Q. What is a claim?

A. A claim is a demand to be compensated for an alleged injury. The most obvious example is when you are being sued. You may encounter a situation with a patient who is unhappy with an outcome. This is not a claim until there is a demand for compensation, or formal proceedings based on alleged medical negligence are initiated. We do encourage you to call our Claims Advice Hotline and discuss the situation. 

Q. I just received a lawsuit or letter of intent to sue. What should I do?

A. If you have been contacted in regard to a lawsuit, or you suspect that you may be contacted in the near future, it is important to contact us immediately so we can proceed in your defense. Call our Claims Advice Hotline, 1-800-640-6504, to discuss your situation with a professional claim representative.

DO NOT attempt to contact the patient or the patient's attorney to discuss the lawsuit or any other paperwork you may receive. Avoid the temptation to talk with your friends and colleagues about the lawsuit. It is important that your insurance provider is the first person with whom you discuss the details of the case. You should also gather and secure the patient's records immediately.

Q. I just received a subpoena for medical records and/or deposition. What should I do?

A. As a busy healthcare professional, it is likely you may be subpoenaed at some time during your career to provide medical records or give a deposition concerning your care of a patient. In many instances this is an every day occurrence and unrelated to criticisms regarding your care and treatment. For example, your patient may be involved in some type of personal injury or workers' compensation accident where your records or testimony as a treating physician is necessary to prosecute or defend the personal injury lawsuit or workers' compensation proceeding. Keep in mind that state laws vary, but in many jurisdictions the attorneys defending personal injury or workers’ compensation claims are not permitted to discuss the patient’s case with you absent written authorization from the patient. Their only means of getting information regarding your care and treatment is a formal deposition proceeding with all parties to the suit present. If you are comfortable that is the case with the subpoena and are experienced in giving depositions, it is not necessary that you contact our Claims Advice Hotline.

If, however, you are not certain about the purpose for the records or deposition subpoena, or have concern that either the patient or other parties already named in the lawsuit could be attempting to claim some wrongdoing on your part, you should contact us immediately so we can proceed in your defense, if necessary. Call our Claims Advice Hotline, 1-800-640-6504, to discuss your situation with a professional claim representative. Again, treat the subpoena just as you would any formal claim against you. DO NOT attempt to contact the patient or the patient’s attorney to discuss the subpoena or any other paperwork you may receive.

Q. I've been hearing more about healthcare providers facing disciplinary charges from their state licensing boards. Does my professional liability insurance pay for an attorney for this type of hearing?

A. Professional Solutions pays your defense costs up to $25,000 per policy period. In addition to state licensing board investigations, that coverage can also be used in defending allegations of wrongful billing brought by government entities, HIPAA issues and other privacy related proceedings.

Q. What is a licensing board investigation?

A. A licensing board investigation is any investigation by your state licensing board. If the board contacts you, and it is not a part of your standard license renewal, then it is an investigation.

Q. What should I do if I know I have a claim or am being investigated by my licensing board?

A. You should report it to Professional Solutions immediately. Even if you aren't sure whether the situation is an actual claim or licensing board investigation, call the Professional Solutions Claims Advice Hotline, 1-800-640-6504. Our professional claim representatives will help you determine the best course of action. You will not jeopardize your coverage by asking if you have a claim or investigation. We may help you use your coverage to its fullest advantage or point you to resources you may not have been aware you had.

The licensing board is there to protect the consumer -- not the doctor. You need the experience of an attorney familiar with licensing board investigations. Even seemingly innocuous questions can be fraught with pitfalls for a doctor unfamiliar with licensing board investigations.

Q. What should I do if I think I have a claim or board complaint?

A. Call the Professional Solutions Claims Advice Hotline, 1-800-640-6504. Talk to one of our professional claim representatives and let them help you determine the best course of action. You will not jeopardize your coverage by asking if you have a claim or investigation. We may help you use your coverage to its fullest advantage or point you to resources you may not have been aware you had.

Q. What kinds of activities might trigger a disciplinary action by a licensing board and/or state regulatory agency?

A. Any act that breaches your professional practice or standards may prompt an action. Common occurrences include such conduct as incompetent practices, medication errors, documentation errors, and practicing outside the scope of your license and/or certification. Our current coverage provides for expenses incurred while defending your interests in disciplinary actions. We understand the importance of your license to your livelihood and will help you to protect it.

Q. How much time do I have to respond to a claim or board investigation?

A. Timing is crucial. When you receive a claim or are under investigation by your licensing board, you often have a limited time to respond—normally between 14 and 30 days. The sooner you report the situation to us, the sooner our defense team can determine the proper course of action. Your attorney needs ample time to help you craft the best defense. Any delay in reporting could impair your defense by limiting the available time for response.

Q. Does Professional Solutions’ respect my consent to settle?

A. Absolutely! Some insurance companies say they will not settle a case without your consent--however, if you don’t provide your consent, their policy may allow for arbitration to determine if you are withholding consent unreasonably. An arbiter’s finding that consent is being unreasonably withheld could authorize the company to settle the claim without your approval. At Professional Solutions, no case is ever settled without your written consent to settle and arbitration is never required – giving you full voice in settlement issues since it’s your reputation and good name on the line.

Q. What is a deposition?

A. A deposition is testimony given under oath before a court reporter. Depositions are important in the preparation of a case for trial. Depositions freeze testimony and can be used to impeach your credibility if you later deviate from prior statements. They are used to discover facts of the case and to uncover additional witnesses. Depositions are also used to narrow the issues of the case. Failing to appear for a deposition subjects you to the potential to be held in contempt of court. Always consider exercising your right to legal counsel before providing deposition testimony.

Q. What action should be taken when a medical error is suspected or occurs?

A. Contact the Professional Solutions Claims Advice Hotline for guidance as soon as possible. Make no admissions of liability. Always attempt to discuss the situation with Professional Solutions before meeting with hospital risk management.