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Insurers' reporting nuances key for risk managers

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Risk managers should closely review their insurance policies to understand what insurers expect for reporting incidents in a timely manner, experts said Monday.

The definition of timely reporting can depend on which insurers a company buys insurance from, no matter whether those policies include professional liability, directors and officers, cyber liability or other types of coverage, said Pauline Barry, assistant vice president with AWAC Services Co. in Farmington, Connecticut, a subsidiary of Allied World Assurance Co. Holdings A.G.

“You're going to find that all of the policies have little nuances. The definitions are not the same from policy to policy, from carrier to carrier,” Ms. Barry said during the American Society for Healthcare Risk Management's annual conference in Indianapolis.

Organizations sometimes fail to report incidents in a timely manner because employees don't understand when an incident should be reported to an insurer, they fear that they'll be punished for reporting an incident, or because employers haven't created a culture that encourages employees to report incidents on time, Ms. Barry said.

Kristen Kenst, assistant vice president with Allied World National Assurance Co. in Chicago, said that loss history is only one factor that insurers consider when underwriting policies for health care organizations.

For instance, she said insurers consider what services health care organizations provide — such as whether they deliver babies or have an emergency room — whether an organization has added doctors and the financial stability of a medical system. Such factors should be discussed truthfully with insurers when negotiating insurance policies, Ms. Kenst said.

“This is the time for accuracy. This is not the time to inflate your numbers to show how successful your system will be in the next year,” she said.

Bridget Zaremba, assistant vice president of health care professional liability claims for Allied World in Chicago, said insurers have varying standards for how they expect employers to report claims. For example, while some will accept claims through email or a phone call, some require claims to be submitted through registered mail.

“When in doubt, contact your claims representative,” she said.