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AUTOMOBILE LIABILITY
&
AUTOMOBILE PHYSICAL DAMAGE
(Damage to Your Vehicles)
Automobile Liability
The JIF will pay for bodily injury and property damage liability claims arising out of
the use of your vehicles in accordance with the coverage described in the Plan of
Risk Management and Coverage Documents provided by the Fund.
Automobile Physical Damage
The JIF will pay for damage to your vehicle as a result of a collision or other
covered event subject to a $1,000 deductible.
Types of losses to be reported on this form:
Any motor vehicle accident involving an insured vehicle which results
in bodily injury or property damage to others.
Damage to any owned vehicle (Automobile Physical Damage).
The purpose of this manual is to highlight the major coverages, limits, sub-limits, and extensions
as afforded through the Joint Insurance Fund. This manual is not a policy of insurance and in no
way modifies, restricts, expands or in any way changes the coverages afforded through the JIF.
For actual coverage determination, reference must be made to applicable coverage documents.
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AUTOMOBILE LIABILITY – Reporting Instructions
AUTOMOBILE LIABILITY
REPORTING INSTRUCTIONS
1. You will receive some type of notice of claim from either the claimant or his/her
attorney. In some instances, the injured party will report the claim by telephone or
letter, which obviously will not contain sufficient information to meet New Jersey
State Statute (See Section 9, Tort Claims Notice Procedures). However, you may
take the information from the injured party and utilize the ACORD Automobile Loss
Notice (sample attached) to report the claim to our office. Although the ACORD
Automobile Loss Notice does not contain a sufficient amount of information to
adhere to New Jersey Statute, we will obtain additional information once we have
received the claim from you. The information you submit, however, should contain
the following:
A. Name of injured party or party by whom damages are claimed.
B. Address and telephone number of above party.
C. Social Security Number, if possible.
D. Date, time and place of accident.
E. Brief facts of accident.
F. Extent of injuries/damages.
G. Witnesses, if any.
2. Once you have obtained the above information, please utilize the Claim Transmittal
Form (sample attached), which will be completed by your office. You will note that
the Transmittal Form includes information as to which department was involved, the
name of the claimant, the date of loss and the date you are transmitting the
information to us. Information also includes whether this is a new claim or
additional information being forwarded to us on an existing claim.
3. Once we have received this information, we will assign an adjuster and an
Acknowledgement Letter will be forwarded to you. The Acknowledgement will
indicate the adjuster assigned, as well as our claim number, which you will use when
transmitting additional documents to us if they are received by your office.
4. It is important that you forward any official reports you may have completed with
reference to the incident. Please do not hold up the claim until the official reports
are completed, but you should forward the reports to us once they are received in
your office.
REFER ALL SUBSEQUENT CORRESPONDENCE AND INQUIRIES BY CLAIMANTS
OR THEIR ATTORNEYS TO SCIBAL FOR HANDLING.
AUTOMOBILE LIABILITY – Reporting Instructions
AUTOMOBILE PHYSICAL DAMAGE
REPORTING INSTRUCTIONS
(Damage to your Vehicles)
1. Please complete ACORD Form (Automobile Loss Notice) to report any
damage to your vehicles. Please advise on the Loss Notice what type of
physical damage is involved, i.e. collision, fire, theft, etc. (sample attached).
Be sure to identify a contact person with the authority to make decisions
and who knows where the vehicle can be seen.
2. Complete the Claim Transmittal Form, which will advise us as to the claim
type, the date of loss, etc. Again, this should be attached to the ACORD Loss
Notice when forwarding it to our office. This will also tell us whether this is
a new report or additional information on an existing claim.
3. Immediately forward (fax or mail) completed forms to our office for
continued handling. (Attach a copy of the repair estimate, if available.)
In the event of a serious loss, please contact your Scibal representative by
telephone to report the claim so that an adjustment can commence immediately.
However, we ask that you follow up with a written notice for further documentation.
NOTE:
There is a $1,000.00 deductible for losses of this type. If information available to you
indicates that the damages are less than that amount, there is no need to report the claim
to us. If other injuries or damages have occurred, however, the claim should be
immediately reported.
AUTOMOBILE LIABILITY – Helpful Hints
HELPFUL HINTS
Below are some helpful hints that will assist you in processing your automobile
loss claims.
If attorney letter (see attached sample) is first notice of claim you
receive, fill in the ACORD Notice with as much information as you
know about the loss. Attach a copy of the attorney letter to the
ACORD Notice and immediately fax or mail to Scibal.
Be sure to keep a copy of all information you send to Scibal.
Identify the location of the damaged vehicle if it has been moved.
Always do what is necessary to maintain a safe environment and
mitigate further loss to damaged property until repairs can be
completed.
If you have a motor vehicle accident and there are injuries to an insured
employee, be sure that separate workers compensation paper work is
filed for the loss.
Identify a contact person with authority to make decisions on your
behalf.
AUTOMOBILE LIABILITY – Common Errors
COMMON ERRORS
These are some common errors that people make when completing Automobile Loss
Notices.
No date of loss on the paper work.
No vehicle information (insured vehicle).
Location of damaged vehicle not disclosed.
No description of the type of damage.
No enclosure of prepared estimates (when available).
Placing insured vehicle information under the “Property Damaged”
portion of the claim form. “Property Damaged” is for damage to
property other than your own property or vehicle.
Failure to identify a contact person with telephone number at
member municipality with authority to make decisions regarding
the vehicle.
AUTOMOBILE LIABILITY – Sample Claim Transmittal Form
CLAIM TRANSMITTAL FORM
TO: Scibal Associates, Inc.
P.O. Box 500
Somers Point, NJ 08244-0500
PHONE: 609-653-8400
FAX: 609-926-9270
FROM: Claims Coordinator
Borough of Sunnytowne
PHONE: 609-555-1234
FAX: 609-555-5678
TODAY’S DATE: 7/22/02
This is a: New Claim
Additional Information on Existing Claim
S
Claim Number, if known
Date of Loss: 7/21/02
Claimant Name: Borough of Sunnytowne
Claim Type: Auto Liability Auto Physical Damage
General Liability
Workers’ Compensation
Department:
Property
NCCI Code:
A
M
Street Maintenance 5509
Water Department 7520
Electric Department 7539
Sewage Disposal 7580
P
Paid Fire Department 7711
Paid First Sid/Rescue Squad 7715
Police 7720
Crossing Guards 7727
Off Duty Police 7728
L
Clerical 8810
Library 8838
Buildings Department 9015
Lifeguards 9053
E
Parks Department 9102
Street Cleaning 9402
Garbage Collection 9403
Municipal Employees NOC 9410
Volunteer First Aid/Rescue Squad 9420
Volunteer Firefighter 9430
Always complete this form whenever transmitting claim information to Scibal Associates
AUTOMOBILE LIABILITY – Sample ACORD Form
ACORD AUTOMOBILE LOSS NOTICE DATE (mm/dd/yy)
7/22/02
PRODUCER PRODUCER PHONE (A/C. No., Ext.) MISCELLANEOUS INFORMATION (Site & Location Code)
SCIBAL ASSOCIATES
PO BOX 500 COMPANY POLICY NUMBER CAT.#
SOMERS POINT, NJ 08244-0500 SELF-INSURED
POLICY EFF. DATE (MM/DD/YY) POLICY EXP. DATE (MM/DD/YY) DATE (MM/DD/YY) & TIME OF LOSS PREVIOUSLY
CODE SUB CODE REPORTED
1/1/02 12/31/02 7/21/02 6:00 A.M. YES
P.M. X NO
INSURED
NAME AND ADDRESS INSURED’S RESIDENCE PHONE (A/C.No) INSUREDS BUSINESS PHONE (A/C. No., Ext.)
* 555-1234 x12
SCIBAL ASSOCIATES PERSON TO CONTACT WHERE TO CONTACT
123 STATE STREET
SUNNYTOWNE, NJ 08000 JAIME C. COORDINATOR WHEN
CONTACT’S RESIDENCE PHONE (A/C.No) CONTACT’S BUSINESS PHONE (A/C. No., Ext.)
* 555-1234 x12
LOSS
LOCATION OF ACCIDENT POLICE OR FIRE DEPARTMENT TO WHICH REPORTED VIOLATIONS/CITATIONS
SE Corner of Elm Street and Maple Avenue Sunnytowne Police Department 94-1234
DESCRIPTION OF ACCIDENT
S
OV was stopped at red light and insured vehicle slid on ice and rear-ended other vehicle
POLICY INFORMATION
BODILY INJURY PROPERTY DAMAGE SINGLE LIMIT MED.PAY OTC DED. OTHER COVERAGES AND DEDUCTIBLES (UM, no-fault, towing, etc.)
LOSS PAYEE
INSURED VEHICLE
NO. YEAR, MAKE, MODEL
10 98 Chev. Caprice
V.I.N. (Vehicle identification)
55052
COLLISION DED.
PLATE NO.
MG 6324
A
M
OWNER’S NAME AND ADDRESS PHONE (AC, no., ext.)
Sunnytowne Borough 555-1234
DRIVER’S NAME AND ADDRESS (Check if same as owner) RESIDENCE PHONE (AC, no.) BUSINESS PHONE (AC, no., ext)
Sgt. G. Hart 555-1111
P
RELATION TO INSURED (Employee, family, etc.) DATE OF BIRTH DRIVER’S LICENSE NUMBER PURPOSE OF USE USED WITH PERMISSION
Employee 4/2/58 118642 15000 94682 Patrol Unit X YES X NO
DESCRIBE DAMAGE ESTIMATE AMOUNT WHERE CAN VEHICLE BE SEEN? WHEN? OTHER INSURANCE ON VEHICLE
Front End Damage $2,000+ A & B Auto, 300 Madison Ave., Sunnytowne 555-3434
PROPERTY DAMAGED (Other Vehicle)
L
DESCRIBE PROPERTY (If auto, year, make, model, plate no.) OTHER VEH/PROP. INS? COMPANY OR AGENCY NAME & POLICY NO.
93 Toyota Camry 2TL438 X YES NO State Farm, P346289SK056
OWNER’S NAME AND ADDRESS BUSINESS PHONE (AC, no., ext.) RESIDENCE PHONE (AC, no.)
Judy Wright, 14 Waverly Way, Sunnytowne, NJ 08000 555-6438
OWNER’S NAME AND ADDRESS BUSINESS PHONE (AC, no., ext.) RESIDENCE PHONE (AC, no.)
DESCRIBE DAMAGE
Rear Damage
INJURED
NAME & ADDRESS
ESTIMATE AMOUNT
Unknown
WHERE CAN VEHICLE BE SEEN? WHEN?
Driven away from scene by claimant - contact Mrs. Wright
PHONE (A/C. No.) PED.
INS OTHER
VEH. VEH. AGE
E
OTHER INSURANCE ON VEHICLE
EXTENT OF INJURY
Sgt. G. Hart x 35 Back/neck
Judy Wright x 28 Back Injury
REMARKS
REPORTED BY REPORTED TO SIGNATURE OF PRODUCER INSURED
Officer C. Hart Police Chief Smith
ACORD 1 (2/88) ACORD CORPORATION 1988
AUTOMOBILE PHYSICAL DAMAGE – Sample Claim Transmittal Form
CLAIM TRANSMITTAL FORM
TO: Scibal Associates, Inc.
P.O. Box 500
Somers Point, NJ 08244-0500
PHONE: 609-653-8400
FAX: 609-926-9270
FROM: Claims Coordinator
Borough of Sunnytowne
PHONE: 609-555-1234
FAX: 609-555-5678
TODAY’S DATE: 11/22/02
This is a: New Claim
Additional Information on Existing Claim
S
Claim Number, if known
Date of Loss: 11/21/02
Claimant Name: Borough of Sunnytowne
Claim Type: Auto Liability Auto Physical Damage
General Liability
Workers’ Compensation
Department:
Property
NCCI Code:
A
M
Street Maintenance 5509
Water Department 7520
Electric Department 7539
Sewage Disposal 7580
P
Paid Fire Department 7711
Paid First Sid/Rescue Squad 7715
Police 7720
Crossing Guards 7727
Off Duty Police 7728
L
Clerical 8810
Library 8838
Buildings Department 9015
Lifeguards 9053
E
Parks Department 9102
Street Cleaning 9402
Garbage Collection 9403
Municipal Employees NOC 9410
Volunteer First Aid/Rescue Squad 9420
Volunteer Firefighter 9430
Always complete this form whenever transmitting claim information to Scibal Associates
AUTOMOBILE PHYSICAL DAMAGE – Sample ACORD Form
ACORD AUTOMOBILE LOSS NOTICE DATE (mm/dd/yy)
11/22/02
PRODUCER PRODUCER PHONE (A/C. No., Ext.) MISCELLANEOUS INFORMATION (Site & Location Code)
SCIBAL ASSOCIATES
PO BOX 500 COMPANY POLICY NUMBER CAT.#
SOMERS POINT, NJ 08244-0500 SELF-INSURED
POLICY EFF. DATE (MM/DD/YY) POLICY EXP. DATE (MM/DD/YY) DATE (MM/DD/YY) & TIME OF LOSS PREVIOUSLY
CODE SUB CODE REPORTED
1/1/02 12/31/02 11/21/02 11:00 A.M. YES
P.M. X NO
INSURED
NAME AND ADDRESS INSURED’S RESIDENCE PHONE (A/C.No) INSUREDS BUSINESS PHONE (A/C. No., Ext.)
* 555-1234 x12
SCIBAL ASSOCIATES PERSON TO CONTACT WHERE TO CONTACT
123 STATE STREET
SUNNYTOWNE, NJ 08000 JAIME C. COORDINATOR WHEN
CONTACT’S RESIDENCE PHONE (A/C.No) CONTACT’S BUSINESS PHONE (A/C. No., Ext.)
* 555-1234 x12
LOSS
LOCATION OF ACCIDENT POLICE OR FIRE DEPARTMENT TO WHICH REPORTED VIOLATIONS/CITATIONS
NE Corner of Main Street and Union Avenue Sunnytowne Police Department 94-1234
DESCRIPTION OF ACCIDENT
S
Insured Vehicle slid on ice and struck tree
POLICY INFORMATION
BODILY INJURY PROPERTY DAMAGE SINGLE LIMIT MED.PAY OTC DED. OTHER COVERAGES AND DEDUCTIBLES (UM, no-fault, towing, etc.)
LOSS PAYEE
INSURED VEHICLE
NO. YEAR, MAKE, MODEL
10 98 Chev. Caprice
V.I.N. (Vehicle identification)
55052
COLLISION DED.
PLATE NO.
MG 6324
A
M
OWNER’S NAME AND ADDRESS PHONE (AC, no., ext.)
Sunnytowne Borough 555-1234
DRIVER’S NAME AND ADDRESS (Check if same as owner) RESIDENCE PHONE (AC, no.) BUSINESS PHONE (AC, no., ext)
Sgt. G. Hart 555-1111
P
RELATION TO INSURED (Employee, family, etc.) DATE OF BIRTH DRIVER’S LICENSE NUMBER PURPOSE OF USE USED WITH PERMISSION
Employee 4/2/58 118642 15000 94682 Patrol Unit X YES X NO
DESCRIBE DAMAGE ESTIMATE AMOUNT WHERE CAN VEHICLE BE SEEN? WHEN? OTHER INSURANCE ON VEHICLE
Front End Damage $2,000+ A & B Auto, 300 Madison Ave., Sunnytowne 555-3434
PROPERTY DAMAGED (Other Vehicle)
L
DESCRIBE PROPERTY (If auto, year, make, model, plate no.) OTHER VEH/PROP. INS? COMPANY OR AGENCY NAME & POLICY NO.
86 Toyota Camry 2TL438 X YES NO State Farm, P346289SK056
OWNER’S NAME AND ADDRESS BUSINESS PHONE (AC, no., ext.) RESIDENCE PHONE (AC, no.)
Judy Wright, 14 Waverly Way, Sunnytowne, NJ 08000 555-6438
OWNER’S NAME AND ADDRESS BUSINESS PHONE (AC, no., ext.) RESIDENCE PHONE (AC, no.)
DESCRIBE DAMAGE
Rear Damage
INJURED
NAME & ADDRESS
ESTIMATE AMOUNT
Unknown
WHERE CAN VEHICLE BE SEEN? WHEN?
Driven away from scene by claimant - contact Mrs. Wright
PHONE (A/C. No.) PED.
INS OTHER
VEH. VEH. AGE
E
OTHER INSURANCE ON VEHICLE
EXTENT OF INJURY
Sgt. G. Hart x 35 Back/neck
Judy Wright x 28 Back Injury
REMARKS
REPORTED BY REPORTED TO SIGNATURE OF PRODUCER INSURED
Officer C. Hart Police Chief Smith
ACORD 1 (2/88) ACORD CORPORATION 1988
AUTOMOBILE LIABILITY – Accident Investigation
AUTOMOBILE ACCIDENT INVESTIGATION
Accident investigation is more than filling out the proper forms, as important as they are.
It is a system of collecting and documenting factual evidence.
The accident investigation itself is prefaced by the training of drivers in the correct
conduct to assume at the scene of an accident, and the following procedures: notifying
the authorities and the municipality, obtaining witness statements, marking the accident
site, protecting the vehicle and its cargo, and yes, doing the necessary paperwork.
For the safety specialist, accident investigation is all this, and more: accurate field
investigation; evidence gathering; witness statement recording; site and vehicle
diagramming; and training, interviewing, and retraining drivers.
Driver Conduct at the Scene of an Accident
If involved in an accident, the driver must do a number of things immediately, because
he/she is usually the only representative of the municipality there at the time. Because
this is so important, all drivers should be trained in the correct procedure to follow in the
event of an accident.
Experts generally agree on the things to be done at the scene of an accident:
FIRST:
Stop immediately and determine damage. Avoid obstructing traffic if possible.
Place emergency reflectors, flares, lanterns or flags.
Aid the injured and see to it that they receive medical attention as soon as possible
Report the accident to the police and to your supervisor
SECOND:
Obtain names, telephone numbers and addresses of witnesses
Record information at the scene of the accident
Name, address, telephone of driver(s) and passengers
Name, address, telephone of vehicle owner(s)
Year, make, model, license number and state of other vehicle(s)
Draw a diagram of the accident scene
IMPORTANT:
Make no statement to anyone except:
An officer of the law.
A representative from your municipality.
A representative from the JIF claims office.
Make no admission of liability. Make no settlements. Do not argue about the accident.
AUTOMOBILE LIABILITY – Accident Investigation
INCIDENT INVESTIGATIONS
(Other than Workers Compensation)
Accidents don’t just happen; they are caused. After incidents or accidents
involving employees, injuries or property damage, someone in authority should
investigate to determine what happened. All accidents, including those occurring
to volunteers or citizens, should be investigated by the supervisor responsible for
the area in which the incident occurred. “Near misses” are accidents also, and
even if they do not cause injury or damage, they should be investigated as
thoroughly as an accident that results in injury or property damage. We have
developed a Supervisor’s Incident Investigation Report form which you can use to
investigate accidents. Attach a copy to your Scibal claims transmittal and forward
copies to your Safety Coordinator and the JIF Safety Director (Commerce National
Risk Control Services). The Incident Investigation Report can be reproduced in
your office or additional supplies can be ordered from the Fund Administrator, the
Fund Safety Director, or the Claims Administrator.
Remember: The purpose of investigating accidents is not to
determine who was at fault, but to determine the cause so that
similar accidents can be prevented in the future.
When an employee is involved in an accident or causes any damage, the
supervisor or someone in authority should make a detailed report about the
incident and should document what happened. Too often, supervisors and
managers focus on a symptom of the problem, such as frequent accidents or
employee injuries, when the actual problem may be a failure to perform proper
inspections for hazards, supervise employees, provide proper instructions and
training, or enforce work rules.
Investigations provide:
Documentation that can be used in analyzing whether claims are justified.
A basis for understanding what causes an incident--whether or not a loss
occurred.
Clues to determine what the actual problem is.
Formation of actions that can be take to address the problem.
Information on incidents and losses that help identify trends and potential
losses.
AUTOMOBILE LIABILITY – Accident Investigation
After acquiring necessary medical aid for injured persons, supervisors should
follow these steps for investigating accidents:
If possible, ask the person or persons involved to describe what happened.
Do not fix blame or find fault; just get the facts.
Survey the accident scene for information. Collect any objects that might
have contributed to the accident.
Determine if there were any witnesses to the accident and get their accounts
of the incident.
Take whatever steps are necessary to prevent recurrences until the condition
can be permanently corrected.
Complete an Incident Investigation Form.
If the police were called, attach a copy of the police report to the Incident
Investigation Form. This is most common for vehicle accidents.
Most accidents occur because of a combination of an unsafe act and an unsafe
physical condition. Look for both, and then draw a conclusion as to why the
unsafe act was committed or why the condition existed.
Once an accident occurs, immediate action must be taken to prevent a recurrence.
Indicate what needs to be done and who is going to do it.
AUTOMOBILE LIABILITY – Sample Claim Transmittal Form
CLAIM TRANSMITTAL FORM
TO: Scibal Associates, Inc.
P.O. Box 500
Somers Point, NJ 08244-0500
PHONE: 609-653-8400
FAX: 609-926-9270
FROM: Claims Coordinator
Borough of Sunnytowne
PHONE: 609-555-1234
FAX: 609-555-5678
TODAY’S DATE: 10/2/02
This is a: New Claim
Additional Information on Existing Claim
S
Claim Number, if known
Date of Loss: 7/21/02
Claimant Name: Borough of Sunnytowne
Claim Type: Auto Liability Auto Physical Damage
General Liability
Workers’ Compensation
Department:
Property
NCCI Code:
A
M
Street Maintenance 5509
Water Department 7520
Electric Department 7539
Sewage Disposal 7580
P
Paid Fire Department 7711
Paid First Sid/Rescue Squad 7715
Police 7720
Crossing Guards 7727
Off Duty Police 7728
L
Clerical 8810
Library 8838
Buildings Department 9015
Lifeguards 9053
E
Parks Department 9102
Street Cleaning 9402
Garbage Collection 9403
Municipal Employees NOC 9410
Volunteer First Aid/Rescue Squad 9420
Volunteer Firefighter 9430
Always complete this form whenever transmitting claim information to Scibal Associates
DUIE, FLEECUM & HOWE
Attorneys at Law
Nole Casio Sub Nostrum Est!
(No Case is Beneath Us!)
September 30, 2002
Borough of Sunnytowne Certified - Return
Receipt Requested
123 State Street
Sunnytowne, New Jersey 08000
Attn: Borough Clerk
Re: Sue Mieh v Borough of Sunnytowne
Date of Accident: July 21, 2002
Place of Accident: State Highway 11 and Gypsy Lane
Dear Sir/Madam:
Please be advised that as a result of our client’s collision
with your police car my client has suffered damages. These
arise out of the negligent operation of your vehicle.
Kindly forward this letter to your insurance carrier and
have them contact me immediately. If you are not insured,
you should have your attorney contact me immediately.
Sincerely,
Huey Duie, Esquire
cc: I. Fleecum, Esquire
N. Howe, Esquire
