Claims Conversation

The leaders of the Big Four national independent adjusting firms discuss the most pressing issues around loss activity

Hot Topic: SABS

The Ontario SABS legislation that was implemented in September 2010 continues to affect loss activity, with some IAs experiencing a decline in the number of reported Accident Benefit (AB) claims. Adding another twist to the matter is that new legislation requires a learning curve in the way the courts handle claims.

According to Greg Dunn, executive vice president, claims and customer service operations at Aviva Canada, there is a disconnect between the judges and the juries when determining what qualifies as a “serious injury.”

“Judges are showing a fairly liberal approach to the types of impairments/injuries will qualify as serious and therefore pass the serious injury threshold, even in cases where juries’ non-pecuniary damages awards make it clear that the juries see these impairments/injuries as minor,” he says.

Dunn adds reform changes are performing well overall, however, some insurers have experienced an increase specifically in bodily injury claims at levels that were not anticipated.

To manage the changes to the SABS legislation, Aviva has reorganized its healthcare services team to ensure it is meeting the needs of its customers.

“Ontario results are favourable following the reforms, however, we expected a honeymoon period following their implementation,” explains Dunn. “It remains to be seen whether the reforms will hold as intended or whether there will be deterioration once more claims work their way through the system.”


 Hot Topic: Hiring and Retention

An ongoing issue in the industry is the hiring and retention of skilled staff. From a claims perspective, the issue is two-fold. First, many insurance companies do not have a resident claims handler, which leads to delays in the resolution of claims, according to Bob Grouchy, assistant vice president and head of claims Canada at Allianz.

“There are less individuals entering the claims field and those who do, tend to find the job extremely difficult,” he says. “Therefore, attrition is high and adequate staff training becomes a key issue.”

Second, the lack of skilled adjusters is an issue for insurers because it’s difficult for insurers to obtain clear, concise reporting to enable quality and timely decision-making, according to Spencer Shusterman, senior vice president, claims at Aegis, a Lloyd’s syndicate.

“It appears the industry has not done a good job in training and developing adjusting talent to succeed current senior technically, proficient personnel,” says Shusterman. “The number of qualified adjusters who can properly investigate and report with clear recommendations are relatively few in number and we do not see a systematic effort or investment on the part of the national firms to address this.”

He adds the decline in the number of skilled adjusters is only further driven by the consolidation of adjusting firms.

“We think that what is a somewhat limited field has shrunk even further limiting the choice of service partners,” says Shusterman.


Copyright 2012 Rogers Publishing Ltd. This article first appeared in the January 2012 edition of Canadian Insurance Top Broker magazine.

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