Missouri Intergovernmental Risk Management Association

MISSOURI INTERGOVERNMENTAL RISK MANAGEMENT ASSOCIATION

CLAIMS HANDLING PROCEDURES

TABLE OF CONTENTS

PAGE

SECTION I: INTRODUCTION 2

SECTION II: CLAIMS REPORTING 2

A. TIME REQUIREMENTS 2

B. CLAIMS HANDLING AND SETTLEMENT AUTHORITY 2

C. WHERE TO REPORT 3

D. FORMS TO USE 4

SECTION III: SENDING ADDITIONAL INFORMATION 6

SECTION IV: CLAIMS MANAGEMENT 6

A. INTRODUCTION 6

B. WORKER'S COMPENSATION 6

C. AUTOMOBILE & GENERAL LIABILITY 8

D. AUTO PHYSICAL DAMAGE & PROPERTY 9

SECTION V: GETTING STATUS INFORMATION 10

SECTION VI: WHERE TO GET FORMS 10

SECTION VII: CLAIMS STAFF 11

REFERENCE: LOCATION CODES 12

DEPARTMENT CODES 13

FIRST REPORT OF INJURY INSTRUCTIONS 14

WORKERS’ COMPENSATION WAGE STATEMENT 17

NCCI CLASSIFCATION CODES 18

TYPE OF INJURY CODES 21

CAUSE OF INJURY CODES 22

PART OF BODY CODES 23

SIC CODES 24

Revised January, 2017

SECTION I: INTRODUCTION

MIRMA is not an insurance company, but rather a non-profit, self-insurance pool wholly owned by our members. MIRMA not only provides a comprehensive coverage package, but also works closely with each member through our loss control services to provide an organized approach for the management of municipal risks.

MIRMA is contracted with Corporate Claims Management, Inc. (CCMI) out of Chesterfield, MO to handle the administration of all claims, except for workers' compensation and employment practices liability (EPL) claims. MIRMA is contracted with Transitional Claims Solutions (TCS) out of Dallas, TX to administer EPL claims. MIRMA handles all workers' compensation claims out of our office in Columbia, MO with our staff adjuster.

SECTION II: CLAIMS REPORTING

A. TIME REQUIREMENTS

All claims, or any incident likely to give rise to a claim, should be reported to MIRMA within two (2) business days of the member’s first knowledge of any such claim or incident. This would include a notice of an EEOC complaint, attorney representation letter or a lawsuit. MIRMA does allow a grace period of 30 calendar days to report a new claim/incident; however, after 30 calendar days, a Late Notice Deductible will be assessed against the member for 25% of all claim costs.

If any employee, official or representative is aware of a claim or incident, that is considered knowledge by the member. It is each member’s responsibility to provide all employees, officials and representatives with the necessary instruction for reporting claims.

It is not necessary to obtain all the details of a claim/incident before reporting it to MIRMA. Simply having the basic facts, such as the date of the occurrence, location and claimant’s name, is sufficient to make the initial claim report. The adjuster assigned to the claim may follow up to ask for assistance in gathering additional information, such as taking photographs or getting damage estimates, but please do not delay reporting a claim to MIRMA once you are aware of it.

In the event of a serious claim, such as a fatality, head injury, amputation, tornado, large fire, widespread wind or hail storm, shooting incident, significant sewer backup(s) with property damage, or multiple vehicle accident, please call MIRMA immediately.

If you are aware of a serious claim after-hours or on a weekend or holiday, please call CCMI (except for workers' compensation claims). Do not call CCMI to report a serious workers' compensation injury – please call MIRMA the next business day. Please only call CCMI about a new claim if the MIRMA office is closed, and then only if it is a very serious, non-workers’ compensation clai m.

B . CLAIMS HANDLING AND SETTLEMENT AUTHORITY

While a member may be asked to assist in obtaining information and/or documentation for a claim, please be careful not to actually get involved in the handling of a claim. The decision to settle, defend or otherwise establish strategy for the handling of a claim is the sole right and responsibility of MIRMA. This means the member should never make any commitment to pay or to deny responsibility for any claim. For example, if an injured worker presents a claim, you must report that to MIRMA without any comment about whether or not you think the claim is compensable.

Please note that Section XI of the MIRMA By-Laws specifically prohibits a member from handling any claim or lawsuit or acting independently from or contrary to MIRMA with respect to any claim or lawsuit that falls within MIRMA’s coverage. Should this occur, the member forfeits all coverage with MIRMA for that particular claim or lawsuit.

For example: If MIRMA denies liability to a homeowner for a sewer backup claim, and that homeowner then files a lawsuit, MIRMA’s coverage would provide a legal defense for the member and pay any settlement or judgment. If, however, the member decided to make a settlement with the homeowner, contrary to MIRMA ‘s liability denial, the member would lose all coverage for that claim. If the homeowner were to later file a lawsuit for additional damage or injury, the member would have no coverage at all with MIRMA for that lawsuit since the member acted independently and contrary to MIRMA.

C. REPORTING A CLAIM OR INCIDENT

All claims should be reported to MIRMA. You can report a claim by fax, email or online. MIRMA prefers that all claims be reported online using Spectrum – the web based online claims access provided by our claims administrator, CCMI. Member employees that are responsible for reporting claims to MIRMA should have a user ID and password assigned to them by CCMI to login to Spectrum. Spectrum not only allows for a member to report claims online, but also provides information about that member’s claims. Some basic loss run reporting is also available on Spectrum.

There are two different forms used to report claims, one for workers’ compensation claims and one for all other claims. The First Report of Injury form – Form WC-1 – is the state required form that must be used for all workers’ compensation claims. For all other claims use the Notice of Occurrence/Claim Form.

If you report claims using Spectrum, the system completes the form for you. Just select whether you are reporting a workers’ compensation claim or other occurrence, and then navigate through the tabs to fill in the necessary information. Please also select whether you are reporting it as a claim or a ‘record only’.

Another benefit of reporting claims using Spectrum is that all of the codes, including all of the required workers’ compensation codes, are in drop down menus. Just follow through the tabs and be sure to complete all required fields.

If you do wish to report a new claim by sending us the physical form, please either fax it to 573-441-0515 or scan and email to . Please do not send new claim reports to us by mail as that will cause an unnecessary delay.

MIRMA office contact information:

MIRMA

3002 Falling Leaf Court

Columbia, MO 65201

(573) 817-2554 or 877-562-1125

Claims Fax: (573) 441-0515

www.mirma.org

Office Hours: 8:00 a.m. to 4:30 p.m.

The contact information for our third party administrators is:

CCMI

782 Spirit 40 Park Drive

Chesterfield, MO 63005

636-519-0330 or 800-449-2264

636-519-0227 (fax)

TransEleven Claims Managers

Kathy Weber, Esq.

Executive Vice President - TCM

5900 S. Lake Forest Dr. Suite 300

McKinney, Texas 75070

844-281-2811 ext. 707

To report an emergency/serious claim after-hours (not a workers' compensation claim), you may contact CCMI at the phone number provided above. Please do not have a claimant contact CCMI direct after hours. CCMI does have extended office hours, but when their office is closed they use an answering service. If you reach the answering service simply advise that you are trying to reach the CCMI on-call adjuster. An adjuster should be back in touch within the hour.

D. FORMS

We strongly encourage all members to report claims online using Spectrum. It is the easiest and fastest way to report your claims. If you need a user ID and password please contact the MIRMA office and we will request one from CCMI.

If you need to submit a physical claim form, please do not complete the forms by hand. Electronic versions of all claim forms are available on the MIRMA website, www.mirma.org. Please also do not give the claim form to an injured worker or claimant to complete.

1. WORKERS COMPENSATION

a. REPORT OF INJURY – FORM WC-1: This is a state form and must be used to report all work related injuries. Do not send this form to the Division of Workers Compensation, send it to MIRMA and we will file it with the Division.

(1) “Employer (Name, Address, incl. Zip code)” should include the name and address of the Member City.

(2) “Location #” is the three letter abbreviation for the Member, plus the three number Department Code found in the DEPARTMENT CODES list found in the following coding section of these procedures.

(3) “Phone #”, immediately under “Location #”, should be the phone number of the department where the employee can be reached. In the Section titled “Employee”, “Phone #” under the employee’s name and address should be the employee’s home phone.

(4) “Carrier (name, address & phone no.)” should read: MIRMA, 3002 Falling Leaf Ct., Columbia, MO 65201.

(5) “Carrier FEIN” should read: 43-1232810.

(6) “NCCI Class Code” is a four digit code corresponding to the employee’s primary occupation. These codes can be found in Appendix B under NCCI Worker’s Compensation Classification Codes.

(7) “Type of injury/illness” - Please be as specific as you can.

(8) “Type of injury/Illness Code” - Two digit code can be found in Appendix B

(9) “Part of Body Affected” - Again, please be as specific as you can.

(10) “Part of Body Code” - Two digit code can be found in Appendix B.

(11) “Cause of Injury Code”- Two digit code can be found in Appendix B.

(12) “How Injury or Illness/Abnormal Health Condition Occurred ...” should include the word “alleged” on all injuries that are:

(a) Suspicious in nature.

(b) Not witnessed.

(d) Non-visible injury such as back strain.

Example: The employee alleges he twisted his back two weeks ago while picking up a screwdriver.

(13) “Physician/Health Care Provider (Name & Address)” should include the doctor or clinic’s name and address if any treatment was rendered to the employee.

b. Keep copies of all forms and written statements for your file.

2. ALL OTHER CLAIMS

All other claims and losses must be reported on the N otice of Occurrence/Claim F orm. Please complete the information in the top box of the form, and please be sure to indicate what city department the claim is for.

The Member Property section is to be used if you are reporting a claim for a damaged city automobile or damage to a city building(s). If you are reporting damage to a city building, please indicate the location number for that property as it is on the property schedule you submitted.

The Claimants section is to be completed when you are reporting a liability claim. The claimant is the person that is alleging the city has caused them harm or damage. Please provide whatever contact information you have for all claimants.

Please report any claim just as soon as you are aware of it. Do not wait to obtain estimates, photographs, police reports, etc. before reporting the claim. As long as you have the basic facts, please report the claim to MIRMA. The adjuster assigned will follow up with you to get whatever additional details are needed.

Revised January, 2017

SECTION III: SENDING ADDITIONAL INFORMATION

All information and documentation, such as police reports, inspection reports or internal investigations, may not be immediately available when you need to report the claim. As mentioned above, please do not wait to report a claim in order to gather additional information.

As a claim develops and you receive additional information, including damage estimates, photographs, reports, or even suit papers, please forward it immediately to the handling adjuster. Please be sure to include the claim number when sending information or in any correspondence to the adjuster.

SECTION IV : CLAIMS MANAGEMENT

A. INTRODUCTION

The timely and proper reporting of a claim is one of the most important steps in the overall claims process. The more quickly an adjuster is involved, the better the adjuster can determine what steps are needed to effectively handle the claim.

There are also some other things the member can do to help ensure proper claims management.

1. PRE - OCCURRENCE: Pre-occurrence handling procedures deal with those things the member can do before a claim occurs in order to be prepared for when a claim is reported. This includes such things as informing all employees to report all incidents, no matter how minor, and establishing procedures such as who is to submit claim reports to MIRMA.

2. OCCURRENCE: Occurrence handling procedures deal with those things the member must do once a claim occurs. This will include such things as using proper forms, taking photographs, obtaining police reports, and supervisory investigations.

3. POST-OCCURRENCE: Post-Occurrence handling procedures deal with those things the member should do after the claim has been reported, such as providing the adjuster with new or additional information

B. WORKER'S COMPENSATION

1. PRE-OCCURRENCE

a. Files should be maintained on every employee to include:

(1) Employment Application

(2) Pre-Placement physicals

(3) Group Health and disability claims

(4) Prior workers' compensation claims

(5) Violations of safety rules

(6) Attendance information

(7) Performance evaluations

b. Pre-select a local medical facility for proper treatment and diagnosis. In Missouri, the workers' compensation statute says the employer has the right to direct medical treatment.

c. During the employee's orientation, he or she should be informed to report all incidents to their supervisor, no matter how minor, immediately.

2. OCCURRENCE

a. Medical Treatment

(1) First aid on site

(2) Refer to your pre-selected doctor or medical facility. If critical or emergency care is needed a hospital ER may be appropriate.

b. Reporting of the Claim

(1) Complete the state required First Report of Injury Form, WC-1 online using Spectrum, or e/mail or fax the physical form to MIRMA within two business days.

(2) Call MIRMA immediately on serious injuries that involve:

(a) Death

(b) Amputation

(d) Multiple injuries or