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Robert, although this is not a "CAT" loss, I'll provide some info. regarding premises liability claims. I'm not aware of any web site that will be of help however you could get excellent info. from "Casualty Claims Practice" by James Donaldson, excellent reference material.

Basically, you're asking about the investigation process. You need to find out what the claimant claims he slipped or tripped on. Obtain a recorded statement from him/her, question about what caused the fall. Ask if the claimant has previous injuries or claims. Was it a condition of the premises- loose carpet, floor tile, etc. or did a customer or employee drop something on the floor? Then determine whether the insured acknowledged the condition (possibly a maintenance issue) or whether this is a condition created by the insured or an employee- wet floor from mopping or? If that's the case, any warning signs or cones on the floor? Be sure to take photos of where the slip/trip occurred and especially from the angle or direction from which the claimant approached. Does it appear to pose a hazard?- is there a problem seeing a transition between surfaces as far as levels? Do steps down appear to blend into one another? Does the insured have employees "patrol" the area on a regular basis for products or food, etc. that have fallen on the flooring, thus creating a hazard. Does the insured keep a floor log noting when inspected and by whom? If so, obtain a copy of the log. If a customer dropped something on the floor which caused the hazardous condition and the insured/employee had not found it in time, then the insured didn't have "constructive knowledge" of the hazard. That can be used as a defense. Find out if any employees or customers saw the claimant prior to the fall- anything suspicious? Did the claimant limp or appear to have a mobility problem before the fall? What type of shoes was the claimant wearing? Any eyeglasses? Obtain recorded statements from any employees or other customers who observed the claimant prior, during or after the fall.

Your role is to do investigation of the "scene of the crime"- be the eyes and ears of the carrier and document findings thoroughly.

Hope this helps.

Excellent information. Thank you for your help.

Tom, good point about the statements. After doing those for years, you taken them for granted and assume new adjusters are given a statement guide to follow.

Robert, check out this web site: www.claimspages.com. This has good info. and a wealth of documents you can print off. For statement guides, go to "Documents" on the left side, scroll down to "More Claims Forms".
Then to the Document Index on the left and click on "Liability". Then click on "Statement Guides". You will find what you're looking for under "Floor- Slip & Fall" and a separate statement guide for claimants, insureds and witnesses.

Sorry I forget about this earlier..

You mentioned witnesses that claimed otherwise...does this mean there was no fall? or there was no apparent injury?  Hopefully the insured has a record of the witnesses names & phone numbers, maybe even a short written incident report taken by the insured.  Several stores/businesses practice that, and it helps.

After contacting the claimant & scheduling an appt for the recorded statement, I might try to get recorded statements from the witnesses.  Have your scene photos with you, and have them well labeled and permanently numbered, and refer to them by number on the recorded statement so the witness can give you the most accurate answer "to the best of their recollection".

If all of the witness statements jive, this will give you a better line of questioning when taking the claimant's statement.  Remember this might just be that there was no "apparent" injury in the minds of the witnesses...no blood, or obvious visual injury...but something that came on a few hours later such as a muscle strain, etc.

Find out if the carrier you are working can run an Index report.  Many carriers participate and report each and every claimant/insured that has filed an injury claim, including work comp.  If an individual has prior injury claims, a report will come back telling when, where, what type, who the carrier was, etc.  

Last thoughts, when turning the recorder off...again state the date and time.  If you are ever interruped (the claimant gets a phone call), announce the date & time and that you are taking an interim break.  State the date & time again when you re-start.  If your tape is ever subpoenaed, this will CYA if accused of editing.  If there are any other people present when taking the statement, introduce them early on & have them acknowledge their presence.  Ask them to remain silent, but if they do interject they need to state their name first & the reason they are interjecting.  This is more CYA, and also makes it easier for the transcriptionist if the carrier decides to have the tape transcribed. 

 

   

 

Just now reading through the info. Thanks for all the input. The "fall" happened in a bar in FL. Customer claims to have slipped and fell. Witnesses say she was doing cartwheels and fell.