Tuesday, February 26, 2013

Walk This Way

Consider this scenario - A Board member hears talk about someone falling on the common area sidewalk over the holiday.  Nothing has been officially reported to the Board or management, so he thinks nothing of it.  Six weeks later a neighbor confirms seeing a guest of another homeowner slip and fall, but still no report has been received.  On the seventh week a homeowner contacts the Board to state his guest had fallen, claimed she was okay, but later had to go to the hospital for a cracked rib. On the eighth week the community manager notifies the Board about the receipt of a letter from the guest, placing a claim against the Association for the injury.

What actions should the Association take, and when?

The goal in any such situation is to gather information as early as possible, and notify the insurance carrier as soon as possible.  Upon hearing the rumor, the Board member should have notified the manager, who in concert with Board members would ask around to verify the incident.  Once confirmed (as when a neighbor stated actually seeing it), the insurance carrier should be put on notice of a potential claim, although no complaint has actually been received.  This notification does not “count as a strike” against the Association’s record when determining annual insurance premiums.

Policies generally require that notice be given shortly after the occurrence.  Waiting to receive an actual claim by the injured party may be used as a reason for the insurer to deny coverage!  Typically, notice needs to occur within a day or two of the incident – refer to your policy for specifics.

In ideal circumstances, the Board member or manager would be able to observe the conditions of the area immediately after the injury occurred and take photos.  For a “slip-and-fall”, the insurer will want to know what type of surface was walked on, what was the weather and lighting at the time, what type of footwear was used, were walking aids, glasses, etc. being used, and was an ambulance called immediately.  If you should come upon an accident, do not assist in moving the individual unless there is immediate danger to leaving the person in that location.  If the injured person states she does not need an ambulance, call one anyway and let the emergency responder be the one to deal with refused assistance.  All such factors will determine what type of insurance settlement may occur. 

An insurance investigator will come out to inspect the area, snap photos, and interview the parties while working the case. It is important that all information, including any that might appear negative for the community, be shared with this agent.  The Association’s goal is not to find some way to deny the claim:  Insurance exists to make this business decision, removing the emotion out of the process.  The Association’s focus is identifying potential safety issues, and addressing these quickly.  For example, if the injury was due to an uneven/raised sidewalk, the Board may require grinding of uneven concrete edges for all sidewalks in the community.  The injury could have easily happened to your loved ones, and the goal is to make conditions as safe as reasonably possible for all.
Finally, details of the incident and follow-up known by Board members and management should only be disclosed after vetting by legal counsel.  Besides the obvious concern of potential copycat claims from others, items such as disclosing medical details of the injured party (a violation of HIPAA, or Health Insurance Portability and Accountability Act) must be avoided.  In our litigious society, all Homeowner Associations should tread lightly when it comes to addressing items involving insurance.   

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