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HomeNews & ArticlesCIP Society Ethics Column – A Timid Claimant
General Interest


CIP Society Ethics Column – A Timid Claimant

April 4, 2016  |  By:  Michelle Baumann

A condensed version of this piece was included in the March 2016 edition of Canadian Underwriter Magazine as a response within its monthly ethics column. 

The original article can be seen on pages 48-49: http://goo.gl/wkmDeH

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Insurance companies have a responsibility to act with good faith in all dealings with insured persons. Despite this, adjusters do sometimes lose sight of the need to be fair and honest in their interactions with claimants.

When personal injuries arise as a result of car accident, the claimant is made particularly vulnerable. Adjusters must ensure that claimants are well-informed about coverages and must assist claimants in the claim process. In the balance of the relationship, it is the adjuster who is informed and it is the claimant who is uneducated; unless she is legally represented, the claimant is literally at the adjuster’s mercy during the claim experience.

In Ontario, medical and rehabilitation benefits are presently capped at $3,500, $50,000, or $1,000,000 depending on the severity of the injury and the pre-morbid health history. Adjusters often maintain coverage at minimal limits despite their claimant’s plea for more. Claimants may try to clarify needs and to provide supportive documentation but adjusters often respond with aggression and steadfast refusal.

It is safe to assume that most adjusters don’t attend work each day with motive of being unkind or unreasonable. Adjusters are busy folks; there is a constant flow of new claims, phone calls, paperwork, meetings and more. Adjusters are pressured and may at times present as impatient or uncaring. Further, with the monotony of minor claims, adjusters may slip into a routine of dismissing all claims as minor or, worse yet, fraudulent. This is unacceptable.

Adjusters must remain attentive for claims that appear minor which are in fact not. Minor traumatic brain injuries, as sometimes referred to as the “invisible injury” are an excellent example in this regard. Adjusters must be willing to listen to claimant concerns, to read the pertinent reporting, to arrange examinations as warranted, and to give genuine consideration to every claim.

Insurers, as employers, ought to be concerned when adjusters lack professionalism or display bad faith. Insurers should attend to the professionalism of its staff to ensure interactions are fair, respectful, and compassionate. Those adjusters who act inappropriately in their claims handling should be directed to develop their customer service skills and technical abilities. It would be expected that any adjuster who consistently fails to act with good faith would be subject to disciplinary action.

At Oatley Vigmond LLP, we have a dedicated team of Accident Benefits Specialists whose sole responsibility is to ensure our clients receive the benefits to which they are eligible and entitled to receive. The claims process can be difficult and stressful at a time when those injured in accidents, and their families, are already exceptionally strained. If you, or your loved one, are suffering as a result of injury or negative insurer interactions, we would welcome your contact directly.


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About the Author

Michelle Baumann

Michelle worked in the insurance claims industry for 10+ years before joining Oatley Vigmond as an Accident Benefits Specialist in 2012. In her past insurance work, Michelle achieved roles of...

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