INFORMATION ON CLAIMS/INCIDENTS FROM START TO FINISH

When should you report a claim?

Incident:  Contact your primary carrier to file an incident report if something happens that you think may be a problem in the future, such as an unexpected event or adverse outcome that results in injury or death.

Request for Medical Records:  While a request for medical records is not necessarily an indication of an eminent malpractice action, you should contact your primary carrier if you believe there may be some future claims filed, in order to provide your carrier with the necessary information. 

Subpoena to Give a Deposition:  If you receive a subpoena to give a deposition in an accident, workers compensation or other type of litigation, please contact your primary carrier. 

Notice of Intent:  With the passage of the 2005 tort reform, in order for a plaintiff to file a medical malpractice matter, they must file a notice of intent with an affidavit from a medical expert attached.  Mediation must be scheduled within 120 days following the filing of a notice of intent. 

Letter from an Attorney:   Please contact your primary carrier if you receive a letter from an attorney or a patient alleging negligent treatment, requesting medical records, or advising you to contact your carrier.  Contact your primary carrier if you receive a letter or a telephone call from an attorney requesting you speak with them.

Do not discuss the case with anyone except an authorized representative of your carrier.  Do not make any alterations or changes to the existing medical or office records.

Summons and Complaint

If you are served with a Summons and Complaint indicating that legal action has commenced in a state or federal court you should contact your primary carrier immediately.  You must provide a formal response to a Summons and Complaint within 30 days in the state court and 20 days in the federal court whether or not you feel it is a valid claim.  Your failure to provide a response could result in a default judgment against you.  If this occurs, your ability to deny any allegations is removed.  Your only defense is against damages.  Further, this could also affect your insurance coverage and expose you personally.

Do not discuss the case with anyone except an authorized representative of your carrier.  Do not make any alterations or changes to the existing medical or office records.

Discovery 

During discovery the plaintiff and the defense attorneys review all records and documents relating to the case in order to fully evaluate the claim. 

Interrogatories

Interrogatories are written questions sent by the plaintiff’s attorney in order to further develop the facts of the case. 

Depositions

Depositions are testimony obtained during the discovery period and are a crucial part of the pretrial process.  A deposition is testimony taken from a witness or party, under oath, transcribed by a court reporter.  A deposition serves as an investigative tool for the plaintiff’s attorney, as well as a vital opportunity in advance of the trial, for the defense attorney to evaluate the case.  This assessment has a major influence on the defense attorney’s perceptions of the doctor’s prospects for prevailing at trial, and on the evaluation of the case for settlement. 

Deposition preparation is essential.  Prior to the deposition the defense attorney will schedule a conference to review questions the doctor may be asked by the plaintiff’s attorney.  Together, the attorney and physician will devise the best approach to use in answering these questions.

Disposition

Settlement

The primary carrier has the fiduciary duty to report all claims to the PCF at the time it is apparent that the PCF layer of coverage will be involved.  The primary carrier will evaluate the case to determine whether settlement is warranted.  The PCF will work with the primary carrier and be involved in the settlement efforts made on your behalf.

Trial

The primary carrier will report on all trials 30 days prior to trial, and will provide updates daily as the trial progresses. The primary carrier will make a recommendation to the PCF regarding proceeding to trial.

If the decision is made to proceed to trial, the decision rests with a 12 member jury which will be given the case to deliberate, make a final decision, and assess value to the claim.  If it is determined that a case will proceed to trial, your attendance is required daily, as you could be called as a witness for the plaintiff, however it is most likely you will be called as a witness for the defense. 

Experience Rating

Experience rating is a method to adjust premium to reflect an individual member’s claims history.  The PCF reviews claims paid over the past ten years.  The point system is charted by the number of claims paid, as well as the total amount paid (includes indemnity and expenses), otherwise known as the severity and frequency of claims paid.  If a claim is closed with no indemnity payment or a defense verdict is received and expenses are paid, you will not be experience rated. 

This plan is designed to identify and surcharge individual policyholders whose claim experience is more adverse than contemplated in the base rates.

The SC Joint Underwriting Association is basic carrier to over 95% of our members. Their website is www.scjua.com. We encourage all of our members to contact the JUA if you have any suspicion that a claim may be brought against. Early notification is imperative to a successful resolution of your claim. The contact information for the JUA is:

Immediate contact will be made by a claims specialist from the JUA. A defense attorney will be assigned to your claim. Both the claims specialist and the defense attorney will be available to assist you thru the claims process. Your input is invaluable. A JUA claims specialist will maintain appropriate communication. Their goal is to exceed your expectations.

The PCF is committed to working with the basic carrier to a final resolution that is in the best interest of all parties. The PCF contact for all claims is Terry Coston, Executive Director; South Carolina Medical Malpractice Patients’ Compensation Fund. She can be reached at 803-896-5290.