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Claims Administration
- Claims Philosophy
- Overview
- Staff
- Claims Reporting Guidelines
- Accident Reports
- Workers' Compensation
- Pollution Coverage
- FAQs
PDRMA Claims Philosophy
The
effective management of claims depends upon a close partnership among PDRMA
members, staff and contracted service providers. Cooperation amongst all partners
is essential to a successful claims process in which claimants are treated fairly,
payments or denials are made promptly, communication is on-going and the interests
of PDRMA members are held in the highest regard.
The PDRMA Claims Department strives to provide service that exceeds the expectations
of our members. We are objective in the investigation and evaluation of the
claims submitted to us.
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Overview
PDRMA's claims were originally handled by Gallagher Bassett. After realizing in 1993 the membership would be better served with an in house claim staff, the PDRMA claims department was born.
Since that time, the department has striven to provide claims handling to the
membership that exceeds their expectations. The PDRMA claims staff works with
the membership on all facets of their claims needs. The same dedication is provided
on all claims, from the smallest to the largest claims.
The claims staff provides claims handling to the membership, including property/casualty
lines of business, workers compensation and employment practices. The staff
also handles events and incidents on behalf of members; while these are not
actually claims, they require investigation and, on many occasions, correspondence
with attorneys, to deny liability on the part of the member.
Assistance to the membership regarding subrogation (recovery of monies paid
by the member, their deductible and in cases were the damages are under the
deductible, the actual losses incurred). This includes working with other insurance
companies and, in many cases, the wrong doer directly responsible who may not
have been insured at the time of the loss and payment plans are arranged.
Utilizing a cooperative approach with the members and their injured employees,
the claims staff works to provide the best medical care available to the injured
employees. The department also developed a prescription card program for the
injured employees to use, thereby saving the cost of out of pocket expenses
for prescription drugs.
Working with our legal department on cases where our membership has done nothing
wrong, and has not met a standard of willful or wanton negligence, has assisted
the claims department in become highly experienced in tort immunity laws. It
has also allowed claims staff to identify a wide range of legal defenses to
defeat claims that do not rise to the level of willful and wanton conduct. The
claims department recognizes that not all injuries can be avoided. When an injury
occurs and one of our members has done something wrong, or may have done something
to prevent the incident, a compromise payment will be considered.
The risk management and claims staff work together to develop new training
programs and share information from the claims generated for analysis by the
risk management department.
The goal of PDRMA's claims staff is to assist all departments in bringing the
membership the best product for their needs.
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Staff
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Claims Reporting Guidelines
This is a summary of PDRMA’s claims reporting and Investigation Guidelines. Included is our purpose statement, claims philosophy and detailed explanation of all of our coverages.
Adobe PDF Format, 
Microsoft Word Format
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Accident Reports
These are the required accident forms for all claims types for reporting purposes to PDRMA.
Prompt reporting improves PDRMA’s ability to successfully handle your claims.
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Workers' Compensation
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Pollution Coverage
If you experience a pollution related claim that involves:
- Illegal dumping on your property.
- Migration of pollution from your property to another.
- Migration of pollution on to your property.
- The contamination of your property by a pollutant
Notify PDRMA immediately during regular business hours at 630 769 0332 or through the after hours emergency line as directed by the recording.
Take Necessary Action to Control a Pollution Incident
Members have an obligation per the pollution policy to provide an emergency response to mitigate a pollution condition to prevent any further exposure or hazards to persons, property, or the spreading of the material making cleanup more costly. Emergency response means reasonable costs incurred to abate and/or respond to an imminent and substantial threat to human health or the environment.
Who Should You Contact to Control a Pollution Incident?
Document #350 on PDRMA’s website provides contact information for environmental consultants, clean-up contractors and an industrial hygienist that can be considered in the event of a pollution incident. PDRMA staff can assist you in making a decision concerning the section of a contractor. However, the payment of expenses arising from a pollution incident will be evaluated per the provisions in the pollution insurance policy.
What Claim Form Should I Complete?
Use the Property Loss Report claim form to provide pollution incident information to PDRMA claims staff.
In the Summary Section of the Property Loss Report form, please obtain the following information:
- Cause and Type of Incident:
- Cause of the incident
- Nature (first-party property or third-party liability)
- List chemical agent(s) (oil, gasoline, other) involved
- Current condition of the spilled material (moving ,contained)
- If the material is contained and stable, how is material being contained?
- Is the material leaking onto member property?
- Is the material leaking onto third-party property?
- Has an environmental consultant or cleanup company been contacted or currently on site?
- Have any patrons/staff been exposed to a chemical or otherwise injured?
Fax the completed claim form immediately to the PDRMA office at 630 769 0449
Consider gathering your Crisis Management Team
Pollution events commonly attract a substantial Fire Department response that often results in a media presence. It is recommended that agencies gather their Crisis Teams following any pollution incident and work with PDRMA to provide information to the general public and media.
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Frequently Asked Claim Questions
- What is lag time?
Lag time is used only for Worker’s Compensation claims. Lag time starts
from the date of loss to the time PDRMA receives a hard copy of the first
report of accident (Form 45) in our office. All Form 45’s should be
faxed to the PDRMA offices.
- How many days do I have to report a property claim?
Technically, 45 days but PDRMA needs to be advised as soon as the member is aware
of the damage. We have certain investigation requirements that must be met
and these can’t be completed if we have no knowledge of the claim.
- What is our member deductible?
$1,000.00 on all first party losses. First party losses are losses involving
damage to property owned by the park district.
- I was using my personal auto for park district business and was involved
in a vehicle accident. Who will pay my claim?
Insurance follows the vehicle owner. The insurance carrier for the employee
would pay for the vehicle damage. Any injury sustained by the employee would
be a worker’s compensation claim as long as it was determined they were
on park district business when the vehicle accident occurred.
- What is Temporary Total Disability
and when it is paid?
Temporary Total Disability
is a statute set by the Illinois Workers' Compensation Commission to compensate employees
when they have missed time from work due to a compensable claim. The injured
employee must have an off duty work slip from a doctor. This benefit starts
after the employee has lost more than three scheduled working days.
- The sheriff's department has served us with a summons and complaint; what
is that and what do we do with it?
A summons and complaint is the first notice that a person is suing the district.
Fax the documentation to PDRMA claims and legal department as soon as possible
for possible defense and coverage.
- What patron incident accident reports does the PDRMA claim department need
to receive?
Any patron injury case in which paramedics were called. Any aquatic related
incident where CPR was rendered or any successful saves should
also be reported. Minor events do not need to be sent in to our office. However,
we do suggest that you keep these forms on file on your premises. Should parents
contact you regarding payment of bills, please forward the incident report
and we will contact the parents. If you need further clarification please
contact the Claims Department.
- When does the PDRMA Claims Department send out patron denial letters?
Denial letters are not routinely sent for all incident reports received in
the PDRMA office. If the member receives a request for reimbursement of expenses,
medical or property, staff will send a denial letter. A request for reimbursement
can come from the injured party, their group insurance, medical provider or
an attorney.
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