Claims booklet

In the Event of a

CLAIM

A Note to Our Commercial Insurance Clients The TrueNorth Claims Team is here to service your claims needs. Our primary focus is to provide advocacy on your behalf to ensure that you will encounter a smooth claims experience throughout the life of the claim. If a claim does occur, please follow the steps highlighted in this guide.

Your insurance contract requires that you report all claims promptly. Therefore, please contact your insurance company directly as soon as possible for all claim matters. An insurance company claims representative will be assigned and will work directly with you to resolve your claim.

In the event you encounter any unusual delays or problems in the handling of your claim, please contact your Claims representative at TrueNorth for further assistance.

We truly appreciate your business and our Claims Team is here to assist you!

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Meet the Claims team!

Matt Rathje Vice President of Operations, Risk Solutions

Christa Peterson Claims Team Leader, Transportation

Jim Gartelos Claims Team Leader, Risk Management

319.739.1242

319.209.7010

319.209.7111

Transportation Claims Representatives:

Brent Thrune Senior Claims Advocate 319.739.1359

Risk Management Claims Representatives:

Melissa Johnson Senior Claims Advocate 319.739.1173

Teri Krumm Claims Specialist

515.735.4504

319.739.1224

Kevin Asehan Claims Advocate

Jack Mann Claims Specialist 319.209.7144

Cindy Bland Claims Specialist

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319.209.7178

In This Guide...

Workers’ Compensation Claims

5-6

Auto Claims

7-8

Property Claims

9-10

General Liability Claims

11-12

EPLI Claims

13-14

Cyber Claims

15-16

PHONE

500 1st Street SE | Cedar Rapids, IA 52401-1901 319.364.5193 | TOLL FREE 800.798.4080 | FAX 319.862.0612 truenorthcompanies.com

Please note that the information contained in this Claims Handling Considerations document is not intended to serve as a substitute for legal or risk management advice. Rather it is intended to serve only as a guide for the purpose of generating discussion to assist the reader in identifying certain action(s) it may wish to consider undertaking when faced with an insurance claim scenario. The reader is strongly encouraged to consult with competent legal counsel of its own choosing regarding any and all insurance claim matters.

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Workers’ Compensation Claims

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In the Event of a Claim...

In the event an employee is injured on the job, follow these steps: 1. Complete the employer’s first report of injury or disease form for all claims. Either use the “call in” reporting system or email your original form to the insurance company.

2. Send a copy of the form to your HR & the Safety departments.

3. Forward a copy of the First Report of Injury to TrueNorth in the event of a significant injury, including

death. We will then follow up with your insurance company so there will be prompt handling of the claim.

4. Please contact your insurance company regarding any questions or the status of the claim. In the event

you experience delays or have questions that have not been responded to by your insurance company,

please contact us for assistance.

After you report the claim to the insurance company, the claims adjuster will do the following: 1. Contact you for additional information.

2. Contact the injured employee to discuss the accident.

3. Request copies of bills and doctors’ reports for medical treatment administered.

It is important to act quickly and take action immediately for legal reasons, but also because studies show that the faster you initiate the workers’ compensation process after an injury, the lower the ultimate cost of your claims. Additionally, waiting more than 48 hours after an incident occurs gives the injured party and witnesses time to forget crucial details about what happened. It also means employees’ recollections may become skewed from opinions from outside parties, like an attorney, or from talking to one another.

• • • • •

Refer employee for medical attention.

Submit the workers’ compensation claim.

Perform an assessment or accident investigation.

Take actions to ensure the injury or accident will not happen again.

Inform employee about company policies on returning to work.

It is important to report worker’s compensation claims timely because your insurance provider could give you valuable information about medical care, make timely payments, and begin his own investigation into the incident as necessary.

In a study published by the Hartford Financial Services Group, it was found that: Claims reported during the second week after an occurrence had an 18% higher average settlement than that for claims reported during the first week.

Waiting until the third or fourth week resulted in claims costs that were about

30% higher.

Claims that were not reported until one month after the occurrence were typically

45% higher.

According to the study, back injuries were particularly sensitive to delayed reporting. Waiting just one week to report a back injury typically results in a

40% increase in the ultimate cost of the claim.

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For alternative Return to Work ideas, click here.

Auto Claims

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In the Event of an Accident..

In the event of an automobile accident, follow these steps: • Report the accident to the police or highway patrol.

• Obtain information about the other people involved in the accident such as the following: • Type of vehicle • Names, address & phone numbers • Auto & driver’s license numbers.

• Insurance company • Take photos of the roadway from all angles and vehicles involved, if possible. Note the date and time the

images were taken.

• Have your vehicle towed to the nearest repair shop if the vehicle is not drivable. Do not authorize repairs

until the claims adjuster gives you the authority to do so. If driveable, obtain an estimate.

• Do NOT take pictures of people injured in the accident.

• Fill out an Auto Accident Form.

• Call your insurance company.

After you report the claim to your insurance company, the claims adjuster will do the following: 1. Contact you to request details of the accident and repair estimates.

2. Arrange for an appraiser to inspect the damages of vehicles that are not drivable or extensively damaged 3. Conduct an investigation into the facts and circumstances and render a decision on fault.

4. Resolve your damages based on your applicable coverages.

5. Deal directly with others involved in the accident if the accident was your fault.

You should not talk to others involved in the accident, but refer them to your claims adjuster.

How to react after a crash: • Protect the accident scene by setting up flares, putting up cones or move your vehicle off the road in a safe manner. Keep these items in your trunk at all times in the event of an accident.

• Once the police arrive, give them as much information as you can about what occurred. Do not admit

fault; simply give the facts.

• Ask the investigating officer for the police report case number as you may have to submit it with your

insurance claim.

• Take as many notes and write down as many details as you can remember about the accident, as this will

help with your insurance company’s investigation of the claim. Keep all records of correspondence that you

have regarding your claim, including the date, name and title of the person that you talked to regarding the accident.

• Keep a record of any expenses that you incurred as a result of the accident. Depending on your

policy, you may be entitled to reimbursement for those expenses.

• In the event the police or highway patrol do not come to the scene, obtain as much information about the

other people involved in the accident such as the following: • Make/Model/Year of vehicles • Names, addresses, phone numbers • Driver’s license number of other parties • Insurance company information

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Property Claims

Understanding Your Property Claims Water can cause damage or destroy a building and contents. If your business is damaged by water, you may assume that your insurance will cover that damage. Coverage will depend on the cause of the water damage and what insurance you purchased. There is no industry-wide rule dictating water damage coverage in commercial property policies. Many commercial property insurance policies include language stating water damage will not be covered in specifically excluded situations. This could be called “water damage exclusion” or “flood exclusion”. A general policy will not cover flood damage, and this type of property insurance is only available through the National Flood Insurance Program (NFIP). It is important for your business to consider all the risks that water can pose whether it be from a bursting pipe, sewer backup, damage from storms or flood.

Business Interruption Coverage provides protection for loss of business income. The trigger for Business Interruption is direct damage to the insured’s property from an insured peril. If you do not have the peril of flood covered under the building and contents policy you would not have Business Interruption arising out of flood.

Temporary Removal of your property is provided by most policies with some coverage. In most contracts the policy provides 30-60 days automatic coverage.

Reconstructing Records in order to claim and/or verify disaster losses, businesses must have records of what was lost or damaged. Also, do not discard computers or papers. There may be experts available who are able to restore paper records and to reclaim records from the hard drive of damaged computers.

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In the Event of Damage...

In the event of damage to your building or contents, follow these steps: 1. Protect the property from further damage.

• Call the proper authorities and utilities (gas, electric,

telephone, etc.)

• Take photos of the damage before having emergency repairs made, such as

boarding up windows or covering holes in the roof.

2. Fill out a Property Claim form.

3. Call your insurance company to report the loss.

4. Call a contractor to estimate the building damages.

5. Separate damaged contents from undamaged contents. Do not discard any items until the claims adjuster gives you the authority to do so.

6. Prepare inventory of personal property damage: • List quantity, description, actual cash value and amount of loss • Attach bills, receipts, related documents.

7. Keep records of expenses if you are forced to temporarily relocate your business.

8. Do not authorize repairs until the claims adjuster has given you the authority to do so.

After you report the claim to the insurance company, the claims adjuster will do the following: 1. Contact you by phone or mail to discuss the loss.

2. Arrange for an appraiser to inspect extensively damaged property.

3. Assist you with your choice of contractors to make the repairs.

4. Contact you for a settlement.

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General Liability Claims

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In the Event of a Claim...

In the event of injuries or damage to property of others which you allegedly caused, follow these steps: 1. Call your insurance company direct.

2. Fill out a General Liability Claim form.

3. Forward any correspondence, including a lawsuit from an attorney representing the other party.

4. If a product is involved and you have the product, save it for inspection.

5. If bodily injury is involved, take pictures of the location where injury occurred (sidewalk, parking lot, etc).

6. Do not discuss the claim with the other party or their attorney. Refer them to your insurance company’s

claims adjuster.

After you report the claim to your insurance company, the claims adjuster will do the following: 1. Contact you to discuss the incident that allegedly caused the injury or damage to the property.

2. Deal directly with the other party and/or attorney to handle the claim.

What Does CGL Cover?

A typical CGL (Commercial General Liability) policy provides coverage for claims of bodily injury or other physical injury, personal injury (libel or slander), advertising injury and property damage as a result of your products, premises or operations. As a safeguard against liability, CGL enables you to continue your normal operations while dealing with real or fraudulent claims of negligence or wrongdoing. CGL policies also provide coverage for the cost to defend and settle claims. Here is more detail into what a typical CGL policy may cover: Automatic additional insured: coverage is provided for written contracts, agreements and permits.

Personal and advertising injury: Protects against offenses made by you or your staff during the course of business, such as libel, slander, disparagement or copyright infringement in advertisements.

Defense Costs: Provides coverage for legal expenses for liability claims brought against your business, regardless of who is at fault.

Medical expenses: Provides coverage for medical expenses if someone is injured on your premises or by your products.

Premises and operations Liability: Provides coverage for bodily injury and property damage sustained by others on your premises or in conjunction with your business operations.

Products liability: Provides coverage for bodily injury and property damage sustained by others as a result of your products.

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Employment Practices Liability (EPLI) Claims

Examples of Employee Claims: Employers can make internal, EEOC or Human Rights Campaign complaints, or file a lawsuit against the employer with a formal complaint & summons. Types of claims include, but are not limited to, the following: Discrimination: During the disciplinary or termination process, an employee from a protected class can allege that he or she is being treated worse for a reason relating to their protected class status than other employees. Protected classes include: race, color, religion, national origin, age, sex, familial status, disability status, veteran status & genetic information.

Harassment: While discrimination claims are centered on mistreatment in official company actions, harassment claims revolve around interpersonal relationships in the workplace. These claims include verbal or physical harassment.

Retaliation: Recent changes to the Dodd-Frank Wall Street Reform and Consumer Protection Act, especially regarding the Whistleblower provision, could lead to an increase in the number of employees who will claim they’ve been disciplined or terminated in retaliation for whistleblowing on the company.

Wrongful Termination: Employees can file claims if they believe they were wrongly terminated for an illegal reason or for a reason that violates the company’s policy. Some examples include breach of contract & constructive discharge.

Post-Termination: Some employees file lawsuits after they’ve been terminated, claiming that the termination resulted in defamation, blacklisting or undue emotional distress.

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In the Event of a Claim...

Any business that has employees is a potential target for an employment practices liability (EPLI) lawsuit.

These lawsuits can be financially and emotionally draining for your company, even if you’re ultimately found not liable. Avoiding an EPLI claim requires management to be proactive by establishing a consistent methodology for employee policies, record-keeping and dealing with your legal counsel and insurers.

In the event of an EPLI Claim: Any company facing an EPLI claim should seek advice from legal counsel to properly investigate the incident and gather as many facts as possible. Time is essential for your attorneys and insurers to gather information and formulate a defensive strategy: 1.

2.

3.

Contact your insurers as soon as knowledge of a potential claim is known.

Gather company records on the plaintiff and establish a timeline of events.

Obtain witness statements from all employees who were involved in or witnessed the event.

Because there are so many types of violations that can occur in the workplace, employers should establish two different channels for employees to report complaints. This way, if one of the contacts is involved in the complaint, the employee still has a way to comfortably report the incident. Employers must take as many steps as necessary to ensure clear communication between management and employees.

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Cyber Liability Claims

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In the Event of a Claim...

A data breach is an incident where private data is accessed and/or stolen by an unauthorized individual. Data can be stolen by a third party, such as a hacker, or by an internal actor (perhaps a disgruntled or recently fired employee).

In the event of a Data Breach: It is common to have an “it will never happen to us” philosophy when it comes to data breaches. Unfortunately, that thinking can lead to lax security measures and carelessness when it comes to protecting sensitive information. If your company suffers a data breach: 1.

2.

3.

4.

Act quickly. Report the breach immediately to local law enforcement. Notify important suppliers, vendors and partners.

Alert your customers. If there is a data breach involving customers’ personal information, activate your plan to alert them. The information compromised could be incredibly harmful to your customers, so alert them as soon as possible.

Investigate. If you do not have the resources to do an internal investigation, consult a third party. The quicker the breach can be dealt with, the fewer negative effects your company will endure.

Take measures to lessen the chance of a future breach. Fortunately, a data breach can be a good learning tool for your company. Analyze why the breach happened and take steps to make sure it doesn’t happen again.

Every day, more than 1 million people become victims of cyber crime. Businesses large & small are increasingly reliant on the internet for daily operations, creating attractive and potentially lucrative targets for cyber criminals.

INSURANCE IS IMPORTANT! Chances are, your company doesn’t have a “rainy day fund” capable of paying for data breach remediation.

Fortunately, there are insurance options available to make recovery easier.

Cyber policies can cover the cost of notifying customers and replace lost income as a result of a data breach. In addition, policies can cover legal defense fees a business may be required to pay as a result of the breach.

It’s important to remember that it is cheaper to prevent a data breach by securing data than it is to lose that data from a breach. A data breach insurance policy can give you peace of mind and allow you to allocate resources to help keep data secure.

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