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Speedy response holds key to defending spurious claims

At a glance

  • Ministry of Justice claims process now demands prompter action when dealing with claims within the portal
  • Clients need to be adept at gathering information about any incidents that may lead to a claim
  • Brokers and clients need to work more closely together, to give insurers as much time as possible to investigate and respond within the new timescales

This article counts towards accumulating your annual CII CPD structured learning hours for Claims.

By reading this article, and correctly answering the three questions underneath, you will have achieved the following learning outcome: Identify key legislative developments affecting claims

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The Ministry of Justice (MOJ) reforms on civil litigation have increased the focus on speed and accuracy when it comes to assessing liability claims. In turn, insurers, brokers and clients need to work more closely together to successfully defend claims.

Collecting the right information

When dealing with an employers’ liability claim, this documentation should include:

  • Accident report
  • Accident record/book entry
  • First aid report
  • Investigation report internal
  • RIDDOR report to Health and Safety Executive (HSE) F2508
  • Risk assessment (task)
  • Risk assessment (personal protective equipment)
  • Instruction/safe system of work
  • Training records
  • Maintenance records
  • Minutes of HSE meetings
  • Correspondence with HSE
  • Accident reports for previous incidents
  • Earning details
  • Occupational health records
  • Witness statements
  • Photographs

When dealing with a public liability claim, the documentation should include everything that is appropriate above as well as:

  • Inspection records
  • Repair records
  • Contract records

In response to the greater emphasis that the reforms have put on the timeframes within a claim, Zurich has significantly reduced the average time it takes to make a decision on liability.

Prior to implementation of last year’s reforms, the average time to make a decision was more than 40 business days. Today, however, it stands at just 22 business days.

For employers’ liability claims, the timescale needed to reach a decision on liability in the MOJ portal is now just 30 business days, down from 90, and public liability claims are just 40 business days, also down from 90. Thus, insurers need to be notified as quickly as possible to give them as much time as possible to investigate and respond within MOJ timescales.

Information gathering

There is a lot that brokers and clients can do to further reduce the time it takes to reach these decisions and to protect themselves against unwarranted claims. If claims fall out of the portal process because these strict timeframes are missed, there is a significant increase in legal costs.

The main issue is making sure there is detailed and accurate information available about the way the client has assessed and then managed its risk generally. Clients also need to be adept at gathering information about any incidents that may lead to a claim.

The faster this documentation can be collated the better, so clients should have an established process to ensure all of this information can be pulled together quickly and retained in case a claim is made.

Commenting on the claims investigation process, Andrew Jones, National Field Force Manager at Zurich, said: “Once the claim is registered, we will then have a discussion with the broker or insured to gather as much information as possible and all the documentation required, and to visit the site if necessary.

“Once we have the documentation and have concluded any site visits, we will review the evidence to determine liability and agree a way forward with the client and broker as required.”

This is an area where brokers can add real value for their clients and help them understand exactly what they need to do and the difference it will make. The simple fact is that without the full complement of risk assessment and risk management information, it is difficult to defend a claim – illegitimate or not.

With the MOJ, we are often the first to hear about a claim, particularly if it is an employers’ liability claim. Sometimes there is not sufficient information provided by the claimant side and we have to get in touch with the client to find out who the broker is

Andrew Jones, National Field Force Manager at Zurich

Value of in-house claims inspectorate

Zurich has invested a lot of resource developing its in-house claims inspectorate and does not outsource this function as some others do.

Indeed, the average inspector working on this team has 20 years’ experience and operates closely with Zurich’s Claims Investigation Unit and internal Fraud Co-ordinators. This level of expertise helps get to an accurate decision on liability and gives clients confidence at a difficult time.

The MOJ portal process means insurers are often the first people to speak to clients regarding a claim and so it is important they can provide an immediate expert-led response.

Further reading

“With the MOJ, we are often the first to hear about a claim, particularly if it is an employers’ liability claim,” said Andrew. “We have found that the way that many solicitors are dealing with the MOJ process, in these early days, includes using paper Claims Notification Forms (CNFs) to clients rather than the portal – giving the bare minimum of detail about the accident circumstances and being unwilling to discuss the circumstances, which all erodes the time to investigate, making it even more critical to have a flexible in-house team.”

Whoever has first contact with the client, the important thing is that previous contact with their broker and insurer has ensured the client has detailed and accurate information to hand.

This is the only way they will be able to defend themselves against unwarranted claims.

Image © Getty

For more information, get in touch

Andrew Jones | National Field Force Manager, UKGI Claims | 07791 431 246

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