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Office of Risk Management. GENERAL LIABILITY CLAIMS. KATHLEEN GASSER CLAIMS MANAGER OFFICE OF RISK MANAGEMENT. Ann Wax, State Risk Administrator-Claims Kathleen Gasser Claims Manager Frank Foret Claims Supervisor Susan West Claims Manager

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general liability claims

GENERAL LIABILITY CLAIMS

KATHLEEN GASSER

CLAIMS MANAGER

OFFICE OF RISK MANAGEMENT

who we are
Ann Wax, State Risk Administrator-Claims

Kathleen Gasser Claims Manager

Frank Foret Claims Supervisor

Susan West

Claims Manager

James Lea Claims Supervisor

(225) 219-0012

(225) 342-8433

(225) 342-8463

(225) 342-6031

(225) 342-8399

Who We Are
cgl adjusters
PENNY BUCHANAN

BARBARA BURNS

JIMMY MARTIN

BYNIE WELLS

DIANE WILLIAMS

TOM BLUFF

225-342-8512

225-342-8516

225-342-6214

225-342-8447

225-219-4428

318-262-2131

CGL ADJUSTERS
what do we cover
WHAT DO WE COVER?
  • The State of Louisiana provides insurance coverage for third party bodily injury and property damage claims for which the agency could be held legally liable.
general liability claims1
General Liability Claims
  • Claims alleging damages in tort due to negligence by the state of Louisiana.
  • The CGL unit handles claims that are not Worker’s Comp, do not involve state owned automobiles, and do not involve damages attributed to the state highways.
  • Claims range from trip and falls to property damage to wrongful acts, for example.
the general liability policy covers
Premises and Operations

Completed Operations and Products Liability

Elevator and Escalator

Watercraft under 26’

Contractual Liability

Wrongful Acts

Errors and Omissions

Professional Liability

Public Officials

Custodial

Garage Keepers

Foster Parents

Protective Liability

Fire Damage Legal Liability

Publisher’s Media

The General Liability Policy covers:
civil rights claims
CIVIL RIGHTS CLAIMS
  • Claims alleging discrimination, harassment and or retaliation are also covered. The General Liability unit handles these claims.
reporting cgl claims
Reporting CGL Claims
  • In writing to:
  • General Liability Claims
  • Office of Risk Management
  • P. O. Box 91106
  • Baton Rouge, LA 70821-9106
  • If loss is serious in nature, also telephone it in to (225) 219-0168.
how to report a claim
HOW TO REPORT A CLAIM
  • For injuries sustained by visitors to your agency, have agency contact complete the CGL claim form found on our website:
  • www.doa.la.gov/orm
on line reporting
ON LINE REPORTING
  • CGL will be introducing On Line Reporting later this year. We plan to provide a Pilot Program with one or more agencies.
  • Worker’s Compensation is using On Line Reporting now.
when a loss occurs
When a Loss Occurs
  • All Property which has been damaged is to be protected against further damage and is to be made available for inspection by a claims adjuster assigned by ORM.
  • The agency is not to assume any obligation or incur any expenses without the authority of ORM.
where to send report of claim
Where to send report of claim
  • 1. Mail it to:
  • Frank Foret, Supervisor
  • Office of Risk Management
  • Post Office Box 91106
  • Baton Rouge, LA 70821-9106
  • 2. Fax it to:
  • Frank Foret, Supervisor
  • (225) 342-4470
how a claim is processed

How a claim is processed

An Adjuster is assigned.

customer service
CUSTOMER SERVICE
  • One adjuster will handle CGL claims for the entire agency in order to provide more effective customer service.
the adjusting process
The adjusting process:
  • 1. Investigation
  • 2. Evaluation
  • 3. Negotiation
  • 4. Settlement
investigation of claim
Investigation of Claim
  • The adjuster investigates to determine coverage by ORM
  • Liability and exposure are determined after obtaining the facts of the incident.
limitation of liability for public entities
Limitation of Liability for Public Entities
  • R.S. 9:2800
  • …No person shall have a cause of action based solely upon liability imposed under CC Article 2317 against a public entity for damages caused by the condition of things within its care and custody unless it had actual or constructive notice of the vice or defect, had reasonable opportunity to remedy it and failed to do so.
constructive notice
Constructive Notice
  • The existence of facts which infer actual knowledge
  • Example:
  • Defective sidewalk in front of administrative building or
  • Defective sidewalk somewhere in middle of campus where there are miles of sidewalk.
evaluation of the claim
Evaluation of the claim
  • Do we have liability?
  • Are we 100% at fault or was there comparative fault by the claimant or fault by another party?
  • What damages were suffered:
  • Medicals
  • Lost wages or lost time
  • Out of pocket expenses
  • Property damage
negotiation of claim
Negotiation of Claim
  • Claims may be filed “Pro Se” by the injured party or by an attorney.
  • The adjuster will negotiate directly to settle a claim.
  • When a lawsuit is filed, the adjuster will work with our defense counsel in negotiations.
settlement of a claim
Settlement of a Claim
  • The adjuster must have settlement authority in order to negotiate and settle a claim.
  • Requests for settlement authority may be presented to supervisors or to Claims Council depending on the level of authority sought.
  • A full and final release of all claims and a dismissal of any legal action are obtained in order to settle a claim.
cgl fy2006 statistics
CGL FY2006 STATISTICS
  • Pending as of 6/30/2006:
  • 1,155 GL
  • 959 PI
  • New claims:
  • 724 GL
  • 245 PI
  • Settlements/Judgments: 86
  • Paid: $5,976,258.27
do we cover trip and falls
Do we cover trip and falls?
  • Were we negligent in maintaining a safe environment?
  • Take pictures of area of fall.
  • Note whether claimant was wearing glasses, carrying things, type of shoes worn.
  • Provide witness information.
how you can help
How You Can Help
  • Tell us about conditions that contributed to the accident:
  • Wet floor, any warning signs?
  • Holes, barriers, irregular surface
  • Lighting
  • Weather
  • Handicap
  • Eyeglasses
  • Carrying anything that might obstruct vision
take photographs of the scene
Take Photographs of the Scene
  • Label with name of injured party and date
  • Take some photos that show location and landmarks
falls that involve a chair
Falls that involve a chair?
  • Only if the agency is negligent in maintaining a chair in a safe condition.
  • If chair broke, remove it from service, save it and label it with name of person who fell and date of incident.
  • Note the manufacturer and supplier of chair.
  • Take pictures
  • Provide witness names
damage to private cars
Damage to private cars?
  • Falling tree branches? Depends on whether it was live or visibly dead. Need photos.
  • Gate arm? If it malfunctioned.
  • Vandalism by unknown person? No.
  • Our mower? Yes if the auto is insured.
  • Need proof of liability insurance required by LA Law.
loss of personal property
Loss of personal property
  • Must determine care, custody and control
  • If property was left behind and then discovered to be lost, it would be abandonment on the part of the owner, and it would not be negligence on the part of the state.
theft or burglary of privately owned auto parked on agency grounds
Theft or Burglary of Privately Owned Auto Parked on Agency Grounds.
  • The state is not the insurer of a privately owned automobile. We act as the gratuitous depository only.
trip and fall in elevators
Trip and Fall in Elevators
  • We must determine the Maintenance Co. who services the elevator and review the contract.
  • Check to see whether a malfunction has been previously reported to the Maintenance Co.
do we cover injuries or damages caused by wildlife
Do We Cover Injuries or Damages Caused by Wildlife?
  • Vehicle traveling on state highway hits a deer
  • Visitor to state park receives insect bite/snake bite
lawsuits filed against your agency
Lawsuits filed against your Agency
  • Forward all lawsuits, demands, or legal documents pertaining to a claim to ORM immediately for further handling.
louisiana governmental claims act
Louisiana Governmental Claims Act
  • R.S. 13:5101 et seq. states this applies to any suit in contract or for injury to person or property against the state, a state agency, an officer or employee of the state or a state agency arising out of the discharge of his official duties or within the course and scope of his employment…
employee coverage r s 13 5108 1
EMPLOYEE COVERAGE R.S.13:5108.1
  • Indemnification of officers and employees of the state; civil rights; representation by the Attorney General.
  • ORM is the insurer
  • State employee is the insured
  • DOJ is defense counsel
named defendant must request representation by attorney general
Named Defendant Must Request Representation by Attorney General
  • Send a copy of the petition
  • Send a cover letter to Attorney General Charles C. Foti requesting representation
  • Provide information regarding service of the petition
  • Within 10 days of date of service of petition
our duty to defend
Our Duty to Defend:
  • The state shall defend and indemnify a covered individual against any claim, demand, suit, complaint or petition seeking damages filed in any court over alleged negligence or other act by the individual, including any demand under any federal statute when the act that forms the basis of the cause of action took place while the individual was engaged in the performance of the duties of the individual’s office or employment with the state.
who is covered
Who is Covered?
  • R.S.13:5108.1(e)
  • 1. An official, officer, or employee holding office or employment:
  • Executive branch
  • Legislative branch
  • State Supreme Court, courts of appeal, family, juvenile or judicial district courts
  • Deep-water ports
claim demand suit complaint or petition seeking damages
Claim, demand, suit, complaint or petition seeking damages
  • Remedy sought determines whether complaint with be handled by ORM.
  • Suits seeking contractual damages or suits on open accounts are not handled by ORM.
limitations
Limitations
  • Suits against the state must be filed in Louisiana state courts
  • Suits for personal injury to any one person total recoverable exclusive of property damages, medical care, loss of earnings, shall not exceed five hundred thousand dollars.
future medical care fund
Future Medical Care Fund
  • In personal injury suits wherein the court awards medical care and benefits subsequent to judgment, this is paid according to R.S. 39:1533.2
  • Medical care benefits are paid directly to providers as incurred.
employment practice liability
Employment Practice Liability
  • Claims of Improper or Discriminatory:
  • -Hiring, Firing, Discipline
  • -Compensation Classification
  • -Treatment, Training, Opportunities
  • -Terms and Conditions of Employment
what is title vii of the civil rights act of 1964
What is Title VII of the Civil Rights Act of 1964?
  • It prohibits discrimination in employment of the basis of:
  • Race
  • Sex
  • National Origin
  • Religion
discrimination is illegal in the following
Hiring and Firing

Compensation, assignment, or classification

Recruitment, testing

Use of facilities

Training

Benefits

Pay, retirement plans

Leave

Other terms of employment

DiscriminationIs Illegal in the Following:
to prove discrimination
To Prove Discrimination
  • There must be an adverse employment action such as failure to hire, promote or termination.
what is title i of ada
What is Title I of ADA?
  • Americans with Disabilities Act prohibits discrimination in employment against a qualified individual with a disability because of the disability.
  • It is unlawful to take retaliatory action against any individual for opposing unlawful practices or for filing a charge.
what is the age discrimination in employment act
What is the Age Discrimination in Employment Act?
  • It prohibits discrimination in employment of the basis of age with respect to individuals who are 40 years of age or older.
who enforces these acts
Who Enforces these Acts?
  • Equal Employment Opportunity Commission (EEOC)
  • Employment Litigation Section, Civil Rights Division, U.S.Department of Justice enforces Title VII against state governments
what does eeoc do
What Does EEOC Do?
  • EEOC investigates claims of discrimination filed by employees.
  • If there is reasonable cause to believe a violation of the law has occurred and conciliation efforts are unsuccessful then
  • EEOC refers the charge to the U.S. Department of Justice to initiate litigation.
  • Or issue a right to sue letter to complainant.
is there a time limit to file
Is There a Time Limit to File?
  • Charges filed against the state must be filed within 300 days of the act of discrimination
  • EEOC does their investigation
  • After a Right to Sue letter is issued, there is an additional 90 days in which to file a lawsuit.
plaintiff recovery rates
Plaintiff Recovery Rates
  • From a $30 million dollar verdict in one case
  • A class action against Coca-Cola settled for $192.5 million,
  • Risk of high verdicts and class action decisions is obvious.
  • EPL favorable verdicts were 50% in 1994.
  • EPL Verdicts for plaintiff increased to 67% by 2000.
  • Research shows, however that 43.6% of favorable decisions for plaintiff were reversed upon appeal.
medical malpractice

MEDICAL MALPRACTICE

KATHLEEN GASSER

CLAIMS MANAGER

Office of Risk Management

who we are1
WHO WE ARE:
  • Kathleen Gasser, Claims Manager Telephone (225) 342-8433
  • Susan Couvillion, Claims Supervisor Telephone (225) 342-8432
  • Anne Whittinghill,Claims Supervisor Telephone (225) 342-0868
malpractice adjusters
Kate Albert

Sylvia Clower

Pam Deslatte

Sandy Pittman

Jim Richard

Brenda Breeland

Nancy Daigle

Percy Williams

(225) 219-0788

(225)342-8440

(225) 219-0408

(225) 219-0411

(318) 487-5412

(225) 219-9832

(225) 219-0410

(504) 568-6825

Malpractice Adjusters
what do we cover1
WHAT DO WE COVER?
  • Medical Malpractice insurance coverage is extended to state health care professionals providing health care services on behalf of the State.
  • Includes medical, surgical, dental or nursing treatment of patients.
malpractice statistics
Malpractice Statistics
  • Pending claims approximately 1,129
  • New claims received 2006 FY 238
  • Paid $14,584,583.71 for 102 settlements/judgments
  • Pending is down 140 cases
hurricane katrina
HURRICANE KATRINA
  • KATRINA RELATED MEDICAL MALPRACTICE CLAIMS 15
  • MCLNO 13
  • UNIVERSITY 1
  • LSUMC 1
medical malpractice statute
Medical Malpractice Statute
  • The State of Louisiana provides Medical Malpractice coverage in accordance with the provisions of R.S. 40: 1299.39
what is malpractice
What is Malpractice?
  • The failure to exercise the reasonable standard of care specified and required in the provision of health care, when such failure proximately causes injury to a patient.
standard of reasonable care
Standard of Reasonable Care
  • The standard of reasonable care for licensed physicians and dentists shall be the same as that required to be proven with respect to them under R.S.9:2794…
  • Knowledge or skill or degree of care ordinarily exercised
breach of standard of care
Breach of Standard of Care
  • Plaintiff must prove negligence
  • Injury alone does not raise a presumption of negligence
  • Plaintiff must prove proximate cause of each injury
who can file a claim
Who can file a claim?
  • The patient
  • Patient’s legal representative (attorney)
  • Legal guardian/parent on behalf of minor patient
  • Next of kin on behalf of deceased patient
how to file a medical malpractice claim
How to file a medical malpractice claim?
  • A request for a Medical Review Panel must be forwarded to:
  • Commissioner of Administration
  • Post Office Box 44336
  • Baton Rouge, LA 70804-4436
  • Filing fee $100 per named defendant
duty of the commissioner
Duty of the Commissioner
  • Confirm receipt of the filing within 30 days
  • Notify all named defendants
  • Notify claimant and defendants of date of filing, and receipt of filing fee or
  • receipt of affidavit of paupership
medical review panel
Medical Review Panel
  • Composed of three medical providers of the same specialty as named defendant
  • Plus an attorney chairman selected by plaintiff and defendant counsel.
  • The attorney chairman supervises the activities and deadlines for the panel
panel decision
Panel Decision
  • Evidence is submitted by plaintiff and defendants in writing.
  • Panel has the sole duty to express its expert opinion as to whether or not the evidence supports the conclusion that the defendant(s) acted or failed to act with the appropriate standards of care as charged in the complaint.
filing a medical malpractice lawsuit
Filing a medical malpractice lawsuit
  • The filing of a panel request suspends the time in which a suit must be instituted.
  • This runs for 90 days after notice by certified mail of the panel decision.
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