“The most underestimated liability... is actually in the human or the systemic layer, especially in medicine,” said Sarah Suschkov (pictured), senior vice president and chief underwriting officer at Trinity Underwriting. While the industry continues to fixate on the emergence of AI and automation, she argued that the bigger risk sits in the overlooked complexity of legacy systems, outdated hospital infrastructure, and the very people expected to adapt to change.
In Canadian R&D, particularly in healthcare and clean tech, innovation is outpacing the systems meant to absorb it. Suschkov pointed to the challenges not in the technology itself, but in its implementation. “The work associated with, and the challenges associated with, implementing new technology or innovations aren’t related necessarily to those innovations. A lot of the time we see it in the data transfer, the legacy system overhaul, and the human error associated with trying to learn a new habit,” she said.
AI and other emerging technologies might be capturing the headlines, but she warned the real exposures are often buried beneath training gaps, procedural friction, and entrenched systems. “AI is, you know, a sexier topic to talk about. But really, when we look at the risk and where I see the risk coming from, it’s in that human error.”
Insuring early-stage R&D companies means navigating a web of unknowns. That’s not new - but the speed and scale of growth in health tech and clean tech have intensified the challenge. At Trinity, Suschkov said underwriting these firms isn’t just about evaluating the business model or the product. It’s about who is behind it.
“We always look at not just the what are they doing and where are they going, but who’s behind them,” she said. “We’ve always looked at who’s behind it, exactly, and how does that look in a startup environment.”
That includes assessing the experience and track record of the leadership team. In rapidly evolving sectors, a reputable founder with prior exposure to regulated markets can signal stability in an otherwise uncertain proposition. “That’s one of the ways that we underwrite startups and then we’re able to look at that exposure and get comfortable with it,” she said.
Environmental innovation brings a parallel set of complications. As clean tech scales, so too do the environmental exposures that come with it. Suschkov called attention to the rising number of catastrophic environmental events, and the risks attached to newer technologies entering ecosystems - especially in biosynthetics.
“When we’re looking at something like a clean tech company or even a life science company that is doing something novel that could have environmental impacts, those are things that we would need to look at more and more,” she said. “Especially as companies are in the novel spaces and you’re dealing with things like biosynthetics and the risks associated with biosynthetic material going into the environment.”
She emphasized the importance of not only evaluating internal risk controls but also anticipating the policy evolution that will be required to manage these exposures. “I hope that companies like us at Trinity and like others in the market… continue to try and innovate in a way that supports the Canadian R&D infrastructure,” she said.
Suschkov described the shift to virtual clinical trials as a tipping point. What began as a pandemic necessity has now become a structural shift – and with it comes a new set of exposures. Once trials go virtual, she said, data crosses borders and touches multiple jurisdictions. That’s when insurers start grappling with the thorniest issues of data sovereignty.
“You are dealing, potentially, with cross-border solutions and then data that’s going cross-border. And now you’re looking at different regulatory touch points and issues surrounding data sovereignty and where the data sits and where it stays,” she said.
These are not purely theoretical debates. Suschkov said data sovereignty and protection risks are fast becoming board-level considerations, raising questions many boards have not historically had to confront. “Boards haven’t really had to make these decisions before about data sovereignty - was that a topic 10 years ago?”
This shift has led underwriters to start looking beyond technical risk and into governance. “What’s really important is to look at the governance there... and the governance of the boards of these companies,” she said.
The COVID-19 response forced some insurers to adapt quickly, but Suschkov believes that wasn’t a one-off - it set a new expectation. “I think it’s our opportunity in insurance to move faster,” she said. “With how rapidly things are changing and regulators aren’t 100% able to keep up... it’s our opportunity there to say, OK, in certain circumstances, we can move quickly to support industry, to support innovators.”
She cited the emergence of digital health infrastructure as one area where underwriters must now consider how to bundle exposures - cyber, malpractice, directors and officers - into meaningful coverage that enables new models of care.
That adaptability will become critical. Canada’s aging population is expected to shift care delivery away from traditional models and toward tech-driven solutions. “By 2030, Canada will have a reverse triangle population,” she said. “There will be questions that we need to ask ourselves related to accessibility of medical provision.”
Despite having one of the highest patent counts per capita, Canada lags in R&D commercialization. Suschkov said the bottleneck isn’t a lack of ideas - it’s a lack of infrastructure to support them. “We have one of the lowest in the developed nations spend on R&D,” she said. “So it’s actually very interesting because... we’re in this climate of a ton of people with great ideas, with patentable ideas, but they’re not commercializing it in the same way.”
For her, that’s where the insurance industry can step in - not just to cover risk, but to reduce it. “My hope is that industry and insurance, and especially MGAs in particular, will be able to innovate products that help further de-risk the Canadian startup,” she said. Doing so, she added, could allow entrepreneurs to focus on what they do best: “It’s innovating the need... it’s changing the world.”
