Deadlines
What is the deadline to Respond to an OCF-1
10 days!
30 year old single female was a passenger in her fathers vehicle at the time of loss, she has her own insurance with Wawanesa but has sent an OCF-1 to Definity. what kind of investigation is needed?
Priority Investigation
How long is the max Non Earner Benefit payable for?
104 weeks
How often should you be calling unrepresented customers?
At least every 60 days or anytime you deny something on the claim
When does the insured need to be notified for an IE?
Not later than 5 business days before scheduled Assessment
What are some Red Flag examples to trigger an SIU investigation?
1. Address Misrepresentation
2. Late Report
3. Use of vehicle for Work
4. Incident/ accident
What calculating method is used when paying Attendant Care invoices?
Malitsky method
What is the most important question you should be asking customers in the Initial Call out?
How are you?
When is an invoice considered late if payment is not made?
30 days after receiving the invoice
What are some Red Flags for Late reporting?
1. If claim was not reported within 7 days of loss
2. OCF-1 was not submitted within 30 days of it being provided to the customer
3. Injuries were not reported when the Pd claim was opened
Customer broke his glasses during the accident, how do we cover this benefit?
Section 24-
Damage to clothing, glasses, hearing aids, etc.
24. The insurer shall pay for all reasonable expenses incurred by or on behalf of an insured person in repairing or replacing the following:
1. Clothing worn by the insured person at the time of the accident that was lost or damaged as a result of the accident.
2. Prescription eyewear, dentures, hearing aids, prostheses and other medical or dental devices that were lost or damaged as a result of the accident. O. Reg. 34/10, s. 24.
What is the expectation for when an Initial call out should be completed?