PROPERTY DAMAGE & EMPLOYEE INJURY CASE STUDY
Background
At about 6:30 p.m. on Wednesday, May 9, 2018, a customer was leaving a bar restaurant in Alabang.
Intending to pull straight out of his parking stall, he accidently put his vehicle into reverse and
accelerated, backing into the building and caving in the wall. Meanwhile, inside the restaurant, an
employee was serving drinks from behind the bar, which is near a cooking area with a broaster.
Suddenly, scalding hot grease erupted from the broaster, splashing everything nearby. The vehicle had
hit the wall that contained the cooking equipment, causing serious injuries to the restaurant employee
and significant damage to the building. She had a third degree burn and the bar cannot be fully operated
at the mean time.
Situation
On Thursday, May 10, 2018, Moon Insurance (an insurance company) received notice of an incident at a
policyholder restaurant in Alabang. Since there were both employee injuries and property damage
associated with this incident, a specialist from Moon’s workers compensation claims team along with a
dedicated representative from Moon’s property claims team were quickly on the case.
1. How do you think Moon will conduct its investigation in order to provide the necessary claims
for the policy holder?
In this situation, policyholder restaurant in Alabang tends to have claim on Moon insurance due to
property damage and employee injury, hoping to receive money from an insurance claim, , to cover the
related expenses. But in reality the insurer is also trying to save money as possible and making sure to
pay more than necessary. This will lead to conducting essential investigations to provide the necessary
claim for the policy holder.
After the policy holder file a claim, the first thing insurer will do is assigning an adjuster or an
investigator who will investigate the facts of an accident like asking a few questions regarding to the
accident, so it is a good idea to jot down the details of the accident immediately while it still fresh from
you memory, which in this case is a vehicular accident causing damage to property and employee injury
and then negotiate for the settlement of the claim. They will also contact the driver involved as well as
witnesses. They will inspect the property and take photographs of damages as they visit the scene of the
accident, request a copy of the police report and contact the restaurant medical provider for the
sustained injury of the employee. Insurance company is conducting these investigations to ensure the
claim is not fraudulent.
2. Which should be the priority claim for the incident? The employee injury or the property
damage? Why?
According to the Philippine Law particularly the Republic Act No. 772 employees’ safety comes first
and getting an injured employee treatment quickly is crucial. So the employee injury should be the
priority claim for the incident. The policy might be used to pay for medical expenses as well as the
employee compensation.
3. Will there be a subrogation on this scenario? Explain.
Subrogation is a legal right held by most insurance carriers to legally pursue a third party that caused
an insurance loss to the insured. In my opinion there will be a subrogation in this scenario because the
incident happens not because of fortuitous event but due to negligence of a third party or the owner of
the car. So the insurance company may recover the amount of the claim to cover the insured loss from
the owner of the car who causes the incident.
