Insurance Training Manual

BODILY INJURY TRAINING
MANUAL-ALBERTA
WRITTEN FOR RBC GENERAL INSURANCE-LAURA TISCHER

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TABLE OF CONTENTS
PAGES
1. Introduction to Bodily Injury Claims 3-4
2. New Claims-Including; New Features, Contacting the Insured, 4-8
the Third Party, Reserves, Statement of Claim, Final Releases,
Underwriting Notes and, Diaries
3. The Use of Independent Vendors -9-
4. HEAT Notices, Large Loss Reports, Interim Large Loss 10-11
Reports, Large Loss Diaries and, Authority Requests
5. 90 Day Reports and, Yearly Reports -12-
6. Computation of Damages-General Principles, Non-Cap 12-16
Claims, Multiple Tortfeasors, Capped Claims and, SEF 44
Claims
7. Legislated Claims
>Homeowner’s Liability Claims 16-18
>The Motor Vehicle Accident Claims Program 18-19
>Workers’ Compensation Claims -19-
>Minor and Dependant Adult Claims -20-
>Fatality Claims (F.A.A) 21-22
8. Legal 22-23
9. Relevent Acts 24-25
10. Appendix 26-31
> (A) HEAT Notices
> (B) Large Loss Report
> (C) Interim Large Loss Report
> (D) Litigation Form-Opening
> (E) Litgation Form-Closing

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INTRODUCTION TO BODILY INJURY (BI) CLAIMS
Claims for bodily injury are well established in Common Law and, fall under the branch of law
known as tort law.
A BI Injury claim refers to those claims where there exists a right to sue. This right to sue exists
only if negligence can be found against a liable party (or at-fault party). A person may sue a
liable party where their negligence has caused death, injury or loss to an innocent party.
Coverage for these “damages” is found under the Third Party Liability section of the Alberta Auto
Policy S.P.F. No.1. Each Province has a legal minimum third party liability requirement, in
Alberta it is $200k.
The liable or negligent party is referred to as the tortfeasor. In our dealings this is typically the
Named Insured (NI) or anyone, who with the NI’s permission, is operating the NI’s automobile at
the time of the accident.
The tortfeasor is expected to make good the wrong, by compensating the injured party for their
loss. The intended purpose is, to place the person in the same position they would have been in
had, the accident not occurred.
This involves a financial payment called compensation or a damage award.
The most common and easily recognizable BI claim exists where the named Insured (NI) is
liable for the accident and the third party (TP) has sustained a loss. In this case both passengers
in the NI’s vehicle and, the TP may pursue claims against the NI’s policy.
The passengers in the insured’s vehicle would have what we call a “passenger hazard” claim.
Cyclists and, pedestrians may also present a claim where our insured is liable.
A third party could be:
1. NI’s passengers (this could also be the NI, if travelling as a passenger in their own vehicle)
2. TP Drivers and passengers
3. TP passengers
4. Pedestrians/cyclists
Liability and Contributory Negligence:
Unlike auto or property damage claims where the fault determination rules apply, a BI
investigation includes a comprehensive analysis where liability is often negotiated as opposed to
assumed within a pre- approved framework.
In determining liability we must first see if the injured party contributed in any way to the
accident.
For example, where there are two drivers equally at fault, a 50-50 split (or apportionment) in
liability would be applied. The passengers who have sustained injury would then sue both
drivers. Thus, in principle will receive 100% compensation.
The NI is only responsible for damages to their degree of liability or fault.
We must further determine, if he injured party contributed in any way to his/her own injuries.

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The following examples may assist.
In such instances deductions can be negotiated and, this can often be a very effective bargaining
tool.
In some cases a claim may be reduced substantially, by any of the following:-
Contributory Negligence Examples:
1) Our insured rear ends a third party but, the third party has defective brake lights that
were not working at the time of the accident.
2) Failure to wear a seatbelt.
3) Speeding
4) Assumption of Risk-an example of this would be knowingly and, willing entering a
vehicle
when you know the driver is impaired
5) Failure to Mitigate a Loss-The injured party has a duty “to make good their loss”, in other
words the injured party must undergo all recommended treatment and, do all other
things to reduce their given loss You can argue for a reduction in compensation, should
they fail to do so.
BI Claims and AB Claims:
Bodily Injury claims differ greatly from “Accident Benefits” or Sec B Claims of the Auto Policy
S.P.F No.1.
A BI claim is a means of paying an injured party for injuries or a loss they have suffered due to
the negligence of a tortfeasor (the at- fault party).
Whereas, Section B, is a first party contract with our insured, by which we extend coverage for a
variety of treatments, services, and lost wages that are a direct result of a motor vehicle accident
and, are deemed medically essential, regardless of fault.
NEW CLAIMS
RBC works on three systems:
1) VL (Virtual Landline), where all claim notes are recorded, reserves entered and,
documents attached.
2) AS400- is our underwriting system that captures the insured’s details, coverage and,
underwriting notes.
3) TyMetrics 360- is where legal invoices are reviewed and, paid.
New claims are called features and, will appear as follows:
1) Third Party Driver-BI
2) Third Party Passenger-BI
3) Insured’s Passenger-PH
4) The NI, as a passenger in their own vehicle-PH
5) Cyclist/Pedestrian-BI
6) Under-Insured Motorist or SEF 44 Claims-UIM (See Page.16.)
Upon receiving a new claim:

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1) Review accident details (who reported it, when reported etc), coverage issues and, any
third party details. (usually viewed under the Auto notes).
2) Confirm coverage->review under Vehicle Detail in VL and, in AS400 and, enter a note
that the said accident, is covered under the policy and, what concerns you may have, if
any; these may already be flagged by a PD Adjuster. For example, an impaired charge,
racing of vehicles or unauthorised use of vehicle etc. Enter note as, Coverage –your
first note under the BI, PH or UIM feature.
3) Contact the NI- and advise of any potential injury claim(s). You will need to confirm the
accident details such as, location, destination, and direction of travel, road and weather
conditions, and speed on impact.-Enter note as, NI Contacted or NI confirms FOL
(facts of loss).
Note if there are any liability concerns, that is issues concerning, who is at fault. (This
may require another heading)–Enter note as, NI’s Accident statement.
You will further need to record all the NI’s observations of the TP-> for example, did they leave
in an ambulance, did they appear injured, and did they mention any previous accidents.
If someone else was driving the insured’s vehicle confirm consent -you will then need to speak
with the driver, to confirm details of the accident and, their observations.
If the NI does not speak English you may engage an interpreter to make the initial call. This will
be in the form of a conference call and, the same questions will be put to the NI.
There is a 24 hour period in which to contact the NI, sometimes this is not possible, should
contact not be made beyond a week, send out a contact letter.
(Please note, if our insured indicates that they or any of their passengers are injured in the
accident, to check if a Section B feature has been opened for them, if not you will need to open a
“new feature” and, forward it to “ABASSIGN”).
4) Contact Driver-If the Insured was not the driver of the vehicle at the time of the accident
and, has given consent to another, to operate the motor vehicle; you must speak to the
driver to confirm accident details and, any observations they may have made of the TP.
Enter note as, Driver Contact/Statement.
5) Contacting The Third Party
When contacting the TP keep, in mind this may be the ****one and, only time of making
contact- so it is paramount that you capture as much detail as possible for reserving purposes.
Once again if the TP does not speak English you may engage an interpreter.
Where there are issues concerning the accident, record this as a separate heading. Enter Note
as, TP’s Accident Statement.
In terms of injury detail you will need to obtain the following:

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1) Confirm name and address;
2) Position in vehicle and, seatbelt use;
3) DOB;
4) Was the TP working at the time of the accident;
5) Marital status and, any dependents;
6) Injuries sustained and , current treatment
7) Any previous MVAs or similar injuries-all details recorded;
8) If any work has been missed as a result of the accident;
9) Even, if there is no missed work time, record occupation, employer and, wages.
**In the case of significant injuries or where there is extensive wage loss potential you
will need to obtain benefit coverage, as to treatment; STD and LTD benefits details.
Note there is a 72 hour contact period in which to contact the TP.
After attempting contact beyond a week send out a contact letter, which also outlines the
limitation period. Enter note as, TP Contact.
Authorizations:
You will need to forward the TP a Section B Authorization, as well as Medical and, Wage
Authorizations. This may be done by e-mail, fax or post.
You will hold these on the TP’s file until they are ready to settle their claim or in cases where the
injury is prolonged, you may wish to order these files sooner.
6) Letter of Notice-Once an injury has been confirmed; a BI letter of Notice must be sent to
the Insured and, attached to the file. This letter advises the NI of the claim and, litigation
process. Enter note as, BI Letter of Notice sent.
7) A Reserve Sheet -Our standard reserve is $3k. The Reserve sheet is to be completed
and, attached to the file when we submit the 90 Day Report. The Reserve must be a
reflection of the detail we have to date not, our intuitive fears. This is why we MUST try to
capture as much information as possible when engaging both parties. By the 90 day mark
we should have sufficient information.
If, there is a reason to think the reserve will be above the $3k, you will then need to enter
the reasons in your 90 Day Report with a breakdown of the reserve.
Reserve Changes
As stated, our reserves are automatically set at $3k for all BI and PH Claims, as most claims will
fall under the Minor Injury Regulations.
UIM (SEF 44) and, Fatality claims will be determined on the facts.(See Pages.16. & .21-22..)
If however, when gathering TP medical documentation and, economic loss; as the claim goes
forward, you may to need to alter your reserve. For example the injuries are worse than first
thought or the injured party has accumulated further wage loss. (This is when the Reserve is
“within your authority”).
You will then need to enter a note indicating, why you are setting a new reserve. You will further
be required to break it down in to “Heads of Damage or areas of Compensation”. Attach the
appropriate Reserve Sheet. Enter note, as Reserve Change.
When Reserves Exceed your Authority

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When a proposed reserve exceeds your Authority, due to the TP’s injuries/income loss or due to
multiple claimants, you will need to create a “Reserve Heading”, indicating the reasons why you
require a reserve beyond your authority. This may require you to include case law, as we strive
for a realistic reserve. Again the reserve is broken down to areas of compensation.
This request is sent to your Manager, by diary in the VL system and, also by e-mail to your
Manager, with the attached reserve sheet(s). Enter note as, Reserve Change Request.
Approval must be granted by your Manager before the increase can be entered. Enter note, as
Reserve Change Approved. (Attach the e-mail from your Manager to your file or alternatively
they may enter their own note.)
Expense Reserves
Expense reserves are entered when you know you will be engaging an outside vender.(See Pages
8-9)
8) Alberta BI Initial File Review – this heading must be included in the initial file set-up. It
is the summary of the file, using what details you have to date; this is regardless of
whether you have made contact or not with the said parties. This can found when you
open “feature note”, and right click on “causality”. The VL system will generate its own
heading.
9) Add all further all notes deemed necessary -to follow the claim, such as TPA details,
further notes concerning coverage, third party representation, witness details etc.
Statement of Claim:
A Claimant/Plaintiff (injured party) has two (2) years in which to settle their claim directly with us.
If however, they wish to preserve their claim (in other words extend that time period) they must
issue a Statement of Claim on or before two (2) years from the date of the accident. They then
have one (1) year from the date of filing the Statement of Claim, to serve it on our NI. Note when
there is a Minor involved this time frame will be extended.(See Pages)
So, it could be three (3) years, before we even find out that there is an injury claim for us to
handle. A BI file can stay open for many years before settlement is agreed upon.
Upon Receipt of a Statement of Claim:
Once a Statement of Claim has been served on our NI, we have twenty (20) days in which to
respond or a default Judgement can be entered against our insured, finding them liable. Enter
note, as Statement of Claim Received (SOC)/SOC Served -> Outline the details of SOC
including, Action Number, injuries, amounts sought and, the Court of filing
You must therefore contact Plaintiff Counsel (TPL) immediately upon service of a Statement of
Claim and, inquire if the TPL requires a Statement of Defence to be filed and, served.
If not, you must retain a waiver (a letter stating that, no Defence is required at this time). Enter
note as, Statement of Defence (SOD) not required.
In the event you need to appoint a lawyer-note name of lawyer and law firm, Enter note, as DC
Appointed. (See Pages .22-23.)
You will also need to contact our NI and, outline the litigation process, as for many this may be
very distressing.

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Final Releases
When settling a claim directly with a third party, which we know can include our NI’s passengers or
even the NI themselves, if they were in the vehicle at fault you must first receive their Final
Release
before releasing the funds. Where Minors or Dependant Adults are involved you will also require
the Guardian’s Acknowledge of Release and, perhaps a Trust before funds can be released (see
Page .20.).
When settling a claim with the lawyer for the third party funds are released prior to the receipt of
the Final Release and where appropriate the Discontinuance of Action. They are released under
the express or implied conditions that the funds will not be distributed until such documents are in
executed (signed).
This is practice the in Alberta, British Colombia and the Territories. Although there is no stated
case law in this area. So in this sense it is a procedural understanding and undertaking by the
parties. Do note that other Provinces require the Final Release and, other necessary documents
to be executed prior to release of funds.
Underwriting Notices
Underwriting Notices must be completed when there is a “material change in risk”, such as,
change of ownership, use of a vehicle for commercial purposes, or statutory breaches of policy
conditions, which are considered “moral risks”, such as, the use of the motor vehicle in violation
of Graduated License Conditions, allowing the use of the vehicle by a non-licensed driver, an
impaired charges, leaving the scene of an accident.
An Underwriting note is completed in “Client Service & Support”. This should later be updated in
AS400 by the underwriter (Link will be provided).
You will further need to add a note in your file that an Underwriting Notice has been completed.
Enter note as, Underwriting Notice.
Diaries
Your diaries from a glance should give an outside reader an overview of the file.
So ensure your headings are clear.
Diaries should be in abeyance for a minimum 6 to 8 weeks when reviewed and, the appropriate
parties contacted.
By the time of your “90 Day Report “you should have contacted the TP on a least two (2)
occasions. This will assist in your reserve setting.
This will vary on litigated files, WCB files, and files where there is an ongoing investigation,
which will require review on a more frequent base.
Diaries will also need to be completed following, the receipt of initial legal opinions, Questioning,
any legal applications, IME/CEs Reports and, all relevant action on the file. This is of particular
importance on Large Loss files, where you are then required, to send these by diary in VL, to
your Manager.
THE USE OF INDEPENDENT VENDORS ->>(All appointments need an Expense Reserve
and must be included on your Reserve Sheet****-see Page.6.)
****The use of Independent vendors is discretionary but, is also limited. Notes must be entered,

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indicating the vendor used.
1) Independent Adjusters-The use of I/As is on a limited basis only. They may be utilized
only in situations where there are coverage issues, liability issues or where the claimant
requires assistance in understanding the claims process and, needs further explanation
or guidance; such as instances, where the insured does not speak English, age,
location and health. If you choose to keep an I/A on a file you must indicate in a note
the reason for this. Otherwise, it is a “task assignment only”.
2) Interpreters-With the wide base of RBC clients, we often need to use interpreters.
They are used to make initial calls to NIs and/or TPs should they not speak English
or, if they feel more comfortable speaking in their native language. This is done by way
of a conference call, with the interpreter on the line, repeating your questions.
Interpreters can also be assigned to meet with an appointed I/As and, the NI and/or the
TP to take formal statements.
During the life of the claim, if the TP is happy to continue to deal with you directly, you
may continue to utilize an interpreter for updates and, to finally assist them in settling
their claim.
Our preferred vendor is Able Translations and, they are easily accessible and, are
accommodating in all areas needed.
“This is a customer service opportunity and, goes towards “deepening our relationship with
clients”.
You simply cannot pass off a statement request to an I/A, because a party cannot speak
English. If you are unsure what language a party speaks view the underwriting notes
in AS400 or in the case of a TP, contact the TP’s Insurance Company.
3) Surveillance-Surveillance is only to be used when authority is given by your Manager.
This is limited to situations where the TP is represented or alternatively forwards written
Notice, that they are going to pursue a claim and, will be engaging a lawyer. It is not
good enough, that the TP states, they will be engaging counsel, as in many instances
they do not or that you have a feeling they will engage counsel.
When requesting surveillance authority, you must indicate the reasons why this will be
beneficial to the claim, as surveillance for the sake of it, is both costly and, has its own
legal pitfalls.
When requesting Authority you need to further, indicate the proposed budget and, the
reasons for the budget.
4) Other Independents-The use of Engineers, Independent Medical Reports, a Certified
Examinations are on a case by case basis and, therefore left to the discretion of the
Adjuster. Such instances are usually obvious, such as fatality claims, very low impact
accidents, liability issues as to speed, questionable injuries and, so on.
If however, you are requesting very costly reports, such as an Economist Report or a
Biomechanical Report, authorization will need to be granted.
HEAT Notices- “High Exposure Accident Types”
Heat Notices are sent on all potentially “high risk files”.
A HEAT loss can usually be identified, on initial contact with the TP, when it is evident there is a

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potentially large exposure, for example- in wage loss-> where there is a high income earner ,
prolonged hospitalization, extensive injuries, multiple claimants or severity of accident. It will
always be sent on a fatality claim.
The purpose of this Notice is to alert the Managers that we may potentially have a Large Loss.
These Notices must be sent within 90 days of receiving the claim (as you may wish to confirm
further loss details) and, then it must be sent immediately.
There is a specific form for a HEAT Notice (which requires a basic outline of facts-accident and
loss, parties are not identified)-> upon completion-> it is sent by e-mail to your Manager. Enter
note as, HEAT Notice. The reserve on a HEAT Notice is to be set after a 90 day period,
allowing you time to gather further information. At which time you may seek a Reserve Change.
(See pages 6 &7).
Large Loss Report
Reserves of $100K or greater require a Large Loss Report (LLR) to be completed; a LLR can be
triggered by a single injury, multiple claimants or a fatality.
A LLR must also be completed during the life of a claim, when new evidence is presented
regarding injuries and, economic loss. Once again these must be completed immediately upon
receiving the new information.
It is not unusual to submit a HEAT Notice and, LLR at the same time, if sufficient facts are
known.
Keep in mind that you have 90 days to set the reserve for a HEAT Loss.
You have six (6) months from the date of notification of the accident to submit your LLR, this is
to allow you time to confirm the potential exposure in more detail and, adjust your reserves
accordingly.
However, ensure your HEAT Notice has been sent.
A LLR also follows a stipulated format, which includes accident detail, TP detail, injuries and
wage loss. (Again this is a reminder to try and, capture all details on first contact with the TP or
the TP’s representative).
The LLR needs to be completed in as much accuracy as possible. If injuries are known, case law
is required to supplement this report.
In terms of economic loss this must be completed to the best of your knowledge, which would
include Sec B payments and other deductions, such as STD/LTD benefits and, wage loss with
the appropriate tax deductions.
Calculations are applied per the Alberta Automobile Policy S.P.F 1->Section B formula; Part II
(3), where there are multiple sources of benefits/income is received.
Reserves must be included on the Report and, are to be broken down to “areas of compensation”
for easy reference, by your Manager.
This must be submitted to your Manager together with Reserve Sheet(s). (Both by VL diary and,
e-mail). Enter note as, LLR Completed.
Should new circumstances come to light that alter the initial LLS, you need to send an Interim
LLS, outlining the new circumstances and, accordingly you will increase or decrease the reserve.
This is again submitted to your Manager together with a new Reserve Sheet(s). (Both by VL

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diary and e-mail). Enter note as, Interim LLR Completed.
LLS, Interim LLS and HEAT Notices are often presented to a Large Loss Committee; this is
comprised of your Manager, the Director of Claims and, your peers. This is an opportunity for
these reports to be reviewed and, suggestions made on approach, reserves and, future action.
Yearly Report on Large Losses
Yearly Report s are to be completed on all files but, of are of particular importance on Large
Loss files. These must be forwarded to your Manager, by way of VL diary.
These will include all updates on prior /current action, current reserves and intended action and,
will need to be comprehensive in detail. For example, detail on legal action or stages of
litigation, progress on injuries or any further developments in the claim. Enter note as, Yearly
Report on Large Loss.
Authority Requests and Reserve Change Requests
These are completed when you wish to settle a claim above your Authority.
There is a template for this (Go to “feature note”, right click and, go to Casualty-and, you will see
this heading). The VL system will generate its own heading.
You will then be required to enter -> coverage, the accident description / fault , TP details, injury
details , employment, collateral benefits, risk assessment and, more often than not you will have
a TPL’s settlement proposal-which you will need to enter. You will then enter your proposed
figures and, this will need to be supported by case law.
You need to state your reasons for settlement and, if there is any contributory negligence and/or
liability issues. This may be presented as a range but, you must also provide reasons for a
presented range. There is a “Forum for Discussion”, where you are able to express your concerns
and, risks.
Authority requests for a Settlement Conference, Mediation or JDR must be submitted seven (7)
days prior to attendance, this allows your Manger and, yourself to thoroughly review the file.
In some instances when requesting authority, you may also require a reserve change to forward
an offer (this may be due to new evidence presented in the TPL’s proposal), again as stated above
->this will be need to entered under a separate heading and, you must state your reasons behind
this request. A diary will need to be sent to your Manager, in VL. Enter note as, Reserve
Change.
90 DAY REPORTS AND YEARLY REPORTS
90 Day Reports- are required on all files.
To enter a “90 Day Report”, you will need to go into “feature note” then, right click on “Casualty”
and go to “Initial Quarterly Report”.->You will need to change the heading to “90 Day Report”. The
following is required:

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Coverage: Note coverage at the time of the accident.
Facts of Loss: Accident details.
Investigation and Liability: This is where you will enter liability or contributory negligence concerns.
Injuries: To be entered in as much detail as known.
Reserves: It is here that you will re-eavluate your reserve. If it should change you must enter under the
“Reserve heading” the proposed reserve and the reserve break down, if it is above $3k.
Future Action (Things to do): Note any investigations, information needed and possible file outcome.
Yearly Reports- are required on all files.
To enter a Yearly Report, you will need to go to “feature note” then right click on “Casualty” and go
to “Interim Quarterly Report”.
You will need to change the heading to “Yearly Report”.
You will need to comment on the following:
Update on prior Action Plan: Enter details of file progress over the past year.
Reserves: Review & enter you reserve-comment as to why is adequate or if the reserve needs to be
altered-again detail and, a breakdown is required.
Comments & Action Plan: Again note what actions you are undertaking to resolve the claim(s).
COMPUTATION OF DAMAGES
Damages are a sum of money paid, by the tortfeasor or the at-fault party that compensates a
loss suffered by the TP.
Compensation is never paid until fault or degree of fault has been fully determined and, the loss
is proven. The TP must not profit by their loss and, awards (set sums of money paid for
compensation) are designed only to place the individual in the same position they would have
been if the accident, had not occurred.
Non-Cap Claims
Non-cap claims refer to those claims where the injuries do not fall under the “Minor Injury
Regulations”. For example, broken bones, broken teeth, lacerations, injuries to internal organs,
brain trauma; the list is extensive.
In determining damages one should be clear on the following principles:
*Causation: To succeed in an action for negligence, the TP (claimant/plaintiff) must prove causation,
which means the said accident, caused the alleged injuries. This is on the balance of probabilities.
*Thin Skull-or Egg- Shell Skull Rule: is the principle, which states you must take your victim as you
find him rule/her. This is referred to if a TP suffers an unusually high level of injury for the given accident,
due to a pre-existing vulnerability or medical condition.

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*Crumbling Skull Rule: is where the TP suffers from a pre-existing condition/injury prior to the
accident. In the "crumbling skull" rule, the prior condition is only to be considered with respect to
distinguishing it from any new injury arising from the accident. This is a means of limiting damages, in
such a way that the NI would not be liable for placing the TP in a better position than they were in, prior to
the accident.
When quantifying or assessing damages/ compensation for a given injury it is necessary to
refer to case law; which are cases that have gone to trial and, have set out damage awards or
amounts of money awarded for a given injury. We call these precedents, which is a legal case
that establishes a principle or a rule.
It is therefore necessary to refer to case law found within your own jurisdiction (Province) which
is binding and, also to those cases found in other jurisdictions or Provinces which are
persuasive (which means they are very influential on your damage assessment).
Furthermore, it is very rare that you will be assessing a single injury but, rather several
overlapping injuries, in these cases you will need to view each injury separately and, devise a
final compensation figure.
You will need to evaluate a number of factors in your assessment, such as but, not limited to->
hospitalization time, rehabilitation time and, age, previous health, other health issues unrelated
to the accident, all previous accidents or subsequent accidents, whether there is a permanent
disability or a partial disability and, what are the long term effects; such the likelihood of arthritis
or other such disabling outcomes.
Multiple Tortfeasor’s/Multiple Accidents
In some cases it is impossible to distinguish the TP’s injuries from your accident and, other
accidents they may have been in.
This is particularly difficult if the other accidents have occurred very close to yours (either prior
or subsequent to your accident) and, where, the injuries are the same or very similar in nature.
In such cases, you may enter a “global settlement” with the other isurer(s) and divide the
compensation accordingly.
If however, the injuries from your accident are distinct you are only liable to the extent of those
losses sustained in your accident.
Capped Claims
Effective as of October 1, 2004 The Minor Injury Regulations (“MIR”) and, Diagnostic and
Treatment Protocols Regulations (“DTPR”) were enacted in Alberta, which legislated a set
amount of damages or compensation to be paid in area of General Damages for all injuries
regarded as soft tissue injuries (“STI”). -”The Cap”
General Damages refer to pain and suffering, inconvenience and, loss of enjoyment of life.
Legislation:
Section 650.1 of The Insurance Act, states-a “minor injury” means an injury as defined or
otherwise described by regulation as a minor injury.
Subsection 1(h) of the MIR provides:
“minor injury”, in respect of an accident, means
(i) a sprain
(ii) a strain or a WAD injury
caused by an that accident that does not result in serious impairment;

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A “sprain is defined in Section 1(k) of the MIR as “an injury to one or more tendons or ligaments
or both”. Subsection of 11(2) of the DTPR states that a “strain” ranges from a few fibres of
ligament torn, to a complete tear of all ligament fibres with a complete opening of the joint
resulting in minor to major disability and loss of function.
A “strain” is defined in Section 1(l) as “an injury to one or more muscles”. Subsection 7(2) of the
DTPR states that a “strain” ranges from a few fibres of muscle torn, to all muscle fibres torn, to all
muscles torn with a major disability, spasms and swelling. The DTPR future defines degree of
injury from 1-3
A WAD (which can only occur in the cervical spine) is defined in Subsection 1(n) of the MIR as “a
whiplash associated disorder than one that that exhibits one or both of the following:
(i) objective, demonstrable , definable and clinically relevant neurological signs;
(ii) a fracture or dislocation of the spine
For the most part STIs sustained, will fit neatly under the cap.
However, the MIR goes on to define those injuries that do not fall under the cap and, defines
these as a “serious impairment”.
Subsection 1(j) of the MIR defines “serious impairment “;
“serious impairment”, in respect of a claimant, means an impairment of physical or cognitive
function
(i) that results in a substantial inability to perform the
(A) essential tasks of the claimant’s regular employment, occupation or profession,
despite reasonable efforts to accommodate the claimant’s impairment and the
claimant’s reasonable efforts to use the accommodation to allow the claimant to
continue the claimant’s employment, occupation or profession,
(B) essential tasks of the claimant’s training or education in a program or course that the
claimant was enrolled in or had been accepted for enrollment in at the time of the
accident, despite reasonable efforts to accommodate the claimant’s impairment and
the claimant’s reasonable efforts to use the accommodation to allow the claimant to
continue the claimant’s training or education, or
(C) normal activities of the claimant’s daily living.
(ii) that has been ongoing since the accident, and
(iii) that is expected not to improve substantially.
There are a number of key Sections in the MIR that are yet to be defined by the Alberta Courts
namely, “serious impairment”; “substantial inability”; “essential tasks”; “normal activities” and,
the question of a time frame, when a claimant is not expected to “improve substantially”.
General Damages under the Cap
Although, the MIR sets out an award of $4,000.00 for all capped injuries, this amount is to be
increased annually based on inflation and, is set out in the “Superintendent of Insurance
Bulletin”, which is to be issued yearly. They are as follows:
Minor Cap Awards:-
2004-$4000.00 (as of October 1st
)
2005-$4,000.00
2006-$4,000.00
2007-$4,144.00
2008-$4,339.00
2009-$4,504.00

Jacka - 15 -
2010-$4,518.00
2011-$4,559.00
2012-$4,641.00
The claimant per the MIR is awarded the “capped” sum for their year of accident. Interest is
added to the date of settlement.
What the Injured Party can sure for:
These are referred to as “heads of damage”.
The TP is entitled to compensation in the below areas regardless, of whether their claim is
“capped” or not.
All losses must be proven in order to receive compensation.
General Damages- Pain & suffering, inconvenience and loss of enjoyment of life.
Housekeeping- A sum paid for the inability to perform regular household or home maintenance
tasks. In some cases the TP may engage a care provider, a gardener, or a housekeeper etc.
You may need to further deduct any Section B payments made under Part II Section A (1),
which provides a housekeeping allowance of $135 a week, for a maximum of 26 weeks.
Out-of-Pocket-Expenses-Receipts are required for additional treatment, medications,
transportation to and, all other additional expenses related solely and, directly to the accident.
Loss of Income-Must be calculated on “net wages only”, so you are required to take out the
relevant tax.
You will further need to deduct any Section B payments, as well as any other benefits received
by the TP.
In order to do this you must apply the Section B formula
Sec B Part II (a) & (b) provides a weekly benefit payable, if the TP is deemed wholly and continuously
disabled; and is paid to a maximum of 104 weeks. No benefit will be paid for the first seven (7) days.
This benefit is based on average gross wages and will be the lesser of $400.00 or 80% of the gross wage,
less any other wage benefits the TP may receive.
Part 11 Section (3) provides a formula for calculating Section B benefits paid out when other income
sources are available to the TP. This must be applied as in some cases; the TP may receive more then
their gross weekly wage.
Loss of Future Income-This needs to be objectively demonstrated.
It must be clear from the medical evidence that the TP will suffer a complete or partial wage loss
due to the injury. Depending on the quantum of wage loss this can be a very complex exercise,
as contingencies of life must be factored in. When the wage loss is excessive you will likely
require an Economist’s report.
Loss of Competitive Edge or Capacity-This acknowledges that due to the injury the TP is no
longer as competitive in the work force, as they may have been before the accident. They may
in fact still be working but, it may be clear that their years in a given industry may be reduced or
alternatively, they have had to seek new employment.
Once again Medical documentation is imperative and, in particular a Vocational Assessment is
needed.
Future Care-This is payment for treatment in the future to maintain the TP. For example->
orthodics, prosthetic limbs, splint therapy and, medication. Again medical documentation is
needed, in this case a Future Care of Costs Report.

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SEF 44 Claims-Family Protection Endorsement
In situations where the NI or a family member is injured in a motor vehicle accident and, there is
not enough coverage under the tortfeasor’s (or at-fault party’s) insurance policy, either because
they are under- insured, the injuries are of a catastrophic nature or there are numerous
claimants.
The NI then may utilise this portion of their policy.
The Insured and/or family member must fall under the definition of the policy.
Furthermore, the Insured’s third party liability limits must not match or exceed the limits of the
tortfeasor’s policy. Should this be the case the NI is unable access this Endorsement.
If, in the event that the NI’s limits are below those of the tortfeasor, this will then, allow them
additional sums to compensate for their loss.
A SEF 44 may require a Judgement to trigger it and, the Insured has one year from the date of
Judgement to serve the SEF 44 claim on his/her Insurer.
However, most often in practice, the SEF 44 Adjuster will work with the Insured’s lawyer and, the
tortfeasor’s BI adjuster/Defence Counsel to come to an equitable settlement.
If there are numerous claimants the SEF 44 will be proportioned per claimant or injured party.
HOMEOWNER’S LIABILTY CLAIMS
These claims arise when a bodily injury is sustained through a slip and fall in or outside the NI’s
residence, dog bites, injuries due to unsecured objects falling etc.
The policy further extends to injuries sustained by a TP outside the NI’s residence, for which the
NI is responsible for.
For our purposes we are going to focus on injuries sustained by a TP at or near the NI’s
residence.
Section 5 of the “Occupier’s Liability Act” (see Page.6. for the link) creates a duty of care for the
NI.
An occupier of a premise owes a duty of care to every visitor on the occupier’s premises
to take such care as in all the circumstances of the case is reasonable to see that the visitor
will be reasonably safe in using the premises for purpose for which the visitor is invited or
permitted by the occupier to be there or is permitted by law to be there.
Section 6- states that the common law duty of care applies in relation to:
(a) the condition of the premises,
(b) activities on the premises, and
(c) the conduct of the third parties on the premises.
There is also an onus on the TP, to prove that there exits a hazard or that a less than
“reasonably safe” condition existed on the premises, as a prerequisite to liability.
The occupier should only be held to a standard of reasonableness.

Jacka - 17 -
Slip and Falls
It is imperative when dealing with such claims that you capture as much detail regarding the
circumstances, as possible. You will most certainly need to obtain scene photos/diagrams. You
must also request that the NI not to alter or otherwise change the accident scene, for example
adding guard rail to stairs, where a TP has fallen.
You will need to keep in mind, when investigating, the activity in question that caused the injury,
location, time and; in terms of the TP-> you will need to know what clothing was worn and, in
particular footwear.
Questions, as to whether the TP was familiar with the premises (even if a hazard does exit) and,
if any such incidences have previously occured.The investigation will depend on the
circumstances of the accident.
In the case of a slip and fall outside the home due to snow/ice, again the above will need to be
ascertained. You will also need to record the time walkways were shoveled/sanded-this is of
particular importance in a condominium accident (as, usually records are kept). You may further
refer to past weather maps, which will indicate what snow fall /icy conditions that are a usual for
the given time of year, the accident took place.
Keep in mind TP also has a duty of care to take care of his/her own safety and, should be
mindful of familiar and, even unusual hazards, given the weather conditions.
Should a TP’s fall occur on a city street outside the NI’s home, in other words a sidewalk, which
the NI is not required to clear.
The claim then lies with the Municipality, and under all Municipality legislation (including roads),
the City cannot be held liable unless there is gross negligence.
Often the NI will be named in an action, simply due to the stringent Municipality Regulations.
And, the only way to prove gross negligence against the city is if:
1. the city was given notice of the hazard, and
2. there was an inordinate time in dealing with it.
Dog Bites
This is another commom claim we come across.
The bite may be to the TP or even the TP’s dog.
In gathering details you need again to know the location (once again scene photos are helpful)
and, concise details on the events leading up to bite, such as-> was the dog off lead, did this
occur in the home of our NI and, was the TP posing a threat of any sort behavior, or behaviour
that could be construed as a threat; was the TP familiar with dog etc.
You will need to ascertain the breed of dog and, research the breed as to the breed’s aggression
and, you will require particulars of the NI’s dog , such age, temperament, any training the dog
may have had, also any past instances; again photo graphs of the dog are also helpful.
In obtaining TP details again gather all facts, if the TP is familiar with the dog you must explore

Jacka - 18 -
this in detail, did the TP report this to Municipality, what injury were sustained, once again photos
of the injury are of great assistance .
Homeowner’s Liability in Summary
As with all claims the onus is on the third party to prove negligence in regard to the NI.
The NI is only expected to meet the standard of reasonableness, in the given circumstances.
Before any settlement for a Homeowner’s liability claim is paid, negligence must be proven on
the balance of probabilities; any contributory factors in the regard to the TP’s actions must be
considered, as they too are held to a standard of reasonableness.
THE MOTOR VEHICLES ACCIDENT CLAIMS PROGRAM (MVACP)
This is a program run through Alberta Justice and, is designed to protect innocent TPs who have
been injured as a result of a MVA and, where the at- fault vehicle either does not have insurance
coverage, the at- fault vehicle flees the scene or the NI Vehicle, is being operated without the
NI’s permission or knowledge – in other words, there is theft of the vehicle.
You may come across this in several ways-> when dealing with a TP, you may discover our
insured’s coverage was not in place at the time of the accident or the vehicle in question was
stolen at the time of the accident; in which case you will need to advise on the TP of the MVACP
and, further provide the TP with a letter, to present to the MVACP outlining why there was no
valid insurance policy in place at the time of the accident.
A further situation is where a SEF 44 claim is brought, because the MVACP cannot cover the
entirety of the loss; either because the injuries are significant or because there are multiple
claimants.
This may also arise when speaking with our NI and you discover that they have been injured in
such circumstances and, you will then need to advise them on the MVACP process, as it is time
sensitive. (This is a customer gesture and, you are required to assist in such circumstance, as this
may be very confusing process for our NI).
Under the “Motor Vehicles Accident Claims Act ”:
1. The applicant has 90 days to serve written Notice on the “Administrator “of the Motor
Vehicle Accident Claims Program. (exceptions are made where are a party was unaware
of this avenue of recourse or alternatively have been hospitalized for 90 day or more
etc.).
2. The MVACP is only available to Alberta residents or to persons who ordinarily reside in
Alberta. The program may extend where the injured party lives in a jurisdiction which
also has a substantially similar program.
3. The applicant will need to sue to collect damages; they may include all heads of
damages or compensation but, are limited to $95k in medical and, rehabilitation costs.
The injured party is expected to utilize their Section B benefits and all other health
benefits available.
4. The applicant must name all drivers and owners in the accident that are deemed at fault
(despite the fact that they do not have valid insurance) as well as “the Administrator “of
the Motor Vehicle Accident Claims Fund.
In the case of a hit-and-run case where the other driver and/or owner are unknown, the
applicant will sue the “Administrator “of the Motor Vehicle Accidents Claims Fund only.

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5. The MVACP has a maximum of $200k to be paid from the General Revenue Fund.
If there is more than one claimant this will be prorated between the parties.
6. The MVACP, techniquely requires a judgment in order to payout damages from the
Fund, as they need a Judgment to pursue the uninsured parties->owner and, driver or in
some cases, the operator of the stolen vehicle. This is decided on a case by case basis
and, often times you can settle with the fund directly.
WORKERS’ COMPENSATION CLAIMS
In an MVA you need to determine if the TP was working at the time of the accident. This may be
evident by the vehicle they are driving. If they are working you will need to determine if they are
covered by the Worker’s Compensation Act (WCA), or if the company they work for is self-insured.
The Workers’ Compensation Board (WCB) will only cover a worker while in the duration of their
employment and, does not cover travel to and, from work. Furthermore, WCB does not cover all
workers. If you are in doubt, you will need to refer to the Worker’s Compensation Act but, in all
likelihood the TP will know.
It the TP does fall under WCB, you will need to advise them to enter a claim with the Board, and
their employer should have the appropriate forms. You can no longer deal with the TP directly
but, you now need to go through WCB.
If it is clear that that the TP sustained minor injuries only, you can suggest to them to sign a
Consent Form with WCB, so that this matter can be immediately assigned to an adjuster who will
contact us and, expedite the claim.
Otherwise, you will need to await contact from WCB, which can be a very drawn out process, as
they are dealing with hundreds of applications daily.
If it is the case that the NI was also working at the time of the accident, the entire matter falls to
WCB. Exact details will need to be recorded here as RBC does not insure commercial vehicles or
vehicles that are intended for work use. So this situation is unlikely to occur.
MINORS’CLAIMS AND DEPENDENT ADULT CLAIMS
If the injured party is 18 years or younger, they are deemed a Minor Child under the law and, you
cannot deal with them directly but, must deal with the minors’ parent(s) or Legal Guardian(s).
This is also true where you have a Dependant Adult claim.
These can be particularly sensitive claims if the Minor is an infant or a toddler, as details on the
injuries are often unclear and, you must rely on the parent ‘s or Guardian’s reports. Again this may
be the case with a Dependant Adult, where there may be some difficulty in articulating the injury.
The limitation period of a Minors’ claim is two (2) years to file a Statement of Claim and one (1)
year in which to serve it on our NI-> once the Minor reaches the age of majority (18 years).
With a Dependent Adult this is not always so clear. If the Dependent Adult has their parents or a
Guardian assisting them, the normal limitation period applies. If however, they do not have anyone
to act on their behalf; an application must be made to the Public Trustee.

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In settling a Minor Child’s claim, you need to refer to the Minor’s Property Act.
Only those claims of $5k or less may settled directly by you.
When settling a Minors’ claim you will require a “Final Release “ which names the parent(s) /Legal
Guardian(s) on behalf of, the “said Child”, together with, a “Guardian’s Acknowledgement of
Responsibility” to be completed and, signed.
The funds are then released to the parent or Legal Guardian on behalf of, the “said child”.
If the settlement is above $5k, a Trustee must be appointed, so that the settlement funds can be
entered into Trust.
The Trustee can be a parent, a close relative or whomever the Court deems fit and, in some cases
this it maybe the Public Trustee itself.
An application must be made to the Court by way of Affidavit with supplemental documents,
including the proposed settlement.
Once this has been approved by the Court, it must be reviewed by the Office of the Public Trustee
to ensure, that the proposed settlement in “in the best interests of the child”. Once approved the
funds are released according to the Trust conditions.
The above procedure also applies to a Dependent Adult. If there is no Guardian in place, the
Public Trustee will usually be appointed. This must be further approved by the Court and, the
funds will then be administered by the Office of Public Trustee, this is again to ensure the
settlement is “in the best interests of the party”->in these instances all settlement funds are
entered into Trust.
These practices are in place to protect both the TP and, the Insurer and, If not followed
properly, a settlement may later be deemed as void.
If you are dealing directing with a Minors’ parents/Legal Guardian, where settlements are above
$5k or in the case of a Dependent Adult and, a Trust needs to be established; you will bear the
cost to establish the Trust. In such cases you will need to engage counsel to do this.
Where Plaintiff Counsel is involved, it is their responsibility to ensure all the requirements are met
and, no funds cannot be released until you are satisfied that all documentation is in order.
THE FATAL ACCIDENTS ACT (The FAA)
This Act provides for legislated sums of money to be paid to the Deceased Estate, in the instance
of a fatality claim.
These sums are for General Damages and, other reasonable expenses related to the funeral and,
visitation of the deceased between time of injury and death.
General Damages in this situation refer to bereavement, loss of companionship, loss of
consortium and loss of guidance.
The FAA framework dictates set sums to be paid to family members and, these are as follows :-
Section 8 (2) of the FAA provides $75k to the parents of the deceased, if the deceased at the time
of the of death,

Jacka - 21 -
(i) was a minor, or
(ii) was not a minor but, is unmarried and has no adult interdependent partner. This
is to be divided equally between the parents.
In the case where the deceased is married or residing with a common law partner at the time of
death. The FAA provides $75k to the spouse.
It is very important to note that in the case where the couple is unmarried, the Adult
interdependent Relationships Act applies.
This Act outlines the key elements that define a common law marriage in Alberta.
For our purposes the couple must:
(a) have lived with the other person in a relationship of interdependence
(i) for a continuous period of not less than 3 years, or
(ii) of some permanence, if there is a child of the relationship by birth or
adoption, or
(b) the couple has entered into an Adult Interdependent Partnership Agreement.
The FAA further stipulates under Section 8 (3) that the partners must be living together at the time
of the deceased’s death.
Section 8 of the FAA, further provides $45k for each child of the deceased, if they were a minor at
the time of the deceased’s death or, if not a minor are unmarried or have no Interdependent
partner.
Furthermore illegitimate child or step children are not included, unless they have been legally
adopted.
The FAA provides under Section 7, costs for the care of the deceased person between the injury
and, death; travel and accommodation for those visiting the deceased between injury and death
(this would apply to immediate family or others deemed as reasonable persons); funeral expense
beyond Section B and, grief counselling for the deceased’s immediate family.
The FAA does not bar any further action by the Deceased Estate such, as loss of future income
loss, where there are dependents and, housekeeping or maintenance claims.
Nor does the FAA bar any other General Damages claims, such as claims for emotional trauma;
this may be by a claimant who was in the vehicle at the time of accident, a relative that comes
upon the accident scene or those traumatised between the deceased’s injury and death.
In order for a FAA claim to be paid out, you must establish who was at fault for the accident.
This is obviously difficult in a fatility as you do not have the benefit of the deceased testimony.
This a lengthy process and, requires the assistance of experts.
If it was the NI’s fault then you are liable for any passengers in their vehicle , as well as the
occupants of the third party vehicle to full extend of the injuries or if deceased, the Act again is
applied in the case of any deceased occupants.

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This will generally require the use of Reconstructionist Engineer, most certainly the Police/RCMP
Report will be needed, as well as their reconstruction of the accident and, witness statements.
Engineers will be needed to view the accident scene, as well as the vehicles involved, this is of
particular importance if liability is in issue.
Engineers are used to determine seatbelt use, speed at the time of accident, road conditions, any
possible mechanical failure of the vehicle and, any factors that may have contributed to the
accident.
Each Insurer will always appoint its own experts.
You will further require the Death Certificate and, the Report from the Medical Examiner’s Office
to confirm the exact cause of death and, that the death was a result of the accident alone.
For example, in some instances it has been found, that that the deceased died of a heart attack
before the occurrence of the accident. In such cases you will need to obtain the deceased’s past
medical records to establish a medical history. (If this is the case, you may have a complete
defence against this claim).
It is wise in terms of these claims, if fault has been established, to pay out the FAA sums as soon
as reasonably practicable, as not to cause the family any further duress but, also to minimalize the
interest accruing.
As in some cases, other aspects of the claim maybe ongoing.
LEGAL/DEFENCE
Legal is appointed to a file where an opinion is sought in writing; Defence is required by the
Plaintiff Counsel or in cases where liability and/or quantum are in issue.
It may further be appointed to files where negotiations have broken down or where there is no
cooperation from the third party lawyer (TPL) and, you wish to advance the claim/ action. You will
be required to enter an Expense Reserve for legal hence your Reserve will change.(See page.6.
for Expense Reserve)
Assigning Legal Representation
When appointing a lawyer you will need to give them precise instructions on what you wish them
to do and, forward them all relevant file contents, including accident details, medical documents,
previous correspondence between yourself and the TPL.
Before assigning a lawyer, you are required to complete a “litigation form”, which will include – the
Court action number, style of cause, amounts pleaded by the TPL, your present current reserve,
the TPL name and, law firm as well , the lawyer who you intend to appoint and, their law firm.
You will need to further indicate the complexity of the file, as low; medium or high-this is a
reflection of your reserve.
This is forwarded to your Manager for approval/comment and, then returned to you.

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You must then forward the approved form to the RBC legal department.
The legal department will then assign an RBC billing number to you and, the respective law firm
appointed.
Litigation forms are also completed on the closing of a file, indicating the Style of Cause (who is
suing who), Court action number, TPL, your lawyer and, the amount the claim settled for. These
are forwarded directly to the RBC legal department.
All these documents are to be uploaded to your file.
Legal invoices are paid in the TyMetrics 360 system, where you will enter a budget for the file and,
pay invoices. Authority to do this must be granted by your Manager.
ACTS THAT INTERSECT ALBERTA TORT CLAIMS
There are a number of Acts and Regulations that determine how compensation is paid
notwithstanding, The Insurance Act and, the Alberta Standard Automobile Policy S.P.F. No. 1.
They are as follows, but not limited to the following:-
Minor Injury Regulation, Alta
http://www.canlii.org/en/ab/laws/regu/alta-reg-123-2004/latest/alta-reg-123-2004.html
Diagnostic and Treatment Protocols Regulation, Alta
Occupiers' Liability Act
http://www.qp.alberta.ca/570.cfm?frm_isbn=0779739426&search_by=link

Jacka - 24 -
Municipal Government Act
http://www.canlii.org/en/ab/laws/stat/rsa-2000-c-m-26/latest/rsa-2000-c-m-26.html
Motor Vehicle Accident Claims Act
http://www.qp.alberta.ca/documents/Acts/M22.pdf
Workers’ Compensation Act
http://www.canlii.org/en/ab/laws/stat/rsa-2000-c-w-15/latest/rsa-2000-c-w-15.html
Minors' Property Act
http://www.canlii.org/en/ab/laws/stat/sa-2004-c-m-18.1/latest/sa-2004-c-m-18.1.html
Dependents Adult Act
http://www.canlii.org/en/ab/laws/stat/rsa-2000-c-d-11/latest/rsa-2000-c-d-11.html
Public Trustee Act
http://www.canlii.org/en/ab/laws/stat/rsa-2000-c-p-44/latest/rsa-2000-c-p-44.html
Adult Interdependent Relationships Act
http://www.qp.alberta.ca/documents/Acts/A04P5.pdf
Public Trustee Act
http://www.canlii.org/en/ab/laws/stat/rsa-2000-c-p-44/latest/rsa-2000-c-p-44.html
Fatal Accidents Act
http://www.canlii.org/en/ab/laws/stat/rsa-2000-c-f-8/latest/rsa-2000-c-f-8.html
canada Reven
Canada Revenue
http://www.cra-arc.gc.ca/menu-eng.html
Alberta Personal Tax Rates
http://www.taxtips.ca/taxrates/ab.htm
Judgment Interest Act, R.S.A. 2000
http://www.canlii.org/en/ab/laws/stat/rsa-2000-c-j-1/latest/rsa-2000-c-j-1.html

Jacka - 25 -
Limitations Act
http://www.canlii.org/en/ab/laws/stat/rsa-2000-c-l-12/latest/rsa-2000-c-l-12.html
Alberta Rules of Court
Appendix
A. HEAT NOTICE
B. LARGE LOSS REPORT
C. INTERIM LARGE LOSS REPORT
D. LITIGATION FORM-OPENING

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E. LITIGATION FORM-CLOSING
(A) HEAT NOTICE-Auto Large Loss Summary Report
INSURED: AGE: PROVINCE: Alberta
INSURED DRIVER: AGE:
CLAIM # DATE OF LOSS:
DATE OF NOTICE: Eff: CLAIM TYPE: Auto Liab
POLICY LIMIT: CHARGEABILITY:
LITIGATION: RSP:
MAIN COVERAGE CODE: BI TOTAL RESERVE:
CLAIM SUMMARY DETAILS:
POLICY ANALYSIS
ANALYSIS SUMMARY:
Policy Bound: Other Lines of Business:
Sales Location: Plan code:
Time on Risk: Next Renewal:
VEHICLE IN LOSS Vehicle No: Year: Make & Model:
Driver in Loss: Listed? Age/Lic Class:

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Other Drivers:
1.)
2.)
Listed?
1.)
2.)
Date(s) MVRs pulled & Results: Autoplus Co. & Results:
VEHICLE RATING at
TOL
Class: Driving Rec: S/C: Grid:
NSFs or Representments with RBC:
1.)
2.)
3.)
Prior Losses (type & dates) with RBC:
1.)
2.)
Reserves / Payout:
1.)
2.)
UW Approval:
RSP Referral? Ceded since?
ACTION TAKEN:
1. What was done incorrectly?
2. What could have been done?
3. What did we learn / post loss action?
(B)
Large Loss Report- Initial
TO: (Manager)
Insured:
File No.:
DOL:
Notice date: (date BI claim opened)
Jurisdiction:
Report Date:
Adjuster:
----------------------------------------------------------------------------------------------------------------------------------
Coverage: TPL amount. Policy Term: Policy Violations Risk Sharing Pool: (yes or no)
Claim Summary:
Brief description of loss details. Did the police attend, any charges, HTA results, witnesses. Nature of
impact. Host liability? Comment on whether investigation is complete and if not, what further investigation
remains outstanding. Liability assessment with reasoning and/or ongoing investigation.
Plaintiff: (How involved in mva: driver, gp, ped)
Name, age on DOL
Solicitor:
NOI:
Martial status/dependents?

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MVA Injuries: Description/diagnosis and impairment.
Pre accident injuries: brief description and whether they were impacting/restricting employment and adl’s
at tol. Any global action?
Post Accident Injuries: In case of fall, can they tie it back to the mva? If a subsequent loss, advise of
liability and if global.
Employment: Employer, job title and income. Comment on collaterals.
AB status:
File status: Strategy for both litigated/non-litigated files.
Reserve Adjustment Reasoning: Provide reasoning for why you are reserving now and the date of the
report necessitating the increase.
Reserves: Current Indemnity Reserve: I recommend an increase as follows:
GD: Low-mid-high end of range?
PLOI: 80% of net to trial. Explain anticipated trial date and deduct collaterals. Age at time of trial.
FLOI/LCA: explain reasoning and amount per year with pv to what age.
FLA: Why?
HK: Justification and consider mention current living arrangements (APT/House).
TOTAL $ (including costs pji etc) ***Copy of BIWS*** Intended Action:Plan to move file forwards.->Next
report due if reserve increase is warranted
(C)
Large Loss Report Update (Label LLR #)
TO:
Insured:
File No.:
DOL:
Notice date: (date BI claim opened)
Jurisdiction:
Report Date:
Adjuster:
Investigation Update:
Liability investigation status and relevant updates. Follow-up/updates since your initial LLR. Advise if
any information has been identified that will impact your liability assessment/claim exposure.
Damages Update:
Plaintiff’s recovery/disability status as well as status as to AB file, collaterals, litigation status.

Jacka - 29 -
Reserve Adjustment Reasoning:
Provide reasoning for why you are reserving now and the date of the report necessitating the increase.
Reserves:
Current Indemnity Reserve:
I recommend an increase as follows:
GD: Low-mid-high end of range?
PLOI: 80% of net to trial. Explain anticipated trial date and deduct collaterals. Age at time of trial.
FLOI/LCA: explain reasoning and amount per year with pv to what age.
FLA: Why?
HK: Justification and consider mention current living arrangements (APT/House).
TOTAL $ (including costs pji etc)
***Copy of BIWS***
Intended action:
Plan to move file forwards.
(D) P&C –New Litigation
H&A and Travel: Send completed form, by e-mail, to Deb Wild within 5 business days of engaging Outside
Counsel for all matters including litigation, arbitration, priority dispute, opinion, loss transfer, subrogation.
Full Case Name (as appears on Statement of Claim/Arbitration):
Lead Plaintiff Name: Insured Name
Policy Number:
Claim Number:
Date of Loss: (yyyy/mm/dd)
Type of Work:
litigation arbitration priority dispute subrogation loss transfer opinion EUO
Alternative Billing Program (applicable to AB and BI only): In Scope Not in Scope
Date of Service: (yyyy/mm/dd) Date Statement of Claim Issued: (yyyy/mm/dd)
Date Outside Counsel Assigned:(yyyy/mm/dd) Date Law Group Notified: (yyyy/mm/dd)
Court File/Arbitration Number: Location of Trial/Arbitration (city and province):
Court/Tribunal Name:
FSCO Ontario Superior Court New Brunswick Queen's Bench
Alberta Queen's Bench Nova Scotia Supreme Court Small Claims
Other (please specify)
Plaintiff’s Counsel: Plaintiff’s Law Firm:
Damages Sought $ General
(per Statement of Claim) $ Punitive
$ Other
$ TOTAL DAMAGES

Jacka - 30 -
HOME & AUTO Claim Type: (check one)
AUTO: Bodily Injury Accident Benefits Comprehensive Direct Compensation
PROPERTY: Liability Physical Damage
CRU: Miscellaneous:
TRAVEL Claim Type: (check one)
CRU: CDW Recovery
MEDICAL: AD&D ASO No sub-type
TCI: AD&D Trip Cancellation Trip Interruption
MISCELLANEOUS:
TRAVEL Issues: (check one)
Pre X First Manifest Late Notice/Proof
Other Life/AD&D Policy Lapse
Misrep Coverage Underwriting
Rescission – Fraud Rescission - Contestable
Outside Counsel Firm:

Outside Lawyer Assigned:

Transit: (n/a for Travel)
13268
File Complexity (n/a for Travel)
ACCIDENT BENEFITS (based on future costs)
HIGH >$300,001 (CAT, exposure to bad faith)
MEDIUM $100,001 to $300,000 priority dispute or
legal precedent may be created
LOW <$100,000 + 3 or fewer issues
(n/a for Travel)
BODILY INJURY
(based on claim reserves)
HIGH >$300,001
MEDIUM $100,001 to $300,000
LOW <$100,000
OUTSIDE COUNSEL RANK
(check one) (n/a for Travel)
HIGH
MEDIUM
LOW
Claim Examiner:
Ext
Approving Manager:
Approval Date:
(E) P&C - SETTLED LITIGATION
H&A and Travel: Send by e-mail to Deb Wild within 5 business days of matter resolution
Please submit upon resolution of all matters including litigation, arbitration, priority dispute, loss transfer,
subrogation, etc.
Full Case Name:
(as appears on Statement of Claim/Arbitration):
RBC Law Manager Matter Number:
Court File/Arbitration Number:
Lead Plaintiff: Insured Name:
Policy Number:
Claim Number:
Date of Loss: (yyyy/mm/dd)
Type of Work:
litigation arbitration priority dispute subrogation loss transfer opinion EUO
Alternative Billing Program (applicable to AB and BI only): In Scope Not in Scope
HOME & AUTO Claim Type: (check one)
AUTO: Bodily Injury Accident Benefits Comprehensive Direct Compensation
PROPERTY: Liability Physical Damage
CRU: Miscellaneous:
TRAVEL Claim Type: (check one)
CRU: CDW Recovery
MEDICAL: AD&D ASO No sub-type
TCI: AD&D Trip Cancellation Trip Interruption
MISCELLANEOUS:
Date Settlement Paid: (cheque date) (yyyy/mm/dd) Date of Resolution (yyyy/mm/dd)
Terms of Settlement:
$ Damages (Includes General Damages Loss of Income, Housekeeping, Medical/Rehab
Expenses, Training, Coordination of Benefits)
$ Punitive/Special Damages

Jacka - 31 -
$ Costs Paid to Opposing Counsel. Includes disbursements & taxes
TOTAL SETTLEMENT
Defence Costs (All fees paid to RBC’s Outside Counsel):
$ Fees (including taxes)
$ Disbursements (including taxes)
$ TOTAL DEFENCE COSTS
Rate Outside Counsel Performance: (check one)
1 Very Poor 2 Poor 3 Good 4 Very Good 5 Excellent
Comments:
Outside Counsel Assigned (lawyer name): Outside Counsel Firm:
Claim Examiner: Ext. Date Completed:

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