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Article
Analysis: Are cavity wall insulation claims the new PPI?

Joseph Noel, complex liability regional director at Sedgwick, contributed to this article

Blog
Drive-thru operators beware: A double-double = an accident benefits claim?

The Court of Appeal for Ontario recently released a decision in a case that has far-reaching impacts. In Dittmann v. Aviva Insurance Company of Canada, an Ontario accident benefits claim was presented to the insurer, Aviva Canada, as a result of a scalding burn sustained on July 7, 2014 when a hot beverage ordered at a McDonald’s drive-thru spilled on the claimant causing significant injuries. Rather than pursuing a commercial general liability claim for damages, a claim was presented to th

Blog
The changing landscape of veterinarian malpractice

Oh, how things change… I remember, growing up, the family dog slept outside in a dog house. Today, over 62% of our pets share our bed. Our pets are now considered part of the family  and we hold great emotional ties to them. Jump on a plane and you might see a companion pet in the seat next to you. Go shopping at Nordstrom and you might be sharing the aisle with a four-legged friend. This Thanksgiving, you may be making plans to curl up on the couch to watch the annual National Dog

Newsletter
PL Risk Resource Newsletter, Third edition 2017

Blog
Definition of “accident” under Ontario auto accident benefits policy expands to “trip and fall!”

In a recent License Appeal Tribunal (LAT) decision between a claimant and TD Insurance Meloche Monex (D.S. and TD Insurance Meloche Monex #16-000131/AABS), it would seem the stranger the circumstances, the wider the allowance to access Ontario accident benefits. This most recent decision (which is final, no appeal possible) has determined that running along the sidewalk, tripping and striking a parked car is now deemed an “accident” by definition. In this case, the injuries are catastrophic i

Blog
It is happening: LMSAs (and NFMSAs) are almost here

For the past several years, the Centers for Medicare & Medicaid Services (CMS) has been providing the industry with vague hints about liability Medicare set-aside arrangements (LMSAs). The absence of clarity left the liability community unable to know how Medicare set-aside arrangements (MSAs) would apply in a liability setting. Earlier this month, CMS released a communication to providers, physicians and suppliers indicating that LMSAs and no-fault Medicare set-aside arrangements (NFMSAs)

Blog
Why you need a forensic accountant

The story is simple and familiar to any experienced property claims professional: a pipe breaks flooding the restaurant downstairs causing it to close for two weeks, or a worker unknowingly drills through a pipe while working on a customer’s equipment which contaminates product in production causing a production shutdown for 72 hours.  Either of these events results in a claim for lost profits. The business owner may not know that it should claim lost profits; the claim may say lost sales

Blog
When medical evidence does not add up in a liability claim

A Sedgwick liability nurse was asked to analyze the records of a claim involving a 52-year-old man whose car was struck when our client’s truck driver fell asleep at the wheel, overturning his rig and causing damage to several cars.  Liability was not in question, but there was substantial dispute over the damages. The initial plaintiff demand of $750,000, included $140,000 in medical specials and defense counsel assessed the verdict value of $350,000-700,000 based on the severity of the

Blog
This 4th of July, stay safe!

Who doesn’t love July 4th, Independence Day, a celebration of our nation’s independence and traditionally a day filled with food, family and good fun? Unfortunately, July 4th is also a holiday that can bring danger and great potential for property and casualty losses due to the negligent use of fireworks if the proper safety measures are not followed. Unified Investigations & Sciences’ professional fire investigation experts nationwide most often find that fires resulting from negligent use o

Blog
Hidden danger: Preventing commercial truck fires

Although fires only represent a small fraction of trucking accidents, they can be deadly and costly. In the fire investigation industry, the cause of a truck fire often relates to preventative maintenance or lack thereof. In fact, the most common causes for truck fires that I have investigated can be broken down into two categories: Wheel, brake or tire failures Hose or wiring insulation failure In both categories, many of these failures are preventable with proper preventative mainte

Blog
Managing drug samples in physician offices

Managing drug samples in a physician’s office or ambulatory care clinic requires a system of checks and balances to help prevent medication errors and adverse drug events, establish a tracking system for alerts and recalls to comply with federal laws and regulations, and to protect from loss of inventory/pilferage. Also, medication dispensing should be held to equivalent standards of care whether done by a provider office or a pharmacy. Some organizations have stopped distributing sample medic

Blog
Healthcare consolidation and its impact on liability claims outcomes

Not that long ago, the insurance industry, if not the business world, was rocked when Connecticut General and INA merged to form CIGNA. Today, mergers and acquisitions are a common everyday occurrence. Once an M&A announcement has been made public, there is a plethora of activities and actions that need to be addressed, including staffing, location of personnel, budget and culture. Each one of these areas, even in a small way, can have an impact on your claims program. The culture of the o

Blog
If lightning strikes…are you at risk for a CSST fire?

A hole is melted in the thin wall of CSST after a lightning-caused fire Since the 1990s, a product called corrugated stainless steel tubing (CSST) has been used in some home and light commercial construction. CSST is used to deliver fuel gases to gas appliances such as furnaces, water heaters and stoves – a function previously done using rigid black iron pipe. Since CSST is sold on a continuous roll and does not require the labor-intensive cutting and splicing that black iron pipe does, it is m

Blog
Change, non-change important to Medicare compliance regulations

If you have been trying to keep up with the latest Medicare compliance changes, you might feel like you are watching the carnival vendor who used to say, “around and around it goes and where it stops nobody knows.” Fortunately, with these answers you don’t have to guess. Liability: CMS withdraws proposal for liability MSAsSometimes the biggest developments come from the changes that don't happen; this was the case for Medicare set-asides (MSAs) in liability cases. In 2012, the Centers for Med

Newsletter
PL Risk Resources - First Edition 2014

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