Archive for the ‘Claims Matters’ Category

The year 2020 is coming to an end. Many would say it can’t end soon enough, but that’s a topic for another day. You’ve done a great job with your goals of implementing or continuing your safety meetings and using safety strategy tools, and you’re almost there to have a claim free year!

Then one morning your employee arrives to work and jumps into your company vehicle to go about his daily service calls, just like any other day. Driving between jobs he stops at a traffic signal. Out of the blue he feels the truck move and realizes it’s been hit in the rear. Thankfully he’s uninjured, but the back of the truck has considerable damage. He follows the company procedure to notify the supervisor and complete an accident report. Your insurance contact files a claim with your carrier, and the claim process begins.

When you purchase a commercial auto policy and choose to include physical damage coverage, an accident like this will generally be covered for you even when the accident wasn’t your fault. The two types of physical damage coverage, comprehensive and collision, include a deductible. So, while the policy does respond and pays out the few thousand dollars for the repairs, you will also have to contribute to the cost of the expense to repair your vehicle through the application of a claim deductible. You’ll also have the claim noted on your loss runs, now ruining your claim-free year. Doesn’t seem quite fair for something that wasn’t your fault and couldn’t be avoided by your employee, now does it?

The process of subrogation is the mechanism insurance uses to have the liable party ultimately be the one to bear the cost of this accident. Subrogation generally happens behind the scenes and is reviewed in every claim and for all types of claims, including auto, property, general liability and even workers’ compensation. Subrogation involves three parties — the insurance carrier, the insured party and the liable or responsible party. Even in property claims related to weather the adjuster will make a quick note that there is no subrogation opportunity.

Once an insurer pays out any loss expense, they will attempt to determine if another party has liability for that loss, and they’ll try to collect those funds from them. In the subrogation process the insurance company has assumed the legal rights of the insured for whom expenses have been paid. When the funds are successfully collected through this process, the deductible that was paid by the insured will usually be fully returned. However, there are different laws in each state, and the remaining funds will be credited against the claim, which will then show less on the insured’s loss run, as well.

Every accident and every claim has its own unique set of circumstances. In this type of rear-ending example given above, liability appears quite obvious. However, there may be situations where the determination of liability isn’t so clear-cut. Liability may be apportioned to both parties — again, state laws may be a factor in this determination — and then each carrier would subrogate against the other for expense at those percentages. Some claims may require an expert opinion to review the facts of the loss and make a determination of liability, such as in the occurrence of a fire, a faulty install or a suspected manufacturing defect claim, just to give a few examples.

The Telcom claims department understands that there may be special circumstances, such as the relationships with your customers, that could potentially cause ill will when pursuing subrogation. They will work together with you as a team to decide whether or not to have the insurance carrier to subrogate. For instance, subrogation may be waived on smaller, low-cost claims, such as a dog bite.

Many contracts or agreements may ask you to sign waivers of subrogation clauses before a claim even occurs, which could also require a policy endorsement in order to do so, because the insurer is agreeing not to pursue. You’ll want to communicate with your agent to stay informed and understand the impact of waiving of subrogation when a loss occurs. Ultimately, the claim dollars spent under the terms of your policy can to some degree impact the premiums you pay.

Claims can and do arise when they’re least expected. Whether one of your employees is the liable party or someone else has caused damage to you, we continue to encourage you to report your claims early, as often as you need to. And remember, in any claims situation, the Telcom claims department is committed to be here to help you every step of the way. We’re only a phone call or email away if you have any questions or need additional information or resources. Please feel free to contact me at 800-222-4664, ext. 1081, or bwm@telcominsgrp.com; or Marilyn at 800-222-4664, ext. 1085, or mab@telcominsgrp.com.

Repetitive Motion, CTS and WC claims

August 3rd, 2020 by admin

Many workers must perform repetitive motions as part of their daily workflow. While we can see injury from repetitive motion in any joint that is used over and over, the most common type by far is when the condition occurs in the hand and wrist. This often results in a diagnosis of carpal tunnel syndrome, or CTS.

CTS is actually a nerve disorder caused by compression of the median nerves and other tendons that allow your fingers to flex. CTS begins as an inflammation and develops over time. The pain from this condition can be very debilitating. When the median nerve becomes compressed by a narrowing of the carpal tunnel in the wrist, the flexor tendons swell. This in turn causes the affected worker to experience pain, weakness and numbness of the hand and wrist.

Workers can also develop this condition when their hands are in positions of extreme flexion for a prolonged period of time, such as may occur when using a keyboard without proper ergonomics.

Some common types of work activities that have been linked to CTS include typing, using power tools or other types of small tools such as screwdrivers or ratchets, pulling/pressing or pushing objects, assembly work, handling objects on conveyor belts and manipulating vibrating objects. Some occupations associated with these types of work activity could include computer and data-entry workers, janitors, painters, mechanics, carpenters, farmers, tailors, craftsmen, factory assembly line workers and telecom outside-plant employees.

CTS or repetitive motion injury can be considered an occupational disease and as such can be covered under workers compensation insurance. But these claims are sometimes difficult to manage and prove, as they generally are a progressive type injury that develops over time and can often take months or even years before the worker begins to have any symptoms.

One of the biggest challenges is to verify that the condition was caused by a workplace activity instead of a nonwork activity. Many of an employee’s personal recreational activities may cause or aggravate this condition — sewing, crocheting, playing a musical instrument and many sports, for instance, that involve repetitive motions. There is also belief that this condition is caused or more prevalent when there are preexisting conditions such as diabetes, arthritis, pregnancy or a thyroid issue involved. For these reasons it becomes very important for a doctor to give the opinion that work, as opposed to other activities, was the primary cause of the injury.

In review of recent years of claims and loss data, the frequency of repetitive motion claims is relatively low. This may be an indication of increased knowledge, better training and use of ergonomically safe work equipment and environments.

While the claim occurrence tends to be low, these claims can be costly when surgery is indicated and the employees will lose some time from work while healing. Sometimes employees need surgery on both wrists, in which case the doctors usually do one, wait for it to heal and then do the other. There can be several weeks away from work. Milder cases might only require medication or splints, so we see these claims range widely in their cost, from a few hundred dollars in medical expense to large claims totaling thousands of dollars. The average cost is approximately $7,983.

Telcom Insurance Group has resources to help you address proper workplace ergonomics and prevention of repetitive motion exposure, along with a vast assortment of other topics to support your company’s risk management program and help you anticipate and prevent claims before they happen.

If you have any questions or need additional information for any claims matter, please visit the Telcom website, www.TelcomInsGrp.com, or call 800-222-4664 and ask for Beckie, ext. 1081, or Marilyn, ext. 1085.

Common Trends of WC Claims

May 13th, 2020 by admin

Each and every day, many claims pass across my desk. I review and read claim descriptions, which explain the circumstances and facts of how the loss occurred. And I’ve observed that over the years, many of them are, unfortunately, very similar in nature and often appear to have definitely been avoidable.

The descriptions provide useful information that allows us to analyze the claims to identify trends in claim types, frequency and severity, then to develop risk management tools and pass that information on to our industry group so you can take steps to prevent these same types of occurrences from happening at your company.

For workers’ compensation claims, the most current five-year data from our carriers shows the No. 1 cause of loss in both frequency and incurred claim dollars to be slips, trips and falls (STF). The most frequent injury type is strains and sprains, often caused by lifting, which has for many years been among the top-five causes for WC claims. There were 128 claims caused by lifting and straining with a total claim cost of $1,761,967 and an average cost per claim of $13,765. These results are consistent with prior-year analysis trends and have not changed. For slips/trips/falls, one carrier had 250 claims in the past five years, totaling $3,323,203 claim dollars spent with an average cost per claim of $13,293.

It’s important to remember that falls, and their impact on your company, can be 100% avoidable in most cases.

According to the National Safety Council, the third-leading cause of unintentional injury-related deaths is falls; this includes falls both at home and at work. The report goes on to add that this data includes falls both from a height and on the same level. In 2016, 48,060 workers were injured badly enough to require days off of work. Workers in construction, which would include many of the tasks done by your outside plant workers, are most at risk from falls from a height, but falls can happen anywhere, including to your “desk workers.”

A detailed review of the notes of our most common slip, trips and falls, and lifting that has caused some type of strain, reveals that the use of ladders is often involved. The employee use of, or fall from, a ladder was indicated in 18% of the STF claims reported, and the average cost of these ladder claims was quite a bit higher, coming in at $21,839, as it includes some of the more serious injuries that can occur to employees that fall from a height. A Consumer Product Safety Commission report cited that OSHA believes 100% of ladder accidents could be prevented with proper attention to equipment and climber training being provided.

There are generally four main types of ladder accidents: selecting the wrong type of ladder, using worn or damaged ladders, incorrect use of the ladder and incorrect placement. Sprains and strains while lifting or using a ladder accounted for approximately 10% of the claims noted above. A strain is an injury to a muscle or tendon. Strain injury most commonly happens to the back, often when getting the ladder from the truck or placing it for use. Lifting and carrying are jobs that require special care and training. Back injuries can be difficult to treat and may result in lengthy and expensive claims.

Telcom Insurance Group has many resources specifically to address STFs and ladder safety to support your company’s risk management program and help you anticipate and prevent claims before they happen.

If you have any questions or need additional information for any claims matter, please visit the Telcom website, www.TelcomInsGrp.com, or call 800-222-4664 and ask for Beckie, ext. 1081, or Marilyn, ext. 1085.

Each day your outside employees probably spend a considerable amount of time in their vehicles. They drive to and from various job sites to perform their daily tasks for your customers, traveling along beautiful countryside on roads in your rural communities.

Your driver most likely enjoys many sights and sounds of nature and wildlife during those trips. When the wildlife stays in the field or forest all is good, but trouble abounds when they appear out of nowhere and leap into the path of an oncoming vehicle. With your rural setting comes an increased risk of deer collisions.

According to statistics published by the Insurance Information Institute, there were 211 deaths from collisions with animals in 2017. This trend had been increasing previous to that time but in the past few years has leveled off. The top five states for claims from a collision involving an animal in 2019 were ranked as follows: West Virginia at No. 1, followed by Montana, Pennsylvania, South Dakota and Iowa. The majority of animal-strike claims are for front-end damage, with the next frequent point of impact being the driver’s side of the vehicle.

Deer accidents happen at any time, but during mating season, or rut, in the fall, the incidence of these claims definitely rises. Data from 2019, the most recent claim year, shows there were three times as many claims in November and two times as many claims in October involving drivers hitting a deer or a deer running into a vehicle as during any other month. Teaching your employees how to react to a deer sighting and reminding them to be more vigilant to watch out for deer at this time of year may help to prevent a serious accident.

In review of the claim loss data from two of our main insurance carriers, deer claims account for approximately 10-12% of all vehicle collisions. During the past three claim years this number has stayed stable without much variance in the frequency of occurrence. In 2019 the average claim cost for a deer accident was $4,574, while the overall average cost incurred during the last three-year period, from 2016-2018, was $3,997. This reflects the gradual increase in the cost of vehicle repairs and associated claims expense during that time.

Smaller cars tend to have more damage and therefore more expensive claims versus trucks and SUVs, which will have the lowest overall cost. Generally, animal-collision claims are not as pricey as colliding with another vehicle, but while these claims aren’t considered high dollar or large loss claims, there is always the potential for driver injury with any vehicle collision.

There are some common-sense rules that drivers should know and follow to help prevent these accidents:

Above all is the reminder to slow down and stay alert to both sides of the roadway, prepared to come to a complete stop if necessary. Your drivers should always be on alert but be most alert at sundown and sunrise, when deer are more active. After dark, using high beams whenever it is safe to do so may help drivers see deer that are down in ditches.

Deer crossing signs may be posted at known areas of high activity, but that doesn’t mean the animals won’t run across the highway at any spot. Deer generally travel in groups or herds, so if one crosses a road safely, it is highly possible that others may follow, often in single file. When traveling on a multilane road, drivers should use the center lane whenever possible, which gives them more time to see and react to a sudden dart out.

Most importantly, if a deer does get directly in the path of a vehicle, the driver should not swerve, since that could put the vehicle into oncoming traffic or off the road into a tree. When this happens the incident of a serious injury to the driver is certainly more likely to occur. Finally, remind drivers to always use their seat belts; if an accident does occur it will decrease the chance of injury.If you ha

ve any questions or need assistance with any claims situation, the Telcom claims department is committed to be here to help you every step of the way. We enjoy hearing from you, and we’re only a phone call or email away if you have any questions or need additional information or resources. Please feel free to contact me at 800-222-4664, ext. 1081, or bwm@telcominsgrp.com; or contact Marilyn at 800-222-4664, ext. 1085, or mab@telcominsgrp.com.