No business wants an incident to happen in the workplace, or anything else that requires filing an insurance claim. But despite your best efforts — robust safety procedures, a great risk management program, and more, it’s good to be prepared for disaster to strike. And no matter what industry you’re in or how large your business is, some business insurance policies are a must.
Workers’ compensation insurance, for instance, is required by law. You’re also better off having general liability insurance, property, and cyber insurance. Other policies, depending on the scale and industry of your organization, could include auto claims, professional liability, employment practices liability, and more.
It’s a good idea to be prepared for an incident by setting up an efficient claims management process. In addition, every insurance claim needs to be reported. Depending on the type of claim, claim reporting can be to one or more different organizations. For example, if an incident requires a workers’ compensation claim, this needs to be reported to both the insurance company and OSHA.
In this article, we’ll see how a typical claim needs to be reported and how to make the process easier and smoother.
Claim Reporting to Regulatory Bodies
While reporting an incident or claim to the relevant insurance company is essential for you to get compensation for your insurance claim, it’s sometimes required by law to make a claim report to regulatory bodies as well.
The best example of this is in case of an incident resulting in a work injury. After you get the required emergency medical treatment for the injured worker, you must first report the claim to OSHA or your local Department of Labor branch using the relevant state claims form. If you fail to make this claim report, it can result in a denial of your claim as well as legal and financial penalties as defined by your state.
But making this simple report part of your claims process will certainly help you with your claim and ensure that you’re covering your bases legally.
Claim Reporting to Insurance Companies
Before diving into the actual reporting of claims, let’s talk a bit about insurance policies and why you need to report claims in addition to filing them.
Insurance policies are contracts that create obligations on the part of both the insurer and the claimant or policyholder (i.e., you as the business with the insurance policy). The main obligation, of course, is that you (the policyholder) pay a fixed premium for the insurance and the insurer resolves any claims you make by paying you (or a third party like a medical provider on your behalf) the amount decided through the claims process.
Another basic obligation of the claimant is to report your claims as quickly and accurately as possible (i.e., communicate that an incident has occurred) to the insurer. Failure to report the claim within a fixed time period (specified in the insurance contact) may even lead to a denial of the claim.
Usually, this is not a problem, especially if the claim is directly related to your workplace, such as auto insurance for a work vehicle or workers’ compensation. But it could be challenging if the claim is delayed by a third party (e.g., a product liability claim coming from a customer). The best way to avoid such issues with your claims is a streamlined claim reporting process that makes it easy for all sources of claims (including third-parties like customers or suppliers) to report the claim.
How to Make a Claims Report
When it comes to claims reporting, it may be easy to get drawn into the paperwork and forget what’s important: That the point of reporting a claim is to help the insurance company decide on the validity of your claim and how much they owe you. It may seem complicated, but here are some simple things to keep in mind to make your claims reporting smooth and efficient.
Who Reports the Claim
Depending on the type of incident or claim, different people may be responsible for reporting the claim. Here are some examples:
- A workers’ compensation claims report is usually completed by the supervisors of injured employees
- An insurance claim for a fleet auto accident is usually reported by the fleet program manager or a driver
- If the claim involves a specific product, the manager in charge of the product will make the claim
Information for this report is best obtained from either people directly affected or involved, or if that’s not possible, a witness who knows all the initial facts.
The First Report
While reporting an insurance claim, it is important to remember that a quick report does not mean an inaccurate one. Even a preliminary report, which is limited in scope, must include as much detail as possible about:
- Who was involved
- What was damaged
- When, where, and how did the incident happen
These basics are important to answer the question of whether or not the insurance policy applies to the situation.
A More Detailed Report
While the who, what, when, where, and how information needs to be quickly jotted down to report to the insurance company ASAP, it’s good to make a more detailed report that will help your insurance adjuster with their investigation into the claim. Some of these details would include:
- The identity and contact information for witnesses who can support your claim
- Any evidence (physical, photo, or video-based) showing damages relevant to the claim
- Documents related to any precautions you took to ensure that such incidents do not take place — this strengthens your claim as it shows the insurer that you did the best you could to mitigate any risks.
- Any additional information that might be relevant to the claim (e.g., an incident investigation report)
When to Report the Claim
Although different insurance policies have different deadlines (e.g., a workers compensation claim can be reported up to 30 days after an accident), remember that rapid reporting leads to better claims outcomes. Here are some benefits of quick and thorough claim reporting (most important in case of work injuries):
- The injured worker can get appropriate medical care sooner rather than later, which in turn, leads to better medical outcomes such as decreased likelihood of permanent injury
- Any identified safety violations can be quickly fixed, protecting other employees
- The claim is more likely to have a favorable outcome, leading to everyone being satisfied and thus no legal disputes with injured parties
- Any fraud (if applicable) can be identified and addressed
- Property and equipment damage can be fixed quickly so that business operations can resume faster
- A history of timely and accurate claims reporting can even lead to reduced cost of claims and related insurance premiums
Automate the Claims Process for Better Reporting
Although claims reporting is not difficult, it is tied into other processes of incident and claims management. So if incident investigation and claims administration are slow or inaccurate, that will affect your claims reporting, and ultimately, your insurance claim itself.
The best way to streamline claims reporting is to automate the entire claims process. Using a claims management platform such as Pulpstream will allow you to consolidate all information, witness statements, evidence, etc. related to the claim in one place, automate communication and notifications to stakeholders, and even perform analytics to find patterns. All of this will make it much easier to create a claims report quickly and send it to the insurance company as well as any required regulatory bodies.
Make claims reporting easier for your team with Pulpstream today! Book a free demo now.