If you have a client who has been affected by the recent severe weather or hurricanes,
please utilize the following phone numbers to report claims:
CHAMP, Brewery & Winery Insurance Program, Builders Risk: 877-371-9774
Addiction Treatment Providers, Care Providers, Churches, Schools or Family Planning: 888-607-6642
Claims Examples Icon

Claims Examples

NSM Pursues Wrongdoer to Avoid Claim

One of our insured’s properties experienced a fire due to a resident making illegal drugs.  The subrogation pursuit was only looking at another insured as a potential recovery target.  NSM stepped in and pushed for subrogation pursuit of the wrongdoer who was making the illegal drugs.  A recovery from the primary wrongdoer will offset loss costs and avoid a claim against another one of the insureds.

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Claims Examples

Improving Insured’s Loss Experience

Several patients in an addiction treatment program branded each other in a brotherhood pact, but one of them got a brand he didn’t bargain for, which resulted in a claim against our insured’s treatment facility.  The claim file was being closed after settlement, with no thought of recovery.  NSM pushed to pursue the wrongdoers, to recover the monies that were paid to settle the claim, which will have a beneficial effect on the insured’s loss experience.

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Claims Examples

NSM Clarifies Subrogation Policy

In a work comp claim involving a falling object injuring a worker, there was a misinterpretation of a subrogation waiver in the policy as being all encompassing.  NSM stepped in and provided clarity on the meaning of the waiver, and conducted training and instruction on how to gather the necessary documents and pursue subrogation.  The recovery of monies from the subrogation pursuit will offset the loss payout and will result in a better loss experience history for the insured.

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Claims Examples

NSM Dedicated to Staffing Lines Insured

A worker died as a result of a tire explosion. The investigators had given up when they couldn’t find the tire, but NSM wouldn’t give up and took extra steps which resulted in the tire being found.   Subrogation is being pursued which should offset most of the work comp death benefits that will be paid out, which will then help the insured’s loss experience history.

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Claims Examples

NSM Educates CPS Client

One of our broker partners recently called our underwriting manager about a serious auto accident on the insured’s loss run.  The broker explained his concern about having to educate his client (the insured) about why the two injury claims resulting from that auto accident have the reserves set high, and how this may impact the insured’s upcoming policy renewal.  The NSM claims dept was asked to assist, and helped the broker prepare for their client meeting by putting together an informative and concise outline of the accident and injury details, including the claim values and the litigation status and expected timelines.   The broker sent along his many thanks for the information, and commented that while it’s not always fun discussing serious claims at renewal time, at least he’s now prepared for any questions his client (the insured) may have about these injury claims.

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Claims Examples

NSM Mediates Workers’ Comp Claim Process

A large Workers Compensation claim had a tentative time-sensitive settlement in a state that requires employer approval before a settlement can finalize.  The employer refused to consent unless the Work Comp carrier issued a letter stating that the insured was not responsible for the claim, which was a request that the carrier could not agree to.   NSM stepped in and worked with the agent to get the employer/insured to understand that the settlement was in their best interest by capping the exposure and avoiding higher payouts.  Through multiple conference calls involving NSM, the employer/insured consented to the settlement, which resulted in a closed claim.  Sometimes insureds have an emotional attachment or reaction to a claim which keeps them from seeing the best interests of their business.  When NSM identifies those situations we help everyone see things more clearly so that the claims can reach the best possible outcomes for all parties involved.

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Claims Examples

Is Your Auto Safe This Winter?

Background/Incident

  • John, a retired Condon Skelly insured, cherished his 1973 Lamborghini Espada. Being a New Jersey resident, John is used to primarily driving during the spring/summer months while storing his vehicle in his garage during the winter months.
  • Last February, NJ received a significant amount of snow fall. Although there were no major storms, there were a number of small storms which accumulated over time.
  • Because there was no major storm, John did not realize just how much snow was accumulating on his roof. After a series of storms, and never removing snow from his roof, the weight became too much and the roof of his garage collapsed. This caused significant damage to all contents inside, including his prized auto.

Claims Handling

  • John reported the collapse timely via our claims reporting email CondonSkelly@yorkrsg.com
  • To make things easier on John during this stressful time, we were able to coordinate our appraisal on the vehicle with John’s Home Owner’s insurance to estimate the damages.
  • Through this appraisal we were able to determine the vehicle was a total loss.
  • John, having experience rebuilding cars, decided to keep the salvage on his vehicle and use his settlement money to restore his Lamborghini.
  • John, thrilled with our claim service and his own work, recently sent the claims team a picture of his newly restored vehicle thanking us for the terrific service.
  • Although things worked out for John in the end, he could have avoided the situation all together by taking steps to prevent his garage ceiling collapse.

Don’t let this happen to you!

  • Remove snow while it is still fresh. The weight of 10-12 inches of “new snow” is equal to about 3-5 inches of old/compacted snow and equal to about 1 inch of ice.
    • Allowing snow to melt and freeze over time could set up a potential collapse in the event of a second or third snow storm accumulating on top of the existing snow/ice.
    • It is best to try and remove snow within a few hours of a storm ceasing.
  • Do not climb on the roof to remove snow!!
    • The risk of injuries sustained from a fall far outweighs the benefits of removing the snow from your roof.
    • Not to mention the added weight could cause a collapse depending on how much snow has already accumulated; resulting in serious injury.
  • Instead, look into purchasing a roof rake.
    • This will allow you to safely remove snow from your roof while safely on the ground. They can be found online for as cheap as $40!
    • Make this part of your shoveling routine and you can make sure this does not happen to you.
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Claims Examples

Claims Department Helps ATP Insured with Defense Counsel

A new claim for one of ATP’s large accounts required the assignment of defense counsel. The insured had requested a law firm that was not on the carrier’s panel list so the claims adjuster assigned the defense to another law firm. The insured’s broker raised concerns and the claims adjuster advised NSM’s claim department of the issue so we could look into it. After numerous discussions with the claims office, the underwriters, and the broker, we were able to locate documentation from several years ago that granted authority from the carrier for the insured to utilize the insured’s choice of law firms. With NSM’s involvement, that issue was resolved, with the insured’s preferred counsel assigned to the claim, all within two days.

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Claims Examples

Cyber Liability Coverage Helps Companies Following Cyberattacks

A personal injury law firm in Alabama sent out notifications to clients that a robbery led to stolen files. Approximately 350 files were taken. Information that was potentially exposed on the files included names, dates of birth, addresses, telephone numbers, and medical insurance information. Moreover, medical records, such as lab results, consultation notes, and hospital notes may also have been included in the missing files. If clients provided Social Security numbers to the firm, then those were also compromised. NSM Insurance Group’s Cyber Liability insurance is specifically designed to provide the unique coverages for this situation, and goes beyond what a professional liability policy would provide. Risk mitigation is key, but having best-in-class cyber liability and data breach coverage from NSM ensures your organization is always protected.

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Claims Examples

Condon Skelly Customer Protected by UIM Coverage

A Condon Skelly insured was driving his 1956 Corvette when he noticed a problem with his car. As he pulled over, another vehicle came up from behind at full speed and rear-ended him. His injuries from the crash required surgery, and his medical bills totaled nearly $250,000, not to mention another $24,000 in damage to his Corvette.

The other driver was found at fault, but only carried the minimum liability insurance for the state, just $25,000. This amount barely covered the damage to the Corvette, leaving the insured with over $250,000 worth of medical bills. Luckily, he elected to carry Under or Uninsured Motorist (UIM) coverage with Condon Skelly for only $16 in premium. His claim was reported to our team and we were able to cover all medical bills at no additional cost to him.

In 2012, an estimated 1 out of 7 drivers on the road was uninsured, and this number is even higher in urban areas. Each year, 14% of motor vehicle accidents in the U.S. involve an unisured motorist. Are your clients protected from these motorists? Give us a call today at 800-257-9496 or visit us online to learn more about Under or Uninsured Motorist coverage.