A 1954 casualty claims Guide of the America Fore Insurance Group discusses the many facets of the casualty claims process. In the mid 1954 America Fore consisted of The Continental Insurance Company, The Fidelity and Casualty Company of New York, Fidelity-Phenix Insurance Company, American Eagle Fire Insurance Company and Niagara Fire Insurance Company.
Raymond Caverly, a Vice President for all five of the carriers America Fore, stated in the Preface that:
“This volume has been prepared mainly for the assistance of men who have recently entered the Claims Department, but it is hoped that it will likewise be useful in giving men who have been longer employed a broader knowledge of casualty claims principles and practices.
The handling of casualty claims requires some knowledge of law, of medicine, sometimes of engineering, but most important of all of human nature.”
In a section on the history of insurance the Guide explains that,
“The name ‘America Fore’ is not a corporate name but a slogan used to denote this group of five corporations. The five companies operate under a single management and are headed by the same chief executives. The departmental, branch, district and field offices of America Fore are found in over 150 cities in the United States and Canada.”
Guide excerpts on Workmen’s Compensation Law:
“There are laws in all states governing the benefits to be received by employees in work-connected accidents.”
“The various compensation acts provide benefits for work-connected injuries, occupational disease and death resulting from work-connected accidents. The liability of the employer is based on work-connected injuries, occupational disease or death rather than on fault (negligence) and the acts make the benefits mandatory for covered employees… The benefits awarded are usually the exclusive remedy that the covered employee has against the employer.”
“Generally the acts required for recovery of benefits that there be an employer-employee relationship, an accident arising out of and in the course of employment, the contracting of an occupational disease as defined by the act or death casually related to the accident.
The benefits provided under the various acts are:
- temporary disability
- medical expenses
- payment to specified dependents
- funeral expenses
- occupational disease”
A glossary of Insurance Terms in the Guide defines Occupational Disease as, “impairment of health caused by continued exposure to conditions inherent in a person’s occupation.”
“The insurance industry has set up the Index Bureaus which are clearing houses for reports of personal injury claim.”
In a chapter on Claims Practices and Procedure some background is given on Index Bureaus:“The Claims Bureau Index is operated for the purpose of accumulating records of personal injury claims and disseminating such information among the companies subscribing for the service. Subscribers obtain the information contained in the Index Division’s files by forwarding, to the appropriate regional bureau, index cards bearing data on their own cases…”
“Cases reported are generally Automobile Liability (except medical payments); Products Liability; Public Liability; Workmen’s Compensation (permanent, total, serious lost time, amputations, etc).”
“Reports issued by the bureau are confidential and should not be exhibited to the persons referred to therein nor to their attorneys or other representatives. All subscribers are expected to cooperate in the exchange of information contained in their claims files—this is usually done by a “Inquiry Form”—used in substantial claims so there will not be any unnecessary burdens.
Index Bureau service is nation-wide in scope and coverage.”
In a chapter on General Principles of Investigation it is noted that:
“An important source of information are the Index Bureau reports. The adjuster should send to the bureau information on the reported claim and if the bureau has reports on the claimant or persons of similar name, they furnish him with this information. The adjuster should then contact the other companies with respect to these prior accidents and in so doing often obtains important information as to the nature and extent of these prior injuries. This information may have significant bearing on the value of the instant claim.”
Safety and the Adjuster
The Guide concludes with a chapter on Safety and the Adjuster. An excerpt: “The adjuster gathering information, dealing with insureds, claimants, witnesses and the insured event and observing persons, places and things, has a responsibility and relation to other company departments and to various safety programs.
He gathers many objective details regarding the condition of property and things, nature and type of activities, the conformity with or violation of various types of safety, factory, building, and health codes. These findings, when reported to the proper company departments, enable them to review their underwriting and inspection.
This information creates a reservoir which the company and the industry utilizes as source materials for the safety or accident prevention programs which find their expression in the Three E’s of safety: education (teaching the cause of accidents and how to avoid them); enforcement (the type and degree of enforcement and punishment which will be used to control, discipline and punish offenders); and engineering (the proper construction of places, things, products to make their use, functions and practices less dangerous).”