1 Guide to Claims Frequently asked questions: When should I contact the Group Risk Office? You should contact the Group Risk Office in the event of a loss or potential claim and if you need advice or assistance about any claims. We are available from 9am to 5 pm, Monday to Friday. In emergencies we can be contacted via Security Control. How should I contact in the Group Risk Office? For all queries relating to insurance and risk management please contact Lorraine Loy, Group Risk Manager. For all claims related to travel and motor claims please contact Cherry Rogers our full details are shown below: Contact for all claims/risk management issues Travel/Motor Claims only Lorraine Loy Group Risk Manager Tel: Cherry Rogers Tel: How should I contact in the Group Risk Office? For all queries relating to insurance and risk management please contact Lorraine Loy, Group Risk Manager. For all claims related to travel/motor claims and general enquiries please contact Cherry Rogers. What type of claims does the Group Risk Office handle? The Group Risk Office handles claims where the School, Institute or Section has suffered any material loss or damage caused by an insured peril to property, covered by the policy. This will include items such as buildings, contents, money, and works in progress. As an example, you need to call the Group Risk Office if a building suffers an arson attack and is badly damaged by fire and smoke. The Group Risk Office also handles the following types of claims: Business interruption where you are, for example, claiming for the costs of hiring alternative premises following severe storm damage to your building. Works in progress such as, claiming for the costs of site materials that were stolen while you were refurbishing a building. Money, for example, claiming for damage caused to your office safe during an attempted robbery. All risks claims such as malicious damage to a sculpture listed on your all risks schedule.
2 Motor Claims The Group Risk Office deals with damage caused to any vehicles and liability claims arising from a motor accident involving University vehicles. For example, call the Group Risk Office if you're involved in a road traffic accident, someone has alleged that one of your vehicles caused damage to a third party, the vehicle suffers damage or is stolen, or you simply require assistance. Liability Claims The Group Risk Office handles claims made against the University for loss or damage to third parties property or for personal injury. If you receive a claim from an employee, this will be dealt with under the employer s liability section of our policy. For example, an employee injures his back whilst working and alleges you're at fault because you did not give him or her correct training. You may also receive claims from another person or organisation, such as a tenant, contractor, visitor or members of the public and we will handle these under the public liability section of your policy. For example, a visitor to a building is injured whilst walking on a pathway and holds you responsible because the pathway has a pothole in it. Libel and slander claims, such as, a member of staff making an alleged slanderous remark and the injured party sues for damages. Professional negligence claims, for example, where a member of staff is working for a fee for another organisation makes an error leading to a financial loss. Engineering insurance claims, such as electrical or mechanical breakdown of a lift, or a cracked boiler. Deterioration of stock claims, including loss of food following a freezer break down. Fidelity guarantee claims, where an employee steals cash from your safe. Personal accident claims, for example, one of your caretakers is physically assaulted while on duty and sustains a fractured kneecap. Property Claims How do I make a property claim? If you suffer a loss or damage by an insured peril, you should let us know as soon as possible after the event and certainly within 30 days of the incident. You should also provide as much information as you can about the circumstances and value of the loss. Arrange emergency repairs immediately to ensure no further damage occurs. Remember to keep all invoices relating to the claim. How do I submit a claim?
3 Contact the Group Risk Office and we will send you a Claim Form. The claim forms are also available electronically via our web pages. Complete and return the Claim Form by post, fax or . If the cost of the claim is set to exceed 5,000, we'll take the details over the phone and a Loss Adjuster will be appointed to handle the claim within 24 Hrs or immediately for a substantial claim. What information do you need? When reporting a claim, please give us as much information as possible, including: full address where the loss occurred date of the incident full circumstances cause information about the extent of the damage; please also include any estimates or invoices for repairs/replacements. Please note that if electronic equipment is damaged, we'll need the specification of the original item to compare with the item you're buying as a replacement. For theft, malicious damage or vehicle impact claims, you should first report the incident to the police. When you contact us, please provide the crime reference number and details of the station you reported the incident to. If a third party is involved, please supply all available information, including the name and address of the third party, vehicle details if this was the cause of the impact damage, and details of any witnesses. This will help us to try recovering money for your claim, in the event the third party is liable for the damage. Do the University s insurers have approved suppliers? Yes. These include glass replacement, tradesmen, emergency repairs, property recovery experts and the like. Please contact the Group Risk Office for more information. Can we perform repairs or do we need authorisation? You should arrange emergency repairs as soon as possible to prevent further loss or damage particularly where there is a security or health and safety risk. You can do this without our authorisation although, please note, this doesn't mean insurers are committed to meeting the full or any costs under the policy. Advice should be sought from the Group Risk Office. Repairs procedures Private Repairs Less than 2,000 Over 2,000 but less than 5,000 Over 5,000 Procedures Proceed with repairs and submit invoices Submit two estimates and details of repairs Notify the Group Risk Officeby phone or fax do not instrutct repairs until authoriation has been given
4 Please note that for subsidence, heave or landslip claims, you must notify us of the claim before repairs commence. How are clams settled? Insurers usually settle claims when we receive the final invoices. If you don't want to reinstate or replace the lost/damaged property, then we can make an indemnity offer which takes into account the age, life expectancy, and wear and tear. Please contact us if this situation arises. If you receive additional information or invoices, can you re-open a settled claim? When a claim is settled, we hold it in the Group Risk Office for six months. After this, we keep the information for a period of three years. We keep subsidence claims for 10 years. However, if you submit additional costs and invoices with an explanation for the delay, they will be considered but may not be accepted. What are the timescales for handling a claim? In most cases, once we receive a claim, we'll record the details within 48 hours and send you an acknowledgement within three days. We'll normally work on incoming post within seven working days. We'll action all urgent correspondence within 24 hours. We'll pass claims over 5,000 to our Loss Adjusters within 24 hours of receiving the claim. Loss Adjusters What are Loss Adjusters? Loss Adjusters are independent claims specialists that we ask to investigate and administer large or technical claims. They assess the extent of damage, guide you through the repair process, and settle the claim as soon as possible in line with your policy cover. When will a Loss Adjuster become involved in my claim? A Loss Adjuster will be appointed if the claim is over 5,000, for lower values at the insurers discretion. Who appoints the Loss Adjusters? The Universitys insurers usually appoint Loss Adjusters. However, the Group Risk Office can appoint a Loss Adjuster in the event of a major loss. What do Loss Adjusters do? They handle the claim on behalf of the insurers, which involves visiting the site, and assessing and agreeing the loss in line with the policy cover. The adjuster will advise and agree on what repairs you require and settle the claim as quickly as possible for you. When do Insurers get involved? For claims below 50,000, Loss Adjusters usually handle the claim themselves. This means our insurers won't have much involvement. However, For claims over 50,000, the Loss Adjuster
5 will have more contact with our insurers. This involves the Loss Adjuster sending full reports and asking for our advice and agreement where necessary. Who should I call if I have a question or a problem? Always contact the Group Risk Office in the first instance for help. Which Loss Adjuster will generally be appointed? We use a selection of approved companies offering loss adjusting services. We will generally instruct one of the following firms: GAB Robins Cunningham Lindsey Frequently asked questions Why do I have to complete a Claim Form? Completing a Claim Form means we won't have to ask so many questions about your claim. It will also help us deal with your claim more quickly. Here are some important points to remember: Report claims to us within thirty days of the event. Report claims to us within thirty days of the event On your Claim Form, show which, if any, All Risks item you're claiming under. Write the date of your loss and provide details of the incident. Provide details of approximate costs together with supporting documentation. Alternatively, let us know the approximate cost and that estimates will follow. Why do I have to send you more than one estimate? We have experience of many claims and the usual costs involved. So if it seems an estimate is high, we'll ask you for another quote. You've dealt with my claim but I didn't send you all the invoices. Can you deal with these too? Yes, as long as you pick this up in a reasonable time. When you send them, please explain why you didn't submit them earlier. We'll then consider each invoice. Does the Group Risk Office review claims regularly?
6 If nothing has happened with a claim for six months, we'll review it. If nothing's happened for over a year, we'll send you a final reminder letter, and settle it if we haven't heard anything after 28 days. What happens if a replacement for one of my stolen items isn't available? We'll consider replacing your item with the nearest equivalent. Do you make interim payments? Yes we do. If, for example, you urgently need a replacement item, we'll make an interim payment and consider the rest of the claim later. If we don't want to reinstate or replace a property or item, will you consider a cash (indemnity) settlement? Yes, we'll consider it, based on age, condition and wear and tear. Can we proceed with urgent and essential repairs? Yes, you should always try to minimise your losses, even if you're unsure whether an insured peril caused the damage. If you need advice before proceeding with repairs, please call the Group Risk Office and we'll let you know whether your policy covers the damage. For example: If a pipe has split and water is escaping, either call a plumber or your own maintenance team to repair the pipe straightaway. If someone has broken into your property and it s unsecured, call out a contractor to perform emergency repairs. Why do you send us reminder letters? We have many outstanding claims, which are often awaiting estimates or information. We simply want to settle these claims for you as soon as we can. After all, it's in your best interest to complete repairs and receive payment from insurers where it's due. If we claim for a fire, do we need to send you a copy of a Fire Brigade Report? No, don't worry. If we need one, we'll obtain this ourselves. Why do we sometimes have to send you original receipts and replacement estimates? We sometimes need to make sure that claimants have replaced items that are exactly the same, rather than buying better and costlier alternatives. Why do you need third party details? If the loss or damage to your property has been caused by someone else, such as a contractor, we will pay for the claim. However we will try to recover any money we have paid from the person or organisation responsible. For this reason we need to know who they are. When should I tell the police about incidents?
7 If you suffer a theft, malicious damage or vehicle impact, you should first report it to the police. When you contact us, please supply the crime reference number and details of the station you reported the incident to. What if loss or damage to property accumulates over a period of time? We would need your help to establish how many incidents there were over that period. The policy excess would apply to each and every incident in every separate incident per property. Can we use our own works team or panel of contractors to complete repairs? Yes, as long as their costs are reasonable and competitive. What evidence do you need that someone has stolen money from us? Please provide such documents as financial spreadsheets, accounts log books and bankbooks. Motor Claims What do I do if I have an accident? If you're involved in an accident with another party, you must exchange details with them, including name, address, registration number, and policy number. Even if you think you're at fault, don't admit liability. Simply call us and follow this by completing the motor accident report form in each vehicle or download from the webpages and we'll arrange repairs as soon as we can. If the vehicle is damaged but you can still drive it, we ll direct you to the nominated approved repairer. Alternatively, you can take it to a repairer of your choice to obtain an estimate. If you can't drive the vehicle, we ll arrange collection by an approved repairer or you can contact a garage of your choice and ask them to collect it. The garage may need to contact us before collection however, we'll pay the cost of collecting your vehicle. How do I claim? In the event of an accident, damage to your vehicle, or if you've damaged another vehicle regardless of fault, complete and return a Claim Form. You can get this from the University webpages or by contacting the Group Risk Office. Do I have to complete a Claim Form? Yes, you'll need to complete one as soon as possible, including a sketch of the accident. This will help us assess liability.
8 Will the vehicles be inspected? This depends on the nature and extent of the damage and the decision will be taken by our insurers Motor Engineers Unit. Sometimes the engineer can do this remotely using electronic imaging equipment. Providing we have all the information we need, the engineer will authorise repairs direct with the garage. Will you pay the garage direct? Do I have to pay the excess and VAT? We'll pay the garage unless you prefer to do this yourselves. The policy excess and the VAT will be deducted or you will need to pay this to the garage. Your organisation may be able to reclaim all or some of the VAT. Do we have approved repairers? Yes, we have an approved repairer network. We can give you details of an approved repairer in your area. This is a national network so regardless of your area of operation or location at the time of the accident, we'll be able to recommend a suitable garage. What are the benefits of using an approved repairer? They will collect and deliver your vehicle following repair. You don't have to pay for repairs in advance. Motor Engineers keep a close eye on repairs costs and standards. You don't need to get an estimate or quote. The approved repairers will give you a courtesy car for the time it takes to repair your vehicle (Group 'A, manual gearbox, less than 3 years old). If a courtesy vehicle isn't available and you need one, we'll try to supply you with a Group A vehicle. We'll match any manufacturer's warranty for repairs. Once images and an estimate have been submitted to our Motor Engineers, the approved repairer will commence work without the need for formal authorisation in all but exceptional cases. All our approved repairers are quality assured professionals. Do we have to use an approved repairer? No, it's not compulsory. If you have a garage you'd rather use, that's fine, providing our Motor Engineer is satisfied that they charge competitive rates. However, we can't guarantee a courtesy vehicle will be available. Advice should be sought from the Group Risk Office to avoid any uninsured losses. What do I do if the windscreen is damaged? We can arrange a direct billing scheme with Autoglass. They will perform the required work and bill us, less the policy excess and any VAT. They have both repair depots and mobile facilities depending on vehicle types. What if someone was injured in the accident?
9 Call the police and the paramedics. You'll also need to try and find out which hospital the injured party was taken to and provide us with a brief description of the injury. If a child is injured, try and obtain the guardian's contact details. Report the accident to the Group Risk Office as a matter of urgency. What if I'm at fault for the accident? Even if you think you're at fault, don't admit liability. All you need to do is exchange such details as name, address and policy number with the other party, and note their vehicle details and registration number. If a third party caused the damage, what will you do? If you're not at fault, we'll write to the driver or the driver's insurers and start our recovery work. If the other driver doesn't have insurance details to hand, just provide us with their vehicle registration, and we can trace their insurer. Liability Claims I've received notification of a claim from a third party. What should I do? Send any correspondence from third parties to the Group Risk Office inanswered as a matter of uregency. If they notify you by phone, take details of the call and ask them to write, providing full details of the claim and their losses. The Group Risk Office will send an acknowledgement letter confirming you have forwarded their letter to your insurers and you can include your contact details and policy number. A third party claimant must prove that you were at fault for any loss, damage or injury they may have suffered. Who should I contact? Group Risk Office. Normal Operating times are open 9am to 5pm, Monday to Friday. Do I need to complete a Claim Form? In most cases, yes. However not all incident descriptions fit neatly into the Claim Form format. Which means you can also describe the incident in a covering letter. Where can I get a Claim Form? From the Group Risk Office or via the university webpages. What information do you need? Accidents happen that's what public liability insurance is there to cover you for. So it's important you provide full and accurate information from the start. Dealing with inaccuracies
10 later can be costly, especially if the case goes to court. Here's a checklist of the information we need: 1. Third parties name, address and telephone number. 2. Exact location. For example, if the incident occurred on a stairway, which step was it? 3. Exact cause. For example, if the cause was a blocked pipe, what caused the blockage? 4. Contractor's details, if applicable, including name, address, telephone number and workmen involved. 5. Date you became aware of the loss or damage. 6. How did you become aware of the loss or damage? For example, did a student notify you, was it through a routine inspection? If you became aware through an inspection: What was the date of the last inspection? What was the condition of the defect or damage at that time? What did you do when you first knew of the defect/damage? Did you document your actions? If not, why? Has an employee seen the damaged items? If yes, please provide a description of the damage items and their approximate value and age. What are the dos and don'ts if there's an incident? Don't admit liability. Don't suggest to a third party that they will automatically receive compensation. Don't discuss the claim with anyone representing the third party, such as a solicitor. Send us all information relevant to the claim, such as a claimant's letter or repair invoice. If you're not sure whether the claim against the University is valid, please get in touch with us to express your concerns and we ll investigate both the circumstances as well as such details as the age and condition of items and amounts claimed. It is our insurers job to ensure we only pay liability claims where genuine loss/damage/injury is caused as a result of your legal responsibility. What information do you need for the different types of claim? We have listed below all the detailed information we'll need for each claim type: Employers' liability claims Generally, accidents involving employees will be investigated by one of our specialist Claims Inspectors. The following however is representative of the type of information they will be looking to collect as part of their investigation in to both the accident and its circumstances and the injured employee themselves.
11 Accidents Accident book entry, F2508 (HSE form), B176 (DSS form), RIDDOR Notification. Safety Officer s report plus any other investigation report. Details of Health and Safety Executive involvement, if any. Names and addresses of witnesses and positions held, plus any statements if you have them. Copy photographs of the accident site location, machinery and equipment, if available. Remember, wherever possible, isolate any machinery and defective equipment, and make it available for inspection. Injured person or claimant Full name, address, date of birth, national insurance number, job at time of accident, plus brief job description detailing any supervision or enforcement issues, length of service, and employment history. Copy of personnel file. Details of injuries including illness or sickness certificates, plus information of absence, date of return to work. Also identify whether the current injury is a recurrent problem such as a back injury. Details of earnings thirteen weeks before the accident, plus details of wages paid in the employee s absence. Confirm whether medical retirement is a possibility or has already started. If so, state the date retirement commenced, and supply details of pensions payments and calculations. If this is linked to a workplace incident we would wish to know before a medical retirement. History Details of any similar accidents, near misses or complaints. Copies of any risk assessments undertaken to comply with EC directives. Detail any training undertaken relating to the job performed at the time of the accident. Also supply documents relating to courses attended, manuals provided, and signed registers. Detail custom and practice, for example, the recognised method of doing the job. Were there any changes in practice after the accident? If so, what and why? Lifting and manual handling Detail the weight, shape and size of the object or person being handled or lifted. How many items were lifted and over what distance and route? Attempt to isolate or mark the object in some way: this will help reconstruct the event. It's important if the incident involved lifting a patient to try and establish their weight as close to the accident date as possible. Were mechanical aids provided to assist with lifting or manual handling? If so, detail the hoists and machinery involved, training offered, and enforced rules. Stress A copy of the personnel file. Any additional information not on the personnel file relating to the employee's family and social background such as hobbies, marital situation, and any recent bereavement.
12 Claimant s medical history, including any known psychiatric history within the family. Names and addresses of other employees performing similar roles plus the identity of supervisors and managers. Details of any risk assessments and their consequences. Details of the incidence of stress and stress-related illness in the claimant's type of work and their workplace. Documentation of written or verbal complaints regarding the employee s job or from fellow employees performing similar roles. When did the claimant first seek medical assistance and from whom? When did you first learn of the nature of the employee s illness? If the employee has returned to work after an initial period of illness, how did you assess their fitness to return? What have you done to alleviate the stress they're under? Repetitive strain injury or work related upper limb disease Specify the tasks involving repetitive movements or prolonged work in the same positions. Did the employee work to a strict production schedule? Give details of breaks and variation in work patterns. Supply details of the workplace or station, with photographs if possible, showing any unnatural or extreme joint movements required to perform tasks. Detail any risks in the job. Did you let the employee know about them? Public liability claims Slips, trips and falls Location Details of owner or occupier, if different, and copies of contractual agreements. Details of when built and compliance with relevant building regulations. Inspections How often is the area and building inspected? Date of your most recent inspection before the accident, plus a copy of the inspection report stating the inspector's identity and defects noted. Detail frequency and nature of maintenance programme. Copy of site inspection report after the accident, with details of what you've done to avoid recurrence. Are any photographs available? Detail previous complaints and accidents in the area. Floors Specify type of flooring or floor covering, and its purpose and usage. E.g. general foot traffic, leisure area, play area, catering etc. Also, provide details of the manufacturer and installation. Detail method and frequency of cleaning and sweeping, and by whom.
13 If you outsource cleaning to independent contractors, please provide details with a copy of the contract. Detail cleaning products used, manufacturer s application instructions and whether or not they were followed. Spillages Nature and cause of spillage. Do you have a system for cleaning spillages? Did you display notices during cleaning and clearance? Stairways Detail any known alleged defects. Was the lighting system working? If not, when was it last checked or identified as not working? Changes following an accident Detail any proposed or implemented changes to inspections, cleaning, or sweeping regarding any of the above. Ice and snow Detail your gritting, salting and snow clearance priorities and procedures. Did you follow these priorities and procedures immediately before the accident? Specify the dates and times of treatment relating to the accident. If there was no treatment, please explain why, for example, you don't treat minor footpaths or estates due to a lack of resources. Details of meteorological reports or severe weather warnings before the accident. Financial loss We don't have a report form for financial loss claims. Please explain the circumstances in a letter to the Liability Claims Unit and provide copies of the following: Background documents. Internal memos. External correspondence. Plans, if applicable. Fidelity guarantee Completing the right Claim Form will help us with our initial investigations. We also recommend you consider the following points: Submitting a full copy of the personnel file relating to any person suspected of causing the loss or defrauding your organisation. This should include all references and checks performed before employing the person. The possibility of freezing the assets of any person known to have caused the loss, plus withholding all outstanding salary, expenses, and pension payments. You might also seek to place a legal charge against any property the person owns. Where criminal proceedings are brought by the Procurator Fiscal, we recommend you apply for a Restitution Order. A restitution Order can be arranged by the Police and is designed to protect your right of recovery.
14 If a suspect doesn't admit to the fraud and isn't convicted, consider the risk of defamation. If this risk exists or you anticipate it, please you let us know straightaway. We may also make further enquiries through our Claims Inspector or a Loss Adjuster. Personal accident Fully completed Claim Form Medical Certificate for the employee s period of absence Employee s average gross earnings for the twelve months before the absence In some cases, we'll arrange for a medical examination. What happens next? Once you've sent us the Claim Form, we'll let you know if we need any more information. For more complex cases, one of our local Claims Inspectors will meet you. The Claims Inspector will make enquiries about the incident. This may include obtaining further documents, speaking with staff, and taking statements. They can also answer any queries you may have. How long will it take you to settle the claim? We aim to resolve claims as quickly as we can, but every claim is different, so it's impossible to state an exact time. First, we'll clarify your policy cover and liability to the claimant. If you're not covered, we'll let you know as soon as possible. If the insurers establish legal liability, they may simply following consultation make an offer to the claimant. With personal injury claims, a medical expert will probably assess the claimant for their injuries. We can't complete the claim until this is resolved and we're sure of the extent of the loss. If you'd like answers to queries on claims, please call the Group Risk Office. What external service providers do insurers use and when? For third-party property claims that are likely to exceed 5,000, a Loss Adjuster is appointed to examine the damage. For damage to a third-party's motor vehicle, insurers will often use their own Motor Engineers to examine the vehicle and arrange repair through the approved repairer network. Finally, if a third party issues court proceedings, a solicitor will be appointed by our insurers to act on our behalf. Frequently asked questions Should we get involved in third-party claims? You can, but please discuss it with the Group Risk Office first. With any claims not relating to property, we'll handle everything. Of course, we need your help for our investigations but you should have no contact with the third party once you've forwarded the papers to us. If a third party, claimant or solicitor contacts you, please refer them to us.