The following are instructions on how to report any incidents and/or request for medical records.

INCIDENTS

NOTE: REPORTING ANY AMOUNT OF INCIDENTS DOES NOT MEAN THAT YOUR PREMIUMS WOULD INCREASE OR YOUR POLICY WOULD BE CANCELLED

Reportable incidents include, but are not limited to the following:

  • Falls, with or without injury
  • Lacerations, skin tears, burns, bruises, etc.
  • Resident to resident abuse
  • Staff to resident abuse
  • Treatment/medication errors
  • Unexplained injury
  • Behavioral occurrences
  • Unexplained or unplanned death
  • Facility-acquired pressure ulcers, ulcers that do not heal or advance in staging
  • Resident/family complaints that cannot be satisfactorily resolved
  • Elopements
  • Severe weight loss
  • Dehydration
  • Facility acquired serious infection

You are required to report all incidents to our Claims Administrators, Certus Claims, by completing the attached Incident/Claim Report form (please make copies for future use), and sending it to them by either fax, e-mail or regular mail as stated below, or you can go to Certus Claims site to submit your report.

MEDICAL RECORDS

To facilitate prompt and accurate defense of any suit, or the processing of any claim made against you, it is imperative that you either maintain your medical records in English, or when submitting such records to Certus Claims, the records should first be translated to English.

Certus Claims

Address

Certus Claims Administration, PO Box 1030, Camarillo, CA 93011-1030

Phone

805-987-8803

Fax

805-987-8806