office of risk management annual conference 2010 regional conference general liability claims...

Office of Risk Management Annual Conference

2010 REGIONAL CONFERENCE

GENERAL LIABILITY CLAIMS

MEDICARE

MSA SECTION 111 REPORTING

NEW LEGISLATION

Office of Risk Management Annual Conference

GENERAL LIABILITY CLAIMS

KATHLEEN GASSER, CLAIMS MANAGER

kathleen.gasser@la.gov

225-342-8433

JIMMY MEAUX, CLAIMS SUPERVISOR

jimmy.meaux@la.gov

225-342-8463

Office of Risk Management Annual Conference

GENERAL LIABILITY TEAM JIMMY MEAUX, SUPERVISOR TOM BLUFF PENNY BUCHANAN BARBARA BURNS LYNDA COLOMB JIMMY MARTIN BERTHA MEISNER BYNIE WELLS MARION WILLETT DIANE WILLIAMS

Office of Risk Management Annual Conference

WHAT DO WE COVER? THE STATE OF

LOUISIANA PROVIDES INSURANCE COVERAGE FOR THIRD PARTY BODILY INJURY AND PROPERTY DAMAGE CLAIMS FOR WHICH THE AGENCY COULD BE HELD LEGALLY LIABLE.

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GENERAL LIABILITY CLAIMS

CLAIMS ALLEGING DAMAGES IN TORT DUE TO NEGLIGENCE BY THE STATE OF LOUISIANA, STATE EMPLOYEES AND/OR STATE AGENCIES.

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GENERAL LIABILITY NEW CLAIMS GENERAL LIABILITY

CLAIMS INCREASED IN 2007 DUE TO THE INFLUX OF HURRICANE KATRINA CLAIMS FILED PRIOR TO THE SPECIAL 2 YEAR DEADLINE.

2009 INCREASES IN NEW CLAIMS WERE RECEIVED FROM DOC AND THE UNIVERSITIES.

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CIVIL RIGHTS NEW CLAIMS CIVIL RIGHTS CLAIM

COUNT INCREASED IN 2006 AND 2007 DUE THE NUMBER OF CLAIMS FILED AGAINST DEPARTMENT OF CORRECTIONS AFTER HURRICANE KATRINA.

2009 INCREASE DUE TO AN INCREASE IN DOC CLAIMS.

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GENERAL LIABILITY CLOSED CLAIMS

CLOSED CLAIMS INCLUDE BOTH LITIGATED AND NON-LITIGATED CLAIMS.

THE INCREASE OF CLOSED CLAIMS SEEN IN 2007 IS GREATEST AT THE UNIVERSITIES FOR NON-LITIGATED CLAIMS.

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CIVIL RIGHTS CLOSED CLAIMS IN 2006 WE CLOSED

ALMOST 100 MORE LITIGATED CLAIMS AGAINST DEPARTMENT OF CORRECTIONS THAN IN 2007 AND 2008.

SEVERAL OF THE LAWSUITS HAD MULTIPLE PLAINTIFFS

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2009 PENDING CLAIMS

GENERAL LIABILITY 1,657

CIVIL RIGHTS 809

TOTAL 2466

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NEW CLAIMS: 1,112 CLOSED: 668 PENDING: 1,657 PAID: $6,748,890.79 SETTLEMENTS: 134

PERFORMANCE OVERVIEW GL

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PERFORMANCE OVERVIEW CR NEW CLAIMS: 253 CLOSED: 206 PENDING: 809 PAID: $2,676,233.10 SETTLEMENTS 38

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CUSTOMER SERVICE ONE ADJUSTER WILL HANDLE CGL CLAIMS

FOR THE ENTIRE AGENCY IN ORDER TO PROVIDE MORE EFFECTIVE CUSTOMER SERVICE.

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HOW TO REPORT A CLAIM For injuries

sustained by visitors to your agency, have agency contact complete the CGL claim form found on our website:

www.doa.la.gov/orm

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When a Loss Occurs All Property which has been damaged is to

be protected against further damage and is to be made available for inspection by a claims adjuster assigned by ORM.

The agency is not to assume any obligation or incur any expenses without the authority of ORM.

Office of Risk Management Annual Conference

REPORTING CGL CLAIMS IN WRITING TO: JIMMY MEAUX, SUPERVISOR KATHLEEN GASSER, MANAGER OFFICE OF RISK MANAGEMENT P. O. BOX 91106 BATON ROUGE, LA 70821-9106 IF LOSS IS SERIOUS IN NATURE, PLEASE

TELEPHONE IT IN TO (225) 219-0168.

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REPORTING FORMS http://doa.louisiana.gov/orm/word/glloss.do

c http://doa.louisiana.gov/orm/word/DA3000.

doc

Office of Risk Management Annual Conference

Office of Risk Management Annual Conference

Office of Risk Management Annual Conference

Office of Risk Management Annual Conference

Office of Risk Management Annual Conference

How You Can Help Tell us about conditions that contributed

to the accident: Wet floor, any warning signs? Holes, barriers, irregular surface Lighting Weather Handicap Eyeglasses Carrying anything that might obstruct

vision

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WHAT TO SAY TO THE CLAIMANT

YOU WILL REPORT THE INCIDENT TO YOUR INSURER, ORM.

DO NOT PROMISE THAT THE CLAIM WILL BE PAID.

DO NOT SEND ANYONE TO A DOCTOR OR PROMISE TO COVER MEDICAL BILLS.

COVERAGE OF THE CLAIM AND LIABILITY ISSUES ARE DETERMINED BY ORM.

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Take Photographs of the Scene Label with name of injured party and date Take some photos that show location and

landmarks

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PRESERVE EVIDENCE TAG AND LABEL

DAMAGED ITEMS WITH CLAIMANT’S NAME AND DATE OF LOSS.

DO NOT DISCARD ITEM. PHOTOGRAPHS SHOULD

LIST DATE OF LOSS, CLAIMANT NAME AND PHOTOGRAPHER’S NAME.

DIAGRAMS, MEASUREMENTS, AND MAPS ARE USEFUL.

WITNESS NAMES AND CONTACT INFORMATION SHOULD BE PROVIDED TO ORM.

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NEW CLAIM

HOW YOU CAN HELP ORM

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HIGH EXPOSURE POTENTIAL CLAIM

SERIOUS INJURY DEATH FIRE EXPLOSION MAJOR PRIVATE PROPERTY DAMAGE

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LIMITATION OF LIABILITY FOR PUBLIC ENTITIES

R.S. 9:2800 …NO PERSON SHALL HAVE A CAUSE OF

ACTION BASED SOLEY UPON LIABILITY IMPOSED UNDER CC ARTICLE 2317 AGAINST A PUBLIC ENTITY FOR DAMAGES CAUSED BY THE CONDITION OF THINGS WITHIN ITS CARE AND CUSTODY UNLESS IT HAD ACTUAL OR CONSTRUCTIVE NOTICE OF THE VICE OR DEFECT, HAD REASONABLE OPPORTUNITY TO REMEDY IT AND FAILED TO DO SO.

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LIMITED LIABILITY

ACTUAL OR CONSTRUCTIVE KNOWLEDGE OF DEFECT OR DANGEROUS CONDITION

TIME TO REMEDY THE CONDITION FAILURE TO DO SO

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WHAT IF A LAWSUIT NAMES A STATE EMPLOYEE AS A DEFENDANT?

IF YOU ARE SUED

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LOUISIANA GOVENMENTAL CLAIMS ACT

R.S. 13:5101 et seq. ARISING OUT OF THE DISCHARGE OF HIS

OFFICIAL DUTIES OR WITHIN THE COURSE AND SCOPE OF HIS EMPLOYMENT

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EMPLOYEE COVERAGE R.S.13:5108.1

INDEMNIFICATION OF STATE EMPLOYEES ORM IS THE INSURER STATE EMPLOYEE OR AGENCY IS THE

INSURED DEPARTMENT OF JUSTICE PROVIDES

DEFENSE

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YOU MUST REQUEST REPRESENTATION BY THE

ATTORNEY GENERAL WITHIN 10 DAYS OF DATE OF SERVICE OF

THE PETITION INCLUDE A COPY OF THE PETITION AND

SERVICE INFORMATION

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FREQUENTLY ASKED QUESTIONS

???

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WERE WE NEGLIGENT IN MAINTAINING A SAFE ENVIRONMENT?

TAKE PICTURES OF THE AREA OF THE FALL NOTE WHETHER CLAIMANT WAS WEARING

GLASSED, CARRY THINGS, AND WHAT TYPE OF SHOES WORN

PROVIDE CONTACT INFORMATION AND WITNESS DATA

DO WE COVER TRIP AND FALLS?

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FALLS THAT INVOLVE A CHAIR? ONLY IF AGENCY IS NEGLIGENT IN

MAINTAINING CHAIR IN SAFE CONDITION IF BROKEN, SAVE IT AND LABEL IT NOTE MANUCATURER AND SUPPLIER OF

THE CHAIR, IF DEFECTIVE TAKE PICTURES AND LABEL PROVIDE WITNESS DATA

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TRIP AND FALLS IN ELEVATORS? PROVIDE MAINTENANCE COMPANY

INFORMATION CHECK TO SEE IF MALFUNCTION WAS

PREVIOUSLY REPORTED

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LOSS OF PERSONAL PROPERTY

MUST DETERMINE CARE, CUSTODY AND CONTROL

IF PROPERTY WAS LEFT BEHIND AND THEN LOST OR STOLEN, IT WOULD BE ABANDONMENT BY THE OWNER, NOT NEGLIGENCE ON THE PART OF THE STATE

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DAMAGE TO PRIVATE CAR? FALLING TREE BRANCHES? DEPENDS ON

WHETHER IS WAS LIVE OR VISABLY DEAD. NEED PHOTOS OF TREE, BRANCH AND AUTO

GATE ARM? IF IT MALFUNCTIONED VANDALISM BY UNKNOWN PERSON? NO OUR MOWER? YES, IF AUTO WAS INSURED NEED PROOF OF INSURANCE

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THEFT OR BURGLARY OF PRIVATE AUTO

THE STATE IS NOT THE INSURER OF PRIVATELY OWNED AUTOS. WE ACT AS A GRATUITOUS DEPOSITORY ONLY.

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DO WE COVER INJURIES OR DAMAGES CAUSED BY WILDLIFE?

VEHICLE TRAVELING ON STATE HIGHWAY HITS A DEER? NO

VISITOR TO STATE PARK RECEIVES INSECT BITE/SNAKE BITE? NO

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MEDICARE MANDATORY REPORTING

SECTION 111 OF PUBLIC LAW 110-173 MEDICARE BENEFICIARIES WHO RECEIVE

SETTLEMENTS/JUDGMENTS THAT INCLUDE MEDICAL PAYMENTS MUST BE REPORTED IN 2010

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MEDICARE REPORTING MEDICARE NUMBER OR SOCIAL SECURITY NUMBER DATE OF BIRTH GENDER CORRECTLY SPELLED NAME AS ON THE SSN

CARD

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MEDICARE REPORTING INSURANCE INFORMATION NOTICE 2010-1 REPORTING REQUIREMENTS FOR SECTION

111 OF THE MEDICARE, MEDICAID AND SCHIP EXTENSION ACT OF 2007

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EMPLOYMENT LIABILITY LILLY LEDBETTER FAIR PAY ACT OF 2009 SIGNED JANUARY 29, 2009 EACH PAYCHECK THAT DELIVERS

DISCRIMINATORY COMPENSATION IS A WRONG ACTIONABLE UNDER EEO STATUTES

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FAIR PAY ACT OF 2009 APPLIES TO ALL CLAIMS OF

DISCRIMINATORY COMPENSATION RETROACTIVE EFFECTIVE DATE OF MAY 28,

2007 ADDITIONAL INFORMATION AT

HTTP://WWW1.EEOC.GOV//LAWS/STATUTES/EPA_LEDBETTER.CFM

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ADA AMENDMENTS ACT OF 2008 EFFECTIVE JANUARY

1, 2009 EXPANDS THE

DEFINITION OF MAJOR LIFE ACTIVITIES

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ADA AMENDMENTS ACT OF 2008 REJECTS A STRICT

INTERPRETATION OF THE DEFINITION OF DISABILITY

ADA TO PROVIDE BROAD COVERAGE

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ADA FURTHER INFORMATION NOTICE CONCERNING ADA AMENDMENTS

ACT OF 2008

www.eeoc.gov/ada/amendments

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FAMILY MEDICAL LEAVE ACT EFFECTIVE JANUARY 16, 2009 IMPLEMENTS MILITARY FAMILY LEAVE GUIDANCE ON QUALIFYING EXIGENCIES EMPLOYER NOTICE REQUIREMENTS FINAL RULES EFFECT ON ATTENDANCE INTERMITTENT LEAVE GUIDANCE ON CERTAIN SERIOUS HEALTH

CONDITIONS

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FAMILY MEDICAL LEAVE ACT FOR FURTHER INFORMATION: www.dol.gov/esa/whd/fmla

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NEW LEGISLATION THREE ACTS THAT PROTECT VOLUNTEERS

OR LIMIT CIVIL LIABILITY IN EMERGENCY SITUATIONS

ACTS: 295, 231, 397 ACT 372: PROTECTS HEALTHCARE

PROVIDERS WHO REFUSE TO PROVIDE CERTAIN SERVICES

ACT 13: VENUE LA GOVERNMENTAL CLAIMS ACT