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The premier provider of medical professional liability insurance for physicians and clinics in Washington, Oregon, and Idaho. |
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Claims FAQ
What is a claim?
What is a potential claim? What is a lawsuit? Should I report claims, potential claims, and lawsuits to Physicians Insurance? Can I discuss a malpractice incident, claim, or lawsuit with the patient, my colleagues, or my staff? With whom can I discuss a malpractice incident, claim, or lawsuit? Does Physicians Insurance provide assistance to me if the state disciplinary agency investigates an aspect of my patient care? What is a claim? A claim is a demand for monetary compensation by a patient or the patient’s attorney to the physician or the liability carrier. What is a potential claim? A potential claim is an incident that may culminate in a demand for compensation. What is a lawsuit? A lawsuit is formal litigation within the judicial system. Should I report claims, potential claims, and lawsuits to Physicians Insurance? Yes. In fact, your Physicians Insurance policy requires that you report to us all actual claims, potential claims, and lawsuits. Early notification to us aids in our early evaluation, which will improve your chances of a successful defense. Our investigation affords us the opportunity to collect and record facts before time fades memories or witnesses disappear. In appropriate instances where settlement is warranted, we may be able to negotiate an early settlement with the patient before the filing of a lawsuit. Can I discuss a malpractice incident, claim, or lawsuit with the patient, my colleagues, or my staff? Talk to your claims representative and/or your counsel before you speak to anyone. In general, you should not discuss any malpractice incident, claim, or lawsuit with the patient or the patient’s attorney. This is important, because you do not want to prejudice your position in the matter. However, Washington law allows you, under certain circumstances, to offer a patient your apology for a bad outcome without making that apology evidence in any subsequent action. Your claims representative or your counsel can help you express yourself effectively in such a situation. Also, do not discuss the patient with any of your colleagues except in the context of protected Quality Assurance programs. You can, and should, communicate as needed with any current treating physician regarding the continuing medical treatment of the patient. We advise you not to discuss the details of the patient’s care with your office staff, or anyone in your administration, because conversations with them may not be considered privileged. However, we have found it helpful to your defense if your staff is aware of the existence of an incident, claim, or lawsuit. You should advise your staff not to release records or information on that patient to anyone without your knowledge and permission. With whom can I discuss a malpractice incident, claim, or lawsuit? You can discuss your case at any time with your claims representative or defense counsel because of the privileged nature of these conversations. Conversations with your spouse, clergy, or counselor are also privileged. Conversations with anyone else may be discoverable. A plaintiff attorney might ask you to name everyone with whom you have had discussions regarding the case, and could subpoena those people for deposition. Therefore, we strongly advise you to limit your communications regarding the case to only those people who are privileged to discuss the case with you. Again, you may contact the Physicians Insurance Claims Department with any questions. Seattle: (206) 343-7300 or 1-800-962-1399 Does Physicians Insurance provide assistance to me if the state disciplinary agency investigates an aspect of my patient care? Yes. Subject to certain exclusions, your Physicians Insurance policy provides reimbursement of legal expenses you incur arising out of an investigation by the state medical or osteopathic disciplinary agency. The investigation must arise from a medical incident involving direct patient treatment after your retroactive date. You must notify Physicians Insurance within 30 days of your receipt of a notice of investigation by the state agency in order to obtain this coverage. There is a limit of $50,000 per year, no matter how many investigations there may be. So, contact your claims representative as soon as you receive an inquiry from the disciplinary agency. Your claims representative may be able to assist you so the matter goes no further. If, however, the matter moves beyond the initial inquiry, it may be necessary to engage counsel. Whatever you do, don’t try to go it alone. NOTE: Do not report claims, or refer to any specific claims, by e-mail or by fax. All claims must be reported to Physicians Insurance by phone or letter. Confidentiality is essential to the claims process, and transmission of claim information through the Internet could jeopardize the confidentiality of your claim. |
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If you have a claim, potential claim, or lawsuit, do not inform us by e-mail. Instead, call us at 1-800-962-1399 (Seattle) or 1-800-962-1398 (Spokane). | ||||||||||||||||||||
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