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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:
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 practitionerís actions or inactions may be construed to contributing to a patientsí:
Reporting the Claim or Incident
Claims or incidents should be reported verbally at the earliest possible moment to Liz Chalmers at Midwifery Support Services. Liz will ask for brief details of the incident and will then give you the contact details for Sedgwick Claims Management. Sedgwick's experienced claims management team will advise you and request full details of the incident. 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
Who to Contact
Liz Chalmers at (425) 956-3227 or (866) 415-6061
Fax: (866) 212-9633
IMPORTANT: If you do not hear back from me within 24 hours of your call, please contact Intercare's Claims Management representative directly. Melonie Ramsey can be reached at (425) 636-1065