Claims Booklet

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, we encourage you to 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 TrueNorth Claims Advocate for further assistance.

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

Jim Gartelos Director of Claims

319.209.7111

jgartelos@truenorthcompanies.com

Cindy Bland Risk Management Claims Advocate

515.735.4504

cbland@truenorthcompanies.com

Sam Skalland-Mills Risk Management Senior Claims Advocate

515.393.5686

sskalland@truenorthcompanies.com

Kevin Asehan Risk Management Claims Advocate

319.209.7178

kasehan@truenorthcompanies.com

Teri Krumm Risk Management Claims Specialist

319.739.1224

tkrumm@truenorthcompanies.com

Brent Thrune Transportation

Senior Claims Advocate

319.739.1359

bthrune@truenorthcompanies.com

Melissa Johnson Transportation Senior Claims Advocate

319.739.1173

mjohnson@truenorthcompanies.com

Zachary Brewer Transportation Claims Specialist

319.209.7212

zbrewer@truenorthcompanies.com

Krystin Sitzmann Transportation Senior Claims Advocate

319.739.1375

ksitzmann@truenorthcompanies.com

Isaac Ridgway Transportation Claims Advocate 319.739.1179

iridgway@truenorthcompanies.com

Please note 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. It should also be noted that most policies are different, regardless of subject matter, and each policy should be reviewed for specific coverage information. The reader is strongly encouraged to consult with competent legal counsel of its own choosing regarding any and all insurance claim matters.

WORKERS’ COMPENSATION CLAIMS

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 claim 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.

For alternative return to work ideas, click here.

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 completed form to the insurance company.

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

3. Advise TrueNorth in the event of a significant injury or fatality. 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 workers’ compensation claims timely. Your insurance carrier can provide valuable information about medical care, make timely payments, and begin their own investigation into the incident.

AUTO CLAIMS

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:

• Names, addresses & phone numbers

• Insurance company

• Type of vehicle

• Auto & driver’s license numbers

• 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 to submit a claim.

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, if necessary.

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 vehicle 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:

• Names, addresses, phone numbers

• Insurance company information

• Make/Model/Year of vehicles

• Driver’s license number of other parties

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.

To protect your property from imminent loss by a covered peril, Emergency Removal of your property is provided by most policies with some available coverage. Please check your policy for specific coverage provisions.

Reproducing 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.

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 an inventory of personal property damage:

• List quantity, description, actual cash value and amount of loss.

• Attach bills, receipts, & related documents.

7. Keep records of extra expenses used for cleanup, mitigation, and continued business operations.

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 to discuss the loss.

2. Arrange for an appraiser to inspect damaged property, if necessary.

3. Assist you with your choice of contractors to pay related & necessary repairs.

4. Resolve your damages based on your applicable coverages.

GENERAL LIABILITY CLAIMS

WHAT DOES A CGL POLICY COVER?

A typical CGL (Commercial General Liability) policy provides coverage for claims of bodily 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, a CGL policy enables you to continue your normal operations while dealing with alleged 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.

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 to report the loss.

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 the 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 resolve the claim.

EMPLOYMENT PRACTICES LIABILITY (EPLI) CLAIMS

EXAMPLES OF EPLI CLAIMS:

Employees 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:

An employee can allege that he or she is being discriminated against for a reason relating to their protected class. Protected classes include, but not limited to, race, ethnicity, religion, national origin, age, sex, familial status, disability status, veteran status, and genetic information.

Harassment:

While discrimination claims are centered on mistreatment in company actions, harassment claims revolve around interpersonal relationships in the workplace. These claims include, but are not limited to, verbal and/or physical harassment.

Retaliation:

Retaliation claims result when an employee alleges punishment, usually in the form of harassment, discrimination, or an adverse employment action, after participating in a protected activity. These activities include, but are not limited to, Whistleblower complaints and filing a workers’ compensation claim.

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 or employment contract. Some examples include, but are not limited to, breach of contract and constructive discharge.

IN THE EVENT OF A CLAIM...

Any business that has employees is a potential target for an employment practices liability (EPLI) claim. These claims 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 working 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. Contact your insurance company as soon as knowledge of a potential claim is known.

2. EPLI policies are claims-made policies. Check your policy for specific claim-reporting guidelines.

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

4. 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.

CYBER LIABILITY CLAIMS

$3.86 million average cost of data breaches in 2020 (IBM, 2020)

$1 trillion projected increase of cybersecurity spending from 2020-2025 (Cybersecurity Ventures, 2019)

280 days to find and contain the average cyber attack (IBM, 2020)

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 limited security measures and carelessness when it comes to protecting sensitive information. If your company suffers a data breach:

1. Act quickly. Call your insurance company and report the claim. Report the breach immediately to local law enforcement.

2. Work with your insurance adjuster/breach coach:

• Your adjuster will determine what coverage applies and what payments need to be made.

• Your breach coach will help navigate the claims process, explain necessary steps in reporting and documenting data incidents, and manage communication with third-party vendors and law enforcement.

• Your breach coach will also help negotiate any ransom and can offer advice on building an incident-response plan and/or developing cyber resiliency.

3. 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.

Of nearly 6,000 claims analyzed from 2016-2020, 99% of claims were from Small to Medium Enterprises (SME, annual revenue < $2 billion).

The 1% of claims (Large companies, annual revenue >$2 billion) totaled $727 million in claim costs while SME claims totaled $537 million.

(2021 NetDiligence Cyber Claim Study)

INSURANCE IS IMPORTANT!

Cyber policies are available and 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 cyber liability insurance policy can give you peace of mind and allow you to allocate resources to help keep data secure.

PROFESSIONAL LIABILITY CLAIMS

Professional Liability Insurance protects businesses when an insured makes mistakes in the professional services they’ve provided to customers or clients.

This insurance is often necessary because general liability insurance typically excludes claims of negligence, malpractice, or misrepresentation. A professional liability policy is also known as Errors & Omissions.

WHAT DOES A PROFESSIONAL LIABILITY POLICY COVER?

TYPICALLY COVERED: NOT COVERED:

• Negligence

• Misrepresentation

• Inaccurate advice

• Personal injury

• Copyright infringement

• Defense costs

• Fees

• Court related fees

• Settlement/judgement costs

• Wage loss

OCCURRENCE VS. CLAIMS-MADE POLICIES

OCCURRENCE

• Bodily injury or property damage

• Employment practices

• Illness and injuries to employees

• Data breach

• Intentional or dishonest acts

Lifetime coverage for events that occurred within the policy period no matter when the claim is filed.

CLAIMS-MADE

The policy must be in effect when the event takes place, and the claim is filed during the policy period. Professional Liability policies are typically written as Claims-made. These policies typically have a retroactive date which extends coverage to events after this specified date. An extended reporting period can be added after a policy period ends, typically 30 to 60 days after the expiration of the policy.

IN THE EVENT OF A CLAIM...

In the event of errors caused by the professional services provided to your clients which you allegedly caused, follow these steps:

1. Report notice to carrier of any claim or potential claim once you become aware.

a. Per the policy, “An Insured shall give the Insurer written notice of any Claim as soon as practicable after the Insured becomes aware of such Claim.”

b. Per the policy, “If, during the Policy Period, an Insured first becomes aware of an act, error or omission that may reasonably be expected to give rise to a Claim, and, if written notice of such act, error or omission is given to the Insurer during the Policy Period then any Claim subsequently made which arises from such act, error or omission shall be deemed to be a Claim first made during the Policy Period…”

2. Review “Notice of Claim” in policy for specific instructions.

“Claim” means: a written demand seeking monetary, injunctive, declaratory or other non-monetary relief; a civil proceeding, including an arbitration or other alternative dispute proceeding, commenced by the service of a complaint, filing of a demand for arbitration, or similar pleading; or a request received by an Insured to toll or waive the statute of limitations or other bars against the filing or maintenance of a lawsuit or arbitration proceeding seeking Damages against, or services from, an Insured.

**A claim can also mean any written assertion of liability made against you

After you report the claim to the insurance carrier, the claims adjuster will do the following:

1. Contact you to discuss the incident that allegedly occurred.

2. The adjuster may request additional documentation.

3. Deal directly with the other party and/or attorney to resolve the claim.