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Public insurer’s Top 5 fraud cases of 2018 Canadian Underwriter

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Manitoba Public Insurance (MPI) has released its annual Top 5 list of insurance fraud cases for 2018. The list is compiled based on the unique circumstances of each fraud, financial savings to MPI ratepayer and “investigative excellence in unearthing the fraud.”

Suspicious claims are handled by MPI’s Special Investigation Unit (SIU). As of the end of November 2018, claims saving are more than $10 million, with the SIU closing 1,600 investigations. It’s estimated that auto insurance fraud costs every MPI ratepayer about $50 a year, for an overall impact of $50 million.

No. 1: “Comic Con Job”

A devout fan of Comic Con, the 25-year-old woman was observed walking around Winnipeg’s Convention Centre for six hours, enjoying the show. An investigator also observed the woman going on numerous shopping trips and driving the two-hour round trip from her rural home to Winnipeg.

Just one problem: the woman was collecting income replacement payments after stating she was unable to work due to injuries from a motor vehicle collision. She told her MPI case manager she could only walk a maximum of 15 minutes before getting dizzy and was unable to drive for long periods of time.

With all the conclusive evidence in hand, Manitoba Public Insurance terminated the woman’s income replacement payments and demanded repayment of $34,000 in benefits already paid out.

No. 2: “Polite Arsonist”

The registered owner opened a theft claim, telling her MPI adjuster she had given her car to her 22-year-old son, who reported the keys were stolen while he was attending a house party. The truth would become evident days later thanks.

One witness stated that while driving down a road in rural Manitoba around 7 a.m., he was shocked to see a man deliberately light a fire within his vehicle, which was parked in a ditch.

As the vehicle quickly became engulfed in flames, the witness stopped and asked if the man was okay. The young man replied, “Yes, thanks. And have a nice day,” before running off into the bush. The witness contacted RCMP.

The investigation would also uncover that the same vehicle had been involved in a hit-and-run collision the previous evening in Winnipeg. After being awoken by the loud crash, a neighbour quickly attended to the crash site where he came upon a young man who told the neighbour “not to speak to police.”

The man, who appeared highly intoxicated, then quickly drove away in a Dodge Nitro – the same vehicle which was burned hours later in the rural ditch.

Police showed photos of several individuals to the witnesses, who were able to conclusively identify the driver. With the evidence in hand, the claim was denied for false statement, resulting in a savings of $57,000.

No. 3: “Breakfast Blunder!”

The registered owner of the vehicle opened a total theft claim with her MPI adjuster after police found her vehicle badly damaged. She reported she had given her vehicle to her 45-year-old son, who told MPI staff he had gone for breakfast with his brother at a downtown hotel.

The son presumed an opportunistic thief must have taken the vehicle keys out of his unattended sweater, which had been left on a chair.

The man’s story quickly unravelled when hotel staff confirmed the restaurant hadn’t served breakfast in a number of years and the brother stated he hadn’t seen his brother in over nine months.

MPI subsequently filed a Statement of Claim for repayment of the $22,800 already paid.

No. 4: “Not So Jolly Christmas Party”

The Winnipeg man told his adjuster that while he and his girlfriend were attending a Christmas party, someone stole his vehicle from a parking lot. He confirmed that he was missing a key. The man’s Dodge Journey was recovered not far from the man’s residence – badly damaged after crashing into a tree.

An investigation was launched after several suspicious circumstances came to light. Investigators would learn the man and his girlfriend did return home from the party, with the male appearing highly intoxicated and agitated. Shortly after arriving home the 22-year-old vehicle owner was seen driving off in his vehicle.

When presented with all the facts the vehicle owner withdrew their claim. Savings totalled $22,600.

No. 5: “Vehicle Technology Tells All”

Thanks to an anonymous call to MPI’s Tips Line, Autopac ratepayers were saved nearly $40,000.

The vehicle owner opened a claim after his 2014 Nissan Titan was badly damaged after crashing into a ditch in rural Manitoba. The man claimed that he was driving at the time of the crash. However, investigators believed the man’s wife was actually driving and was heavily intoxicated at the time of the crash. However, police were unable to place her at the crash.

The vehicle owner was told that the vehicle’s onboard crash data recorder had been removed and MPI staff were going to download the data to confirm occupants’ weight in the front seat at the time of the crash. The man then withdrew his claim.

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Multiple trucking violations by Humboldt semi driver noted in government report Canadian Underwriter

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MELFORT, Sask. – A Saskatchewan government report says the driver of a semi-truck should not have been on the road the day he flew through a stop sign and caused a crash with the Humboldt Broncos team bus.

The report filed during the sentencing hearing for Jaskirat Singh Sidhu notes 51 violations of federal trucking regulations on drivers’ hours and 19 violations of Saskatchewan trip inspection rules.

It includes the 11 days prior to the April 6, 2018, crash at a rural intersection that killed 16 people and injured 13 others.

The wreckage of a fatal collision, involving a bus carrying the Humboldt Broncos junior hockey team, outside of Tisdale, Sask., is seen Saturday, April, 7, 2018. THE CANADIAN PRESS/Jonathan Hayward

“If Jaskirat Singh Sidhu had been stopped and inspected on April 6, 2018, prior to the incident he would have been placed under a 72-hour out-of-service declaration … preventing him from operating a commercial vehicle,” says the report.

The document is signed by two senior Saskatchewan government officials and is included in the RCMP’s forensic collision reconstruction report.

It expresses concerns about the distances Singh was driving as well as the amount of time he took off to rest.

The report notes that if Singh had accurately documented his time at work on April 1 it ‘would have resulted in the driver being in violation of the maximum on-duty time of 14 hours for the day.”

The report says questions remain about what happened the day of the crash.

“We have strong concerns regarding the timelines of Jaskirat Singh Sidhu’s day on April 6, 2018, as there are unanswered questions as a result of the incomplete log on that day,” it says.

“The identified mileage and distances required to travel to the locations identified in the log and known locations also cause concerns.”

Sidhu had been driving for about a month before the crash occurred.

The owner of the Calgary-based trucking company, Sukhmander Singh of Adesh Deol Trucking, faces eight charges relating to non-compliance with federal and provincial safety regulations in the months before the crash.

They include seven charges under the federal Motor Vehicle Transport Act: two counts of failing to maintain logs for drivers’ hours, three counts of failing to monitor the compliance of a driver under safety regulations, and two counts of having more than one daily log for any day.

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Signs of progress on national flood program for Canada Canadian Underwriter

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Canada is making good progress on a national flood program, pending a final decision by federal, provincial and territorial (FPT) ministers responsible for emergency management.

“What they are looking at is one national insurance solution to improve outcomes for high-risk Canadians across the country,” Craig Stewart, vice president of federal affairs at Insurance Bureau of Canada (IBC) told Canadian Underwriter in an interview Tuesday. “There may be regional insurance pools adapted to local conditions, but it would be nationally coordinated.”

FPT ministers responsible for emergency management have mandated IBC to lead a national working group to take a look at options and what they would look like. IBC provided three options:

  • A pure market approach (like in Germany and Australia) where governments exit disaster assistance
  • A broadened version of the status quo, but with better-coordinated insurance and disaster assistance
  • Deployment of a high-risk pool analogous to Flood Re in the United Kingdom.

The next step is for the working group, which Stewart chairs, to cost out the pool. “The pool needs to be capitalized as it was in Flood Re,” Stewart said. “So, we need to figure out where that money is going to come from. Is it going to come from governments? Is it going to come from insurers? Where is it going to come from?”

A final decision will be made by ministers after the high-risk pool is costed, which Stewart expects to be completed by June. Decisions on eligibility, how to capitalize the pool, and on any cross-subsidization await the results of that costing analysis.

In addition, this spring, the ministers will hold a technical summit on flood data and science. “Our view of the risk many not align with the government’s view of the risk,” Stewart said. “We need to bridge the gap. This symposium is going to focus on essentially the data and science of flood modelling.”

In early 2020, there will be the launch of a consumer-facing flood risk portal. IBC has been working with the federal government to develop the authoritative flood portal, where consumers can discover their risks and what to do about them.

“Elevating consumer awareness of flood risk is key,” Stewart said. “Consumers aren’t going to be incented to protect themselves or to buy insurance unless they know their risk.”

In May 2018, FPT ministers responsible for emergency management tasked IBC to lead the development of options to improve financial outcomes of those Canadians at highest risk of flooding. IBC worked with a wide range of insurers, government experts, academics and non-governmental organizations to produce the three options, which were tabled with ministers last week.

The ministers released the first-ever Emergency Management Strategy for Canada: Toward a Resilient 2030 on Jan. 25. The document provides a road map to strengthen Canada’s ability to better prevent, prepare for, respond to, and recover from disasters.

“In less than two years, Canadian insurers have secured a mandate with every province and territory to finalize development of a national flood insurance solution, have successfully catalyzed a national approach to flood risk information, have secured over two billion dollars in funding for flood mitigation, and have succeeded in securing a funded commitment for a national flood risk portal,” Stewart said.

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Insurers disagree over meaning of ‘household’ in policy language Canadian Underwriter

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A dispute over what exactly constitutes a “household” in a home insurance policy has reached the Court of Appeal for Ontario.

Several members of the Weiner family were sued after a person drowned in 2010 in a vacation home on Lake Eugenia, about 70 kilometres west of Barrie.

The homeowner was Enid Weiner, who had moved to a nursing home in 2008 or 2009 and has since passed away.

The home was insured by Intact. Enid Weiner was the only named insured, but the policy provided liability coverage for relatives of the named insured while those relatives were “living in the same household” as the named insured.

Whether this means Intact is also providing liability coverage for Enid Weiner’s adult son, Scott Weiner, was a source of disagreement among judges and insurers alike.

Scott Weiner, along with his wife and daughter, were named defendants in the drowning-related lawsuit. Also named was the estate of Enid Weiner. Scott Weiner used his mother’s house as a cottage but did not live there permanently.

Scott Weiner’s own insurer, TD Insurance, settled the lawsuit. TD Insurance took Intact to court arguing Intact has a duty to defend the lawsuit.

As it stands, TD has lost its case.

“The mere fact of co-residence is not enough to constitute membership in a household,” wrote Ontario Court of Appeal Justice Bradley Miller in Ferro v. Weiner, released Jan. 28, 2019.

Initially, Ontario Superior Court of Justice Pamela Hebner ruled in favour of TD. In her ruling, released Apr. 12, 2018, she ordered Intact to pay $62,500, or half the cost of settling the lawsuit.

Justice Hebner found that Scott Weiner was in the same household as his mother. He came to the cottage when he wished and took care of it as if it were his own place.

But Justice Miller of the appellate court countered that, at the time of the accident, Enid was living in a nursing home.

“Scott lived with his family in the city and had organized his life around his urban household. Prior to entering the nursing home, Enid lived with Scott’s brother, and not with Scott and his family,” added Miller, citing several court rulings, including Wawanesa Mutual Insurance Co. v. Bell, released in 1957 by the Supreme Court of Canada.

Wawanesa v. Bell arose after Murley Miller was killed in 1955 while driving a Vauxhall car owned by his brother, John Milley.  Other victims of that accident sued Miller’s estate. Murley lived at John’s home in Sarnia.

The court in the 1957 case defined the term “household” in the following way:

“The ‘household,’ in the broad sense of a family, is a collective group living in a home, acknowledging the authority of a head, the members of which, with few exceptions, are bound by marriage, blood, affinity or other bond, between whom there is an intimacy and by whom there is felt a concern with and an interest in the life of all that gives it a unity.”

Members of a household could include domestic servants and distant relatives living there permanently, the court found in 1957.

“Although a household is not synonymous with a family, the existence of a household is evidenced by the extent to which its members share the intimacy, stability, and common purpose characteristic of a functioning family unit,” Judge Miller of the Court of Appeal for Ontario wrote in 2019 in Ferro v. Weiner.

Members of a household “typically share a residence and resources, and integrate their actions and choices on an ongoing and open-ended basis,” added Miller.

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