Claims

How to Report a Claim

Early reporting and active involvement by the institution and UE are essential for successful claims resolution. An institution that fails to meet the reporting responsibilities outlined in its insurance policy risks denial of coverage or loss of full benefits. The reporting mechanism varies with the type of policy. And there are certain considerations whenever an institution reports a claim.

• Educators Legal Liability
• Other Claims
• Primary General Liability and
  Excess General Liability
• Catastrophic Event (Fatality, Significant Injury) Reporting After Hours

The educators legal liability (ELL) policy requires that a claim be reported to UE “as soon as reasonably practicable,” and in the case a policy has been cancelled or nonrenewed, within 60 days after the expiration of the policy. A claim is defined as written notice of the intent to hold the institution or an entity or individual covered under the member’s policy responsible for a wrongful act. Claims can come in many forms, including a lawsuit, a charge filed with the EEOC or state civil rights agency, an attorney demand letter, a demand for arbitration, or even an email.

Prompt reporting is necessary so that UE claims professionals have the opportunity to assess threatened legal action, gather additional facts from key institutional contacts, approve or select outside defense counsel to represent your legal interests and, where appropriate, coordinate with UE risk management specialists to assist you in handling ongoing events that may have an impact on future litigation.

New claims may be reported in writing to:

United Educators
Two Wisconsin Circle, Fourth Floor
Chevy Chase, MD 20815-9913

You can also report new claims via facsimile to (301) 907-0303 or email: newclaims@ue.org

If you have any questions about claims reporting please contact any UE representative or your broker, who can also help you in reporting claims.

Accompanying Materials
If the institution has been sued, please send us the complaint and include any exhibits; otherwise, please send us the demand letter, agency charge, email, or other document that constitutes a “claim” under the ELL policy and triggers the institution’s reporting obligations. We also would appreciate receiving any prior correspondence with the claimant or his or her attorney, internal reports or results of appeals (such as in faculty tenure or promotion cases or disciplinary situations involving staff or students), and any other document that bears on the claim. A representative of UE’s Claims Department usually will contact you to discuss your claim soon after you report it. It is not unusual for us to request additional materials at that time.

Once a claim has been made, do not agree to discuss the matter externally, especially with the media, without first consulting your UE claims counsel or claims manager. Do not sign or accept any releases from any parties without obtaining approval from us. Accept all correspondence, memoranda, suit papers, and the like without comment or argument. Do not admit liability and do not attempt to place blame.

Outside Counsel
If the circumstances require referring the matter to legal counsel, depending on the terms of your policy, UE must either select defense counsel to represent you or approve any attorney you wish to use. Until we do so, you should not incur legal costs unless approved in advance by UE. Costs incurred before UE is notified of a claim without our approval normally will not be credited to your Self-Insured Retention or be reimbursed by the company.

“Incident” Reporting and Pre-Claim Advice Credit
In order to provide the broadest coverage, the ELL policy also allows you to report circumstances that are not yet claims but that you believe may give rise to a claim sometime in the future. Please send us a written description of that circumstance, the name of the person or persons who may seek to hold the institution liable, and the manner in which you first became aware of the circumstance.

One advantage of reporting an incident is to discuss the potential claim situation with an experienced UE claims attorney. We can offer our own advice to help the institution prevent or defend a claim, consult with in-house risk management specialists, direct the member to appropriate resources, or put the institution in touch with local UE Select Counsel for pre-claim legal advice. Up to $5,000 of a UE Select Counsel’s time expended in advising the member would be credited to its Self-Insured Retention if the incident later develops into a claim.

Other Insurance
Coverage for a claim may also be provided by another institutional policy, such as a Primary General Liability policy. To protect your interests, notice of a claim should be submitted to any potentially responsible carrier. If your GL policy is with UE, only one report is necessary.

Claims Handling Process
As the claim proceeds, UE will monitor and assess progress. Where legal proceedings have been instituted, we will maintain contact with you and your attorney regarding the status of the case. Outside counsel must agree to conduct the defense in accordance with UE's Defense Counsel Guidelines and to submit a defense budget when requested. The guidelines provide for the communication and accountability necessary for UE to assist in the timely resolution of the claim and to approve costs reimbursed under your policy.

Over the life of the claim, UE will work with you to evaluate various strategic options and courses of action. In consultation with the institution’s representative and outside counsel when involved, we will make recommendations about whether the case should be defended or settled. Under the ELL policy, we must give our prior approval to any settlement that the member expects to be credited toward its retention or reimbursed by us. No settlement will be entered into without your consent.

Immediately notify United Educators in writing at:

United Educators, Two Wisconsin Circle, Fourth Floor
Chevy Chase, MD 20815-9913
FAX: 301-907-0303

You can also report new claims to: newclaims@ue.org

Include a complete account of the circumstances and forward any relevant documents. If the circumstances indicate a need for immediate counsel and advice, call one of the United Educators claims attorneys. A representative of United Educators' Claims Department will contact you to discuss your claim and reporting requirements for the claim soon after you report it.

If the circumstances require legal counsel, depending on the terms of your policy, United Educators must either select defense counsel to represent you or approve any attorney you wish to use. Until defense counsel is selected or approved, you should not incur costs unless approved in advance by United Educators. Costs incurred before UE is notified of a claim, without UE's approval, will not be credited to your retention or be reimbursed by the company.

Coverage for a claim may also be provided by another institutional policy, such as the Primary General Liability policy. In order to protect your interests, notice of a claim should be submitted to any potentially applicable carrier.

Once a claim has been made, do not agree to attend any conferences or to discuss the claim without first consulting your UE claims attorney and/or claims representative. Do not sign or accept any releases from any parties without obtaining approval from your claims representative. Accept all correspondence, memoranda, suit papers, etc., without comment or argument. Do not admit liability and do not attempt to place blame.

As the claim proceeds, United Educators will monitor and assess progress. Where legal proceedings have been instituted, we will maintain contact with you and your attorney regarding the status of the case. Your attorney is required to agree to UE's Defense Counsel Guidelines and to submit a defense budget when requested. The Defense Counsel Guidelines provide for the communication and accountability necessary for UE to assist in the timely resolution of the claim and to approve costs reimbursed under your policy.

Over the life of the claim, United Educators will be evaluating courses of action and will make recommendations to you about whether the case should be defended or settled. No settlement will be entered into without your consent. Remember, prior approval must be obtained from UE on any settlement you expect to be credited toward your retention or reimbursed by the company.

The primary general liability and excess general liability policies require that notices of claims and incidents that have not yet become claims, but which are “reasonably likely to involve” either or both policies, be made in writing as soon as practicable.”

In addition, there are some instances in which the severity of the injury requires the institution to report all incidents, regardless of whether or not the institution feels that a claim will arise. They are as follows:

• fatality;
• major paralytic conditions such as paraplegia and quadriplegia;
• second or third degree burns to 25% or more of the body;
• amputation, permanent loss of use or permanent loss of sensation of a major extremity;
• head or brain injuries resulting in permanent disorientation, behavioral disorders, personality changes, seizures, aphasia or coma;
• loss of sight in one or both eyes or loss of hearing;
• injury resulting in incontinence of bowel or bladder;
• sexual molestation, sexual assault or rape;
• AIDS; or
• bodily injury resulting from medical services (excess policy only) or bodily injury resulting from health care services provided in a clinic, infirmary, student health center, treatment room or other similar facility that provides medical or health services to students or at other locations in the event of a medical emergency

In addition, both policies have a special requirement for occurrences involving Pollution. Please see the policy definition and exclusion for additional requirements.

Prompt reporting is necessary so that UE claims professionals have the opportunity to assess threatened legal action, gather additional facts from key institutional contacts, approve or select outside defense counsel to represent your legal interests and, where appropriate, coordinate with UE risk management specialists to assist you in handling ongoing events that may have an impact on future litigation.

New claims may be reported in writing to:

United Educators
Two Wisconsin Circle, Fourth Floor
Chevy Chase, MD 20815-9913

You can also report new claims via facsimile to (301) 907-0303 or email: newclaims@ue.org

If you have any questions about claims reporting please contact any UE representative or your broker, who can also help you in reporting claims.

Accompanying Materials
When reporting a new claim or incident, please send us the campus incident report and investigation, if one exists, including any witness statements. A representative of UE’s Claims Department usually will contact you to discuss your claim soon after you report it and to request additional information if necessary.

Other Insurance
Coverage for a claim may also be provided by another institutional policy, such as an Educators Legal Liability policy. To protect your interests, notice of a claim should be submitted to any potentially responsible carrier. If your employment practices liability policy is with UE, only one report is necessary.

Claims Handling Process
As the claim proceeds, UE will investigate and evaluate any potential exposure against the institution or, in the case of excess liability claims, monitor its progress. In cases in which defense counsel has been assigned, counsel must agree to conduct the defense in accordance with UE's Defense Counsel Guidelines and to submit a defense budget when requested. The guidelines provide for the communication and accountability necessary for UE to assist in the timely resolution of the claim and to approve costs reimbursed under your policy.

Over the life of the claim, UE will work with you to evaluate various strategic options and courses of action. In consultation with the institution’s representative and outside counsel when involved, we will make recommendations about whether the case should be defended or settled.

Should a catastrophic event happen on your campus please follow the reporting directions above. Should you need guidance after regular business hours and you have experienced a fatality, including suicide, or other catastrophic event, such as severe injury, sexual molestation, or rape, please contact Robb Jones at (703) 624-4814 or via email rjones@ue.org. In the event he cannot be reached, please contact Rick Schlegel at (301-) 442- 5787 or rschlegel@ue.org. For a list of events that UE considers to be catastrophic, please see Primary General Liability and Excess Liability Reporting.

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