Welcome to Dubai ! Managing Claims in the Hospitality and Tourism Sector
On The Panel • Ronald Smith Risk Manager • Joana Nogueira Complex Claim Adjuster • David Todd Loss Adjuster • Michael Ducker Senior Associate
Four Steps of Claim Management 1. RESORTS 2. INSURANCE 3. LOSS ADJUSTING 4. LEGAL DEFENCE
Four Steps of Claim Management 1. RESORTS 2. INSURANCE 3. LOSS ADJUSTING 4. LEGAL DEFENCE
RESORTS: SOURCES OF Food & Beverage CLAIMS Waterpark Hotel ANNUAL ATTENDANCE Resort Guests: 1.2m F&B Covers: 4.1m Waterpark: 1.6m
CLAIM MANAGEMENT PROCESS INCIDENT INTERNAL EXTERNAL INQUIRY LITIGATION OCCURS REPORTING REPORTING (Fact Finding) DEFENCE Risk Management/ Security HOTEL Legal Department FOOD & BEVERAGE Claims Manager Food Safety Q.A. Waterpark WATERPARK Dept. Management Opportunities to Settle
CAUSES/TYPES OF CLAIMS • WATERPARK • Slips, Trips and Falls • Collision (slides) • Contusions/Strains/Sprains • Abrasions/Lacerations • HOTEL • Slips, Trips & Falls • Bruises/Strains/Sprains • Abrasions/Lacerations • FOOD & BEVERAGE • Food Allergies • Food Contamination • Flu-like symptoms
Claim Management Challenges • Late or Non-Reporting of Incident • Failure to Get Statement from Claimant • Failure to Get Statements from Witnesses • Inability to Use CCTV Technology • First Reports from Outside Correspondence • Aggregation of Low Value Settlement • Conscious of Power of Social Media UK: Package Travel Regulations of 1992 Tour Operator Claim Management and Indemnification Clauses
1 http://www.dailymail.co.uk/news/article-3953448/Travel-firm-uses-spies-rumble-company-bogus-sick-claims.html
Trolling for Illness Claims by UK Solicitors
Four Steps of Claim Management 1. RESORTS 2. INSURANCE 3. LOSS ADJUSTING 4. LEGAL DEFENCE
Risks Triggering Your Liability Policy • Each day brings different incidents with the potential to escalate. • Some Are Routine: • Slips and falls, • Food poisoning, • Missing items from guests . • Damages caused by valet parking . • Others Are Extraordinary: • An allergy caused by a henna tattoo. • Child drowning in the adults swimming pool.
Process: Practices for Liability Claims • Claims handler to acknowledge receipt of a claim in a prompt fashion: • Request further information to assist in taking a coverage position • Appointment of experts to assist in the enquiries when needed. • Insured to facilitate insurers investigation, acquisition of documentation and evidence. • Depending on the case, insurers might select to guide the insured how to conclude a simple case. With more complex cases, insurers will establish direct contact with the claimant, with the aim of conducting a successful negotiating . The ultimate objective is to bring the matter to a fair and just conclusion. • All documents that support payments, diagnosis, disability, evaluations, calculations etc. should be secured and preserved. • When required, insurers will appoint defense counsel to defend insured interest.
Best Approach in Case of an Incident • Listen Properly • Protect guest’s privacy • Be alert: a docile guest might become an aggressive claimant! • Report the incident • Investigation is required to determine liability, the sooner the better • Decide what information is required and the right questions to ask • Take photos of the scene, conduct site investigation, and preserve evidence • Witness memories fade quickly: please secure written statements
What Do People Claim For? • Property Damage : • The cost of repair or replacement of a damaged or lost object • Bodily Injury/Illness: • Reimbursement or payment of medical expense and compensation for the pain and suffering caused by the injury and the effect it has had on their lifestyle . • Financial losses : • Lost earnings, bonuses and overtime because of the accident; in addition to travelling expenses for visits to the hospital. Loss of use of vehicle . • Provisional Damages : • Where there is risk that a medical condition caused by the accident will deteriorate within a certain time in the future .
Required Information Incident Report: • Information on the guest (name, age, nationality, ID copy, contact details) • The circumstances (incident date/time, reported date/time) • Action taken • The allegations • Description of the injury or damage • Description of the location of the incident • Photographs / measurements / CCTV footage • Highlights on any demands/allegations Additional Documents: • Witness statements: Avoid personal opinions • Medical records • Police / Fire brigade report • Damage estimates
Key Points • Hotels are not liable for every accident or loss that occurs on the premises • For the hotel to be liable, there should be a proven Breach of duty and causation • Hotels have a general duty to exercise "reasonable care" for the safety and security of their guests, either to: a) Correct any situation that can constitute danger (mostly when there are similar incidents reported); b) Warn on the existence of that danger. • Hotels may be "vicariously liable" for the NEGLIGENCE of their employees, vendors or 3rd party contractors. • Take corrective measures to prevent re-occurrence
Alert - Suspicious Claimants • Opportunists, repeat offenders, professional and organized fraud; • Motives: greed, financial pressure, moral hazard, arrogance, etc…; • Indicators: very friendly, very angry, previous history, suspicious circumstances, altered documents, non-disclosure of proper information or documents, exaggeration and fabrication, with an intention to make a gain or cause a loss; • How we might defeat it: develop an anti-fraud culture, while respecting the company policies and the applicable laws.
Four Steps of Claim Management 1. RESORTS 2. INSURANCE 3. LOSS ADJUSTING 4. LEGAL DEFENCE
What is a Loss Adjuster? • Insurance claims expert • Appointed by Insurance/reinsurance carrier • May specialize in a certain field, e.g., liability claims • Independent, impartial – first party claims • Third party claims – we’re on your side! • Duty to act professionally
The Role of the Loss Adjuster • Establish the circumstances of loss – Insurer’s eyes and ears on site • What happened – who, what, where and when? • Cause – involvement of forensic experts/interview witnesses • Extent of Loss & Damage – type of injury/extent of physical loss or damage • Gather evidence – potential defence? • Subrogation – can I get my money back? • Communication – with both Insured, Insurers & third parties
Who is at Risk for Claims? • Hotels • Restaurants • Spas • Water parks • Theme parks • Golf course operators • Marine & aviation operators
Risks & Sources of Potential Liability Claims • Swimming pools • Water parks • Water sports • Marine pleasure craft • Desert safaris • Aviation – hot air balloons/light aircraft • Slip/trip & fall
Risks & Sources of Potential Liability Claims (cont.) • Food poisoning • Fire • Golf course risks • Theft of personal effects • Valet parking • Amusement rides • Miscellaneous – e.g. legionnaire's disease
Loss Adjuster Enquiries • Review of initial documentation received • Review policy coverage • Arrange site attendance • Inspect the situation of accident/incident • Establish the standard operating procedure • What went wrong, if anything? • Gather evidence • Interview witnesses • Take photographs • Prepare report(s) for Insurer’s consideration
Four Steps of Claim Management 1. RESORTS 2. INSURANCE 3. LOSS ADJUSTING 4. LEGAL DEFENCE
Liability Claims: Litigation Process • UAE Courts: – Civil Courts – Criminal Courts – Shariah Courts • Litigation divided into three stages: – Courts of First Instance – Courts of Appeal – Court of Cassation • Procedures of the UAE Courts • Role of advocacy / pleadings • Proceedings in Arabic • Expert appointment
Liability Claims: Duties and Legislation • Employers required to ensure the health of safety of employees at work, and of visitors to premises • Breach of this duty, leading to death or injury, can give rise to both financial and criminal penalties • Principle legislation: – Labour Law (Federal Law 8 of 1980) – Penal Code (Federal Law 3 of 1987) – Protection of Workers from Hazardous Works (Min. Dec. 4/1 of 1981) – Working in Remote Areas (Min. Dec 27/1 of 1981) – Employee Penalty Guidelines (Min. Dec. 28/1 of1981) – Prevention of Hazards at Work (Min. Dec. 32 of 1982) – Standards of Medical Care (Min. Dec. 37/2 of 1982)
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