REPORT A CLAIM
PROCEDURES TO FOLLOW WHEN AN ACCIDENT OCCURS
Whenever an accident occurs on your property or involves your parish, school or organization, the following steps should be taken immediately to mitigate losses:
· Fully complete and sign the designated Diocesan Accident Report.
· Document the exact date and time.
· Obtain the name, address, phone number and Date of Birth of any injured party.
· Determine the extent of the injury to the best of your ability and call for medical assistance if necessary.
· Ask the injured party to give you a detailed description of how the accident occurred.
· Determine the exact location of the accident site.
· Obtain the names, addresses and phone numbers of any and all potential witnesses. Remember, a witness does not necessarily have to be an eyewitness.
· Inspect the accident site immediately, and document your findings, take pictures if you are able.
· Preserve and secure any evidence, such as chairs, ladders, etc.
· If a contractor or organization using you premises is involved, obtain the above mentioned information and research your files for an updated Certificate of Insurance, Hold Harmless Agreement and contract agreement.
· Attach any diagrams, statements, police reports and photos to the designated Diocesan Accident Report.
· Report all non-employee bodily injury claims of a serious nature within 24 hours to Brian McAuliffe at Risk Management at 315-470-1494. Be prepared to give a verbal report of the results of your investigation.
· If your office is served with a Summons & Complaint or a letter from an attorney, please call Risk Management immediately for instructions.
RC DIOCESE OF SYRACUSE ACCIDENT REPORT INVOLVING BODILY INJURY
(click on the form below to fill out for an injury involving a Parishioner, Volunteer, Visitor and Other). This form should be filled out and signed by a Business Administrator or Parish employee or Pastor.
AUTO / VEHICLE ACCIDENT (Click on form below)
PROPERTY DAMAGE / VANDALISM / THEFT TYPE CLAIMS
Please contact Brian McAuliffe at 315-470-1494, or Sue Wuerthner at 315-470-1495 at the Risk Management office.
Be prepared to give a detailed description of the loss and the extent of the damage.
BOILER AND MACHINERY CLAIMS
This Boiler & Machinery policy provides additional coverage, over and above the coverages provided by our existing Protected Self-Insurance Program. Schools specifically were included in this blanket boiler policy as this policy provides coverage for a number of items often found in our schools including:
All HVAC systems (boilers, ventilators, air conditioning systems)
Electric panels and transformers
Large office equipment
Computers and computer systems
Sound and bell systems
The Boiler & Machinery policy provides broader coverage than typical property insurance including equipment breakdown losses and artificially generated electric current and arcing losses. It also includes spoilage and related extra expenses that often accompany these types of losses.
IF YOU HAVE ANY SUDDEN OCCURRENCE OR DAMAGE involving your boiler or any HVAC, electric, computer or office equipment, please contact Brian McAuliffe at 315-470-1494 at the Risk Management Office immediately. He will assist you in determining what coverage may apply and will assist you in reporting the loss to the boiler insurance company.
WORKER COMPENSATION CLAIM
For more detailed information on WORKERS' COMPENSATION, see the Workers Compensation section of the Risk Management portal.
FIRST REPORT OF INJURY C-2F FORM - (download and print out to fill out this injury report)
Fax or scan the (C-2F) and any attachments you may have to:
Office of Risk Management fax @ 315-474-6890 or email to: firstname.lastname@example.org and mail the originals to:
ROMAN CATHOLIC DIOCESE OF SYRACUSE
ATTENTION: RISK MANAGEMENT
240 EAST ONONDAGA STREET
SYRACUSE, NY 13202
SCHOOL AND CYO ACCIDENT REPORT FORMS
STUDENT ACCIDENT INFORMATION
When a student is injured, always complete the Roman Catholic Diocese of Syracuse Catholic Schools Bodily Injury Report (see form below). Send the original to the Risk Management Office, 240 East Onondaga Street, Syracuse, NY 13202; keep a copy for your records.
If a parent inquires about insurance coverage, our insurance carrier for student accidents is Wellfleet New York Insurance Company. The primary insurance would be the parents/guardian’s personal health insurance plan and Wellfleet insurance is secondary to the personal Health Insurance of the parent or guardian. In the event that the parent or guardian does not have health care coverage, the Wellfleet Student Accident Insurance becomes primary.
If a parent wishes to file a claim with Wellfleet', give the Wellfleet Student Accident Insurance form (see form below) to the parent/guardian to complete the form. (Note – there is a different form for a CYO accident; please use the CYO form). It is the parents responsibility to file the claim with Wellfleet.
THERE IS A $500 DEDUCTIBLE WITH Wellfleet. The parent/guardian will be responsible for the $500 deductible of medical payments, after that the remaining balance will be processed under Wellfleet Student Accident Plan.
TO ACCESS STUDENT CLAIM FORMS, CLICK ON THE LINKS BELOW:
To “Report a Cyber/Internet Breach”
Please contact Justin Bartlett, Director of IT Department, at 315-422-9063, immediately.
Be prepared to give a detailed description of the breach to your network system.
Or contact Brian McAuliffe of the Risk Management office at 315-470-1494.
Bulletin from the Office of Information Systems regarding hackers who solicit wire transfers and payments via email.
Please read and be aware of the fake emails that may be sent to parishes looking to defraud the parishes posing as legitimate requests.