Claims 101: How Preferred members can mitigate claims costs


by Monika Coleman, Liability Claims Supervisor, PGCS

Position yourself to minimize the impacts of claims by building a physical incident response plan into your culture of safety and security. The first steps you take after an incident can significantly reduce the negative financial and reputational impacts of incidents and claims.

Assign an uninvolved responder, if possible, to collect information and offer comfort to victims without interfering with first responders. Someone who has just been involved in a car accident or witnessed a co-worker get injured is justifiably pre-occupied. Train your responders to gather facts that will help get an injured worker prompt, appropriate treatment, and help the adjuster quickly and accurately determine compensability and liability. This information can later be used to target your loss control resources to reduce frequency and severity. Some key information to gather:

  • A detailed description of the accident and location
  • Written statements from involved employees
  • Details like equipment malfunctions, horseplay, aggressor in fights
  • Year, make, model, plate, VIN or serial numbers for vehicles and equipment, and their location if moved from scene.
  • Names and two types of contact information for all potential witnesses
  • Information on the responding agencies (police, fire, EMS) and reports
  • Material Safety Data Sheets for any chemical exposures
  • Source patient information for pathogen and blood exposures
  • Scan for cameras and note locations: body-worn, in vehicles or on houses/buildings
  • Photographs or video of the location, zoomed in and out, all four corners of the vehicle(s), defects, objects/spills, injuries if allowed
  • Possession of machinery, objects involved. Secure as evidence
  • Ownership, maintenance records and contracts for the location

Create an easy method for staff and citizens to report hazards and incidents. Secure locations or equipment with warnings if they cannot be immediately repaired. This reduces hazards and shows your employees and customers that their safety is prioritized. Use signed employee and supervisor/responder report forms to keep records that can be provided to your adjuster and analyzed for loss control data.

Report your incident or claim to PGCS or your TPA as soon as possible. If you wait, critical mitigation information and opportunities can be lost, which may result in increased claim costs and expensive, time-consuming litigation. There are also penalties for late reporting, from state-imposed fines to coverage declinations. Preferred does not penalize members for “Report-Only” claims. Maintaining open communications with your adjuster throughout the claim will help get a well-reasoned decision made faster and reduce the claim cycle time. You are the eyes and ears of your organization and sharing facts that your adjuster would not otherwise know can help target mitigation efforts.

Build a culture of safety and security that includes preventing, responding to and reporting incidents.  It will reduce the negative financial and reputational impacts of claims for your organization. To schedule a Claims 101 Training Seminar, please contact your Preferred Loss Control Consultant.               

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