Innovative Strategies:

1. Innovative Strategies: Effectively Handling Your Claims Presented by: Henry W. Gorham Leslie P. Lasher Jennifer B. Milak November 16, 2011

2. Investigation When A Claim Is First Reported Three Goals: Obtain Details Identify Witnesses Prepare Documentation

3. Written Statement from Claimant

4. Written Statement from Claimant This is a written statement from a comp claim. Claimant reported the incident immediately after it happened. Claimant was offered medical treatment but did not seek any. Claimant worked full duty for four months and then filed a claim for a torn rotator cuff and torn labrum when his doctor recommends surgery.

5. General Liability Claims • While the goals of obtaining details, identifying witness and preparing or preserving documentation apply to all claims, there are some differences in the type of details that you will need for liability claims when compared to comp claims because…. • In liability cases, fault matters • In comp cases, fault does not matter (for the most part)

6. General Liability Claims It is a good idea to recommend to the insured that no one admit to any fault at the scene of the accident (i.e., “We’re sorry that we left out those boxes.” or “I’m sorry I wasn’t paying attention.”) Any statements to this effect could be introduced at a hearing or trial against the insured. Never agree to pay for medical bills at the accident scene

7. General Liability Claims - Premises • In premises case, the issue frequently becomes whether the insured knew about the condition or whether the condition lasted so long that they should have known about it. • Cases literally go into great detail about the appearance of the spill. • Very important to identify what the substance is and the source of the spill.

8. General Liability Claims - Premises The initial investigation may be conducted by the insured, especially when the accident happens on their premises. Here are other good recommendations to make to them to assist in getting the best information: Assist the person who fell, etc. Obtain their contact information, including all phone numbers (work, cell, and home), address, date of birth, driver’s license number, and employer. Obtain same contact information for all eyewitnesses (eyewitnesses include other patrons, customers, or employees) of accident and for all persons with the potential plaintiff.

9. General Liability Claims - Premises Ask the insured to prepare written documentation of all interviews. Ask the following: a) How accident occurred? b) What caused accident? c) Identify any possible witnesses to the alleged accident. Provide name and address, if known. d) Ask for a detailed description of how the accident happened.

10. General Liability Claims - Premises Based on their observations, the insured should document the following: a) Type of clothing and shoes worn by the person b) physical condition and appearance before and after alleged accident (i.e., blood, bruises, redness, liquid or stains on clothing/skin) c) All verbal statements said to the insured, other eyewitnesses or other employees by potential plaintiff regarding the accident or alleged hazardous/dangerous condition (i.e., “I should have seen this cord.” or “This is a lousy place to put this display.”)

11. General Liability Claims - Premises d) Detailed description of alleged hazardous/dangerous condition that contributed to the alleged accident. Include physical measurements, shape, color, smell and how long condition had been in place. If there is nothing that they can see, make a note of it. e) Whether there were any warning or caution signs (i.e., flags, tape, barricades, signs, cones, etc) advising patrons to exercise caution around the condition. If so, what warning signs were used and where were they located in relation to the condition. f) Whether they have received similar complaints or are aware of other accidents that have occurred. When?

12. General Liability Claims Here are some things to consider when an accident is first reported: Should an accident reconstructionist or engineer be called to the scene? Can photographs of the scene be taken? If so, have they been taken? Is there any evidence that needs to be preserved or taken into custody? Ask the insured to save everything related to the vehicle and the employee involved.

13. General Liability Claims Other good reminders for the insured/member: Maintain all logs: maintenance logs, cleaning logs, or inspection logs for the day of the alleged accident. It’s good to obtain maintenance logs from before the accident. If an ambulance is called, obtain the name of the EMS personnel and the call number for the incident. Get information on law enforcement involved.

14. All Claims Additional reminders to assist the insured/member: Keep ALL documentation, logs, statements, contact information, and photos in ONE separate file, properly labeled with plaintiff’s name and date of the alleged accident so that the file can be easily identified when information is requested. Do not give any documentation to plaintiff, plaintiff’s counsel or other carriers/entities unless it is through you or through counsel.

15. All Claims Additional reminders (cont.) • Ask the insured/member to tell all employees not to discuss the alleged accident or case with anyone, including plaintiff or his/her attorney. • Continue to document their file with any communications, correspondence, or other information they receive about customer or the alleged accident and pass it along.

16. Reminders for All Claims • Reminders: • Follow up • If it isn’t documented, it didn’t happen. • Call your counsel with questions so you can collaborate and confirm that everything has been covered.