General Liability
Overview
Claims in this category consist of injury to others or damage to property of others (except by automobile) your company may be legally liable that arise out of the company’s business activities. Follow the instructions below when a loss of this type occurs.
Instructions
Complete the report form and submit it to McGriff Claims Central as soon after the incident as possible.Obtain the names, addresses and phone numbers of all injured persons or property owner and all details of how the injuries or damages occurred.If necessary, secure first aid for any injured person/s.Do not admit liability or offer payment for injuries or damages. This will be addressed by the insurance company.If a product is involved and you have the product, save it for inspection by the claims adjuster.Obtain the names, addresses and phone numbers of all witnesses. If possible, have them give a written account of what happened and include their signature, date, and contact information. Have all employees who responded to the incident give you a written statement of what they saw, heard, or were told by the injured party, incident or product involved.Take photographs, videos or draw a diagram of the area just as it was when the incident occurred. This is extremely important if the condition of the area changes before the adjuster investigates. Preserve all digital images and video.Call or fax the report to McGriff. Refer to the account service team sheet for phone numbers. McGriff will report the incident to the insurance company. Failure to report the claim may void your coverage for that claim.If the accident occurs during evening or weekend hours and is of a serious nature, contact McGriff as soon as possible on the next business day.If you are served with a Summons or Complaint (suit papers), you must notify McGriff immediately. These are legal documents that require a timely response. Failure to do so may result in a default judgment against your company.Do not discuss the details of the accident with anyone without proper identification. He/she may want to speak with you or other employees about the accident. The claim adjuster will work directly with the claimant or his/her attorney; you should not interact with the claimant yourself. Please refer them to McGriff representative or the insurance company representative handling the claim.
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Company Details
Insured/Company Name
*
Report Date (mm/dd/yyyy)
-
Month
-
Day
Year
Date
Contact Name
*
Contact Phone Number
Please enter a valid phone number.
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Incident Details
Please select all that are applicable to this incident.
*
Injury occurred
Property was damaged
Witnesses are available
A lawsuit has been filed
Description of Incident (i.e., visitor injured, product claim, damage to property)
*
Date of Incident (mm/dd/yyyy)
*
-
Month
-
Day
Year
Date
Time Incident Occurred
Hour Minutes
AM
PM
AM/PM Option
Street Address of Incident
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Specific Location of Incident (i.e., kitchen, parking lot, etc.)
Weather Conditions (wet, dry, etc.)
Please upload any photos/videos from the incident.
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Responding police/authority
*
Office and Report Number
*
Did the incident occur on your business premises?
*
Yes
No
Did the incident involve a product you manufacture or distribute?
*
Yes
No
Did the incident involve work that you completed for a client?
*
Yes
No
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Injury Details
Please provide information of injured party.
Contact information
Name
*
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Email Address
example@example.com
Nature of Injury
*
What was the injured party doing?
*
Please provide hospital or treating physician information (if any)
*
Please use the field below to provide details for any additional injuries that occurred - include as much detail as possible like name, phone number, and address of injured party, nature of injury, what were they doing before injury occurred, etc.
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Attestation
I attest the information provided in this report is true and correct to the best of my knowledge.
Name
*
This acts as a digital signature.
Today's Date (mm/dd/yyyy)
*
-
Month
-
Day
Year
Submit
Should be Empty: