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What to do in the Event of a Professional Liability Claim

When a problem situation emerges, or when a formal claim has been made ( a demand for money or services) you should report it directly to us. We will alert the insurance company's claims department, and you should be contacted by them within 24 hours. 

It is particularly important to put your insurance company on notice of a potential claim when you have a claims-made policy (your professional liability policy is claims-made). There are several reasons for this:

  1. Many times the insurance company will be willing or able to work with you prior to an actual claim to prevent a problem circumstance from turning into an actual claim.

     

  2. In the event that there is a potential claim that you do not report, you are opening yourself up to losing coverage for this situation if it results in an actual claim in the future.

 

As an example, let's say that in November of 2009 you become aware of a circumstance that could give rise to a claim. Optimist that you are, you fail to report it and hope that it will go away. In January of 2010, you switch coverage from Company A to Company B. In February 2010, the circumstances previously described turn into an actual claim which you report to Company B.

Company B will deny the claims because you were aware of the claim circumstances at the time they placed the coverage. Logically, you go back to Company A for coverage. Unfortunately, coverage was written on a claims-made basis. Since the policy period has expired, and the claim is being made after the expiration date, there is no coverage under Company A's policy either.

 

Remember! Stay calm and don't:

  • Assume that you are at fault until the insurance company has had an opportunity to investigate and analyze the issues

     

  • Place blame on other or criticize subconsultants and other team members

     

  • Sign of accept releases from any parties

     

  • Expose yourself to unsafe conditions

In addition, make sure you:

  • Gather all relevant documentation

     

  • Notify your employees that the situation exists and ask them not to discuss the matter outside the firm (assign a media representative if necessary)

     

  • Remember that the insurance company will need to access your key employees on this issue.

     

  • Photograph site conditions if appropriate.

     

  • Keep communication lines open with all parties to help preserve important relationships

     

  • Document and make notes while details are fresh in your mind

     

  • Accept all letter and suit documents without comment

 

If a formal claim has been made, we will need copies of suit or demand letters. Regardless of whether it is a formal claim of a mere circumstance, we will also need a narrative describing the fact and circumstances of the dispute, a copy of the client agreement, and any correspondence to and from the client (including relevant billing statements) concerning the alleged claim.

 

Remember that nothing can of will be paid on your behalf to resolve a dispute without your express consent. The insurance company will provide you with the information and advice you need to make an informed business decision about resolving the claim, but the final decision will be yours.

 

What to do in the Event of a Workers' Compensation Claim 
 

  1. Provide first aid when necessary if trained staff is available.

  2. Consult your medical provider if there are questions about the injury. Minor injuries may become major injuries if not properly treated.

  3. Encourage your employees to report injuries to you.

  4. Take or send your injured worker to you preferred medical provider.

  5. Generally, the employer controls medical treatment 30 days after an injury is reported, unless, in advance of the injury, the employee has given your written notice of the name and address of his/her personal physician, in which case the injured employee may go to that physician.

  6. If equipment breakdown contributed to the injury, prevent its further use until full repair and a safety check have been completed.

  7. Consult your workers compensation's Loss Control Department.

  8. Investigate the circumstances of the injury and prepare an "Employers Report of Occupational Injury of Illness"

  9. The law requires you to send the report to your insurance company within five (5) days after you have knowledge of the injury. We recommend that you report it within 24 hours to assist prompt delivery of benefits. (Some insurance companies will allow you to complete this form either on line or via an 800 number)

  10. Please call your insurance company's claims adjuster if you have questions about an injury, or in cases of serious injury of death.

  11. Promptly return the "Employers Report of Occupational Injury of Illness" to your insurance Company.

  12. An Employers Report should be sent even though a claim seems extremely doubtful. Sending an Employers Report does not constitute an admission of liability. Delays in reporting make it more difficult to investigate the validity of a claim and control costs. Provide a complete explanation of the situation on the report.

  13. Don't wait to hear form the doctor before reporting the claim. The doctor will report directly to your insurance company.

  14. Provide the Employee and "Employee Claim for Workers' Compensation Benefits"

  15. This must be provided to the employee within one(1) working day of receiving notice of a job-related injury.

  16. If possible, have your employee complete and return the form to you immediately. Send the original of the employee claims form directly to your insurance company, keep a copy for yourself, and provide a copy to the injured worker.

  17. The doctor should give your employee a notice stating when she or he can return to work.

  18. Often the doctor will recommend light or modified work. If you are able to provide modified work, it can speed recovery to full duty and reduce expenses.

 

What to do in the Event of a Commercial Auto Claim

  1. Keep your registration and auto insurance papers, as well as any relevant medical information for you and your family, in the car.

  2. Make sure you have the right amount of auto coverage to fit your needs.

  3. Immediately After an Accident

  4. Assess the Damage. If possible, pull the vehicle to the side of the road to a safe place to see if anyone is injured, and the extent of the damage to the vehicle.

  5. Call the police or highway patrol, if you are in a serious accident.  Let law enforcement know if anyone is hurt and the extent of injuries. The police will notify the nearest medical unit. If the police can't come to the scene of your car accident, you can head to the nearest police department (or their website) to file an incident report yourself. Having an official report can help in case the other driver decides to sue for damages or medical injuries, or there is more damage done to your car than initially thought. If the police do come to the accident scene, get the officers’ names and badge numbers and ask where you can get a copy of their report. 

  6. Collect as much information as possible.  Get the names and contact information of everyone involved in the crash, including witnesses. Ask the driver (or drivers if you are involved in a multi-car accident) for their license, car registration and insurance ID card. Get the make and model of the cars involved. Lastly, make note of the location of the accident, time of day and the weather conditions. You can use your smart phone or other device to document this information, as well as the accident itself, but it’s also a good idea to always keep a pad of paper/pen in your glove compartment. It may not be high-tech, but it is an easy way to record important information. When talking to others, keep to the facts.  Do not discuss who was at fault, or how much insurance you have, with other drivers

  7. Don’t leave the scene of the accident.  If you run into an unattended vehicle, try to find the owner. If you can’t, leave a note containing your name, address and phone number.  Record the details of the accident, including the make and model of the car and the address where the accident occurred.

  8. Get the claims process started.  Notify your insurance professional as soon as possible—the longer you wait, the harder it will be to remember the details.  Many insurance companies now use mobile apps to get the claims process started.  These apps allow you to report a claim, check the status, upload photos, check your deductible, schedule an appraisal, reserve a rental car, and request reimbursements for towing and glass claims. Some apps even allow you to notify the insurance adjuster what happened by visually re-creating the events and circumstances of your car accident. When working with your insurance company, make sure that you get the name, title and contact information of everyone you speak with. You will likely also receive claim forms to fill out. Make sure that you do this as soon, and as accurately, as possible.  If you have any questions, don’t be afraid to ask the claims adjuster for assistance. Your insurance company wants your claims experience to be as pleasant and efficient as possible.

  9. Finally, keep a file of all of your notes and any claim forms. The more organized you are, the simpler and easier the claims process will be.