Welcome to Dubai ! Managing Claims in the Hospitality and Tourism - - PowerPoint PPT Presentation

Welcome to Dubai !

Managing Claims in the Hospitality and Tourism Sector

• Ronald Smith

Risk Manager

• Joana Nogueira

Complex Claim Adjuster

• David Todd

Loss Adjuster

• Michael Ducker

Senior Associate

On The Panel

1. RESORTS 2. INSURANCE 3. LOSS ADJUSTING 4. LEGAL DEFENCE

Four Steps of Claim Management

• 1. RESORTS

2. INSURANCE 3. LOSS ADJUSTING 4. LEGAL DEFENCE

Four Steps of Claim Management

Waterpark Food & Beverage Hotel

RESORTS: SOURCES OF CLAIMS

ANNUAL ATTENDANCE Resort Guests: 1.2m F&B Covers: 4.1m Waterpark: 1.6m

INCIDENT OCCURS HOTEL FOOD & BEVERAGE WATERPARK INQUIRY (Fact Finding) Security Food Safety Waterpark Management INTERNAL REPORTING

Claims Manager

EXTERNAL REPORTING LITIGATION DEFENCE

Opportunities to Settle

Q.A. Dept.

Risk Management/ Legal Department

CLAIM MANAGEMENT PROCESS

• WATERPARK
• Slips, Trips and Falls
• Collision (slides)
• Contusions/Strains/Sprains
• Abrasions/Lacerations
• HOTEL
• Slips, Trips & Falls
• Bruises/Strains/Sprains
• Abrasions/Lacerations
• FOOD & BEVERAGE
• Food Allergies
• Food Contamination
• Flu-like symptoms

CAUSES/TYPES OF CLAIMS

• Late or Non-Reporting of Incident
• Failure to Get Statement from Claimant
• Failure to Get Statements from Witnesses
• Inability to Use CCTV Technology
• First Reports from Outside Correspondence
• Aggregation of Low Value Settlement
• Conscious of Power of Social Media

UK: Package Travel Regulations of 1992 Tour Operator Claim Management and Indemnification Clauses

Claim Management Challenges

http://www.dailymail.co.uk/news/article-3953448/Travel-firm-uses-spies-rumble-company-bogus-sick-claims.html

1

Trolling for Illness Claims by UK Solicitors

1. RESORTS

• 2. INSURANCE

3. LOSS ADJUSTING 4. LEGAL DEFENCE

Four Steps of Claim Management

Risks Triggering Your Liability Policy

• Each day brings different incidents with the potential to escalate.
• Some Are Routine:
• Slips and falls,
• Food poisoning,
• Missing items from guests .
• Damages caused by valet parking.
• Others Are Extraordinary:
• An allergy caused by a henna tattoo.
• Child drowning in the adults swimming pool.

Process: Practices for Liability Claims

• Claims handler to acknowledge receipt of a claim in a prompt fashion:
• Request further information to assist in taking a coverage position
• Appointment of experts to assist in the enquiries when needed.
• Insured to facilitate insurers investigation, acquisition of documentation and evidence.
• Depending on the case, insurers might select to guide the insured how to conclude a simple
• case. With more complex cases, insurers will establish direct contact with the claimant, with the

aim of conducting a successful negotiating. The ultimate objective is to bring the matter to a fair and just conclusion.

• All documents that support payments, diagnosis, disability, evaluations, calculations etc. should

be secured and preserved.

• When required, insurers will appoint defense counsel to defend insured interest.

Best Approach in Case of an Incident

• Listen Properly
• Protect guest’s privacy
• Be alert: a docile guest might become an aggressive claimant!
• Report the incident
• Investigation is required to determine liability, the sooner the better
• Decide what information is required and the right questions to ask
• Take photos of the scene, conduct site investigation, and preserve evidence
• Witness memories fade quickly: please secure written statements

What Do People Claim For?

• Property Damage:
• The cost of repair or replacement of a damaged or lost object
• Bodily Injury/Illness:
• Reimbursement or payment of medical expense and compensation for the pain

and suffering caused by the injury and the effect it has had on their lifestyle.

• Financial losses:
• Lost earnings, bonuses and overtime because of the accident; in addition to

travelling expenses for visits to the hospital. Loss of use of vehicle.

• Provisional Damages:
• Where there is risk that a medical condition caused by the accident will

deteriorate within a certain time in the future.

Required Information

Incident Report:

• Information on the guest (name, age, nationality, ID copy, contact details)
• The circumstances (incident date/time, reported date/time)
• Action taken
• The allegations
• Description of the injury or damage
• Description of the location of the incident
• Photographs / measurements / CCTV footage
• Highlights on any demands/allegations

Additional Documents:

• Witness statements: Avoid personal opinions
• Medical records
• Police / Fire brigade report
• Damage estimates

Key Points

• Hotels are not liable for every accident or loss that occurs on the premises
• For the hotel to be liable, there should be a proven Breach of duty and causation
• Hotels have a general duty to exercise "reasonable care" for the safety and security of their guests,

either to: a) Correct any situation that can constitute danger (mostly when there are similar incidents reported); b) Warn on the existence of that danger.

• Hotels may be "vicariously liable" for the NEGLIGENCE of their employees, vendors or 3rd party

contractors.

• Take corrective measures to prevent re-occurrence

Alert - Suspicious Claimants

• Opportunists, repeat offenders, professional and organized fraud;
• Motives: greed, financial pressure, moral hazard, arrogance, etc…;
• Indicators: very friendly, very angry, previous history, suspicious circumstances,

altered documents, non-disclosure of proper information or documents, exaggeration and fabrication, with an intention to make a gain or cause a loss;

• How we might defeat it: develop an anti-fraud culture, while respecting the company

policies and the applicable laws.

1. RESORTS 2. INSURANCE

• 3. LOSS ADJUSTING

4. LEGAL DEFENCE

Four Steps of Claim Management

What is a Loss Adjuster?

• Insurance claims expert
• Appointed by Insurance/reinsurance carrier
• May specialize in a certain field, e.g., liability claims
• Independent, impartial – first party claims
• Third party claims – we’re on your side!
• Duty to act professionally

The Role of the Loss Adjuster

• Establish the circumstances of loss – Insurer’s eyes and ears on site
• What happened – who, what, where and when?
• Cause – involvement of forensic experts/interview witnesses
• Extent of Loss & Damage – type of injury/extent of physical loss or damage
• Gather evidence – potential defence?
• Subrogation – can I get my money back?
• Communication – with both Insured, Insurers & third parties

Who is at Risk for Claims?

• Hotels
• Restaurants
• Spas
• Water parks
• Theme parks
• Golf course operators
• Marine & aviation operators

Risks & Sources of Potential Liability Claims

• Swimming pools
• Water parks
• Water sports
• Marine pleasure craft
• Desert safaris
• Aviation – hot air balloons/light aircraft
• Slip/trip & fall

• Food poisoning
• Fire
• Golf course risks
• Theft of personal effects
• Valet parking
• Amusement rides
• Miscellaneous – e.g. legionnaire's disease

Risks & Sources of Potential Liability Claims (cont.)

Loss Adjuster Enquiries

• Review of initial documentation received
• Review policy coverage
• Arrange site attendance
• Inspect the situation of accident/incident
• Establish the standard operating procedure
• What went wrong, if anything?
• Gather evidence
• Interview witnesses
• Take photographs
• Prepare report(s) for Insurer’s consideration

1. RESORTS 2. INSURANCE 3. LOSS ADJUSTING

• 4. LEGAL DEFENCE

Four Steps of Claim Management

Liability Claims: Litigation Process

• UAE Courts:

– Civil Courts – Criminal Courts – Shariah Courts

• Litigation divided into three stages:

– Courts of First Instance – Courts of Appeal – Court of Cassation

• Procedures of the UAE Courts
• Role of advocacy / pleadings
• Proceedings in Arabic
• Expert appointment

Liability Claims: Duties and Legislation

• Employers required to ensure the health of safety of employees at work, and of visitors to premises
• Breach of this duty, leading to death or injury, can give rise to both financial and criminal penalties
• Principle legislation:

– Labour Law (Federal Law 8 of 1980) – Penal Code (Federal Law 3 of 1987) – Protection of Workers from Hazardous Works (Min. Dec. 4/1 of 1981) – Working in Remote Areas (Min. Dec 27/1 of 1981) – Employee Penalty Guidelines (Min. Dec. 28/1 of1981) – Prevention of Hazards at Work (Min. Dec. 32 of 1982) – Standards of Medical Care (Min. Dec. 37/2 of 1982)

Types of Liability – Criminal / Administrative Sanctions

• Penal Code
• Contains financial and detainment penalties
• Labour Law and Ministerial Decisions
• Breach of H&S obligations punishable by fine >AED10k and/or imprisonment for >6 months
• Fines can be levied against the company, but officers could face imprisonment
• Imprisonment usually only imposed where gross negligence has occurred
• Administrative Sanctions:
• Ministry of Labour and Social Affairs is the competent authority to “police” the workplace and apply certain

administrative sanctions

• Ministry can suspend or cancel a company’s licence in the following circumstances:
• Failure to take adequate precautions against H&S risks to employees, visitors
• Failure to remedy violations of the regulations
• Failure to report an accident or death in the workplace
• With the exception of a failure to report an accident or death in the workplace (which attracts immediate criminal

proceedings), administrative sanctions are usually applied prior to any criminal sanctions.

Types of Liability – Fixed Compensation

• Shar’ia Principles:
• Diya (blood money for causing a death, currently set at AED200k)
• Arsh (compensation for causing injury, operates on a sliding scale)
• Ghurah (compensation for causing death of an unborn baby)
• The effect of Diya on other forms of compensation?
• Cassation No 119/2004 it was held that claim for material losses

(i.e. LOE) can also be made

• Claims culture in the UAE
• Comparison with other jurisdictions
• Damages awards

Types of Liability – Fixed Compensatory Damages

• Any other relevant laws?
• Article 282 Civil Code: general provision whereby those committing acts causing harm to others

can be made to account for their actions

• Article 290 Civil Code: damages may be reduced in the case of contributory negligence
• Article 291 Civil Code: principle of joint and several liability
• Vicarious liability?
• Article 313(b) Civil Code: those who suffer damage/loss due to a harmful act committed by a

subordinate/employee by virtue of, or during the performance of his job.

• Supervisor: whoever has actual control by way of supervision and direction over a person who

caused the damage

Hazards of Litigating in the UAE

• No binding precedent
• Lack of disclosure rules
• “Without prejudice” communications
• Settlement negotiations / admissions of

liability

• Protracted proceedings
• Forum shopping

Q & A