Putting the Person Back Into the Injury

As Ontario sharpens its focus on auto injury claims, the job has become increasingly complex for the adjuster. For the first time, industry organizations are partnering to develop and deliver training that will allow the adjuster to handle serious injury claims better.

Over the years, experts contend, the adjusters’ job became that of a “box checker.” Mired in forms and paperwork, it became easier for the adjuster to lose sight of the person who had the injury – an approach that does not always facilitate the best possible path to healing.

Gaps in Training

The Financial Services Commission of Ontario (FSCO) identified this gap during its recent review of Ontario’s auto insurance legislation and recommended improved adjuster training. In response to the recommendation, Ontario Independent Adjusters’ Association (OIAA) partnered with the Insurance Institute of Canada (IIC) to develop ‘Understanding Serious Injury Adjuster Training and Education.’

Over the course of its most recent five-year review of Ontario’s auto insurance scheme, FSCO made a series of recommendations to the Ontario Ministry of Finance in early 2009. The province announced in November 2009 that it would adopt several of the recommendations as part of its auto insurance reform package, introduced in September 2010. Among them, it adopted Recommendation 35, which suggested adjusters should be better trained to deal with serious injuries.

Recommendation 35 read: “Insurance claims departments need to better focus on the needs of claimants with serious injuries. The IBC [Insurance Bureau of Canada], Insurance Institute of Ontario and the Ontario Insurance Adjusters Association should work together to train adjusters on the needs of claimants with serious injuries to reduce exposure to potential allegations of unfair and deceptive acts or practices.”

Tammie Norn, president of Proformance Adjusting Solutions and second vice president of the Ontario Independent Adjusters’ Association, contacted FSCO to ask why the recommendation was made.

“At that point, FSCO advised there was some feedback from the health care industry with regard to adjuster training on serious injuries,” Norn says. “[The health care providers] had mentioned they were seeing some not-so-great arbitration decisions coming out of FSCO, and some of those had to do with not-so-great adjusting or adjuster knowledge on the serious injury side.”

The OIAA formed a strategic committee and surveyed its membership to identify perceived gaps in the current training offerings. “We surveyed the membership,” Norn said. “And the membership said: ‘Yes, we believe in training. We see a need for this type of [serious injury] training. And yes, we would love to send our adjusters to something like this.'”

Industry Collaboration

OIAA then met with the IIC and IBC to see how the three groups might collaborate to develop and deliver such training. “We had two meetings with the IBC,” Norn says. “From their view, they would support any training of their membership (the insurance companies), but they’re not an entity that provides the actual training.”

The IIC is well known for its specialty in training people in the insurance industry, Norn says. “They have the facilities, the resources and the manpower to develop and deliver the training product.”

The OIAA, on the other hand, has the expertise and knowledge base to help identify needs and help create content. “Then we leverage the IIC to deliver that product,” Norn says. “It’s a great partnership.”

The difference between this training program and courses currently offered is that the serious injury training will focus more on the injury and the person rather than on the nuts and bolts of the regulations. “It’s not about the Statutory Accident Benefits Schedule, it’s not about accident benefits and it’s not about bodily injury,” Norn says. “It’s about how an injury affects a person and how the different characteristics of a person might affect healing and recovery.”

Norn says the serious injury training program is intended to augment the “amazing job of training” insurance companies already do. But the training insurers provide tends to be about the different forms involved in an assessment, and what to do with the forms when adjusters get them. “This [serious injury] training is focusing on how that form might be affected by the person and the psycho-social factors around them,” Norn says. “The course material is much deeper and a reflection of real-life and the different circumstances each injured person may face.”

Nuts and Bolts of the Program

The training intends to modify the way an adjuster views the claim and injury, by expanding the perspective to include not just the physical ailment, but what external forces may affect the healing of that ailment.

Dawna Matton, senior director for Ontario at the IIC, says the program will consist of five modules. Each will be two days in length and they will be spread out over the course of 10 weeks.

“Setting it up this way provides the opportunity for participants to have two days of learning, and five days of thinking before moving onto the next module,” Matton says.

A facilitator will lead participants through each module. Each module will also have a subject matter expert and possibly a guest speaker specializing in that specific area.

The five modules will cover the following topics:

• Getting to Know the Injury: Medicine for the Non-Medical. This module focuses on skeletons, muscles and anatomy to give a foundation for the program.
• The Person Behind the Injury: Sociological and Psychological Impacts.
• Other Contributors: Community Resources. “Local community services, occupational therapists and vocational specialists can have a positive impact on injury healing,” says Matton. This module is designed to teach adjusters the resources available to them and how they might leverage them.
• Understanding the Opportunities for the Future, Managing Expectations. “This focuses on the difference between acute and chronic injuries, and how the adjuster might do some planning for post-injury and treatment,” Matton says. “So when the injury is healed, what happens? Some people are rehabbed, and some will never heal completely, and that’s huge in terms of healing and the adjustment of the claim.”
• Applying the Tools: Case Study and Group Work.

The fifth module is key, Matton says. Participants will use all of the knowledge gained in the first four modules to work through a case study. The approach is practical, rather than theoretical, Norn says.

“Participants will have a case presented to them, and they’ll work through it in groups,” Matton says. “As the two days unfold, more information will be added to the case – an additional piece of information, a new development in the injury – in the same way a real claim would unfold. Using what they learned, they will go through and have some lively discussion about the best way to handle it.”

The pilot program is targeted for late 2011. With a maximum of 40 participants, the course is structured so that if it is successful, the framework can be applied and tailored to other jurisdictions in Canada.

Although the program is not a part of a designation or certification program, participants will receive a certificate upon completion. Norn adds the committee developing the program has updated FSCO on their progress, and accreditation is not out of the question.

More information is available at www.insuranceinstitute.ca/seriousinjury.