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Ask An Expert Briefs

Big "I" Virtual University VUpoint Newsletter
Vol. 20, No. 23 - Issue #486 - November 8, 2019
Copyright  2019 by the Independent Insurance Agents & Brokers of America, Inc.

The Virtual Universitys Ask An Expert (AAE) service may be our best known member benefit. Daily we receive questions from members wanting help with denied claims, coverage and procedural issues, and agency management concerns. Our faculty includes some of the nation's foremost experts in the insurance industry. These volunteer faculty members generally charge for the time they give to our members. Think about that, the insight you get through our AAE service costs nonmembers THOUSANDS!

For the next two weeks, VUpoint subscribers have access to a few of these incredible insights right here. When the next edition of VUpoint is published, this AAE content go back into the members-only vault. And remember, beyond having access to all of our valuable Ask An Expert content, only members are allowed to ask the questions.


Using an Interpreter When Completing a New Application

If our agency needs to use an Interpreter for a customer when completing a new application, policy changes, etc., is there anything we need to document on the Interpreter so that if the customer comes back later on and says they didn't understand or didn't give the correct information because of the information the Interpreter told them?

Answers:

Have the interpreter sign a sworn declaration that he or she has translated your questions and the answers from the language to English and from English to the language.

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Carefully note the use of an interpreter during your business transactions with the insured.  It is also important for the interpreter to be qualified to communicate the complexity of issues under discussion. 

It may be prudent for you to arrange an interpreter to transmit a translation of your letters delivering the quotes and policies.

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Other than document the file with all pertinent information regarding the transaction, I am not sure what other actions could be undertaken. If you don't have a witness that understands the language as well that is something else, I would encourage to aid in your E & O Documentation efforts.

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I believe previous court cases showed that there are problems that arise:

1. Does anybody know if the interpreter understood the discussion?

2. Does anyone understand what the interpreter said to the other party?

3. Does anyone really know if the other party understood the interpreter?

My agency had insureds from India, Philippines, Germany and Greece among our clients. I hired a bilingual college student to be available if necessary. The student was non-involved with the insured personally nor any member of our agency. I have taught many e/o classes and never come across a solution that made me feel secure. Remember, the person causing a suit may be the insured or the injured party trying to put the onus on the agent.

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Check out this VU article E&O Exposures Involving Non-English Speaking Prospects.

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The safest approach is to document back to the client the details of your conversation. At least one management system will allow you to add a translation along with the English version of that correspondence.


Work Comp Response to Employees' Physical Altercation

Two employees get into a scuffle (fight) while on the job one employee is choking other employee causing him to bump into a machine that employee has presented to hospital with a back injury from the fight is this an incident that work comp will respond to?

Answers:

It's a legal question with the answer determined by the law in your state. It should be reported because it's not your call. These kinds of cases have been fought in the courts with mixed results. The correct answer is, it depends upon the exact circumstances and the ruling of the courts.

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I wish there was one absolute answer, but in WC, the real answer is it depends. In general, fighting is considered outside the course and scope of employment; but there are states that hold that if the injury occurs at work (regardless the reason), it's compensable.

The ultimate answer is heavily fact-based. My initial inclination is that the injury would not be covered; but here is my advice, YOU should not make that call. Leave it up to the carrier.

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No one here can answer that question definitively. You submit the claim and go from there. This issue has likely been established by case law, so if there is an answer, it lies there. You can also check with your state labor department.

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I regret that I am not familiar with any vagaries of workers compensation law in your state. That said, I feel confident that I can reasonably say it depends." If the fight was initiated due to some work-related dispute (you put me in danger by working too close to me"), and if the injured party was not the first to make physical contact, I think there is a strong argument for coverage. If, on the other hand, the fight was not work-related and the injured worker started the confrontation, the argument is weakened. And, of course, there are shades in between!

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It most certainly should be reported to the carrier within the proper time allotted by the law.  Not reporting a claim could cause the employer to be fined. Then it's up to the carrier to interpret the law and the policy.

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It varies by state as to whether or not horseplay and activities between employees are work related injuries covered by WC. Submit the claim to the WC insurer review the facts of the incident and the law and to make a determination.

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Employee horseplay and fights are not easy or straight-forward claims to review. You want to submit the claim to the insurer in all cases.

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File a claim with the WC carrier and let them decide. Agents should never try to determine whether or not a claim is/isn't covered. That's the adjuster's job. Likely, there is a statutory provision in your state's code for this situation (injuries while fighting) that will address the coverage question.


Cancelled Carrier Contract Conundrum

One of our insurance carriers has put us in a bad situation. The carrier cancelled the contract of a local agent and told that agent's customers to call our agency because as we are closest to their office. When the customers came to us the carrier told them to sign a Broker Of Record letter placing the business with our agency. During this process, we noticed that most of the client's coverage was written incorrectly; we set about to correct the problems. These corrections caused an increase in premium. Because of these increases, several clients allowed their policies to cancel. The carrier is now charging our agency for the returned premiums (commissions). We never received any commission on these accounts, it all went to the other (cancelled) agency. Is this correct? 

Answers:

If the carrier was telling the customers to call you, then the cancelled agent needs to speak with legal counsel NOW. They are his customers and there is legal precedent for that relationship. What do the laws of your state allow in this scenario?

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Your carrier contract will detail what you are and aren't responsible for. This sounds like an accounting mistake to me, have you talked to your company rep?

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You need to review your agency contract to determine what should occur in these situations. Likely, what the carrier is doing complies with the contract. If so, your agency principal needs to go to the carrier to discuss the situation to determine if the carrier could assist in any manner so that your agency is not repeatedly penalized for trying to assist the customers.

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