YOUR GUIDE TO CLAIMS REPORTING
|
|
- Flora Cain
- 5 years ago
- Views:
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
12
13 Page 11
14 Page 12
15 Page 13
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
Passenger Vehicle Investigation Kit Checklist
Passenger Vehicle Investigation Kit Checklist Employee Statement Form Other Driver Statement Form Vehicle Accident Form Vehicle Accident Guide Road Diagram Vehicle-Injured Party Form Witness Statement
More informationCollision Reporting, Investigation, and Analysis
In this procedure, a collision is defined as any occurrence involving a motor vehicle driven by an employee on company business which results in death, injury, or property damage, unless the vehicle is
More informationCLAIMS KIT. Package Insurance
InCONTROL 2017 2017 18 CLAIMS KIT Package Insurance If you have any questions about Gallagher s InCONTROL Program, your coverage or if there s anything we can assist you with, please let us know. bsd.mcdlossprevention@ajg.com
More informationWorker s Compensation Investigation Kit Checklist
Worker s Compensation Investigation Kit Checklist Claim Handling Instructions Workers Compensation Instructions Employee Statement WC Accident Investigation Guide WC Activity-Communication Log Accident
More informationPackage Insurance Claims Kit
2018-2019 Claims Kit Package Insurance If you have any questions about Gallagher s InCONTROL Program, your coverage, or if there s anything we can assist you with, please let us know. bsd.mcdlossprevention@ajg.com
More informationGeorgia School Boards Association. Risk Management Fund Claims Manual
Georgia School Boards Association Risk Management Fund Claims Manual July 1, 2018 - June 30, 2019 Table of Contents Section GSBA Claims Services 1 GSBA Claims Team.2 GSBA Liability Claim Reporting Procedures..3
More informationHOW TO FILE AN INSURANCE CLAIM
Reporting a Claim as a Foursquare Church, School, Camp or District Filing an insurance claim can be stressful, but we have arranged for claims administrators to help you 24 hours a day, 7 days a week.
More informationUCLA Procedure 300.3: University Owned or Leased Motor Vehicles: Physical Damage Insurance Coverage, Accident Reporting, and Claim Procedures
UCLA Procedure 300.3: University Owned or Leased Motor Vehicles: Physical Damage Insurance Coverage, Accident Reporting, and Claim Procedures Issuing Officer: Associate Vice Chancellor, Business & Financial
More informationProvide 24/7 Toll-Free Claim Reporting
Associated Industries Insurance Company Rochdale Insurance Company Technology Insurance Company AmTrust Insurance Company of Kansas Milwaukee Casualty Insurance Company Security National Insurance Company
More informationGeneral Liability Incident Response Kit
General Liability Incident Response Kit Risk Control from Liberty Mutual Insurance Companies strive to conduct their operations, perform services, and manufacture and distribute products without causing
More informationELECTRON SERVICES NORTH EAST LIMITED
ELECTRON SERVICES NORTH EAST LIMITED Accident & Incident Investigation Policy JULY 2015 Next Scheduled Review: July 2016 Policy This policy outlines the procedures that are to be adopted when any employee,
More informationEmployee Guidelines for Workers Compensation Accidents
Employee Guidelines for Workers Compensation Accidents The information included in this packet will become important to you in the event that you seek medical attention or lose time from work due to a
More informationAUTO ACCIDENT REPORT KIT
AUTO ACCIDENT REPORT KIT I. In Case of Accident A. Stop and investigate immediately B. Set out warning devices if available or set vehicle flashers C. Assist injured persons but do not move if it will
More informationUnderstanding the Claims Handling Process
Understanding the Claims Handling Process About This Brochure This brochure was designed to answer frequently asked questions about the claim handling process. If you have other questions or would like
More informationMAINE COMMUNITY COLLEGE SYSTEM
MAINE COMMUNITY COLLEGE SYSTEM HEALTH AND SAFETY Section 800.1 SUBJECT: PURPOSE: MOTOR VEHICLE PROCEDURE To promote the safe the authorized operation of motor vehicles operated on behalf, or for the benefit,
More informationNOTICE OF CLAIM FORM FAXES & S WILL NOT BE ACCEPTED PLEASE RETURN BY HAND-DELIVERY, CERTIFIED AND/OR REGULAR MAIL
Joseph N. DiVincenzo, Jr. Essex County Executive OFFICE OF THE COUNTY COUNSEL Hall of Records, Room 535, Newark, New Jersey 07102 973.621.5003 --- 973.621.4599 (Fax) www.essexcountynj.org Courtney M. Gaccione
More informationCOMPREHENSIVE LOSS CONTROL PROGRAM OVERVIEW
OVERVIEW Risk Management Services Department of Administrative Services FY2009 Georgia s goal is to become the best managed state in the country. To accomplish this we are changing the way we do business.
More informationOwn Damage & Accident Reporting FAQ
Own Damage & Accident Reporting FAQ MAKING A MOTOR CLAIM With effect from 1 st Jun 2008, under the Motor Claims Framework (MCF), Insured is required to report any accident, irrespective of whether it would
More informationAdministrative Services Operational Guidelines
Risk Management and Insurance A. Risk Management General. North Idaho College strives to provide a safe environment for employees, students and visitors. Risk Management includes activities that reduce
More informationVEHICLE ACCIDENT REPORT FORM
GENERAL ALLIANCE INSURANCE LIMITED Alliance House, Corner Sharpe Road & Independence Drive P.O. Box 1811, Blantyre, Malawi. Central Africa Tel: 01 822 100 / 111 Fax: 01 821 088 email: info@generalalliancemw.com
More informationRCAB Office of Risk Management What to do in the Event of an Auto Accident
RCAB Office of Risk Management What to do in the Event of an Auto Accident Even a minor fender bender can be an emotional experience. The Office of Risk Management will provide you with assistance in navigating
More informationSOUTH CAROLINA OFFER OF ADDITIONAL UNINSURED MOTORISTS COVERAGE AND OPTIONAL UNDERINSURED MOTORISTS COVERAGE
IL U 007 07 07 SOUTH CAROLINA OFFER OF ADDITIONAL UNINSURED MOTISTS COVERAGE AND OPTIONAL UNDERINSURED MOTISTS COVERAGE Policy Number: Policy Effective Date: Company: Producer: Applicant/Named Insured:
More informationAPPLICATION FOR PERSONAL INJURY PROTECTION BENEFITS THROUGH THE MICHIGAN ASSIGNED CLAIMS PLAN
Michigan Automobile Insurance Placement Facility PO Box 532318 Livonia, MI 48153-2318 Phone: 734-464-8111 Fax: 734 744-8552 www.michacp.org Please note, you referenced throughout this application is defined
More informationAUTO ACCIDENT REPORT KIT
AUTO ACCIDENT REPORT KIT I. In Case of Accident A. Stop and investigate immediately B. Set out warning devices if available or set vehicle flashers C. Assist injured persons but do not move if it will
More informationRecreational Vehicle Rental Agreement Fleetwood Jamboree 26Q (B) Class C RV VIN: 1FDXE45S64HB03606
Recreational Vehicle Rental Agreement Fleetwood Jamboree 26Q (B) Class C RV VIN: 1FDXE45S64HB03606 Important Disclosures: Responsibility for Damage or Loss; Reporting to Police By signing this agreement
More informationMotor Vehicle Claim Form
Motor Vehicle Claim Form We re sorry to hear you ve had an accident. Our aim is to settle your claim as quickly as possible. You can help us do this by ensuring the enclosed claim form is completed promptly
More informationSupplier / Subcontractor Information Package
Supplier / Subcontractor Information Package Please take time to review the following information on 1 st Call Restoration, LLC policies and procedures. After reviewing, please complete the information
More informationThird Party Statement Form
Third Party Statement Form Location #: Date of Incident: Name: Home Phone: Time of Incident: Address: Business Phone: USE THE BACK OF THIS FORM IF YOU NEED ADDITIONAL SPACE I attest that I am over the
More informationNOTICE OF TORT CLAIM
NOTICE OF TORT CLAIM GENERAL INSTRUCTIONS: Pursuant to the provisions of the New Jersey Tort Claims Act, this Notice of Tort Claim form has been adopted as the official form for the filing of claims against
More information2. What is difference between liability and accident insurance coverage? What kind of protection are UC ANR volunteers provided?
1. What does the UC ANR liability insurance cover? UC s general liability insurance provides limited liability coverage for UC ANR volunteers in cases where there are allegations of negligence on behalf
More informationThe Nature Conservancy Auto Safety Program (Revised 12/1/14)
The Nature Conservancy Auto Safety Program (Revised 12/1/14) Table of Contents I. Auto Safety Operating Procedures II. III. IV. Organization and Responsibilities Vehicle Use Driver Selection V. Accident
More informationCOLUMBIA INSURANCE COMPANY
Truck Application COLUMBIA INSURANCE COMPANY NATIONAL FIRE & MARINE INSURANCE COMPANY NATIONAL INDEMNITY COMPANY NATIONAL INDEMNITY COMPANY OF MID-AMERICA NATIONAL INDEMNITY COMPANY OF THE SOUTH NATIONAL
More informationJohns Hopkins University Hop Vans. Collision Report Form
Accidents Stay at the scene in a safe place to gather information. Contact JHU Parking IMMEDIATELY 410-516-7275 Contact JHU Security if near campus 410-516-4600 Contact the police (911) if: o There are
More informationIncident and Accident Reporting and Investigation. September 29, 2014
Incident and Accident Reporting and Investigation September 29, 2014 Outline Purpose Definitions General Reporting Guidance Electronic Submission of Forms Specific Reporting Requirements Summary Purpose
More informationAgero, Inc. Copyright
Agero Policies and Procedures To Our Valued Service Provider, Thank you for your interest in working with Agero. As we partner with you, your company and employees become the vital link in delivering first
More informationAccident and Incident Investigation Reporting
Page 1 of 6 Purpose: This policy establishes the procedures to be followed when a City of Mobile employee suffers a workplace injury, is involved in a vehicle accident, or is involved in any other incident
More informationCanal Truck Insurance Application
Canal Truck Insurance Application Insurance Indemnity Sections 1 through 6 must be completed for a quote indication. Sections 7 through 9 must be completed in order to bind. 1. General Information Applicant
More informationSTAFF LEASING AGREEMENT
STAFF LEASING AGREEMENT Upon the parties voluntarily entering into this Staff Leasing Agreement (hereinafter Agreement ) for the joint employment of labor entered into and effective upon the date specified
More informationUtah Transit Authority Personal Injury Protection Information
Utah Transit Authority Personal Injury Protection Information Revised 11/2016 A passenger on a UTA bus or a pedestrian injured by a bus may be entitled to Personal Injury Protection benefits. To claim
More informationOwner Operator Application
Owner Operator Application Name: (first) (middle) (last) Current Address: (street /city) (state, zip) (how long?) Previous Addresses: (street /city) (state, zip) (how long?) (street /city) (state, zip)
More informationInsuring Your Quiznos Franchise
Insuring Your Quiznos Franchise Table of Contents Quiznos Franchisee...1 The Importance of Insurance...2 Quiznos Insurance Requirements...2 Marsh-Administered Quiznos Insurance Program...4 3 Steps to Obtaining
More informationCODE DE SÉCURITÉ SAFETY CODE
CODE DE SÉCURITÉ SAFETY CODE Mandatory as defined in SAPOCO/42 A2 Rev. 3 Edited by: Director-General Date of issue: May 2005 Original: English Reporting of Accidents and Near Misses Contents 1 Legal Basis
More informationH2P CAR INSURANCE MOTOR ACCIDENT CLAIM FORM
H2P CAR INSURANCE MOTOR ACCIDENT CLAIM FORM CLAIM NUMBER NAME OF CLAIMS OFFICER PHONE NUMBER IMPORTANT INFORMATION ABOUT MAKING A CLAIM 1. Please ensure PERSONAL INFORMATION is read before signing the
More informationREPORT OF INCIDENT. Type of Accident (Check all that apply): Public (Property Damage or Personal) Incident
(757) 457-9312 or (888)892-0787 REPORT OF INCIDENT Date: Assigned Work Location: Type of Work: Administrative Professional Management Technical Maintenance Other Involved MANCON Employee s Name and ID#:
More informationAfter a Car Accident. Your Post-Crash Handbook
After a Car Accident Your Post-Crash Handbook When your vehicle is damaged and it s someone else s fault, you have certain rights under North Carolina law and the rules and regulations of the North Carolina
More informationNOTICE OF CLAIM FOR DAMAGES AGAINST THE COUNTY OF PASSAIC
NOTICE OF CLAIM FOR DAMAGES AGAINST THE COUNTY OF PASSAIC -- -- -- For 1. and to: CLAIMANT: PASSAIC COUNTY LEGAL DEPARTMENT PASSAIC COUNTY ADMINISTRATION BUILDING 401 GRAND STREET PATERSON, NEW JERSEY
More informationBSP TravelCover Claim From
American Home Assurance Company Trading in Papua New Guinea as Chartis Level 1, Deloitte Tower, Douglas St, Port Moresby P O Box 99 Telephone: (675) 321 2611 Port Moresby Facsimile: (675) 321 7034 (Please
More informationEmployees Handbook/Guide to UCIPP Coverage
University, College and Institute Protection Program (UCIPP) Employees Handbook/Guide to UCIPP Coverage September 2011 Web site address www.bcucipp.org Foreword The University, College and Institute Protection
More informationIT S GO TIME. WELCOME TO BMW FINANCIAL SERVICES. CONTENTS
IT S GO TIME. WELCOME TO BMW FINANCIAL SERVICES. 1 Paying for Your BMW Motorcycle 3-4 UltimatePay, EasyPay 4 Phone and Mail Payments 4 Managing Your Account 5-6 BMW FS Central 6 Paperless Invoicing 6 Insuring
More informationMOTOR VEHICLE ACCIDENT CLAIM FORM
MOTOR VEHICLE ACCIDENT CLAIM FORM Insurer: Policy No.: VAT Reg. No.: Insured Identity No.: Occupation: Phone No.: Vehicle Reg No.: Make: Tare: Gross Vehicle Mass: Kilometers: Date Purchased: Price Paid:
More informationBernards (Project Name) CCIP Insurance Manual
Bernards (Project Name) CCIP Insurance Manual Policy Year: xxxx-xxxx Alliant Version 01 1 Table of Contents 1.1 INTRODUCTION... 3 1.2 Overview... 3 1.3 About this Manual... 4 2.0 PROJECT DIRECTORY... 5
More informationTEXAS STATE TECHNICAL COLLEGE STATEWIDE OPERATING STANDARD
TEXAS STATE TECHNICAL COLLEGE STATEWIDE OPERATING STANDARD No. GA 1.6.6 Page 1 of 10 Effective Date: 06/24/16 DIVISION: SUBJECT: AUTHORITY: General Administration Driver Safety SORM Program Risk Management
More informationFLORIDA STATE UNIVERSITY ALUMNI ASSOCIATION CLUB & CHAPTER INSURANCE AND CLAIM MANUAL
FLORIDA STATE UNIVERSITY ALUMNI ASSOCIATION CLUB & CHAPTER INSURANCE AND CLAIM MANUAL EFFECTIVE FOR THE ANNUAL TERM: AUGUST 1, 2017 - AUGUST 1, 2018 TABLE OF CONTENTS Introduction..... 1 Alcohol Policy.....
More informationCatholic Diocese of Columbus
1500.0 - Risk Management The Diocese of Columbus has established a program for the management of insurable property and liability risks. This program, managed by the Diocesan Insurance Office, provides
More informationLAKE BOLAC P-12 COLLEGE & COMMUNITY BUS DRIVER RECORD FORM
PLEASE RETURN TO OFFICE WITH PHOTO COPY OF LICENCE LAKE BOLAC P-12 COLLEGE 90 Montgomery Street LAKE BOLAC, 3351 Tel: 5350 2302 Fax: 5350 2411 Email: lake.bolac.co@edumail.vic.gov.au LAKE BOLAC P-12 COLLEGE
More informationARIZONA DEPARTMENT OF ADMINISTRATION RISK MANAGEMENT DIVISION FISCAL YEAR 2009 ANNUAL REPORT
JANICE K. BREWER GOVERNOR DAVID RABER INTERIM DIRECTOR ARIZONA DEPARTMENT OF ADMINISTRATION RISK MANAGEMENT DIVISION FISCAL YEAR 2009 ANNUAL REPORT RESPONSIBILITIES/STATUTES The Fiscal Year 2009 Annual
More informationState Vehicles, Automobile Coverages & Accident Reporting
APRIL 2017 State Vehicles, Automobile Coverages & Accident Reporting Presented by the Office of Risk Management Commonwealth Risk Management Plan ODU as a state institution is a participant in the Commonwealth
More informationAdministrative Policies and Procedures Page 2
Administrative Policies and Procedures Page 2 2.5.3 MINIMUM DRIVING STANDARDS Authorization to drive a Commission-owned, leased, or personal vehicle for Commission business will be granted only when an
More informationNew Auto Liability Accident Reporting Program
New Auto Liability Accident Reporting Program The Tennessee Division of Claims and Risk Management has implemented a new state reporting program. The State can apply a $1,000 penalty per incident for not
More informationGEORGIA DEPARTMENT OF CORRECTIONS Standard Operating Procedures
Policy Number: 404.03 Effective Date: 10/4/17 Page Number: 1 of 13 I. Introduction and Summary: This standard shall apply to all Georgia Department of Corrections (GDC) staff to insure the proper investigation
More informationHANDBOOK For. Insurance Coverage & Claims Procedures
HANDBOOK For Insurance Coverage & Claims Procedures Table of Contents General Information... 2 Automobile Coverage... 3 General Information... 3 Automobile Liability Coverage.. 3 Automobile Physical Damage
More informationScarborough Fire Department Scarborough, Maine Standard Operating Procedures
Scarborough Fire Department Scarborough, Maine Standard Operating Procedures Book: Chapter: Subject: Organization Revision Date: 10/07/2016 Approved by: B. Michael Thurlow Personnel, Policies, & Procedures
More informationADDENDUM C VEHICLE OPERATIONS POLICY
ADDENDUM C VEHICLE OPERATIONS POLICY 1 VEHICLE OPERATIONS POLICY (from the Shasta County Personnel Rules, Chapter 33) SECTION 33.1. PURPOSE. Vehicle accidents pose a significant threat to public and personal
More informationTaxicab or Commercial Transportation Vehicle Business Owner License
Submit Application to: City of Caldwell ATT: City Clerk 411 Blaine Street Caldwell, ID 83605 Phone: (208) 455-4656 Fax: (208) 455-3003 Taxicab or Commercial Transportation Vehicle Business Owner License
More informationOffice of Risk Management
Office of Risk Management Patrick M. Durbin, CHMM, Assistant Director of Risk Control Michelle N. Bost, CHMM, Environmental Program Coordinator Eric Agnew, CPCU, ARM, Risk & Insurance Analyst U. T. System
More information2.8.1 VEHICLE USE POLICY FOR CONDUCTING THE OFFICIAL BUSINESS OF THE COLLEGE OF CHARLESTON. Policy Statement
OFFICIAL POLICY 2.8.1 VEHICLE USE POLICY FOR CONDUCTING THE OFFICIAL BUSINESS OF THE COLLEGE OF CHARLESTON 2/3/16 Policy Statement It is the Policy of the College to use motor vehicles in the performance
More informationNuts & Bolts of Market Management
Farmers Market Managers Professional Certification Program Module 1: Unit 1.4 Nuts & Bolts of Market Management Understanding Liability Insurance UNIT OVERVIEW This unit will emphasize the risk management
More informationA REPORT BY THE NEW YORK STATE OFFICE OF THE STATE COMPTROLLER
A REPORT BY THE NEW YORK STATE OFFICE OF THE STATE COMPTROLLER Alan G. Hevesi COMPTROLLER NEW YORK DEPARTMENT OF MOTOR VEHICLES AUDIT OF THE DEPARTMENT S ASSESSABLE EXPENSES FOR THE ADMINISTRATION OF THE
More informationEmployment Application CDL Holder Federal Rd, Suite B Houston, TX
Employment Application CDL Holder 1818 Federal Rd, Suite B Houston, TX. 77015 713.330.3000 1 Date: Personal Information First Name: Last Name: Street Address: City: State: Zip Code: Home Phone: Cell Phone:
More informationL O U I S I A N A I N S U R A N C E G U A R A N T Y A S S O C I A T I O N
L O U I S I A N A I N S U R A N C E G U A R A N T Y A S S O C I A T I O N LIGA To be completed by all persons making claims against the Louisiana Insurance Guaranty Association ( LIGA ) pursuant to the
More informationInstructions for the Incident/Accident Investigation Form (SORM-703)
Purpose of Form: Instructions for the Incident/Accident Investigation Form (SORM-703) Effective loss control efforts require documentation of incidents and accidents to determine hazards or problem areas,
More informationPROACTIVE RISK MANAGEMENT COVERAGE LIABILITY AND PROPERTY MANAGEMENT. Focus
COVERAGE LIABILITY AND PROPERTY 1 Focus Assure Ohio Townships have the correct Property/Casualty coverage to meet the needs of the individual township Review the necessary information required when filling
More informationREQUEST FOR SEALED BID PROPOSAL
REQUEST FOR SEALED BID PROPOSAL OWNER: SAGINAW CHARTER TOWNSHIP PROJECT: BIOSOLIDS MANAGEMENT Bids will be received by Saginaw Charter Township at the Wastewater Treatment Plant, located at 5790 W. Michigan
More informationDAY MOVING OPERATIONS / WAREHOUSE I I
DAY MOVING OPERATIONS / WAREHOUSE I I POLICY INFORMATION Name Effective Date: Address Web Address: Email Address: Fed ID: The following items should accompany this supplemental questionnaire: ACORD Applications
More informationIII. CLAIMS ADMINISTRATION
III. CLAIMS ADMINISTRATION Insurance Providers: Sport Accident Insurance: National Union Fire Insurance Company of PA Liability Insurance: AXIS Insurance Company Claims Administration: Claims Representative
More informationColgate University Driver Safety and Motor Vehicle Use Policy
Purpose Colgate University Driver Safety and Motor Vehicle Use Policy This policy provides employee and student requirements for operation of Colgate University owned, leased, or rented motor vehicles,
More informationTradewise Insurance Company Limited Statement of Claim
Page 1 Tradewise Insurance Company Limited Statement of Claim Please remember that it is normal practice for an Insurer to fully investigate a claim. You must ensure that you are open and honest with your
More informationClosing the Gaps - Insurance Review for Pet Services Professionals
Closing the Gaps - Insurance Review for Pet Services Professionals By David Pearsall, CIC Most professionals working in the Pet Services Industry today are aware of the need to be insured. But it is one
More informationFLORIDA STATE UNIVERSITY ALUMNI ASSOCIATION SEMINOLE CLUBS & CHAPTERS INSURANCE AND CLAIM MANUAL
FLORIDA STATE UNIVERSITY ALUMNI ASSOCIATION SEMINOLE CLUBS & CHAPTERS INSURANCE AND CLAIM MANUAL EFFECTIVE FOR THE ANNUAL TERM: AUGUST 1, 2013 AUGUST 1, 2014 Prepared by: TABLE OF CONTENTS Introduction...
More informationINCIDENT WITNESS STATEMENT Department of Environmental Health & Safety
STATE OF GEORGIA Liability Incident Report Form If property of others is damaged (or alleged) as a result of the State s operations, whether negligent or not, report the claim directly to Risk Management
More informationTHE AIG GROUP INSURANCE PROGRAM
THE AIG GROUP INSURANCE PROGRAM IS SPECIALLY DESIGNED FOR CHARTERED LITTLE LEAGUES TO CREATE AFFORDABLE PROTECTION FOR ALL ELIGIBLE PARTICIPANTS AND LOWER PROGRAM COSTS TO LOCAL LEAGUES. INSURANCE Online
More informationACCIDENT REPORTING POLICY
ACCIDENT REPORTING POLICY POLICY: Accident Reporting Policy ISSUE: 5 ISSUED: October 2016 REVIEWED: October 2019 RELATED POLICIES All Health & Safety related Policies. SCOPE OF POLICY This policy applies
More informationWESTERN RIVERSIDE COUNCIL OF GOVERNMENTS EQUIPMENT PURCHASE AGREEMENT
WESTERN RIVERSIDE COUNCIL OF GOVERNMENTS EQUIPMENT PURCHASE AGREEMENT This Equipment Purchase Agreement ( Agreement ) is entered into this day of, 20, by and between the Western Riverside Council of Governments,
More informationNorthwest University s Student Accident Excess Insurance Information
Northwest University s Student Accident Excess Insurance Information Northwest University provides excess medical coverage for all students, and it is very important that Parents and Students understand
More informationClaim Form. General Information Policyholder : Claimant (if it differs from the policyholder): Insurance Policy No:
Jetstar Travel Travel Insurance Insurance Claim Form IMPORTANT NOTE: Please answer all questions contained in this claim form as leaving items blank, using ticks, dashes and N/A may make it necessary for
More informationCAR INSURANCE VISIT IBC.CA ALL ABOUT AUTO INSURANCE
CAR INSURANCE VISIT IBC.CA ALL ABOUT AUTO INSURANCE TABLE OF CONTENTS DO I REALLY NEED AUTO INSURANCE? 3 BUYING AUTO INSURANCE 4 Who is insured?...4 If you are borrowing a car...4 If you are lending a
More informationWHAT YOU SHOULD KNOW WHEN YOU HAVE BEEN INJURED IN A MOTOR VEHICLE ACCIDENT
WHAT YOU SHOULD KNOW WHEN YOU HAVE BEEN INJURED IN A MOTOR VEHICLE ACCIDENT This document provides current information about obtaining assistance to meet your needs through insurance benefits and other
More informationBoard of Claims General Instructions
Board of Claims General Instructions 130 Brighton Park Blvd. * Frankfort, Kentucky * 40601 * 502-573-7986 office Website:boc.ky.gov You must use ink or type the information. Although no filing fee is charged,
More informationAutomobile Accident Questionnaire
Automobile Accident Questionnaire Date of Accident: Time of Day: Please explain in detail: Name of driver in your vehicle: Name of driver in other vehicle: Type of vehicle you were driving: How many passengers
More informationSubcontract Agreement
S THIS AGREEMENT made as of the day of, 2012 BETWEEN the Contractor: TCL Partners 5212 123 rd Place SE Everett, WA 98208 and the For the Following Project: The Architect for the Project: The Contractor
More informationWorkers Compensation Procedure
City and County of Denver Workers Compensation Procedure Issued September 10, 2001 Workplace Safety 201 West Colfax Avenue Dept. 1105 Denver, CO 80202 Risk.Management@Denvergov.org Workplace Safety Home
More informationSecure Boat Claim form
Secure Boat Claim form Notes: The issue of this Claim Form is not an admission of liability on our part. All questions must be fully answered in either black or blue pen. Please print clearly and tick
More informationAutomobile, health, life, disability, and property insurance provide fi nancial protection. An insurance claim must be fi led to recover losses.
What can insurance do for me? Chapter 28 Key Terms policy premium deductible health maintenance organization (HMO) preferred provider organization (PPO) life insurance dividend disability insurance property
More informationANSWERING THE MIDNIGHT CALL:
ANSWERING THE MIDNIGHT CALL: REACTING TO A CATASTROPHIC ACCIDENT AND HOW PLAINTIFFS ARE TURNING TO REPTILES Jack Riordan Kurt Rozelsky Smith Moore Leatherwood LLP South Carolina North Carolina - Georgia
More informationRequirements and Guidelines for Insuring and Protecting Your Business
Requirements and Guidelines for Insuring and Protecting Your Business Having enough insurance is essential for any business to protect against unanticipated events ranging from accidents to lawsuits. It
More informationCLAIM FOR DAMAGE, INSTRUCTIONS: Please read carefully the instructions on the FORM APPROVED INJURY, OR DEATH
CLAIM FOR DAMAGE, INSTRUCTIONS: Please read carefully the instructions on the FORM APPROVED INJURY, OR DEATH reverse side and supply information requested on both sides of this OMS NO. 1105-0008 form.
More informationVERMONT MUTUAL MASSACHUSETTS PERSONAL AUTOMOBILE MANUAL. The types of coverages available in the Massachusetts Automobile Insurance Policy are:
VERMONT MUTUAL MASSACHUSETTS PERSONAL AUTOMOBILE MANUAL RULE 2. COVERAGES AND LIMITS The types of coverages available in the Massachusetts Automobile Insurance Policy are: Compulsory Insurance Coverages
More informationAmerican Express Cardmember / Business Travel
American Express Cardmember / Business Travel Claim Form The information requested and supporting documents required for your claim are detailed below each section. Further documents or information may
More informationMonsoon Production Services, LLC Lease/Rental Agreement Terms and Conditions
Monsoon Production Services, LLC Lease/Rental Agreement Terms and Conditions Indemnity. Lessee/Renter ( You ) agree to defend, indemnify, and hold Monsoon Production Services, LLC, their officers, employees
More informationGENERAL GUIDELINES. Report all accidents regardless of the degree of injury or damage.
CIAW CLAIMS REPORTING KIT CIAW MEMBERS Your membership in the insurance program requires ALL accidents and losses CIAW provides full claims management services to its members through Clear Risk Solutions
More information