Legal Defense 101
What to Expect From LAMMICO's Legal Defense of a Claim
View the article on How To Be More Effective at Your Deposition by Marc Judice, J.D., of Judice & Adley in Lafayette, LA.
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. To reference additional insights, view the article on How To Be More Effective at Your Deposition by Marc Judice, J.D., of Judice & Adley in Lafayette, LA.
Your coverage depends on the allegations raised and the facts and circumstances of each individual claim. For this example, consider a policyholder who bought limits of $1 million/$3 million:
- Claims Category 1: LAMMICO defends claims reported in the same policy period 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: LAMMICO defends claims reported in the same policy period 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.
LAMMICO offers comprehensive resources to LAMMICO insureds and is keenly aware of the additional burden a malpractice claim can place on an already taxed healthcare provider. This is precisely why our Risk Management and Patient Safety Department developed products and services related to emotionally preparing for litigation. LAMMICO is here to support healthcare providers experiencing anxiety during the malpractice litigation process. Online education is available for our policyholders to assist them in dealing with litigation stress.
Legal Defense Glossary
A legal document containing a defendant’s written response to a lawsuit.
Losses or injuries caused by the fault of another.
Out of Court testimony given under oath in response to an attorney’s questions.
The legal process of gathering information by pleadings or depositions before a Medical Review Panel or Trial.
Written questions submitted by one party for another party to answer, as part of the discovery process.
A Motion seeking dismissal of a lawsuit generally for lack of evidence to support the allegations made.
Legal documents filed by any party in a lawsuit or Panel proceeding.
A series of factual statements served by one party to the other that must be admitted or denied in writing, under oath, within a certain time frame.
An insurer’s notification to an insured that some of the allegations in a claim are not covered by their insurance policy with the company. Such notification allows an insurer to defend and investigate a claim to determine whether coverage applies, in whole or in part, without waiving its right to later deny coverage for allegations that are not covered by the policy.
For claims reported on a “claims made” insurance policy, this is the date after which an incident must occur in order for coverage to apply.
In general, the standard of care is what a reasonable physician (or other provider) would do when faced with the same or similar circumstances. The standard of care is established in a legal proceeding by expert testimony—whether by the Panel opinion or expert witness testimony.
Under certain circumstances, a different standard of care may be applied to a healthcare provider’s actions. Most recently, under the Governor’s Order during the COVID emergency, the standard of care applied for all healthcare providers is whether the provider committed willful misconduct or gross negligence. This is a temporary change in the applicable standard of care, which will expire with the COVID emergency order.
Civil liability, or legal responsibility, for the fault of others. Healthcare providers may be vicariously liable for the negligent acts of their employees committed within the scope of their employment.