Accident Investigation Accident Investigation The Call Determine exact

Accident Investigation

Accident Investigation The Call Determine exact location. Is anyone injured? Determine the extent of damage. Dispatch notifies appropriate emergency responders. (Police, fire, EMS) Appropriate organizational notifications are made. Designated Keolis supervisors/managers go to the accident scene.

Accident Investigation Critical Incident Notification Does incident qualify as “Critical”? (see Section 5. 2. 13 of the Policy & Procedure manual) If YES, then Terminal Manager Notifies SVP of Operations and Region Director of Safety. If there is media involvement, GM must notify Dwight Brashear, Executive Vice President Business Development: Office: (310) 981 -9500, ext. 180 Cellular: (310) 497 -0506

Accident Investigation The Scene Check on the drivers condition. If the driver is uninjured, have them assemble a passenger list. Check on the passengers condition. Ask “Is everyone alright? ” Never ask “Is anyone hurt? ” Check on the other vehicle occupants. Begin photographing the scene. Start in close, then work your way out.

Accident Investigation The Scene Photograph all four sides of all vehicles involved. Photograph license plate and inspection stickers. Photograph the point of impact as well as the final resting place(s) of the vehicles. As you work your way back from the scene, be sure to photograph any traffic control devices, stop signs and speed limit signs. Attempt to photograph all drivers perspectives as they approached the point of impact.

Accident Investigation The Scene Obtain information from other operator(s). (name, address, license, insurance carrier) Obtain witness statements, if available. Interact with law enforcement and emergency responders – be cooperative. Determine where any injured parties were transported. Does the accident meet the criteria for a D&A test? ?

Accident Investigation The Report The accident report should be completed by the driver as soon as possible. If the driver is unable to complete the report, a supervisor should assist the driver. (Driver must sign the report) The accident diagram must be detailed. The driver’s statement must be complete and concise.

Accident Investigation The Report Review the report for completeness. The report must be completed online with our Third Party Administrator (TPA) within 24 hours of the occurrence. Forward the Supervisors Investigator report. File the report in an accident file in sequence by date.

Accident Investigation Preventability The Basic Question – “Did our driver do everything reasonably possible to avoid the accident? ” If the answer is “YES”, then the accident is considered “Non-Preventable”. If the answer is “NO”, then the accident is deemed “Preventable”. NEVER indicate Preventability on the accident report or related documents.

Accident Investigation Re-Training Re-training must always be presented as beneficial to the driver. The purpose of re-training is to correct operator deficiencies and enhance the driver’s skills. The intended outcome is a safer and more proficient driver. Re-training must never be represented as part of the disciplinary process.

Accident Investigation Re-Training Post accident re-training must be of a duration sufficient to measure the drivers competency. The re-training must focus on the causation factors of the accident. An evaluation form must be completed by the trainer as documentation of the re-training. Post accident re-training must be completed before the driver returns to service.

Accident Investigation The Claim Forward to the TPA all supporting documentation for the accident. 35 mm or digital photos. Repair estimates and /or repair orders. Maintain copies of all documents in the accident file. Respond quickly to all requests from the TPA.

You need value added claims reporting solutions!

All Accidents Are To Be Reported To: Auto & General Liability National Interstate 3250 Interstate Drive Richfield, Ohio 44286 -900 By Phone: 866 - 294 -8264 By Fax: 877 -303 -3832 By E-mail: newclaims@natl. com For Serious or Catastrophic Cases: 800 -929 -0870 (24/7) Workers’ Comp Highpoint Risk Services (REM) P. O. Box 600 Brea, CA 92822 By Phone: 877 -473 -2753 By Fax: 800 -877 -7750 By E-mail: highpoint@actec. net

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

Some vitally important information that should be secured at the scene: 1. 2. 3. 4. 5. 6. 7. Photographs. Other party’s insurance information. Other party’s driver’s license & plate number. Other party’s home and business telephone numbers. Names of witnesses as well as contact information. Name of police officer and department. Names of all first responders if possible. Please refrain from using cell phones to shoot pictures !!!

Some critical shots that can make or break the ultimate outcome!!!! 1. Vehicles @ point of impact. 2. Shots of approach views @ 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. 2. 3. 4. Pictures of other vehicles & license plates @ the scene. Shots of by-standers & possible witnesses. Shots of inside the vehicles. Pictures of surveillance cameras in close proximity.

Please properly identify all photos as follows: 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.

Work comp program features: 1. 2. 3. 4. 5. Bill Review – Physician & Hospital. Telephonic Case Management. Pharmacy Benefit Management. Utilization of Re-employability. Utilization Review.

Some general observations about work comp: 1. Historically, our subrogation results have been lackluster. 2. Our ratio of Lost Time to Med Only cases is out of sync. 3. Our denial rate is 3. 77%. 4. 58% of our WC claims are reported 5 or more days late. 5. 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 nonwork 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?

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

This is a straight forward process! 1 KEOLIS CONDUCTS ACCIDENT INVESTIGATION 2 3 GENERAL MANAGER SENDS SUBRO PROVIDER ACCIDENT REPORT 6 5 KEOLIS AWAITS OUTCOME OF SUBRO VENDOR’S EFFORTS 1 1 IF NO RECOVERY IF RECOVERY 4 IF APPLICABLE VENDOR CONTACTS KEOLIS FOR FURTHER INFORMATION IF APPLICABLE 10 7 SUBRO VENDOR REVIEWS MATERIAL 8 VENDOR ISSUES CHECK TO KEOLIS 9 KEOLIS ENTERS RESULT INTO SUBRO LOG KEOLIS PROCESSES CHECK SUBRO VENDOR DETERMINES IF SUBROGATABLE 1 2 CLAIM IS CLOSED

Your Subrogation Service Provider Wilber & Associates 816 Eldorado Road, Suite 1 Bloomington, IL 61704 T: 800. 313. 5169 F: 800. 313. 5179 E-mail your Accident Reports to: caseinfo@wilbercollect. com

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

Documents to be Obtained for Subrogation Claims 1. 2 3. 4. Accident report. Repair estimates, invoices and receipts. Police report, if available. Photos of damages.

Preparing Estimates 1. All receipts & invoices for replacement parts. 2. All invoices for outside services performed. 3. The total number of labor hours is to be noted separately from the cost of parts. 4. 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 !!!!!