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Understanding the Differences Between Claims and Incidents

December 12th, 2018

Ken Haney

“Malpractice claim” is a terrifying term for a physician to hear, as it notifies them of an allegation of misconduct or substandard care from a dissatisfied patient or a patient’s family member. Many doctors do not involve their medical liability insurer until they receive notification of an outstanding claim, but waiting until then can be detrimental. To protect themselves, we encourage physicians keep an open line of communication with their med mal carrier when they are accused of malpractice.

The best way to do this is to quickly report any adverse event that takes place with a patient, whether or not the physician feels he or she is at fault. Claims are often filed months if not years following the triggering event, after many of the finer details have been forgotten. These gaps in memory can be a point of weakness for physicians’ defense against malpractice allegations, and they can easily become key to the plaintiff’s case.

When to Make the Call

So, what constitutes a “triggering event”? It’s important for physicians to understand when it’s the right time to pick up the phone and report an incident. When care goes awry, resulting in an angry patient and/or family member, major billing issues, unexpected outcome, doctor error, or catastrophic event, malpractice insurers need to know when it happened, who it happened to, and all details surrounding the event.

As for timing: the sooner the better. By gathering details immediately following an incident, the insurer will be able to build a comprehensive picture of what happened while the memory is still fresh, potentially helping the physician in the event a lawsuit is filed. It’s important to note that reporting an incident does not immediately launch an investigation, but only puts the insurer on notice and confirms coverage for a potential future claim.

In addition to helping protect physicians against potential liability, proactive reporting can also help the practice assess internal quality control. By reporting these incidents, leaders can better understand trends within their practice and implement new ways to manage internal processes to avoid such events.

On Your Side

Physicians should never hesitate to call their insurance provider whenever there is a question about whether or not to report an incident. At Medical Mutual, doctors who make this call will always have access to a claims professional can provide guidance. As doctors know from their time in medicine, problems are easier to fix when they are diagnosed early. By identifying potentially harmful incidents as soon as they occur, physicians can improve their chances of successfully defending against a potential malpractice claim.

For further guidance on this issue, Medical Mutual members are encouraged to reach out to our Claims and Risk Management Departments at 800.662.7917.

Ken Haney is a Claims Supervisor based in Medical Mutual’s Raleigh, NC office.


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