I am a medical malpractice claim. I was born in the Great Lakes State of Michigan. And you, you are the claims professional trying to stop me from growing into a big settlement.
I am hidden sometimes in the disappointment of an elected cosmetic surgery. Or, sometimes, I am as apparent as a pair of surgical scissors left behind. Be careful when handling me. I am hot to the touch because there were many health professionals involved in my coming to life. So, I can burn doctors, nurses and technicians regardless of fault. And since my owner had treatment and consultations for months, I can even trigger coverage across multiple years for each of my targets.
Not to fret though, there is a ceiling in my home state. My owner cannot recover more than a few hundred thousand for pain and suffering. Luckily though, that ceiling gets higher every year. I wish I was born in one of the 20 or so states with no caps on medical liability damage awards.
My goal is to show that one or more doctors or nurses breached the recognized standard of care. Once I do that, it will be pretty easy to show that my owner suffered an injury caused by that breach. I also have to show that there was more than a 50% chance that a better result could have been achieved if the standard was followed.
You are probably hoping that my owner fails to file me as an official lawsuit in time. Trust that I will make it to court on time. You will know about me long before the court finds out. Michigan law requires I give some advance notice and that a qualified medical expert certifies me as “meritorious.”
My hope is that you lack the tools and knowledge to handle me when I arrive. Many of my older relatives were lucky enough to be input into a system made for handling auto property damage or residential flood claims. I love it when they do that. Those systems have no way of properly organizing the expert testimony needed to defend me. If they had an investigative workspace where opinions and testimony could be adequately gathered and analyzed, I would be in trouble. When I see that you have compiled notes and analysis in the way shown below, I know I am in for a battle.
Once you have set me up in your system, you are going to make a guess as to what I am worth. But, if you fail to address all of the damage categories I can claim, you will definitely not get it right. One of your colleagues used a chart like the one below for a friend of mine, and my friend got picked apart. There was a lack of supporting evidence for my friend and he got whittled down to nothing.
One way I really confuse people is by introducing a continuum of errors and mistakes by several different medical professionals. I know it sounds crazy but almost no one puts together a proper timeline anymore. Timelines like the one shown below would make it pretty apparent that my owner’s injuries were not related to medical treatment but instead caused by an auto accident that occurred 3 weeks after his operation.
This will be an exciting ride for both of us. Of course, I am playing the percentages that your failure to have the proper handling tools will result in a nice settlement for my owner. I will soon go from being a medical malpractice claim to a large medical malpractice settlement. And one day, you get to tell your friends at parties about how much money is paid out on medical liability claims because of greed. A better system would show exactly where Med Mal claims come from. Check out the segmentation by legal theory shown below.
Takeaway
Claims adjusters across the country face daily challenges as they take on cases involving complex areas of law. In this article, I address medical professional liability claims. But, the tools needed to handle specialized claims are generally lacking in most software solutions.
The solutions needed are not going to come from your traditional carrier or the broker. The risk managers and legal professionals of self-insured organizations are the ones who must create the right tools to handle the challenges of today’s liability claims.
Darren Lossia is Director of Risk Management Services at Innovative Computer Systems, Inc. and creator of the Direct Claim Solution (DirectClaimSolution.com). He is a licensed attorney and claims professional specializing in bringing creative claims handling solutions to clients seeking significant operational improvements.
