Full Text
CLAIMS HANDLING AND PROCESSING POLICY 1 Adopted 11/09/2010 1.0 Purpose The purpose of this policy is to set forth the policy and procedure for handling and processing liability claims brought against the City of Lewiston. 2.0 Policy It is the policy of the City of Lewiston to purchase insurance to cover those risks not excluded by the Maine Tort Claims Act which can be reasonably anticipated and for which insurance is available in amounts and limits consistent with the Maine Torts Claim Act. It is also the policy of the City to use reasonable efforts to work closely with our insurer in processing claims in a timely and fair manner. Further, it is the policy of the City to abide by the determination of our insurer as to whether the City is liable for damages arising out of such claims, but not any determination as to whether the insurer properly provides coverage. 3.0 Procedure 3.1 All individuals or organizations that contact the City in regard to potential situations where a liability claim may be brought are to be directed to the Finance Director or his or her designee. 3.2 The Finance Department shall inform such individuals or organizations of the process to be followed in filing a claim and shall inform the City’s insurer of the potential for such claim. 3.3 The Finance Department shall take the necessary steps to research and document the circumstances surrounding the claim. 3.4 Should a claim be filed, the Department shall forward that claim along with documentation relating to it to the City’s insurer. 3.5 The Department shall provide, in a complete and timely manner, any and all additional information that may be requested by the City’s insurer. 3.6 The Department shall monitor the status of all claims and shall work with the City’s insurer and the claimant to ensure a timely review and response to the claim. 3.7 All documentation pertaining to any claim filed against the City shall be maintained by the Department. 4.0 Determination of Insurer The determination of the City’s insurer shall be final and binding on the City and its personnel with regard to the amount of the claim, but not with regard to the availability of insurance coverage. 5.0 Appeals 5.1 Should a claimant be dissatisfied with the determination of the City’s insurer, appropriate City staff shall review the claim and the insurer’s determination to ---PAGE BREAK--- CLAIMS HANDLING AND PROCESSING POLICY 2 Adopted 11/09/2010 ensure that all information has been provided and all aspects of the situation have been evaluated. Based on this review, staff may request that the insurer consider additional information or undertake further research relating to the City’s liability including, with the approval of the City Administrator, seeking a legal opinion from the City Attorney. 5.2 All additional information and/or legal opinions may be shared with the City’s insurer as appropriate under the circumstances. 5.3 Once the City’s insurer has come to a final conclusion, any further appeal by a claimant must be taken through appropriate court action by the claimant at his or her own expense. 6.0 Miscellaneous Provisions 6.1 All employees shall cooperate with the Finance Department and the City’s insurer in the investigation and analysis of any claims filed against the City. 6.2 To the greatest extent reasonably possible, City staff shall assist claimants throughout this process to provide all relevant information and considerations to the City’s insurer.