DCS Asia Pacific – Claims Management

Epsilon Underwriting Agencies (Epsilon) has engaged DCS Asia Pacific Pty Ltd (DCS) to manage Epsilon claims. The Managing Director of DCS is Jon Sitwell who can be contacted as below. Further details are available at www.dcsclaims.com.au

Claim and incident notifications should be made by:

t. 02 8235 4044
f. 02 8235 4040
e. jon.sitwell@dcsclaims.com.au (General Enquiries)
epsilon@dcsclaims.com.au (Notifications)

Policy Deductible

It is standard Epsilon practice to underwrite liability insurance policies with a Deductible that is inclusive of costs. What this means is that any external costs incurred in the management of any claim will fall within the Deductible and will be required to be paid by the Insured until the Deductible is exhausted. Such costs could include investigation/adjustment fees and legal fees but does not include Epsilon’s administrative claims costs or DCS’ fees.

Epsilon’s appointed service providers and lawyers will invoice Epsilon from time to time and Epsilon will then seek reimbursement from the Insured of those invoices, up to the point of exhaustion of the Deductible. Reimbursement must be made promptly to ensure the Insured’s compliance with the terms of the liability insurance policy. If the claim against the Insured is resolved by settlement or by judgment and, at that time, the Deductible has not been exhausted by defence and investigation costs, the Insured will be called upon to pay up to the balance of the deductible toward the settlement or judgment.

If preferred, Epsilon is more than happy to quote an extra premium to transfer the Deductible to a costs exclusive basis.

Proactive Claims Management

Epsilon believes in proactive claims management. This entails attempting to resolve matters early and actively responding to third parties.

Commercial Resolution

Many small matters can be commercially resolved without the need for litigation. Litigation substantially escalates the cost of claims and in many cases will exceed the commercial worth of a third party’s claim. It is Epsilon’s policy to commercially resolve such matters without recourse to litigation. In those matters that can be commercially resolved where liability is not clear and an Insured opposes settling the matter, Epsilon will pay to the Insured the amount for which such a claim can be settled in return for a release in respect to the matter.

Reporting of serious injury or death

In the event of the reporting of a serious injury or death, Epsilon will require the matter to be investigated in anticipation of a claim. The investigation would be completed by an external claims investigator who would most likely be instructed by a lawyer who will prepare a report outlining the legal position and possible defence strategies. The legal report is necessary to provide professional privilege to the investigator’s report. The external investigation fees and legal fees would form part of the costs inclusive Deductible.

	DCS Claims Protocol
	DCS Public Liability Insurance Claim Form
	Professional Indemnity Notification Form

Proactive Claims Management

Epsilon believes in proactive claims management. This entails attempting to resolve matters early and actively responding to third parties.

Commercial Resolution

Many small matters can be commercially resolved without the need for litigation. Litigation substantially escalates the cost of claims and in many cases will exceed the commercial worth of a third party’s claim. It is Epsilon policy to commercially resolve such matters without recourse to litigation. In those matters that can be commercially resolved where liability is not clear and an Insured opposes settling the matter, Epsilon will pay to the Insured the amount for which such a claim can be settled in return for a release in respect to the matter.

Reporting of serious injury or death

In the event of the reporting of a serious injury or death, Epsilon will require the matter to be investigated in anticipation of a claim. The investigation would be completed by an external claims investigator who would most likely be instructed by a lawyer who will prepare a report outlining the legal position and possible defense strategies. The legal report is necessary to provide professional privilege to the investigator’s report. The external investigation fees and legal fees would form part of the inclusive of costs Deductible.

Contact Proclaim

PLEASE ENSURE THE FORM IS COMPLETED AND SENT WITHIN 48 HOURS OF THE INJURY OCCURRING TO:

Proclaim Pty Ltd
Locked Bag 32012
Collins Street East VIC 8003
or
Fax 1300 858 329 Email dnguyen@proclaim.com.au

PROCLAIM HELP DESK
02 9287 1300
After Hours Mobile: 0401 691 254

Public liability Poster

The Manager is to display these procedures in a position prominent to all employees (but out of sight of customers).

Accident Reporting and Investigation

• It is the responsibility of employees to report promptly to the Manager all accidents and incidents involving third parties, including -
  
  Any incident involving serious bodily injury to patrons which include:
• A fractured/broken bone or bad sprain, concussion;
• Any injury requiring further medical attention (stitches,dressings):
• Any injury requiring an ambulance to be called; and
• Any incident involving an aggressive customer who makes mention of taking the matter further, regardless of the severity of injury
• Property damage to patrons property that exceeds $500

 

The Manager must investigate the matter and complete and return a full Incident Report within 48 hours of the accident to Proclaim.

The Hotel must maintain an Incident Book which includes particulars regarding near misses, fainting and fits and details of any ejection for intoxication (for risk management purposes).

The Incident Book should be available for review by the Insurer/Proclaim if requested.

WHAT IF THE INCIDENT OCCURS WITHOUT MY KNOWLEDGE?

Your customers should be informing you of incidents that occur in areas that are your responsibility. It is the Manager’s responsibility to have a method of capturing your customers’ incidents. Any incident that potentially could result in liability to you needs to be reported to Proclaim for immediate assessment.

FIRST AID AND WHAT SHOULD YOU DO AFTER A CUSTOMER INCIDENT

• Provide a high standard of care and response. If you have staff members trained in first aid ensure they assist to the extent possible.
• If requested by the injured person call for a supervisor, a person experienced in first aid, a doctor/ambulance, or the injured person should be accompanied to the nearest medical surgery/hospital.
• Call an ambulance or doctor for serious injuries
• While you should not admit liability, that is not an excuse for not providing a high standard of care.

 

INCIDENT REPORT

• Complete the Incident Report/Customer Injury form as soon as the injured person departs
• Witnesses should be identified on the Incident Report
• Ensure you have accurate detail of the injured person (including contact details) and have recorded details of the injury
• If it is a slip or fall injury, inspect the area the incident occurred for reasons for the fall. Also note the customer’s footwear or any other factor that may have contributed to the incident (intoxication, skylarking, lack of supervision).

 

FOLLOW UP!

Proclaim will follow up with the injured person within a week to ensure the customer is OK. Any further complaints or statements of demand should be recorded and communicated to Proclaim immediately.

WHAT IF THEY ASK ME TO PAY BILLS?

Any request for payment of medical bills or compensation should be directed to the claim manager at Proclaim

Renee James

HOW DO I COMPLETE THE RIGHT FORM?

Complete the paper based incident report form and fax it to PROCLAIM at 02 9261 2410

IT IS CRITICAL THAT THE INCIDENT IS NOTIFED TO US WITHIN 48 HOURS

Proclaim Liability Incident Form