Instructions for the Claim Notification Form

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1 Instructions for the Claim Notification Form Introduction The following instructions are to assist with the correct completion of the proposed Claims Notification Template for which Claimant Representatives & Defendant Insurers will use to correspond through the method of . The intention is that the template is ed through to the Defendant Insurers at the earliest opportunity to enable them to make an early stance on liability & to also provide the Insurer with the opportunity of providing the claimant with any required services. (e.g.repairs /Hire / Rehabilitation etc) The Defendant Insurer will then use the template received to respond accordingly by to the Claimant s Representatives THE TEMPLATE IS AN INITIAL DRAFT WHICH WILL BE REFINED TO MAKE IT MORE USER FRIENDLY AT A LATER STAGE. Instructions In principle the template is split into two parts; Part 1 = Claimant Notification Information. (Completed by Claimant s Representative) This includes all information about the claimant and their losses sustained in the accident. (Completed by Part 2 = Insurer Response (Completed by the Defendant Insurer) This includes the Insurers response to the information provided, advising their stance on liability & also outlining whether any services have been provided to the claimant. In order to initially complete the template the Claimant s Representatives must first complete the key basic essential information about themselves and the relevant parties involved. (See below) All the text in Red is Free Format completion, for which they must complete to enable the Insurer to identify the case accordingly once received. This also provides the Insurer with all the relevant details to enable them to respond accordingly. Attached overleaf is a copy of the full template; In summary; All boxes shaded yellow in Part 1 are questions to be completed by the Claimants Representatives. Al boxes shaded green in Part 2 are questions to be completed the Defendant Insurers. All the white boxes are the response boxes that require completion. All the white boxes showing with red text are those that require completing through free-format text. All the white boxes showing with blue text are those that require completing through various drop down lists.

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3 As seen from the volume of blue text within the template there are various questions hat require completion through drop-down options. The options available for these questions are as follows; Part 1 Claimant Notification Information Section (A) Claimant Details - N/A - All questions to be completed through free-format text Section (B) Injury & Medical details - (Questions listed are those to be completed with drop down lists) i) Please select the most appropriate injury from the list below Options - Soft Tissue, Bone Injury, Whiplash, Other ii) Has the claimant had to take any time off work as a result of the injury? iii) Has the claimant sought any medical attention? iv) Did the claimant attend hospital as a result of the incident? v) If hospital attended, was the claimant detained overnight? vi) Was the claimant wearing a seatbelt? Section (C) Rehabilitation - (Questions listed are those to be completed with drop down lists) i) Has a medical professional recommended the claimant should undertake any rehabilitation such as physiotherapy? Section (D) Accident Details - (Questions listed are those to be completed with drop down lists) i) At the time of the accident the claimant was; Options; Driving. The owner of the vehicle but was not driving. A passenger in a vehicle owned by someone else. A pedestrian. A cyclist. Section (E) Accident time / Location /Description- (Questions listed-those with drop down lists only) i) Weather conditions? Options; Sun, Rain, Snow, Ice, Fog ii) Road conditions? Options; Wet, Dry, Icy, Snow, Mud, Oil iii) Please select the most accurate description of the accident circumstances from the list below; Options; Claimant hit in the rear. Claimant hit by party emerging from side road. Claimant s vehicle hit whilst parked. Accident in a car park. Accident on a roundabout. Accident involving vehicles changing lanes. Concertina collision. Other. iv) Was the incident reported to the police?.

4 Section (F) Repairs - (Questions listed are those to be completed with drop down lists) i) Was the claimant s vehicle damaged in the incident?. ii) Details of the insurance cover held for the vehicle? Options - Comprehensive, TPF&T, TPO. iii) Is the claim for repairs proceeding through the insurers?, No Damage. iv) Is the claim for repairs proceeding through an alternative company?, v) What is the current position with the repairs? Options Complete, Authorised, Not yet authorised. vi) Do you require ourselves to organise the repairs and/or inspection of the vehicle? Section (G) Mobility - (Questions listed are those to be completed with drop down lists) i) Does the claimant require use of a hire vehicle?. ii) Has the claimant been provided with the use of a hire vehicle?. iii) Is the hire still ongoing? iv) Do you require ourselves to provide your client with the use of a hire vehicle? Section (H) MIB Uninsured cases Sex of the Defendant Options Male/Female Section (I) Other Party details N/A - All questions to be completed through free-format text Section (J) Liability N/A - All questions to be completed through free-format text. Section (K) Other relevant information N/A - All questions to be completed through free-format text Part 2 Insurer Response Section (A) Liability / Causation - (Questions listed are those to be completed with drop down lists) i) Please select the relevant statement from those below; Options; Defendant admits breach of duty & some loss/damage subject to causation. Defendant admits breach of duty & some loss/damage subject to causation, however note the claimant wasn t wearing a seatbelt. The Defendant does not admit breach of duty. Section (B) Services provided by the Insurer (Questions listed are those completed with drop down lists) (B1) Rehabilitation i) Has the Insurer instructed a rehabilitation supplier? (B2) Mobility i) Has the Insurer instructed a mobility supplier? (B3) Repairs / Inspection i) Has the Insurer organised repairs or arranged an inspection?

5 Prior to responding to the claimant s representatives the defendant Insurer will also update Section C of the form highlighted below, providing the Claimants solicitors with all the correct information for the handling office. Upon doing so, the Number of days to respond box will highlight Green or Red automatically depending on the time taken for the insurer to respond to the initial . (This is calculated from the date that is stated on the template at the time the claimants solicitors submit this to the defendant Insurer) Eg.1 (Within 15 working days) Eg.2. (Over 15 working days) P:\PUBLIC POLICY\MOJ NOTES FOR NOTIFICATION NOV 08.DOC

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