Claims and Loss Control

Clearly, the most effective way to deal with claims…is to avoid them. But accidents happen – and HAI Group is here to help members be prepared to defend themselves when claims and lawsuits are filed. These defensive techniques are classified as “post-event loss control activities”; they are actions or procedures that are carried out after an accident happens.

Claims Process

When you need to file a claim, the process should be as simple as possible for you and your housing agency. This section provides information to guide you through the claims handling and filing process. Please click any of the links below for help ranging from pre-event documentation and claims reporting to recordkeeping.

Pre-Event Documentation

The most important procedure in the pre-event phase is establishing and maintaining accurate documentation of your risk control activities. This documentation not only establishes policies and procedures to help prevent unwanted accidents, but it also provides a measure of proof that can help defend your housing agency against a future claim. For instance, consider accidents involving smoke detectors. Many housing agencies require their maintenance employees to test and inspect living unit smoke detectors during every work order visit. The smoke detector test should be documented on the work order or separately on an inspection form to provide proof that inspection has taken place.

Reporting a Claim

Your first priority, whether a claim is for property or liability, is to report the loss as quickly as possible after the incident. Investigating a claim in a timely manner allows the investigating team to collect facts while they’re still fresh in the minds of involved parties. Immediate assessment also allows investigators to view the location, if needed, before changes are made to the site. Please note, if a claim is reported late, or not reported at all, coverage could be restricted or even denied.
Report a Claim »

After a Claim is Filed

The insurer will designate a claims examiner to investigate, detail, document, and appraise every aspect of the claim. A determination is then made as to whether or not the claim is covered by your insurance policy – during this process, deductibles and other individual housing agency policy provisions are taken into consideration. Legal counsel, experienced claims adjusters, or appraisers are used to help settle claims as quickly as possible. Insured housing agencies can receive regular reports that indicate the status of their outstanding claims reserves, as well as claims paid. Loss reports are available in the User Dashboard once you log into this website.

After a Property Loss

Post-event loss control (or action taken after an incident takes place) is needed to prevent further property loss or additional accidents beyond what has already taken place. Depending upon the type of loss, post-event loss control can include:

  • Boarding up openings in a damaged structure
  • Locking doors
  • Covering openings in a roof
  • Draining heating systems
  • Turning off electricity

If you have a loss as a result of a “hazard,” it’s important to remove the hazard or secure the area as quickly as possible to prevent further or additional losses.

Factual Investigations

Housing agencies must establish formal procedures that will be carried out after an accident or loss on your property. These procedures, if conducted properly and promptly, will help reduce the cost of a claim against a housing agency, or may even become a factor in eliminating the claim altogether. All of your employees should be trained adequately in post-event loss control. Detailed below are basic questions that need to be answered if an accident or incident occurs on housing agency property:

Who? The name, address, date of birth, Social Security number, occupation, name of guardian (if minor), and gender of the person(s) involved, and whether he/she is a resident, visitor, or contractor.

What? The nature of the accident or incident and the injury(ies). Approach witnesses for an accurate statement and record witness(es) name, address and phone number. Document the exact sequence of events that led to the circumstances of the incident. Use a step-by-step approach to determine what happened, including every person and every object that contributed to the occurrence. Select words judiciously, stating the facts, but leaving out opinions. Include estimated property damage costs, even though actual costs will be determined later.

When? The date and time of the event, as well as weather and lighting conditions. Be aware that incidents are sometimes alleged to have occurred days and even weeks prior to the date they are reported. The “when” data have tremendous value in legal actions and in court decisions, and they are a key indicator of the need for additional investigation.

Where? The exact location of the accident or incident, with notes on details that may have caused the event or been a factor. Take photos whenever possible.

Recordkeeping

Following a factual investigation as described above, all details should be documented, and the appropriate Claim Forms completed and forwarded to the insurance company for resolution. Despite negligence by the injured, injuries occurring on housing agency property have the potential to become claims. It is critical that full documentation is on file to prove any valid defense if a claim is later filed against a housing agency.

The key to all recordkeeping is good file maintenance. Organized, accurate files are especially important when claims are made against a housing agency, and timely accessibility to these files will improve the efficiency of the legal defense process. Computer tracking programs that are designed to improve record keeping are recommended, so the defense team will have access to critical documentation that has an audit trail. Examples of activities that would benefit from having computer audit trails are: maintenance work order systems; housing unit modernization and improvement programs; and accident investigation records.

Professionals Standing By, Ready to Help

It may seem daunting to estabilsh loss controls and prepare organized files and documentation, but we have a full team of professionals ready to help you through the entire process. Each step of the way we’re available to answer questions, research your needs, and help you enjoy the best possible protection.