FAQ: TripleGuard™ Insurance Pandemic Coverage

 

Last Update: September 30, 2020

 

NEW If a second wave of COVID-19 causes my practice to shut down again in 2020, will TripleGuardTM insurance provide pandemic coverage benefits?

 

Here are some important considerations to help you determine if you may be eligible for coverage in 2020:

 

  • Your pandemic coverage has an annual maximum coverage limit. If you already received a payout equal to your annual maximum payout in 2020, your TripleGuardTM policy will not provide any additional pandemic benefits in 2020.

 

  • If you did not receive the maximum TripleGuardTM insurance pandemic payout, you may be eligible for a “top up” claim payment amount, up to your maximum annual limit. This would be triggered if a pandemic shut down is ordered again in 2020 by a public health official or civil authority.

 

  • TripleGuardTM insurance pandemic coverage is only activated when there is an order given by a public health official or civil authority to shut down your premises as a direct result of the pandemic. It is not the date of any instruction from your dental association or college that triggers the coverage.

 

 

NEW How do I know what my annual TripleGuard™ insurance pandemic coverage limit is under my policy?

 

There are 3 versions of coverage under the TripleGuard™ insurance pandemic policy:

 

  • Up to $1,000 per day, up to an annual maximum of $20,000 aggregate, or

 

  • Up to $2,500 per day, up to an annual maximum of $50,000 aggregate, or

 

  • Up to $5,000 per day, up to an annual maximum of $100,000 aggregate.

 

You can check which coverage limit applies to you by accessing your online account at cdspi.com.

 

NEW Can I buy more TripleGuardTM insurance pandemic coverage?

 

No. Unfortunately, CDSPI is unable to accept any further requests for new or increased coverage amounts under the TripleGuardTM insurance pandemic extension.

 

NEW When I renew my TripleGuardTM insurance policy, will pandemic coverage be included in 2021?

 

No. Unfortunately, Aviva Insurance Company of Canada (Aviva) has made the decision to no longer offer pandemic coverage as part of the TripleGuardTM insurance policy. This coverage is not available on a standalone basis.

 

NEW Will there be any changes to my TripleGuardTM insurance policy at renewal, including any premium increases for 2021? If so, when will these changes be announced?

 

Details about the 2021 rates and policy wording updates are currently being finalized by Aviva. We will communicate any changes to you in November.

 


 

Why is it taking so long to hear from an adjuster?

The speed with which this situation developed, and the sheer volume of dentists impacted, was both unprecedented and unpredictable. On March 16th when the first recommendation from a licensing body was sent out, CDSPI began receiving thousands of calls.  Following that recommendation, there were discussions between Aviva Insurance Company of Canada (Aviva) and CDSPI while Aviva worked to resolve complex legal, regulatory and operational hurdles. On April 1, Aviva confirmed that pandemic coverage would apply.

Now that Aviva has determined that pandemic claims have been triggered, Aviva has put in place a specialized team and processes to begin working through the thousands of claims submissions. This of course, will take some time as adjusters will be reaching out to everyone individually.

Insureds will begin receiving calls from Aviva adjusters the week of April 13th.

There is no other action for you to take until an adjuster has reached out to you.

 

What documentation do I need to provide to the Aviva adjuster so they can adjudicate my claim?

  • Financial statements for your practice for the year ended December 31, 2019 or for your most recent year-end.
  • If your year end is prior to December 31, 2019 or if you have a new practice, then you should provide your most recent year-end as well as any statements and reports you have available that pertain to the period prior to closure.
  • If you have provided emergency work during the closure, information of weekly earnings from the point of closure to present.
  • Other information may be required – the adjuster will let you know if that is the case for you.

 

Why do I have to submit my financial information?

As with any claim, it is a requirement to provide documentation of the actual financial loss incurred.

 

How should I submit the required information?

You will be asked to provide this information to the Aviva adjuster only once they contact you about your claim. There is no other action for you to take until an adjuster has reached out to you.

 

What is the effective date that is being used to determine the claims being paid out?

Aviva has clarified that the pandemic coverage is activated when there is a Provincial Order in place by the government to shut down non-essential services. This is not the date of any instruction from your respective dental associations or colleges, rather the government order.

For ease of reference, we have included the date of the Order by Province below:

 

 

Province
Effective Date of Order
AB
March 27, 2020
MB
April 1, 2020
NB
March 19, 2020
NL
March 24, 2020
NS
March 21, 2020
NU
March 19, 2020
ON
March 24, 2020
PEI
March 27, 2020
QC
March 25, 2020
SK
March 23, 2020
YK
March 27, 2020
NT
March 23, 2020
NT
March 23, 2020
BC
March 23, 2020

 

Is there is a deductible?

There is a 24-hour waiting period deductible from the date of the government order.

Therefore, actual financial loss will be calculated from the Provincial Order date + 24 hrs.


If I have follow-up questions about my claim, who should I contact?

Your assigned Aviva adjuster will be your point of contact. They will reach out to you and answer any questions you may have about your claim.

If you reside in British Columbia or Quebec, Aviva has contracted ClaimsPro to manage your claims. A ClaimsPro adjuster will reach out to you and they will be your point of contact.

 

What is my coverage limit under TripleGuard™ pandemic insurance?
There are 3 versions of coverage afforded under the TripleGuard™ Insurance policy pandemic coverage options:

  • Up to $1,000 per day up to a max $20,000 aggregate
  • Up to $2,500 per day up to a max $50,000 aggregate
  • Up to $5,000 per day up to a max $100,000 aggregate

CDSPI will provide your coverage limit to Aviva in order to facilitate the processing of your claim and you may also check your coverage limit by accessing your account online at www.cdspi.com.

 

Can I buy more TripleGuardTM pandemic coverage?

Unfortunately as of 11:59 p.m. on March 12, 2020, CDSPI was unable to accept any further requests for new or increased coverage amounts under the TripleGuardTM pandemic extension. The insurer determines the circumstances under which CDSPI may bind coverage under the TripleGuardTM In this case, as the pandemic became a known risk, the insurer informed CDSPI that it would not accept requests received by CDSPI after 11:59 p.m. on March 12, 2020. Only if an insured is able to provide evidence that he or she successfully contacted CDSPI by email, fax, phone or voicemail, before 11:59 p.m. on March 12, 2020 to request new or increased pandemic insurance coverage, are those requests to be accepted. In the absence of such evidence, CDSPI does not have authority to bind coverage and the insurer will not accept requests for new or increased coverage after that deadline.

 

How is the claim payment calculated and what information is required?

The claim payment calculation is: Revenue from the last fiscal year-end, less Variable and Non-Continuing Expenses during the indemnity period.

For a newer practice, the claim payment calculation requires:

  1. Monthly revenue from the inception of the practice to present and,
  2. Detailed monthly expenses from the inception of the practice to the present.

For an Associate, the claim payment calculation requires:

  1. Income from the last fiscal year-end (refer to financial statement it exists),
  2. Or monthly income for the period between March 2019 through to February 2020.

 

How will Aviva calculate the amount of my claim under TripleGuard™ Insurance pandemic coverage?
The Aviva adjuster will be providing you with more details on the calculation when they reach out to you. Please be ready with the documentation required by the adjuster. Please refer to the previous question “What documentation do I need to provide to the Aviva adjuster so they can adjudicate my claim”.

 

How long do I have to wait until an Aviva adjuster contacts me?

We expect adjusters to begin reaching out to claimants on an individual basis starting the week of April 13th. We thank you for your patience as it will take some time for the Aviva adjusters to personally contact the thousands of claimants.

 

How will I know who my adjuster will be?

You will receive a phone call or an email from your Aviva adjuster with their name and contact information

 

How long will it take for my claim to be paid?

Your adjuster will be able to confirm the timing of your claim payment once they reach out to you.

 

Is the claim payment tax-free?

Tax will not be deducted from the claim payment. We recommend you discuss your individual circumstances with your tax advisor.

 

My dental practice is open for emergencies only as dictated by my licensing body. Will I still be able to make a claim for TripleGuard™ Insurance pandemic coverage?

You are still eligible to make a claim and you will be asked by Aviva to submit your weekly revenue as part of the claim process.

 

I am a dentist volunteering in an emergencies-only clinic at a hospital. Will I still be able to make a claim for TripleGuard™ pandemic coverage?

You are still eligible to make a claim and you will be asked by Aviva to submit your weekly revenue as part of the claim process.

 

Will any COVID-19 related government assistance affect my claim payment?

The CEBA is the Canada Emergency Business Account. As it is a business loan, it will not be taken into consideration when calculating your claim amount.

The CERB is the Canada Emergency Response Benefit. It is a personal benefit to individuals and will not be taken into consideration when calculating your claim amount.

The CEWS is the Canadian Emergency Wage Subsidy. As this benefit has a direct impact on payroll and income, if you are eligible for this subsidy, it will be taken into consideration when calculating your claim amount.

 

Does being in self-quarantine qualify under pandemic coverage?

Aviva has advised that this is not included under the pandemic coverage.

 

Can I make a claim for CDSPI Office Overhead Expense Insurance coverage during the pandemic?

CDSPI Office Overhead Expense coverage is triggered when you suffer an illness or accident. If you test positive for the COVID-19 virus and you are approved for OOE benefits within the definition of the certificate, Manulife has advised that the elimination period will begin from the date of self-isolation or the date of a positive COVID-19 test, whichever comes first.

For more information on the OOE policy, you can access it here.

 

Can I make a claim under my CDSPI DisabilityGuard™ Insurance policy if I test positive for COVID-19?

DisabilityGuard™ coverage is triggered when you suffer an illness or accident.

If you test positive for the COVID-19 virus and are approved for disability benefits as defined within your certificate, we encourage you to file a claim. Manulife has advised that the elimination period will begin from the date of self-isolation or the date of a positive COVID-19 test, whichever comes first.

For more information on the DisabilityGuard™ policy, you can access it here.

 


What if a client becomes disabled while offices are closed, how would DisabilityGuard™ and Office Overhead Expense insurance pay?

DisabilityGuard™ and Office Overhead Expense insurance are disability policies and they cover you for disabilities resulting from illness or accident.  DisabilityGuard™ insurance provides a monthly benefit based on your coverage amount to replace your income. Your pre-disability income will be determined using the period of time immediately prior to your disability (12 consecutive months out of the last 24 months or the 24 months prior to your disability, whichever works better for you). Office Overhead Expense insurance reimburses your eligible on-going office expenses if you are disabled.  Your elimination period is the period of time before benefits begin.  If you have tested positive for COVID-19 and you were self-isolating prior to receiving your test results, please note that your elimination period will be considered from 14 consecutive days prior to the date you receive your positive test result, provided you have been approved for a claim under this coverage.

 

Doesn’t the pandemic declaration also trigger the benefits available under business interruption?

Aviva has advised that your TripleGuard™ policy does not include coverage for general business interruption due to a pandemic, such as COVID-19. For this to apply there must be physical damage to your insured premises. However, if your TripleGuard™ policy includes a specific Pandemic Outbreak Extension, this coverage may apply to locations which are subject to a Government Provincial Order requiring a shutdown of non-emergency dental services.

 

What do I need to know about my TripleGuard™ insurance protection if my practice or building continues to be vacant?

Aviva is waiving the Vacant Property Exclusion in TripleGuard™ insurance for practices or buildings that were occupied in the normal course of business but ordered to be shut down by order of Civil Authority, for a period of up to 90 days.

The following conditions will apply:

  • The property is subject to both site and perimeter visits every 7 days (either by the Insured or a designated representative of the Insured).
  • Security systems and utilities are to be maintained.
  • A written log has to be kept, recording each site and perimeter visit.

 

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