cpd-2016011 qsd insurance series 2016 (1) handling of car and ec insurance claims.pdf
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Construction Insurance –Claims Handling Procedures
15 March 2016
Brief Review
• Contractors’ All Risks (CAR) – Section I– Section II
• Employees’ Compensation (EC)
Brief Review – CAR• CAR – Section I
– Material Damage (Temporary & Permanent Works but excluding Constructional Plant and Temporary Buildings)
– Professional Fees– Removal of Debris (RoD)– Temporary Buildings* – Constructional Plant (other than Tower Cranes)*– Tower Cranes*
*listed items with corresponding insured amount
Brief Review – CAR
• CAR – Section II– Accidental bodily injury (including death) and/or loss
or damage to physical property caused by theInsured including all costs and expenses of litigation
Brief Review – CAR Major Endorsements• Vibration or Removal or Weakening of Support• Testing and Commissioning • Designer’s Risk• Inland Transit• Offsite Storage• Extra Charges for overtime, night work• Employer’s / Principal’s Property• Employer’s employees as Visitors
Brief Review – EC – Chapter 282 • Application
– An employer is liable to pay compensation in respect ofinjuries sustained by his employees as a result of anaccident arising out of and in the course of employment;or in respect of occupational diseases specified in theOrdinance suffered by the employees.
– The Ordinance in general applies to employees who areemployed under a contract of service or apprenticeship.Employees who are injured while working outside HongKong are also covered if they are employed in Hong Kongby local employers.
Brief Review – EC – Chapter 282
• Assessment of Loss of Earning Capacity– A two-tier system - Employees' Compensation (Ordinary
Assessment) Board and Employees' Compensation (SpecialAssessment) Board - is provided for to assess the necessaryperiod of absence from duty and the percentage of loss ofearning capacity permanently caused to the employee as aresult of the work injury.
Brief Review – EC – Chapter 282 • Compensation for death
(1) - Maximum monthly earnings = HKD26,070.00(2) - Minimum amount of compensation for death = HKD375,950.00
Age of deceased employee Amount of compensationunder 40 84 months' earnings(1) or minimum amount
of compensation(2),whichever is higher40 to under 56 60 months' earnings(1) or minimum amount of
compensation(2), whichever is higher56 or above 36 months' earnings(1) or minimum amount
of compensation(2),whichever is higher
Brief Review – EC – Chapter 282
• Funeral and medical attendance expenses in fatal cases– Any person who has paid funeral and/or medical attendance
expenses on an employee who died in a work-related accident is entitled to claim reimbursement from the employer of the deceased employee of such expenses not exceeding HKD76,220.00.
Brief Review – EC – Chapter 282 Compensation in cases of permanent total incapacity
(1) - Maximum monthly earnings = HKD26,070.00(2) - Minimum amount of compensation payable for permanent total
incapacity = HKD426,880.00
Age of deceased employee Amount of compensationunder 40 96 months' earnings(1) or minimum amount
of compensation(2),whichever is higher40 to under 56 72 months' earnings(1) or minimum amount of
compensation(2), whichever is higher56 or above 48 months' earnings(1) or minimum amount
of compensation(2),whichever is higher
Brief Review – EC – Chapter 282 Periodical Payment• An employee is entitled to receive periodical payments during the
period of temporary incapacity (sick leave) up to 24 months. The payment should be calculated as follows:
Monthly earnings Monthly earnings ( at the time of less after ) X 4/5
the accident the accident
• If the employee's temporary incapacity lasts more than 24 months, he may apply to the Court for an extension of his entitlement for the payment. The extended period shall not be longer than 12 months.
Brief Review – EC – Chapter 282 Medical Expensesthe medical expenses for each day of stay in the hospital where an employee is given medical treatment as an in-patient
HKD200.00
the medical expenses for each day on which an employee is given medical treatment other than as an in-patient in a hospital
HKD200.00
the medical expenses for each day on which an employee is given medical treatment both as an in-patient in a hospital and other than as an in-patient in a hospital
HKD280.00
Brief Review – EC – Chapter 282
Settlement of Claims• Depending on the nature of the case, a claim for employees'
compensation can be settled in the following ways: – Direct Payment – Determination of compensation by agreement according to the
Ordinance– Settlement by Certificate – Settlement by Court
Claims Procedure
• The above Form must be made in 2 copies, 1 copy to Labour Department and 1 copy to insurance broker / insurance company for handling
Situation Form Submission Deadline# of sick leave is 3 days or less
2B Within 14 days
# of sick leave is more than 3 days
2 Within 14 days
Death 2 Within 7 days
Claims ProcedureApart from Form 2 / Form 2B, the below documents must be enclosed for handling:• Copy of ID of the Injured; • Copy of Construction Workers Registration Card and
Construction Industry Safety Training Certificate of the Injured
• Original Copy of Sick Leave certificate;• Original Copy of Medical Expenses receipt;• Payment Receipt signed by the Injured acknowledging
receipt of the compensation
Claims Procedure(Cont’d)• MPF Record• Employment contract (and its amendments)• Copy of Payroll record for the past 12 months prior to
the accident • Copy of Payroll record for the past 12 months of 2
comparable workers of the same type if the Injured is employed for less than 1 month
• Copy of sub-contracting contract between Main Contractor and Sub-contractor
Claims Procedure
• After Assessment by the Labour Department, the below documents must also be submitted• Form 5 – Certificate of Compensation Assessment• Form 6 – Certificate of Compensation Re-Assessment• Form 7 – Certificate of Assessment • Form 9 – Certificate of Review of Assessment
Claims Procedure
Legal Documents• Should you receive any legal documents e.g. writ of
summons, please save 1 copy for yourself and submit a copy to us for handling
• Do not reply or admit any liability • Legal action can only be taken within 36 months from
the date of accident
Claims Example – Case 1• Type of Works: Building A&A Works• Type of Loss: Water Damage to Busbars – falls
under Nominated Sub-contractor (NSC)• Involved Cleaning and Replacement
What do you need to prepare to submit this Claim?
Case 1 – Procedure • Claim Form (to be provided by Insurer)• Description of exact location of the incident• Photos of the surrounding areas and the damaged
parts• Incident Report(s), if any• Any letters issued by Consultant or Employer or NSC• All Invoices / Billings
*For this case, since there is a replacement of busbars, the removed busbars becomes the property of Insurer which must return to the appointed Loss Adjuster or Insurer’s representative
Claims Example – Case 2• Type of Works: Water Mains Construction• Type of Loss: Burglary at Site
What do you need to prepare to submit this Claim?
Case 2 – Procedure • Claim Form (to be provided by Insurer)• Police Report• Description of exact location of the incident • Photos of the incident location• Incident Report(s), if any• Description of Loss items and its cost with supporting
documents• CCTV footage, if any
*Loss Adjuster normally will be appointed for such case. Please only clean up the incident area after Loss Adjuster has conducted their investigation.
Claims Example – Case 3• Type of Works: Building A&A Works• Type of Loss: Fire Damage• Works are at least 50% completed• Building collapsed due to fire damage• Damages to 3rd parties are also reported
What do you need to prepare to submit this Claim and what can be covered?
Q & A
Contacts
Westfield Holdings LimitedChristopher ChengDirect: (852) 2510-7999Tel: (852) 2510-7299Fax: (852)2510-7566E-mail: christopher.cheng@wfhl.hk
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