1 INSURANCE CLAIMS HANDLING & REPORTING PROTOCOL PURPOSE: The purpose of the Protocol is to guide all affected parties, including Council, County staff, Board appointees and volunteers, in their responsibilities when insurable losses occur or claims are presented against the County. The goals of the protocol are: 1. To allow for a consistent approach to reporting and handling claims brought against the County which affect the general insurance self-insured program. 2. To ensure all claims are handled sensitively, yet efficiently. 3. To reduce unnecessary costs and delays in claims handling. 4. To reduce the incidence of incurring legal costs for claims resolution. 5. Continuous quality improvement in County operations through analysis of claims and preventative measures. Haldimand County aims to reduce the incidence and adverse effects of claims against the County by: a. Adopting risk management strategies to continually improve the quality of services provided by the County. b. Adopting a systematic approach to claims handling to ensure effective and appropriate claims management. c. Carrying out effective root cause analysis of reported incidents and claims in an effort to prevent recurrences and reduce the frequency and severity of future incidents. DEFINITIONS: Appointed Solicitor the solicitor selected by the municipal Insurance provider. Automobile Claim - a first party claim involving loss related to licensed motor vehicles owned by the County. Claimant - Any individual/entity who pursues a claim against the County or who enters legal proceedings against the County seeking compensation for damages or remedial action. County Solicitor the vendor of record who has been contracted directly by Haldimand County for the provision of legal services. First Party Claim a divisional request for compensation for damages related to internal County operations. An internal claim may be a Property or Automobile Claim. Insurance Provider the vendor of record who provides the external insurance program for Haldimand County including, but not limited to, municipal liability, excess liability, errors and omissions, property and environmental liability. Liability Claim a claim involving bodily injury, property damage or other loss suffered by a third party.
2 Preliminary Claim Analysis an initial examination of the immediately available evidence which needs to be tested against the legal criteria of duty of care and causation to see if there is a realistic prospect of a successful claim being made. Preliminary analysis should normally be completed within thirty days of receipt of requested documentation, however, in more complex cases, this may require more time. Property Claim a first party claim involving loss or damage to County owned property, buildings, contents, or unlicensed equipment. Release a discharge from an obligation or responsibility such as a legal claim. SMT Senior Management Team for Haldimand County consisting of the Chief Administrative Officer, General Manager of Corporate Services, General Manager of Community Services, General Manager of Planning and Economic Development, Director of Engineering and Roads Operations and the Director of Environmental Services and Fleet. Third Party Claim - notice to the County requesting compensation or remedial action for damages allegedly caused by the negligence of the County. RESPONSIBILITIES The Support Services Division leads the internal insurance claim-handling process and will involve appropriate employees at all levels as well as outside sources such as the insurer, claims adjusters, legal counsel and others. Every Haldimand County employee, Council member, Board member and volunteer has a responsibility in the claims process as outlined below. 1. The Risk Management and Insurance Coordinator will undertake the day-to-day coordination of claims handling and reporting. i. The Risk Management and Insurance Coordinator will be responsible for: a. Receiving, acknowledging and assessing all new claims. b. Registering new claims on the County s insurance database. c. Setting up a claim file for each new claim. d. Setting an appropriate reserve for each claim and reassessing and adjusting claim reserves as appropriate. e. Notify Manager, Support Services, and General Manager, Corporate Services, of an individual claim with a reserve set above $25,000. f. Advise and update the department/division affected through the appropriate Manager and General Manager. g. Investigate a claim, which may include but is not limited to: identifying and preserving records, interviewing staff or members of the public, site visits and photograph scene. h. Recommend and/or negotiate settlements or deny claims, depending on dollar value, based on investigation findings. i. Subrogate claims on behalf of the County where advantageous to do so. j. Prepare proper financial requests for payment processing. k. Upon execution by claimant of Final Release or distribution of denial notice, close claim file.
3 l. Reporting first party claims which exceed the County s deductible to the County s insurance provider. m. Reporting third party liability claims which are expected to exceed 50% or more of the County s deductible to the County s insurer. n. Establish and maintain contact with relevant staff. o. Obtain necessary information and documentation related to claim. p. Initiate and maintain contact with County or Appointed solicitors, claims investigators and adjusters as required. q. Liaise with the County s adjuster to gather and coordinate incident reports, witness statements and other necessary documentation and information related to the claim. r. Provide appropriate training for County staff who may be involved in claims, specifically inspections, documentation and dealing with the claimant. s. Checking for coincidental connections or synergies with reported incidents or claims and reporting to the Manager, Support Services. t. Use information from incidents in a positive way to make recommendations for continuous quality improvement. u. Ensure members of the public have accessible information on how to submit an incident report or claim. v. Preparing reports for Council, SMT and the Manager, Support Services. ii. The Manager, Support Services, is responsible for: a. Ensuring appropriate procedures are in place for the management, recording and investigation of claims against the County. b. Reporting to Council and SMT. c. Approving initial contact with County solicitors as required. d. Reporting to General Manager with significant connections or trends in claims. e. Preparing budget information relative to the self-insurance program. f. Monitoring the financial status of the self-insurance reserve and making recommendations to the General Manager of Corporate Services as to its funding adequacy. iii. Managers/Supervisors are responsible for: a. Responding to requests for information from Support Services, the County s adjuster and/or the County or Appointed solicitor relating to claims investigation. This may include information with respect to witness statements, producing documentation and attending meetings, recognizing the time sensitivities involved. b. Ensuring staff are documenting daily operations, maintenance and inspections adequately. c. Notifying staff that may be directly named or involved in a claim brought against the County. d. Reviewing and ensuring the proper accident/incident or damage forms have been adequately completed by staff prior to their submission to the Risk Management and Insurance Coordinator. e. Submitting completed forms to Risk Management and Insurance Coordinator within 24 hours of receipt from staff. f. Providing staff with necessary help and support throughout the claims process.
4 iv. All Haldimand County employees, Council members, Board members and volunteers are responsible for: a. Immediately notifying the Risk Management and Insurance Coordinator of all incidents or occurrences which could reasonably and possibly be expected to result in a claim being brought against the County, its agents, officers, or employees, or for losses to County owned property during the course of County operations. b. Appropriately documenting all information relevant to the claim. c. Refraining from offering opinions or implying liability to members of the public regarding circumstances of a claim or potential claim. d. Advising members of the public, when approached with allegations of the County s responsibility for an injury or property damage, to file a written claim with the County. e. Cooperating with Support Services, the County s adjuster and/or the County or Appointed solicitor with respect to any investigation into claims brought against the County, if applicable. f. Providing written, signed witness statements where necessary. g. Providing evidence in writing or in person when required, including, but not limited to, attendance at Examinations for Discovery, required court appearances, etc. h. Providing all relevant facts when being interviewed. i. Completing the appropriate forms related to insurance claims (i.e. Property Damage Form, Vehicle Accident/Incident Form) and submitting them to their Supervisor/Manager within 24 hours. j. Maintain confidentiality with respect to claims brought against the County. Employees or volunteers involved in a claim are encouraged to contact the Risk Management and Insurance Coordinator for information, advice or support on any matter. Staff may seek external advice at their own cost (i.e. from their professional association s defense fund) if they wish. REPORTING 1. Reports will be submitted by the Manager, Support Services, or designate as follows: a. Quarterly Council reports on the number of internal claims, the value of internal claims, costs incurred on claims, any suggested remedial action, the number of open and closed claim files. b. Significant or potentially controversial claims will be reported to the SMT and the applicable Manager as they are received or when a claim approaches the point of significance/controversy. The General Manager, Corporate Services will advise Council. 2. Reporting to the Insurer The Risk Management and Insurance Coordinator and the Manager, Support Services will report claims to the municipal Insurance provider as per the terms and conditions mutually agreed upon by each party. All bodily injury claims, proven or potential, will be reported to the insurance provider.
5 INTERNAL SETTLEMENT PROCESS Authority to Award 1. The Risk Management and Insurance Coordinator, upon completion of investigation, will make a decision to settle or deny a claim valued at $5,000 or less. 2. The Risk Management and Insurance Coordinator, upon completion of investigation, will make a recommendation to the Manager, Support Services, to settle or deny a claim valued at over $5,000 and up to $25,000. The Manager, Support Services will review and make a decision on the recommendation. 3. The Risk Management and Insurance Coordinator, upon completion of investigation, will make a recommendation to the General Manager, Corporate Services, to settle or deny a claim valued at over $25,000 and up to $100,000. The General Manager, Corporate Services, will review and make a decision on the recommendation. 4. The Risk Management and Insurance Coordinator, upon completion of investigation, will make a recommendation to the C.A.O. and the General Manager, Corporate Services, to settle or deny a claim valued at over $100,000 and up to $250,000. The C.A.O. and General Manager, Corporate Services, will review and make a joint decision on the recommendation. 5. All claims valued at more than $250,000 are not considered internal claims and will be forwarded to and managed by the municipal insurance provider. 6. Before monetary compensation can be offered to a claimant, other than a County divisional claim, authorization must be received as follows: Position Authorization CAO & General Manager, Corporate Services Over $100,000 up to $250,000 General Manager, Corporate Over $25,000 up to $100,000 Services Manager, Support Services Over $5,000 up to $25,000 Risk Management and Up to $5,000 Insurance Coordinator 7. The Risk Management and Insurance Coordinator will complete a cheque requisition for payment to insurance claimants as required and submit to Finance Division with appropriate back-up documentation. 8. Upon receipt of the cheque requisition for insurance claimants, Finance shall process the payment and return the cheque to the Risk Management and Insurance Coordinator. 9. The Risk Management and Insurance Coordinator will ensure receipt of appropriate release(s) from claimant prior to distribution of payment to claimant. DISPUTE RESOLUTION PROCESS A dispute which arises following the settlement of a claim shall follow the chain of authority through the Corporate Services Department to the CAO. A claimant who disputes the resolution of a claim by the Risk Management & Insurance Coordinator shall be referred to the Manager of Support Services for a review of the claim.
6 In the event that the Manager of Support Services is unable to respond within 30 days or the response is unsatisfactory to the claimant, the dispute shall be submitted to the General Manager of Corporate Services. The General Manager of Corporate Services shall review the claim and respond within 30 days. If the General Manager is unable to respond within 30 days or the response is unsatisfactory to the claimant, the dispute shall be submitted to the CAO for review. The CAO shall review the claim and respond within 30 days. If the CAO is unable to respond within 30 days or the response is unsatisfactory to the claimant, the claimant may attend the next available Council Meeting, under the normal delegation to Council process, to have their dispute heard. The decision of Council with regard to the claim shall be final. LEGAL SERVICES The Manager, Support Services, shall have the discretion to request the services of a solicitor, via a Legal Services Request Form, for the following purposes: a. To seek advice pertaining to insurance claims involving the County. b. Preparing response litigation documentation. c. Representation of Haldimand County in civil litigation proceedings. If there are unusual circumstances not related to the normal claims handling process, surrounding an issue where legal services are required, the General Manager, Corporate Services must approve the Legal Services Request Form. CONFIDENTIALITY The confidentiality of information concerning insurance claims is paramount. The Manager, Support Services, and the Risk Management and Insurance Coordinator will be responsible for ensuring all documentation in their possession relating to claims is handled in accordance with the Municipal Freedom of Information (FOI) and Protection of Privacy Act and directing any FOI request to the Clerks Division. All staff are required to maintain confidentiality regarding claims contemplated or brought against the County and investigation or information surrounding claims contemplated or brought against the County. RELATED REFERENCES 1. Policy HS-04 Employee Accident & Incident Reporting 2. Property Damage Form 3. Vehicle Accident/Incident Form 4. Risk Management Procedure Manual
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