Getting Back to Basics

You know you are an adjuster when you have sat at the same desk for four years and worked for five different companies. The joke, explains Louise Rivett, is a statement of the market facing adjusters today. As incoming president of the Ontario Insurance Adjusters Association (OIAA), Rivett says adjusters are facing shrinking markets and greater demands on their knowledge and skills.

Yet, facing changing legislation, litigation threats, and market forces, the key ingredient in the adjuster’s repertoire remains customer service, and it is sometimes the biggest challenge, Rivett admits. “One thing about adjusters, whether they be seasoned or junior, it’s hard to make customers happy when they want everything covered…this is a customer-service driven industry,” she notes.

In regard to auto insurance in Ontario, “the government tells you what you’re going to sell, how much you’ll charge and how to deliver it.” Nonetheless, in a constantly changing product environment, understanding and interpreting coverage is of as much importance as ever. This translates to being able to explain coverage limitations and exclusions in a way that clients can understand and accept. These “basics” of the adjusting trade are the foundation in the shifting insurance world, where insurer’s dismal financial results of the past few years are focusing attention on rising loss costs. Despite this pressure, the makings of a good adjuster remain the same, “common sense, no assumptions, being able to establish a rapport in order to instill confidence so that they [the adjuster] can properly investigate, someone who can articulate both good news and bad news to a client, someone who knows what the product is”.

Smaller markets

“As mergers and acquisitions go forward, adjusters’ markets are getting smaller. Expectations on claims people are quite high,” observes Rivett. With fewer companies to work for, either as inhouse claims staff or as independents, adjusters are taxed to do more, know more, and keep the lid on loss costs.

Technology also presents challenges. As adjusters move through the market they are faced with a wide diversity of technology adoption levels, a situation that is frustrating for adjusters, clients and suppliers as well. The adjuster who has worked for five different companies has likely used five different systems and is expected to perform equally well in all, she notes.

Consolidation has also been a factor from an association standpoint, she adds. It has challenged the OIAA to increase its ties with other organizations in the industry. The goal is to market the OIAA’s product, education, to a wider audience. These organizations include the Canadian Independent Adjusters Association (CIAA), the Canadian Insurance Claims Managers Association (CICMA), of which Rivett is also a member, and now the Ontario chapter of the Risk and Insurance Management Society (ORIMS). Rivett sees ORIMS members as a great market for the OIAA’s educational offerings. “Members are drawn in a lot of different directions,” she admits. “We are in competition with other associations, other educational facilities, including companies, including the Institute [Insurance Institute of Canada].” Despite this competition for adjusters’ scarce time, she notes that “great strides” have been made in strengthening ties to these other groups.

Status quo?

One issue with which the CIAA, CICMA and OIAA are all watching with interest is the potential for adjuster licensing. While last year’s decision in Alberta seemed to some a death knell for the future course of licensing in Ontario, as insurers fought to keep staff adjusters from being required to hold licenses and won.

The CIAA’s president Keith Edwards has affirmed the association’s desire to see independent adjusters licensed nationally, and wants to be the overseeing organization in this process. Currently in Ontario, independent adjusters must be licensed with eight course requirements from the Financial Services Commission of Ontario (FSCO). There is also no continuing education requirement for independents, and staff adjusters do not require licenses. Despite any push from the CIAA or other organizations, it is “status quo” in Ontario for adjusters. If, and when a national licensing system, or continuing education requirements for independents might be put in force, are issues that continue to be debated.

Rivett points out that if a continuing education requirement were to be added for independent adjusters, the association would like to be an accredited provider of courses. She is confident that if this situation arises, the OIAA would be recognized as an educational body. “We have a respected and recognized professional association.”

Privileged information

In the meantime, the OIAA is looking to develop new courses and seminars to draw in adjusters. And there is a wealth of emerging issues that could be tackled.

Privilege is one area where education is needed, suggest Rivett. There is a need to keep adjusters up-to-speed on “what can go in a [claims] file, disclosure of a file, and what information is confidential to the adjuster and the company”. Adjusters need to understand “that they could be called upon to answer for anything in a file, including in court”. The same privilege enjoyed by doctors and lawyers with their clients does not extend to adjusters. On the other hand, files need to contain all the necessary information to justify claims decisions. Adjusters also need to understand if they will be protected by the insurers they are representing if such a court case arises.

The recent trend, particularly evident in the U.S., to adjusters being named personally in bad faith lawsuits has caused concern throughout the profession. But, following original fears, Rivett notes that in the cases she is aware of employers have backed adjusters, ensuring that their personal assets are not put in peril.

Adjusters are also riding a learning curve with the new federal privacy legislation. Rivett sees the legislation as being an overall positive step, despite original fears that the requirements might impede the ability of insurers to tackle fraud. She credits the Investigative Services Division of the Insurance Bureau of Canada (IBC) for dealing with the issue by being named as the industry’s representative fraud control body with the responsibility to collect and disseminate information in a controlled fashion in order to assist in claims investigation. “[The system] does work well and gives that extra bit of integrity [to investigations].”

Other legislative issues that adjusters will be watching with interest are changes to snowmobile regulations that would see drivers licensed, and changes to the way healthcare claims, particularly accident benefit and bodily injury claims, will be handled in Ontario. With the IBC already victorious in having a standard healthcare invoice implemented, Rivett says she hopes regulatory changes in this area “will alleviate some of the stresses on adjusters in terms of compliance”.

Inspiring involvement

With adjusters becoming increasingly specialized, finding common ground in course offerings is a challenge, Rivett admits. And she adds that getting members out to the educational seminars will be a prime goal for the coming year.

Membership remains high, and social events are well attended, including events held outside the Greater Toronto Area (GTA), as well as the association’s annually held trade show. However, educational seminars held within the GTA, including the educational component of the trade show, have not been well attended in the past. “We need to market ourselves a bit more,” she says, particularly to employers, whose support is required if their claims staff are to take time away from work to become more involved with the OIAA.

The association has also changed its format, now offering seminars during the day, in conjunction with its luncheons, in order to increase attendance. So far the plan has worked, with the most recent seminar being sold out. Rivett wants to see this momentum continue, and emphasizes the value to members of getting out of their offices and taking part, particularly for the opportunity to network with other members. “The OIAA provides a wealth of experienced members who can share their war stories…we all get into jackpot claims and we all get snowed under, it’s comforting to know you’re not the only one.”

This is a lesson the OIAA executive is taking to heart, and this year they have for the first time formally met with past executive committee members in order to learn from their “war stories”. A survey of the membership was also conducted to look at areas for improvement and to understand what members see as the association’s value.

Personal insight

Rivett herself brings a wealth of experience to this presidency. She has been in the business since the late 1970s, and has worked for both independent and company adjusting departments first in her hometown of MacTier, Ontario, then in Orillia, and later Toronto.

In 1991 she started her own adjusting firm, one of few women in the industry to take this step. In the seven years she operated Candor Insurance Adjusters Ltd., Rivett began to specialize in fraud investigations. “What I learned from those years is I never prejudge any fact, I never assume anything.”

She was also a founding board member of the Canadian Association of Special Investigation Units (CASIU). The original board wanted to “tie together Canadian provinces with information”. In 1998 she merged her firm with Shumka, Craig and Moore, and now works for Crawford Adjusters Canada, where she manages a large commercial account with exposures across North America. It has given her the chance to deal with the different regulatory structures of each jurisdiction, on both sides of the border, particularly in auto insurance. She holds the CIP designation from the Insurance Institute of Canada. Rivett has also gone “back to the basics” in her personal life, as she and daughter Pamela have relocated from the city to a farm near Shelburne, Ontario.