There are several ways an insured may be notified of a claim or potential claim:
Oral demand—A patient may make an oral demand in person or over the telephone. Sometimes it may be implied. For instance, the patient may state that he or she has out-of-pocket
expenses that would not have been incurred had it not been for a perceived injury that should not have happened. Perhaps the patient outright demands $5,000 for the chemical burn
he or she received when full-strength acetone was used instead of the diluted solution.
These types of claims are unique in that they can be handled and settled without notification of settlement to the National Practitioner Data Bank. Therefore, it is important to handle these
claims as quickly as possible, especially if the negligence question is obvious. Do not ask the patient to formalize these types of claims in writing or in any other matter. Contact SCPIE and report the claim.
Demand letter—This letter generally includes an allegation of negligence, a description of the injury and the demand for compensation. The patient or his or her attorney may send the demand letter. Just because a
patient sends the letter rather than an attorney does not mean it is less serious. It may just mean that the patient has not contacted an attorney yet and is trying to resolve the issue with the insured. Regardless
of the letter’s authorship, it should be treated with the same importance.
Notice of Intent—In some states, a plaintiff must, by law, give a defendant advance notice that he or she intends to sue. (In California, plaintiffs must give at least 90 days’ notice before commencing with a court action.) Such laws were designed to reduce court congestion by giving a defendant an opportunity to investigate and, if warranted, resolve the claim without litigation.
Subpoena—A subpoena is a legal demand to produce documentation or other information, or to appear in court. There is a penalty for failure to comply. In the healthcare field, subpoenas are generally issued for medical or billing records, or for an insured’s deposition and/or appearance at trial.
Summons and Complaints—In most states, an insured will receive a summons and complaint when a lawsuit has been filed. The summons means the insured is being called to court because he or she has been sued. The complaint explains what the insured is being sued for.
This requires that a formal responsive pleading be filed with the court on the insured’s behalf within a specific window of time (e.g., 30 days from the date the summons and complaint is served).
For further information on claims management, please review the following topics:
