Making a Claim / Notifying a Circumstance
Insurance claims are all unique; a negligence allegation; a stolen laptop, a fire, getting sick overseas, losing all your data or a disgruntled employee. No two claims are ever the same.
Therefore the advice and assistance of an insurance professional to make your claims experience a good one is paramount. Our experienced team of insurance professionals appreciate that the only time you get real value from your insurance policy is in the event of a claim.
Professional Indemnity - PPRUA
We act as agent for the Insurer in receiving and managing claims and notifications.
When to notify:
Whenever a complaint of breach of professional duty is made against you
• whether the complaint is made by a client or non-client
• whether the complaint is made in writing or verbally
• whether you believe the complaint to be justified or not.
Whenever in the course of your practice you become aware of any act or omission by you, your employees or your sub-consultants that might give rise to a claim against you - even if no complaint has been articulated against your practice.
The claim / notification process:
Claims and Notifications must be reported in writing. This is done by completing a Notification of Circumstances (‘NOC’) form, which can be obtained from your account manager or may be downloaded from www.professionalriskserices.com.au. Attach any supporting documents to the NOC form.
Do not make any statement on the NOC form that could be construed as an admission of fault. Confine your notification to statements of fact, and leave expressions of opinion for later discussion with a Claims Manager.
If the matter is urgent, immediate telephone advice can be obtained from one of our legally qualified Claims Managers.
Return the completed NOC form by fax or post to:
Planned Professional Risks Underwriting Agency
236 Balaclava Road
North Caulfield 3161
(PO Box 2257 Caulfield Junction)
Fax: (03) 9500 2274
Receipt of your notification will be acknowledged in writing. A Claims Manager will evaluate the notification, and contact you by telephone or in writing as is necessary, to obtain further information that may be required, and advise you as to the steps to be taken in the management of the matter.
Some rules to note and observe
If you fail to notify at the appropriate time, you may forfeit your entitlement to indemnity. If you are in doubt as to whether a circumstance is notifiable, speak to your account manager or a Claims Manager. The golden rule is – IF IN DOUBT, NOTIFY.
Early notification enables us to determine what, if any, steps can or ought to be taken immediately to protect both your interests and those of the Insurer. This is critical to reducing the overall cost of claims.
Open a separate file for your correspondence and communications with us. Do not place these documents on your project file.
Your dealings with us are private and confidential, and not your client’s concern:
o Do not tell your client that you have notified your Insurer. Many claimants are opportunistic, and may press on with a claim, or exaggerate the claim, when they know an Insurer is involved.
o Do not provide your client with copies of communications passing between you and us and do not identify us or your Insurer by way of ‘cc’ on any correspondence you send to your client.
When you become aware of a claim or a circumstance that might give rise to a claim, you must not do anything that could increase the amount of a claim or prejudice your Insurer’s rights. To avoid potential problems in this regard:
• Keep us fully informed of developments, and seek our consent before taking steps in the management of any matter you have notified.
• Do not volunteer documents from your project file to your client, loss adjusters or other third parties without first consulting us. Claimants are often ‘fishing’ for information to use against you.
• Do not sign any statements prepared by your client’s solicitor or barrister without our prior approval. Neither should you attend meetings with them without first checking with us, and avoid going to such meetings on your own.
• If you have continuing contractual obligations (e.g. as contract superintendent or assessor) do not ignore those duties – if in doubt, seek advice from us or from your own solicitor.
• Do not make embarrassing notes or comments on original documents you receive from others. They will most likely be subject to the rules of discovery and could later be used against you.
Professional Indemnity - Non PPRUA
We act as an intermediary between the Insured (“you”) and the Insurer, representing your interests as a broker in receiving and managing claims and notifications.
When to notify:
Whenever a complaint of breach of professional duty is made against you
• whether the complaint is made in writing or verbally
• whether you believe the complaint to be justified or not
Whenever in the course of your practice you become aware of any act or omission of yours, your employees or your sub-consultants that might give rise to a claim against you - even if no complaint has been articulated against your practice.
Claims and Notifications must be reported in writing.
This is done by completing a Notification of Circumstances (‘NOC’) form, which can be obtained from us. Attach any supporting documents to the NOC form.
Do not make any statement on the NOC form that could be construed as an admission of fault. Confine your notification to statements of fact.
Planned Professional Risk Services
236 Balaclava Road
North Caulfield 3161
(PO Box 2257 Caulfield Junction)
Fax: (03) 9500 2274
Receipt of your notification will be acknowledged in writing.
We will send your completed NOC form to the Insurer for their action and we will then facilitate communications between you and the Insurer.
We have no responsibility in the management, decision making or settlement of these matters.
If you fail to notify at the appropriate time, you may forfeit your entitlement to indemnity. If you are in doubt as to whether a circumstance is notifiable, speak to your broker or a Claims Manager. The golden rule is – IF IN DOUBT, NOTIFY.
Open a separate file for your correspondence and communications with us and your Insurer. Do not place these documents on your project file.
Your dealings with us and your Insurer are private and confidential, and not your client’s concern:
• Do not tell your client that you have notified your Insurer. Many claimants are opportunistic and may press on with a claim or exaggerate the claim when they know an Insurer is involved.
• Do not provide your client with copies of communications passing between you, us and your Insurer and do not identify your broker or Insurer by way of ‘cc’ on any correspondence you send to your client.
When you become aware of a claim or a circumstance that might give rise to a claim, you must not do anything that could increase the amount of a claim or prejudice your Insurer’s rights. To avoid potential problems in this regard:
• Keep us fully informed of developments and seek your Insurer’s consent before taking steps in the management of any matter you have notified.
• Do not volunteer documents from your project file to your client, loss adjusters or other third parties without first consulting your Insurer. Claimants are often ‘fishing’ for information to use against you.
• Do not sign any statements prepared by your client’s solicitor or barrister without your Insurer’s prior approval. Neither should you attend meetings with them without first checking with your Insurer, and avoid going to such meetings on your own.
• If you have continuing contractual obligations (e.g. as contract superintendent or assessor) do not ignore those duties – if in doubt, seek advice from your Insurer or from your own solicitor.
• Do not make embarrassing notes or comments on original documents you receive from others. They will most likely be subject to the rules of discovery and could later be used against you.
Non Professional Indemnity
We act as an intermediary between you and your insurer, representing your interests as a broker in receiving and managing claims.
Minimising further loss
In relation to any loss you are expected to act as a prudent uninsured. This means you are expected to take immediate prudent action to minimise further loss by acting as if you were not insured eg arranging for emergency repairs to prevent further damage, acting to secure premises after a burglary or cleaning up a liability risk etc.
Contact Us
You should contact us as soon possible to report your loss. We will
Report your claim to your insurers
Provide you with specific advice regarding the claim
Arrange for any claim forms or other required documentation to be sent to you
Arrange for your insurer to appoint a loss adjuster if required
Advise you what documentation etc you will need to include in your claim report
Advise you once your insurer has confirmed policy coverage
Liaise between you and your insurer on any contentious matters
Each insurer treats and acts upon claims differently and policy wordings and coverage vary form insurer to insurer. For these reasons and because we do not act for the insurer we can not confirm policy coverage to you until your insurer has confirmed coverage to us.
ADELAIDE • BRISBANE • MELBOURNE • PERTH • SYDNEY
ABN 65 005 754 718 | Australian Financial Services Licence No 231203
© 2011 IBL Limited trading as Planned Professional Risk Services.
All Rights Reserved | Disclaimer |
Privacy Statement | FSG |