Attn. Administrators: Four Key Claim Takeaways
Assurance placed the new carrier on notice, since its a claims made policy and no incident was reported to their previous carrier. The new insurance carrier denied coverage for the lawsuit stating the Prior Knowledge Exclusion. This exclusion stipulates that if the insured knows about an event that could give rise to a claim and fails to report it to their carrier at the time, there would be no coverage.
Assurance believed strongly that just because a resident falls and gets injured this should not automatically constitute notice of a potential claim. The carrier argued that because the resident never returned to the facility following the incident, the facility should have been aware he was upset and a potential claim was possible.
After numerous conference calls and meetings, Assurance was able to convince the carrier to agree to a portion of the settlement. We also worked with a defense counsel to use the denial as leverage to settle the case early and for a low amount.
Four Key Takeaways
- Report incidents that may become a claim, instead of waiting for the lawsuit to be filed.
- Report claims and incidents right away, as facility staff may not be aware there is a renewal coming up.
- Report claims and incidents to your agent to ensure coverage is handled under the appropriate carrier. You may forget about an incident reported a year ago, so when a lawsuit gets filed, you might think it needs to go to your new carrier. But in fact, it would be your old carrier as they were put on notice of the potential claim. Your agent will keep track of where your claims and incidents are covered so you dont have to.
- Always let your agent know questions or concerns you have with your claims and the coverage being afforded.
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