Lee CountyRisk Management

Claims Reporting Procedures

this manual and forms supercedes any previous claims reporting procedures

August 14, 2007

Sections

Section 1 – Introduction------Page 1

Section 2 – Accident Investigation Guidelines------Page 2

Section 3 – Claims Procedures & Where to Report------Page 6

Section 4 – Workers’ Compensation Reporting Procedures------Page 7

Section 5 – Vehicle Crash Reporting Procedures------Page 10

Section 6 – General Liability Claims Reporting Procedures------Page 12

Section 7 – Property Claims Reporting Procedures------Page 13

Section 8 – How to Respond to a Claimant------Page 15

Section 9 – Pollution Liability Reporting Procedures------Page 16

Section 10 – Investigating Near Misses------Page 17

Addendums

Property Loss Form------Addendum 1

Vehicle Accident Report------Addendum 2

Liability Accident/Incident Report------Addendum 3

Investigation Report for Workers’ Compensation Injury------Addendum 4


Scope

This manual supercedes any previous Claims Procedures Manual, and/or claim forms, which are hereby rescinded. In case of conflict with any other existing policy or procedure of LeeCounty, this manual will take precedence. It is the intent of this manual to address the claims procedures and operational issues which apply to all Lee County Board of CountyCommissioners (BoCC) departments, divisions, and constitutional agencies employees who are insured under Lee County Risk Program. In cases of operations unique to only a single department or entity, the affected organization is expected to take the lead in formulating appropriate options, solutions, and operating procedures.

Purpose

The purpose of this manual is to provide policies, procedures, and forms to assist supervision in establishing and implementing effective reporting and investigations of all incidents and accidents. Conducting effective investigations is the key to preventing future incidents and potential costly claims. Therefore unless the root causes are determined and corrective actions are taken, often history repeats itself, resulting in avoidable accident and/or injury. Also, state laws and insurance policies mandate that notices of losses are reported within a certain time period in order to avoid potential penalties and bad faith claims.

Therefore, it is essential that each department develops and implements reporting and investigation procedures for all incidents and accidents, involving their respective departments. All employees need to be trained in proper reporting procedures and supervisors need specialized training in the investigation techniques of incidents and accident.

Claims Philosophy

It is the philosophy of LeeCounty to handle and to pay legitimate claims for which the County becomes legally obligated to pay in a fair and prompt manner. Therefore, timely reporting of any incident that may lead to a claim is mandatory.

Proper claim management begins with employees promptly reporting claims to their supervisor. It is the supervisor’s duty to make each of their employees aware of and comply with these procedures described in this manual. It is the responsibility of each employee to report all incidents and/or accidents to his/her supervisor in accordance with this section.

Conducting effective incident investigations is the key to preventing claims. The guidelines outlined below provide techniques for conducting basic investigations for employee injuries, property damage, and other incidents leading to a claim.

Serious or complex claims may require in-depth investigations utilizing experts such as engineers, claims adjusters, local law enforcement agencies, attorney, etc. Employees shall be instructed not to admit fault or liability for a particular accident, especially those involving third parties.

Responsibilities

All employees have some responsibilities for reporting incidents and/or accidents to their supervisor. Typical responsibilities include the following:

1)Management

  1. Implement the Claims Reporting Procedures outlined in this manual.
  1. Conduct or arrange for incident prevention and investigation training for supervisors.
  1. Ensure that all accidents and injuries are properly investigated.
  1. Ensure that immediate and long-term corrective actions are taken to prevent reoccurrence of incidents and/or accidents.
  1. Provide light duty work if available, for injured employees as outlined by Human Resources and Risk Management.

2)Supervisors

  1. Conduct immediate initial investigations of all incidents and/or accidents related to their department.
  1. Report all incidents and/or accidents to Risk Management immediately.
  1. Collect and preserve all evidence that may be useful in an investigation.
  1. If the incident and/or accident cause injury to county employee (workers’ compensation), supervisors will interview all potential witnesses that may provide the root cause of the incident.
  1. If the incident and/or accident involves a third party (private property or person(s)), the department supervisor will develop a list of potential witnesses who may be interviewed by Risk Management or their appointed representative.
  1. Do not attempt to find or assign blame for incidents and/or accidents.
  1. Take appropriate action to protect people and property.

3)Employees

  1. Immediately report all incidents and/or accidents to your supervisor(s).
  1. Assist as requested in all incident and/or accident investigations.
  1. Report all hazardous conditions and near misses to supervisors.
  1. Do not admit liability to anyone.

4)Supervisors’ Involvement

In most cases, the department supervisor will conduct the initial phase of an incident investigation since he or she is most familiar with the employee’s work environment and assigned tasks. If a team approach is used, the same steps may be used.

  1. Immediate Steps
  1. Provide or arrange for first aid or emergency medical treatment for injured parties.
  1. Prevent further injury or property damage by eliminating or controlling any hazardous conditions or activities.
  1. Secure the accident scene so evidence is not destroyed.
  1. Notify Senior Management and Risk Management of serious accidents.
  1. File initial accident reports.
  1. Gather the Facts
  1. Observe and document general conditions scene of the incident and/or accident, including any potential safety hazards.
  1. Listen, let the witness speak freely and be professional, courteous, and considerate.
  1. Take notes without distracting the witness.
  1. If possible take photos or use sketches and diagrams to help with the investigation.
  1. Do not argue with the witness.
  1. Record the exact words used by the witness to describe each observation. Ask them to clarify any answers if necessary.
  1. Identify each potential witness and provide his or her name, address, and contact telephone number.
  1. Review the sequence of events that led up to the incident and/or accident.
  1. Record all relevant facts as outlined in the appropriate reporting form.

5)Determine Root Causes

Most incidents and/or accidents will have more than one root cause. Analyze the physical hazards, environment where the incident and/or accident occurred and behaviors of those involved.

  1. Determine what, if any unsafe conditions, such as tools and equipment, may have contributed to the incident and/or accident.
  1. Review pertinent policies and procedures to see if they may need to be revised.
  1. Consider whether at-risk behaviors of the injured, fellow employees, or third parties contributed to the incident and/or accident.
  1. Determine whether environmental factors such as weather, noise, etc. may have contributed to the incident and/or accident.
  1. Review all facts for accuracy.
  1. Develop a list of root causes of the incident.

6)Implement Corrective Actions

Once the root causes of the incident and/or accidents are identified, corrective actions need to be implemented for each root cause, so future incidents and potential accidents can be prevented. This may involve a number of measures including, but not limited to:

  1. Changing work procedures.
  1. Repairing or replacing defective equipment.
  1. Coaching or counseling employees who performed at-risk behaviors.
  1. Establishing new workplace policies or modifying existing ones.
  1. Providing safety equipment.
  1. Conducting safety training.
  1. Enforcing existing safety rules and procedures.
  1. Providing more effective supervision.
  1. Taking appropriate disciplinary action for any rule violations.

7)Follow-up

Follow-up must occur to ensure that any necessary corrective actions have been implemented and are working as designed. To ensure time frames are being met, the responsible supervisor should review the corrective action recommendations periodically.

Procedures

1)CountyRisk Management will be the main point of contact for any third party claims.

2)All potential losses must be reported to the department director and/or supervisors who are responsible for the initial investigation and reporting their findings to Risk Management.

3)Whenever possible, serious lossesmust be reported immediately to the department director and/or supervisor.

4)It is the department director and/or supervisor’s duty to take all reasonable steps to protect the County’s property from further damage. If feasible, the director and/or supervisor will set the damaged property aside and in the best possible order for examination.

5)All other non-serious losses are to be communicated to the Risk Management within 24 hours.

6)Self-explanatory claim forms are provided (see Addendums for proper form). If you have any questions regarding the claim procedures, please contact Risk Management.

7)Do not delay reporting any claim even though you may not have all of the necessary information. You can always submit a supplementary report or send additional information regarding the loss.

Where to report Claims

Report all losses and claims to Risk Management – 4th Floor via telephone, fax, or email:

Claims Reporting Procedures – Page 1

Risk Generalist

LeeCounty BoCC

2115 2nd Street

Ft. Myers, FL 33901

1-239-533-2509 Phone

1-239-485-2262 Fax

Risk Program Manager

LeeCounty BoCC

2115 2nd Street

Ft. Myers, FL33901

(239) 533-2221 Phone

(239) 485-2262 Fax

Claims Reporting Procedures – Page 1

ALL CLAIMS, REGARDLESS OF HOW MINOR, ARE TO BE REPORTED TO RISK MANAGEMENT within 24 hours.

Part I – IF YOU and/or your employee ARE INJURED IN A WORK-RELATED ACCIDENT THAT IS NOT LIFE threatening, YOU MUST DO THE FOLLOWING:

1)Report the injury to your supervisor or manager immediately.

2)For injuries that occur between 7:30 AM to 4:00 PM, Monday through Friday, call:

Employee Health Nurse

2115 Second Street, 3rd Floor, Room 323

Downtown Fort Myers

CountyAdministrationBuilding

(239) 533-2067

If Employee Health Nurse is not available, the injured employee should report to:

Lee Convenient Care Central

4771 S. Cleveland Avenue(next to Pep Boys at Page Field)

Fort Myers, Florida 33907

Phone (239) 274-7100

Fax (239) 274-7123

Hours of operation: 7:00 AM to 7:00 PM, 7-days a week, including holidays

  1. Any additional medical treatment would require authorization from the Employee Health Nurse, Workers’ Compensation Adjustor, or Risk Management.
  1. Prescriptions given to injured employee by authorized physicians can be filled at any local pharmacy. Employees are required to secure receipts for reimbursement.

Employees can also have prescriptions filled at:

Edison Prescription Shoppe (across from LeeMemorialHospital)

2665 Cleveland Avenue

Fort Myers, Florida 33901

Phone (239) 332-1612

Hours of operation:Mon. – Fri. 9:00 AM – 5:00 PM

Sat. 9:00 AM – 1:00 PM (closed Sundays)

Employees will not be asked to pay for Workers’ Compensation prescriptions at the above location.

3)Complete a “Supervisor Accident/Incident Investigation for Workers’ Compensation Injury” form and fax a copy to Risk Management at 485-2262 and Employee Health at 485-2094 within 24 hours. The original can follow by inter-office mail.

4)Employee shall do the following:

  1. Attend all scheduled appointments with authorized workers’ compensation physicians.
  1. Follow all instructions given to them by the authorized workers’ compensation physicians.
  1. Contact the Employee Health Nurse, Workers’ Compensation Adjustor, and/or Risk Management with concerns about their claim.

Part II – IF YOU and/or your employee ARE INVOLVED IN A WORK-RELATED INJURY THAT OCCUR AFTER HOURS, WEEKENDS, OR HOLIDAYS, which are non-life threatening, YOU MUST DO THE FOLLOWING:

1)Seek medical treatment at the following locations:

Lee Convenient Care Central

4771 S. Cleveland Avenue(next to Pep Boys at Page Field)

Fort Myers, Florida 33907

Phone (239) 274-7100

Fax (239) 274-7123

Hours of operation: 7:00 AM to 7:00 PM, 7-days a week, including holidays. If the above facility is closed, employees with non-life threatening injuries that do not incur loss of blood, are encouraged to seek treatment the next following day.

2)Complete a “Supervisor Accident/Incident Investigation for Workers’ Compensation Injury” form and fax a copy to Risk Management at 485-2262 and Employee Health at 485-2094 within 24 hours. The original can follow by inter-office mail.

3)Employee shall do the following:

  1. Attend all scheduled appointments with authorized workers’ compensation physicians.
  1. Follow all instructions given to them by the authorized workers’ compensation physicians.
  1. Contact the Employee Health Nurse, Workers’ Compensation Adjustor, or Risk Management with concerns about their claim.

Part III – IF YOU and/or your employee ARE INVOLVED IN A WORK-RELATED INJURY THAT IS Life Threatening AND REQUIRES IMMEDIATE Medical Attention,immediately CALL 9-1-1:

1)Ask a representative from the hospital to call the Employee Health Nurse or Risk Management (during normal business hours 7:00 AM to 4:30 PM) at (239) 533-2067.

2)The employee’s supervisor will complete a “Supervisor Accident/Incident Investigation for Workers’ Compensation Injury” form and fax a copy to Risk Management at 485-2262 and Employee Health at 485-2094 within 24 hours. The original can follow by inter-office mail.

3)Employee shall do the following:

  1. Attend all scheduled appointments with authorized workers’ compensation physicians.
  1. Follow all instructions given to them by the authorized workers’ compensation physicians.
  1. Contact the Employee Health Nurse, Workers’ Compensation Adjustor, or Risk Management with concerns about their claim.

A “vehicle crash” is any occurrence involving a vehicle owned by the County or any non-owned vehicle operated by an employee in the course of their duties; and/or which results in any property damage; and/or personal injury; regardless of who was injured, what property was damaged, to what extent.

Employee’s Responsibility

1)Stop immediately. All motor vehicle crashes must be reported to the local law enforcement agency. Call 911, provide first aid if necessary, DO NOT leave the scene of the accident and DO NOT move any patients unless they are at immediate risk.

2)Immediately, call your supervisor.

3)DO NOT ADMIT LIABILITY AND DO NOT ATTEMPT TO SETTLE YOUR OWN CLAIM. Do not make any statements regarding, who was at fault in the crash. Cooperate with investigating law enforcement by just providing the facts leading up to the crash. Cooperate with the County’s Claims Adjustor, and/or County Risk Management during the investigation.

4)Crashes involving injury or death must be reported immediately to Risk Management’s Office at (239) 533-2509. The report(s) must be faxed to (239) 485-2262.

5)Complete the VehicleCrashReport, (see Addendum 3). Obtain the crash report number, names of all parties involved, their addresses, phone numbers and any witnesses. This same information is usually available in a Drivers Exchange Information provided by the responding law enforcement agency.

6)If the County unit is inoperable, or unsafe to drive, notify the Fleet Management’s Service Desk at (239) 338-3239 for instructions on designated wrecker service for towing.

Supervisor Responsibility

1)DO NOT attempt to move any injured party unless they are at immediate risk.

2)Assure that proper law enforcement agency has been notified and call Risk Management to assist if necessary.

3)Review and complete the information on the Vehicle Crash Report. Try to maintain all evidence (photos are not necessary but are helpful).

4)Assist Risk Management as necessary to prepare reports and/or investigation.

5)If required,arrange a drug test for the County employee.

6)Submit a copy of the Vehicle Crash Report along with the “Driver’s Exchange Information” to Risk Management within twenty-four (24) hours.

Risk Management’s Accident/Incident Investigation Reports are considered “CONFIDENTIAL” and are exempt from public disclosure until termination of all lawsuits and settlement of all claims pursuant to F.S. Section 768.28 (15)(b)


General Liability claims include all liability claims other than injuries or damages caused by licensed motorized vehicles. This includes losses resulting from slips and falls, pot holes, civil rights, false arrest, personal injury or injury on recreation equipment, heavy equipment accident, improper warning in construction areas, etc.

1)The department director and/or their line supervisors will complete a LiabilityAccident/IncidentReport (see Addendum 4) and forward completed form to Risk Management with in twenty-four (24) hours. The purpose of this report is to provide Risk Management with the who, what, where, and how, so that Risk Management can appropriately respond to any claimant’s request to a given incident and/or accident.

2)The department director and/or supervisors will forward any evidence and documents as requested to Risk Management and/or the County Attorneys Offices.

3)County employees will not attempt to make any settlement, or commit the County to any payment, nor make any statements as to the cause of the incident, without speaking to Risk Management and/or CountyAttorneys Offices.

Please be advised that, all Liability Claims, and Liability Incident Reports, are CONFIDENTIAL and exempt from public disclosure until termination of all litigation and settlement of all claims pursuant to F.S. Section 768.28 (15)(b).

Property losses include losses to either real or personal property owned or under the care, custody, and control of the County. Examples of these types of losses are, but not limited to: windstorm, fire, theft, vandalism etc., to building or contents.

1)Department director and/or supervisor will assist Risk Management in any investigating and reporting of all property losses.

2)It is the department director’s duty and responsibility, to protect their assigned property and/or building(s) from further damage. Any extra expenses associated with emergency repairs may be considered part of the County’s insurance claim, subject to the County’s policy conditions and limits.