Claim Reporting Forms

CLAIM REPORTING FORMS

Claim Form - Liability/Directors and Officers

This form is used to report liability claims to the HCPP. Claims that should be reported using this form include but are not limited to the following: 

  • General Liability (personal injury, damage to third party property, advertising liability, employee benefits).
  • Directors and Officers Liability.
  • Premises Liability (for example, slip and fall, lost dentures, food poisoning).
  • Malpractice Liability (errors or omissions in rendering medical care, administration or drugs etc.).

Claim Form – Property, Boiler and Machinery, and Crime

This form is used to report property and crime related claims to the HCPP. Claims that should be reported using this form include but are not limited to the following:

  • Property – damage to property owned by the Health Authority/Member. For example, fire or water damage to building owned by the Health Authority/Member.
  • Crime – Theft of money/securities etc. from the Health Authority/Member. For example, embezzlement or unauthorized use of patient cheques by an employee of the Health Authority/Member.

Claim Form – Vehicle

This form is used to report all vehicle related incidents (for vehicles owned or leased in the name of the Health Authority/Member) including but not limited to physical damage to the vehicle and damage to third party property.  If a third party is injured in the accident, a liability claim reporting form should also be completed.

In cases of injury or death, vehicle or property damage to others, hit and run over $350, or if the circumstances appear to be such that another involved vehicle may be at fault the claim should also be reported to ICBC.