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
225-342-8433
JIMMY MEAUX, CLAIMS SUPERVISOR
225-342-8463
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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
Office of Risk Management Annual Conference
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
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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
Office of Risk Management Annual Conference
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