How Can I File A Claim Under the OASW Plan?
July 23, 2020
Social work is all about communication. But despite your best intentions, what you communicate isn’t always what ’s understood. In the heat of the moment when clients are at their most vulnerable, you may be just as vulnerable to risk. Sometimes it only takes a single documentation error, misstated fact, or a difference of opinion with a client to trigger a claim.
Dealing with a claim can be stressful, especially when you’re not entirely sure how to proceed. But with communication, teamwork, and the right support, the whole process will be over before you know it. To help you out, we’ve put together a step-by-step guide to filing a Professional Liability claim.
1. Receive the claim.
First things first: how will you know if someone is making a claim against you? Most of the time, it’s once you’ve received a formal notice or statement of claim, whether that’s by mail, email, personal delivery, or even fax. However, in some cases, you might have reason to suspect or anticipate a claim before you’ve actually been served. Examples include:
- If a client or their lawyer issues a written or verbal demand for damages;
- If a client or their lawyer makes written or verbal threatening comments indicating that they are seeking damages and/or may sue you; and,
- If you believe you made a mistake in how you rendered your professional services and may have caused harm to a client.
If at any point during your Policy Period or Discovery Period (which keeps your policy in force for a specified duration of time following cancellation or non-renewal), you become aware of an actual or potential claim:
- DO NOT make any written or oral statements to any involved or third parties;
- DO NOT offer compensation or admit liability to independently settle; and,
- DO NOT amend or change any previous clinical records;
- DO NOT seek independent legal services or assume legal fees before notifying your Insurer (any fees incurred may not be reimbursed).
Taking such actions could interfere with your insurer’s ability to manage the claim and jeopardize your access to insurance coverage and/or legal defence.
2. Seek legal counsel or HR advice from Trisura, if necessary.
If you are unsure whether or not an incident is claims worthy, take advantage of the Trisura Legal Helpline. As a member of the OASW, your plan with Trisura Guarantee Insurance Company includes complimentary, unlimited access to specialized legal and HR information. The Helpline is available in English and French from 8AM to midnight (local time), seven days a week at 1 866 945 5207. All you need is to provide your PROLINK policy number and an intake agent will schedule a convenient time for a lawyer to call you back and advise on your specific issue.
Remember, the agreement you have with your insurer requires that you inform them anytime there is a situation that might give rise to a claim. Even if you decide to report it and nothing comes of the matter, it won’t affect your loss ratio, insurability, or renewal pricing. Don’t wait for a problem to blow over—check in with Trisura as you’re aware of an actual or potential claim.
3. Report the claim.
Timely notification is critical to the claims-handling process. The sooner you report, the sooner your insurer can get to work on resolving your claim. If legal defense is required, the insurer needs to begin gathering information immediately, and if you don’t notify them until later, an effective legal defence might not be possible. And sometimes, delayed reporting or failure to report can result in denial of coverage altogether.
OASW members must give notice of claims in writing as soon as is practicable once they become aware of a claim, but no later than 60 days after the expiration of the Policy Period or Discovery Period, if exercised, in which the Claim was first made. Be sure to provide full detail based on your knowledge and recollection of the incident, including dates, events, and all persons and entities involved.
You can report claims to PROLINK directly at 1 800 663 6828. We’re available Monday to Friday from 8AM to 5PM. We’ll take your claim, confirm your policy, and report it to your insurer. If your claim must be reported immediately and it’s after 5PM, connect with our after-hours claims service, Kernaghan Insurance Adjusters at 1 800 387 5677, or contact Trisura directly and they’ll loop us in. You can email your claims information to Trisura at firstname.lastname@example.org.
4. Prepare documentation.
After reporting, PROLINK will help you fill out paperwork to prove that your claim is genuine and satisfies the terms and conditions of your policy. Share any additional detail or documentation you have with us, like as a copy of a police statement, if relevant, any expenses, invoices, photographs, client correspondence, or other related files. We’ll provide the information to your insurer who can begin the process of reviewing your claim.
5. Let us take care of the rest.
Once you’ve provided all the necessary information, you can sit back and relax. We know—it’s easier said than done. Especially when even a single claim can put huge financial strain on a business. But as your broker, it’s our job to advocate for you so that you can get the protection you need and the service you deserve (how we find your perfect fit). We’re working hard every day to make the claims process as smooth and painless for you as possible. And we’ll reach out and advise you as needed so you can get your business back on its feet sooner rather than later.
Ideally, you will never have to make a claim against your insurance. But no matter how careful you are, sometimes a claim is unavoidable. When a single allegation has the power to devastate your finances, you’ll need the support of a team that understands the unique threats you face as a social worker.
With nearly a decade of serving OASW members, PROLINK—Canada’s Insurance Connection has the expertise to provide superior protection, an exceptional claims-handling approach, and personalized client service just for you. We’ll take care of you so you can take care of your clients.
For more information, visit prolink.insure/OASW.
PROLINK’s blog posts are general in nature. They do not take into account your personal objectives or financial situation and are not a substitute for professional advice. The specific terms of your policy will always apply. We bear no responsibility for the accuracy, legality, or timeliness of any external content.