Company Operational Manual(COM) Insurance 5.3 Crew Insurance Claims	Doc No.: COM 5.3 Revision: 1 Date: 15 Oct 2024 Issued by: DPA Approved by: MD

1 APPLICATION

This document applies to Vessel (Master), Crewing, Insurance, P&I Club and Vessel Accounting.

2 PURPOSE

The purpose of this document is to provide instructions regarding the crew insurance claims process. Specific instructions for the Master can be found in FOM Chapter 6- Insurance.

3 CREW INSURANCE CLAIMS PROCESS WORKFLOW

The workflow for this process is illustrated in Figure 1 below.

Figure 1. Crew Insurance Claims Process Workflow

4 RESPONSIBILITIES WITHIN THE WORKFLOW

Function	Responsibility
Crewing Executive	Arrange doctor’s visit and repatriation if crew is unfit for work. P&I Club/Owners to be informed with copy to Insurance. Provide updates on crew member’s condition and all expenses coded into pending account.
Insurance Department	Open claim file and advise Crewing and Vessel Accounting of the claim number and deductible. Consolidate all relevant documents and expenses for the case and submit to Club if expenses above deductible. Advise Vessel Accounting to close the pending account once case is closed.
P&I Club	Provide P&I club reference number and appoint local correspondent (where required). Reimburse net claim amount.
Vessel Accounting	Create pending account and advise project code. Confirm receipt of funds if there is a claim reimbursement. Close the pending account and forward closure notice.

5 CREWING ACTIVITIES

5.1 Doctor’s visit and repatriation

The Crewing Executive shall:

• Arrange for doctor’s visit for the crew member
• Arrange for repatriation if crew is declared unfit for duty

5.2 Case reporting and update

5.2.1 Case reporting

The Crewing Executive shall report the case to the Owner and vessel’s P&I Club and provide the following documents, with Insurance in copy, for claim creation:

• Seafarer’s Employment Agreement (SEA)
• Pre-Employment Medical Examination (PEME)
• Applicable Collective Bargaining Agreement (CBA), if any
• CRV-09 – Doctor/Dentist Report and Account
• HSSEQ-17/17A – Incident Investigation Report
• Medical reports issued at the port of repatriation

5.2.2 Case updating for Non-Filipino crew claims

The Crewing Executive shall provide updates (with supporting medical reports) on crew member’s condition to P&I Club with Insurance Department in copy until declared fit or end of maximum treatment period.

5.2.3 Case Updating for Filipino crew claims

The Insurance Department shall provide updates (with supporting medical reports and assessment) on Filipino crew member’s condition to P&I Club/Owners/Marine-HR until declared fit or end maximum treatment period.

5.3 Identification of expenses

The Crewing Executive shall identify and code all expenses to the pending account for the case, such as:

• Repatriation and reliever’s air ticket expenses
• Medical/disbursement/transportation expenses at port of repatriation and for on-signing crew
• Further medical/disbursement/transportation expenses at seafarer’s home country
• Sick Wages (with calculation)
• Compensation (disability/death)
• Funeral expenses (for death cases)

The Crewing Executive shall also chase for the invoice from port agent or from other engaged entities so that all expenses can be consolidated before closure of the case.

6 INSURANCE DEPARTMENT ACTIVITIES

6.1 Claim file creation

Insurance Department shall create crew claim file once case has been reported to P&I Club. Advise Crewing and Vessel Accounting of claim file number and deductible.

6.2 Consolidation of expenses

Insurance Department shall:

• Check that all relevant expenses (refer to section 6.3) have been booked in Qlikview
• Consolidate supporting invoices and request from Vessel Accounting for invoices not in Qlikview
• Obtain Crewing Executive’s confirmation that no further expenses incurred or expected

6.3 Submission of expenses

If the total expenses have exceeded the claim deductible, Insurance Department shall:

• Check that supporting invoices and medical reports are received
• Check that corresponding medical reports are available for the post-medical treatment expenses
• Submit expenses and supporting documents to Club for reimbursement of claim

6.4 Claim file closure

Insurance Department shall:

• Request P&I Club for remittance details of claim reimbursement
• Advise Vessel Accounting of the reimbursement details
• Proceed to close the claim file once Vessel Accounting has confirmed receipt of funds
• Request Vessel Accounting to close the pending account for the case and to forward the closure notice

7 P&I CLUB ACTIVITIES

7.1 P&I File creation

The P&I Club shall:

• Provide their claim file reference number for the case and request for further documents where necessary (refer to section 6.2.1)
• Appoint local correspondent for monitoring of expenses if required

7.2 Reimbursement of claim

The P&I Club shall:

• Check and approve the request for claim reimbursement
• Reimburse the net claim amount and provide remittance details

8 VESSEL ACCOUNTING ACTIVITIES

8.1 Project code creation

Vessel Accounting shall:

• Create the pending account for the case based on the claim file number provided by Insurance
• Advise the project code to Crewing Executive and Insurance

8.2 Claim reimbursement

Vessel Accounting shall:

• Provide invoice copy as supporting document for claims submission
• Check whether the claim reimbursement has been received from P&I Club and to book fund receipt into pending account
• Advise Insurance upon receipt of funds

8.3 Closure of pending account

Upon receiving the claims closure request from Insurance, Vessel Accounting shall:

• Close the pending account with end date
• Forward pending account closure notice to Insurance

9 REFERENCED FORMS AND CHECK LISTS

• Doctor Dentist Record and Account
• Incident- Injury Investigation Report