We recently received an article from one of the insurance companies we represent which outlined a real-life example of why it is so important to report claims, no matter how minor, in a timely fashion.
In the example, the driver had burned his arm in the process of unloading. The driver decided it was a “minor” injury, since the burn was only the size of a quarter. Rather than reporting the injury to his employer, he simply covered it with a band-aid and went on with his day.
Fast forward a couple weeks and employer notices the unhealed wound. He asks the driver what happened and, after hearing the tale, does not report the injury to the company’s workers’ compensation insurance carrier.
Another three weeks pass and the driver experiences “bladder pain.” He heads to the local emergency room to have it looked at. Ultimately he is admitted to the hospital for an antibiotic resistant staph infection in his blood stream, which spread to his arms, kidneys and heart. While in the hospital medical staff diagnose the driver as being diabetic, which they list as the major contributing factor to his arm not healing and the catalyst to the infection spreading throughout his body. Health professionals determine the only way to relieve the extreme swelling of the driver’s arms is to make a large incision in each arm.
Sometime after he originally visited the emergency room the employer reports the original burn injury to their workers’ compensation carrier. The driver is ultimately hospitalized for more than five weeks from the date he first sought treatment for “bladder pain”.
Many times our clients fail to realize that their commercial insurance policy includes certain contractual claim reporting “duties” on the part of the insured and that failing to fulfill these contractual obligations can result in claims being denied. As an example, one workers’ compensation policy claims reporting provision reads, in part, “Your Duties if Injury Occurs…Tell us at once if injury occurs that may be covered by this policy.”
Fortunately in this case, despite the motor carrier’s failure to comply with their insurance policy’s claims reporting requirements, the insurance company chose not to deny the claim. However, because the claim was reported so late the insurance company was unable to direct the driver to an appropriate specialist who could have offered appropriate and timely treatment and follow-up care. As a result, the insurance company estimates that this claim (which likely could have been resolved for only a few hundred dollars) will now have associated with it nearly a half-million dollars in medical bills and lost wages. By far the most upsetting consequence of this claim not having been reported immediately is that the driver is now expected to have permanent damage to both of his arms, which may in turn prevent him from ever returning to work as a truck driver.
It cannot be stressed enough just how important it is to report all claims, no matter how minor they may appear at the onset, in a timely fashion. I would hate to see a client’s claim be denied due to non-compliance with their insurance policy’s claim reporting provision. Additionally, we can never foresee when it might be a matter of one’s livelihood or even life. If you have any questions regarding your insurance carriers claims reporting process or contact information, please call our office today at (800) 596-TRUCK (8782). At the Navigator Truck Insurance Agency we work hard to be accessible, helpful and result oriented.
Until next month,
Jeffery A. Moss, ARM
President