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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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