Commentary

Weighing when to report bad outcomes to insurance carriers


 

In Ken Heland’s Medicolegal Consult column [December], he stated that medical malpractice insurance companies should be notified of all bad outcomes or potential claims.

While I thought his comments were valuable, physicians should be aware that many insurance carriers will enter any report a clinician gives them concerning a bad outcome as a “claim” or “incident,” even if no legal notice of a lawsuit or intent of a lawsuit is present. This claim will then permanently show up in a physician’s record with the malpractice insurance company.

Reporting all bad outcomes prior to legally being required to do so is an open invitation to increased premiums or cancellation of coverage. Therefore, I would like to argue that it is better to err on the side of caution and report only those cases in which there is a credible threat of litigation.

Byron G. Darby, MD
Austin, Tex

MR. Heland responds:

Most malpractice insurance carriers can distinguish between a “bad outcome” and an actual claim. Certainly a physician who reports an excessive number of bad outcomes will be at higher risk for termination or a higher rate. Insurance underwriters will think that he or she is an accident waiting to happen, whether or not the bad outcomes result in claims.

Some companies want all “incidents” to be reported; others prefer to focus on actual claims. Obtain a written letter from your insurance carrier as to its specific policy.

Absent a written policy, always report cases with a likelihood of permanent disability, as well as cases of unexpected death. Only report temporary disability cases or those that can be corrected by subsequent surgery when the extent of the temporary disability was quite painful and severe and the medical costs were high. In my opinion, these are the types of cases that are most likely to lead to litigation, and reporting them to your insurance company at the time of the incident might give you and the carrier the tools to help manage the case in order to avoid a claim.

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