Notify carrier, or risk loss of coverage Physicians often unaware of requirements
Executive Summary
Physicians should immediately notify their medical malpractice insurance carrier if they believe a lawsuit is likely.
- Some policies specify that certain information needs to be provided.
- Physicians should report even a potential claim.
- Some insurers offer support programs for defendant physicians.
Physicians might choose to ignore papers indicating there is a lawsuit at hand, rather than immediately notify their medical malpractice insurance carrier. Ignoring papers is a mistake, says Michael R. Tamucci Jr., vice president of claims at MagMutual, a provider of medical professional liability insurance based in Atlanta.
"We’ve heard of physicians simply putting the papers away in their desk drawer, hoping the lawsuit would simply go away," says Tamucci. "Physicians should always reach out if an issue arises."
Tamucci says physicians should immediately notify their insurance carrier in these instances:
- if the physician is served with lawsuit papers;
- if the physician receives a records request or demand letter from an attorney or patient;
- if there is any suggestion of a potential lawsuit or pursuit of a claim, such as a patient appearing uncharacteristically angry or if there is an unexpected outcome with which the physician is just not comfortable.
Physicians might be unaware of the notice requirements in their medical malpractice policies, says Mike Merlo, Esq., managing director of casualty legal and claims at Aon Risk Solutions in Chicago. "It’s important for physicians to be aware of insurance technicalities. You don’t want to put your coverage in jeopardy," says Merlo.
Some policies specify certain information that needs to be provided when a claim is noticed, such as a copy of the lawsuit or demand letter documenting the claim. MagMutual, for example, asks that physicians provide:
- details of what happened;
- names and addresses of any injured people and witnesses;
- specific dates of treatment;
- all lawsuit documents received;
- all medical records.
Tamucci advises physicians to keep a copy of all documents sent and use registered or certified mail to confirm receipt.
Physicians who don’t strictly comply won’t necessarily lose coverage.
"There are some cases where courts have found that the insurer cannot be hypertechnical in denying a claim due to a policyholder’s failure to strictly comply with notice requirements," says Merlo.
Timely response needed
A delayed response could complicate the defense in these ways, says Tamucci:
- A delay could mean that the plaintiff’s attorney is able to review the case first and might begin raising issues that compromise the defense.
- A communications lag might interfere with the insurer’s ability to negotiate directly with the patient or coordinate efforts with other potential defendants.
- Physicians might run the risk of a lapse in coverage if there is a delay in reporting the claim.
Once reported, the insurance carrier will confirm coverage and begin an investigation.
"Physicians should contact the insurer by phone, then follow up with an email. They must be prepared to supply all associated records," says Tamucci.
Physicians should not share any facts or speculation with anyone outside the claims defense team, he emphasizes. MagMutual offers a doctor-to-doctor support program that pairs a defendant physician with a colleague who already has been sued.
"This peer support provides emotional insight and guidance about the rigors and stress of being named in a lawsuit, but does not involve discussion of case facts," says Tamucci.
