"What Claims Questions Are Our Non-Profits Asking?" & "What Claims Questions Should Your Non-Profit Be Asking”?"
Todd Higley
Vice President-Business Development
F.A.R.A. Insurance Services
This year’s FARA session, presented at the 2nd Annual Florida Insurance Educational Retreat was a claims round robin discussion “What Claims Questions Are Our Non-Profits Asking And What Claims Questions Should Your Non-Profit Be Asking” moderated by Ted Baldassarre - Vice President and East Coast Regional Manager, and Jennifer Lister - Workers’ Compensation Supervisor from FARA’s Boca Raton office. The session focused on the most commonly asked claims related questions that FARA’s adjusting staff are asked on a regular basis, as well as, general claims related information that FARA and NPIS staff wanted to disseminate to the FIT members regarding some of the misunderstood information primarily related to reporting of claims and what constitutes a “claim”.
The most commonly asked and/or misunderstood questions all relate to “What constitutes a claim”, “What claims should I report”, and “How long do I have to report a claim?” One of the benefits of an insurance program like the FIT program is regardless of the number of claims reported, or frequency of claims reported do NOT “count against you”, both from an overall underwriting standpoint, as well as workers’ compensation experience modification standpoint. Unlike a traditional insurance program with a traditional insurance carrier, a FIT member is not penalized for reporting claims that have no associated reserves or claims payments. In fact, it’s beneficial for the insured FIT member and to NPIS, the program administrator, to have ALL incidents or minor claims reported to FARA, as FARA’s claims system generates valuable loss control reports that help to identify and isolate claims trends early on in the hopes that such identification will result in the FIT members taking the appropriate risk control measures to address those frequent “near misses” before they result in a “real” claim with associated medical, lost time, property damage, or bodily injury exposures and payments. Although that information is used for the development of experience modifiers, and an overall underwriting analysis, incident only/reporting only/first aid/minor medical type claims do NOT have any adverse impact on underwriting and premiums. This is another big benefit of being a FIT member!
Another related question was “How long do I have to report a claim”? Again, it’s best to report all claims as well as incidents that could give rise to a claim as soon as possible. The sooner a claim or incident is reported, the sooner FARA can set the claim up and begin an initial investigation to determine if something is an incident or claim. If a claim, FARA can then take all of the necessary steps as mandated by FARA’s standards of service to begin handling the claim which mandate that certain things occur within 24-72 hours upon receipt of an actual claim, as well as complying with Florida’s jurisdictional reporting requirements as related to workers’ compensation claims. In addition, certain types of claims, specifically professional liability claims, may be covered by claims made policies. Those policies have reporting triggers which generally mandate that “a claim or incident that could give rise to a claim must be reported within the policy period” or within a short period of time upon policy expiration in order to trigger (or, not jeopardize) coverage. Ted and Jennifer reiterated that it’s best to report EVERYTHING, and let FARA determine what is an incident and what is a claim, and that there are NO negative ramifications by doing so.
The last common question was “What worker’s compensation exposure does my non-profit have for volunteers, and am I covered for those exposures”? Under Florida Statutes, the only types of entities that are mandated to provide workers’ compensation benefits for injured volunteers are public entities/municipalities. All other types of entities are not required to provide workers’ compensation coverage for volunteers and most workers’ compensation policies exclude coverage for volunteers. However, most if not all of the types of non-profits that qualify for FIT also utilize volunteers just as they are utilized by public entities and municipalities. Further, there is an exposure to your entity for injured volunteers. Accordingly, FIT’s workers’ compensation program specifically provides coverage for injured volunteers at a very small additional premium, and this is a huge benefit to FIT members. By doing so, FIT members do not have to incur additional expenses related to having a volunteer file a claim under a member’s general liability policy, or buying coverage for such claims via an accident/disability insurance policy with higher associated premiums than covering them under the FIT workers’ compensation policy.
Based upon all of the feedback from those in attendance, the conference was a great success, and we at FARA were glad to be a part of the conference again this year. We are looking forward to seeing everyone at next year’s conference.
FARA will be contributing claims related articles for each FIT newsletter related to what claims trends or issues are currently “hot topics”. The best “hot topics” are those that are important to FIT’s members. Do you have any claims related questions or topics you’d like to see addressed? If so, please drop a note to NPIS or FARA and we’ll do our best to incorporate those into to the next newsletter! E-mail us at marketing@npis.com.
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