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~ Alberta - Section B ~
Points to
Consider for Alberta Claimants
Knowledge is power.
See Your own doctor. If you are unsure, inquire whether your doctor also
works for your insurance company. You may be surprised. In Alberta
there are a number of physicians and other health care practitioners who also
work for Alberta Insurance Companies and the Worker's Compensation Board.
Be particularly wary, once performing their insurance company duties, physicians
may be exempt from any responsibility to you under their Code of Ethics.
Check out the College of Physicians and Surgeons of Alberta (CPSA) (http://www.cpsa.ab.ca).
You can search physician profiles and see whether there has been disciplinary
action against any particular physician. Ideally take someone with you to
your appointments. Being injured can be overwhelming and it is sometimes
possible to forget to ask questions or forget the answers if you do. This
is understandable. In our experience having someone with you is very
helpful.
Understand your rights and responsibilities as an Albertan (http://www.amvic.org/about.htm)
injury claimant. Familiarize yourself with the Section B Protocol (http://www.finance.gov.ab.ca/publications/insurance/super_bulletin0407_accident_benefits.pdf)
Realize that your adjuster is in a conflict of interest. The claims
adjuster is managing your claim but also defending the
Corporation’s position (and financial bottom-line). As a claimant, you
need to be truthful and helpful however, you shouldn’t be too naïve.
Don’t say anything that may be misconstrued and used against you to jeopardize your
claim. You may wish to have a lawyer do the work for you from the very beginning
of your claim.
It is my personal opinion that all contact should be in
writing, this leaves nothing to be misunderstood or misinterpreted.
Contact with your adjuster, by phone or in-person, is very questionable.
In my experience, the notes made by the adjuster regarding conversations have
been less than an accurate representation of the actual words exchanged.
The choice is yours. Consider yourself forewarned. Record
conversations (tell them you are doing so) and document all contact and
meetings with your adjuster (date, time, place, attendees). It is perhaps
more prudent to always have a family member or a friend accompany you to all
meetings at your insurer, in addition to recording. Of course, keep all
correspondence.
Accurate and comprehensive documentation of the very first
contact and meetings between you and your adjuster are important. Often
problems with contentious claims can be traced back to initial contact when
there may have been miscommunication (or simply lack of a witness).
Don’t feel
intimidated or pressured by your adjuster. If you are making a injury
claim you still have two choices. It is most likely difficult for you to think
straight. Important decisions deserve careful thought and
consideration. If you don’t understand something, ask for clarification.
If you still don't understand ask again, document this in writing. If you
disagree with something, document your disagreement in writing. If you are
not comfortable with signing a particular form please don't do so. Be
cautious of a pushy (coercive) adjuster, don't allow them to bully you.
If you are dissatisfied with the Section B policies or the
behavior of your insurance adjuster you can take your complaint to the Alberta
Insurance Council, (http://www.abcouncil.ab.ca/).
You can also take your concerns to the Minister Responsible
for Alberta Insurance (historically the Minister of Justice). See (http://www.gov.ab.ca)
good luck, you will need it.
There
is also the Alberta Ombudsman (http://www.ombudsman.ab.ca/),
though that office can’t address employee behavior. The Ombudsman is
limited to making recommendations to your private insurer regarding issues that
they investigate. There is no enforcement capability. Again, good
luck. Consider saving your energy.
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