Incident Reporting Manual

Transcription

1 Pillar Income Asset Management, Inc. Incident Reporting Manual For use in reporting: Property Losses General Liability Incidents Workers Compensation Incidents Commercial Auto Incidents Prepared by: The Risk Management Department Pillar Income Asset Management, Inc Lyndon B Johnson Freeway Suite 300 Dallas, TX (Fax) PIAM Risk Management Department

2 Incident Reporting Manual Table of Contents I. Introduction II. III. IV. Incident versus Claim Incident Investigation Incident Report Basics V. Property Losses VI. VII. VIII. General Liability Incidents Workers Compensation Incidents Commercial Auto Incidents Appendices I. Incident Acknowledgement Form II. III. IV. General Incident Report Form Concluded Property Loss Report Medical Provider Notice 2

3 Introduction This manual provides instructions on incident reporting procedures for each major type of insurance coverage Pillar Income Asset Management, Inc. (PIAM) has placed for you. This is designed to assist with your specific reporting needs. It is intended to be a guide to inform and facilitate the incident reporting process, not answer all questions that may arise in a particular situation. Please read the instructions carefully and adhere to them as closely as possible. If you have questions which are not answered in this manual or need further assistance, PLEASE CONTACT YOUR AVP 3

4 Incidents versus Claims A claim is nothing more than a demand or obligation for payment as a result of a loss. An incident is a disruption of normal activity. All legitimate claims are preceded by an incident. Example: If a guest slips and falls on a premise, an incident has occurred. If that person then makes a demand for something (pain & suffering, medical bills, lost wages, etc.), a claim has occurred. Throughout this manual the terms will be used with these specific meanings in mind. They are not intended to be used interchangeably. 4

5 Incident Investigation All incidents should be properly investigated and documented per instructions below. A complete investigation will allow PIAM to evaluate an incident to determine how to handle or defend any claim that may result. All incidents should be fully investigated to determine the root cause of the incident. At a minimum the following questions should be answered during each investigation. 1. What happened? Obtain signed, written statements from all parties involved 2. When did it happen? Date and time of incident 3. Where did it happen? Inside, outside, on-site, off-site, etc. 4. Who was involved? Injured party, witnesses, authorities, etc. 5. Why did it happen? This is the most important question to answer. Be specific as to the root cause of the incident. Example: A guest slips and falls - this would be the What happened. The Why may be that there was water on the floor. Why? If we dig deeper, however, we may determine that water was on the floor because there was a leak in a mop bucket. Why? If the water leaked from a mop bucket we may determine that maintenance did not realize there was a leak in the mop bucket. Why? This may be because they did not inspect the mop bucket or are not alert and actively looking for potential hazards. Why? The root cause could then be determined to be either lack of training or active disregard for safety procedures. Both of which can be remedied to prevent future incidents. For every incident, the question Why should be repeated as many times as it takes to get to the root cause of an incident. A note on incident/claim investigations You are the front-line investigators of all claims. If you ever feel that a claim being made against your property is unfounded, you need to let either the Risk Management department or the insurance company adjuster know your concerns. All too often I hear from property managers after a claim has settled that they suspected the claim was false. When asked with whom they discussed this information, many respond that they did not discuss with anyone because they thought their concerns would be discovered during the investigation. Unfortunately, since most claims will be investigated from the insurance adjuster s desk, he or she will never have access to the amount of detailed information you develop in your investigation. Please share the results of your investigation with the Risk Management department or the insurance adjuster and relay any concerns you have about the claim. If you feel the insurance adjuster is not listening to you, please call the Risk Management to discuss. 5

6 Incident Report Basics 1. Incident Reports The General Incident Report Form must be completed by the property manager or appropriately designated representative. Under no circumstances should an incident report be completed by the party to whom the incident occurs. For instance, an injured worker is not allowed to complete his own workers compensation incident report. Incident reports will be completed within 24 hours of notification of the incident and forwarded to the Risk Management department within 48 hours of notification. In the event of a catastrophic incident (major property loss, major bodily injury including hospitalization or fatality) the property manager should telephone PIAM s Risk Management department for specific, immediate instructions. 2. Release of Incident Reports Incident reports are to be kept confidential and are proprietary to PIAM. If a person involved in an incident asks for an incident report that person should instead be given an Incident Acknowledgement Form (See Appendix I). This form simply lists the date, time, parties involved and what the alleged incident was. It will not list cause of incident. 3. Incident Reporting Information Incident reports are located in the appendices of this manual. 6

7 Property Losses A property loss results when your entity s OWNED or LEASED property is damaged in some manner. Damage may occur from fire, storm, theft, a vehicle crashing into a part of the property, flood, etc. Damage can be to a physical structure, such as a building or for damage to movable property, such as furniture, fixtures or equipment. The key here is that the damage occurs to property for which you are directly responsible. What is not considered a property loss? - Damage to a tenant/resident s owned property or damage to someone s vehicle. While it may be that property is damaged, this is not owned property, therefore, it is not considered a property loss. These other types of losses may be covered under General Liability. Please refer to that section for further discussion. When a loss occurs: If damage is substantial and causes or could potentially cause a dangerous condition, take all measures to protect the general public from entering the structure. Protect all property from further damage. Take the necessary emergency steps as circumstances allow (i.e.: cover holes in building with plywood or roofs with plastic, etc.). Keep all receipts for these emergency repairs. Place signs to notify other residents of hazards when appropriate. Photograph the damage. Photos should show the location and extent of the damage. Write the date and location on the back of each picture, along with your name. Keep the photos to show the insurance company s claim adjuster and PIAM s adjuster, the Baldwin Company. Complete the General Incident Report Form (see Appendix II). Fax the original to PIAM s Risk Manager within 48 hours of incident and send a copy to your property supervisor (where applicable). Retain a copy for your files. Report all property incidents to the Risk Management department. PIAM currently maintains different deductible levels for different types of properties and losses. Because of this, your property loss may not be reported to and handled by the property insurance company. If your property suffers a loss and the estimated damage is less than $5,000, the property should go ahead and obtain estimates from contractors to repair/replace the damaged property. For losses handled directly by the property (not handled by the insurance company), please complete the Concluded Property Loss Report (see Appendix III) and fax it to the Risk Manager upon completion of total repairs. For losses over $5,000, PIAM will work with the property manager to secure bids for construction to repair or replace damaged property. 7

8 General Liability Losses A General Liability loss occurs when a third party (usually a resident, client, guest, the general public, etc.) suffers an injury or property loss on an owned premise. In theory, the loss must occur as a result of negligence of one of our employees or as result of a condition on our premise. Common examples include slip and falls, broken stairs, assault, damage to personal property, etc. A note on liability: When a claim is made against one of our properties that a person sustained an injury as a result of an employee s negligence, a frequent question the attorneys may ask is Was the dangerous condition previously reported to the management of a property?. It may sound simple but if a resident or a guest reports a potentially dangerous condition to any employee, that condition needs to be investigated and documented immediately. If there is truly a dangerous condition, all reasonable steps need to be taken to remedy the situation. Furthermore, all efforts to fix the problem need to be documented. When a loss occurs: Take whatever action is needed to provide emergency care to protect life or prevent further injury to person(s) or damage to property. If there is a dangerous condition, be sure to place warning signs, rope off the area or take other appropriate action to prevent further injury or damage. Also, before any permanent repairs are made please take photographs of the alleged condition or defect. If the size of the alleged condition is not apparent in the pictures, be sure to place something next to the condition to document size, such as a ruler in a hole to show the depth, etc. Complete a General Incident Report Form (see Appendix II) Fax the original to PIAM s Risk Manager within 48 hours of incident and send a copy to your property supervisor (where applicable). Retain a copy for your files. Report all incidents to the Risk Management department. PIAM currently maintains a large deductible for General Liability losses. Because of this, the incident may not be reported to and handled by the general liability insurance company. The Risk Manager will frequently ask you to document actions taken, conversations held with potential parties, ask for copies of correspondence, leases, etc. Please treat these requests as important. The Risk Manager is documenting the file kept in the Risk Management department in the event an incident turns into a claim. This is information that could potentially be used for litigation defense purposes. Sometimes this may not happen for several years, depending on the statute of limitation where the incident occurred. The following points should be adhered to in all cases of an incident or intent to file a liability claim or lawsuit: Do NOT assume or admit to any liability Do NOT discuss the details of the loss with the person making the incident report Do NOT turn the matter over to any attorney 8

9 Do NOT discuss the matter with an attorney representing person making the incident report Do NOT agree to any written or verbal/recorded statement for anyone other than our insurance company representative or a properly identified police office or fire investigator. When in doubt if it is allowable to speak to a particular party, please call the Risk Manager to discuss. Do refer any interested parties to the Risk Manager Do document everything If served with a lawsuit (a Summons and Complaint), immediately contact the Risk Management department and fax the lawsuit to the attention of the Risk Manager. There are a limited number of days in which to respond to a lawsuit or the case may be lost by default. Prompt attention to all lawsuits is absolutely necessary. 9

10 Workers Compensation Losses Workers Compensation losses occur when an employee makes a claim that he or she has been injured while in the course and scope of employment. When a Loss Occurs: Life-Threatening/Catastrophic Injury to the Employee If the employee s life is in danger, call 911 and request EMS be dispatched to the scene Unless the employee is in danger of further injury, do not attempt to move the employee Follow the directions of emergency authorities Once the employee has been taken away by EMS, contact the Risk Manager immediately Report claim following the procedures below Non Life-Threatening/Catastrophic Injury to Employee (see below) Claim Reporting Procedures: The following steps should be completed following all work-related incidents: 1) Local property gathers information about incident/claim and completes the Prime General Incident Report. A General Incident Report will be generated for ALL incidents, regardless of severity of claim 2) The General Incident Report will be forwarded to the Designated Claim Coordinator (DCC). The DCC s are as follows: a. Apartments your corporate HR representative b. Hotels your Executive Assistant/HR Manager c. Commercial/Corporate report to Kevin Tolson d. Mountaineer State Operations report to Kevin Tolson 3) The DCC will review the form for completeness and, if necessary, discuss the claim with the local property for additional information. 4) The DCC will forward ALL General Incident Reports to Kevin Tolson at Prime. The DCC will review the following guidelines to determine which claims need to be called into the insurance company and which claims can be kept as incident-only. If the claim meets the following guidelines, the DCC will call it in to the insurance company. Local properties should not call any claims directly to the insurance company. 10

11 Guidelines for Reporting Claims to the Insurance Company Any claim with medical treatment beyond locally administered first aid (band-aids, ice, etc.), and/or Any claim which results in lost time beyond the state mandated waiting period, and/or Any claim that appears to be questionable or suspicious. These are claims where red-flags are noted. Discuss these claims with Kevin Tolson before calling the claim in to the insurance carrier. In the event the DCC has a questionable or suspicious claim, he/she needs to be sure that when the claim is reported that the fact that the employer questions the claim is communicated to the report taker. Further, a specific request needs to be made that the handling adjuster contacts the DCC for further information about the reasons why the employer questions the claim. These guidelines have been adopted to ensure that only significant claims are reported. This will help the experience of PIAM in the eyes of the insurance company since small, insignificant claims will not now be reported. If an employee seeks medical treatment, please complete the Medical Provider Notice form with the employee and property information. This form should help alleviate the medical provider billing the local property. If you are located in Texas you must use a health care provider in Travelers Workers Compensation Health Care Network. To locate a health care provider near you go to the link: If you have questions regarding the handling of a workers compensation claim, such as should I pick a doctor for my employee, when does the employee begin to receive lost time wages, who will pay for medical bills, etc., please contact the Risk Management department. The current Workers Compensation Insurance Company is Travelers. To report a workers compensation claim, call: The report taker will ask you many of the same questions that are on the General Incident Report Form, so it is handy to have this form completed prior to calling Travelers. Sometimes the report taker will ask for the policy number. The Travelers policy number is: UB-1618R000 Travelers Mutual will complete the required state-specific forms and transmit them to the various state reporting agencies. They may also fax you a copy of the completed form. 11

12 Commercial Auto Losses An auto incident may result from one of two ways. First, an employee who is driving an owned company vehicle may be involved in an incident where another party is injured or suffers property damage or the owned company vehicle suffers property damage. Second, the employee may be driving his/her employee owned vehicle on company business and may be involved in an incident where another party is injured or suffers property damage or the employee owned vehicle suffers property damage In either case, a proper investigation needs to take place. When a Loss Occurs: Instruct your driver that if a loss occurs, contact the authorities Instruct your driver to gather as much information for the other party (if applicable) as possible. The following types of information should be gathered and documented: Other party s name, address, phone number Other party s insurance information: Insurance company, agent, phone number, policy number Other party s vehicle s make, model, VIN and license number Complete the General Incident Report Form (Appendix II) and Fax to the Risk Manager within 48 hours of the incident As with General Liability claims: Do NOT assume or admit to any liability Do NOT discuss the details of the loss with the other party Do NOT turn the matter over to any attorney Do NOT discuss the matter with an attorney representing the other party Do NOT agree to any written or verbal/recorded statement for anyone other than our insurance company representative or a properly identified police office or fire investigator. When in doubt if it is allowable to speak to a particular party, please call the Risk Manager to discuss. Do refer any interested parties to the Risk Manager Do properly document and notify Risk Manager 12

13 Appendix I Incident Acknowledgement Form 13

14 Pillar Income Asset Management Incident Acknowledgement Form Property Name: Property Address: City, State, Zip Party Involved: Address: Date of Incident: Property Phone: Phone Number: City, State, Zip: Description of Incident: Your Name: Title: Thank you for reporting your incident to the proper management contact at this property. A report has been completed and forwarded to our Risk Management department. If you would like to discuss your incident, please feel free to contact the Risk Management department. CONTACT YOUR AVP 14

15 Appendix II General Incident Report Form 15

16 Property Loss Type of Loss General Incident Information Pillar Income Asset Management General Incident Report Form 1) Please be as complete with your information and descriptions as possible 2) Complete a new Incident Report Form for each non-related claimant 3) Attach additional pages as necessary Page 1 of 3 Date of Incident: Time of Incident: Property Name: Phone Number: Address: Fax Number: City, State, Zip: Specific location of incident (where on property): Description of incident or allegation: Your assessment of cause of loss: Physical conditions you investigated that may have contributed to the incident (wet area, loose steps, weather, etc.) Were the authorities contacted (police, EMS, fire dept., other)? Yes No If yes, please list name of authority who investigated incident: Badge Number: Report Number: Witness Name: Phone Number: Address City, State, Zip: Property Liability Workers Compensation Auto Other Your entity s owned property has been damaged A third party has been injured or had property damaged Injured employee Entity s vehicle is damaged or caused injury or damage to a someone Please specify: Please complete the additional section(s) depending on the type of loss Extent of damage: Property Loss (building): $ Initial estimate of costs of damage: Loss if Revenue (rents, fees, etc.): $ Other Costs: $ Have you taken steps to prevent further loss or damage? Yes No If no, please do so at this time. Keep receipts for all emergency or temporary repairs. 16

17 Auto Loss Workers Compensation Liability Loss Pillar Income Asset Management General Incident Report Form Page 2 of 3 Claimant Name: Phone Number: Address: Tenant/Resident Guest Other City, State, Zip: Nature of Loss Injury Property Damage Both Other Description of injury/property damage/other: Claimant Name: Home Phone Number: Address: Social Security #: City, State, Zip: Title: Date of Birth: Date of Hire: How is employee paid? Hourly Salaried Variable Other Average Weekly Wages: Supervisor s name Date employee notified you of incident: Date employee began to lose time: Has employee returned to work? Yes No Date of return to work: Description of injury (be specific as to body parts reported by employee to you): Was safety equipment provided? Yes No Was it used by the employee? Yes No Clinic/Hospital/Doctor Name: Phone number: Address: City, State, Zip: Your Driver s Name: Home Phone Number: Address: Driver s License Number: City, State, Zip: Age: Make/Model of Your Vehicle: VIN Number: Other party s name: Address: Home Phone Number: City, State, Zip: Driver s License Number: Make/Model of other vehicle: Your VIN number: Other party s insurance company: Policy number: Insurance agent: Phone number: Nature of loss: Injury Property Damage Both Other Description of Injury/Property Damage/Other: 17

18 Your Information Other Comments Other Type of Loss Please describe nature of incident or allegation: Pillar Income Asset Management General Incident Report Form Page 3 of 3 Please add any additional comments you feel are necessary: Your Name: Your Title: Address: City, State, Zip: Today s Date: Your Phone: Your Fax: Your Your Signature: Thank you for your hard work and investigation of this incident. Your active participation on the front-end of incident investigations is crucial to properly defending or resolving claims. CONTACT YOUR AVP 18

19 Appendix III Concluded Property Loss Report 19

20 Your Information Pillar Income Asset Management Concluded Property Loss Report Property Name: Type of Loss: Extent of Repairs: Date of Loss: Was there a responsible third party? Amount of recovery from third party? $ Yes No Any recovery from third party? Yes No Your Name: Your Title: Address: City, State, Zip: Your Signature: Today s Date: Your Phone: Your Fax: Your Thank you for your hard work in working to repair the damaged property. CONTACT YOUR AVP 20

21 Appendix IV Medical Provider Notice 21

22 Medical Provider Notice for Workers Compensation Claims Employee: Property Name: Address: Local Employer Contact: Date of Injury: Employer Phone: City, State, Zip: The above mentioned employee has reported an injury as work-related. We have turned this injury in to our workers compensation carrier, Travelers. Travels will make a determination if benefits are to be provided. Please follow the standard workers compensation procedures for your state. Submission of this form to your practice does not guarantee payment nor does it assume compensability of the reported claim. The above mentioned employer will not be responsible for any medical charges incurred. To make a workers compensation claim or to follow up on a claim, call Travelers at If you have any questions regarding this insurance arrangement, please feel free to contact to your AVP. CONTACT YOUR AVP 22