Claim Against EP? Upfront Approach Speeds Resolution

Whether a claim against an emergency physician (EP) is ultimately settled, defended, or dismissed, taking an upfront approach has resulted in quicker resolution of claims, reports Ryan Domengeaux, vice-president of enterprise risk management and internal counsel for Schumacher Group, an emergency medicine practice management company in Lafayette, LA.

"When it comes to managing claims, there is just no place for defensiveness or obstinacy," he says. "What should take place is honesty, objectivity, and intent to do the right thing."

After a very thorough review of the case is completed, when a claim is first received by Schumacher Group, the next step is to have a candid discussion with the plaintiff or family and their counsel, regardless of Schumacher Group's evaluation of the claim. Almost every claim received in the past five years has followed this process, with the goal of finding a way to expeditiously seek resolution of the claim to the benefit of all parties involved.

"If we didn't visit with the plaintiff or family and their counsel very early on in a case, it's not for lack of an effort or desire on our part," says Domengeaux. "We want to visit with them early on in the claim to talk candidly about how we see the care. If we see a problem with the care, we say so."

The most challenging claims to close are those in which one of the parties isn't forthcoming, he adds. "All too many people handling claims still think that being honest and candid is a detriment to resolution, and that honesty is not the best policy," says Domengeaux. "We disagree wholeheartedly and have the statistics to prove it."

Domengeaux says that if he could make one change in the legal system, he would require all parties to sit down at a table and have a discussion about the claim within 60 days after it's received, and not with a neutral third party. "The parties to a case should sit down, face to face, and talk. It may not always lead to resolution, but it's going to lead to progress," he says.

Attorneys occasionally haven't allowed their clients to be present, and these discussions have been, for the most part, unsuccessful, he says, whereas claims tend to move toward resolution when everyone involved is present.

"The plaintiff's attorneys may act as a filter. Maybe they don't relay all the information, or tell them all the strengths and weaknesses of the case," he explains. "This is not always the case, but if the plaintiff personally hears me say, 'Let me tell you the things we did to care for you, but also where we have some weaknesses,' it can't be misconstrued."

The same is true at times for defense attorneys who try to suppress certain aspects of the case for fear of giving up defenses, to the point that it actually hinders resolution. In some cases, the plaintiff's attorney actually called a short time after the discussion took place, stating the claim would be dismissed primarily because Schumacher Group took the time to show the patient or family that they genuinely cared about their situation despite the defensibility or indefensibility of the case.

"Even when we have been extraordinarily honest about the care that was rendered — let's say we dropped the ball and issued a medication the patient was allergic to — I have never seen the plaintiff take advantage of our honesty in disclosing this and apologizing for what we did," Domengeaux says. "Our honesty has always benefitted the patient or their family and the provider."

The meeting is a chance to discuss the provider's care in order to explain it and to address any questions the plaintiff may have regarding the care.

"If a plaintiff doesn't get to hear directly from us on behalf of our EP named in the lawsuit, all they get to see are sanitized medical records, says Domengeaux. The plaintiff's position needs to be understood as well, in order to evaluate the claim thoroughly."

"In the end, all we are doing is fast forwarding to the point of where the case will inevitably land after years and years of protracted and expensive, often unnecessary, litigation," says Domengeaux.

Discussing the care in an open forum gives the patient or their family and the providers a chance to be heard. "Our average age of claim is extraordinarily low, likely best in the industry. This is directly a result of us having these face-to-face conversations very early on in the life of the claim," he says.

The process has reduced open time on claims by months or even years and mitigated costs associated with settling claims, according to Domengeaux, and allows those costs to be directed to those plaintiffs who deserve compensation instead of being spent on unnecessary litigation.

"When we are successful in getting all this done in the first two to three months before people are so rooted in their positions that they can't hardly find the path to resolution, we resolve claims," he says. "And most of the time, we find resolution."

Source

For more information, contact:

• Ryan Domengeaux, Vice President of Enterprise Risk Management and Internal Counsel, Schumacher Group, Lafayette, LA. Phone: (337) 354-1117. Fax: (337) 262-7329. E-mail: ryan_domengeaux@schumachergroup.com.