Trained to Help

The Financial Services Commission of Ontario (FSCO), which regulates the insurance industry in Ontario, completed its mandatory review of Part VI of the Insurance Act and submitted its recommendations to the Minister of Finance in March 2009. The Ontario Ministry of Finance adopted several of FSCO’s recommendations in its proposed changes to the Ontario auto insurance product, which the government announced in November 2009. One of these adopted proposals, Recommendation 35 in FSCO’s report, will have a direct affect on the province’s adjusters.

In this article, I will discuss the implications of Recommendation 35, as well as the Ontario Insurance Adjuster Association (OIAA)’s position on the recommendation. Basically, the province has deemed that the OIAA should have a direct role in the training of adjuster to handle catastrophic cases properly.

BACKGROUND

Ontario’s legislature amended the province’s Insurance Act in 2003 to change Section 289.1.With that new change, FSCO’s superintendent was given responsibility to review Part VI of the act, as well as any regulation therein, at least once every five years — or more often if requested by the minister of finance. The superintendent is obliged to report back to the government on how the Act is working and provide recommendations on changes to improve the act for Ontarians if they are needed. To prepare for its report, FSCO started consulting with various stakeholders in the summer of 2008.

The stakeholders were made up of a diverse group, with different levels of experience and perspective. Among the participants were insurers, insurance professionals, defence and plaintiff lawyers, health care providers, consumers, municipal authorities and brokers. Many of FSCO’s recommendations were based on the opinions provided by the stakeholders.

FSCO’s final document, submitted to the minister of finance, touched on the profitability of the property and casualty insurance sector and the trend of financial results — including how the 2003 reforms affected the cost of losses in the first year after the reforms, and how loss costs have trended since. The superintendent commented in 2009 that increasing loss costs and the current levels of rate increases are not on an equal pace. The industry as a whole has seen a year of declining profitability, lower earnings and higher costs. Without real changes to stabilize costs, claims costs will continue to accelerate.

To address this trend, the government has announced 41 proposals to bring back auto insurance product stability. The recommendations cover all aspects of insurance in Ontario from accident benefit to tort claims; consumer protection to premium costs. The report addresses the availability of insurance to the general public, the dispute resolution process, public education and managing claims involving serious injured claimants. I now turn to the role of the adjusting community in managing claims involving serious auto injury claimants.

OIAA AND TRAINING

One point emphasized in FSCO’s March 2009 report is the overwhelming complexity of the province’s auto insurance system. However, many of the recommendations submitted by the stakeholders to fix the system in fact add to its complexity.

The OIAA received a copy of FSCO’s report, reviewed the document and discussed it over several of our monthly meetings. We immediately focused in on Recommendation 35, which directly involves our association.

Recommendation 35 reads: “Insurance claims departments need to better focus on the needs of claimants with serious injuries. The IBC, 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.”

In our OIAA meetings, we discussed the main parts of Recommendation 35.

OIAA ROLE IN TRAINING

The first question we asked was: Is there a role for the OIAA in training of adjusters?

Yes, there is, and the OIAA definitely wants to be involved. Our mandate as an organization is to be a leading educator of our members and to adjusters in general in Ontario. We expect our magazine, Without Prejudice, to be perceived as a reference tool for adjusters. When adjusters come across an unusual claim on their desks, we would like them to remember an article they recently read in our magazine and go back to that issue for the answer. In addition, our annual February Claims Conference and Professional Development day is the largest of its kind. It is a day full of seminars for adjusters across all insurance lines.

PARTNERSHIP IN TRAINING

Secondly, we asked: Do adjusters handling serious injury cases need more training? We have many accident benefit adjusters among our membership; several members of our executive handle mainly accident benefit claims. After talking to our members and executive members who work in all regions across the province, we concluded that more training is indeed required.

The training should be a team effort with two other organizations mentioned in the report: the Insurance Bureau of Canada (IBC) and the Insurance Institute of Ontario (IIO). Our next step was to reach out to these two organizations and obtain their input; we have since put a committee together consisting of members of all three organizations to produce combined ideas on the training.

Each organization has different areas of strength. The IIO has locations across the province available to be used for in-class lessons. They have an extensive library of course material that could be used or adapted for our purposes. At the OIAA, we have our membership list and various ways to communicate to our members, allowing us to learn from them about what areas of training they feel are needed and how to best deliver the training. We provide regular educational seminars for our members across the province. We have a close working relationship with our vendor partners, including health care providers who can provide input on subject matter and lecturers from among from among their ranks. The IBC has a roster of member insurance companies whose staff makes up the majority of the adjusters in the province. The trade association thus has a strong working relationship with decision-makers at the insurance companies.

METHODS AND OBJECTIVES

If we are going to train adjusters, we must determine the best method to deliver the training. The range of different options is wide. There could be full-or half-day formal classroom sessions, correspondence courses, Webinars or in-house training at the insurance companies, to name a few. To obtain the thoughts of our membership, we sent out a survey to all of our members, asking them to comment on the best method of training that suits their needs.

Based on comments made by FSCO’s stakeholders and the language of the government’s proposal itself, the goal of the training is to produce adjusters with the expertise necessary to quickly identify the services available to seriously injured claimants and deliver those services promptly. Adjusters should be able to identify required assessments; also, their timing should be on the mark when it comes to assessing the nuances of each individual case. In addition, adjusters must have the right claim count in order to deal with these cases correctly. Having the right claim count will help to reduce the turnover of adjusters on these files and keep these specialized individuals on staff to mentor up-and-coming adjusters as they start to handle more complex accident benefit cases.

Our organization expects the end result will be accreditation. In other words, a certificate, designation or diploma will identify specialized individuals who are trained and qualified to handle serious injury cases. Our next step in conjunction with the IIO and IBC is to determine what materials ar e required, how they should be delivered and who will deliver the material. We also have to consider funding for the production of course material and to retain the professionals required to teach adjusters the skills needed to handle complex accident benefit cases confidently.

Our research is ongoing. We are looking at internal and external training in the community. We do not need to reinvent or start a new form of education if resources in the community already exist that we can leverage for our purposes and for the benefit of our members, adjusters in general and the general public as a whole.

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The OIAA expects the end result to be accreditation. In other words, a certificate, designation or diploma will identify specialized individuals trained and qualified to handle serious injury cases.

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The goal of the training is to produce adjusters with the expertise necessary to quickly identify the services available to seriously injured claimants and to deliver those services promptly.