National Account Claims Protocol

Transcription

1 National Account Claims Protocol For Account Contact WINMAR International Inc Deb Matz Manager, Corporate Marketing Tel: (905)

2 PROGRAM GUIDELINES: Claims will be ed to your office during business hours to After hour claims will continue to be called to your office. John Torosantucci and I will be c.c d so CUMIS and WINMAR can track claims. 1. Contact to be initiated within one hour of accepting assignment from CUMIS. If not possible, contact the CUMIS Examiner. (Phone calls must be returned the same day). 2. All workers must be courteous and deal professionally with our clients, including having the appropriate attire for the trade. (Shoes removed or booties are worn) HR Report to be completed and ed with photos to the Examiner/Adjuster and Deb Matz ASAP. On any Commercial/Credit Union claims, the report/photos should be ed to rob.martin@cumis.com & cindy.unsworth@cumis.com. If you do not know who the CUMIS Examiner is and/or if it s an after hours claim, please the 24 HR report to john.torosantucci@cumis.com and Deb Matz. 4. Photograph requirements: Front of building. Each area of damage visually describing the origin/source of the loss and extent of damages. Must be labeled according to the room or area and should illustrate damages related to the loss. Showing any issues regarding age/wear/tear associated with the origin/source of damage or surrounding areas. Additional information included on pages 4 & Diagrams are required for: All damaged floor coverings Roofing losses Structural losses 6. Immediate contact must be made with CUMIS Examiner if there are coverage issues and/or any underwriting concerns. 7. WINMAR to secure authorization form from client prior to starting any emergency services. (Unusual situation and/or job delays must be communicated to the Examiner and the client) 8. Emergency Services: Time & Material pricing at Overhead 10% & Profit 5% (incl. overtime) 9. Rebuilds: Xactimate unit pricing. Overhead 10% & Profit 5% - up to $50,000. Over $50,000: The most efficient use of the unit cost in Xactimate. Adapt accordingly.

3 10. ICC validation required when replacing carpet, vinyl, laminate and hardwood flooring: Establish time requirements with the ICC vendor and advise the Adjuster when they can expect to receive the ICC quote. Validation reports should accompany the ICC quote. 11. No Emergency Service Call charge (during or after hours). 12. Travel Time Charges: In the event you are asked to attend a claim that is over 100km return from your office, and there is not a closer WINMAR, CUMIS will pay mileage. Use Xactimate Coding FEEDRV Additional Driving Charge per km. (Example: Calgary is.53 cents a km and Mississauga is.54 cents a km) DO NOT CHARGE O/P. CUMIS will also pay mileage over 100 km return from your office if you do not receive the claim. 13. Estimates to be submitted within 1 to 2 business days after completion of emergency services. If this cannot be achieved, then the estimator will contact the CUMIS Examiner or Independent Adjuster. (CATS will be dealt with separately). 14. WINMAR to advise start date and length of repairs (Unusual situation and/or job delays must be communicated to the Examiner/Adjuster and the client). 15. Competitive repair estimates may be requested on jobs that are over $20, Inspection/Estimate Fee: No estimate fee will be charged if the preferred vendor completes any portion of the repair/emergencies of the claim. Repair Estimate: Inspection/Estimate Fee: $0 - $5,000: $75 - $150 $5,001 - $10,000: $150 - $250 $10,001 - $25,000: $250 - $350 $25,001 - $50,000: $350 - $400 Over $50,000: Negotiable HST or O & P is not to be included. 17. Ice Back up limit is $10,000. This includes emergency services, repairs and contents damage. 18. Sewer Back up limit is $5,000, 15,000 or $25,000 (only if the insured has the Extended Water Coverage endorsement). This includes emergency services, repairs and contents damage. 19. Authorization and Job Completion forms to be completed and sent with final invoice. 20. Invoices: c.c. Deb Matz on all Emergency and Rebuild Invoices.

4 RE: Roof, Siding and Flooring Claims: Roof claims WINMAR s 24 Hour Report or subsequent repair estimate should include a roof inspection report including a diagram that clearly identifies where the damage is on each affected slope. Photographs: To be taken of: Water entry source (if applicable), All wind, hail, impact damaged areas of roof (including hail hits to soft metals), Entire roof showing age and overall condition. Hail impact damage should be circled in chalk. The photos should include a full view of each slope with hail hits circled in chalk and several close-up photos of the same hail hits. This will allow the Adjuster to determine the extent of damage and overall condition of the roof. All photos of roof damage should be taken from the roof or at a minimum the roof s edge. Will CUMIS replace the whole roof? Yes, but only if most of the roof is not repairable due to damage by windstorm and/or hail or other insured peril such as falling object(s). If 1 slope is damaged, we will only replace that damaged slope. Our policy does not guarantee a colour match. If necessary, CUMIS will waive the deductible as an appearance allowance where a close colour match is not possible. If site lines are an issue due to an obvious colour match, CUMIS may pay for an additional slope so that this problem is not noticeable. If more than 60% of the roof requires replacement, then CUMIS will consider full replacement of the roof.

5 Siding claims CUMIS does not require a formal report from a siding company, however, WINMAR s 24 Hour Report should clearly identify the source of water entry (if applicable). Photographs: To be taken of: Water entry source (if applicable) All wind, hail, impact damaged areas of siding, The rest of siding showing age and overall condition. Will CUMIS replace all the exterior wall siding? Yes, but only if most the siding is damaged due to windstorm, hail and/or impact. If 1 wall is damaged, we will only replace that damaged wall. Our policy does not guarantee colour match. If necessary, we will waive the deductible as an appearance allowance where a close colour match is not possible. If site lines are an issue due to an obvious colour match, CUMIS may pay for an additional wall so that this problem is not noticeable. If there s an issue with the original siding profile not being available, please contact the Independent Adjuster or CUMIS Examiner if it becomes an issue with the client. Flooring Claims WINMAR s 24 Hour Report and photos should clearly identify the cause and origin of damages and overall condition of the flooring (especially if any pre-existing damages). Diagram should be provided. ICC validation required when replacing carpet, vinyl, laminate and hardwood flooring. Will CUMIS replace all flooring/carpet after a covered loss? If not all flooring is damaged, the client is not entitled to replacement in non-affected areas at obvious break points such as doorways, where a closed door serves as a logical stop point. If there s an issue with the same colour and materials not being available, please contact the Independent Adjuster or CUMIS Examiner if it becomes an issue with the client.

6 GENERAL CUMIS General Insurance Company Credit Union Members Insurance Services The CUMIS Group Ltd. partners with credit unions to deliver insurance and financial solutions. In doing so, it creates financial security and promotes the growth and success of the credit union system in Canada. As the leading provider of insurance-related products and services to the Canadian credit union system, CUMIS serves approximately 380 credit unions, with a total of more than five million members. By partnering with CUMIS, credit unions can offer their members many types of insurance including credit and mortgage protection, life, home and auto. CUMIS also offers business liability and property insurance to credit unions themselves. CUMIS' principal companies are CUMIS Life Insurance Company and CUMIS General Insurance Company. CUMIS also has a 50 per cent interest in Credential Financial Inc. CUMIS is jointly owned by Co-operators Life Insurance Company and Central 1 Credit Union. Personal Lines: Commercial: CUMIS policy holders are primarily credit union members. CUMIS insures credit union/caisse populaire buildings as well as foreclosed properties and some credit union member s properties. Crawford & Company, ClaimsPro, Cunningham Lindsey and some other independent adjusting firms may assist in handling claims. Crawford & Company handles CUMIS after hours personal lines claims calls. Cunningham Lindsey handles CUMIS after hours commercial/credit union calls. CUMIS General Insurance Company PO Box 5065, 151 North Service Road Burlington, Ontario L7R 4C2 Phone # Property & Casualty Team: Personal Lines Property Claims: john.torosantucci@cumis.com (Unit Specialist) Ext april.edwards@cumis.com Ext jeff.bielby@cumis.com Ext david.paquette@cumis.com Ext tony.porco@cumis.com Ext Commercial Credit Union Claims: rob.martin@cumis.com Ext cindy.unsworth@cumis.com Ext