Once a Claim has Been Made
Our estimating philosophy where there is no formal claim
Our policy is to hold an accurate file estimate against any incident reported to us, including those claims where a formal claim has yet to be received. We take into account all of the circumstances and information provided relevant to the incident, until such time that the case can be closed.
There are occasions where we do not have sufficient information to place an accurate estimate on a case from day one. In these circumstances, we allocate an estimate as follows:
No Formal Claim and value falls below £25,000
We will place a fixed estimate through the life of the claim until closure or a formal claim is made. If a formal claim is made, we will estimate the claim on a full liability basis. The fixed estimates are as follows:-
- EL Injury £1,599
- PL Injury £1,399
Claims that do not meet the criteria listed under Claim Notification Guidelines - £ 999
No Formal Claim and value is above £25,000
Our policy is to hold an accurate file estimate against any incident reported to us where a formal claim has been made or in absence of a formal claim we value that claim at £25,000 or more. The estimate will be reduced periodically in absence of a formal claim. Until we are in receipt of sufficient information to accurately estimate the claim, we will place the following ‘Day One’ estimates:
- EL Injury £13,999
- PL Injury £3,999
Following feedback from you, we have introduced guidelines for our estimates for all liability claims where we have no formal claim and the value is above £25,000, in order to improve the service we offer.
For claims where a formal claim has not been presented and the value is above £25,000, the estimate will be reduced as follows:
- 90% of the original estimate 6 months after notification
- 75% of the original estimate 9 months after notification
- 50% of the original estimate 12 months after notification
- The estimate is retained at this level until the claim can be closed”
How we investigate the claim
When we receive a formal claim, in order to establish whether it is a valid claim, we need to investigate. To do this, we appoint one of our Claims Inspectors. We have a team of Claims Inspectors providing national coverage with a proven track record of investigating claims for a full spectrum of Policyholders ranging from sole traders to multinational corporations.
The Claims Inspector will liaise with the appropriate individuals within the Policyholder’s business to not only investigate the circumstances of the incident but will also ensure that any subsequent decision on liability is conveyed and understood.
To assist the Claims Inspector with their investigation it is important that evidence from the accident is preserved. This will include the following:
- Witnesses to the accident or those who can comment on training, previous incidents or the system of work. Details of those witnesses should be recorded.
- CCTV or photographic evidence if available. This can be extremely valuable to confirm or refute accident circumstances / locations and it should be kept securely.
- Documentation for the accident accident book entries, reports to the HSE, internal investigation reports,
- Background documentation Risk assessments, training records, inspection records, written systems of work or instructions, attendance records, employment history, wage details, previous accidents, product information, leases or contracts
The Claims Inspector will contact the Policyholder and prior to the investigation will discuss what is available and specifically relevant for that particular case.
In addition to this, the Claims Inspector will be in a position to provide the Policyholder with advice regarding risk improvement to prevent repetition of a similar incident as well as any other risks identified during his visit. He can also arrange for risk assessment
material to be sent to the Policyholder.
You will also be given the opportunity to attend the site investigation visit if you wish.
Whether you attend or not, you will also receive a call from the Claims Inspector, post investigation, to discuss the liability findings.