration certificate

allows an individual to grow their own marijuana instead of

purchasing it from a licenced producer. Section 129 provides

that only residents of Canada may become clients of a licenced

producer.

The “medical document” information is set out in section

8, which states that a health care practitioner may provide a

Helen D.K. Friedman offers her clients expertise, value, innovation, and a wealth of experience in a practice focused on the defence and risk assessment of first-party insurance claims. She is a leader in Miller Thomson’s insurance industry practice.

Evan Bawks is an insurance defence lawyer whose litigation practice includes accident benefits disputes and tort cases involving motor vehicle accidents, property claims, and occupiers’ liability claims. He practices with Miller Thomson.

12 Claims Canada August/September 2017 www.claimscanada.

medical document for a person under

professional treatment which must in-

clude their personal information, the

address where the consultation with

the practitioner occurred, the daily

quantity of marijuana, (in grams), which

the practitioner authorizes for the per-

son and the period of use (which cannot

exceed one year).

What medical marijuana does not

have, however, is a Drug Identification

Number (DIN). The absence of a DIN is

a major barrier to insurance coverage and

is also a deterrent to many doctors who

are asked to prescribe it. A DIN confirms

the product has been evaluated and ap-

proved for sale in Canada and identifies

the manufacturer, brand name, medici-

nal ingredients, strength, pharmaceuti-

cal form and route of administration.

According to the Canadian Life and

Health Insurance Association, if medical

marijuana was issued a DIN by Health

Canada, it would be far more likely to

be covered by health insurance. The pro-

cess to obtain a DIN involves rigorous

clinical research, generally including 10

year double blind studies. Instead, some

licensed medical marijuana produc-

ers are assigning Product Identification

Numbers (PINs). PINs are available

when a drug or product is classified as an

investigational drug or non-pharmaceu-

tical. The purpose of the PIN is to make

it as easy as possible for insurance ad-

ministrators to approve or cover product

costs under a benefit plan.

Context in Statutory Accident Benefits Cases (Ontario)Persons injured in motor vehicle acci-

dents, particularly those with chronic

pain and anxiety issues, are submitting

requests for coverage to their accident

benefits insurers.

Currently, the Statutory Accident Ben-

efits Schedule (SABS) provides medical

benefits for:

s.15(1) …all reasonable and necessary ex-

penses incurred by…the insured

personas a result of the accident

for…(c) medication.

(2) Despite subsection (1), the insurer

is not liable to pay medical benefits

(a) for goods or services that are

experimental in nature.

Further, section 38 provides:

38(2) An insurer is not liable to pay

an expense in respect of a medi-

cal benefit…that was incurred

before…a treatment plan…unless…

(c) The expense is reasonable and

necessary as a result of the im-

pairment sustained by the insured

person for, (i) drugs prescribed by

a regulated health professional…

Whether or not medical marijuana is

experimental in nature may be somewhat

fact specific, depending on the nature of

the impairment. Medical marijuana may

be considered experimental with respect

to some impairments but not others.

The cases below outline some of the

considerations applied by SABS adjudi-

cators pertaining to ‘experimental’, ‘rea-

sonable and necessary’, administrative

requirements and funding for medical

marijuana.

TN v. The Personal Insurance Company of Canada, FSCO A06-000399, FSCO 3853In Arbitrator Bayefsky’s seminal July 26,

2012 decision, medical marijuana was

found to be a good and service of a medi-

cal nature. On the issue of whether or not

it was experimental in nature, the insur-

er successfully established a prima facie

case that, in general, the use of marijuana

for treatment in neuropsychiatry (brain

injury) was experimental.

The Arbitrator then incorporated

the reasoning in Paquette v. Certas,

FSCO A05-000934 as to the meaning of

“experimental in nature”. While accept-

ing scientific principles should underlie

the interpretation of terms, the SABS

was intended to be a more remedial re-

gime concerned with the provision of a

therapeutic medical service. There was

no requirement to prove with medical

or scientific certainty that a treatment

be therapeutic or effective. Accordingly,

a low threshold was set.

In TN, the Arbitrator accepted that

the use of marijuana for some of TN’s

symptoms, namely pain, anxiety, insom-

nia and poor appetite, would not be con-

sidered experimental. The fact that the

use of marijuana to treat these symptoms

remains controversial, did not relieve

the insurer’s obligation to cover the cost

provided that it was reasonably required

as a result of the accident. As well, the

Arbitrator noted evidence that conven-

tionally prescribed medications (for

pain) also carried significant risks and

further accepted evidence that marijua-

na may be beneficial in mitigating those

risks. (This line of reasoning has become

even more cogent five years later.)

Doyon v. Allstate Insurance Company of Canada, FSCO A15-002442, FSCO 4993

In this case, Doyon sought payment

of medical marijuana expenses for the

period June 2012 to November 2014 in

the amount of $12,600. The insurer had

agreed to fund the medical marijuana

and/or related growing equipment pro-

vided it complied with the terms of Doyon’s

licence. The stumbling block, however,

was the provision of documentation

confirming that the amounts claimed

were provided by licensed suppliers in

accordance with the terms of the licence.

In this case, some of the marijuana and

equipment had been purchased outside

the terms of Doyon’s licence, specifical-

ly from “gray area” suppliers including

compassionate societies.

While accepting the insurer’s need to

confirm properly incurred expenses, the

Arbitrator was prepared to accept the

Health Canada price guide and Doyon’s

prescription for a specific level of con-

sumption (in grams) to fill in the gaps.

In so doing, the Arbitrator followed a

Workplace Safety and Insurance Appeals

Tribunal practice of accepting the Health

Canada price with evidence of a specific

level of consumption to set a monetary

benefit. On a go forward basis, in order

to satisfy the insurer’s requirement for

proof, no less than once per year Doyon

was required to submit written confir-

mation of the amounts of medical mari-

juana she was consuming.

MJ v. Pembridge Insurance Company, 2017 CanLII 1556 (ON LAT)

MJ sought funding for two grams of

medical marijuana per day. The insurer

was prepared to fund the same, however

required MJ to conform to the regula-

tory scheme. Specifically, the MMPR,

which was still in force at the time, pre-

scribed a “medical document” and the

information required in the medical docu-

ment to allow holders to possess medical

marijuana. MJ was unable to produce a

proper medical document to confirm

entitlement to possess and use marijuana

for medical purposes. Accordingly, the

Tribunal agreed with the insurer, ab-

sent the proper medical documentation,

the insurer was not required to fund

the expense.

Based on these decisions, expert evi-

dence is available to support the argument

that medical marijuana is not experi-


www.claimscanada.ca August/September Claims Canada 13

mental in nature, at least for some con-

ditions. Whether it is reasonable and/or

necessary may be more fact specific.

Another line of inquiry is whether

consumption is as a result of the accident.

The focus of the recent SABS decisions

on the administrative aspects of fund-

ing rather than the therapeutic aspects

of the product is a tacit admission that

times have changed. Since SABS insurers

are entitled to offset for collateral ben-

efits, coverage developments outside the

SABS context are becoming increasingly

relevant.

Outside the Accidents Benefits ContextA number of other tribunals have ad-

dressed entitlement and funding for

medical marijuana in the broader insur-

ance context.

Skinner v. Board of Trustees of the Canadian Elevator Industry Welfare Trust Fund, 2017 CanLII 3240 (NS HRC)This particular decision, under the Human

Rights Commission of Nova Scotia, con-

sidered whether employee benefits under

Skinner’s group plan could include cov-

erage for medical marijuana (specifically,

whether or not exclusion of coverage was

a violation of the Human Rights Act in

Nova Scotia). The plan restricted cover-

age to “medically necessary” drugs or

medicine but did not define this term.

The decision contains an in-depth

and lengthy review of coverage consid-

erations and policy language, including

a number of Ontario Human Rights Tri-

bunal decisions which generally found

no grounds for discrimination when

benefit plan administrators declined

funding for medical marijuana.

The Tribunal ultimately agreed that

Skinner experienced discrimination as a

result of the group plan’s decision to deny

coverage and further held this decision

was not supported by a reasonable jus-

tification. The Tribunal ruled in favour

of coverage for medical marijuana. Re-

imbursement was ordered only when the

medical marijuana was purchased from a

producer licensed by Health Canada or a

person legally authorized to produce for

the complainant.

Corporation of the City of Hamilton v. Hamilton Profes-sional Firefighters Association, 2016 CanLII 16885 (ONLA)This labour arbitration decision relates to

claim for payment of medical marijuana

for a grievor’s spouse. Payment was de-

nied as the expense was not covered by

the group benefit plan and because the

drug had not been assigned an identifi-

cation number (DIN) by Health Canada

under the Food and Drug Regulations.

The collective bargaining agreement pro-

vided reimbursement for drug expenses

specifically when the drug in question

was approved by Health Canada under the

Food and Drug Regulations. Although

medical marijuana was approved for

sale in Canada by Health Canada, it

had not be incorporated by the Food

and Drug Regulations. The arbitrator

gave deference to the language in the

collective agreement and the grievance

was denied and dismissed.


Decision No. 221/17, 2017 ONWSIAT 460This recent Workplace Safety and insur-

ance Act Tribunal (WSIAT) decision

outlines the principles considered by the

Tribunal when a worker seeks entitlement

to reimbursement for the costs of medi-

cal marijuana from the Board following

a workplace accident. Under the Work-

place Safety and Insurance Act, a worker

is entitled to health care benefits “as may be

necessary” as a result of the injury. This

includes “prescription drugs”. (Note that

this wording is similar to SABS word-

ing). The decision granted the worker’s

application noting:

[10] A number of Tribunal decisions

have granted entitlement for medical

marijuana as a necessary health care

expense where the marijuana pre-

scription is for a work-related injury,

the worker has a severe impairment,

and the worker has been granted an

exemption by Health Canada to pos-

sess or cultivate marijuana for me-

dicinal purposes. Tribunal decisions

have generally required that there be

medical support for the use of mari-

juana to treat the compensable im-

pairment and that other alternatives

first be explored.

[11] In Decision No. 2445/15, the

Vice-Chair provided a succinct

summary of the circumstances

under which the Tribunal will pro-

vide funding for the use of medical

marijuana. As stated in Decision No.

2445/15, the mainstream approach

taken in previous Tribunal decisions

(see Decision Nos. 480/15, 1393/14,

1537/12, and 491/12) where entitle-

ment for medical marijuana has

been granted is as follows:

• The worker experiences constant

and debilitating pain related to the

worker’s compensable workplace

accident;

• The worker’s treating physician

has recommended and/or prescribed

medical marijuana to treat the work-

er’s ongoing debilitating pain;

• The worker has obtained from

Health Canada the necessary autho-

rization to legally possess medical

marijuana with the approval of the

worker’s physician;

• Other methods of pain control

have been tried to address the work-

er’s pain, but have proven to be less

effective or practical than medical

marijuana; and

• There are no circumstances which

make it inappropriate for the worker

to use medical marijuana to treat on-

going pain.

[12] Decision No. 2335/06I held as

follows:

The Panel does not dispute that there

may be controversy in the medi-

cal community about the effective-

ness of marijuana in relieving pain.

The same may be said to be true of

many types of medication however.

Notwithstanding the controversy

surrounding the success of mari-

juana as a treatment for pain, we see

nothing in the legislation or policy

which prohibits an adjudicator from


continued page 16

concluding that the use of marijua-

na could be an appropriate health

care measure to be used in treat-

ing intractable pain arising from a

compensable injury. While one would

expect that the use of marijuana

would be the exception rather than

the rule in treating pain, we are sat-

isfied that in the appropriate case, the

prescription of marijuana is a form of

treatment that can [sic] authorized for

injured workers. In our view, this is

one of those cases.

We see no reason why requests for

payment of marijuana-related ex-

penses ought to be treated as excluded

from the Act. As we interpret the

legislation and policy, we believe it

provides that entitlement to mari-

juana can be granted if the evidence

establishes that it is required as a re-

sult of the injury and it improves the

quality of life of a severely impaired

worker.

In reaching our decision, we have

been particularly influenced by the

fact that Health Canada has seen

fit to allow this worker access to

marijuana. As noted in the Health

Canada information included in

the case materials, the Marijuana

Medical Access Regulations, which

came in to force on July 30, 2001,

established a framework to allow

access to marijuana by individuals

suffering from “grave or debilitating

illnesses, where conventional treat-

ments are inappropriate or are not

providing adequate relief”. Health

Canada has approved the worker’s

access to marijuana on this basis.

[13] The above decision was interpret-

ed by the Vice-Chair in Decision No.

882/15 to mean that using marijuana

for medicinal purposes would be the

exception and not the rule. Entitle-

ment is granted in each cased based on

the particular facts of the case.

WSIB adjudicators continue to address

the issue on a case-by-case basis, while

acknowledging the benefits for treat-

ment of certain symptoms. For other in-

surers, policy wording remains critical.

Coverage by Incremental ExtensionThe extension of private insurance to

cover medical marijuana is incremental.

In March 2015, a University of Waterloo

student, covered by Waterloo’s Student

Health Plan, petitioned the Univer-

sity of Waterloo’s Student Union as the

Plan Sponsor to ask Sun Life to make an

exception under their plan to fund his

medical marijuana.

The student had exhausted other

medications to ease his chronic head-

aches. He submitted his medical mari-

juana expenses under his plan and was

denied. Following his presentation, the

Student Union requested Sun Life make

an exception and cover the costs.

Sun Life confirmed medical marijua-

na is not an eligible expense in its stan-

dard benefit plans, but it would consider

requests for exceptions if directed by

the Plan Sponsor. Manulife advised of a

similar policy in similar circumstances.


The extension of coverage does not mean

University of Waterloo students were

automatically covered for medical mari-

juana, rather, the door is open for others

to follow the exemption process.

The incremental approach allows in-

surers to justify payment on a case by

case basis.

Loblaws’s coverage, while ground-

breaking is also incremental. The cover-

age is limited to $1,500 per year, with the

actual cost of the product to plan mem-

bers being significantly higher. Similarly,

Loblaws’s coverage is only extended to

treat symptoms of multiple sclerosis and

the side effects of chemotherapy for can-

cer patients. Presumably, this accords

with “grave or debilitating illnesses” cri-

teria, where conventional treatments are

not providing adequate relief.

In the private plan context, Adminis-

trative Services Only plans or self-fund-

ed, self-insured plans are more likely to

extend coverage. These plans are admin-

istered by insurance companies while

the costs of coverage are paid by the

employers. Self-insured companies are

able to choose what their benefit plans

cover and in so doing, are responding to

their employees’ needs.

In this context, Windsor Ontario

Union LIUNA Local 625 extended cov-

erage for medical marijuana to its mem-

bers as a means of reducing opioid use

and the consequent and attendant costs

of opioid addiction ultimately borne by

the insurers, including OHIP.

In keeping with safety concerns, LI-

UNA’s coverage extension allows for

medical marijuana to its retired or per-

manently injured workers. For those

members who are still on the job, only

medical cannabis oil products with re-

duced THC will be covered. Union mem-

bers pay for the prescription up front and

are reimbursed. The Union intends to

monitor how often opioids are prescribed

after the extension of medical marijuana

coverage, in order to determine whether

their objective has been achieved.

On June 15, 2017, the Ontario Pub-

lic Service Employees Union (OPSEU)

introduced a plan allowing OPSEU

employees, their spouses and depen-

dants to claim up to $3,000 annually

for medical marijuana. The product must

be prescribed by licensed physicians

and obtained from legally authorized

vendors. Of note, coverage is not limited

to specific medical conditions.

With the advent of coverage extension

under collateral benefit plans, accident

benefits insurers may ultimately have the

opportunity to offset some costs of medi-

cal marijuana claims. While coverage

remains incremental, there are positive

indications for future offsets, given the

extension of coverage for medical mari-

juana under the WSIB, Quebec’s CSST,

and Veterans’ Affairs via Blue Cross and

the delisting of higher-strength opioid

medications under the Ontario Drug

Benefit program, effective January 2017.

The delisting of these substances will

create further demand for ‘safer’ (and

more organic) pain control medication.

There is no doubt that the times they

are a changing. �

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Heather Matthews, senior vice

president of the National

Claims Management Centre at

Crawford & Company (Canada) Inc, is

in the final weeks of her year as presi-

dent of CIAA. We decided to talk with

Heather towards the end of her tenure,

to learn what makes her tick and dis-

cover her thoughts on independent ad-

justing in Canada.

From criminology to claimsLike many people who work in

claims adjusting, Heather says, she “just

fell into it”. With a background in crim-

inology, she had realized she “wasn't

cut out to be a cop,” but when she had a

chance to join Waterloo Insurance as a

telephone adjuster Heather quickly saw

that “a lot of the stuff that I had learned

from an investigative standpoint and

the law was applicable to insurance claims.”

She credits the experience gained

during her first year on the job, when

a large tornado hit Barrie, Ontario and

the surrounding areas, for a very quick

exposure to a huge volume of claims.

She stayed there for three years as an

adjuster, then as an examiner, which she

says taught her a lot about the commer-

cial side of the business.

Eventually she decided that op-

portunity lay elsewhere and moved to

Crawford & Company as a road adjust-

er covering all lines—property, liability,

“pretty much everything”.

In the early 1990s she got on board

with Crawford's healthcare division,

and after a brief detour with another

employer, Heather returned to Craw-

ford as the operations manager of the

healthcare division.

In 2011, as part of a restructuring,

Crawford established a national claims

management centre that was designed

to “mirror an insurer”, including call

centres for first notice of loss, vehicle

appraisals and more, with 200 desk ad-

justers that handle all lines of claims.

They task out the fieldwork to Craw-

ford's adjuster network.

Heather applied for the top job and

was chosen to run the national claims

management centre, which she has

done for five years now.

“My days now are spent doing bud-

gets, forecasts, dealing with clients,

any kind of escalation, staffing, human

resources issues, making sure we're

staffed properly, trying to grow the

business efficiently and always looking

at new opportunities,” she says.

Technology vs the human touchNew technologies to streamline the

claims process are among the most com-

mon new opportunities she's been seeing.

“There isn't a week goes by I don't look at

some form of technology,” she notes.

For example, self-serve technology is

big right now. “I could push an app out

to an insured and they can photograph

the item, they can do videos, they can

have discussions as a video link with an

adjuster who is managing the process,”

Heather says.

Technology is bringing the industry

to a crossroads, she believes. It is in-

creasingly coming into play, especially

with low-value claims. But with other

areas a lot of technical skills are still re-

quired. She notes that cyber, business

interruption, machinery claims—lots in

the commercial space—still need strong

technical skills to properly investigate,

and must be paired with strong people

skills.

“That's where I think we're at that

crossroads, because technology is defi-

nitely having an impact, but we still see

that push where people want to talk to a

human and still want to be reassured,”

she believes.

Heather notes that the aftermath of

the Fort McMurray wildfire last year

people wanted one-on-one service.

“They didn't want an email, they didn't

want any form of technology, they

wanted you to come see them and dis-

cuss their claims.” As a result, she says,

the average time to intake a client was

probably at least double because they

just needed to talk to somebody.

“As we try to push people to technol-

ogy, in times of a crisis they don't want

technology. But once the claim's estab-

lished most will be okay with sending

an update by text or something like

that,” she says.

“Trying to deliver bad news to some-

one is really difficult,” Heather says. “A

denied claim is incredibly difficult. You

can't just send them a text and say 'your

hundred-thousand-dollar homeowners

claim is denied', and think they're go-

ing to go away. You know it doesn't work

that way.”

Ultimately, she says, there is no sub-

stitute for the amazing people skills

and communications skills that a good

claims adjuster brings to the table. Tech-

nology will make it possible to avoid

some of the more dangerous physical

tasks an adjuster does—like climbing

a ladder up to a roof, for example—but

it won't replace the sympathetic ear of

an experienced adjuster listening to an

insured's tale of loss and woe.

A valuable associationSince early in her career Heather has

been active in CIAA, working on con-


S• spotlight

Exit interviewHeather Matthews reflects on the claims industry and her year as CIAA presidentBY EMILY ATKINS

ferences and helping to recruit mem-

bers to the association. She recalls hav-

ing to overcome the objections of some

who questioned the value of hanging

out with their competitors in the adjust-

ing industry.

“I think once people get involved,

they realize very quickly that there's

tremendous networking opportuni-

ties,” she says. “Just to build your own

network, whether it's through your

competitors or through insurers or ven-

dors to the industry, the knowledge that

you get is extremely valuable. I think

it's better to operate in a holistic, broad

manner than to stick your head in the

sand and only look at your own busi-

ness and what's going on in your shop.”

She also believes in the strength of

the collective: “I feel there is a benefit

in collectively promoting the group and

the association. Whet her it s lobbying

for legislative changes, or constantly re-

evaluating the education we provide to

our members. Working with partners

like the institute [the Insurance Insti-

tute of Canada] means instead of me

being out there on my own, together we

can say 'this is what we want to work on.'"

As for taking on the top job, Heather

says she knew it would be a lot of hours,

and that she needed to do it to give back.

And she wanted to share her notion of

what the claims business needs.

“As of now I have not tried to change

the world in any way shape or form, it's

really all about messaging and getting

people to think about what we need

to do,” she says. “My view has always

been to embrace change and try to have

transparent conversations to try to work

through the issues. More than ever we

have to really, really work on our skills

and those aren't the technical skills, but

the customer service skills. The popula-

tion now has incredibly high expecta-

tions and I think other industries have

pushed us. We need to continue to re-

ally up our game on speed, efficiency,

customer experience because [custom-

ers are] demanding it.”

Never boredAs with many in the claims business,

Heather is in love with the variety the

job affords. She notes that there is al-

ways something new to learn, different

kinds of claims are continually popping

up, and now with the rapid advances in

technology there are even more learn-

ing opportunities.

As well, she thinks about the impor-

tance of remembering that for many

claimants it's the first time they've expe-

rienced a loss, and it's up to the adjuster

to walk them though the process and ex-

plain how things work, as well as being

that sounding board for their emotions.

“We're not building bridges, we're deal-

ing with people, and at the end of the day

they're not just a policy number. We have

the ability to make a positive impact and

get them through that bad situation and

get them out on the other side. And it's

really rewarding; we still get hand-writ-

ten notes from insureds and they are so

thrilled at how we help them, and how we

were there for them and comforted them

and explained things to them.”

Curiosity, empathy and initiativeWhile her love for claims shines

brightly, Heather acknowledges it's not a

career for everyone. Those who are con-

sidering work in the field need to have

an endless curiosity, great empathy and

communications skills and the ability to

self manage. But those who “want to sit

behind a machine and not communicate

with people,” should look elsewhere for a

satisfying career, she advises.

That said, there are tremendous op-

portunities in the field at the moment.

Young adjusters who come up through

the ranks and work to develop an area of

expertise are doing extremely well.

“You've got flexibility with all the

online systems now,” she says. “You run

your book of business and the whole

concept is not nine to five. I don't have

to see you in the office to know that

you're working.” �


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As technology that

tracks and records our

daily lives becomes

ubiquitous, privacy

risk is moving be-

yond data breach and

ransomware, which

currently dominate media attention.

Advances in technology are reshaping

insurable privacy risk, yet scant atten-

tion is being paid to the full extent of

the exposure involved in collecting

and using data, and how best to insure

associated risks.

Insurance profit is generated

through assessment of and protection

from risk. Insurance companies, and

those who act on their behalf, should

be paying close attention to the grow-

ing tension between rapidly expand-

ing technology and individual privacy

interests. Opportunities are emerging.

Using existing technologies, com-

panies are able to collect almost incal-

culable amounts of data from individ-

uals, including information on family

status, employment, financial infor-

mation, physical and mental health

status, ethnic background, sexual ori-

entation, immigration status and even

a person’s regular daily habits.

Many organizations believe they

are allowed to use this data as they

see fit. For the most part, consumers

don’t understand how their data is be-

ing used and sold. But they will, and so

will their lawyers, who will be turning

their attention to emerging and novel

grounds of liability as technology

erodes traditional fee-generating areas

of practice, such as automobile-related

personal injury claims. Privacy litiga-

tion, technology litigation, and regula-

tory litigation will be the new fodder

for the plaintiffs’ bar.

Technology we could barely imag-

ine a few years ago has already arrived.

The Internet no longer exists solely on

our computers and mobile devices. It is

increasingly ambient, with many bil-

lions of sensors now in use in homes,

workplaces, cars and in the environ-

ment generally.

Many people are uncomfortable

with the resulting loss of privacy. Until

recently, individuals could largely con-

trol their electronic presence and per-

sona. Increasingly, however, personal

Tech advances reshaping insurable privacy risk BY DAVID MACKENZIE


data footprints are likely to generate

as much disquiet for those concerned

with privacy as carbon footprints do

for environmentalists. It is a future

fraught with risk, but also one that

portends opportunities and competi-

tive advantages for Canadian busi-

nesses and insurers.

Because of these growing privacy

concerns, new legal barriers are

looming. How will companies that

generate or obtain data be permit-

ted to use it? Privacy rights, long an

afterthought, have come into their

own, recognized both by legislation

and ever more fully by judges, who

are extending broad common law

recognition to concepts character-

ized as “intrusion upon seclusion,”

“public disclosure of private facts”

and the “right to be forgotten.”

The conflict between ever-in-

creasing access to personal data and

emerging limits on using that data

foreshadows a great deal of litigation,

early examples of which have recently

emerged in the United States. Google

has been sued for exploiting loopholes

in cookie-blocking technology that

allows advertisers to track users in

ways to which they had not consented.

LinkedIn faced litigation for access-

ing email contacts folders to seek out

new users. Bose is fighting allegations

that an app on its headphones surrep-

titiously collects customers’ listening

habits and provides that information

to third parties.

Each of these claims engages pri-

vacy issues. Did Google intrude on se-

clusion by giving third parties access

to information to which users had not

consented? Did LinkedIn cast its us-

ers in a false light when it used their

email contacts list to invite others to

join LinkedIn, suggesting that the us-

ers themselves were involved in send-

ing the invitation? Could disclosure

of personal listening habits, as Bose

is alleged to have done, embarrass

headphone users with terrible tastes in

music? While all the foregoing involve

global corporations, privacy risk issues

also exist on the most mundane levels:

for example, can landlords use per-

sonal information collected by third

parties to determine the suitability of

tenants?

Wearable technology, GPS track-

ing and connected medical devices

compound the problem by collecting

individuals’ health and physical activ-

ity data. How will companies exploit

that knowledge? Do they risk liability

in the approach they take?

Snapchat’s new “Snapmap” func-

tion, when activated, can broadcast an

individual’s whereabouts to every one

of their contacts. Does the company

risk exposure for tracking someone’s

location within inches and disclosing

that information to others?

All these risks can arise from tech-

nologies that many Canadian busi-

nesses are already using. Virtually all

of these risks are insurable. The di-

lemma facing the insurance industry

relates to the type of coverage and

the language under which these risks

should be insured.

“Cyber” coverage seems an obvious

place to start. But the primary focus

of these policies remains accidental or

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criminal breach, rather than privacy

claims related to intentional business

conduct. While some cyber policies

may cover this risk, the lack of stan-

dard wording suggests that many will

not. To the surprise of many, perhaps,

coverage is also likely to be found in

other commonly used standard form

policies that expose insurers to an ar-

ray of privacy risks.

Many insurers have not updated

their CGL, bricks and mortar proper-

ty, or professional errors and omis-

sions policies to exclude or elimi-

nate coverage that is being sold and

priced in the cyber and technology

insurance markets. But as contexts

have changed, the courts have not

been afraid to expand existing cov-

erage and language written in other

times to make the consumer whole

in the modern world.

CGL coverage, for example, offers

privacy coverage for publication of

material in any manner that violates a

person’s right to privacy. But the extent

of the coverage in the modern context

is unclear: did LinkedIn publish mate-

rial that violated privacy rights when

it sent emails to individuals found

in customers’ contact folders? Did

Google publish material that violated

privacy rights when it circumvented

cookie blockers by sending informa-

tion from website to website as a user

was surfing? What about Bose’s alleged

sale of data pertaining to users’ love of

early Styx albums?

Is the CGL policy really the right

place to cover privacy risks? Or should

the industry be considering whether

other policies (e.g. Cyber and Tech

E&O) might be more effective? Unless

the industry addresses these issues di-

rectly, only time will tell which policies

will respond best. Better to understand

the risk and underwrite it intentional-

ly. “Accidental” coverage is an unpleas-

ant and expensive surprise.

Adding grist to the mill, a recent

decision from the Supreme Court of

Canada (SCC) suggests that Canada

is emerging as fertile ground for pri-

vacy and technology-related claims. In

Douez v. Facebook, the court charac-

terized privacy rights as “quasi-con-

stitutional”. On that basis, the court

refused to enforce a clause in Face-

book’s terms of service that required

lawsuits against Facebook to be filed in

California (a jurisdiction favorable to

Facebook). In another recent decision

establishing individual rights broader

than in most other countries, the SCC

ordered Google to take down all of a

company’s websites, both inside or

outside Canada.

Clearly, the risks related to data

breach are of great concern to Cana-

dian businesses and insurers. At the

same time, a wave of privacy litigation

may be emerging from under the ra-

dar. Canadian insurers will not want

to ignore these developments, and will

wish to consider how best to address

them from an underwriting perspec-

tive. Risk, after all, creates opportunity

for insurers. These new privacy risks

are no exception.

David Mack enzie is Partner, Insur-

ance Practice at Blaney McMurtry LLP

in Toronto, Ontario.


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It’s been a record

year for catastrophic

disasters in Quebec,

said J.D. Power in a

recent press release.

As a result, regional

insurers are under

tremendous pressure, and the strain

they feel has its mirror image in their

customer satisfaction scores.

However, there’s no reason that

customer service has to suffer when

resources are scare and the claims pro-

cess is challenging. By focusing on big

picture, start-to-finish customer satis-

faction, insurers can emerge from ca-

tastrophes with satisfaction intact.

To find out how, let’s take a look at

the two most notable disasters mak-

ing waves in the West. We’ll observe

the impact they have on claims for re-

gional insurers. Finally, we’ll explore

what this year’s annual customer satis-

faction study by J.D. Power says about

mitigating the worst effects.

Fort McMurray: Costs still smoldering

Welcome to the largest insured

disaster in Canadian history. Ten

months after the 2016 wildfire swept

Fort McMurray, MacEwan University

estimated the cumulative damages (fi-

nancial, physical, and social) at nearly

$9 billion.

Prior to that, Canada’s most expen-

sive insured disaster was the Quebec

ice storm of 1998, CBC News reported,

in which insurers paid out $1.9 billion.

Bear in mind: the current damage

estimates regarding Fort McMurray

are admittedly an underestimation. It

may be years – even decades – before

the full cost of the wildfire is fully cal-

culated.

To say that this event has challenged

Western regional insurers is a bit of

an understatement. According to J.D.

Power, their claims satisfaction score

fell 10 points this year on a thousand-

point scale. Compare that to national

carriers, whose satisfaction score rose

by more than 20 points within the

same period.

“When dealing with losses on the

scale of the Fort McMurray fire, the

logistical challenges faced by carriers

can be overwhelming,” said Valerie

Monet at J.D. Power.

Quebec: Lack of coverage, a splash in the face?

Now let’s turn our attention from

fire to water. Last May, nearly three

thousand Quebec residents voluntarily

evacuated their homes in response to

“the heaviest rainfall we have seen in

over 50 years,” CNN said. As dikes

weakened, Montreal declared a state

of emergency in what Mayor Denis

Coderre described as “an exceptional

and historic circumstance.”

The insurance impacts are uncer-

tain yet. But what we do know doesn’t

bode well for customer satisfaction.

According to J.D. Power, while almost

half of customer respondents said they

have overland flood coverage, the In-

surance Bureau of Canada estimated

that in fact, only 10 to 15 percent do. If

customers weather a disaster thinking

that they have coverage, only to find

out, in their time of need, that they

BY DARA BANGA, FCIP, CFEI

How to weather a disaster

with customer satisfaction intact


don’t, there’s going to be some major

grief where satisfaction is concerned.

Resources strained, satisfaction falling

Obviously, disasters like these im-

pose uncommon strain on the insurers

they affect. And within this landscape,

it’s uncommonly challenging to de-

liver a positive claims experience. As

a result, we’ve seen a major decline in

claims satisfaction.

To put it succinctly, “a spike in ma-

jor claims has created significant

challenges for insurance carriers,

with Western regional carriers as a

group experiencing a 10-point year-

over-year decline in customer satis-

faction with the claims process,” J.D.

Power said.

From a customer’s perspective,

there are several claims complaints.

Two deserve special mention:

• Claims payment cycles are longer

than average

• Annual premium increases fol-

lowing a claim are greater

Now, strain is strain: you can’t blink

it away. When resources are slim, some

dissatisfaction is to be expected. That

said, insurers can do much to mitigate

the negative impacts of dissatisfac-

tion in their claims process. How? By

choosing to lean hard into customer

service, big picture.

Two ways to achieve superior satisfaction despite the disasters

In fact, the gains one can achieve by

prioritizing customer service go well

beyond simply mitigating the damage.

Insurers may find they can raise their

satisfaction scores, even while strug-

gling to navigate major challenges in

claims – to the extent that companies

“that follow best practices for proac-

tive customer communications can...

achieve superior levels of customer sat-

isfaction,” Monet said.

To buck the dissatisfaction trend,

focus on “providing truly great cus-

tomer experiences even in periods of

significant operational stress.” Ac-

cording to Monet, that’s an achievable

goal even for insurers who are taking a

flood of calls from the flooding in Que-

bec – even if the customer on the other

end doesn’t have coverage.

Steps to takeCommunicate: Managing

customer expectations through

the claims process makes a ma-

jor difference for customer satis-

faction. Let’s illustrate that point. Cus-

tomers who’ve had to make a claim in

the Western region report lower satis-

faction than customers elsewhere – no

surprise there.

• Western region: 773

• Atlantic/Ontario region: 789

• Quebec: 812

But customers in the same region

whose carriers provided a timeline for

the process exceeded scores from all the

regions mentioned above. In the West-

ern region customers who were provided

a timeline gave a satisfaction score of 823.

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Your customer has a list of the vehicles that are covered by your fleet policy. You have a list of the vehicles that are covered by that policy.

And your lists aren’t the same.

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Even if you’re struggling to deliver

an above-average claims experience,

make it a priority to communicate

with customers so they know what to

expect. Managing expectations can, in

itself, improve claims satisfaction, even

when other aspects of the process are

less enjoyable.

Look beyond claims: No

matter how you’re doing right

now in claims satisfaction,

you may be able to push your

score up the scale by finessing your

non-claims customer interactions.

Remember, while the claims expe-

rience is important, it’s only a small

component of overall satisfaction.

Even within the context of recent di-

sasters, customer satisfaction has ris-

en across the board by 37 points, J.D.

Power noted, because insurers have

been leveraging non-claims interac-

tions to wow their customers.

The J.D. Power study looks at five

factors:

• Non-claim interactions

• Policy offerings

• Pricing

• Billing and payment

• Claims

Some of these factors promise more

opportunity for improvement than

others. Of course, it’s important to

make your offerings and pricing com-

petitive, and, of course, you want your

payment and billing system to be easy.

It’s also vital to make your claims pro-

cess fast and equitable, keeping pay-

ment cycles prompt and premiums af-

fordable.

But that first factor, non-claim in-

teraction, is by far the most important

of the five. It’s also somewhat broader,

encompassing interactions with local

agents and brokers, with call centre

service representatives and the insur-

er’s website.

What business are we in?There’s no doubt that disasters make

customer satisfaction more challeng-

ing. That said, we’re in the business

of dealing with disasters. Therefore,

more than any other industry, we in

the insurance industry should make it

our business to know how to maintain

high satisfaction in the worst of times.

Clearly, that process starts long before

disaster strikes.

Dara Banga, FCIP, CFEI, is the Pres-

ident of DSB Claims, headquartered in

Brampton, Ontario.


2

With over 40 offices on 5 continents, over 30

language fluencies, 18 distinct professional

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than 130 countries and 800 industries, we are truly

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To work with a member of our respected team

contact any one of our Canadian offices or visit us

at mdd.com.


Recovery for psychological injuries

Supreme Court decision puts physical and mental injury on equal footing

BY TODD DAVIES AND JENNIFER GROENEWOLD

The Supreme Court

of Canada released a

unanimous decision

in Saadati v. Moor-

head, 2017 SCC 28 on

June 2, 2017 and held

that psychiatric inju-

ries need no longer

be proved by expert

evidence.

A Plaintiff can be

awarded damages

for mental injuries

caused by a tortfeasor if they are able

to show evidence of a serious and pro-

longed mental disturbance that rises

above ordinary annoyances, anxieties,

and fears that comes with living in a

civil society.

By way of background, Saadati was

involved in five separate motor vehicle

collisions between 2003 and 2009. This

case arises from the action brought

in the second car accident, which

arose after Saadati's tractor-trailer

was struck by the Hummer driven by

Moorhead. Liability was admitted.

Decisions in the courts belowSaadati was unavailable to testify at

trial, having been found mentally in-

competent in 2010, and his litigation

was conducted through a litigation

guardian. At the trial level the judge

rejected the claim for physical injury

arising from this accident; however,

the trial judge did make an award for

psychological injury based on the evi-

dence of Saadati's friends and family.

They testified that Saadati experienced

a personality change and cognitive dif-

ficulties. Saadati was awarded $100,000

in non-pecuniary damages.

The British Columbia Court of Ap-

peal overturned the decision on the

basis that Saadati did not demonstrate

a medically recognized psychiatric or

psychological injury to support the

award of non-pecuniary damages.

Further, the Court of Appeal found

that in awarding damages for mental

injury, the trial judge erred by decid-

ing an issue that was not “pleaded or

argued” by the Plaintiff. In his State-

ment of Claim, Saadati entered a

boiler plate pleading of “such further

and other injuries as may become ap-

parent…” and “the effects or results

of the said injuries upon the Plaintiff

include headaches, fatigue, dizziness,

nausea and sleeplessness” as well as

making claims under the broad heads

of damages.


The Supreme Court of Canada decisionThe Supreme Court of Canada held that recovery

for mental injury in negligence does not require a

plaintiff to prove a specific recognized mental illness.

In order to recover, the plaintiff must show that the

psychological injury is serious, prolonged and more

than ordinary emotional upset or distress; this claim

can be assisted by expert evidence but expert evidence

is not necessary to recover.

The plaintiff must prove that the defendant owed

the plaintiff a duty of care, that the defendant breached

that duty of care, that the plaintiff sustained some

psychological damage, and that there was a legal and

factual causal relationship between the breach of the

duty and the resulting claimed injury. The occurrence

of a mental injury needs to be proven on a balance of

probabilities and is open to rebuttal evidence, of an

expert or otherwise.

The Court stressed that the important factors to

consider are the plaintiff’s symptoms and their effect,

not the diagnosis involved. The Court discussed that

the law of negligence must afford equal protections

to victims of mental and physical injuries, citing that

there is no need for a plaintiff to prove that a physi-

cal condition meets a threshold of diagnostic criteria.

Writing for the Court, Justice Brown explained that

if tort law does not afford identical treatment to men-

tal and physical injuries, the law would continue to

perpetrate a “dubious perception” of psychiatry and

mental illness.

The Court did not approve of the law as developed

in the lower courts (and also applied in other jurisdic-

tions like the UK, Australia, and New Zealand), which

required plaintiffs alleging mental injury to prove, via

expert evidence, that their injury qualified as a recog-

nized psychiatric illness or condition. The Court held

that confining recovery for a mental injury to condi-

tions defined by a “diagnostic classification scheme”

was flawed as a matter of legal methodology.

In response to the concern that mental illness is

subjective and easily exaggerated and that the law

should not compensate "trivial matters", the court

concluded that the elements of the cause of action of

negligence are sufficient barriers to unmeritorious

claims. The court cited Mustapha v. Mulligan of Can-

ada Ltd., 2008 SCC 27 as evidence that the elements of

the cause of action "furnish a sufficiently robust array

of protections against unworthy claims" as well as ad-

dressing concerns regarding indeterminate liability, as

Mustapha failed to prove his claim on causation. The

court commented that where there is genuine factual

uncertainty regarding the worthiness of a psychologi-

cal injury claim, the trier of fact is in the best position

to make that decision, similar to the trier of fact being

left to make findings on a witness’s credibility.

It remains open to the defendant, “in rebutting a

claim, to call expert evidence establishing that the ac-

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cident cannot have caused any mental injury or at least

any mental injury known to psychiatry”.

Sufficiency of pleadingsThe Supreme Court reiterated that cases should not

be decided on grounds not raised in the pleadings.

However, it held that in claims for negligently caused

mental injury, it was generally sufficient that the Plain-

tiff’s pleadings allege some form of the injury. Justice

Brown held that there were references and argument

during the course of the trial to “psychological”, “emo-

tional” or “psychiatric” that did not draw an objection

from the defendants, and combined with the plead-

ings, provided ample notice to the defendants as to the

case they had to answer.

Conclusion The Supreme Court of Canada has explicitly put

mental and physical injuries on equal footing with

this judgment. Plaintiffs can recover for mental illness

if they can show a serious and prolonged disturbance

that rises above ordinary annoyances, anxieties, and

fears. This evidence can come from the plaintiff, or

from lay evidence such as from family or friends, and

the claim does not necessarily need to be supported

with expert opinion evidence.

When assessing a claim, if there is a potential claim

for psychological injuries it will be important for de-

fence counsel to be alive to the issue, by investigating

and planning for the appropriate rebuttal evidence, for

example, by way of expert evidence, collateral witness

evidence, or the use of surveillance.

Procedurally, defence counsel need to be to alert

to the potential for psychological claims, even when

not specifically pleaded, as this case is a reminder that

courts will construe a plaintiff’s pleadings liberally

when considering whether they are sufficient to sug-

gest a psychological injury. Defence counsel need to

be quick to object if “psychological” or “emotional”

evidence is first raised at trial if there is no basis for a

psychological claim grounded in the pleadings.

Todd Davies is a partner and Jennifer Groenewold is an

associate with Alexander Holburn Beaudin + Lang LLP.

Both practice with the firm’s insurance group and regularly

team up in handling the defence of catastrophic per-

sonal injury claims.

First GeneralThere when you need us most.

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RESTORATION

QUESTION?

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Email us - no cost!


In a decision issued June 29, 2017, the Court of Queen’s

Bench of Alberta held that a social engineering fraud did

not meet the requirements for coverage under the Funds

Transfer Fraud (“FTF”) insuring agreement of a commercial

crime policy. In doing so, the court established The Brick

Warehouse LP v. Chubb Insurance Company of Canada,

2017 ABQB 413, as Canada’s first legal precedent on the ap-

plicability of cyber coverage.

At issue was an increasingly common cyber crime known as

“social engineering fraud”. Borrowed from the social sciences,

the term “social engineering” refers to the use of psychological

manipulation to trick people into taking some action that will

benefit a fraudster.

In this case, a fraudster posed as a representative of one

of The Brick’s trusted vendors and, through a series of emails

and phone calls, he obtained enough information from The

Brick’s accounts payable department to understand the de-

partment’s internal procedures for changing a vendor’s ac-

count information. The fraudster then used that knowledge

to submit a request to The Brick to update its records to re-

flect that the vendor had a “new” bank account. The Brick’s

accounts payable department, believing the request had

come from the company’s vendor, complied.

Following the account information change, The Brick in-

structed its bank to pay the vendor’s legitimate receivables

via a series of electronic transfer payments to the account

it had on file for the vendor – i.e., the fraudulent account.

By the time the fraud was discovered, the bank had already

made several payments to the “new” bank account. The

Brick attempted to recall the previous transactions, with

only partial success.

The Brick sought to recover the lost funds under the FTF

insuring agreement of its Chubb commercial crime policy.

That insuring clause provided that Chubb would pay for:

direct loss sustained by an Insured, resulting from . . .

Funds Transfer Fraud by a Third Party[.]The policy defined a “Third Party” as, essentially, a non-em-

ployee. The definition of “Funds Transfer Fraud” was:

the fraudulent written, electronic, telegraphic, cable,

teletype or telephone instructions issued to a finan-

cial institution directing such institution to transfer,

pay or deliver Money or Securities from any account

maintained by an Insured at such institution, with-

out an Insured’s knowledge or consent.

Chubb denied coverage on the basis that The Brick had

not met all the requirements of the insuring agreement. The

Brick disagreed and issued a coverage action in Alberta.

The matter ultimately proceeded to a summary trial on an

agreed statement of facts.

At trial The Brick made a number of arguments about

why it met the FTF coverage. It also argued, in the alterna-

tive, that it met the required elements for coverage under the

policy’s Computer Fraud insuring agreement, which cov-

ered direct loss resulting from “Computer Fraud by a Third Party”. The policy defined “Computer Fraud” as “the unlaw-

ful taking of Money, Securities or Merchandise through the

use of any Computer System”.

Ultimately the court addressed only three of The Brick’s

arguments in its decision: (1) the insured’s expectations regard-

ing coverage, (2) the role of the “Third Party” in the fraud; and,

(3) whether the insured had “knowledge or consent”.

1The Insured’s Expectations About CoverageThe court first addressed an argument that is

commonly made by insureds whose insurers

have denied coverage: that the insured expected

the policy to protect it against a particular kind of loss. Here,

The Brick said it had purchased a crime policy because it meant

to protect itself against loss due to crime. The court dealt with

this argument summarily, noting that, no doubt, The Brick

intended to insure itself against crime, but that the insurance

Alberta court issues Canada’s first cyber coverage decision

in he Brick v. Chubb

BY ANNE JUNTUNEN


policy naturally restricted the kinds of

crime losses it would cover. The Brick’s

expectations did not affect the scope of

coverage that was actually provided.

2The Role of the “Third Party”The second argument had to do

with the role played by the third

party fraudster. The Brick argued

that it was entitled to coverage so long as a

third party had a role in the overall fraud.

According to The Brick, the wording sup-

ported this interpretation because the in-

suring agreement simply required “Funds Transfer Fraud by a Third Party”, whereas

the definition of “Funds Transfer Fraud”

did not itself require a third party to play

any specific role.

Here, The Brick argued, it was enough

that an outside fraudster had clearly

masterminded the scheme and had, in

some sense, caused the “Funds Transfer Fraud” to take place. This was important

because the third party did not actually

instruct The Brick’s bank to do anything

– the third party fraudster instead duped

an employee into instructing the bank to

make the transfer.

Chubb submitted that, in order to

meet the coverage requirements, fraud-

ulent instructions must come from a

third party and be sent to the insured’s

bank. Chubb submitted that this was

consistent with the purpose of coverage,

which was to protect the insured against

a risk it cannot reasonably avoid: that an

unknown person will steal from the in-

sured’s bank account by impersonating

the insured in direct communications

with the insured’s bank.

Where transfer instructions bypass

the insured entirely, there is little the

insured can do to avoid the loss. In this

case, however, the only instructions re-

ceived by the insured’s bank had come

from an authorized accounts payable

employee. While that employee was

clearly mistaken as to some of the infor-

mation underlying those instructions,

the instructions still came from the em-

ployee – not the third party.

In making its arguments on this point,

Chubb urged the court to follow a deci-

sion from the US Ninth Circuit Court of

Appeals that was, at the time of argument,

only three weeks old: Taylor & Lieberman

v. Federal Insurance Co., No. 15-56102

(9th Cir. Mar. 9, 2017). That case involved

an FTF insuring agreement identical to

the one in The Brick, with similar facts.

The court in Taylor & Lieberman upheld

a ruling that the insured was not entitled

to coverage for a social engineering fraud

because, among other things, the insured’s

reliance on a fraudulent email to instruct a

bank to transfer funds did not amount to a third party issuing instructions to a finan-

cial institution.

Without explicitly adopting Taylor &

Lieberman, the court noted the similar-

ity of its facts before siding with Chubb,

holding that the FTF insuring agreement

required The Brick to “show that its bank

transferred funds out of [T]he Brick’s ac-

count under instructions from a third

party impersonating [T]he Brick.” Here,

it was an employee – not a third party –

who issued the instructions.

ACCIDENT BENEFITS

SPECIALIST

3The Insured’s Knowledge or ConsentThe last issue the court dealt with

was whether instructions were

issued to the bank without The Brick’s

“knowledge or consent”. The Brick argued

that, even though its accounts payable em-

ployees did instruct its bank to make the

transfers, the instructions were induced

by a fraud that vitiated any knowledge or

consent on the part of the insured. The

Brick urged the court to interpret “consent”

to require informed consent – something

it said was absent here. Chubb argued that

information obtained from a prior fraudu-

lent communication – in this case, the in-

formation that the vendor had a new bank

account – did not transform the employ-

ees’ transfer instructions into instructions

given “without knowledge or consent”.

The court sided with Chubb, hold-

ing that, because “consent” was not

otherwise defined in the policy, it

should be given its plain meaning:

“permission for something to happen”.

Here, The Brick’s employee permitted

the bank to transfer funds out of The

Brick’s account and the court held that

this was sufficient to show the transfer

took place “with either [T]he Brick’s

knowledge or consent”.

The end result was that the insured

had not established the required ele-

ments of a covered loss under the FTF

insuring agreement.

Implications of the DecisionThe court’s decision in The Brick is con-

sistent with the underwriting intent of

the FTF coverage, which is to reimburse

the insured in the event the insured’s

bank transfers funds out of the insured’s

account under instructions from some-

one impersonating the insured. Where

the insured itself issues those instruc-

tions, there is no coverage.

The decision is also the first indica-

tion that Canadian courts are willing

to join the body of US precedent draw-

ing an increasingly bright line between

the risk of an outside fraudster taking

some action (what FTF and Computer

Fraud coverages are aimed at) and the

risk of a fraudster duping an employee

into taking an action (the risk addressed

by social engineering coverages). When

evaluating coverage in the wake of a loss,

the role of the third party is key to de-

termining which insuring agreement is

likely to respond.

For insureds, this decision shows

the importance of examining whether

the right coverage is in place for the

risks they intend to insure against.

Insureds who are concerned about

the risks posed by social engineering

schemes will want to consider pur-

chasing a social engineering rider or

standalone cyber coverage.

Anne is an associate at Lerners LLP in

Toronto and a member of Canadian De-

fence Lawyers. Her practice includes cover-

age advice and litigation in fidelity, directors’

and officers’, and cyber insurance matters.

Anne and Jamieson Halfnight, a Lerners

LLP partner, acted for Chubb in The Brick.



OTS• on the scene

CIAA member Joanne Morgan of Crawford, Dartmouth NS, won a recent Canadian Association of Insurance Women (CAIW) national public speaking competition in Montreal. Joanne, centre, is shown receiving her award from Donna Brown, with sponsor Intact on left, and CAIW director, Jacki Lisi, on the right.

John Tung

Dennis Van Luit

John Tung has joined Totten as vice president, professional lines. John brings over 23 years expe-rience to this newly created role. Most recently he was AVP at a major US-based insurer, responsible for the strategy and underwriting of professional li-ability and cyber, with a focus on technology. A Uni-versity of Toronto grad, John also holds a bachelor of commerce from Ryerson University. He is a Fellow Chartered Insurance Professional (FCIP) and a Fel-low in Risk Management (FRM). “John got in on the

built a stellar reputation on delivering skilled under-writing,” says Denis Dei Cont, COO and executive vice president of Totten

John will be responsible for a team of professionals handling E&O, enhanc-ing broker relationships, and developing new products.

FirstOnSite Restoration has strengthened the se-nior management team in Ontario by promoting Den-nis Van Luit to the newly created role of director of operations – Ontario. Dennis joins the leadership team of Jason Prescott who is senior vice president. In this new role, Dennis is supporting the growth of the Ontario Region, ensuring performance related to

to the local branches. “Dennis bolsters the strong existing team that continues to grow FirstOnSite in the Province of Ontario and ensures the company is

delivering the highest standards of customer experience in our industry,” says Dave Demosexperience, Dennis began his career as an adjuster before moving to resto-

-tors before it joined FirstOnSite in 2008, and continued to run the branch as

FirstOnSite’s new Ottawa branch, and added its management to his role.

APPOINTMENT

Aaron T. Lewicki

Claude Blouin and Jamie Dunn, Partners at Blouin, Dunn LLP, are extremely pleased to announce that Aaron T. Lewicki has joined the firm as an associate.

Aaron received his Bachelor of Arts degree in Political Science and Legal Studies (Joint Honours), from the University of Waterloo in 2012, and subsequently obtained his Juris Doctor from the University of Windsor in 2015.

As a student at Windsor Law, Aaron was an active member of the law school community. While completing his undergraduate degree, Aaron competed in four seasons of CIS varsity hockey split between Dalhousie University and University of Waterloo. Aaron is a four-time Academic All-Canadian.

Aaron was called to the Ontario Bar in 2016. Before joining Blouin Dunn, Aaron worked for a well-known, full-service firm in Hamilton where he gained valuable experience in insurance defence litigation.

Aaron practices in the areas of civil litigation and insurance defence, with a focus on motor vehicle accidents, bodily and personal injury claims, property damage, occupiers’ liability, and subrogation.

Outside of work Aaron enjoys cooking at home, live music, and physical fitness activities.

Aaron’s contact information is:[email protected]

(416) 365-7888 ext. 170

Blouin Dunn is one of Ontario’s leading insurance defence firms whose members have been providing quality legal support to the insurance community for over 30 years. We offer services in Ontario to property and casualty insurers throughout North America, at all levels of experience, at appropriate and competitive rates.

www.blouindunn.com


OTS• on the scene


Grace Klemke is the new regional sales manager for Western Canada with DAS Canada. Grace is a dedicated individual with more than 25 years of experience in the insurance industry. As a designated Chartered Insurance

-

and customers that align with their goals, values, and stra-tegic objectives. Grace is passionate about people and has devoted her time to providing mentorship, coaching, and education to sales professionals and those who are new to the industry. She is proud to lead the regional sales team

in Western Canada and has the pleasure of working with our top-notch broker consul-tants: Shari Sanders, Lynnette Cappis, and Crystal Lidgren.

MKA Canada Incappointed Etienne Nel as regional manager. Etienne has

experience gained on various projects in the contracting -

ule reporting, quality control and multiple subcontractor management. He has experience overseeing numerous projects spanning across South Africa, Canada, the Unit-ed Kingdom and extending into other parts of Europe.

role of construction project manager in Manitoba on a large-scale substation project. His experience included the management and

large containment pits.

30 Forensic Engineering has launched its newly redesigned website www.30fe.com. The revamped website offers visitors a seamless user experience with easy access to essential information which is now fully integrated with the

new website now falls in line with our 30 FE brand, and helps to tell the story of 30 Forensic Engineering, our growth as a company, and our vision of being a centre of excellence in forensic engineering and science,” stated , CEO of 30 Forensic Engineering.

Gra e Klemke

Tammy Nichol

Etienne Nel

DKI Canada introduces Tammy Nichol as the incoming director for Atlantic Canada. She will be based in Halifax, Nova Scotia. In her new role, Tammy will have overall responsibility for regional strategic planning, business development and account main-tenance. She will report directly to the senior vice president of DKI Canada, Paul Burns. “We are very

brings a unique skill set that we believe will allow us to successfully execute on our strategic objectives in the region and also continue to support both our

Atlantic membership and our clients’ business needs.” Tammy brings to DKI close to 20 years combined insurance, human resource development, account management and business development experience. In addition, she carries both her Chartered Insurance Professional (CIP) and Chartered Professional in Human Resources (CPHR) ) designations. She is currently pursuing her Ca-nadian Risk Management (CRM) designation. Tammy has recently returned from Christchurch, New Zealand, where she has been working to assist in the earthquake recovery.

APPOINTMENT

Michael Connors

The Insurance Council of British

Columbia (“Council”) is pleased to

announce the election of Michael

Connors, CIP, CRM as its chairperson

for 2017-2018.

Mike Connors is an independent

adjuster and a Partner in Payne, Travis

& Associates. Previously, he was an

independent adjuster and Partner

at Can West Claims Vancouver, an

independent adjuster with Meredith

Allan & Robinson, and a road adjuster

with Commercial Union Vancouver.

Mr. Connors has been in the insurance

industry since 1989 and was first

appointed to Council in 2012. He has

been a voting member since 2014.

Active in his community, he is a member

of Runners of Compassion, former Vice-

President of the Insurance Softball

League, a past coach with the Coquitlam

Minor Soccer League, and a member

of Nanaimo Ultimate Frisbee. He is an

ambassador with Career Connections

for the Insurance Institute of Canada.

Council is a regulatory body established

under the Financial Institutions Act, responsible for the licensing and

professional conduct of 38,000 insurance

agents, adjusters, and salespersons

doing business in British Columbia. Its

mandate is to uphold the public interest

in dealings with insurance licensees

by promoting ethical and competent

behaviour. Council consists of 11 voting

members with representation from

the life and P&C insurance industries,

adjusters, and non-industry persons.


OTS• on the sceneKernaghan Adjusters has expanded

its Nova Scotia team with the addition of Scott Lynds CIP, senior adjuster. Scott is a veteran large-loss property adjuster with over 30 years experience in the industry. His specialties include: complex com-mercial property, catastrophic bodily in-jury and commercial liability claims. “We are excited about the depth of expertise Scott brings to our team,” said Nova Sco-tia regional manager, Phil Harris

Scott’s adjusting knowledge spans a number of different loss types such as: marine liability, pharmaceutical malpractice, pollution and environmental liability, livestock, warehouseman liability and motor

and CEO, Patti Kernaghan FCIP, CRM, FIFAA stated: “I am very glad to welcome Scott back to KA. He is a great addition to our company and we value his loyalty and excellent work ethic.”

David Horner of Kernaghan Adjusters received his Chartered Loss Adjuster (CLA) accreditation from CIAA Western Region president, Jody Schmidt. Having met strin-gent experience and competency require-ments, David, successfully completed a

-erty courses, adjuster skill and knowledge courses as well as legal concept courses in contract law and tort law. He is now eli-gible to proudly display the CLA designation,

Scott Lynds

CIAA New Members — July 2017

CORPORATE MEMBERSHIP ESIS Canada Inc. Toronto, ON

INDIVIDUAL MEMBERSHIP

Bannatyne & Company General Insurance Adjusters Ltd.Peter MacKinnon Hamilton, ON Level 1

Coast Claims Service Ltd. Katie Fulton Victoria, BC Level 1

Cunningham Lindsay Canada Tracy Adamson, CIP Richmond Hill, ON Level 2Maria Codarin Hamilton, ON Level 2Ben Ogunleye, CIP Richmond Hill, ON Level 3

ESIS Canada Inc. Morgan Bonner Toronto, ON Level 1Jovan (John) Calkov Toronto, ON Level 2Krystal Elhajj Montreal, QC Level 1Fred Silvestri, BA, B.Ed, CIP Toronto, ON Level 3Emily Tanandar Toronto, ON Level 1

Midwest Claims Services Nathan Rivard, CIP Saskatoon, SK Level 3

Rocca Claims Jenna Levac Sudbury, ON Level 1

FIRST Insurance Funding of Canada (FIRST Canada) has ac-quired Insurance Premium Finance Company (IPFC). The two will offer payment solutions and service for brokers and clients in West-ern Canada. “We have been looking to expand our commitment and physical presence in Western Canada and as those in the industry know, good people are the hardest part of the puzzle. That’s why this opportunity to join teams with IPFC is a win-win for both our compa-

nies and our clients,” said Stuart Bruce, CEO of FIRST Canada. FIRST Canada is in the initial stages of the transition. There will be no impact to brokers and their clients.



OTS• on the scene

Cunningham Lindsey held a cocktail reception for more than 100 invited guesets on June 28 at Hy’s Steakhouse in Toronto, raising a toast to a late-breaking summer and highlighting the work of four of its specialty services divisions.


OTS• on the scene

The Ontario chapter of Women in Insurance Cancer Crusade (WICC) held a Canada 150-themed golf tournament on July 12 at the Angus Glen Golf Club in Markham, Ont. Thanks in large part to the financial support of numerous sponsors, the 18th-annual event raised $55,000 for the Canadian Cancer Society.

Spencer Bailey Assistant Branch Manager, West GTA Branch Hub (Mississauga, Hamilton and St. Catharines branch locations)Spencer brings a vast knowledge of claims adjusting to this position, with more than two decades of experience working in all aspects of the claim administration process. Spencer is an industry recognized expert and has a reputation for handling complex losses in the areas of residential and commercial property, general liability and environmental, with a special focus on greenhouse claims. He holds his Chartered Insurance Professional (CIP) designation and is licensed in all lines. In his new role, Spencer will be responsible for the direct supervision of front line associates in the property and casualty lines of business.

Mike McLeod Manager, West Ontario Branch Hub (Kitchener, Waterloo, Brantford, London and Windsor branch locations)Since joining Crawford in 1998, Mike has held positions as bilingual adjuster-trainee, all lines field adjuster, branch supervisor and branch manager. Mike has gained a wealth of knowledge in both his field and management roles. As branch manager, Toronto West,Mike was also instrumental in helping Crawford work through several large branch consolidations in the GTA. These experiences and his vast capabilities make Mike an ideal candidate for this role.

Joe Turcotte National General Manager, Insurer Markets As a claims professional for over 30 years at Crawford, Joe has held a number of progressive positions including multi-line claims adjuster, control adjuster, branch manager and national general manager, insurer markets. Throughout his professional career he has worked closely with many of Crawford’s insurer clients and has implemented effective service solutions. Joe is an active member of the Insurance Brokers Association of Hamilton and past president of the Ontario Insurance Adjusters Association (Hamilton chapter), and he holds his Chartered Insurance Professional designation from the Insurance Institute.

Keith Marentette Managing Professional, West Ontario Branch Hub(Kitchener, Waterloo, Brantford, London and Windsor branch locations)Keith began his insurance career in Windsor, Ontario with Crawford, as an all lines adjuster in 1975. Throughout his professional career he has held branch manager positions within Kamloops, British Columbia and London, Ontario. Keith will be working with Mike McLeod to help manage this growing area.

Mary Charman, Manager, North GTA Branch Hub (Newmarket, Barrie, Orangeville, Huntsville and Owen Sound branch locations) Mary has been with Crawford for over 22 years and is heavily involved in the insurance community. She holds executive positions with both the Canadian Independent Adjusters Association and the Ontario.

Kelly Stevens, Manager, West GTA Branch Hub(Mississauga, Hamilton and St. Catherines branch locations) Kelly commenced her insurance career in 1995 and has occupied numerous progressive roles with several insurers in the Ontario auto and property space. She has been with Crawford since 2007 and has been branch manager of the former Toronto West operation since 2015.

Crawford & Company (Canada) Inc. Makes Key Operational AppointmentsCrawford & Company (Canada) Inc., is pleased to announce the appointment of several key operational staff on a national level and within our Ontario operations. Joe Turcotte, an employee of Crawford for over 30 years

has been appointed to the position of national general manager, Insurer Markets. In his new role Joe will serve as liaison between Crawford’s branch network, operations and sales, with the objective of growing our business

through streamlining and simplifying operational processes and supporting branch functions.

On a branch level, a number of seasoned, highly successful Crawford branch managers have taken on managerial roles within their newly expanded branch networks. The appointment of Mary Charman, Kelly Stevens and

Mike McLeod as managers, Spencer Bailey as assistant manager, and Keith Marentette as managing professional for their respective branch hubs, will serve to enhance the operations of our branch network.

Crawford has strategically grouped its Ontario branches into hubs based on geographic proximity and service reach. These newly established service hubs consist of North GTA, West GTA and West Ontario, all of which serve as

the central location for surrounding branches.

This initiative, coupled with the professional acumen, service excellence and devotion to quality that former branch managers Joe Turcotte, Mary Charman, Kelly Stevens, Mike McLeod and Keith Marentette have displayed

throughout their careers at Crawford, serves to strengthen our operational excellence and service delivery to our clients.

www.crawfordandcompany.ca

$2.2 billion

$3.8 billion

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CIAA Members are proud to have played a critical role in assisting in the costliest insured natural disaster in Canadian history

The fire forced an entire city of 80,000 residents to evacuate for weeks and some for months and destroyed 2400 structures, including 1600 homes

CIAA members provide expertise in residential and commercial losses and were instrumental in adjusting losses to the infrastructure of Fort McMurray

Canadian Independent Adjusters’ Association (CIAA) members were on the ground in challenging conditions helping the citizens of Fort McMurray recover and rebuild. 108

Insurer Clients serviced by CIAA members:

total value of Commercial and Residential insured losses handled by CIAA members

Northern LightsRegional Health Centre CIAA member Adjusters handling the

hospital claim were among the first on the ground and went in on a military flight

ciaa-adjusters.ca

60%

CIAA Memberadjusters:

PCS Canada estimates total value

of Commercial and Residential insured losses at

Infrastructure – The one College; the one Hospital; all 41 schools; all municipality claims for Wood Buffalo; Restaurants; Churches; Retail stores

Documents

for Medical Marijuana - Canadian Underwriter · Boston, Massachusetts-based Novarica provided an overview of how payment gateways allow insurers to respond to cus- tomer needs, as