2016 Fall #2 Part e

DulcineaDelCA

Hi Graham,

According to the new 2016 bulletin, insurers may use UBI data for fraud prevention and claims management. Does this mean UBI data can now be used to deny and adjust claims (the answer to part e is permitted)?

Thank you!

graham

I see what you mean and I wondered about that too. A strict reading of the source document says you still cannot decline / cancel / non-renew / surcharge based on UBI data, but it might be ok to deny a claim if UBI data indicated dishonest answers by the insured on the policy form, or if there was suspicion of fraud.

There full statement from the source document is as follows:

• UBIP data may be used to detect and prevent fraud and to manage claims as permitted by law and in accordance with the Unfair or Deceptive Acts or Practices Regulation (O. Reg. 7/00). For example, the use of UBIP data should not result in the unreasonable delay in, or resistance to, the fair adjustment and settlement of claims. Additionally, it is expected that UBIP data will supplement – rather than replace – standard claims management practices.

So maybe if you see something suspicious in the UBI data, you can then investigate further and if your further investigation uncovers fraud or dishonest answers you can then take further action like denying a claim.

I think this is still a bit of a grey area.