Insurance incidents/accidents

Normally refers to insurance coverage for bodily injury and death resulting from accidental means (other than natural causes). For example, an insured person is critically injured in an incident. Accident insurance can provide income and/or a death benefit if death ensues. 

The safety audit is designed to take accoimt of quantitative information available through data on injuries, incident reports, insurance claims, accident reports, first aid records and any other documents that can provide an indication of performance. In looking at the administrative structure, attention is drawn to the support mechanisms that provide the foimdation for hazard management and accident prevention. 

Griffith and Malaro highlight the need for museums to exercise a duty of care to their public. Failure to do so, in the United States of America at least, may lead rapidly to a costly lawsuit. Most museum administrations of course take particular care to ensure that access to exhibits and galleries is not impeded and that fire exits and evacuation systems are provided, in many cases to satisfy specific insurance requirements. Accidents involving visitors do occur, however (see Table 4), although the incidence rate for major injuries is thankfully extremely low. The limited survey used as the basis for Table 4... 

If the incident constitutes a reportable accident as defined in legislation the plant engineer will also ensure that the incident is immediately reported to the Factory Inspectorate. The Inspectorate will decide whether they wish to carry out an enquiry and, particularly if there has been loss of life, the accident site may be compulsorily isolated. Unless this is so, investigation by the insurer or a loss adjuster acting on his behalf may proceed. 

When the cause of the incident has been established and the costs of rectification finalized, these will be compared with the insurance cover provided by the policy and the extent of the insurer s liability, if any, determined. The policy will normally be one of indemnity, i.e. returning the insured to the same position after an accident as he was before. This may be achieved by repairing or replacing what is damaged or by paying the amount of the damage. It may be necessary to carry out modifications to prevent a recurrence of the accident or desirable to up-rate the specification for better performance or the life of the machine may have been extended by the repairs carried out. In this case a degree of betterment is involved which will be reflected in the settlement by a contribution by the insured to the cost of repairs. 

The source of the data—insurance claims files and records of plant owners — cannot provide reliable accident causal data. From personal experience, 1 can say that insurance claims reports rarely include causal data. And my studies of incident investigation reports completed by supervisors require the conclusion that they are not a reliable source for valid causal data. 

Five of the 15 forms received require entry of codes for causal factors, incident types, and injury t)q)es. When computer analysis programs first became available, I had been an aggressive promoter of the entiy of causal factor codes for later analysis. That proved to be inappropriate because accurate causal data are often not included in supervisors investigation reports or in insurance claims reports. Now, I recommend that computer-based analysis systems not include provision for causal data entry. They serve analysis purposes quite well for types of accidents, injury types, parts of body injured, and identification data (location, age, job title, etc.). 

In the insurance-related literature, peril is a frequently found term. It may be used synonymously with hazard or risk or exposure. Perils insured against are commonly considered to be fires, explosions, falling aircraft, windstorms, floods, automobile accidents, embezzlements, et cetera. Perils are incidents that occur when hazards are realized. Perils are events they are not hazards or risks or exposures. 

The origin of the Domino Theory is credited to Herbert W. Heinrich, circa 1931, who worked for Travelers Insurance. Mr. Heinrich nndertook an analysis of 75,000 accident reports by companies insnred with Travelers. This resulted in the research report titled The Origins of Accidents, which concluded that 88 percent of all accidents are caused by the unsafe acts of persons, 10 percent by unsafe physical conditions, and 2 percent are Acts of God. His analysis of 50,000 accidents showed that, in the average case, an accident resulting in the occurrence of a lost-time work injury was preceded by 329 similar accidents caused by the same unsafe act or mechanical exposure, 300 of which produced no injury and 29 resulted in minor injuries. This is sometimes referred to as Heinrich s Law. Mr. Heinrich then defined the five factors in the accident sequence, which he identified as the Domino Theory. Heinrich s work is the basis for the theory of behavior-based safety, which holds that as many as 95 percent of all workplace incidents are caused by unsafe acts. See also Accident Chain Behavior-Based Safety. 

Some insurance companies have business opportunities that insure employers and others against accidents and incidents involving people, property and the environment. A significant kind of insurance is workers compensation, discussed in Chapter 6. To reduce claims, insurance companies created services to help their clients reduce accidents and incidents leading to claims, this is called loss control. The fimction involves studying the frequency and severity of claims and how they came about. Loss control specialists use the results to advise clients on ways to avoid those events. The professional organization is the Insurance Loss Control Association (ILCA). 

Chapter 6 discussed methods for setting workers compensation insurance premium rates. In some methods the cost to the insurer for claims made against a policy determine future premium rates. Insurance rates for liability or other business protections also influence premiums. Some people buying auto and home insurance encounter this after an accident or claim. Incident records and reports may also help determine the value of a loss. 

For the insurance industry, another aspect of risk is loss control. Loss control is controlling conditions that can lead to a loss. It is part of risk management. For an insurance company, loss control is helping insured customers prevent loss producing events. Few losses means few insurance claims. From a safety perspective, loss control helps clients manage safety and health, recognizes hazards and implements preventive measures. The measures eliminate accidents and incidents that create personal, property or financial losses for both parties. When loss control is effective, the insurance company and the insured gain benefits. 

The estimated RR statistic (metal processing, year 2002) shows that the incidence of injurious work place accidents (including commuting) was clearly higher in blue-collar employees than in white-collar employees. The amount of CA was so minor in supervisors there was no reliable base to estimate RR separately for them. Hence, the WA and CA were analysed together. They belong to the common accident insurance system in Finland in the same way. 

If one intentionally refers to accident-like occurrences, the definitions accident, case of imperilment," incident, or similar definitions should be used. Due to the necessary flexibility of such words in language, the various meanings of these words cannot be sharply delineated. They will be used in the following sense (based on actual usage in insurance law) ... 

Implementing an effective safety program to reduce work site incidents can influence workers compensation premium costs. Lowering the frequency and severity of construction accidents will help to lower experience modification rates (EMR) and manual rates that, in turn, lower workers compensation insurance premiums [3,7]. 

The source of the data was insurance claims files and records of plant owners, which cannot provide reliable accident causal data because they rarely include causal factors. Nor are accident investigation reports completed by supervisors adequate resources for causal data. When this author provided counsel to clients in the early stages of developing computer-based incident analysis systems, insurance claims reports and supervisors investigation reports were examined as possible sources for causal data. It was a rarity for insurance claims reports to include information from which causal factors could be selected. 

Any accident or incidence of ill-health will cause both direct and indirect costs and incur an insured and an uninsured cost. It is important that all of these costs are taken into account when the full cost of an accident is calculated. In a study undertaken by the HSE, it was shown that indirect costs or hidden costs could be 36 times greater than direct costs of an accident. In other words, the direct costs of an accident or disease represent the tip of the iceberg when compared to the overall costs. 

Information for insurance/compensation purposes following accident or incident... 

On the other hand, accidents and other incidents may prove very costly not just in terms of lost production, but also in terms of compensation which may have to be paid out to those injured and so may adversely affect insurance costs. A study by the HSE has shown that in a number of case studies, the uninsured costs such as those which result from loss of goodwill or hiring and training of replacement staff often far exceed the insured costs. Indeed, for the cases under consideration, the uninsured costs exceeded the insured costs by a... 

---