Determining When to Report an Incident
    08/07/2019
    Should I report this incident to my insurance carrier? Before asking this question, it is important to understand if your policy is written on an Occurrence form or a Claims Made form. Not sure what the difference is? In layman’s terms, the coverage trigger on an Occurrence form is tied to the date of the incident, or “occurrence.” Under this form, the policy that is in force on the date of the incident must defend or pay the loss. In the case of Claims Made, coverage is triggered by the date you first became aware and notify the insurer of a potential claim or incident. The insurer’s policy in force on the date you became aware must defend or pay the loss.
     
    While that sounds easy, let’s dig a little deeper into what triggers coverage under Claims Made forms.
     
    How do I know what my claims trigger is?
    There are two types of claims triggers – written demand and incident sensitive. For coverage to be triggered under written demand, you must have an actual suit or demand from a claimant. Incident-sensitive, on the other hand, has a little more flexibility. Coverage is triggered when you report a circumstance that may give rise to a claim, regardless of having received an actual demand.
     
    Every policy defines the claims trigger, some more clear than others. Written demand policy forms will specifically state within the “claim” definition that the insured must receive a written demand for damages.  Incident Sensitive policy forms define “claim” or “potential claim” as an event or incident that the insured should be aware of, that may result in a claim.
     
    How does the insurer define when a claim is “made”?
    Insurers tend to have different rules based on the definition of when a claim is “first made.” Claims can be defined as “made” in several different ways. Here are some common examples:
    • Incident reported
    • Lawsuit filed
    • A written demand for money
    • Contact by an attorney
    • Request for Medical Records
    • “G” level or higher deficiency in a state survey
    • Threats by the resident’s family member
    When should I report these potential claims?
    Many senior living operators on Claims Made policies are rightfully fearful that if incidents aren’t reported before the end of the policy expiration date, there will be no coverage under that policy. Failing to report incidents in a timely manner could potentially jeopardize your coverage. Understanding what to report and when to report is critical to avoiding claim denials.

    To avoid the risk of your claim being denied, report incidents or potential claims as soon as you first become aware of the circumstance.

    Claim Reporting Tips:
    • Review your liability policy and understand your insurer’s definition of a “claim”
    • Implement an internal system for your staff to report claims or incidents
    • Educate your staff on what incidents need to be reported and who they need to be reported to
    • Communicate with your broker if you think an incident or circumstance may give rise to a claim

    At AssuredPartners, we provide dedicated claims consultants available to our senior living clients to address any question.  If you would like additional information on how to educate your staff on incident reporting, please reach out to the AssuredPartners Senior Living experts.

    07/09/2020
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    06/26/2020
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    06/19/2020
    LAKE MARY, FL – June 19, 2020 – AssuredPartners, Inc. is proud to announce Rand-Tec Insurance Agency of Vernon Hills, IL has joined AssuredPartners. The staff of 24 will remain under the operational leadership of Todd Silver. The agency currently reports $8 million in annualized revenues. Todd...
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    06/12/2020
    AssuredPartners recognizes the significant impact that COVID-19 has had on our nation. As COVID-19 continues to affect health systems across the world, AssuredPartners is proud to continue supporting our communities and healthcare providers during this time. We are pleased to announce our $20,000 donation to...
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    06/08/2020
    LAKE MARY, FL – June 8, 2020 – AssuredPartners, Inc. is pleased to announce Williams & Williams, Inc. of Smithtown, NY has joined AssuredPartners. The staff of 4, led by Glenn Williams, currently reports $1.2 million in annualized revenues. “Founded in 1928, we pride ourselves on three...
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    05/28/2020
    LAKE MARY, FL – May 28, 2020 – AssuredPartners, Inc. is pleased to announce the acquisition of Cypress Insurance Group, Inc. of Fort Lauderdale, FL. The team of 20 will remain under the operational leadership of Terry Bond and Debbie Arciola. The agency currently reports $3 million in annualized...
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    04/21/2020
    LAKE MARY, FL – April 21, 2020 – AssuredPartners, Inc. is pleased to announce the acquisition of Transportation Insurance Advisors, LLC located in Sanford, FL. The team of 55 will remain under the operational leadership of Scott Light, in addition, the agency currently reports $14 million in...
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    04/15/2020
    LAKE MARY, FL – April 15, 2020– AssuredPartners, Inc. is proud to announce GIGA Solutions, Inc. of Boca Raton, FL has joined AssuredPartners as the 15th acquisition of 2020. GIGA Solutions provides tailored insurance solutions for the PEO industry. The team of 9 will remain under the operational...
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    04/06/2020
    LAKE MARY, FL – April 6, 2020 – AssuredPartners, Inc. is pleased to announce the acquisition of Early, Cassidy & Schilling, LLC (EC&S) of Rockville, MD. EC&S has been a trusted insurance advisor in Maryland since its founding in 1927. New York based advisory services firm, Dowling Hales,...
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    03/20/2020
    LAKE MARY, FL – March 20, 2020 – AssuredPartners, Inc. is pleased to announce that Aniello Insurance Agency, Inc. of Las Vegas, NV has joined AssuredPartners. The dedicated team of 11 will remain under the operational leadership of Rick Aniello. The agency currently reports $3 million in annualized...
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