The following information contains answers to frequently asked questions related to claims. If you need additional assistance, or your specific question does not appear, please contact us.
Immediately notify us if:
- You receive notice of a lawsuit;
- You receive a claim letter demanding compensation on behalf of an injured patient;
- You become aware of an incident that may lead to a medical negligence claim;
- You receive a request to meet with an attorney regarding your care of a patient;
- You are summoned to give testimony;
- You become the subject of a regulatory or administrative investigation;
- You experience a privacy/data breach; or
- You experience a ransomware attack.
Note that reporting an incident has no effect on your Claims History, underwriting rating, or premium. Reporting an incident allows us to prepare for the possibility of a future claim or lawsuit.
Generally, you must release a copy of a patient’s medical records upon receipt of signed authorization from that patient. You should NOT prepare new or additional chronologies or reports, even if requested.
If you have questions about releasing your records or suspect that your treatment could lead to a claim or lawsuit, call our Claims Department prior to taking further action.
- Do not ignore any documents you receive related to the case. Litigation is time sensitive, so forward all documents received to us or your attorney immediately.
- Do not speak to anyone about the case other than our representatives, your attorney, or your spouse, if you are married. Anything said to your spouse about the case must remain strictly confidential.
- Do not make any corrections or modifications to the patient’s records. Changes are often detectable and making changes may constitute a criminal offense. Changing records may also preclude coverage for the claim. If you recall something that you forgot to note in the records, tell us or your attorney.
- Do not request or access any of the patient’s records outside of your current possession, including records from any hospital, clinic, institution, or other healthcare provider. We will obtain these records through the proper channels as we investigate the case.
- Do not store legal or claim-related documents pertaining to the case with your medical records. Keep these items in a separate file and in a secure location.
- Do not attempt to contact the individuals or attorneys who have filed the claim or lawsuit against you.
- Do not perform literature searches or research the medicine at issue in the case unless you must do so in the course of your normal practice.
- Do not enroll in Continuing Medical Education (CME) courses about issues related to the case without first contacting us or your attorney.
Your attorney will schedule an initial interview with you and your Claims Representative. During this meeting you will learn what to expect during the litigation process and you will discuss your case in detail. If possible, bring the original, unaltered medical chart and a copy of your Curriculum Vitae with you to the meeting.
Professionals Advocate only works with top local law firms that we have approved to defend our Insureds. These firms specialize in advocating for healthcare providers, and we monitor their performance to ensure that they follow our guidelines and defense philosophy. We will make every effort to provide counsel that you feel comfortable with.
Log in to the secure area of our website here to request that we send your Claims History to a specific facility.
Alternatively, you may send a written request for a Claims History by fax to 410-771-0177. Your written request must include:
- Your full name;
- Your license number;
- Your policy number (if you are not insured under your own name);
- The specific years that the Claims History should cover; and
- Your signature.
When making your request, please confirm that the mailing and email addresses are correct. When processing a request for a facility, the Claims History will be sent directly to the requested institution.
In a malpractice claim, a claimant typically must prove:
- The defendant’s duty to the patient;
- A violation of the standard of care;
- An injury for which compensation can occur; and
- Demonstration of a causal relationship between the violation of the standard of care and the alleged harm to the patient.
We must report information to the NPDB when we make a payment on behalf of an Insured.
We will not settle a case without your knowledge and consent. Your claims team will assist you in making an informed decision as to the best response to your claim after thoroughly examining several factors, including applicable laws and relevant medical issues.