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Claim Chronicles of the Mishap Family – The Slip and Fall

By March 16, 2016 December 6th, 2017 Business Insurance, Claim Chronicles

Meet the Mishaps: Liability Larry and Catastrophe Cathy are married with two kids, Deductible Dudley and Peril Polly, and a dog, Risk. As their name would imply, they are often faced with very unfortunate circumstances. What’s worse, everyone around them seems to get caught up in their bad luck, too!

Join us each month as we dive into some of the adversity that comes their way, all from the insurance perspective!

The Story

Catastrophe Cathy Mishap’s restaurant, La Grande Malchance, may be a white tablecloth establishment known for fine French dining, but the employees were as hyped up about March Madness as the patrons of a sports pub. In the kitchen, talk turned to brackets and bets. It was all fun and games until, while attempting to score by tossing a food scrap into a trash can, a sous chef slipped in a puddle near the sink and landed flat on his back.

After he fell, Guy the Sous Chef told everyone he was fine. He peeled himself off the floor and laughed it off, hoping everyone would quickly forget his epic wipeout. He finished his shift without complaint. The incident was not reported to management and nothing was noted in his employment file.

The Loss

A week later, Guy called to say he wouldn’t be in due to back pain. He called out again the next day, too. When he finally reported back to work, he presented Cathy with bills for doctor visits and x-rays, citing the slip and fall as the reason for his missed work. He also indicated that he would not be finishing out his shift and had a note from a doctor stating he needed to be home on bed rest for a period of four weeks.

The Investigation

Cathy was surprised to learn that Guy had been injured. She had been working that night, but at the time of the fall, she was up in the front of the house greeting patrons. When she returned to the back, there was some scuttlebutt in the kitchen but everyone remained tightlipped about the accident. After all, Cathy had a pretty strict no-shenanigans policy and would have been quite displeased if she’d heard about it.

The Outcome

When Cathy learned of the fall, she immediately notified her insurance agent who reported the claim to the insurance carrier. The insurance company was skeptical of the claim because of the length of time between the incident and the filing. The lack of timely reporting caused them to question if the employee had actually been hurt outside of work and was able to conveniently blame it on the fall.

The insurance company investigated the claim and ultimately it was covered. There were witnesses to the fall who were able to corroborate that Guy could have reasonably injured himself that evening. Although Cathy ran a tight ship, there was nothing in her employee training or written handbook that prohibited goofing off in the kitchen, so even though Guy wasn’t hurt actually doing his job, he wasn’t technically breaking any rules either.

The Lesson

Cathy always thought she was doing a great job at preventing workplace injuries and creating an environment where employee safety is paramount. But like most things, there’s always room for improvement. First, she hired a kitchen manager to oversee operations in the kitchen area for those times when Cathy can’t be there. The kitchen manager will keep an eye out for things that will compromise safety such as a puddle on the floor or an overly excited employee.

Next, the employee handbook at the restaurant was updated to reflect that any sort of horsing around in the kitchen was grounds for discipline. It also required all employees to report injuries immediately to the kitchen manager who would then report the incident regardless of the cause or severity. Doing so solidifies the expected behavior of employees and a commitment to safety, as well as a comprehensive record-keeping procedure that aids in the investigation process set out by the worker’s compensation insurance carrier.

Cathy wants her employees safe and she is committed to providing the appropriate insurance coverage in case someone is injured on the job. Thankfully this worked out and her employee’s injury was covered. Going forward, she’s going to do everything she can to make an injury a far less likely event. If one does occur, there will be procedures in place so that coverage will not be jeopardized by improper reporting.

Claims Chronicles of the Mishaps is a fictional series based on actual claims. The Mishaps are an imaginary family and any resemblance to any person is purely coincidental. Claim details and circumstances have been changed to protect the privacy of individuals. All insurance policies are different and each separate policy will dictate the coverage in each unique scenario. Nothing in this post is meant to suggest a guarantee of coverage.