accident investigation. accident investigation the call determine exact location. is anyone injured?...
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Accident Investigation
Accident Investigation The Call
Determine exact location.Is anyone injured? Determine the extent of damage.Dispatch notifies appropriate emergency responders. (Police, fire, EMS)Appropriate organizational notifications are made.Designated Keolis supervisors/managers go to the accident scene.
Accident InvestigationCritical Incident Notification
Does incident qualify as “Critical”? (see Section 5.2.13 of the Policy & Procedure manual)If YES, then Terminal Manager Notifies SVP of Operations and Region Director of Safety.If there is media involvement, GM must notify Dwight Brashear, Executive Vice President Business Development:
Office: (310) 981-9500, ext. 180Cellular: (310) 497-0506
Accident Investigation The Scene
Check on the drivers condition. If the driver is uninjured, have them assemble a passenger list.Check on the passengers condition. Ask “Is everyone alright?” Never ask “Is anyone hurt?”Check on the other vehicle occupants.Begin photographing the scene. Start in close, then work your way out.
Accident Investigation The Scene
Photograph all four sides of all vehicles involved.Photograph license plate and inspection stickers.Photograph the point of impact as well as the final resting place(s) of the vehicles.As you work your way back from the scene, be sure to photograph any traffic control devices, stop signs and speed limit signs.Attempt to photograph all drivers perspectives as they approached the point of impact.
Accident Investigation The Scene
Obtain information from other operator(s). (name, address, license, insurance carrier)Obtain witness statements, if available.Interact with law enforcement and emergency responders – be cooperative.Determine where any injured parties were transported. Does the accident meet the criteria for a D&A test??
Accident Investigation The Report
The accident report should be completed by the driver as soon as possible. If the driver is unable to complete the report, a supervisor should assist the driver. (Driver must sign the report)The accident diagram must be detailed.The driver’s statement must be complete and concise.
Accident Investigation The Report
Review the report for completeness.The report must be completed online with our Third Party Administrator (TPA) within 24 hours of the occurrence. Forward the Supervisors Investigator report. File the report in an accident file in sequence by date.
Accident Investigation Preventability
The Basic Question – “Did our driver do everything reasonably possible to avoid the accident?”If the answer is “YES”, then the accident is considered “Non-Preventable”.If the answer is “NO”, then the accident is deemed “Preventable”.NEVER indicate Preventability on the accident report or related documents.
Accident Investigation Re-Training
Re-training must always be presented as beneficial to the driver.The purpose of re-training is to correct operator deficiencies and enhance the driver’s skills.The intended outcome is a safer and more proficient driver. Re-training must never be represented as part of the disciplinary process.
Accident Investigation Re-Training
Post accident re-training must be of a duration sufficient to measure the drivers competency.The re-training must focus on the causation factors of the accident. An evaluation form must be completed by the trainer as documentation of the re-training. Post accident re-training must be completed before the driver returns to service.
Accident Investigation The Claim
Forward to the TPA all supporting documentation for the accident.35 mm or digital photos.Repair estimates and /or repair orders.Maintain copies of all documents in the accident file.Respond quickly to all requests from the TPA.
You need value added claims reporting solutions!
All Accidents Are To Be Reported To:
Auto & General Liability
National Interstate3250 Interstate DriveRichfield, Ohio 44286-900
By Phone: 866- 294-8264
By Fax: 877-303-3832
By E-mail: [email protected]
For Serious or Catastrophic Cases:
800-929-0870 (24/7)
Workers’ Comp
Highpoint Risk Services (REM)
P.O. Box 600Brea, CA 92822
By Phone: 877-473-2753
By Fax: 800-877-7750
By E-mail: [email protected]
PRINT THIS FOR MANAGERSPRINT THIS FOR MANAGERS
Proper Accident / Claims Reporting Is Essential to Effective Claims Management
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.
Accident / Claims Reporting
It is not the duty or responsibility of any Keolis personnel to determine liability, only to report the facts surrounding the accident.
Statements concerning liability or preventability are not to be made on the accident report form.
Important claims reporting guidelines:
1. Photographs.2. Other party’s insurance information.3. Other party’s driver’s license & plate number.4. Other party’s home and business telephone numbers.5. Names of witnesses as well as contact information.6. Name of police officer and department .7. Names of all first responders if possible.
Please refrain from using cell phones to shoot pictures !!!
Some vitally important information that should be secured at the scene:
1. Vehicles @ point of impact.2. Shots of approach views @ varying distances.3. Use a common point of reference.4. Photos of visible damage to vehicles and property.5. Shots of skid marks.6. Pictures of debris. 7. Photos of traffic controls & signals.
Some critical shots that can 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.
Some critical shots that can make or break the ultimate outcome!!!!
1. Date of accident.2. Vehicle number.3. Location number.4. Driver and other party’s name.5. Name of person who took the photos.
Please properly identify all photos as follows:
Work comp program features:
1. Bill Review – Physician & Hospital.2. Telephonic Case Management.3. Pharmacy Benefit Management.4. Utilization of Re-employability.5. Utilization Review.
Some general observations about work comp:
1. Historically, our subrogation results have been lackluster.
2. Our ratio of Lost Time to Med Only cases is out of sync.
3. Our denial rate is 3.77% .4. 58% of our WC claims are reported 5 or more days
late.5. 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 employee2.Injury occurring late Friday or early Monday3.Injury not reported until a week or more after it supposedly occurred4.Injury occurring before a strike or holiday, or in anticipation of termination5.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 injury8.Employee history of workers' comp claims9.Conflicting diagnoses from subsequent treating providers10.Evidence of employee working elsewhere while drawing benefits
Subrogation Claims Management
What is subrogation?
There are 4 keys to successful subrogation:
Proper Investigation
Timely Reporting
Complete Maint. Records
Professional Litigator
IF APPLICABLE VENDOR CONTACTS KEOLIS FOR
FURTHER INFORMATION IFAPPLICABLE
GENERAL MANAGER SENDS SUBRO PROVIDERACCIDENT REPORT
KEOLIS ENTERS
RESULT INTOSUBRO LOG
KEOLIS CONDUCTS ACCIDENT
INVESTIGATION
KEOLIS AWAITS
OUTCOME OF SUBRO VENDOR’SEFFORTS
SUBRO VENDORREVIEWS MATERIAL
IF RECOVERY
IF NO RECOVERY
CLAIM IS CLOSED
KEOLISPROCESSES
CHECK
VENDOR ISSUES
CHECK TO KEOLIS
1 2 3
456
7 8 9
1012
11
SUBRO VENDOR DETERMINES IFSUBROGATABLE
This is a straight forward process!
Your Subrogation Service Provider
Wilber & Associates816 Eldorado Road, Suite 1Bloomington, IL 61704 T: 800.313.5169 F: 800.313.5179
E-mail your Accident Reports to:
You must allow the adverse party / insurance carrier the opportunity to inspect your damages and conduct an appraisal within a reasonable period of time.
1. Accident report.2 Repair estimates, invoices and receipts.3. Police report, if available.4. Photos of damages.
Documents to be Obtained for Subrogation Claims
Preparing Estimates
1. All receipts & invoices for replacement parts.
2. All invoices for outside services performed.
3. The total number of labor hours is to be noted separately from the cost of parts.
4. 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 !!!!!!!!!!