by Jenn Negley
Peace of mind is paramount for healthcare providers. However, some physicians hesitate to report potential medical malpractice claims to their insurance carriers for fear of jeopardizing their coverage. This article aims to clarify the importance of timely reporting and dispel common misconceptions.
Understanding “Claims-Made” and “Occurrence” Policies and Incident Triggers
With a claim-made policy the carrier defends incidents reported during the policy period, even if the incident itself occurred earlier (within the retroactive date). Crucially, both the incident report and the claim itself must happen while the policy is active.
An Occurrence policy protects you from any incident that “occurs” during the policy period, regardless of when a claim is filed. Meaning, the carrier you are insured with when the incident occurred covers you for the claim and is who you need to report to.
Why Early Reporting Matters
Delaying an incident report can have serious consequences. If a potential claim later materializes, the insurer may deny coverage due to non-disclosure. Even when switching insurers, a past unreported incident could negatively impact future coverage options.
What is an Incident? What is a Claim?
An incident is any event that could potentially lead to a future claim. This includes situations causing injury, potential injury, or even dissatisfaction with a service. Claims come in two forms: formal and informal.
- Formal claims: Receiving a legal document, a demand letter from an attorney, or even a seemingly innocuous request for medical records by a patient’s lawyer (unless unrelated to your care).
- Informal claims: Verbal threats of litigation, requests to waive fees, or patient harassment.
Examples of Incidents to Report:
- Patient deaths
- Birth injuries
- Serious injuries
- Disfigurement
- Loss of limbs
- Sensory impairment
- Verbal threats
- Patient family harassment
Additional Reporting Recommendations
Report any instance involving:
- Demands for money
- Legal threats
- Lawsuits naming you
- Notices of intent to sue
- Requests for arbitration or depositions
Protecting Yourself After Reporting
Once you report an incident, communication is key:
- Only discuss the case with your claims manager, a lawyer representing you, protected peer-review attendees, or your spouse.
- Never alter medical records, even for seemingly minor corrections.
- Do not include claim correspondence in patient records.
- Maintain copies of all claim-related documents in a secure location.
A Word on “Background” Interviews
Be wary of requests from plaintiff attorneys to discuss a case you’re not directly involved in. These seemingly casual interviews can be traps leading to future lawsuits against you. Always contact your insurer and request legal representation for such inquiries.
By understanding reporting requirements and taking proactive steps, healthcare providers can protect themselves and ensure their medical malpractice insurance provides the valuable protection they deserve.
For more information, please contact Jenn Negley, Vice President, Risk Strategies Company at 267 251-2233 or JNegley@ Risk-Strategies.com.
Sidebar:
Risk Strategies, National Health Care malpractice team by the numbers:
- Supports over 6,000 clients representing over $200,000,000 in physician premiums.
- Representing every major medical malpractice insurance carrier in the market. In New York, we represent MLMIC, EmPro(PRI), The Doctors Company (TDC), HIC, MedPro RRG, Coverys RRG, ProAssurance RRG, TDC RRG, AMS RRG.
- Specialists with over 25 years’ experience in medical malpractice insurance
- Programs designed for independent physicians and self-insured programs as well as large practices and hospitals.
