Marine Claims Guide and Handling Procedures.pdf

8/10/2019 Marine Claims Guide and Handling Procedures.pdf

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Revised 06/08/2011NSIEastern Atlantic Seaboard Claims Manual

MARINE CLAIMS GUIDEANDHANDLING PROCEDURES

ATLANTIC

SEABOARD

USCGDISTRICTS 1,5AND 7

NORTH STAR MARINE INSURANCE SERVICES,L.L.C.59MAIN STREET, UNIT #1

FAIRHAVEN,MASSACHUSETTS 02719

774.202.2751(OFFICE)774.202.3764(FAX)508.272.1245(MOBILE)

[email protected]
mailto:[email protected]:[email protected]:[email protected]


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TABLE OF CONTENTS

CONTACT INFORMATIONNUMBERS YOU MAY NEED IN CASE OF INJURY OR ACCIDENT

HULL &MACHINERYIN CASE OF ACCIDENT,WHO TO CONTACT AND CLAIM FORMS

PROTECTION &INDEMNITYWHAT IS P&IINSURANCEIN CASE OF ILLNESS OR INJURYWHAT TO DOWHAT IS THE JONES ACTFORMS: COMPLETE THESE FORMS INCASE OF ILLNESS OR INJURY

PERSONAL INJURY REPORTMASTER/SUPERVISORS REPORTWITNESS STATEMENTAUTHORIZATION TO RELEASE HEALTH CARE INFORMATIONCG-2692COAST GUARD FORM FOR INJURY OR ACCIDENT

CG-2692BCOAST GUARD FORM FOR DRUG/ALCOHOL TESTING(SEE INSTRUCTIONS FOR HOW AND WHEN TO COMPLETE USCGFORMS)

HEALTHFORCE PARTNERS -MEDICAL SERVICESFOR IMMEDIATE 24HOUR PHYSICIAN ADVICE

ACCIDENTAL DEATH &DISMEMBERMENTCLAIMANTS STATEMENTATTENDING PHYSICIANS STATEMENT

ABBREVIATED GUIDE TONAVIGATION RULES OF THE ROAD

MARINE EMERGENCY RESPONSE RESOURCE LIST


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CONTACTINFORMATION:

BRADFORD BOWEN,BROKER OFFICE 774.202.2751CELLULAR 508.272.1245FAX 774.202.3764EMAIL [email protected]

U.S.COAST GUARD 1STDISTRICTMAIN PHONENUMBER 617.223.8457SEARCH &RESCUE 617.223.8278

5TH DISTRICTMAIN PHONENUMBER 202.475.3400MAIN FACSIMILENUMBER 202.475.3920

7TH

DISTRICTMAIN PHONENUMBER 843.724.7616MAIN FACSIMILENUMBER 843.724.7608

MEDICAL EMERGENCY

HEALTHFORCE PARTNERSFOR IMMEDIATE 24HOUR PHYSICIAN ADVICE 425.806.5770

LOCAL EMERGENCY 911

HOSPITALSEMERGENCY ROOM24HOUR SERVICE

BAR HARBOR,ME MOUNT DESERT ISLAND HOSPITAL 207.288.5081PORTLAND,ME MAINE MEDICAL CENTER 207.662.2381GLOUCESTER,MA BEVERLY HOSPITAL 978.283.4000PLYMOUTH,MA JORDAN HOSPITAL 508.732.4500NEW BEDFORD,MA SOUTHCOAST HOSPITAL GROUPS 508.961.5388FALL RIVER,MA ST.ANNES HOSPITAL 508.675.5682PROVIDENCE,RI MIRIAM HOSPITAL 401.793.3000LONG BRANCH,NJ MONMOUTH MEDICAL CENTER 732.923.7200ATLANTIC CITY,NJ ATLANTIC CITY MEDICAL CENTER 609.345.4000OCEAN CITY,NJ MEDICAL CARE OF AVALON &OCEAN CITY 609.391.8105

CAPE MAY,NJ BURDETTE TOMLIN MEMORIAL HOSPITAL 609.463.2138
mailto:[email protected]:[email protected]:[email protected]


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FIFTH DISTRICT

ANNAPOLIS, MD410.267.8108

CRISFIELD, MD410.968.0323

HOBUCKEN, NC252.745.3131

OCEAN CITY, MD410.289.7457

WACHAPREAGUE, VA757.787.9526

ATLANTIC CITY,NJ609.344.6594 CURTIS BAY,MD410.576.2625 I

MARV,DE410.397.3103 OCRACOKE,NC252.928.3711 W

ASHINGTON DC202.767.1194

BARNEGAT,NJ609.494.2661

ELIZABETH CITY,NC919.335.6085

INDIAN RIVER INLET,DE302.227.2440

OREGON INLET,NC252.441.6260

WRIGHTSVILLE BEACH,NC910.256.2615

BEACH HAVEN,NJ609.494.2661

EMERALD ISLE,NC252.354.2719

LITTLE CREEK,VA757.464.9371

OXFORD,MD410.226.0580

CAPE CHARLES,VA757.331.2000

FORT MACON,NC252.247.4583

MANASQUAN,NJ732.899.0887

PORTSMOUTH,VA757.483.8526

CAPE MAY,NJ609.898.6995

GREAT EGG,NJ609.399.0144

MILLFORD HAVEN,VA804.725.2125

ST.INIGOES,MD301.872.4344

CHINCOTEAGUE,VA757.336.2874

HATTERAS INLET,NC919.986.2175

OAK ISLAND,NC910.278.1133

STILLPOND,MD410.778.2201

SEVENTH DISTRICT

CHARLESTON, SC843.724.7616


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HULL &MACHINERY/INCREASED VALUE

In the event of an accident or occurrence, which could potentially affect your policies ofinsurance, please send notice to:

North Star Marine Insurance Services, LLC.

59 Main Street, Unit #1

Fairhaven, Massachusetts 02719

Attn: Mr. Bradford Bowen

774.202.2751 (Office)

774.202.3764 (Fax)

508.272.1245 (Cell)

The notice should include extent and circumstances of loss together with vessel location, a

contact name and details.

Upon receipt of your communication, North Star Marine Insurance Services will immediatelydiscuss your advice with your insuring underwriters and will instruct a Hull & MachinerySurveyor to survey the damage. We will also ascertain a time that the surveyor will attend thevessel to survey damage and advise you of the surveyors names and details accordingly.


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Return to: Bradford BowenNorth Star Marine Insurance Services, LLC59 Main Street, Unit #1Fairhaven, Massachusetts 02719774.202.2751 (Office)774.202.3764 (Fax)

508.272.1245 (Cell)

HULL &MACHINERY INCIDENT REPORT

Office Contact Name: Telephone:

Vessel Name: Official No.:

Date of Incident:Location of Incident:

If collision, name of other vessel:

Has owner of other vessel been notified in writing? (Attach copy)

Extent of damage to other vessel:

Attach diagram of accident:

If engine damage, make/year: Number of Hours:

Last overhauled?

Describe what happened (in detail):

(use back of page if needed)

Extent of Damage:

Is this casualty to be reported to the Coast Guard? Yes No

Have you completed a USCG form 2692? Yes No

(If yes, please attach a copy.)

Signed: Dated:


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PROTECTION &INDEMNITY

In the event of an injury or illness, which could potentially give rise to a claim under the policy,please obtain a Personal Injury Report from the affected party together with a Masters/

Supervisors Report and a Witness Statement, if applicable.

Please immediately fax or scan and email all reports and statements of this new claim to NorthStar Marine Insurance Services including as much detail as possible.

LITIGATION

If you receive a Summons & Complaint or understand that an injury claim may go into litigation,please immediately advise North Star Marine Insurance Services. A defense attorney will beassigned and all further communication should be addressed to the attorneys, who will copy yourunderwriters and North Star Marine Insurance Services in order to protect client / attorneyprivilege.

ON-BOARD INJURY/ILLNESS PROCEDURE

Administer First Aid.

Document, Document, Document. (samples of forms with owner/manager)

Personal Injury Form

Masters/Supervisors Report of Injury Form

Witness Statements completed by anyone seeing the incident

Authorization to Release Health Care Information

USCG 2692 Report of Marine Accident, Injury or Death Form if the crewmemberrequires medical attention beyond first aid and, if the individual is unfit to perform

routine duties. USCG 2692B Report or Chemical Drug and Alcohol Testing Following a Serious

Marine Incident alcohol test within 2 hours and drug test no later than 32 hours

after incident.

Collect evidence. Inspect the area where the injury occurred to confirm the facts presented.

Obtain injury report statements including witness statements as soon as possible.

Drug test all persons in close proximity or who are involved in the incident at the earliestreasonable opportunity.

IF CREWMANNEEDS TO LEAVE THE VESSEL

If possible, have somebody accompany them to the clinic or airport so they do not feelabandoned by the vessel.

In addition, ensure that crewman has adequate cash, maximum of 10 days maintenance, asper contract, e.g., if $25/day then $250.00.

Ensure that injured person is not left alone at a time when they may need assistance orsupport. If necessary, contact owner/manager or P&I Adjusters to make arrangements forsomebody to meet them.


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JONES ACT

Adopted by Congress in 1920, since no workers compensation statute applicable toseamen exists, the Jones Act granted seamen the same rights to sue their employers for

personal injuries and death as railway workers were entitled under the Federal EmployersLiability Act (FELA).

Federal admiralty and maritime jurisdiction is defined as maritime activity occurring onall waters, whether or not connected to the sea, which are used or are capable of beingused in interstate or foreign commerce, either usable in their natural state or which are

possible to make navigable with a reasonable expenditure. Navigable waters of theUnited States include waters which form a continued highway over which commerce is

or maybe carried on with other States or foreign countries.

Seaman defined: Seaman status has traditionally been subject to court interpretation.Most recently, the Supreme Court, in Chandris vs. Landris, 1995 has defined it as 1) theworkers duties contribute to the function of the vessel or to the accomplishment of its

mission, and 2) the worker has a connection to a vessel in navigation that is substantial

in terms of both its duration and nature.

Remedies available to seamen:1) General Maritime Law

Duty of care

Maintenance & cure

Damages for unseaworthiness

Unearned wages

Wrongful death2) Jones Act negligence

Past and future wage loss

Future medical

Pain and suffering

Permanent or partial disability

Jones Act requires a more lenient standard of legal cause, which does not require that anegligent act be the sole proximate cause of an injury to result in liability, but only that itcontributed even in the slightest degree to the injury.

Seamen have a duty to mitigate1) May not decline reasonable medical treatment to correct a disability.2) If permanently unfit for sea duty, must seek other work suitable for their physical

condition.


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PERSONAL INJURY REPORT

TO BE COMPLETED BY INJURED PARTY

PAGE ONE

Name: Social Security #:Address:

City: State: Zip:Telephone:Date Employed: Length of Contract:

(if applicable) (if applicable)Vessel Name:

Where on the vessel did the accident occur?

When did the accident happen? Date: Hour: am/pm

What part of your body was injured? Right Left

Did you lose consciousness? If so, how long?

What happened?

What caused your accident?

Do you hold anyone to blame for your accident? Whom?

What were you doing when the accident happened?

Describe fully your current complaints related to your injury. Be specific.

Have you ever had the same or similar illness/injury before? (If yes, please explain)

PLEASE COMPLETE PAGE 2


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PERSONAL INJURY REPORT

TO BE COMPLETED BY INJURED PARTY

PAGE TWO

Did anyone else see the accident?

How could this accident have been avoided? __________________________________________

WITNESSES:Name (Real Name and not nickname), Address and Telephone

1. 2.

3. 4.

5. 6.

(Use Reverse if more than 6 Witnesses)

I declare under penalty of perjury of the laws of the United States that theforegoing is true and correct.

Signature of injured party Position aboard vessel (deckhand, etc)


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MASTERS/SUPERVISORS REPORT OF INJURY/ILLNESS

PAGE ONE

Vessel Name: Vessel/Location:Address:

City: State: Zip:Telephone:

Person injured/ill:

Address:City: State: Zip:

Telephone:

Social Security #: Job Title:

Is injured a Crewmember; if so, job position:Other (Passenger, etc.): (Explain)

Date of Injury/Illness: Description of Illness/Injury:

Weather conditions at time of injury:

Drinking: Yes No

Was time lost from work? Yes No

If so, how long (date, time):

Did the crewmember leave the employ of the vessel? Yes No

Date departed:

Did anyone else see the accident? Yes No

WITNESSES:Name (Real Name and not nickname), Address and Telephone

1. 2.

(Use Reverse if more than 2 Witnesses)


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MASTERS/SUPERVISORS REPORT OF INJURY/ILLNESS

PAGE TWO

Was first aid necessary? Yes No

If so, who provided it?

Doctor who treated injured/ill person:

Name of hospital/clinic:

Address:

City State: Zip:Telephone:

Comments: Explain in detail how injury/illness occurred, what caused it, why it occurred. (Usereverse if necessary): *Any additional comments not made on USCG 2692.

Signature and job title of person completing the form Date


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WITNESS STATEMENT

PLEASE PRINT

Name of Witness: Name of injured Person:

Address: Date Accident Occurred:City State Zip: Location of Vessel:Telephone:

1. Were you an eyewitness to the actual accident? Yes No

2. If yes, date and time:

3. If not, did you come on the scene shortly after? Yes No4. Weather conditions at the time of the accident:

(State wind conditions as well as sea conditions, if known)

5. Do you consider these conditions: Normal? Abnormal?(Check one)

6. Light conditions were: Excellent Good Average Below Average

7. Describe in your own words what happened, what you saw, and the nature of the injury.(Use reverse if necessary)

Name, address and phone number of someone who usually knows how to reach you:

I declare under penalty of perjury of the laws of the United States that theforegoing is true and correct.

Witness Signature Date of this report


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AUTHORIZATION TO RELEASE HEALTH CARE INFORMATION

Patients Name:

Date of Birth: Social Security #:

Previous Name:

I request and authorize To release all health careInformation of the patient named above to:

Name:

Address:

City State Zip:

This request and authorization applies to:

Health Care information relating to the following treatment, conditions, or dates of

Treatment

All health care information

Other

I understand that my express consent is required to release any health care information relating to testing, diagnosis,and/or treatment for HIV (AIDS virus), sexually transmitted diseases, psychiatric disorders/mental health, or drugand/or alcohol use. If I have been tested, diagnosed, or treated for HIV (AIDS virus), sexually transmitted diseases,psychiatric disorders/mental health, or drug and/or alcohol use, you are specifically authorized to release all healthcare information relating to such diagnosis, testing or treatment.

I understand that this consent for disclosure of protected health information constitutes a waiver of my right to

confidentiality under 42 U.S.C. #290dd-3 and 42 C.F.R. #2.1, et seq, and information may be redisclosed toindividuals or organizations not subject to Health Insurance Portability and accountability Act of 1996 (HIPAA)and, therefore, my no longer be protected by HIPAA. I agree to hold the individuals and entities referenced aboveharmless for their release of records pursuant to the terms of this authorization.

You may be asked to discuss my condition or contents of my medical records with representatives of my employer.Under the law, you are permitted to discuss my injuries and medical condition with representatives of said firm.This authorization and all authority to disclose information pertaining to me, shall expire one year from the date ofthe signature below or on the date that my claim resulting from the injury/accident occurring on the abovereferenced date is settled or otherwise concluded. I understand that this authorization can be revoked I writing, butnot retroactive to the release of information made in good faith. Please consider a photostatic copy of thisauthorization to release records to be as effective and valid of the original signed by me.

Signature of Patient or Authorized Representative Date

Relationship or status if signed by anyone other than patient (parent, legal guardian,

personal representative, etc.)


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HEALTHFORCE PARTNERS 18323BothellEverettHighway,Suite220Bothell,Washington98012

FORIMMEDIATE24HOURPHYSICIANADVICE,CONTACTHEALTHFORCEBYANYOFTHEFOLLOWINGMETHODS

COMMUNICATION METHODS:24HoursaDay7DaysaWeek 1.INMARSATorotherDIRECT VOICE WORLDWIDEACCESS

TELEPHONENUMBER: (425)806-5770FACSIMILE: (425)806-5771

2. TELEX WORLDWIDEACCESS

INMARSATC: (MCI)6838206TELEXDIRECT: 6838206MHSUW3.E MAIL: [email protected]

Please contact HealthForce physicians early in the course of an illness or soon after an

injury so we can consult with you in initiating medical attention promptly.

Trainedstaffinthecommunicationcenterwillrequestinformationaboutyourvesselandthe ill or injured crew member. If possible, please be ready with the informationrequestedontheattachedsheet.Thephysicianondutywillassistindeterminingthebestmedicaloptions.Please have pen and paper ready, if possible, to write down the physiciansrecommendations.

Voiceconsultationsfromshipsatseaaredigitallyrecorded.Pleasehaveyourmedicalchestorinventorylistavailable.

PLEASEPOSTTHISSHEETINCOMMUNICATIONSAREA
mailto:[email protected]:[email protected]


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PLEASE POST THIS SHEET IN COMMUNICATIONS AREA

Print Date: 6/18/2010

BE READY WITH THE FOLLOWING INFORMATION:

Vessel Name: Caller Name:

Crew Name: Age: Sex:

Medications: Allergies:

For Injury:

What Happened:

When: Where:

Visible Injury: Laceration Right Left

Amputation/ Crush Head/Face

Broken Bone/Contusion Eye(s)

Other Chest/Torso

Comments Abdomen/PelvisLeg Arm

Foot Hand

Last Tetanus / / date Toe Finger

For Illness:

Complaint:

Onset:

Pain Where:

Sore Throat Cough Sputum Color:Ear Dental Facial Swelling

Chest Pain Short of Breath Asthma Smoker

Abdominal Pain Nausea/Vomiting Diarrhea Black/Bloody

Pain on urination Frequent urination

Fainting/Loss of Consciousness Seizure Stroke

Vital Signs: B/P / Pulse Resp. Rate Temp

Describe Physical Findings:

Treatment Already Started:

Vessel Operating Area/Next Port

1. Have a pen & paper ready to write down physician recommendations.

2. You may photocopy this form and use for your vessel records.


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Accidental Injury Claim Claimants Statement (Please print Attach separate sheet if additional space required)

INSURED INFORMATION

Insureds Name________________________________ Soc. Sec. No. _____-_____-_____ Date of Birth ___/____/____ Marital Status ____

Insureds Address ________________________________________________________________ Phone No. (H)_________________________

________________________________________________________________________________ Phone No. (W)________________________

Name and address of employer ___________________________________________________________________________________________

Policy Number (Required)__________________________ Insureds Occupation ________________________________________________

Did the insured have any other insurance ? _________If yes, please list all companies, type of insurance, policy numbers and insurance

amounts:______________________________________________________________________________________________________________

___________________________________________________________________________________________________________

CLAIM INFORMATION

Date of accident _____/_______/_______ Time and place accident occurred______________________________________________________

Please describe in detail the circumstances of accident (attach separate sheet if needed): ___________________________________________

_____________________________________________________________________________________________________________________

Was the accident related to the Insureds occupation? ___________________ If so, how? __________________________________________

Please describe the nature of Insureds injuries:_____________________________________________________________________________

Please list the names and addresses of all treating physicians and hospitals:______________________________________________________

_____________________________________________________________________________________________________________________

_____________________________________________________________________________________________________________________

Did police or other authorities investigate the accident? ____ If yes, please provide name, address and telephone number of all investigating

officers and agencies: ___________________________________________________________________________________________________

CLAIMANT INFORMATION (If different than Insured Information above)

Claimants Name__________________________________________________________ Age_______ Relationship to Insured______________

Claimants Address________________________________________________________________ Phone No. (H) ________________________

_________________________________________________________________________________ Phone No. (W)________________________

In what capacity are you making this claim? ________________________________________________________________________________

AUTHORIZATION

I authorize any insurance company, physician, hospital or other healthcare provider, or any other organization, institution or person that may have records,

documents or knowledge regarding the insured to release any information requested regarding this claim and the loss reported. I understand this

information will be used by the Chubb Group of Insurance Companies, or its authorized representatives, for the purpose of evaluating and determining

coverage for this claim. I know I have a right to receive a copy of this authorization upon request and agree that a photographic or facsimile copy of this

authorization is as valid as the original. I agree that this authorization shall be valid for the duration of this claim.

I understand that any person who knowingly and with intent to defraud or deceive any insurance company files a claim containing any materially false,

incomplete or misleading information may be subject to prosecution for insurance fraud.

SIGNED (Claimant or authorized person) ___________________________________________________________ DATE ____/____/____

CHUBB


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Accidental Death

HOW TO FILE A CLAIM

1. Complete all items on the attached claim form.

2. Attach the following documents (as applicable):

Certified copy of death certificate (Required for all claims) Certified copy of all documents supporting claimants authority (e.g., Letters

Testamentary, Letters of Administration, Guardianship Papers, etc.,)

Copies of all police reports, newspaper articles, etc. describing accident

3. Send the completed and signed claim form and all required documents to:

CHUBB GROUP OF INSURANCE COMPANIES

CLAIM SERVICE CENTER

600 INDEPENDENCE PARKWAY

P.O. BOX 4700

CHESAPEAKE, VA 23327-4700

4. Retain a copy for your records.

YOU WILL BE CONTACTED BY A CLAIM ADJUSTER IF ADDITIONAL

INFORMATION OR DOCUMENTATION IS REQUIRED.

IF YOU HAVE ANY CLAIM RELATED QUESTIONS PLEASE

CALL CHUBB AT 1-800-CLAIMS-0 (1-800-252-4670)

CHUBB


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Accidental Death Claimants Statement (Please print Attach separate sheet if additional space required)

INSURED INFORMATION

Insureds Name________________________________ Soc. Sec. No. _____-_____-_____ Date of Birth ___/____/____ Marital Status _____

Insureds Address______________________________________________________________________________________________________

Name and address of last employer _______________________________________________________________________________________

Policy Number (Required)__________________________ Insureds Occupation (at time of death) ________________________________

Did the insured have any other accident or life insurance? _________ If yes, please list all companies, policy numbers and insurance

amounts:_____________________________________________________________________________________________________________

CLAIM INFORMATION

Date of accident ______/_______/______ Time and place accident occurred______________________________________________________

Please describe in detail the circumstances of accident (attach separate sheet if needed): __________________________________________

______________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________

Was the accident related to the Insureds occupation? ___________________ If so, how?__________________________________________

Please describe the cause of the Insureds death: ____________________________________________________________________________

Please list the names and addresses of all treating physicians and hospitals:______________________________________________________

______________________________________________________________________________________________________________________

Did police or other authorities investigate the accident? ____ If yes, please provide name, address and telephone number of all investigating

officers and agencies: _______________________________________________________________________________________

Was an autopsy performed?______ If yes, please provide name and address of Medical Examiner__________________________________

______________________________________________________________________________________________________________________

Was a coroners inquest held? _______If yes, what was the determination?______________________________________________________

CLAIMANT INFORMATION

Claimants Name_______________________________________________ Age_______ Relationship to Insured_______________

Claimants Address__________________________________________________ Phone No. (H)____________________________

____________________________________________________________ Phone No. (W)____________________________

In what capacity are you making this claim? _____ Beneficiary ______ Executor* ______ Administrator* _____ Guardian* _____Trustee* _____Assignee*

*Please provide certified copy all documents supporting your authority (e.g., Letters Testamentary, Letters of Administration, etc.)

I authorize any insurance company, physician, hospital or other healthcare provider, or any other organization, institution or person that may have records,

documents or knowledge regarding the insured to release any information requested regarding this claim and the loss reported. I understand this

information will be used by the Chubb Group of Insurance Companies, or its authorized representatives, for the purpose of evaluating and determining

coverage for this claim. I know I have a right to receive a copy of this authorization upon request and agree that a photographic or facsimile copy of this

authorization is as valid as the original. I agree that this authorization shall be valid for the duration of this claim.

I understand that any person who knowingly and with intent to defraud or deceive any insurance company files a claim containing any materially false,

incomplete or misleading information may be subject to prosecution for insurance fraud.

SIGNED (Claimant or authorized person) ___________________________________________________________ DATE ____/____/____

CHUBB


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IMPORTANT NOTICE

Notice to Alaska Claimants: A person who

knowingly and with intent to injure, defraud, or

deceive an insurance company files a claim

containing false, incomplete, or misleadinginformation may be prosecuted under state law.

Notice to Arizona Claimants: For your protection,

Arizona law requires the following statement to

appear on this form: Any person who knowingly

presents a false or fraudulent claim for payment of a

loss is subject to criminal and civil penalties.

Notice to Arkansas Claimants: Any person who

knowingly presents a false or fraudulent claim for

payment of a loss or benefit or knowingly presents

false information in an application for insurance is

guilty of a crime and may be subject to fines andconfinement in prison.

Notice to California Claimants: For your

protection, California law requires the following to

appear on this form: Any person who knowingly

presents a false or fraudulent claim for the payment

of a loss is guilty of a crime and may be subject to

fines and confinement in state prison.

Notice to Colorado Claimants:It is unlawful to

knowingly provide false, incomplete, or misleading

facts or information to an insurance company for the

purpose of defrauding or attempting to defraud thecompany. Penalties many include imprisonment,

fines, denial of insurance, and civil damages. Any

insurance company or agent of an insurance

company who knowingly provides false, incomplete,

or misleading facts or information to a policyholder

or claimant for the purpose of defrauding or

attempting to defraud the policyholder or claimant

with regard to a settlement or award payable from

insurance proceeds shall be reported to the Colorado

Division of Insurance within the Department of

Regulatory Agencies.

Notice to Delaware Claimants: Any person whoknowingly, and with intent to injure, defraud or

deceive any insurer, files a statement or claim

containing any false, incomplete, or misleading

information is guilty of a felony.

Notice to District of Columbia Claimants:

WARNING:It is a crime to provide false or

misleading information to an insurer for the purpose

of defrauding the insurer or any other person.Penalties include imprisonment and/or fines. In

addition, an insurer may deny insurance benefits if

false information materially related to a claim was

provided by the applicant.

Notice to Florida Claimants:Any person who

knowingly and with intent to injure, defraud or

deceive any insurer files a statement of claim or an

application containing any false, incomplete, or

misleading information, is guilty of a felony of the

third degree.

Notice to Idaho Claimants: Any person whoknowingly, and with intent to defraud or deceive any

insurance company, files a statement containing any

false, incomplete, or misleading information, is

guilty of a felony.

Notice to Indiana Claimants:A person who

knowingly and with intent to defraud an insurer files

a statement of claim containing any false,

incomplete, or misleading information commits a

felony.

Notice to Kentucky Claimants:Any person who

knowingly and with intent to defraud any insurancecompany or other person files a statement of claim

containing any materially false information or

conceals, for the purpose of misleading, information

concerning any fact material thereto commits a

fraudulent insurance act, which is a crime.

Notice to Maine Claimants:It is a crime to

knowingly provide false, incomplete or misleading

information to an insurance company for the

purpose of defrauding the company. Penalties may

include imprisonment, fines or a denial of insurance

benefits.


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IMPORTANT NOTICE

Notice to Minnesota Claimants:A person who

submits an application or files a claim with intent to

defraud or helps commits a fraud against an insurer

is guilty of a crime.

Notice to New Hampshire Claimants:Any person

who, with a purpose to injure, defraud or deceive

any insurance company, files a statement of claim

containing any false, incomplete or misleading

information is subject to prosecution and

punishment for insurance fraud, as provided in RSA

638:20.

Notice to New Jersey Claimants:Any person who

knowingly files a statement of claim containing any

false or misleading information is subject to

criminal and civil penalties.

Notice to New Mexico Claimants:Any person

who knowingly presents a false or fraudulent claim

for payment of a loss or benefit or knowingly

presents false information in an application for

insurance is guilty of a crime and may be subject to

civil fines and criminal penalties.

Notice to New York Claimants:Any person who

knowingly and with intent to defraud any insurance

company or other person files an application for

insurance or statement of claim containing any

materially false information, or conceals for thepurpose of misleading, information concerning any

fact material thereto, commits a fraudulent insurance

act, which is a crime and shall also be subject to a

civil penalty not to exceed five thousand dollars and

the stated value of the claim for each such violation.

Notice to Ohio Claimants:Any person who, with

the intent to defraud or knowing that he is

facilitating a fraud against an insurer, submits an

application or files a claim containing a false or

deceptive statement is guilty of insurance fraud.

Notice to Oklahoma Claimants:WARNING: Anyperson who knowingly, and with intent to injure,

defraud or deceive any insurer, makes any claim for

the proceeds of an insurance policy containing any

false, incomplete or misleading information is guilty

of a felony.

Notice to Oregon Claimants:Any person who,

knowingly and with intent to defraud an insurance

company or other person, submits an application or

files a claim for insurance that contains anymaterially false information relating to an insurance

companys acceptance of risk, or conceals for the

purpose of misleading, information concerning any

fact material to an insurance companys acceptance

of risk, may be guilty of a fraudulent act, which is a

crime.

Notice to Pennsylvania Claimants:Any person

who knowingly and with intent to defraud any

insurance company or other person files an

application for insurance or statement of claim

containing any materially false information or

conceals for the purpose of misleading, informationconcerning any fact material thereto commits a

fraudulent insurance act, which is a crime and

subjects such person to criminal and civil penalties.

Notice to Virginia Claimants:It is a crime to

knowingly provide false, incomplete or misleading

information to an insurance company for the

purpose of defrauding the company. Penalties

include imprisonment, fines and denial of insurance

benefits.

Notice to Claimants in all other states:Any

person who knowingly and with intent to defraud ordeceive any insurance company files a claim

containing any materially false, incomplete or

misleading information may be subject to

prosecution for insurance fraud.


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Abbreviated Guide To Navigation Rules Of the Road

QUICK REFERENCE

Based on the Navigation Rules International Inland(Commandant Instruction M16672.2D, 1999)

DEFINITIONS(From Rule 3)

Vessel Engaged in Fishing Any vessel fishing with nets, lines, trawls or other fishing apparatus that restricts

maneuverability, and excluding vessels fishing with trolling lines or other fishing apparatus that does not restrictmaneuverability

Vessel Not Under Command A vessel unable to keep out of the way of other vessels because an exceptional

circumstance is hindering its maneuverability (steering failure, engine breakdown, etc.)

Vessel Restricted In Its Ability To Maneuver A vessel unable to keep out of the way of other vessels because

the nature of its work is hindering its ability to maneuver (buoy tender picking up a buoy, vessel transferring persons,

provisions or cargo while underway, etc.)

Underway A vessel not at anchor, aground or made fast to the shore

Give-Way Vessel A vessel that must change course or speed to avoid a collision with a stand-on vessel

Stand-On Vessel A vessel that must maintain course and speed except to avoid collision with another vessel

LOOKOUT(From Rule 5)

Every vessel shall at all times maintain a proper lookout.

SAFE SPEED(From Rule 6)

All vessels must

proceed at a safe speed at

all times.

You must go slow enough to

prevent a collision no matter

what the conditions.

DETERMINING RISK OF COLLISION(From Rule 7)Every vessel must use all

available means appropriate,

including lookout (eyes and

ears), radar and radio, to

determine if a risk of collision exists.

Steady bearing and

decreasing range indicate a

risk of collision.

ACTION TO AVOID COLLISION(From Rule 8)

Action to avoid collision should be taken well in advance

of any potential meeting. Any course or speed change

should be great enough to be obvious to any approaching

vessel. Avoid a succession of small alterations of course.

NARROW CHANNELS(From Rule 9)

A vessel engaged in fishing shall not impede the

passage of any vessel navigating in a narrow channel or

fairway.

TRAFFIC SEPARATION SCHEMES(From Rule 10)

A vessel engaged in fishing shall not impede the

passage of any vessel following a traffic lane.

RESPONSIBILITIES BETWEEN VESSELS

(From Rules 13, 18)

To determine which vessel must give-way in an

approach situation, it is essential to know the hierarchy

established by the Rules:

1st Vessel not under command or vessel restricted in

its ability to maneuver

3rd Any vessel being overtaken

4th Vessel engaged in fishing

5th Vessel under sail

6th Power-driven vessel

MEETING ANOTHER VESSEL HEAD-ON

(From Rules 14)When two power-driven vessels meet on reciprocal

(head-on) or nearly reciprocal courses so as to involve the

risk of collision, both shall alter course to starboard so that

they pass port-to-port (except as provided by Rules 9, 10

and 18)

CROSSING SITUATION(From Rules 15 and 17)

When two power-driven vessels are crossing so as to

involve the risk of collision, the vessel which has the other

on her own starboard side shall keep out of the way and

avoid crossing ahead of the other vessel.

OVERTAKING ANOTHER VESSEL(From Rules 13 and 17)

A vessel that is being

overtaken shall keep its

course and speed.

ACTION BY THE GIVE-WAY VESSEL(From Rule 16)

Every vessel n sight of another and required to give way

to another vessel shall, so far as posssible, take early and

substantial action to give way.

ACTION BY THE STAND-ON VESSEL(From Rule 17)

When one of two vessels is required to give way, the

other vessel (the stand-on vessel) shall maintain its course

and speed.


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Rules in this part shall be complied with in all

weathers. Rules concerning lights apply from sunset

to sunrise. During such times no other lights shall be

exhibited, except lights that cannot be mistaken for and

that do not impair the visibility or distinctive character of

the lights specified in these Rules, or interfere with thekeeping of a proper lookout.

The lights specified in these Rules shall also be

exhibited from sunrise to sunset in restricted visibility

and may be exhibited in other circumstances when

deemed necessary.

The Rules concerning shapes shall be compiled with

by day.

Lights And Shapes

APPLICATION(From Rule 20)

Vessel engaged in

fishing other than trawling

not making way (Rule 26)

Vessel engaged in

fishing other than trawling

making way (Rule 26)

For either of the above, where there

is outlying gear extending more than 150

meters horizontally from the vessel, display

an all-round white light or a cone apex

upward in the direction of the gear.

Vessel 164 feet (50meters) or more in length

engaged in trawling


Vessel 164 feet (50

meters) or more in length

engaged in trawling not


Right:

Vessel less

than 164 feet

(50 meters

in length

engaged in

trawling

making way

Far right: Vessel less than 164 feet (50 meters) in length

engaged in trawling not making way (Rule 26)

Power-driven vessel

164 feet (50 meters) or

more in length underway

(Rule 23)

Power-driven vessel

less than 164 feet (50

meters) in length underway

(Rule 23)

Power-driven vessel

towing astern - towing

vessel less than 164 feet

(50 meters) in length;

length of tow exceeds 656feet (200 meters) (Rule 24)

Power-driven vessel

pushing ahead or towing

alongside vessel less than

164 feet (50 meters) in

length (International ONLY

- Rule 24)

Vessel or object beingtowed - length of tow

exceeds 656 feet (200

meters) (Rule 24)

Rules apply to both International and Inland waters

unless otherwise noted

Above -

Left: Sailing vessel underway (Rule 25)

Middle: Sailing vessel underway (less than 65.6 feet)

(Rule 25)

Right: Vessel under oars (Rule 25)


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33/37

Abbreviated Guide To Navigation Rules Of the Road

QUICK REFERENCE

Based on the Navigation Rules International Inland(Commandant Instruction M16672.2D, 1999)

CONDUCT OF VESSELS IN RESTRICTED VISIBILITY(From Rule 19)

If you hear a fog signal forward of your beam, or if you detect by radar another vessel forward of your beam, take

avoiding action in ample time. Unless you are overtaking, avoid if at all possible altering your course to port; wheneverpossible alter course to starboard. Also, adjust to a safe speed for prevailing circumstances and conditions of visibility.

This includes, if necessary, taking all way off your vessel (see Rules 2, 6 and 19).

Warning and Maneuvering

Signals

(From Rule 34 apply to International

and Inland waters with differences noted )

Short blast signals are onlysounded in sight

of the other vessel, not in restricted visibility.

Note: Dash is a 4 - 6 second or prolonged blast.

Dot is a 1 second or short blast.

International: I am altering course tostarboard

Inland: I intend to leave you on my port

side

International: I am altering course to port

Inland: I intend to leave you on my

starboard side

I am operating astern propulsion

Danger signal

Bend signal

Sound Signals In Restricted

Visibility(From Rule 35 apply to both International and Inland

waters) Signal intervals are

not more than 2 minutes unless otherwise noted

Power-driven making way

Power-driven underway butstopped, making no way

Vessel not under command, vessel

restricted in ability to maneuver,

vessel constrained by draft, sailing

vessel, vessel engaged in fishing,

or vessel engaged in towing or

pushing

Vessel being towed or last vessel

of tow, if manned

Rapid ringing Anchored

of bell for 5 secondsevery minute

Anchored (optional signal)

Rapid Anchored over 100 meters

ringing of bell

for 5 seconds

followed by sounding

of gong every

minute

Three Aground

strokes ofbell immediately

before and after

an Anchored

bell signal

Pilot vessel engaged in pilotage

duty

This guide provides only an overview of

navigation rules of the road. In no instance

in this publication has a complete rule from

Navigation Rules International Inland been

reprinted.

Rule numbers cited refer to the rules from

which information was extracted. This guide

is not intended as a substitute for the actual

Navigation Rules International Inland(Commandant Instruction M16672.2D)

This publication was created by the Commercial

Fishing Vessel Industry Safety Advisory Committee

with the the cooperation of the U.S. Coast Guard,

the Alaska Marine Safety Education Association, the

North Pacific Fishing Vessel Owners Association

Vessel Safety Program and Crawford Nautical

School.

2009


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North Star Marine Insurance Services, LLC59 Main Street, Unit #1

Fairhaven, Massachusetts 02719774.202.2751 (Phone)

774.202.3764 (fax)

-1-

MARINE

EMERGENCY RESPONSE

RESOURCE LIST

A. EPIRB designated contacts or other individuals who received call mustimmediately notify following team members from Company:

Name Home Phone Cell Phone E-mail

[List should include company officers, HR director, designated claims handler,operations manager, and government affairs liaison]

All emergency response team members are to report immediately to office to work oninitial response.

B. The following should also be notified immediately:

Name Home Phone Cell Phone E-mail

Marine

Insurance BrokerMarine ClaimsAdjuster

DefenseCounsel

CorporateCounsel

These individuals (or as many as possible) should also report immediately to offices.

C. After above have reported to office and situation is defined/assessed, the

following should be considered and assigned to individual team members.

1. Notify USCG or applicable local authorities, depending on situation.

USCG: 510-437-3701.


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774.202.3764 (fax)

-2-

2. Notify P&I and Hull Underwriters [name, telephones, e-mail].

(Note: Your broker will do this for you)

3. Consider notifying marine surveyordepending on situation [name,

telephone, including after hours information]. (Note: Your broker will

arrange for this, too).

4. Consider sending response team to scene (or nearest port) for investigation

and assist vessel personnel; response team may include some combinationof: counsel, investigator, adjuster, surveyor, designated company

representatives (probably including, at least, HR director), interpreter(s).

5. Designate a press liaison. All press inquiries to be funneled through this

individual. This may be a full time job in the initial days following a

significant casualty.

6. Designate persons to contact family members, and work to maintain

regular contact. Family members should hear about casualty from

company, not press, and be updated with developments regularly.

7. Gather interpreter teamfor assistance in contacting crew family

members. Have appropriate languages of vessel crewmembers (e.g.,

Spanish, Vietnamese, Tagalog, Russian). Have at least two interpretersidentified for each language, with after hours contact information for each:

Interpreters

Language Name Home Phone Cell Phone E-mail

A.

B.


A.

B.


A.

B.


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774.202.3764 (fax)

-3-

8. Identify and arrange staging area(local facilities for to receive crew,

provide lodging food) where crew will make land (e.g., Portland, ME,

New Bedford, MA, Cape May, NJ).

Name Facility Phone

A.

B.

D. Government Agencies who may need to be contacted:

1. USCG 510-437-3701

2. NTSB

3. EPA 1-800-424-8802

4. Department of Ecology (MA)5. Department of Environmental

Conservation (Mass Dep)

1-888-304-1133

6. State and Local Police (e.g., MA) 508-820-2300

7. Medical Examiners Office (MA) 617-267-6767

E. Crewmember and Family needs

Immediate

a. Medical (local clinics);

b. Cash;c. Identification (immigration, immigration counsel, licensing, social

security;

d. Clothing (have ready personal items);e. Phone cards

f. Repatriation (airlines).

Short to Medium Term

a. Grief counseling

b. Funeral or Memorial

c. Assistance with insurance, social security, etc.d. Psychological counseling for crew of families

e. Death Certificates


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F. Safety Records

a. Wheelhouse log

b. Drill logs

c. Engineers logd. USCG/OSHA inspection reports

e. Safety equipment inspection reports (e.g., EPIRB, life raft, fire equipment,

survival suits)f. Radio/communication equipment inventory

g. Crew training records

h. Company safety videos

G. Document gathering

a. Blueprints

b. Stability bookletc. All surveys

d. Maintenance, repair, shipyard records and invoices

e. Photos of ship and interiorf. Purchase records---major equipment

g. Crew personnel files

Maintain current crew list with Emergency Contact information with the Resource List.

Marine Claims Guide and Handling Procedures.pdf

Documents

Transcript of Marine Claims Guide and Handling Procedures.pdf