Claims
General Overview and Advice on Procedures
You must notify D&P / Insurers of all details of any incidents that could give rise to a claim without delay and provide us with all material information in order for us to inform insurers and to comply with the terms and conditions of your insurance contract.
We will provide you with advice of the insurer’s decision about the claim promptly upon receipt from that insurer.
In the event that the insurer accepts your claim we will remit claims payments to you as soon as possible after they have been received by us from the respective insurer on your behalf. In the event that an insurer rejects your claim we will inform you promptly upon receiving that information, together with any explanation of that insurer’s reasons.
We will provide a claims handling service for you as long as you remain a client of D&P, providing you with reasonable guidance in pursuing a claim under your insurance contract. We will handle any such claim fairly and promptly, exercising the duty of care, skill and diligence as is required by the FCA, keeping you informed of the claim’s progress. We reserve the right to charge a reasonable fee for our services if, for whatever reason, you cease to be our client but request us to handle any claim on your behalf and we agree to do so. We will not seek recovery of uninsured losses for you unless specifically agreed with you.
How do I obtain a Claim Form?
DOWNLOAD | Please click this download link to obtain our standard claims form |
Click on the "DOWNLOAD" link above and you will be able to download a "Claim Form" or if you have any questions, make contact with the D&P office for the most appropriate advice to be given, suitable for your specific circumstances.
Once you are in receipt of the Claim Form complete this form answering all the questions to the best of your ability and knowledge of the circumstances. Send the form back to D&P either electronically/e-mail or by post or fax.
With all classes of insurance there will be conditions within the policy that expressly request the time frame in which a claim and/or circumstance which may give rise to a claim must be reported to Insurers. Please adhere to these time constraints and return the completed Claim Form back to D&P without delay. If you are unsure on how to answer any of the questions or require assistance in returning this form, please make contact with the Service Team at D&P.
Should an insurer become insolvent or delay making settlement we do not accept liability for any unpaid amounts. This is usual insurance market practice but you should be aware of this fact.
N.B. If any additional information is required the "Service Team" at D&P will advise you accordingly.
General Information about Employers Liability & public Liability Claims ( from 31 July 2013)
From 31 July 2013 all employers liability and public liability personal injury claims with a value up to £25,000 will be managed through an online system called the Claims Portal.
The major effect is that the time to investigate these types of claims has been drastically reduced. However, in cases where liability is admitted and the claim is resolved within the portal, you and your insurer will benefit from fixed legal fees which are considerably less than the fees which would otherwise be payable. To ensure that you benefit from these changes, please note the following points regarding the notification of claims and assisting with subsequent investigations.
How will you know there is a claim?
You receive a Claim Notification Form: If a personal injury claim is made against you on or after 31 July 2013, you will receive a Claim Notification Form (EL1) or (PL1).
Receiving a letter requesting your public liability or employers liability insurers’ contact details could indicate that a claim is likely to follow. - You should notify D&P of the potential claim straight away.
What should you do with the Claim Notification Form (CNF)?
N.B. On the same day you receive the CNF you must:
- Send a copy of the CNF to your Insurer ( e-mail will be fine or fax )
- Also advise D&P at the same time
- Acknowledge, by email, receipt of the claim to the claimant or their representative.
BUT YOU MUST NOT:
- Make any comment on the contents of the CNF or accompanying correspondence
- Complete the compensator response section of the form. We will deal with this step for you
Timescales - On the same day or within the next 5 days:
- D&P with information and documents to investigate the claim (see further details below)
DO NOT:
- Delay sending the CNF to D&P / or the Insurer if supporting documents are not immediately available
Adhering to the deadlines for reporting a claim is important, there are rules and a strict timetable to provide a full reply to the allegations made:
- 30 days for employers liability claims
- 40 days for public liability claims
If these are not complied with the benefit of the low fixed costs will be lost.
What happens next?
Acknowledgement: Insurers will formally acknowledge the CNF in the Claims Portal within 24 hours of receipt.
Investigation: Insurers will consider the allegations in the CNF and the supporting documents you provide to make an initial assessment of legal liability. If we cannot come to a conclusion on the basis of that information or if a denial looks a realistic possibility it is likely that we will instruct a loss adjuster to make investigations and provide a report.
Conclusion –– Admit liability
If insurers conclude you are liable, they will communicate their views and advise you how they intend to proceed. Unless the situation is very time critical, insurers will provide you with short period to make any comments and supply any additional information that may have been overlooked previously. If insurers conclude that you are liable and there is no prospect of successfully defending the claim, insurers will proceed to admit liability within the 30 or 40 day time period to ensure that the claim will benefit from the lower fixed legal fees.
Conclusion –– Defend liability
If liability is to be denied, a full explanation of the reasons for this and copies of all documents relevant to the dispute must be provided to the claimant and at this stage the claim exits the electronic Claims Portal.
Failure to notify Insurers may invalidate your policy
You are required to notify of any circumstance likely to give rise to a claim (not just actual claims) under the terms of your policy. Notifying insurers of such circumstances is critical because failure to do so could invalidate the cover under the policy. Time is critical, so if insurers are made aware of an accident / incident prior to a claim being received, insurers will have a “head start” in investigating the matter. As such, it is more likely that insurers will be able to keep the claim within the portal thus keeping costs down.
What incidents should you notify?
The type of events that may give rise to a claim will vary from organisation to organisation, but as a rule of thumb insurers should be notified of:
- Any incident of personal injury resulting in a member of staff being absent from work
- In respect of service users or others such as visitors, any incident giving rise to injury in relation to which you are required to complete a RIDDOR report
- Any incident in relation to which you receive a request for your insurance details
- Any incident resulting in injury or harm which requires police involvement
- Any incident involving injury or harm which results in a safeguarding investigation into your activities by external authorities
- Any incident causing injury or harm which results in a complaint by a service user / service user’s family or others with responsibility for a service user such as social services.