NOTICE OF CLAIMS OR POTENTIAL CLAIMS

Transcription

1 1. What are my obligations under the Policy for reporting Claims or potential claims? You are required to provide the Insurer, ( Arch ), with notice of any Claim that is made against you (or someone insured under your policy) as soon as practicable during the same Policy Period in which you first receive notice. Please remember that a Claim does not need to be valid to be made against you. Claims without merit are frequently brought against agents and you have the same obligation to report a Claim that is unjustified or without merit as those based on an actual error or omission. You need not wait until the Claim is actually made; under the Notice/Claim Reporting provision, the Policy does permit you to report a potential claim. If you become aware of any Wrongful Act or allegation of a Wrongful Act, even if you feel that the matter is unjustified, report the available particulars immediately. Should the circumstances or potential claim develop into a Claim at some future date, your reporting of a possible incident will serve as a notice of Claim under this Policy Period. E&O policies generally will not cover Claims that arise out of acts, errors or omissions of which you had knowledge prior to enrolling under that policy if you knew on the date of your enrollment under that policy, that such act, error or omission could reasonably result in a Claim. For this reason, it is always better to err on the side of reporting any matters which you believe could result in a Claim being made against you during the same Policy Period in which you become aware of the potential claim. 2. What is considered a Claim? A Claim means: (a) A written demand for monetary damages received by an Insured; (b) A civil proceeding commenced by the service of a complaint or similar pleading in which monetary damages are sought; or (c) An arbitration commenced by the filing of the statement of claim in which monetary damages are sought; including any appeal from proceedings identified in paragraphs b and c above. Claim does not include a demand or proceeding for non-monetary or injunctive relief or any criminal proceeding. 3. What is a potential claim? A potential claim refers to any circumstances which may reasonably be expected to give rise to a Claim, as defined in Question 2, being made against an Insured. Some examples of what might be considered a potential claim include, but are not limited to: a letter or phone call from a current or former client stating you made a mistake or that a mistake has occurred, but the client has not made a specific request for money or some action to fix the mistake or to compensate the client for any alleged loss due to the mistake; Page 1 of 6

2 3. What is a potential claim (continued)? any threatened lawsuit, arbitration proceeding or FINRA Statement of Claim; or a notice of deposition or subpoena that you have received in a lawsuit or arbitration. 4. How do I report a Claim or potential claim? For all types of Claims it is important that you notify Arch as soon as possible. Promptly complete the attached Claim form and send it to Arch and the broker, CalSurance Associates, at the addresses indicated on the form; Please note that in litigated matters there may be a response time predetermined by a court. In the event suit is brought against you, immediately (within 24 hours upon being served with a summons and complaint) forward to Arch copies of any written demand, notice, summons or other process you have received; Develop a written chronology of events giving rise to the Claim; Be prepared to provide a copy of your file; and As soon as practicable thereafter, send any other information that may be requested by Arch. 5. What actions should I avoid in the event of a Claim? Do not engage your own attorney without specific authorization from Arch. Do not voluntarily make payment, assume any obligation or incur any expense. If you do, your rights to coverage under the Policy could be jeopardized, resulting in the denial of your Claim. Once an incident has been identified or an errors and omissions Claim has been made, great care should be exercised to avoid any disclosures or discussion of any facts or information relating to the Claim with anyone, unless they identify themselves to be from CalSurance Associates, Arch, National Life or a designated representative appointed to handle your Claim. Do not admit liability. If you do, your rights to coverage under the Policy could be jeopardized, resulting in the denial of your Claim. 6. What happens after the Claim is reported? After you have reported the Claim, a representative from Arch will contact within a few days by telephone to acknowledge the receipt of the Claim and discuss the particulars of the situation. Additional information or documents may be requested at that time. Coverage under the Agents E&O program will be determined and you will be advised of any coverage issues. If necessary, an attorney will be retained. In order to ensure the best possible defense, you should cooperate completely with the individual retained, provide full details, and be candid. Page 2 of 6

3 6. What happens after the Claim is reported (continued)? During the evaluation and settlement of your Claim, continue to cooperate with Arch by: o Meeting with representatives of Arch, submitting to their examination and interrogation under oath if requested, and giving written statements to such representatives; o Attending hearings, depositions and trials; and o Assisting in effecting settlement, securing and giving evidence, and obtaining the attendance of witnesses in the conduct of the suit. In every case, once the situation has been identified as an errors and omissions Claim, great care should be exercised to avoid any disclosures or discussions of any facts or information relating to the Claim with anyone other than CalSurance Associates, Arch, National Life or a designated representative appointed to handle your Claim. You are responsible for any deductible owed under the Policy and Arch will inform you of the deductible due and how payment should be made. Page 3 of 6

4 Important Telephone Numbers for your Reference Claims advice: Jason Krauss, Esq. Arch Insurance Group (973) (866) Fax Coverage questions or Claims advice: Alex Lefebvre CalSurance Associates (800) , extension #418 (413) Direct (714) Fax Enrollment and premium payment: CalSurance Customer Service Department (866) (800) Fax Home Office Contact: Agent Services National Life Group (800) x 6765 (802) FAX Page 4 of 6

5 CLAIM FORM National Life Group Independent Channel & Not Full Time Career Channel Agents Professional Liability Policy Number May 1, 2012 to May 1, 2013 There is certain information that should be developed in order for the E&O Insurer to evaluate the Claim made against you. If some of the data is not immediately available, do not hold up your report to Arch. Please send it along while you continue to develop the additional data. Please complete the Claim form below: Date Claim Potential Claim Insured Information: Agent Full Name: Business Address: Telephone number: Agent number: Name of your agency Agency address (if different from above) Agency telephone number (if different from above) Name of your customer or client or the identity of the person who has made allegations or might allege a Claim or potential claim: Name: Address: Telephone number: Attorney information, if applicable Summons and Complaint information, if applicable: Date received: Method received (by mail or in person): Amount of demand: Please list the type of product or professional services that gave rise to this Claim or potential claim. Page 5 of 6

6 CLAIM FORM National Life Group Independent Channel & Not Full Time Career Channel Agents Professional Liability Policy Number May 1, 2012 to May 1, 2013 Please provide the name of the insurance carrier with which the coverage was placed or should have been placed. If one of the National Life Group companies, please provide the policy number. If other than with National Life Group, please indicate whether you had an agency appointment or if it was brokered. Describe what the customer has alleged or might allege was your error or omission for this Claim or potential claim. Provide a list of events and documents that led up to this Claim or potential claim (e.g., date you initially discussed this product; copy of the application taken; any deposits received; was coverage bound; any correspondence in your possession (chronologically dated for the sequence of events that took place)). Photocopy all documents and send to via one of the following methods: Electronically claims@archinsurance.com Fax (866) Via Mail Arch Insurance Group Professional Liability Claims Mill Valley Road, Suite 210 Omaha, NE Please also provide a copy to the broker, CalSurance Associates: CalSurance Associates, Attn: Alex Lefebvre P.O. Box 7048 Orange, CA alefebvre@calsurance.com (714) Fax Page 6 of 6