How long must I keep medical records?
How long must I keep billing records/schedule books, etc.?
How do I handle a non-compliant patient?
How do I terminate the physician-patient relationship?
What should I do when a managed care organization does not approve recommended treatment?
I've received a request for release of my records. Can I release them?
What should I report to ProAd?
Will reporting an incident affect my premium or policy?
How do I report a claim?
After I have reported a claim, what should I do?
Can I choose the attorney I want to defend me?
Once an attorney has been assigned to my case, what can I expect?
Who determines whether a claim is settled?
When does information get reported to the National Practitioners Data Bank (NPDB)?
How can I obtain my Claims History for a hospital, HMO, etc.?
What must a claimant do to prove a claim of medical negligence?
The correct name for the "Tail"
endorsement is the Extended Reporting Period Endorsement
because it extends the time to report claims beyond the
termination date of coverage.
For coverage to apply under a "Tail" the alleged act or omission giving rise to the claim must have taken place on or after the retroactive date of the coverage and on or before the coverage termination date. The "Tail" endorsement covers claims arising from incidents occurring during the period of time between the retroactive date and the termination date.
ProAd’s "Tail" endorsements for
medical professional liability do not have an expiration date.
There are several ways for qualified Insureds to receive a
professional liability "Tail" at no cost: permanent and total
retirement from your professional practice after having been
insured continuously with ProAd for a specified period of
time; permanent and complete disability; and on death it is
free to the estate. Contact your ProAd broker/agent for
detailed and current information on the length of time of
continuous ProAd coverage required for a free "Tail."
A "Claims-Made" policy covers claims that are made during the policy period provided that the incident giving rise to the claim occurred on or after the retroactive date and on or before the termination date of the policy.
An "Occurrence" policy covers claims which arise from incidents which occur during the policy period regardless of when the claim is made.
In other words, in the event of a claim, coverage will be provided by:
The policy in force when the claim is made, as long as the incident which resulted in the claim occurred on or after the Retroactive Date and on or before the Termination Date, if the Insured is on a "Claims-Made" program; or
- The policy in force when the claim is made, as long as the incident which resulted in the claim occurred on or after the Retroactive Date and on or before the Termination Date, if the Insured is on a "Claims-Made" program; or
- The policy which was in force when
the incident occurred which resulted in the claim, if the
policyholder is on an "Occurrence" program.
Prior Acts ("Nose") coverage refers to coverage for acts that took place prior to the inception or effective date of the first Claims-Made policy written by one insurer that replaces the Claims-Made policy written by the prior insurer.
In order for a policyholder to avoid
gaps in coverage it is important to remember when moving from
one insurer to another that either a "Tail" or Prior Acts
coverage is required.
Premium is billed annually
approximately 60 days prior to the effective day of the
policy. The company offers a quarterly billing option that
allows our policyholders the option to spread premium payments
over 4 installments. Each installment is billed quarterly,
approximately every 90 days after the initial bill.
This varies from state
to state. Contact Risk Management Services at Professionals
Advocate for guidance on this issue.
These records can
prove to be very important in the defense of a claim. If
possible, keep them indefinitely.
There are several important steps:
- Document everything the patient has or has not done which shows his/her non-compliance.
- Send the patient a letter (send
both regular and certified mail) explaining the
treatment recommended and the importance of compliance. You
may indicate that continued non-compliance could
result in termination of the physician-patient relationship.
Do not terminate the relationship during an acute situation which could lead to allegations of abandonment. Send the patient a letter (both regular and certified mail) indicating your desire to terminate the relationship; your willingness to handle any emergency situations for the next 30 days; and suggestions on where to find another physician (i.e., County Medical Society). Clearly state what the patient's medical situation and needs are at this point, and let the patient know that you will be happy to furnish their new physician with a copy of the patient's medical record.
*If the patient
belongs to a managed care organization, you must first check
with them to determine termination protocol, if any.
- You need to go through the appeals process with the managed care entity.
- Advise the patient your recommended treatment was not approved and give the patient their options (including paying for the recommended treatment themselves).
- Document #1 and 2.
As a general rule you must release a
copy of the records upon receipt of an authorization signed by
the patient. You should not prepare new or additional
chronologies or reports, even if requested. Some states have
specific statutes governing this. If you have any questions
about releasing your records, call the Claims Department at
800-492-0193. Should you have any suspicion that your
treatment could lead to a claim or suit for medical
negligence, you should request ProAd's assistance prior to
An Insured should immediately notify
ProAd of any incident that may lead to or trigger a medical
negligence claim. In the event the Insured receives a claim
letter from an attorney or a lawsuit, swift reporting is
crucial to allow ProAd adequate time to respond within the
allotted time frame. Insureds are encouraged to contact ProAd
with any questions or concerns regarding an incident.
Simply reporting an incident has no
impact on your premium.
Contact the ProAd Claims Department and provide the needed preliminary information. Contact can be via telephone (800-492-0193), fax (410-785-1670), or mail (Claims Department, Professionals Advocate, 225 International Circle, Box 8016, Hunt Valley, MD 21030). Please include:
- Patient’s name, gender, age, marital status, address and employment status .
- Names of any other physicians involved in care .
- Names of any involved hospitals, clinics, etc.
- Chronology of medical treatment including dates of treatment.
- Any information available regarding
the nature of the claim.
After reporting an incident, you will be given a list of precautions to follow. It is important that you adhere to these admonitions, as they will help to preserve the integrity of your case.
- Do not discuss the circumstances surrounding the incident with anyone other than the attorney representing you or a ProAd Claim Representative.
- Do not make any additions or deletions to the patient’s records.
- Do not respond to any inquiries regarding the patient before contacting ProAd.
- Do not respond to any legal papers before contacting ProAd.
- Do not review any medical
literature specific to the alleged or potential claim.
Defense counsel advises such actions are potentially
discoverable and should be undertaken only upon specific
direction of counsel representing you.
ProAd has a listing of law firms
throughout the region that have been approved by our Claims
Department. These firms specialize in the advocacy of
physicians and their performance is monitored to ensure that
they follow our guidelines and defense philosophy. We will
make every effort to work with the Insured to provide counsel
with whom he or she feels comfortable.
Initially you will be contacted to
schedule an initial interview with your attorney and/or the
ProAd Claims Representative. During this meeting you will be
advised what to expect from the litigation process as well as
discussing your case specifically. It is helpful if you have
available the original medical chart and a copy of your CV.
ProAd will not settle your case
without your knowledge. It is the policy of ProAd not to
settle without the express written consent of the Insured.
The information is reported to the
NPDB only when the company makes a payment on behalf of an
Insured. A situation could exist where there is a judgment
against an Insured and the Insured chooses to pay that
himself/herself. In that case, it is not reportable. The same
would apply if the Insured pays a settlement himself/herself.
Requests for Claims Histories must be in writing and signed by
the Insured. The request should include the Insured’s name,
license number, policy number (if not insured under your own
name), and the specific years which the history should
address. The Claims History will be mailed or faxed to the
current address on your policy, as requested. The Claims
History will also be mailed directly to the requesting
institution. In the event further information is required
regarding a closed claim, please write to the Claims
Department, Professionals Advocate, 225 International Circle,
Box 8016, Hunt Valley, MD 21030 and specify what further
information is required. In the event you need additional
information regarding a pending claim, contact the attorney
retained to represent you in that case.
In general, to prove a claim of medical malpractice three basic elements must be present. These are:
- Negligence – defined as a departure from the accepted standard of care.
- Causation – there must be a causal link between the negligence of the defendant and the damages suffered by the claimant.
- Damages – which must be verifiable
and suffered by the claimant(s).