Managing Claims: Before, During. Learning Objectives

Transcription

1 Managing Claims: Before, During and After the Loss Greg Logan Vice President, Risk Management EIIA Karen Davis Vice President of Administration and Finance California Lutheran University David Golnick Executive Director EIIA Learning Objectives Areas to address prior to an incident to ensure the institution is prepared Managing a situation after a loss occurs Claims to be prepared for in the future URMIA s San Diego, CA #URMIA

2 Who is EIIA? Educational & Institutional Insurance Administrators Created in the 1960s by HBCUs and the United Methodist Church to secure insurance EIIA is owned by its Members, who represent a variety of faith based institutions On the scale of a Fortune 200 company Currently serve over 130 institutions URMIA s San Diego, CA #URMIA Who is CLU? California Lutheran University Founded 1959 in Thousand Oaks, CA. >4,100 Students 34 states and 45 countries 36 undergraduate majors and 35 minor programs 450 FT faculty, staff and administrators URMIA s San Diego, CA #URMIA

3 Prevent Incidents from Occurring Loss history Common concerns o Slips and falls o Auto o Housekeeping Training! URMIA s San Diego, CA #URMIA Pre Loss URMIA s San Diego, CA #URMIA

4 Prepare for a Claim Understand your policy Set up defense counsel o All lines o Inform carriers Access to resources o Crisis Management o Public Relations URMIA s San Diego, CA #URMIA Pre Loss: Workers Compensation Identify medical facility(ies) Transporting an injured person Transitional Duty program URMIA s San Diego, CA #URMIA

5 Transitional Work Transitional Duty vs. Light Duty The Process: o Develop a policy o Communicate with medical providers o Identify options o Educate on the benefits o Accountability URMIA s San Diego, CA #URMIA Pre Loss: Other Coverages Policies and procedures Facilities/Equipment o Accessibility o Maintenance o Supervision o Training URMIA s San Diego, CA #URMIA

6 Pre Loss Property Loss Mitigation o Restoration services o Back up equipment Business Continuity o Housing o Dining URMIA s San Diego, CA #URMIA Post Loss URMIA s San Diego, CA #URMIA

7 Reporting Campus reporting o Initial Contact Campus Security o Investigation Campus Security o Report to Carrier(s) Single point of contact o Evaluation Safety Committee, Risk Manager Publicize the process URMIA s San Diego, CA #URMIA Reporting Lag Time Days GOAL Admin Lag* (Lag 2) Total Lag* (Lag 3) 0.50 URMIA s San Diego, CA #URMIA

8 What to Investigate Fatality Major Injuries Reactive Minor Injuries Near Misses Proactive At-Risk Behaviors URMIA s San Diego, CA #URMIA Investigation Investigation vs. report completion Investigation process Third party(ies) involvement Training URMIA s San Diego, CA #URMIA

9 Broker, Carrier, and/or Adjuster Work with everyone All on the same team Provide information and concerns Have copies of your policies available URMIA s San Diego, CA #URMIA Workers Compensation Provide medical care or direct employee to designated facility Utilize the WC claim file Contact reporting system Contact employee Was employee on duty at time of loss o Get exact date/time/location URMIA s San Diego, CA #URMIA

10 Workers Compensation Contact with medical facilities Collect and pass along all paperwork Return to Work with restrictions Pharmacy Benefit Management URMIA s San Diego, CA #URMIA WC Avoiding Litigation Maintain the relationship Understanding that the employee will be taken care of and are not in trouble Regular communication is the key before and after they return to work URMIA s San Diego, CA #URMIA

11 Workers Compensation File Create a specific claim file should not be in the personnel file in separate locked storage Medical Authorization form o Policy number o Billing address o Institution contact info o Return to work available URMIA s San Diego, CA #URMIA Workers Compensation File (cont.) Checklist and documents Policy number, carrier, who to report to and how Incident report Medical authorization form Reminder to get job description Reminder to get wage report URMIA s San Diego, CA #URMIA

12 Other Lines of Coverage URMIA s San Diego, CA #URMIA Other Lines of Coverage Do not destroy evidence Do not make repairs until you communicate with the adjuster Keep all surveillance Prepare for a lawsuit Subrogation opportunities URMIA s San Diego, CA #URMIA

13 Property URMIA s San Diego, CA #URMIA Property Eliminate the cause of the loss Protect the undamaged property Assess the need for outside resources or facilities Secure the area Evaluate the area for contingent exposures URMIA s San Diego, CA #URMIA

14 Property URMIA s San Diego, CA #URMIA Property Manage time spent by employees Loss accounting o Replacement cost of damaged property o Business Interruption o All expenses associated with the loss o Document proof of loss Plan the rebuild URMIA s San Diego, CA #URMIA

15 Advice from the Trenches Patience and persistence Ask for clarification What is a claim trigger for your policy Do not assume that exposures are covered Adjusters are on your team URMIA s San Diego, CA #URMIA Emerging Issues Drones Title IX respondent claims Aging demographic Pharmaceuticals in WC Activism on Campus URMIA s San Diego, CA #URMIA

16 Questions? URMIA s San Diego, CA #URMIA