Incident and claim reporting

What should you do when faced with an adverse incident or complication resulting in patient injury?  While not necessarily the result of negligence on your part, the incident may result in a lawsuit. 

The early reporting of an incident or claim provides you with the following benefits:

  • You can more easily recall details

  • You will receive professional advice on how to maintain rapport with the client and reduce further liability exposure.

  • Because your policy is a Claims-Made policy, you are not covered for claims made after you cancel your policy, even for incidents occurring during your policy term, unless you either purchase a tail or reported the incident while your policy was still active. So it is very much in your interest to report all incidents.

What is an incident? What is a claim?

An incident is any untoward or unexpected event resulting in injury, or having a serious potential for injury or damages.

Claims are of two basic types: formal and informal.  A formal claim results when you are served with a legal document or receive a letter from a claimant or attorney.  A request for medical records by your patient or an attorney should be regarded as a formal claim unless the request is unrelated to the care you provided.  An informal claim is usually presented verbally, the most common being a threat of litigation or a request to waive fees or service billings.

What Must Be Reported

Reportable events include, but are not limited to, the following, when the practitioner's actions or inactions may be construed to contributing to a patients:

  • Death.

  • Damage or impairment of the nervous system.

  • Damage to any organ or adjacent tissue. 

  •  Loss or impairment of any of the five senses.

  • Loss, fracture, or impairment of any appendage or digit.

  • Burns

  • Birth related injuries

  • Adverse complications from medication administration or prescription.

  • Unexpected complications

Click here to download a more complete list: What to Report to the JUA

Reporting the Claim or Incident

Claims or incidents should be reported verbally at the earliest possible moment to Melonie S. Ramsey at Intercare Insurance Services, Inc. Melonie will request information to determine whether or not a claim file should be established and will obtain the necessary information. Information needed to start processing your claim includes the date of the incident, the date of birth of the injured party, identification of all personnel involved (including witnesses), a description of the incident, follow-up action taken, current condition of the injured party, and response of party (and family, if applicable) toward events that have transpired. You may be asked to send a complete copy of the medical record.

After a Claim or Incident

  • Do not discuss the case with anyone except Melonie Ramsey or a representative of Intercare Insurance Services, Inc., an attorney retained to represent you, protected peer review attendees, or your spouse. Discussing the case broadly raises the possibility of others being subpoenaed and/or conflicting information being circulated.

  • Never alter a medical record after a claim has been made.  This includes making additions, corrections, or deletions.

  • Do not include any claims correspondence in the patient's medical record.

  • Maintain copies of all claims correspondence in a secure location.

Who to Contact

Melonie S. Ramsey at (425) 636-1065     

Fax: (916) 781-5650