For at least five years, the city has adopted "an attitude of denial" toward insurance claims and systematically misled people with insurance complaints against it, according to the city ombudsman. Fiona Crean's office looked at more than 12,000 claims worth more than $2,000,000 spanning five years and found that 93 per cent of claims against the city were denied outright.
A number of those were denied without any investigation, Ms. Crean said, even though claimants were sent letters claiming one had taken place.
"The city must stop promising things on which it cannot deliver," she said. "There's no point offering a fair, transparent, open investigative procedure if the reality is the claims are just denied at the outset. The city holds out a promise of fairness in the resolution of claims. It's promise is flawed. No such thing actually happens."
Most of those claims arose from property damage resulting from potholes, falling tree limbs, problems with contractors and sewage or water backup – high-volume, low-value "desktop claims" generally under $10,000 and considered nuisance claims at City Hall.
The problem appears to be getting worse. In 2005, 76 per cent of pothole claims were denied. Last year the rate was 97 per cent.
For tree limb claims, the rate jumped from 78 per cent in 2005 to 99 per cent last year.
Ms. Crean said she was mindful of the city's responsibility to protect itself from onerous financial liability and focused her investigative gaze on whether it met a certain bar of fairness.
Of 62 cases her office reviewed closely, Ms. Crean found 32 per cent were denied out of hand and 21 per cent were closed without informing the claimant. It took four months to respond to the average claim with a report.
The city pays McLarens Canada (now called Granite Claims Solutions) $195 to process the desktop claims. With that comes a massive workload. Put together, "this puts pressure on them to deny claims as quickly as possible," according to the report.
Her report cites examples of several unnamed claimants. One man, Mr. Z, put in a claim stemming from pothole damage to his car. The day he filed a complaint, he received a letter back denying his claim due to an investigation. When Mr. Z contacted the adjuster to obtain the investigation report, he was told to make a Freedom of Information request. The adjuster later said it would obtain more detailed information, but never followed through.
Six months later, when Mr. Z actually filed a Freedom of Information request, he received a report that said there was liability for negligence on the part of the city and that the pothole in question had been the matter of previous complaints. When he challenged the adjuster on his conclusions, he didn't receive a response.
Ms. Crean is recommending that the city set strict service standards for insurance claims by Jan. 31, 2012.