How it Works
1. Log into Your Account to Start the Claims Process
Log into your account to review your coverages from Embroker and other carriers. Click on the “Claims” tab in the side menu. Depending on your coverage, you’ll find instructions for next steps to submitting a claim.
2. Claim Professional Contacts You and Reviews Your Coverage
Once you’ve filed your claim, you’ll get a submission confirmation. A Claim Professional will contact you to review and investigate your claim. A written coverage determination will be issued within 30 days of reporting a claim.
3. Work with Claim Professional to Resolve Claim
If coverage is available for your reported claim under your policy, you’ll work with your assigned Claim Professional to secure any necessary outside counsel and strategize as a team to resolve your claim.
If you are experiencing a cyber-related threat event, such as denial of service, cyber extortion, ransomware, ransom, hostage, or other highly delicate situation, please call the support number/hotline listed on your policy for the fastest assistance.
If the matter is not an active cyber-related threat event, you can report it to the insurer directly. At minimum, you’ll need to have the following information handy:
- Your policy number
- The full name of the key contact at your company to manage through the claim(s) — this will be the “Claims Contact Person”
- Claims Contact Person’s email and phone number
- Description of events, such as the names of parties involved/claimant name, the type of loss, key dates/times of circumstances/occurrences, and other details. You should also let us know if there’s a demand or a lawsuit.
You should file your claim as soon as possible. You will be able to add and update information later. For now, please submit any information you do have available via the links provided, or call the claims reporting phone number listed on your policy.
Every insurance policy has a section describing claims and their reporting. You can view and download policies in your Embroker account and then search those files for the words “Report,” “Notice,” “Claim,” or similar terms. Usually within the first few or the last few pages, there’s also a “Claim Contact” or “Report To” page that may contain other helpful information.
Time varies depending on the type of the loss, coverage available, and how long it takes to investigate and manage through your claim. While we cannot offer a specific time frame, most state laws require that claims professionals respond within defined time frames after a claim is reported, and provide regular updates as the law requires.
A variety of factors — including your claim history, risk profile, exposures, and type of insurance — make up your insurance premium and coverage terms. If it appears that your premium or coverage terms will change as a result of a claim, many, but not all, types of policies/insurers are required to give you notice that change is coming. The best way to understand what your renewal program will cost and/or cover is to get your renewal application submitted as early as possible to be quoted. Many insurers are not required to offer renewal terms automatically, and so the earlier you submit your application, the more time you will have to plan for any impact to your renewal.
Some claims that are principally straightforward, such as those involving damaged property or vehicles, usually require an in-person inspection, which can take a bit of time.
More complex claims dealing with financial loss (for instance, Directors and Officers Liability, Cyber claims, etc.) can take significantly more time. The Claim Professional will guide you through that process.
After all the facts about the loss are reviewed, and it is determined that your loss is covered by your insurance policy, your assigned Claim Professional will let you know about the payment process.
One of the most important things to remember is that startups should be contacting their insurers as soon as they become aware of a claim, and before any affirmative actions are taken with regard to the matter. That’s because most policies are “duty to defend.” This means that if your claim is covered under your policy, the insurance carrier has the right and duty to defend you, which includes appointing counsel from their pre-approved panel counsel list, and consenting to any claim-related fees, costs, or settlements before they are incurred.
Therefore, the first step in the claims process is notifying your insurer of the claim via a claim submission. The most important part is to get the notice in. If you don’t have all the facts, just indicate that, and the Claim Professional will follow up for details.
A basic claims submission will package the party’s demand letter, email, or the circumstances and any other relevant materials. It will also include the name of the person/s at your Company that an assigned Claim Professional should contact for more details. That Claims Contact becomes the “point person” on the claim for your company. The Claim Professional will work with them to review the details and any additional information submitted, and initiate the handling strategy, which may include coordinating legal counsel, other consultants, and/or response coordinators.
Here’s an example of an Employment Practices Liability (EPL) claim.
Imagine you’re the CEO of a SaaS company. A few years into starting your business, the company has a reduction in force that includes laying off a total of 20 employees to adjust to business and economic conditions. A month after that reduction in force, you receive a letter from an attorney who represents one of the terminated employees. They allege that she was chosen to be part of the reduction in force because of her race and gender, make a demand to settle her claims before they file suit, and include a draft Complaint to be filed if you do not contact them within two weeks.
While the allegations may be groundless, the time and expenses required to fight the allegations are likely going to pose a substantial distraction for the company.
In a case like this, you should report this matter to your EPL carrier as soon as you receive such a letter. The carrier would guide you through the claims process from claims submission through a resolution, which may or may not include a monetary settlement.
Product liability claims are generally associated with product design, manufacturing, and/or issues with instructions/warning labels which lead to injury or damage to property:
- Product design: For example, a children’s dresser topples over because of its design, causing injury.
- Manufacturing: Let’s say something goes wrong on the assembly line for a new smartphone and the incorrect components are used in the phones’ construction. As a result, the affected phones can overheat and explode. Claims for injury or property damage result from that manufacturing defect.
- Issues with Instructions or Warning labels: These can range from incomplete or improper warnings (consider drug interactions on medicines, supplements, etc.) or insufficient instructions provided with unassembled products. Not disclosing or leaving ambiguity beyond what a reasonable person might expect can also lead to injury or damages, thus resulting in a claim. To take this full circle, what if the design of the dresser mentioned above included a wall anchor system to prevent tipping, but the instructions were incorrect in how to mount/install the anchors?
While these are typically the core types of product claims, in reality, anything associated with the product creates exposure to a company, and thus could result in a claim.
Professional liability claims generally stem from a party’s financial loss in performance of an agreement. In terms of the types of professional liability claims you could face, most commonly these pertain to contracts, services, or work that you performed or failed to perform. Malpractice claims are a more specific type of professional liability as those claims often include allegations of bodily injury in some form — physical, psychological — in addition to the financial loss claims.
Accountants, lawyers, and other people who perform professional services that involve opinions and advice leave themselves open to claims if their work has not managed to meet a client’s expectations. Similarly, doctors, dentists, and other healthcare workers face exposure from patient allegations of wrongdoing in their care, or perceived lack of care.
Errors such as misfiling paperwork, miscommunicating details, performing the wrong services, failing to perform services promised, giving or failing to give advice, or something as simple as forgetting about a deadline can result in financial loss to a party — and thus, a professional liability claim. Even if you believe that you have performed your duties flawlessly, the consumer of your services might think otherwise which can drive a claim.