Long tail claim review

HBA was retained to undertake a review of a long tail claim, for a client within the transport and logistics industry. 

In this case, the employee had suffered a heart attack while driving. At the time of the heart attack, he was on his way home from a location in the country where he had earlier been sent by his employer. 

​Liability for the claim had been accepted, and, due to the serious nature of the injury, the claim costs were quickly approaching the employer’s re-insurance level and having a significant impact on actuarial assessments. 

When HBA reviewed the file, we noted that detailed investigations had not been undertaken into the circumstances of how and when the heart attack arose.  It quickly became apparent during conversations with his work colleagues, that the employee had been involved in an extramarital relationship.
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​It also became clear that he had been directed by his Manager not to drive home the night he suffered the heart attack as he had been working long hours and would have exceeded the fatigue policies of the employer. 

Based on these investigations, the employee’s old mobile phone was retrieved, and an analysis of SMS messaged undertaken.  Signed statements were also obtained from co-workers.  On the basis of this evidence, a fair opportunity letter was sent to the employee notifying him that it appeared he should not have received compensation as the injury occurred when he was on his way to visit his girlfriend, at a time when he had been specifically directed by his employer not to drive. 

To manage the claim, we met with the employer and Comcare to keep Comcare informed in case a complaint arose.  We also offered the employee independent counselling and financial advice. 

After a period of time, liability was denied for the claim but only on the basis of any future payments of compensation under the Hannaford principle. 

​We believe that due to our involvement and management of the claim, the employee did not request a reconsideration of the determination denying liability.  This saved the employer a large financial exposure from a claim and actuarial point of view.