As many of our members have deployed personnel to assist with the L.A. Fires, we wanted to provide a few friendly reminders should any of your employees sustain an injury during the scope of their employment.
Q. Did you know that claims arising from one of the fires may combine for one Excess Loss?
The EWC Memorandum of Coverage (MOC) Endorsement U-5 provides that an occurrence consists of all bodily injury sustained or alleged to have been sustained by one or more employees involving one or more Covered Parties from any one disaster, accident or event or any series of such, shall be deemed to arise from a single occurrence. However, any one occurrence shall be limited to no more than seven calendar days from the first recorded date of injury.
Injuries arising from an occupational disease or communicable disease shall be deemed to arise from a separate individual occurrence for each claim and not part of the global occurrence. This may include claims for smoke inhalation, exposures, pneumonia, etc.
The EWC Memorandum of Coverage (MOC) Endorsement U-3 provides that occurrences involving multiple members shall be considered one occurrence for each Tower.
What does this mean?
All claims for injuries sustained during any one disaster, accident or event or series of such for each member roll up into one occurrence for purposes of exhausting your individual self-insured retention (SIR). Additionally, all claims for all members combined, collectively roll up into one single Excess occurrence.
What is a single event and occurrence period?
Endorsement U-5 of the EWC MOC provides that all injuries sustained from any one disaster or event shall be deemed to arise from a single occurrence and shall be limited to no more than seven calendar days, meaning there may be more than one occurrence (Excess Loss) arising from the LA Fires. The Palisades Fire would be considered one event, and the Eaton Fire would be considered a separate single event. Please note that each combined Loss Occurrence shall be limited to a seven-day period per the MOC, starting with the date of the first Loss in each seven-day period. Thus, if a specific incident such as the Eaton Fire continues for multiple weeks, there could be one or more occurrences during the duration of the fire depending upon how many injuries occur and when they occur.
Example: Member A’s first date of loss is on 1/8, Member B’s first date of loss is on 1/10, Member C’s first date of loss is on 1/17. The first combined occurrence period for all members combined would be 1/8-1/14, and the second would be from 1/17-23. As you can see, the start date of each seven-day period is contingent upon the first date of loss, so it is imperative that all members promptly report claims to aid in determining the seven-day occurrence period while minimizing this period fluctuating over time as claims are reported.
What should you do?
- Report all claims arising from a single event to PRISM, even if the individual claim does not meet the normal reporting thresholds. This may include both Medical Only and Indemnity claims. Make sure to specify which fire the employee was assigned to at the time of the injury.
- Do you have a Service Agreement or Mutual Aid Agreement in place?
- Is there a service agreement or mutual aid agreement with Cal Fire for your employees responding to this State of Emergency?
- If yes:
- Who retains liability for injuries?
- It may be partial indemnification, meaning the Member retains the risk, but Cal Fire will reimburse salary which means we may have recovery potential for lost time wages (depends on language)
- If Cal Fire retains all of the risk, the claim may need to be filed with SCIF
Should you have any questions, please contact any of the following at PRISM at 916-850-7300 or via email:
Jen Hamelin, Chief Claims Officer – WC: jhamelin@prismrisk.gov
Karin Valenzuela, WC Manager: kvalenzuela@prismrisk.gov
Suzanne Nutter, WC Supervisor: snutter@prismrisk.gov