What every physician needs to knoW:

the medical malpractice claims process

1 NotificatioN

Notify your carrier if you receive:• notice of a claim letter;• a lawsuit; or• a written demand from a patient for monetary compensation

1 NotificatioN

• If a policyholder reports something else, such as an unusual incident, medical record request, or oral threat, the claims department makes note of the report but does not open a claim file, in most instances.

• Once a claim file is set up, the loss is assigned to a claims supervisor and coverage is entered and verified.

2 respoNse

A response letter is sent to the policyholder and the plaintiff’s attorney.

3 iNvestigatioN

The claims supervisor investigates the claim over the next several months. This includes collecting and reviewing the medical records and referring the case to independent medical consultants for evaluation. During this time, the case may become a lawsuit or it may remain as a claim.

3 iNvestigatioN

If a suit is not filed, the case remains a claim. After the investigation, the claim is re-evaluated on a routine basis. At this time, a claim is closed if:• no lawsuit is filed;• no response from the plaintiff’s attorney;• your carrier denies the claim; or• the statute of limitations expires.

4 defeNse assigNmeNt

If a lawsuit is filed, then a defense attorney is assigned. The policyholder receives a letter advising of the attorney assignment.

Under the direction of the claims supervisor, the defense attorney prepares the case for trial by conducting discovery, locating expert witness testimony, and taking depositions. The claims supervisor, the attorney, and the policyholder work together to develop a defense strategy.

5 defeNse strategy

6 settlemeNt

After the investigation, the policyholder, the attorney, and the claims supervisor may decide to settle the case. It’s important to determine if your carrier requires policyholder consent before settling.

7 NegotiatioN

• If settlement is warranted and physician consent is granted (when applicable), negotiations begin. If acceptable terms are reached during negotiations, the case is settled.

• The case may also be settled before trial during mediation. At mediation, all parties meet with an independent mediator who may help resolve the case.

8• If the decision is made to proceed with the trial, a date

is scheduled.• The length of a trial varies by complexity and the

number of parties involved.

trial

8• If the defense wins at trial, your carrier may be able to close

the claim file. However, the plaintiff may appeal the verdict. • If the plaintiff wins at trial, your carrier and defense counsel

evaluate the case to determine if there is a legal basis to appeal. Such an appeal may result in a new trial or an opportunity to settle the case.

• If it’s decided to appeal a jury verdict, your carrier will continue to defend you throughout the appellate process.

trial

9 iNdemNity

If a claim is closed with indemnity payment to the plaintiff, it is reported to the National Practitioner Data Bank.

10 protectioN for a New era of

mediciNeabout tmlt:With more than 18,000 physicians in its care, Texas Medical Liability Trust (TMLT) provides malpractice insurance and related products to physicians. Our purpose is to make a positive impact on the quality of health care for patients by educating, protecting, and defending physicians. www.tmlt.org

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