Frequently Asked Questions

Claims - Frequently Asked Questions

Any incident—whether a precautionary matter or not—that suggests a medical malpractice claim may be filed, should be reported to LAMMICO as soon as possible. Early reporting may provide an opportunity to obtain advice for managing the situation, which could prevent a formal claim from being filed in the future.


There are definite advantages to reporting such incidents to LAMMICO as soon as practical after they occur. The most important advantage is that when you give notice to LAMMICO that an incident has occurred, you can be sure that your coverage is in effect at the time that the incident is reported.


Examples of incidents to report to LAMMICO include:
 

  • Subpoenas or requests for medical records from attorneys, particularly those who are known as plaintiff advocates in malpractice actions.
  • Contact from an attorney, even if it appears to be informal.
  • A diagnostic or therapeutic event resulting in injury.
  • Verbal or written notification of a patient complaint from the state board of medical examiners, patient’s healthcare insurer, or other entity.
  • A patient expresses unhappiness related to his or her care.
  • Hostile patients or family members who threaten to sue.
  • Patients or family members who demand that bills be forgiven.
  • Unanticipated events or outcomes, such as a surgical complication, a medication error, an incorrect or missed diagnosis, or a failed treatment.
  • Accidents resulting in bodily injury or property damage on the premises.

Some policyholders may be hesitant to report incidents; however, LAMMICO encourages you to report incidents as soon as possible. Incidents that remain incidents and do not end up as claims will not be reflected on a credentialing claims history, nor should it affect your insurability at that level.


When notifying the Claims Department about a new claim, contact the office that serves your area.


As a policyholder, you can benefit by reporting any incident that suggests that a medical malpractice claim may be filed. You can obtain advice on how to manage the situation, which could prevent a formal claim from being filed. If necessary, LAMMICO can investigate the matter while it is still fresh in everyone’s mind and witnesses are available. But the most important advantage is that when you give notice to LAMMICO that an incident has occurred, you ensure that your coverage is in effect at the time the incident is reported.


Incidents that remain incidents and do not end up as claims will not be reflected on a credentialing claims history, nor should it affect your insurability at that level.


When notifying the Claims Department about a new claim, contact the office that serves your area.


If a claim is filed against you, management of that claim ensues. You, the insured healthcare professional, will participate in the process along with your defense team, comprised of your claim representative and your defense attorney. As a policyholder with LAMMICO, you may take part in the selection of a defense attorney from a list of approved counsel. And, as a physician whose primary coverage is with LAMMICO, you can be assured that no claim against you will be settled without your consent.


LAMMICO has the responsibility under the insurance policy for payment of any settlement or judgment on behalf of you, the insured, up to the policy limit. The company also has the responsibility of investigating and defending the claim. You can be assured that no medical professional liability claim against you will be settled without your consent, subject to the terms of your policy.


A third party claim is when someone who is not your patient makes a claim against you regarding a medical incident arising from the performance of your professional services. Some examples of when this may occur are:
 

  • One of your patients caused an automobile accident while under the influence of a prescription drug prescribed by you, and a third person was seriously injured. The seriously injured party, who is not a patient of yours, decides to file a claim against you.
  • You are a psychiatrist who counseled a patient who then harmed a third party, and that party chose to pursue a claim against you alleging negligence in your handling of the matter.
  • A third party allegation of infection, e.g. Methicillin-resistant Staphylococcus Aureus (MRSA) due to failure to warn the patient of the contagious nature of the infection and thus a third party contracts the infection from the patient.


If your insurer does not cover these types of claims, you, personally, may be responsible for damages. This is especially important in Louisiana where the Supreme Court has taken the position that the Patient's Compensation Fund covers injury to patients only, not to third parties.


If you have any additional questions, please contact us at 800.452.2120.


To receive a copy of your claims history, please contact our Underwriting Department at 800.452.2120.


View the article on How To Be More Effective at Your Deposition by Marc Judice, J.D., of Judice & Adley in Lafayette, LA.


Frequency refers to the number of claims filed per healthcare provider. High frequency means that more than the average number of claims are being filed.


Severity is the judgment/settlement component of the cost of a claim. High severity indicates that the judgments/settlements are large.


In Louisiana, LAMMICO separates claims into two broad categories.
 

  • Category one (1) consists of claims that are capped pursuant to the Louisiana Medical Malpractice Act (or would have been capped had the policyholder been PCF-qualified).
  • Category two (2) consists of all uncapped claims except those that are uncapped solely because the policyholder was not PCF-qualified.


Claims in the first category are subject to $100,000/$300,000 limits, and claims in the second category are subject to the maximum limits purchased by a policyholder.


Examples
Keep in mind that coverage will depend upon the allegations raised and particular facts and circumstances of each claim. We provide the following coverage examples to clarify how this works for policyholders who purchase limits of $1 million/$3 million:
 

  • Claims Category 1: For claims in the first category reported in the same policy period, LAMMICO will defend all such claims until the company has paid judgments and/or settlements totaling $300,000, regardless of the number of claims reported during the policy period and subject to a $100,000 limit per claim. Once $300,000 in judgments and/or settlements has been paid, LAMMICO’s duty and obligation to pay judgments and/or settlements on any remaining capped claims ends.
  • Claims Category 2: For claims in the second category reported in the same policy period, LAMMICO will defend all such claims until the company has paid judgments or settlements totaling $3 million, regardless of the number of claims reported during that policy period and subject to a $1 million limit per claim. Once $3 million in judgments and/or settlements has been paid, LAMMICO’s duty to defend and obligation to pay judgments and/or settlements on any remaining claims ends.


If you have additional questions, visit our Frequently Asked Questions section or contact our Underwriting Department at 504.831.3756 or 800.452.2120.



The information provided on this site is distributed for informational purposes only. It is not intended to constitute legal advice. Visitors are urged to consult with their own counsel concerning the matters presented.