Legal Expense Insurance
CLAIMS – All you need to know
Claims: All you need to know
Agenda
•
Claims process
•
A day in the life of a Legal Expense Insurance Claims Adjuster
•
LEI Claims in numbers
•
The civil litigation process
•
The element of confidentiality / privacy
•
Reasonable prospect of success
•
Our panel law firms
•
Customer stories
Claims Process
1
It starts with a
phone call
2
Legal advice
is given
3
Claims
determination
4
Panel lawyer
is assigned
A day in the life of a Claims Handler
CLAIMS
• Review the advice lawyer’s notes
ON-GOING CLAIMS
• Contact the insured to get the full picture
• Review files to ensure a smooth and
timely progression
• In most cases, request and review
documents relevant to the case
• Ensure the file meets the likelihood of
success requirements
• If the claim is covered and legal
representation is required, a lawyer is
appointed
• Manage cost and invoices
• If the claim is not covered, contact the
insured and explain why
• Discuss the evolution of files with the
panel lawyers
• Be the advocate for the clients
LEI Claims in Numbers
5 million dollars
Paid in claims since DAS Canada opened its doors in 2010
LEI Claims in Numbers
13,000 calls
to the Legal Advice Helpline
LEI Claims in Numbers
2,808
claims submitted
1,741
1,067
claims covered
claims not covered
829
912
107
960
claims closed
active claims
exclusions
pre-inception
LEI Claims in Numbers
The Legal Advice Helpline
TOP 3 TYPES OF CLAIMS:
1.
Traffic tickets
2.
3.
Contract disputes
Employment disputes
Civil Court – Active Cases
Elapsed time from case initiation to first disposition
350,000
52%
300,000
250,000
200,000
•
150,000
18%
100,000
On average, in one year, there are
920,000 active civil court cases
15%
8%
8%
50,000
-
CANSIM Table 259-0015
The Civil Litigation Process
Demand
letter
Negotiations
Courtmandated
negotiations /
settlement
discussions
Legal
issue
START
HERE
Legal
representation
Trial
Issue
proceedings
The element of confidentiality / privacy
• Solicitor-client privilege and client privacy/confidentiality apply.
• Detailed information regarding the nature of your client's claim
cannot be disclosed to you.
• If your client encounters any issue during the claims process,
we ask you direct them to contact DAS Claims Department
Representative directly.
• Feel free to raise your client's concern with your DAS Broker
Consultant, who can monitor the issue on your behalf and keep
you informed while staying within solicitor-client privilege rules.
“Reasonable Prospect”?
51%
“Reasonable Prospect”?
Reasonable prospect of success:
• For civil cases, “reasonable prospect of success” means we agree it is always more likely
than not that an insured person will recover losses or damages (or obtain other legal
remedy which we have agreed to) or make a successful defence.
• Is it possible to appeal the decision?
Our Panel Lawyers
•
•
National coverage
Strict service standards
Customer Stories – Meet Jenn
Jenn purchased a vacation to a 5 star resort in the Caribbean
through a travel agent, and was looking forward to a week in
paradise. Upon arrival, she found that the resort was not at all
as advertised. To her surprise, not only was the hotel a 2 star
facility, it was also infested with insects.
Customer Stories – Meet Jenn
As the bugs had invaded the entire hotel, Jenn called the travel agent for help. She was told that cancelling
the holiday was not an option and had to stay for the full 7 days. By the end of the week, she was covered
in bites and sleep deprived, having only managed to sleep a few hours each day.
The holiday created a great deal of anxiety for Jenn, and cost her a lot of money. The bug infestation was so
severe she had to leave her luggage and belongings behind. When all attempts to recover any expense
through the travel agency failed, Jenn turned to her DAS policy for help.
As it was the first time she was using her DAS policy, Jenn wasn’t sure what to expect. She braced herself,
anticipating never ending meetings and huge amounts of paperwork. To her delight, none of her concerns
materialized. The DAS team handled everything, only asking Jenn to provide receipts, dates and contact
information. Three weeks later, the assigned lawyer was able to recover 67% of Jenn’s expenses. She also
saved $1,500 in legal fees.
Customer Stories – Meet Fred
Fred owns a small trucking company and often works
with a broker to arrange shipments. While on his way to
deliver a shipment to a client, one of Fred’s drivers got
stopped at a weighbridge. The truck was found to be
overloaded. In order to be allowed to continue, the
driver was forced to go back to the warehouse to
unload parts of the shipment. As a result, the driver
failed to arrive on time for the delivery, and the client
refused the shipment as it was time sensitive. Not only
did the broker refuse to pay Fred for the job, he also
refused to pay for 12 previous jobs.
Customer Stories – Meet Fred
Fred called DAS for help.
We appointed a lawyer who successfully negotiated a
settlement whereby Fred agreed to return the goods to
the customer at his own cost, and in return the broker
released the funds for all the jobs that had been done.
Fred saved $4000 in legal fees.
Customer Stories – Meet Peter
Peter is a taxi driver. One Saturday night, he picked
up an intoxicated customer who began to verbally and
physically abuse him. Peter had no choice but to
defend himself from the unruly passenger. As a result,
the passenger called the police and Peter got charged
with battery.
Customer Stories – Meet Peter
Peter called DAS immediately. We assigned a lawyer
who had the charges dismissed. Without a DAS
insurance policy, Peter would have had to pay $7,500.
Customer Stories – Meet Brenda
Brenda had been an employee of a financial services
company for over 10 years. When the company was bought
out by another company, a lot of staff were dismissed,
including Brenda. Her contract contained a clause making it
impossible for her to work in the same industry and province
for the next 3 years. On top of this, Brenda was only offered
the statutory minimum.
Customer Stories – Meet Brenda
Brenda called DAS. It only took a couple of months for the
appointed lawyer to get Brenda double the severance, as
well as a cancellation of the post termination restrictions.
This allowed her to start applying for other jobs in the
province she lived in right away.
Brenda saved $3500.
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