YOUR GUIDE TO CLAIMS REPORTING

Transcription

1 YOUR GUIDE TO CLAIMS REPORTING...SEEING YOU THROUGH PHONE: FAX:

2 TABLE OF CONTENTS 1 WELCOME 2 POLICY AND CLAIMS OVERVIEW 3 AUTOMOBILE CLAIMS 4 AUTOMOBILE CLAIMS FORM 5 PROPERTY CLAIMS 6 PROPERTY CLAIMS FORM 7 GENERAL LIABILITY CLAIMS 8 GENERAL LIABILITY CLAIMS FORM 9 WORKERS COMPENSATION CLAIMS 10 WORKERS COMPENSATION FIRST REPORT FORM 14 WORKERS COMPENSATION SUPERVISOR S ACCIDENT INVESTIGATION REPORT FORM

3 WELCOME As Your DII Claims Representatives We are pleased to present your Loss Guide, designed with your risk management needs in mind. Please report all losses, or events you believe could become a claim, as you are made aware of them. Your DII Claims Contact: Ellen Fick Direct Dial:! ! ellen.fick@dii-ins.com Prompt reporting of losses enables your insurance company to offer you more prompt settlements. Rising claim costs continue to be a significant challenge facing employers. Your team can help to reduce this cost by reporting claims promptly and thoroughly. In fact, the sooner a claim is reported, the lower the total cost is likely to be. Slow reporting can increase claims costs by 50% or more. Within 24 hours of reporting your loss, the company s loss adjuster should make contact with you. Should you not receive this call, please notify us immediately and we will gladly intervene on your behalf. Customer service is our number one priority. While we realize that experiencing a loss may not be pleasant, with our help, the inconvenience to you will be minimized. Thank you for allowing us the opportunity to serve you.! Very Cordially Yours,!!!!! Bob Barczak!! Associate Director!! Risk Management Group!!!!!! Page 1

4 POLICY & CLAIMS OVERVIEW Here are your insurance policies: Automobile Your Insurance Company:!! Philadelphia Insurance Company Claims Reporting Number:!! ! Your Policy Number:!! PHPK Policy Effective Date:!! 11/1/ /1/2012 General Liability Your Insurance Company:!! Philadelphia Insurance Company Claims Reporting Number:!! ! Your Policy Number:!! PHPK Policy Effective Date:!! 11/1/ /1/2012 Property Your Insurance Company:!! Philadelphia Insurance Company Claims Reporting Number:!! ! Your Policy Number:!! PHPK Policy Effective Date:!! 11/1/ /1/2012 Page 2

5 FOR AUTOMOBILE CLAIMS For automotive or truck related incidents, including your liability for bodily injury or property damages to others, their vehicles or property, or claims involving physical damage to your vehicle: You will need as much of the following information as possible to report your claim: Date and time of loss Location and description of accident Vehicles involved (year, make and model) Vehicle Identification Number (VIN) Description of damage Photos of damage and/or scene, if possible Description of injuries, if any (Note: complete a Workers Compensation first report of injury if an employee is injured in the automobile accident) Witnesses with name, phone numbers and address Name of police department and accident report number Name of other driver and insurance information Estimate of repairs costs to your vehicle Complete the Automotive Claim Guide Form (Page 4) included in this Loss Guide. Complete the Supervisor s Investigation Form (Page 14) included in your Loss Guide. As a general guideline: do not discuss fault, do not admit liability and do not voluntarily make a payment for any claim. You may ask if the person involved would like medical treatment but do not recommend treatment or offer payment for the treatment. Send completed forms to DII s Claims Department as soon as possible at or via fax at In all circumstances: notify DII s Claims Department as soon as possible at or by fax at You may also scan and to ellen.fick@dii-ins.com. Page 3

6 AUTOMOBILE CLAIMS FORM Your Information Today s Date: Date of Loss: Name of Insured: Hospitality Cover Plus, LLC Hotel Name: Alternative Phone: Policy Number: Police Report Number: Your Vehicle Information Vehicle (Year, Make, Model): VIN Number: Driver s Name: Driver s Alternative Phone: Describe Incident & Damage to Vehicle: Accident Location: Other Vehicle Involved Vehicle! (Year,! Make,! Model):!!!!! Owner of Vehicle: Tag Number: Owner s Alternative Phone: Insurance Company: Policy Number: Describe Incident & Damage to Vehicle: Name of Witness #1: Name of Witness #2: Additional Information: Witness Information Alternative Phone: Alternative Phone: Completed By:: Phone: Page 4

7 FOR PROPERTY CLAIMS For incidents involving damage to your property, or property for which you are responsible, (including building, furniture, fixtures, stock, material held for processing, contractor s equipment, and electronic data processing, etc.): You will need as much of the following information as possible to report your claim: Date and time of loss A description of the occurrence Location and description of damage Photos of damage and scene, if possible Estimate of damages Take the following actions: Take necessary steps to protect the property and from further damage Call a restoration service or emergency clean-up service to mitigate your loss Document your expenses. Compile any service or repair documents Keep all damaged property as is. The insurance carrier may want to inspect it Complete an inventory of damaged and destroyed property (brief description of the item, estimated replacement cost, age of the item and where item was purchased.) Complete the Property Claims Form (Page 6) included in this Loss Guide. Complete the Supervisor s Investigation Form (Page 14) included in your Loss Guide. Send completed forms to DII s Claims Department as soon as possible at or via fax at In all circumstances: notify DII s Claims Department as soon as possible at or by fax at You may also scan and to ellen.fick@dii-ins.com. Page 5

8 PROPERTY CLAIMS FORM Loss Information A Police Report is REQUIRED for all Theft Losses Today s Date: Name of Insured: Hospitality Cover Plus, LLC Hotel Name: Loss Location: Estimated Cost of Repairs: Describe Accident: Date of Loss: Alternate Phone: Name of Witness: Name of Witness: Witness Information Alternate Phone: Alternate Phone: Additional Information: Report Completed By: Phone: By fully completing this Property Claims Form and submitting it to your insurance carrier, with a copy to DII you expedite the processing of your claim. By fully completing the Property Claims Form and submitting it to your insurance carrier, with a copy to DII, you expedite the processing of your claim. Page 6

9 FOR GENERAL LIABILITY CLAIMS General and Professional Liability are: General Liability Claim: For allegations of bodily injury or property damage from someone other than an employee,and not related to an auto incident (Automobile Coverage) Professional Liability or Errors & Omissions: Allegations of a wrongful act relating to your professional service, but not bodily injury or property damage You will need as much of the following information as possible to report your claim: Date and time of loss Name, address and phone number of the parties involved Location and description of accident Description of injuries or property damage Photos of damage and/or scene, if possible Witness information including: name, phone numbers, and address What to do if Suit Papers are received: Record the date and time suit papers were received and to whom they served Verify the response date Forward the suit papers to Diversified Insurance immediately for review as well as a copy to your insurance company Complete the General Liability Claims Form (Page 8) included in your Loss Guide. Complete the Supervisor s Investigation Form (Page 14) included in your Loss Guide. As a general guideline, do not discuss fault, do not admit liability and do not voluntarily make a payment for any claim. You may ask if the person involved would like medical treatment but do not recommend treatment or offer payment for the treatment. Send completed forms to DII s Claims Department as soon as possible at or via fax at In all circumstances: notify DII s Claims Department as soon as possible at or by fax at You may also scan and to ellen.fick@dii-ins.com. Page 7

10 GENERAL LIABILITY CLAIMS FORM Today s Date: Loss Information A Police Report is REQUIRED for all Theft Losses Name of Insured: Hospitality Cover Plus, LLC Hotel Name: Loss Location: Estimated Cost of Repairs: Describe Accident: Date of Loss: Alternate Phone: Name of Person Injured #1: Describe Injury: Injuries Alternate Phone: Name of Person Injured #2: Describe Injury: Name of Witness #1: Name of Witness #2: Alternate Phone: Witness Information Alternate Phone: Alternate Phone: Additional Information: Report Completed By: Phone: By fully By completing fully completing this Property the General Claims Liability Form and Claims submitting Form and it to submitting your insurance carrier, it to with your a insurance copy to DII carrier, you expedite with a copy the processing to DII, you expedite of your claim. the processing of your claim. Page 8

11 FOR WORKERS COMPENSATION CLAIMS For incidents involving employee bodily injury, or loss of pay for a work related injury in the course of employment: For reporting Workers Compensation claims: Have the employee complete the First Report Form (Page 10) Have the supervisor complete the Supervisor s Accident Investigation Report (SAIR) Form (Page 14) Complete the Supervisor s Investigation Form (Page 14) included in your Loss Guide. As a general guideline, do not discuss fault, do not admit liability and do not voluntarily make a payment for any claim. You may ask if the person involved would like medical treatment but do not recommend treatment or offer payment for the treatment. Send completed forms to DII s Claims Department as soon as possible at or via fax at If you are currently being served by A-1 Staffing, please refer to their Claims Reporting Guide for Workers Compensation claims. Page 9

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16 SUPERVISOR S INVESTIGATION FORM (TO BE COMPLETED BY SUPERVISOR FOLLOWING ALL INCIDENTS) 1.! When and how were you first informed of the incident/ accident/ exposure? 2.! Describe your account or impression of how the incident occurred: 3. Did the incident result from employee not following Safety Rules? Yes / No Have there been other violations of this type? Yes / No! Explain: 4.! Did this incident involve a third party? (visitor, other employee, equipment, tools, etc.)! Explain the nature of involvement: 5.! How could this incident have been prevented? 6.! What will the supervisor do to prevent this accident from occurring again? In review of this report, ensure all blanks are completed, explicit and witness statements are attached. Attach any additional comments you have regarding the validity of the claim. SUPERVISOR NAME:! (printed) SIGNATURE :! Telephone Number:!! Date:!!!! / / By fully completing the Supervisor s Incident Form and submitting it to your insurance carrier, with a copy to DII, you expedite the processing of your claim. Page 14

17 ADDITIONAL INFORMATION Page 15