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GENERAL LIABILITY CLAIMS FRANK FORET OFFICE OF RISK MANAGEMENT.

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Presentation on theme: "GENERAL LIABILITY CLAIMS FRANK FORET OFFICE OF RISK MANAGEMENT."— Presentation transcript:

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2 GENERAL LIABILITY CLAIMS FRANK FORET OFFICE OF RISK MANAGEMENT

3 Who We Are Ann Wax Claims Officer Ann Wax Claims Officer Kathleen Gasser Claims Manager Kathleen Gasser Claims Manager Frank Foret Claims Supervisor Frank Foret Claims Supervisor James Lea Claims Supervisor James Lea Claims Supervisor (225) (225) (225) (225)

4 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. 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.

5 General Liability Claims Claims alleging damages in tort due to negligence by the state of Louisiana. Claims alleging damages in tort due to negligence by the state of Louisiana. The CGL unit handles claims that are not Worker’s Comp, do not involve state owned automobiles, do not involve Medical Malpractice, and do not involve damages attributed to the state highways. The CGL unit handles claims that are not Worker’s Comp, do not involve state owned automobiles, do not involve Medical Malpractice, and do not involve damages attributed to the state highways. Claims range from trip and falls to property damage to wrongful acts, for example. Claims range from trip and falls to property damage to wrongful acts, for example.

6 The General Liability Policy covers: Premises and Operations Premises and Operations Completed Operations and Products Liability Completed Operations and Products Liability Elevator and Escalator Elevator and Escalator Watercraft under 26’ Watercraft under 26’ Contractual Liability Contractual Liability Wrongful Acts Wrongful Acts Errors and Omissions Errors and Omissions Professional Liability Public Officials Custodial Garage Keepers Foster Parents Protective Liability Fire Damage Legal Liability

7 CIVIL RIGHTS CLAIMS Claims alleging discrimination, harassment and or retaliation are also covered under the General Liability policy. Claims alleging discrimination, harassment and or retaliation are also covered under the General Liability policy.

8 FALSE ARREST False ArrestFalse Arrest False ImprisonmentFalse Imprisonment Illegal DetentionIllegal Detention

9 OTHER PERSONAL INJURY DefamationDefamation – Libel – Slander Malicious ProsecutionMalicious Prosecution Wrongful EntryWrongful Entry Wrongful EvictionWrongful Eviction

10 Reporting CGL Claims In writing to: In writing to: General Liability Claims General Liability Claims Office of Risk Management Office of Risk Management P. O. Box P. O. Box Baton Rouge, LA Baton Rouge, LA If loss is serious in nature, also telephone it in to (225) If loss is serious in nature, also telephone it in to (225)

11 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: For injuries sustained by visitors to your agency, have agency contact complete the CGL claim form found on our website:

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14 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. 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. The agency is not to assume any obligation or incur any expenses without the authority of ORM.

15 Where to send report of claim 1. Mail it 1. Mail it Attention Frank Foret: Attention Frank Foret: Office of Risk Management Office of Risk Management Post Office Box Post Office Box Baton Rouge, LA Baton Rouge, LA Fax it to: 2. Fax it to: (225) (225)

16 How a claim is processed An Adjuster is assigned.

17 The adjusting process: 1. Investigation 1. Investigation 2. Evaluation 2. Evaluation 3. Negotiation 3. Negotiation 4. Settlement 4. Settlement

18 Investigation of Claim The adjuster investigates to determine coverage by ORM The adjuster investigates to determine coverage by ORM Liability and exposure are determined after obtaining the facts of the incident. Liability and exposure are determined after obtaining the facts of the incident.

19 What is Our Negligence? What did we do wrong, or fail to do right?

20 Limitation of Liability for Public Entities R.S. 9:2800 R.S. 9:2800 …No person shall have a cause of action based solely 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. …No person shall have a cause of action based solely 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.

21 Constructive Notice The existence of facts which infer actual knowledge The existence of facts which infer actual knowledge Example: Example: defective sidewalk in front of administrative building or defective sidewalk in front of administrative building or Defective sidewalk somewhere in middle of campus where there are miles of sidewalk. Defective sidewalk somewhere in middle of campus where there are miles of sidewalk.

22 Evaluation of the claim Do we have liability? Do we have liability? Are we 100% at fault or was there comparative fault by the claimant or fault by another party? Are we 100% at fault or was there comparative fault by the claimant or fault by another party? What damages were suffered: What damages were suffered: Medicals Medicals Lost wages or lost time Lost wages or lost time Out of pocket expenses Out of pocket expenses Property damage Property damage

23 Negotiation of Claim Claims may be filed “Pro Se” by the injured party or by an attorney. Claims may be filed “Pro Se” by the injured party or by an attorney. The adjuster will negotiate directly to settle a claim. The adjuster will negotiate directly to settle a claim. When a lawsuit is filed, the adjuster will work with our defense counsel in negotiations. When a lawsuit is filed, the adjuster will work with our defense counsel in negotiations.

24 Settlement of a Claim The adjuster must have settlement authority in order to negotiate and settle a claim. The adjuster must have settlement authority in order to negotiate and settle a claim. The adjuster may present requests for settlement authority to supervisors or to Claims Council depending on the level of authority sought. The adjuster may present requests for settlement authority to supervisors or to Claims Council depending on the level of authority sought. He/she must obtain a full and final release of all claims and a dismissal of any legal action in order to settle a claim. He/she must obtain a full and final release of all claims and a dismissal of any legal action in order to settle a claim.

25 Frequently Asked Questions ???

26 Were we negligent in maintaining a safe environment? Were we negligent in maintaining a safe environment? Take pictures of area of fall. Take pictures of area of fall. Note whether claimant was wearing glasses, carrying things, type of shoes worn. Note whether claimant was wearing glasses, carrying things, type of shoes worn. Provide witness information. Provide witness information. Do we cover trip and falls?

27 How You Can Help Tell us about conditions that contributed to the accident: Tell us about conditions that contributed to the accident: Wet floor, any warning signs? Wet floor, any warning signs? Holes, barriers, irregular surface Holes, barriers, irregular surface Lighting Lighting Weather Weather Handicap Handicap Eyeglasses Eyeglasses Carrying anything that might obstruct vision Carrying anything that might obstruct vision

28 Take Photographs of the Scene Label with name of injured party and date Label with name of injured party and date Take some photos that show location and landmarks Take some photos that show location and landmarks

29 Falls that involve a chair? Only if the agency is negligent in maintaining a chair in a safe condition. Only if the agency is negligent in maintaining a chair in a safe condition. If chair broke, remove it from service, save it and label it with name of person who fell and date of incident. If chair broke, remove it from service, save it and label it with name of person who fell and date of incident. Note the manufacturer and supplier of chair. Note the manufacturer and supplier of chair. Take pictures Take pictures Provide witness names Provide witness names

30 Damage to private cars? Falling tree branches? Depends on whether it was live or visibly dead. Need photos. Falling tree branches? Depends on whether it was live or visibly dead. Need photos. Gate arm? If it malfunctioned. Gate arm? If it malfunctioned. Vandalism by unknown person? No. Vandalism by unknown person? No. Our mower? Yes if the auto is insured. Our mower? Yes if the auto is insured. Need proof of liability insurance required by LA Law. Need proof of liability insurance required by LA Law.

31 Loss of personal property ? Must determine care, custody and control Must determine care, custody and control If property was left behind and then discovered to be lost, that would be abandonment on the part of the owner, and would not be negligence on the part of the state. If property was left behind and then discovered to be lost, that would be abandonment on the part of the owner, and would not be negligence on the part of the state.

32 Theft or Burglary of Privately Owned Auto Parked on Agency Grounds. The state is not the insurer of a privately owned automobile. We act as the gratuitous depository only. The state is not the insurer of a privately owned automobile. We act as the gratuitous depository only.

33 Trip and Fall in Elevators We must determine the Maintenance Co. that services the elevator and review the contract. We must determine the Maintenance Co. that services the elevator and review the contract. Check to see whether a malfunction has been previously reported to the Maintenance Co. Check to see whether a malfunction has been previously reported to the Maintenance Co.

34 Do We Cover Injuries or Damages Caused by Wildlife? Vehicle traveling on state highway hits a deer Vehicle traveling on state highway hits a deer Visitor to state park receives insect bite/snake bite Visitor to state park receives insect bite/snake bite

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37 Lawsuits filed against your Agency Immediately forward all lawsuits, demands, or legal documents pertaining to a claim to ORM for further handling. Immediately forward all lawsuits, demands, or legal documents pertaining to a claim to ORM for further handling.

38 What if Lawsuit names a State Employee as a Defendant?

39 Louisiana Governmental Claims Act R.S. 13:5101 et seq. states this (Act) applies to any suit in contract or for injury to person or property against the state, a state agency, an officer or employee of the state or a state agency arising out of the discharge of his official duties or within the course and scope of his employment… R.S. 13:5101 et seq. states this (Act) applies to any suit in contract or for injury to person or property against the state, a state agency, an officer or employee of the state or a state agency arising out of the discharge of his official duties or within the course and scope of his employment…

40 R.S.13: Indemnification of officers and employees of the state; civil rights; representation by the Attorney General. Indemnification of officers and employees of the state; civil rights; representation by the Attorney General. ORM is the insurer ORM is the insurer State employee is the insured State employee is the insured DOJ is defense counsel DOJ is defense counsel

41 Named Defendant Must Request Representation by Attorney General Send a copy of the petition Send a copy of the petition Send a cover letter to Attorney General Charles C. Foti requesting representation Send a cover letter to Attorney General Charles C. Foti requesting representation Provide information regarding service of the petition Provide information regarding service of the petition Within 10 days of date of service of petition Within 10 days of date of service of petition

42 Our Duty to Defend: The state shall defend and indemnify a covered individual against any claim, demand, suit, complaint or petition seeking damages filed in any court over alleged negligence or other act by the individual, including any demand under any federal statute when the act that forms the basis of the cause of action took place while the individual was engaged in the performance of the duties of the individual’s office or employment with the state. The state shall defend and indemnify a covered individual against any claim, demand, suit, complaint or petition seeking damages filed in any court over alleged negligence or other act by the individual, including any demand under any federal statute when the act that forms the basis of the cause of action took place while the individual was engaged in the performance of the duties of the individual’s office or employment with the state.

43 Who is Covered? R.S.13:5108.1(e) R.S.13:5108.1(e) 1. An official, officer, or employee holding office or employment: 1. An official, officer, or employee holding office or employment: Executive branch Executive branch Legislative branch Legislative branch State Supreme Court, courts of appeal, family, juvenile or judicial district courts State Supreme Court, courts of appeal, family, juvenile or judicial district courts Deep-water ports Deep-water ports

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46 Claim, demand, suit, complaint or petition seeking damages  Remedy sought determines whether complaint with be handled by ORM.  Suits seeking contractual damages or suits on open accounts are not handled by ORM.

47 Limitations Suits against the state must be filed in Louisiana state courts Suits against the state must be filed in Louisiana state courts Suits for personal injury to any one person total recoverable exclusive of property damages, medical care, loss of earnings, shall not exceed five hundred thousand dollars. Suits for personal injury to any one person total recoverable exclusive of property damages, medical care, loss of earnings, shall not exceed five hundred thousand dollars.

48 Future Medical Care Fund In personal injury suits wherein the court awards medical care and benefits subsequent to judgment, this is paid according to R.S. 39: In personal injury suits wherein the court awards medical care and benefits subsequent to judgment, this is paid according to R.S. 39: Medical care benefits are paid directly to providers as incurred. Medical care benefits are paid directly to providers as incurred.

49 Civil Rights Lawsuits

50 What is Title VII of the Civil Rights Act of 1964? It prohibits discrimination in employment on the basis of: It prohibits discrimination in employment on the basis of: Race Race Sex Sex National Origin National Origin Religion Religion

51 Employment Practice Liability Claims of Improper or Discriminatory: Claims of Improper or Discriminatory: -Hiring, Firing, Discipline -Hiring, Firing, Discipline -Compensation Classification -Compensation Classification -Treatment, Training, Opportunities -Treatment, Training, Opportunities -Terms and Conditions of Employment -Terms and Conditions of Employment

52 Discrimination Is Illegal in the Following: Hiring and Firing Hiring and Firing Compensation, assignment, or classification Compensation, assignment, or classification Recruitment, testing Recruitment, testing Use of facilities Use of facilities Training Benefits Pay, retirement plans Leave Other terms of employment

53 To Prove Discrimination There must be an adverse employment action such as failure to hire or promote, or termination. There must be an adverse employment action such as failure to hire or promote, or termination.

54 What is Title I of ADA? Americans with Disabilities Act prohibits discrimination in employment against a qualified individual with a disability because of the disability. Americans with Disabilities Act prohibits discrimination in employment against a qualified individual with a disability because of the disability. It is unlawful to take retaliatory action against any individual for opposing unlawful practices or for filing a charge. It is unlawful to take retaliatory action against any individual for opposing unlawful practices or for filing a charge.

55 What is the Age Discrimination in Employment Act? It prohibits discrimination in employment on the basis of age with respect to individuals who are 40 years of age or older. It prohibits discrimination in employment on the basis of age with respect to individuals who are 40 years of age or older.

56 Who Enforces these Acts? Equal Employment Opportunity Commission (EEOC) Equal Employment Opportunity Commission (EEOC) Employment Litigation Section, Civil Rights Division, U.S.Department of Justice enforces Title VII against state governments Employment Litigation Section, Civil Rights Division, U.S.Department of Justice enforces Title VII against state governments

57 What Does EEOC Do? EEOC investigates claims of discrimination filed by employees. EEOC investigates claims of discrimination filed by employees. If there is reasonable cause to believe a violation of the law has occurred and conciliation efforts are unsuccessful then If there is reasonable cause to believe a violation of the law has occurred and conciliation efforts are unsuccessful then EEOC refers the charge to the U.S. Department of Justice to initiate litigation, EEOC refers the charge to the U.S. Department of Justice to initiate litigation, Or issues a right to sue letter to complainant. Or issues a right to sue letter to complainant.

58 Is There a Time Limit to File? Charges filed against the state must be filed within 300 days of the act of discrimination Charges filed against the state must be filed within 300 days of the act of discrimination EEOC does their investigation EEOC does their investigation After a Right to Sue letter is issued, there is an additional 90 days in which to file a lawsuit. After a Right to Sue letter is issued, there is an additional 90 days in which to file a lawsuit.

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