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Feature Article - October 2004

The Claim Game

Make your facility as safe as possible by establishing solid incident-response procedures

By Allen F. Wetzel


You returned to your office to find a phone message requesting you call a woman who said her son was hurt on your grounds. She wants to file a claim. A claim? No one's ever filed a claim. You don't even know your insurance carrier's name. Now what? Don't worry, we can help.

Whatever your facility, obviously visitors do not wish to go home unhappy or injured. Certainly, the goal is zero claims, but in this litigious society, many industries would welcome a lower loss ratio. Unfortunately, people still file trivial lawsuits. Whether you have one claim or hundreds, there are common procedures that can reduce claims and improve safety.

CLAIM PROTOCOLS

The keys to handling claims are communication and speed. Clearly, you need to make your facility as safe as possible by planning, training, conducting frequent inspections and following solid incident-response procedures.

Once an incident does occur, the facts need to be gathered quickly and communicated to the person who will handle the claim. If this person is unknown to you, do some research so you will know where to send patron complaints. Successful facilities do not rely upon security or management staff to gather and forward data. Require all involved employees to complete an Employee Witness Statement (EWS) on every incident, which is immediately submitted to the claims manager. The EWS tells the claims manager that something occurred.

Additional documents such as first-aid, security, maintenance and manager reports are incident keys, helping the claims staff understand what happened. Anyone who was associated with an incident, including customers, should be interviewed or fill out a statement. Train new employees that they must automatically complete an EWS, no matter how insignificant incidents appear to be. It is helpful to receive multiple reports from various departments on the same incident. All reports help piece the puzzle together and allow the claims staff to identify trends. Let the claims expert decide what data is or is not important. Do not let anyone, including management, refuse to write up what they saw or edit their statement because they believe their involvement was minor, the incident seems insignificant or they are too busy to write reports.

THE FIRST 12 HOURS

Investigation and reporting should begin immediately following any incident. Apply a "one voice" process to claims management, minimizing the number of employees who talk to patrons prior to any communication with the claims handler. Once initial data is gathered, immediately fax, e-mail, Fed Ex or phone the details to your claims administrator. Do not wait until all data is collected. Make sure your staff knows how to contact your claims person following any incident, especially if you are off property. Forwarding partial data to your claims expert, within the first 12 hours, allows them to decide if they need to make a courtesy call to the patron. Waiting until an investigation is complete causes the loss of valuable contact time. Most guests want to know that your business cares about them. Immediate contact with an injured guest can head off ill feelings and their desire to seek further damages, find a lawyer or open a claim.

In some cases, a claims expert may not contact the patron if it appears the guest caused the event, and your facility will be denying their claim, thereby not inviting a disagreement. When contacting the guest, the claims handler should concentrate on gathering the patron's side of the story. There is time, later, to debate the facts or dig for further details. The first story will be closest to the truth. If your claims administrator is non-confrontational, the guest will have little desire to embellish their account to gain sympathy or inflate their claim.

BACK TO BASICS

Sufficient preparation must go into developing a claims relationship before your claims program runs smoothly. One secret is to treat your general liability (GL) team (insurance carrier and broker, claims administrator and legal counsel) like part of the company family. Educate the team about your facility. Let them see the site, annually. Advise them of procedural changes. They should understand your entire operation, so when the claims handler talks with an aggrieved patron, your expert will know if a claimant is stretching the truth about an incident.

Conduct meetings with your GL team to review safety programs and discuss improvements. Do not change your claims administrator or legal counsel frequently. Maintain continuity with the GL team, so they know your staff, procedures and the kind of events that occur. Some companies require new insurance carriers to allow facilities to retain their preferred claims administrator and counsel. Your legal counsel should approve all incident documents for content and layout. Employees should have easy access to incident forms.

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