Information Form
Members’ Reporting Obligations
Pursuant to clause 10.4.1 of the APIV By Laws, ‘Members must promptly notify the Compliance Manager about every civil or criminal claim, complaint, accusation, charge, notification or settlement involving a Member and must keep the Compliance Manager informed about the outcome’.
As part of the APIV Scheme membership, Members are required to:
· report to the APIV all notifications/claims/settlements of claims/complaints and disciplinary actions throughout the year as necessary;
· immediately advise the APIV when a notification or claim approaches the Scheme cap;
· update the APIV throughout the year as necessary on the status and progress of all notifications/claims/settlements of claims/complaints and disciplinary actions reported to the APIV in the past 12 months .
APIV’s Reporting Obligations
The professional standards legislation requires the APIV to monitor and analyse all notifications/claims/ settlements/complaints and disciplinary action made against its members for occupational liability. The APIV must report annually to the Professional Standards Councils (“PSC”) on:
· notifications/claims received by members, including:
- the source of the data (i.e., from members, from insurance industry, etc);
- the number and the dollar amount of the claims/settlements;
- the types of claims, causes of claims and demographic information; and
- identification of trends and conclusions that may be drawn from the claims data.
· complaints and discipline of members, including identification of trends and conclusions that may be drawn from the complaints data.
The PSC requires the APIV Limited to identify and report to the PSC as soon as reasonable practicable after receipt of any claim or notification which is in breach (or may reasonably breach) any limit of liability set by the Scheme.
Obligation to provide accurate information
It is critical that that the information provided by members to the APIV and the data reported in turn by the APIV to the PSC is accurate.
Giving false or misleading information to the APIV, and in turn to the PSC, is a serious offence. See, for example, section 307B of the Crimes Act 1900 (NSW) and similar provisions in other States.
Privacy Statement
APIV Limited respects the privacy of companies/individuals and acknowledges that the information you provide on this form and any attachments is “personal information” as defined by the Privacy Amendment (Private Sector) Act 2000. This information is being collected principally to provide aggregated and unidentifiable data to the PSC to discharge the APIV’s reporting obligations.
Where appropriate, this information may also be used to identify key risk areas for the purpose of providing educational material to members and to generally improve the standard of APIV’s member services.
Name of Business
Name and Position of Contact Person
Phone Number
Mobile
Email address
Date of completion of this Form
Current Monetary Ceiling / $
Current PI policy excess/deductible / $
Summary of Notification/Claim/Settlement/Complaint & Disciplinary action 1
If there was more than one notification/claim/settlement/complaint in any one year, please provide information on each and every notification/claim/settlement separately (ie., not in the aggregate).
Date of Notification/Claim / Date of Valuation
Total amount notified/claimed / $ / Is the amount notified/claimed above your firm’s monetary ceiling? / ☐ Yes
☐ No
State of Jurisdiction / Date of Court Judgment
Amount ordered by Court
to be paid / $ / Date of Settlement
Settlement Amount / $ / Defence Costs Paid / $
Address of subject property
Claimant
Claim Status
(tick all that apply) / ☐ Notified / ☐ Outstanding / ☐ Court Award / ☐ Settlement / ☐ Dismissed
Type of claim
(tick all that apply) / ☐ Commercial / ☐ Residential / ☐ Development / ☐ Other (please provide details)
Brief description of notification/claim issue(s) and the basis of notification/claim
Brief description of Court order / settlement (if applicable)
Summary of Notification/Claim/Settlement/Complaint & Disciplinary action 2
If there was more than one notification/claim/settlement/complaint in any one year, please provide information on each and every notification/claim/settlement separately (ie., not in the aggregate).
Date of Notification/Claim / Date of Valuation
Total amount notified/claimed / $ / Is the amount notified/claimed above your firm’s monetary ceiling? / ☐ Yes
☐ No
State of Jurisdiction / Date of Court Judgment
Amount ordered by Court
to be paid / $ / Date of Settlement
Settlement Amount / $ / Defence Costs Paid / $
Address of subject property
Claimant
Claim Status
(tick all that apply) / ☐ Notified / ☐ Outstanding / ☐ Court Award / ☐ Settlement / ☐ Dismissed
Type of claim
(tick all that apply) / ☐ Commercial / ☐ Residential / ☐ Development / ☐ Other (please provide details)
Brief description of notification/claim issue(s) and the basis of notification/claim
Brief description of Court order / settlement (if applicable)
Additional Comments (if any)
Once this form has been completed, please return it to
Scheme Administrator APIV Limited
10 Beach Street Email:
Port Melbourne VIC 3207 Web: www.api.org.au
Phone: (03) 9644 7505
APIV Claims Information Form - 1 September 2016 Page 2 of 4