Accident Investigation and
Claims Management Training
Revised 07232012
1
You need value added
claims reporting solutions!
All Auto Accidents Are To Be Reported To:
National Interstate
3250 Interstate Drive
Richfield, Ohio 44286-900
By Phone: 866- 294-8264
By Fax: 877-303-3832
By E-mail: newclaims@natl.com
For Serious or Catastrophic
Cases:
800-929-0870 (24/7)
CA Work Comp Claims Are To Be Reported To:
Liberty Mutual
Insurance Co.
330 N. Brand Blvd. – Suite 500
Glendale, CA 91203
Phone: 800-281-1120
First Report Fax: 800-329-3297
To Report by Phone: 800-362-0000
Policy Number:
WA7-65D-290802-012
General Liability Claims Are To Be Reported
To:
Please contact Doug Lawson or Drew Jones before reporting claims in
this category.
Scottsdale Insurance Co.
Address:
PO BOX 4120
Scottsdale, AZ 85261
Phone #
Fax #
800-423-7675
480-483-6752
REPORT YOUR CLAIMS TO:
TOM COLE
Unit Manager
PIMA CENTER
Scottsdale, AZ 85258
Phone: (480)365-3607
Policy Number:
BCS0027919
Property Damage Only Claims Are To Be Reported To:
For damage of $25,000 or greater to Keolis or
in cases where Keolis operates client owned
vehicles and provides PD coverage by contract
Liberty Mutual Insurance Co.
Fax:
By Phone:
800-329-3297
800-362-0000
TO REPORT A WORK COMP CLAIM VIA THE WEB
Proper Accident / Claims Reporting Is Essential to
Effective Claims Management
Accident / Claims Reporting
PLEASE DO NOT LEAVE ANY BLANK SPACES ON THE FORM
Accident / Claims Reporting
1. Ensure entire accident report form is accurate and
complete.
2. Ensure all other pertinent documents concerning
the accident are gathered and sent to the
insurance carrier.
3. Fax or email the accident report and all other
applicable documents within 24 hours of
becoming aware of the accident.
4. Refer all calls from claimants or their attorneys to
the adjuster handling the claim. Do not comment
on liability or other aspects of the incident.
Important claims reporting guidelines:
1. It is not the duty or responsibility of any
Keolis personnel to determine liability,
only to report the facts surrounding the
accident.
2. Statements concerning liability or
preventability are not to be made on the
accident report form.
Some critical shots that can make or break
the ultimate outcome!!!!
1.
2.
3.
4.
5.
6.
7.
Vehicles @ point of impact.
Shots of approach views @ varying distances.
Use a common point of reference.
Photos of visible damage to vehicles and property.
Shots of skid marks.
Pictures of debris.
Photos of traffic controls & signals.
Some critical shots that you may not consider
that may make or break the ultimate outcome!!!!
1. Pictures of other vehicles & license plates @ the
scene.
2. Shots of by-standers & possible witnesses.
3. Shots of inside the vehicles.
4. Pictures of surveillance cameras in close proximity.
Please properly identify all photos as follows:
1.
2.
3.
4.
5.
Date of accident.
Vehicle number.
Location number.
Driver and other party’s name.
Name of person who took the photos.
Serious accidents are defined as follows,
but not limited to:
Fatality (including accidental death on a bus or
company property, regardless of fault)
Serious burns
Quadriplegia or Paraplegia
Amputation
Brain damage – actual or alleged
Serve injury with apparent permanent disability
Severe cosmetic disfigurement
Blindness or loss of hearing
Serious accidents are defined as follows,
but not limited to:
Severe fractures or multiple fractures
Psychiatric problems due to trauma, actual or alleged
Serious vascular abnormalities due to trauma
Any accident involving more than four persons
Any pedestrian accident
Assault or molestation incidents
Severe bleeding
Vehicle roll-over
Work comp program features:
Bill Review – Physician & Hospital.
Telephonic Case Management.
Pharmacy Benefit Management.
Utilization of Re-employability.
Utilization Review.
Some general observations about work comp:
Historically, our subrogation results have been
lackluster.
Our ratio of Lost Time to Med Only cases is out of
sync.
Our denial rate is 3.77% .
58% of our WC claims are reported 5 or more days
late.
17% of our WC claims are reported 10 or more days
late.
There are 3 types of workers’
comp fraud:
Applicant Fraud
These cases involve workers who fake an injury,
lie about the extent of their injury, lie by denying
filing previous claims, fail to disclose a prior injury
to the same body part, claim a non-work injury is
work related, or illegally work while obtaining
benefits. Sub rosa surveillance tapes regularly
expose applicants who are fraudulent.
Claim Mills
Organized workers’ compensation fraud involving
doctors and lawyers have been an ongoing
problem, especially in Southern California. Fraud
rings have made a practice of recruiting people to
file phony work injury claims. The workers are
sent to medical clinics or legal referral centers
(commonly known as "claim mills"), which in turn
refer them to a doctor or lawyer who is in on the
scheme.
Provider Fraud
Regardless of the legitimacy of the original claim,
many medical or other health practitioners fraudulently
maximize the number of medical reports and referrals
in each case to increase the number of billings. They
may also over bill or render unnecessary treatment.
Some common work comp fraud indicators:
1. Injury that has no witness other than the
employee
2. Injury occurring late Friday or early Monday
3. Injury not reported until a week or more
after it supposedly occurred
4. Injury occurring before a strike or holiday,
or in anticipation of termination
5. Injury occurring in a location where
the employee would not normally work
Some common work comp fraud indicators:
6. Injury that is inconsistent with normal job
duties
7. Employee observed in
activities inconsistent with the reported
injury
8. Employee history of workers' comp claims
9. Conflicting diagnoses from subsequent
treating providers
10.Evidence of employee working elsewhere
while drawing benefits
Subrogation Claims Management
What is subrogation?
Subrogation is the process in
which Keolis attempts to
recover a loss from a third
party when our property is
damaged as a result of a
negligent act by a third
party also referred to as the
“adverse party”.
There are 4 keys to successful subrogation:
Proper
Investigation
Timely Reporting
Complete Maint.
Records
Professional
Litigator
This is a straight forward process!
1
2
KEOLIS
CONDUCTS
ACCIDENT
INVESTIGAT
ION
3
GENERAL MANAGER SENDS
SUBRO PROVIDER
ACCIDENT REPORT
6
5
KEOLIS
AWAITS
OUTCOME
OF SUBRO
VENDOR’S
EFFORTS
1
1
IF NO
RECOVERY
IF RECOVERY
4
SUBRO
VENDOR
DETERMINES
IF
SUBROGATA
BLE
IF APPLICABLE VENDOR
CONTACTS KEOLIS FOR
FURTHER INFORMATION IF
APPLICABLE
1
0
7
SUBRO
VENDOR
REVIEWS
MATERIAL
8
VENDOR
ISSUES
CHECK TO
KEOLIS
9
KEOLIS
ENTERS
RESULT
INTO
SUBRO LOG
KEOLIS
PROCESS
ES
CHECK
1
2
CLAIM IS
CLOSED
Your Subrogation Service Provider
Ward and Federman, Attorneys
at Law
1177 Marsh St., 2nd Floor
San Luis Obispo, CA 93401
T: 805-542-9002
F. 805-544-5837
E-mail your Accident Reports to:
doug@wardandfederman.com
You must allow the adverse party / insurance carrier the
opportunity to inspect your damages and conduct an
appraisal within a reasonable period of time.
Documents to be Obtained for
Subrogation Claims
Accident report.
Repair estimates, invoices and receipts.
Police report, if available.
Photos of damages.
Preparing Estimates:
All receipts & invoices for replacement parts.
All invoices for outside services performed.
The total number of labor hours is to be noted
separately from the cost of parts.
Towing charges and storage fees are to be included.
Downtime
If downtime is being claimed, the documentation
substantiating the loss must be provided with the accident
report documents, i.e., copy of the page from our contract
which reflects the revenue per vehicle per day if
applicable.
Our Primary Goal:
Getting Paid !!!!!!!