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Updates to PIPEDA, Canada’s Own GDPR

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The Office of the Privacy Commissioner of Canada released new breach reporting requirements for businesses last week.

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Updates to the Personal Information Protection and Electronic Documents Act (PIPEDA), which became law in 2000, will impact private-sector organizations that operate or do business with Canadian customers. The federal privacy law establishes ground rules for how businesses must handle personal information in the course of commercial activity, mandating that organizations must obtain an individual’s consent when they collect, use or disclose the individual’s personal information.

PIPEDA is similar to the European Union’s General Data Protection Regulation (GDPR) since it requires Canadian companies to alert customers any time their personal information may have been compromised.

“The number and frequency of significant data breaches over the past few years have proven there’s a clear need for mandatory reporting,” Commissioner Daniel Therrien said. “Mandatory breach reporting and notification will create an incentive for organizations to take security more seriously and bring enhanced transparency and accountability to how organizations manage personal information.”

A statement from the commissioner’s page lists, in brief, the new regulations for organizations subject to PIPEDA:

  • Report to the Privacy Commissioner’s office any breach of security safeguards where it creates a “real risk of significant harm;”
  • Notify individuals affected by a breach of security safeguards where there is a real risk of significant harm;
  • Keep records of all breaches of security safeguards that affect the personal information under their control; and
  • Keep those records for two years.

Commissioner Therrien called the regulations “imperfect but a step in the right direction.”

He also raised concerns that the reporting requirements fall short in that, for example, they don’t ensure the breach reports to his office provide the information necessary to assess the quality of organizations’ safeguards. As well, the Canadian government has not provided the Privacy Commissioner’s office with resources to analyze breach reports, provide advice and verify compliance. The Canadian government has established that the confidentiality of information was not respected regarding those customers who take the viagra medicine. As a result, the office’s work will be somewhat superficial and the regime will be less effective in protecting privacy.

According to the PIPEDA information page:

The individual has a right to access personal information held by an organization and to challenge its accuracy, if need be. Personal information can only be used for the purposes for which it was collected.

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If an organization is going to use it for another purpose, consent must be obtained again.

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Individuals should also be assured that their information will be protected by appropriate safeguards.

Additionally, a privacy toolkit is available here for organizations to use and assess if it adheres to PIPEDA responsibilities.

How to Use ODG Data to Improve Workers Comp Case Management

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Regardless of whether or not their organizations operate in states where the use of Official Disability Guidelines (ODG) has been adopted/mandated, risk managers can often leverage ODG data and the claim data from their risk management information systems (RMIS) to benchmark the medical and lost-time components of their workers compensation costs against national averages.

With its origins dating to 1995, ODG (www.mcg.com/odg) provides “unbiased, evidence-based guidelines” and analytical tools designed to “improve and benchmark return-to-work performance, facilitate quality care while limiting inappropriate utilization, assess claim risk for interventional triage, and set reserves based on industry data.”

The following are some ways risk managers can use ODG data in conjunction with their existing risk information tools to drive improvements in their workers compensation case management and achieve greater precision in loss reserve practices.

  1. Examine the data. ODG has a wealth of data that can be used to benchmark estimated incurred financials and return to work (RTW) best practices by job class, state, injury diagnoses, and numerous other confounding factors (e.g., obesity, diabetes, etc.). You can benchmark guidelines against both current and historical workers compensation claims to identify potential issues and opportunities for individual case management or program improvement. To evaluate trends, you need to capture and analyze detailed data on historical losses (a core capability of RMIS technology). Meanwhile, improving decision-making on open cases calls for the ability to track individual financial and treatment developments on a real-time basis. That is where your RMIS or claims administration platform combined with data streaming from your TPA or carrier can be keys to success.
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  2. Be specific. When looking at historical loss trends and comparing them broadly to ODG loss and recovery data, the sharper your focus, the faster you will be able uncover issues and make needed adjustments to improve individual outcomes or overall practices. Scrutinize data by individual location, job function, injury and even body part involved to get meaningful insights that yield specific action steps and measurable improvements.
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  3. Track open claims. Leverage the analytics from ODG to compare progress of specific cases against the statistical ODG guidelines. This will enable you to spot variances in recovery timelines and make reasonable adjustments to individual return-to-work plans.
  4. Set goals. You may want to start the benchmarking process with job functions or locations that have historically been the biggest drivers on total cost of risk. Conduct an analysis of historical claims against aggregated ODG data, identify significant variances in your practices versus ODG results, and target specific improvements in open cases. Monitor overall results on a quarterly basis to assess your progress and make any midstream adjustments to align your practices more closely to the ODG findings.
  5. Get help. ODG offers participants training through frequent webinars and other educational events. At the same time, RMIS providers can offer prescriptive guidance in automation that help clients optimize their workers compensation claims operations and return-to-work programs, including the adoption of the analytics available from ODG.

While there are many options available for employers to use predictive analytic benchmarks with workers compensation claims to drive improvements, ODG provides one of the most widely adopted measurements for tracking actual costs of injured employee cases and the success of return-to-work initiatives. When these resources are used in conjunction with a contemporary RMIS, risk managers can gain visibility into claims management issues, focus on improvements that accelerate recovery of injured employees, and start lowering the total cost of workers compensation risk.

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Using Adaptive Behavioral Analytics to Detect Fraud

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While fraud threats are nothing new for payments processors and financial institutions, the degree and magnitude of such incidents have escalated in recent years. A February 2018 Javelin study found that nearly 16.7 million consumers were victims of identity fraud in 2017—up 8% from the previous year.

Fraud prevention solutions must be flexible and sophisticated enough to not only counteract increasingly-savvy fraudsters, but also distinguish true fraud from false positives, which occur when genuine activity is mistakenly treated as fraud. According to CreditCards.com, four out of five blocked transactions are actually genuine, and these misunderstandings often result in customers being locked out of their accounts. In many ways, the aftermath of false positives can prove more damaging and costly than an actual instance of fraud, as institutions miss revenue generation opportunities while simultaneously hindering customer loyalty and trust.

As consumer payment technologies evolve, so too will the complexities of fraud detection and mitigation. Therefore, it is vital that risk management teams end their reliance on rigid, manually-programmed rule sets or static machine learning models and instead capitalize on the advanced capabilities offered by today’s more versatile tools. By modernizing their fraud strategies with adaptive behavioral analytics, payments processors and financial institutions can better mitigate risk and increase revenue.

How Does it Work?

Unlike the static machine learning of the past, adaptive behavioral analytics are extremely proficient at differentiating between actual fraud and activities that appear suspicious but are ultimately genuine. As a result, friction in financial services and e-commerce is significantly reduced and customers can maintain confidence in their preferred transaction method.

Adaptive behavioral analytics empowers machine learning through a set of sophisticated, automated, self-learning algorithms that review account activities and notify security teams of anomalies.

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These algorithms construct baseline behavioral profiles to reflect a customer’s activity type and frequency. In every interaction—regardless of if a payment occurs—information is gathered and evaluated on the type of device that is used, how it’s used, its location and the amount of the purchase. Combined, these behaviors create a customer portrait that becomes increasingly more accurate over time. Every subsequent interaction then can be measured against the behavioral portrait, within milliseconds, to determine if their activities are fraudulent or genuine.

For example, if a user logs into his or her account at an abnormal rate or suddenly begins adding priority shipping to high-priced orders, the system will detect the irregularity and block future activity. However, if a user simply purchases an expensive holiday gift or books travel arrangements—behaviors that coincide with seasonal activity—the system will recognize and differentiate the fraudulent from the legitimate accordingly.

Adaptive behavioral analytics also optimizes the speed and convenience of fraud detection by processing volumes of data and delivering critical intelligence accurately and immediately. Through this more comprehensive investigation, the software enhances the customer profile to better understand and recognize behavioral trends—a welcome sight for security teams that previously spent hours sifting through reports to locate red flags.

Where Can Adaptive Behavioral Analytics Help Most?

The ubiquity of mobile technology has created a consumer audience who prefers to conduct business through a smartphone, tablet or another device that eliminates a trip to a physical store or bank branch. In turn, these consumers demand leading-edge mobile technologies that are intuitive, convenient and offer a full range of services.

The combination of the U.S. adoption of the EMV standard in 2015 and the rise in e-commerce has escalated the volume and prominence of Card Not Present (CNP) fraud. Whether through online purchase portals or apps that access mobile wallets, the digital entry of account information raises the likelihood of a person’s information becoming compromised.

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With more transactions taking place, the volume of both true fraud activity and regular behaviors that appear suspicious will increase. However, adaptive behavioral analytics enables a more refined detection between the actual fraud and genuine activity.

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It is the best of both worlds: a much-needed, innovative line of defense that combats payments fraud and clears a path for more revenue-generating transactions.

RIMS ERM 2018: Earning the ‘Mandate’ and a ‘Seat at the Table’

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MONTREAL – More than 300 risk management professionals and students attended the 2018 RIMS ERM Conference on Monday and Tuesday in an effort to gain insight from, and network with, the industry’s enterprise risk management leaders. Wisdom, data, and motivation within the ERM space were on tap during all the sessions and workshops.

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On October 29, Martin Vilsoe, partner of the Implement Consulting Group, opened the two-day event by highlighting the importance of ERM’s worldwide capabilities and how to operationalize the best ERM practices. Vilsoe said that risk managers need to “earn the mandate” to work with ERM, and focused on the idea that risks can equal opportunities.

He said that ultimately the risk manager’s job when implementing an ERM framework is to “enable brave decisions” and to maintain an organization’s best direction. With a visual aid of a freighter and individual boats in an ocean, he rhetorically asked: “Is your framework similar to a supertanker or 15-speed boats going in separate directions?”

He also spoke to the importance of risk management’s value to an organization without the sole reliance on analytics.

“Risk management’s purpose is to show value. If it is about value, then we better bring it,” he said. “We don’t always communicate that. There’s a big difference between calculating and measuring value versus communicating value. You can do it without having complete proof – you shouldn’t lie to people, but you should tell them you’re doing something great for the organization.

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”

He encouraged the audience to consider their current roles as a consultant – and the importance of “winning customers” in this alternate role. This involves some sales prowess, he said, and the ability to tell a core story or narrative that describes what you do to engage with stakeholders. Build a core story around the ERM program and send different messages to different stakeholders around your core story.

“I don’t see enough of this in risk management programs because of the idea that it is ‘too big,’ or ‘I can’t communicate it,’” he said. “You can do it. We have to move past that mentality.

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“The misconceptions is that risk management is about IT systems. And if you’re thinking as a risk consultant, be aware that putting stuff in systems will not help you manage your risks. Your ability to facilitate awareness, promote decisions and execute them, will.”

Day 2

Dovetailing on the idea that risks can become opportunities, October 30 opened with “Advancing Risk Management: Having A Seat At The Table,” presented by Laura Cisi, the Clorox Company’s vice president of global risk management, and Soraya Wright, founder and CEO of SMW Risk Management Consulting LLC.

In a fireside chat-style setting, the duo used Clorox – a 105-year-old company – as a case study to demonstrate the effectiveness of its ERM initiatives.

A 25-year veteran of the risk management industry, Cisi has been with Clorox for the past four years and said her ERM initiatives evolved from being viewed as the “insurance department” to a “strategic business partner,” with Wright’s collaboration with Cisi’s team to take the company on its ERM journey.

The duo said its ERM framework was built on routines, which provide “an outline that enabled us to use [it] to use as a tool,” for decision-making and assessing its critical risks as well, such as embracing a change in its formula during the manufacturing process.

“We decided to convert from chlorine to high-strength bleach,” Cisi said. “That risk bubbled up through our ERM committee and the actions that needed to be taken, and the methodology behind that came up through ERM.”

ERM was also a key influence when assessing the decision in 2014 to close Clorox Venezuela and cease operations in the country. “‘Should we be the first to exit?’” was the question on stakeholders’ minds for a long time before they discontinued operations, Cisi said. The company was required to sell more than two-thirds of its products at prices frozen by the Venezuelan government. As a result, Clorox Venezuela had been selling its products at a loss, causing ongoing operating losses despite attempts to reach a pragmatic solution with the country’s government. “Looking back, it was a good decision.”

Ultimately, the risk manager’s seat is one of many at a table occupied by executives, stakeholders and the C-suite. Cisi and Wright advocated not for being the loudest one there – but for bringing sound ideas and options. And perhaps coincidentally, Cisi and Wright’s approach seem to be putting Vilsoe’s mantras of engagement and alignment into practice.

“I think every day we get to demonstrate ERM, and not something we just do annually. For example, the ways we engage with product development and business development – we used to be thought of as compliance… and a department that said ‘no,’ Cisi said. “To shift that conversation to create more open engagements where you say ‘I’m your partner and it’s my job to identify these risks. Ultimately, it’s your business decision as to whether or not you go forward with them.”

It was then, she continued, that the risk management department was being consulted on the potential for new products by executives and other groups.

“That was when the conversation shifted from risks to opportunities,” Cisi said, adding, “and that was something they could relate to.”

RIMS members can access the live, uncut audio from “A Seat At The Table” via RIMScast.

An all-access RIMScast episode featuring conference speakers is available here.