Signs of a Claim
Early Warning Signs of a Claim
An unhappy client who:
- Expresses dissatisfaction with performance
- Questions your actions
Signs of an Imminent Claim
- Client makes accusations and/or assigns blame
- Client expressly asks for restitution
- Client has hired a lawyer
- Client avoids contact with you
- Client escalates contact with you
How to Report a Claim
Important Notice: As of May 1, 2017, the APA program has been insured by Zurich Insurance Company Ltd. Before renewing any coverage with an effective date prior to May 1, 2017, you must report any potential claim to the former insurer Liberty Mutual. Failure to do so may cause administrative delays in the provision of coverage or denial of coverage.
- A Claims Notice form must be submitted to the program broker, ABS Inc. for review and submission to the Insurer. They should not be submitted directly to the Insurer.
- Please ensure that your current Certificate of Insurance Number is noted on your claims submission form.
- ABS will review your notice and confirm that the required information is supplied in order to provide better claims service.
- Once you have reported a claim by submitting the information as required below, a claims manager will contact you.
- Please fax or email your claims information to Advocis Broker Services Inc. at the address below. If your claim information is exceptionally voluminous, you may use mail or overnight delivery instead of fax. Claims are NOT to be reported to the insurer directly. All claims are to be reported directly to ABS Inc. first.
Claims Do’s and Don’ts
The claims process can be frustrating and stressful. The most important thing to remember is that the claims team assigned to handle your file is there to provide you with the advice and guidance you need to make it through the process. Always cooperate with the claims team. It is their job to assess the merits of the claim and defend you.
- Review your client file in light of the allegations
- Be understanding and forthright
- Cooperate with regulators
- Contact the APA’s claims management firm
- Provide them with details of the situation
- Seek their advice on how to manage the situation
- Above all, follow their advice and directions
- Make an offer of compensation to your client
- Provide copies of your insurance
- Share your files
- Interpret your actions in writing to the client
- Avoid contact with the client
The Claims Process
What you need to provide when submitting a claim
- A completed claims form. A pdf copy of this form is available above.
- All legal papers served on you, if any.
- A copy of your entire file related to the claim.
- A copy of your most recent Errors & Omissions certificate of insurance.
What happens once you have submitted a claim
You will receive an acknowledgment letter from the insurer’s claims handler assigned to your claim within 7 business days from the day following your submission. This letter will set forth your claim number and include information on the next step in the claim handling process. If you have been sued, the name and contact information of your defense counsel will be set forth. If the claim has raised coverage concerns under the policy language, these issues will be set forth.
The overwhelming majority of lawsuits end in a settlement among the parties; they do not go to trial. Similarly, many pre-suit claims are resolved by settlement. Your insurer’s professional and experienced claims personnel settle claims, if appropriate, according to your insurance policy’s terms and conditions.
Your policy gives you the right to refuse to settle. However, please be aware that if your insurer recommends a settlement and you refuse your consent, your insurer’s liability for the claim may then be reduced to the amount in excess of your deductible for which the claim could have been settled. Obviously, such a situation could put you out a considerable amount of money and should be considered with great care and the advice of your personal counsel.
The policy requires you to pay your deductible for any claims reported, regardless of whether or not a settlement is rendered. If the insurer pays the funds for the settlement without first collecting the deductible from you, you will be required to remit the deductible within 30 days of the request from the insurer. Alternatively, the insurer may request payment of the deductible at such time during a claims investigation as the costs of adjustment have reached the level of the applicable deductible.
Renewals and policy changes
All policy renewals, requests to change policy limits, and other policy changes affecting your coverage options should be coordinated through ABS Inc. Your insurer’s claims professionals cannot answer questions about the status of your coverage or make changes to your coverage options.