Accident Investigation and Claims Management Training 1 Revised

You need value added claims reporting solutions!

All Auto Accidents Are To Be Reported To: National Interstate 3250 Interstate Drive Richfield, Ohio By Phone: By Fax: By For Serious or Catastrophic Cases: (24/7)

CA Work Comp Claims Are To Be Reported To: Liberty Mutual Insurance Co. 330 N. Brand Blvd. – Suite 500 Glendale, CA Phone: First Report Fax: To Report by Phone: Policy Number: WA7-65D

FL Work Comp Claims Are To Be Reported To: Liberty Mutual Insurance Co. P.O. Box Tampa, FL Phone: First Report Fax: To Report by Phone: Policy Number: WA7-65D

VA Work Comp Claims Are To Be Reported To: Liberty Mutual Insurance Co. P.O. Box 7170 Indianapolis, IN Phone: First Report Fax: To Report by Phone: Policy Number: WA7-65D

VA Work Comp Claims Are To Be Reported To: Liberty Mutual Insurance Co. P.O. Box 7170 Indianapolis, IN Phone: First Report Fax: To Report by Phone: Policy Number: WA7-65D

General Liability Claims Are To Be Reported To: Scottsdale Insurance Co. Address: PO BOX 4120 Scottsdale, AZ Phone # Fax # REPORT YOUR CLAIMS TO: TOM COLE Unit Manager PIMA CENTER Scottsdale, AZ Phone: (480) (480) Policy Number: BCS Please contact Doug Lawson or Drew Jones before reporting claims in this category.

Property Damage Only Claims Are To Be Reported To: Liberty Mutual Insurance Co. Fax: By Phone: For damage of $25,000 or greater to Keolis or in cases where Keolis operates client owned vehicles and provides PD coverage by contract

TO REPORT A WORK COMP CLAIM VIA THE WEB

Proper Accident / Claims Reporting Is Essential to Effective Claims Management

Accident / Claims Reporting PLEASE DO NOT LEAVE ANY BLANK SPACES ON THE FORM

Accident / Claims Reporting 1.Ensure entire accident report form is accurate and complete. 2.Ensure all other pertinent documents concerning the accident are gathered and sent to the insurance carrier. 3.Fax or the accident report and all other applicable documents within 24 hours of becoming aware of the accident. 4.Refer all calls from claimants or their attorneys to the adjuster handling the claim. Do not comment on liability or other aspects of the incident.

Important claims reporting guidelines: 1.It is not the duty or responsibility of any Keolis personnel to determine liability, only to report the facts surrounding the accident. 2.Statements concerning liability or preventability are not to be made on the accident report form.

1. point of impact. 2. Shots of approach varying distances. 3. Use a common point of reference. 4. Photos of visible damage to vehicles and property. 5. Shots of skid marks. 6. Pictures of debris. 7.Photos of traffic controls & signals. Some critical shots that can make or break the ultimate outcome!!!!

1. Pictures of other vehicles & license the scene. 2. Shots of by-standers & possible witnesses. 3. Shots of inside the vehicles. 4. Pictures of surveillance cameras in close proximity. Some critical shots that you may not consider that may make or break the ultimate outcome!!!!

1.Date of accident. 2. Vehicle number. 3. Location number. 4. Driver and other party’s name. 5. Name of person who took the photos. Please properly identify all photos as follows:

Serious accidents are defined as follows, but not limited to: Fatality (including accidental death on a bus or company property, regardless of fault) Serious burns Quadriplegia or Paraplegia Amputation Brain damage – actual or alleged Serve injury with apparent permanent disability Severe cosmetic disfigurement Blindness or loss of hearing

Serious accidents are defined as follows, but not limited to: Severe fractures or multiple fractures Psychiatric problems due to trauma, actual or alleged Serious vascular abnormalities due to trauma Any accident involving more than four persons Any pedestrian accident Assault or molestation incidents Severe bleeding Vehicle roll-over

Work comp program features: Bill Review – Physician & Hospital. Telephonic Case Management. Pharmacy Benefit Management. Utilization of Re-employability. Utilization Review.

Some general observations about work comp: Historically, our subrogation results have been lackluster. Our ratio of Lost Time to Med Only cases is out of sync. Our denial rate is 3.77%. 58% of our WC claims are reported 5 or more days late. 17% of our WC claims are reported 10 or more days late.

There are 3 types of workers’ comp fraud:

Applicant Fraud These cases involve workers who fake an injury, lie about the extent of their injury, lie by denying filing previous claims, fail to disclose a prior injury to the same body part, claim a non-work injury is work related, or illegally work while obtaining benefits. Sub rosa surveillance tapes regularly expose applicants who are fraudulent.

Claim Mills Organized workers’ compensation fraud involving doctors and lawyers have been an ongoing problem, especially in Southern California. Fraud rings have made a practice of recruiting people to file phony work injury claims. The workers are sent to medical clinics or legal referral centers (commonly known as "claim mills"), which in turn refer them to a doctor or lawyer who is in on the scheme.

Provider Fraud Regardless of the legitimacy of the original claim, many medical or other health practitioners fraudulently maximize the number of medical reports and referrals in each case to increase the number of billings. They may also over bill or render unnecessary treatment.

Some common work comp fraud indicators: 1.Injury that has no witness other than the employee 2.Injury occurring late Friday or early Monday 3.Injury not reported until a week or more after it supposedly occurred 4.Injury occurring before a strike or holiday, or in anticipation of termination 5.Injury occurring in a location where the employee would not normally work

Some common work comp fraud indicators: 6.Injury that is inconsistent with normal job duties 7.Employee observed in activities inconsistent with the reported injury 8.Employee history of workers' comp claims 9.Conflicting diagnoses from subsequent treating providers 10.Evidence of employee working elsewhere while drawing benefits

Subrogation Claims Management

What is subrogation? Subrogation is the process in which Keolis attempts to recover a loss from a third party when our property is damaged as a result of a negligent act by a third party also referred to as the “adverse party”.

There are 4 keys to successful subrogation: Proper Investigation Timely Reporting Complete Maint. Records Professional Litigator

IF APPLICABLE VENDOR CONTACTS KEOLIS FOR FURTHER INFORMATION IF APPLICABLE GENERAL MANAGER SENDS SUBRO PROVIDER ACCIDENT REPORT KEOLIS ENTERS RESULT INTO SUBRO LOG KEOLIS CONDUCTS ACCIDENT INVESTIGAT ION KEOLIS AWAITS OUTCOME OF SUBRO VENDOR’S EFFORTS SUBRO VENDOR REVIEWS MATERIAL IF RECOVERY IF NO RECOVERY CLAIM IS CLOSED KEOLIS PROCESS ES CHECK VENDOR ISSUES CHECK TO KEOLIS SUBRO VENDOR DETERMINES IF SUBROGATA BLE This is a straight forward process!

Your Subrogation Service Provider Ward and Federman, Attorneys at Law 1177 Marsh St., 2 nd Floor San Luis Obispo, CA T: F your Accident Reports to:

Your Subrogation Service Provider Wilber & Associates 816 Eldorado Road, Suite 1 Bloomington, IL T: F: your Accident Reports to:

You must allow the adverse party / insurance carrier the opportunity to inspect your damages and conduct an appraisal within a reasonable period of time.

Accident report. Repair estimates, invoices and receipts. Police report, if available. Photos of damages. Documents to be Obtained for Subrogation Claims

Preparing Estimates: All receipts & invoices for replacement parts. All invoices for outside services performed. The total number of labor hours is to be noted separately from the cost of parts. Towing charges and storage fees are to be included.

Downtime If downtime is being claimed, the documentation substantiating the loss must be provided with the accident report documents, i.e., copy of the page from our contract which reflects the revenue per vehicle per day if applicable.

Our Primary Goal: Getting Paid !!!!!!!