Submit a Claim
Property Claims
What is it?
A property claim is a request for the insurer to make a payment in response to a covered loss. This could include damage to buildings, property and business contents.
What to do
Immediately report the claim to us, then call us at 1.866.870.2700 to notify us of your report.
If possible, take pictures of the damage before repairs have begun.
Retain any damaged property for inspection by an insurance company adjuster.
Take action to stop ongoing damage. For example, if a water line is broken, shut it off. If windows have been broken, secure them with plywood. If the roof is damaged, place a tarp over it. Beyond this, hold off on permanent repairs until you have filed a claim and consulted with your insurer.
In the meantime, keep the area safe for the public.
If it’s relevant, file a police or fire department report and obtain a copy.
Making repairs
Even though the need may be urgent, take time to make sure repairs are undertaken correctly and to coordinate with your insurer. As with any industry, the quality of construction and restoration companies varies widely. Be sure to seek a firm that is highly regarded.
Before agreeing to anything, you’ll need a comprehensive, written quote from the contractor.
Share the bids you have received with your insurer and include all relevant details, not merely the cost.
Obtain your insurer’s Scope of Loss report before signing a contract with a repair company. This report documents the damage and identifies the quantity and quality of materials needed for repair or restoration.
Mechanical, electrical and equipment breakdown claims
What is it?
A mechanical/equipment claim is a request for the insurer to make a payment in response to a loss caused by mechanical or electrical equipment breakdown. This may include damage to equipment and other property as well as damage to the property of others.
What to do
Immediately report the claim to us, then call us at 1.866.870.2700 to notify us of your report.
If possible, take pictures of the damage before beginning repairs.
Retain any damaged property for inspection by an insurance company adjuster.
In the meantime, keep the area safe for the public.
If applicable, seek an expert report regarding the cause of the equipment failure.
Making repairs
Even though the need may be urgent, take the time to make sure repairs are undertaken correctly and coordinate with your insurer. As with any industry, the quality of construction and restoration companies varies widely. Be sure to seek a firm that is highly regarded.
Before agreeing to anything, obtain a comprehensive, written quote from the contractor.
Share the bids you have received with your insurer and include all relevant details, not merely the cost.
Obtain your insurer’s Scope of Loss report before signing a contract with a company. This report documents the damage and identifies the quantity and quality of materials needed for repair or restoration.
General Liability Claims
What is it?
A general liability claim is a request for the insurer to provide compensation or pay for a legal defense in response to claims of:
Bodily injury
Personal injury
Property damage
Advertising injury (slander, copyright infringement)
General liability usually applies to two types of incidents:
Property-based issues: A non-employee is injured on your property.
Product liability: Something you manufacture, sell or distribute causes injury, illness or damage.
What to do
Immediately report the claim or summons to us, then call us at 1.866.870.2700 to notify us of your report.
Determine if there are injuries and, if necessary, seek medical attention.
Take photos and inspect the area, noting any conditions that may be relevant to the accident. Preserve any video or surveillance footage that is available.
Preserve any item involved in the incident, such as equipment or property.
Obtain contact information from the claimant or injured person, including full name, address, home and work phone numbers and e-mail address.
Obtain contact information from all witnesses, including full name, address, home and work phone numbers and e-mail addresses.
If necessary, file a police report and obtain a copy.
Do not admit fault or make promises to pay or compensate an injured person. Instead, work through your insurance company’s adjuster.
Do not assume responsibility for medical bills or property damage. Instead, work through your insurance company’s adjuster.
Do not discuss the claim with other insurance companies. Instead, refer them to your insurance company’s adjuster.
Professional Liability Errors and Omissions Claims
What is it?
Professional Liability, Errors and Omissions Insurance protects the policyholder in the event a client, member, or other party allege negligence, mistakes and failures that resulted in loss. A claim is a request for the insurer to provide coverage in response to these allegations (which often take the form of litigation).
What to do
Immediately report the claim to us, then call us at 1.866.870.2700 to notify us of your report. Failure to immediately report the claim could jeopardize your coverage with the insurer.
Insurance policies in this category are not uniform, so take time to understand what errors and omissions your policy covers and what can be considered a valid claim.
Do not hire an attorney, negotiate, or settle a claim without the insurer’s consent. Doing so may result in the loss of coverage.
If your policy is categorized as a “duty to defend” policy, the insurer has the right to hire legal representation to defend the claim. If you hire your own attorney, you may jeopardize coverage and the insurer may replace your chosen attorney so that legal fees will be covered. Hiring an attorney without the approval of the insurer could result in denial of coverage.
Directors and Officers Liability Claims
What is it?
Directors and Officers Liability Insurance provides a legal defense when leaders are sued. Common allegations that lead to litigation include failure to provide financial oversight, fraud, putting an organization’s tax-exempt status at risk and improper financial disclosures, to name just a few. A liability claim asks the insurance company to protect and defend the board or individual leaders who are part of the board.
What to do
Immediately report the claim to us, then call us at 1.866.870.2700 to notify us of your report. Failure to immediately report the claim could jeopardize your coverage with the insurer.
If you are aware of a potential threat that may result in a claim (but hasn’t yet), alert Ministry Pacific. Proactive communication will help prevent a claim from being denied.
Cooperate with your insurer’s process. Some policies include a request for mediation before a case goes to court.
Familiarize yourself with your policy. A “duty to defend” policy means the insurer is obligated to defend a claim. Other policies may reimburse legal expenses and generally provide less robust coverage.
Employment Practices Liability Claims
What is it?
Employment Practices Liability Insurance provides coverage for a legal defense and payment of damages related to alleged wrongful actions in the workplace. Allegations may include wrongful termination, discrimination and retaliation.
What to do
Immediately report the claim to us, then call us at 1.866.870.2700 to notify us of your report. Failure to immediately report the claim could jeopardize your coverage with the insurer. A claim may include demands for financial and/or non-financial action.
If you have Employment Practices Coverage and receive notice of charges filed with the EEOC or a state employment agency, notify Ministry Pacific immediately. This should be done even if the case has only recently been opened.
Do not negotiate, offer to settle a claim or hire an attorney without your insurer’s consent. Doing so could result in denial of coverage.
If your policy is categorized as a “duty to defend” policy, the insurer has the right to hire legal representation to defend the claim. If you hire your own attorney, you may jeopardize coverage and the insurer may replace your chosen attorney so that your legal fees will be covered. Hiring an attorney without the approval of the insurer could result in denial of coverage.
Crime Coverage
What is it?
Crime coverage is insurance against criminal acts. It provides coverage for losses related to theft, forgery, the disappearance of funds, robbery, forgery, fraud, dishonest acts and other criminal acts. Some policies provide coverage to assist in determining the scope and method of loss. Note: Not all policies provide coverage for all of these offenses, so please take time to understand your policy.
What to do
Immediately report the claim to us, then call us at 1.866.870.2700 to notify us of your report. Do not wait to quantify the loss. Failure to immediately report the claim could jeopardize your coverage with the insurer.
Insurers usually require a sworn proof of loss statement, including comprehensive details, within six months of the criminal act.
Cyber Insurance Claims
What is it?
Generally, cyber insurance provides reimbursement or payment of costs associated with a malicious cyber event. This can be a data breach, network hacking, a ransomware demand or a related event. Cyber coverage also provides legal defense against claims filed by third parities alleging they have been harmed by the cyber incident.
What to do
Immediately report the claim to us, then call us at 1.866.870.2700 to notify us of your report.
Do not hire a vendor (see below) without obtaining the express consent of the insurance adjuster. Failure to use insurer-approved vendors can result in denial of the claim.
Many insurers have a 24-hour cyber breach hotline providing immediate interaction and direction. Take advantage of this resource.
Contact your approved breach-response attorney immediately to establish attorney/client privilege and to begin investigating the incident. The breach response attorney will work with you to ensure all relevant information and documentation is preserved.
Retain an approved forensic investigator with the guidance of the breach-response attorney. The breach-response attorney will engage the forensic investigator on your behalf to protect the exchange of information under attorney/client privilege.
INITIAL COVERAGE EVALUATION
You can expect to receive an initial acknowledgement of your claim from the cyber insurance company.
Generally, within about 30 days, a formal claim evaluation will be provided by the insurer. This will determine if coverage is available for the claim. The insurance company will follow up, as needed, for additional information about the breach.
The insurance company will provide confirmation of the approved service providers (if any) and the scope of services covered.
POST-BREACH LITIGATION
A breach can leads to litigation brought by the people impacted by it. If this happens, having a comprehensive breach response plan is important to your legal defense. Choose a qualified defense counsel who is authorized by your insurance company. It’s best to interview several firms and choose two or three who are qualified. This way, if a conflict precludes a firm from working with you, you have other options. In addition, the breach-response attorney may also serve as defense counsel (if approved by the insurer).
Workers’ Compensation Claims (California)
What is it?
Workers’ compensation pays benefits to employees who are injured or disabled as a result of job-related activities. Benefits may include partial-salary payment, disability payments, rehabilitation and medical expenditures, and a death benefit. By accepting workers’ compensation benefits, employees waive the right to sue the employer for damages.
What to do
Immediately report the claim to us, then call us at 1.866.870.2700 to notify us of your report.
Respond to the incident swiftly and thoroughly. Do this by determining, as best you can, the seriousness of the injury. Call 911 if immediate medical assistance is needed. If it is not an emergency, many workers’ compensation insurers provide hotlines to help employers evaluate an injury. This can help determine the most appropriate health care response.
Ministry Pacific will assist you in reporting the injury to your insurer immediately. A claims adjuster will be available to help you with the claims process. Be prepared to provide details such as:
The date and time of incident
The location where the incident occurred
A description of the injury
The date you became aware of the injury
Even if you are still gathering information, begin the report immediately so the process is not delayed.
Maintaining contact with your injured employee
It’s important to maintain contact with any employee injured on the job. Support and encouragement during the period of disability will help employees maintain connection to the workplace and contribute to their desire to return to work as soon as medically feasible.In California, employers must direct injured employees to a medical provider registered with the California MPN Website. These medical professionals specialize in occupational injury recovery and helping employees safely return to work.
What is a California MPN (medical provider network)?
An MPN is a group of health care providers set up by an insurer and approved by California’s Division of Workers’ Compensation to treat workers injured on the job. Under state regulations, each MPN must include a mix of doctors specializing in work-related injuries and with expertise in general areas of medicine. MPNs are required to meet access-to-care standards for common occupational injuries and work-related illnesses. Regulations also require MPNs to follow all medical treatment guidelines established by the Division of Workers’ Compensation and allow employees a choice of providers in the network after their first visit. Additionally, MPNs must offer an opportunity for second and third opinions if the injured worker disagrees with the diagnosis or treatment offered. If a disagreement still exists after the second and third opinions, an injured worker may request an MPN independent medical review.
Complete these forms related to an employee’s workplace injury:
You must provide Workers’ Compensation Claim Form (DWC 1) and Notice of Potential Eligibility (e3301) to your employee within one working day (Labor Code §5401).
You may also provide the employee with the “I Have Just Been Injured on the Job, What Happens Now?” document.
There are strict timeframes for reporting occupational injuries to your carrier.
The completed Notice of Potential Eligibility (e3301) form must be submitted to your carrier within one calendar day of receipt.
The California Employer’s Report of Occupational Injury must be submitted your carrier within five calendar days of your knowledge of the injury.
You may refer to the Workers’ Compensation Claims Kit for instructions on how to complete these forms.
Employer’s workers’ compensation checklist
Familiarize yourself with the names and phone numbers of your contacts for questions related to employee safety and workers’ compensation. Capture this information so it can be easily located in the event of an injury.
Know your department’s California Injury and Illness Prevention Plan (IIPP).
Have an emergency treatment plan to ensure that any employee who is injured or ill receives prompt and proper medical treatment.
Read the Posting Notice (e13913, Spanish e13914) or equivalent form and become familiar with your department’s chosen medical provider. It is the employer’s responsibility to authorize the first visit and either arrange transportation or accompany the injured employee to the appointment.
Keep your employees’ job descriptions within reach and send them with your injured employees to the doctor. It is also beneficial to provide the doctor with any available “transitional” or “light duty” job descriptions.
Provide Workers’ Compensation Claim Form (DWC 1) and Notice of Potential Eligibility (e3301) to your employee within one working day (Labor Code §5401).
Complete the California Employer’s Report of Occupational Injury immediately for submission to the State Fund within five days of knowledge of the injury.
Maintain regular contact with your employee during their recovery period. Encourage coworkers to do the same.
Accident investigation report
A fact-finding investigation must follow an accident report. Investigators should strive to identify the cause and take corrective action to prevent future incidents. Among other details, the investigation should detail the “who, what, where, why, when and how” of the accident.
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