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When should you report General Liability Claims for your Adult Residential Care Facility?

By Heather Brown
October 24, 2014

Spokane, WA….May, 2007 resident Falls from Bed…June 2007 Resident goes to hospital for Pneumonia…August 2008, facility reports claim to insurance company…15 months after incident occurs, claim is reported to insurance carrier…

Western, PA….January 14, 2005 visitor falls entering facility…January 23, 2009 lawsuit filed against facility…March 10, 2009, facility notifies insurance company of claim…50 months after the incident occurred, claim is reported to insurance carrier…

LaCrosse, WI….April 21, 2007 a resident assaults a visitor to the facility…June 26, 2008 incident reported to insurance carrier…14 month delay in reporting claim to insurance carrier…

Philadelphia, PA…. March 22, 2007 pedestrian falls on broken sidewalk in front of facility…Facility receives letter from pedestrians attorney in October, 2007…lawsuit filed March 19, 2009…Claim reported to insurance carrier April 16, 2009…18 month delay in reporting claim to insurance carrier…

In operating a facility, we carry a lot of responsibility and often are trying to do several things at one time or have several things to complete in a specific period of time. We try to organize, schedule, prioritize and delegate to get everything completed properly and timely, however, occasionally things slip through the cracks. It cannot be stressed enough the importance of reporting incidents/claims/notice of loss to your insurance carrier in a timely manner.

Many facilities delay reporting a claim to the insurance carrier for fear that their insurance may be canceled on renewal, they do not feel that anything will come of the incident that occurred, and they fear that the state regulators will find out about the incident, complete another inspection and possibly fine or write up the facility.

This article is to help clear up some of those misconceptions as to how PCH Mutual, handles these reports of incidents/claims/notices of loss. Because PCH Mutual’s purpose is to serve and protect the small and mid-sized adult residential care community, before PCH Mutual would consider non-renewing or canceling an insurance policy for one or two incidents, they would look at the whole picture, including steps the facility has taken to reduce or eliminate the same incident from occurring again in the future, the information provided on the renewal application and your latest state regulatory inspection report.

Many times we tend to think everything is going to be o.k. after an incident because no one says anything, no threats of a lawsuit are made or it appeared to be a normal occurrence. Silence can sometimes be deadly. We have found that often lawsuits don’t come up until months or sometimes years after the incident. This may result from the claimant conversing with a friend or attorney, a visit to a doctor or medical expert down the road, reading an article, etc. Next thing you know, you are served with a lawsuit.

One of the biggest misconceptions is that when the incident is reported to the insurance carrier, the insurance carrier will notify the state regulators, resulting in a lengthy inspection of the facility with a deficiency report and maybe even fines. PCH Mutual doesn’t notify the state regulators when incidents are reported to them. We work with you and your facility to minimize the chances of a similar incident occurring in the future, to minimize any future loss resulting from the incident and to assist in managing a covered loss. Now that we have hopefully cleared-up any inhibitions you may have had regarding reporting of incidents/claims/notice of loss to your insurance carrier, it is important that you be aware that your insurance policy requires that you notify us of any incidents/claims/notice of loss within a timely fashion.

The policy wording could be, “Duties In The Event Of Occurrence, Claim or Suit. (a.) You must see to it that we are notified as soon as practicable of an “occurrence” or offense which may result in a claim. To the extent possible, the notice should include: (1) How, when and where the “occurrence” or offense took place; (2) The names and addresses of any injured person and witnesses; and (3) The nature and location of any injury or damage arising out of the “occurrence” or offense. Notice of an “occurrence” is not notice of a claim. (b.) If a claim is received by any insured you must: (1) Immediately record the specifics of the claim and the date received; and (2) Notify us as soon as practicable. (c.) You and any other involved insured must: (1) immediately send us copies of any demands, notices, summons or legal papers received in connection with the claim or a “suit;” (2) Authorize us to obtain records and other information; (3) Cooperate with us in the investigation, settlement or defense of the claim or “suit;” or something similar. Should you not report an incident in a timely or practicable time, you could be denied coverage for the claim.

IT’S YOUR COMPANY…!

PCH Mutual is owned by the member-insured’s and part of the benefit of this is that there are no stockholders or high paid company executives to drive up the cost of the insurance. However, the cost of insurance is based on more than just normal business expenses. Like in many businesses, your premiums are affected by the amount of claims paid by the company. It is the responsibility of every member-insured to utilize good business practices to minimize claims, which in turn minimizes the cost of your liability insurance. Many tools are made available on the PCALIC website to help you in reducing or eliminating areas of potential claims or losses in your communities and homes. Please take advantage of using these tools and keep the cost of your insurance to a minimum.

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