责任申索决定

当成员向信托基金报告责任索赔时, the Trust must determine whether the member is legally liable for the damages that are being claimed. 在一般情况下, 会员对他人的损害负有责任, 必须满足以下三个条件:

1. 这个会员一定是玩忽职守.
2. 损害一定是由于会员的疏忽造成的.
3. 这不是一个成员可以免除责任的领域.

A liability claim will usually be denied if the claim was not caused by the member’s negligence. 有, 然而, some situations in which a claim denial is not clear and other claim resolutions may be considered. 在某些情况下, 向受损方付款似乎比较容易, 尽管从法律上讲，会员不承担支付的责任. 的信任, 虽然, cannot do this because the funds the Trust uses to pay claims are public funds that are the joint property of all Trust members. 的信任 has a duty to ensure those funds are paid out only when legally owed. 否则将是未经授权使用公共资金(明尼苏达州. 常量. 艺术. X, § 1).

解决责任索赔

There’s often a good deal of judgment involved in evaluating liability claims, and members may disagree or have questions about the Trust’s evaluation and conclusion. If there are facts or information your claims adjuster isn’t aware of or issues they haven’t investigated, the member should always bring those concerns to their assigned adjuster. 如果问题仍然存在, contact the adjuster’s supervisor or the Trust’s 索赔经理 达林理查森 at drichardson@sfcjuniorblues.com or (651) 281-1283. They will review the claim to ensure the correct conclusion was reached.

会员作出最终结算决定的权力

的信任 has the legal authority to settle a covered liability claim on a member’s behalf. 然而, 因为信托是一个合作组织, it strives to keep members informed of how a case is developing and whether a settlement or a claim denial is being considered. 信托总会欢迎会员提出意见, 建议, and opinions on how a claim should be approached and whether a settlement should be considered or a claim should be denied.

有时, situations arise where the Trust believes a liability claim should be settled, 但该成员强烈反对. The “consent-to-settle” provisions of the Trust’s liability coverage would usually apply in those situations. These provisions give the member the right to review a proposed settlement before it’s finalized and make the final decision on whether the settlement will be offered. 然而, the consent-to-settle provisions do not apply to claims handled under the Trust’s land use or special risk litigation coverages, 其中的决定是由信托和成员共同作出的.

作出最终结算决定的程序

To exercise the rights of the consent-to-settle provisions contained in the Trust’s liability coverage agreement, the member needs to follow the procedures spelled out in the Trust’s liability coverage document and be aware of the financial risks involved. 根据这些程序要求，该成员:

• 必须在结算前向信托提供通知吗. To exercise the right to review and approve or disapprove a settlement on a liability claim, the member must give notice to the Trust before it has offered or made a settlement. A notice must be given for each specific claim on which the member wishes to exercise its consent-to-settle rights. The member must also designate an individual who is authorized to approve or disapprove a proposed settlement on the member’s behalf, 它必须包括名字, address, 还有那个人的电话号码. 除非及直至会员发出通知, 信托有权在适当情况下解决索赔.
• 必须审查结算并了解结算的截止日期吗. When the member has given notice to the Trust that a case may not be settled without its permission, the Trust will contact the member’s designated individual to inform them of the terms and conditions of any proposed settlement on that claim. The member has 14 days to disapprove or approve the proposed settlement (in certain situations, 经双方同意，该期限可延长或缩短。. If the member does not notify the Trust within 14 days that it has disapproved the settlement, 该成员被视为同意和解, and the Trust is authorized to proceed with the settlement if appropriate.
• Must be aware of three financial risks of choosing to veto a proposed settlement.
  • 第一个, 如果成员不赞成提议的和解, there’s the risk the cost of the case will turn out to be greater than the proposed settlement. If the ultimate total cost for damages and defense costs on the claim is greater than the proposed settlement plus the defense costs incurred to that date, 会员要为差额负责.
  • 第二个, if the member’s refusal to consent to a proposed settlement results in a further claim for damages or action seeking penalties against the Trust, 该成员必须为该索赔辩护并赔偿信托, 针对任何此类要求或行动为自己辩护, and be responsible for any damages or penalties awarded against the member.
  • 第三, in situations where Medicare is involved and the member does not consent to a settlement, the member must cooperate with the Trust so it can ensure Medicare’s financial interests are protected, 根据联邦法规的要求. Members that do not consent to settlement must defend and indemnify the Trust for Medicare claims that result.
• 行使同意和解权后是否可以否决和解. If a member vetoes the proposed settlement after exercising its consent-to-settle right, 有两种方法:
  • 的信任 can make payment to the member equal to the amount of the proposed settlement minus any applicable deductible. At this point, it becomes the member’s duty to defend both itself and any other covered p艺术y.
  • 信托基金可以继续为索赔进行辩护和管理, 但如果成本超出了可以解决的范围, 该会员必须偿还信托基金的额外费用.