Liability Claims

Reporting General Liability Claims Guide

Account Information

  • Provide Company Information if applicable

Product Liability

  • Provide location of your Company Headquarters

Slip and Fall or Other Liability

  • Provide location where accident occurred

All Liability Claims

  • Your Business name & address (include specific division if applicable and mailing address if different than above. 
  • Specifics e.g. aisle of fall, Dept.

Accident Information

  • Date & time of accident
  • Detailed description of accident

Product Liability

Product Information

  • how was product being used
  • specify manufacturer's name
  • make/model/size/style/serial # and/or product I.D.
  • was there damage to product
  • where & when purchased
  • where & when can product be seen

IMPORTANT!
SAVE THE PRODUCT INVOLVED FOR INSPECTION
DO NOT DESTROY

Slip and Fall

  • What substance or object did claimant slip/trip or fall on (if any)
  • How did substance or object get there

All Liability

  • Witnesses including specifics on where they were at time of accident, any relationship to involved parties and means of contact (address, phone #, best time & place)
  • Authorities (ambulance, police, fire) include address, report # and any violations/citations that may have been issued
  • Nature of Occurrence Were there complaints of injuries (any special treatment)?
  • Was there any damage to property you don't own?
    • If yes, refer to info needed in "property damage" section

Injuries

  • Name, address, home & business phone for injured
  • Occupation (if provided)
  • Date of birth (age) Social Security # & sex
  • Description of injury
  • Was medical treatment received? If so, from who
  • Name, address, phone # of hospital/clinic/doctor
  • Type of treatment, length of stay, specialty of doctor
  • First day of treatment
  • Is injured represented by an attorney?
    • Name, address & phone number
    • Was lawsuit served? If yes, date of service
  • Employer Information (Name, address & phone) (If multiple injuries, repeat above section)

Property Damage Information

  • Property owner's name, address, home and business phone
  • Description of damage (include both description of item and damage to that item)
  • Estimate of damage, if available (If other property damage, repeat above section)

Account Contact Information

  • Best person (including time & place) to contact for more information
  • Additional comments and information

Our Customers Say

Jacquelynne Maloney at the Tonry agency has helped us immeasurably navigating the bonding process.  She took the time to get to know us and develop a complete picture of our company, our goals and objectives, our capabilities, our needs and the history of our company.  Her knowledge of the market allowed her early on to recognize what program would work for our company.  Other bonding agencies simply asked for a copy of our financial statement, balance sheet and work on hand.  They appeared to have no interested in whether we were making cupcakes or nuclear missiles.  Jacquelynne took the time to get to know us personally.  To her we were more than just our financial statement.

President

Richardson Electrical Company, Inc.

VIEW ALL TESTIMONIALS