Liability insurance is an important part of any medical practice. In fact, most states require medical practitioners to maintain a certain minimum amount of coverage for liability. Liability insurance covers medical practitioners against any disputes arising from the services they provided.
There are many cases where a patient suffers additional injuries (or even death) as a result of the services offered by their healthcare provider. Liability insurance is designed to help such patients make a claim against the provider for compensation.
In a perfect world, all liability claims would be appropriately addressed and covered by medical practitioner’s insurance policy. However, it’s not uncommon for patients to have such liability claims denied, even if their case is legitimate. Most liability claims made against a medical malpractice require lots of evidence, time, and hard work to actually go through. Many patients often give up along the way when pursuing a claim for damages that happened to them while undergoing treatment.
Because insurance companies are driven by the goal of bringing in more premiums than they pay out, patients often have to be vigilant and ready to follow through on their claims for compensation.
Understanding Liability Insurance for Medical Practitioners
Many businesses have liability insurance policies. Retail stores keep them to cover themselves against defective products purchased by customers, while employers also obtain such insurance to protect them from actions of negligent employees. How it works is a business pays regular premiums, and the insurer settles claims that have been made for any wrongful action.
In the medical world, liability insurance is often referred to as medical malpractice insurance. Thisinsurance policy covers medical practitioners against any harm they may cause to patients when administering treatment. In other words, this liability insurance is often your only safety net when undergoing treatment. If your healthcare provider makes a mistake and causes injury or death to a patient, it is this insurance policy that will compensate you on behalf of the healthcare provider.
What Liability Insurance Covers
A liability insurance policy for medics covers many different types of cases. When ailing, we tend to entrust ourselves under the care of doctors, nurses, and surgeons. But what happens if these medical professionals make a mistake and cause further injury/death to a patient? Liability insurance is often the only line of defense for patients to be compensated under such circumstances.
Liability insurance can cover the following types of claims:
Pregnancy and birth are one of the most vulnerable times for women. Every birth process is unique, and healthcare providers often have to provide specialized care during such situations.
If you experience injury or death to your child during birth when undergoing care, you can make a claim for medical compensation. You often have strong grounds for a claim if your healthcare provider missed out on important information, provided substandard care, or was negligent during childbirth
An accurate diagnosis for an ailment is key to providing proper treatment. It only takes a single missed symptom for a doctor to provide the wrong treatment for a patient’s ailment.
If you’ve been misdiagnosed, you may end up suffering further from your ailment or from the side effects of improper medication. Such a situation is grounds for making a malpractice claim.
Errors in treatment
Any mistakes made by a doctor when providing treatment may also cause further injury or even death to a patient. Errors in treatment can be costly to a person’s health, and correcting this condition may be expensive. Therefore, liability insuranceplays an important role in covering the associated costs of treatment mistakes.
Negligence during healthcare delivery
Liability insurance also comes in handy during cases of outright negligence. We entrust our care into the hands of medics, but there arealways cases where these professionals may neglect their duties or overlook important patient details
Liability insurance protects patients from the harm and damages caused by such negligence. This may occur during diagnosis, treatment, and in/out patient care.
Failure of essential medical devices
Advancements in technology have given rise to medical devices that help patients during their daily lives. These devices provide essential services such as monitoring blood pressure, heart rate, blood sugar level, etc.
If medical devices fail and you become injured as a result, you can make a claim for compensation. Many patients entrust their health in the monitoring capabilities of medical devices, and they ought to function well enough without untimely failure.
Types of Medical Liability Insurance
Even before making a claim for medical malpractice, it helps to know how these insurance policies work. Understanding the framework can help you not only prepare an accurate claim, but also select healthcare providers who are covered by sufficient insurance.
Most medical liability insurance policies come in two forms: “claims made” and “occurrence” policies. Claims made policies will only cover cases where the insurance policy was active when a claim was made (or a lawsuit was filed). This means that the claimant should make their claim before a policy elapses in order to have a chance of receiving compensation.
Such insurance policies require proper timing. Because medical claims are often made months or even years after the actual incident occurred, a patient may miss out on coverage because the liability insurance policy already elapsed. Some “claims made” policies extend coverage for a certain amount of time after the actual policy expiration date. For example, the insurance may still cover claims made up to 5 years after a medical liability policy expired.
The second type of medical liability policy is an occurrence policy. Such policies cover any claim for an event that occurred during a specific coverage period. Even if the policy is currently expired, if a valid claim is made for an event that happened when the policy was active, compensation can be given to the patient.
Occurrence policies are often less frequent and more costly for medical practitioners. However, they provide a better cushion for patients who are victims of medical malpractice.
Denied Claims Occur More Often Than You May Think
While the concept behind liability insurance is meant to protect both medical practitioners and their patients, there are many cases where patients are denied compensation for medical malpractice. It’s not uncommon to hear stories of patients who have been injured or even died as a result of wrongful treatment. Even more worrying is that many claims for liability compensation go unpaid. And those that are paid are only paid after the patient diligently follows up with the insurance company for months on end.
If you’ve been injured due to medical malpractice, time is of the essence. You often need to undergo corrective treatment as soon as possible to prevent further deterioration of your health. And if your loved one passed away from medical malpractice, you may be pursuing compensation for all the damages you and your family incurred.
A denial for a liability claim can be particularly disheartening to you and your family. Unfortunately, insurance companies are out to make a profit. They will often avoid paying out costly claims if they find a way out. Some medical practitioners also wouldn’t want their names tarnished byclaims of negligence or wrongful treatment. Giving patients the run around is sometimes in the best interests of both the insurance company and your healthcare provider. Therefore, cases of denied liability claims are not uncommon.
Many patients pursuing compensation for medical malpractice give up after being taken around in circles. Even for claims that have a high chance of being accepted, some insurers may look for the slightest reason to complicate the process. There is also a growing trend where onlylarger and more obvious claims of medical malpractice are given attention.
Insurance companies know that denying significant claims could end up in the national news and catching the attention of insurance regulators. Therefore, they only pay enough claims to cover up their bases while neglecting smaller claims that affect many other patients. In fact, a study carried out by the Center for Justice Democracy at New York Law School revealed that as many as 93-98% of deaths from medical negligence were not compensated by liability insurance.
Such high denial rates often cause lawyers to become wary about pursuing these cases. If the likelihood of compensation for a claim is low, lawyers may shy away due to the high costs involved
However, all is not so gloomy. By preparing a solid claim for liability and working closely with a law professional, you can receive the compensation you deserve for any medical malpractice you experienced.
How to File A Claim for Medical Malpractice
If you or a loved one is a victim of medical malpractice, it’s important to file a claim for compensation. The consequences, both financially and psychologically, of medical malpractice, may be quite extensive. You may have to incur high costs for correcting medical complications due to negligent care. Even worse is when a loved one passes away from such negligence. The damages incurred by a family can be extensive.
Even if liability insurers may make it challenging to file a claim, being awarded damages for medical malpractice can help you correct a medical complication arising from negligence. The following is an overview of the claims process for liability insurance.
Start by contacting the medical professional
The first step you should take is to contact the medical professional who administered treatment to you or your loved one. Contacting the people directly involved will help you get a solid understanding of what actually went wrong, and whether the situation can be fixed.
In most cases, the healthcare provider may be willing to correct your injury free of charge or to help you in preparing a claim for compensation. However, there are situations where the healthcare provider chooses not to acknowledge their mistake. Note down what the grounds for denial are and request for copies of all your medical records
Contact the oversight body involved
An oversight body governs all healthcare providers. This body ensures that situations such as medical malpractice are thoroughly investigated. Oversight bodies are often medical licensingboards
If your healthcare provider is not being cooperative, don’t hesitate to report them to the relevant licensing board. The board may issue warnings and disciplinary actions to your healthcare provider, compelling them to be more cooperative.
Preparea claim with the insurance company
Now you can proceed to follow the claims process with your provider’s liability insurer. You should begin by finding out how much time you have to make a claim, after which you can collect the required medical evidence.
You may need to have your case reviewed by an independent entity (such as another physician) before filing a claim. An independent review affirms that your negligence case is strong enough to warrant compensation.
Each insurance company has a unique claims process. The important thing to note is that you should collect as much evidence as possible to support your case.
Get help from an attorney
Pursuing a medical malpractice claim is a complicated process. Even if you have strong grounds for compensation, simply collecting all the required documentation can be confusing and time consuming. You should always have a lawyer by your side to help you prepare such claims.
Why Your Claim May Be Denied
There are many reasons why a liability insurer may deny your claim. Some reasons may be purely procedural, while others may be related to the nature of your situation.
Insufficient medical evidence
Perhaps the most common reason for a denied claim is where the available medical evidence is insufficient. For medical malpractice, you have to show how your healthcare provider actually carried out wrongful treatment, and how you were affected in the process.
This threshold is higher than most people think. The available medical evidence should be clear and convincing,otherwise, the insurance company may deny your claim.
Lack of coverage for the claim
Another reason for denial is if your claim is not covered by the liability policy. There are some situations where the insurer doesn’t cover your healthcare provider’sactions. These situations are commonly referred to exclusions of the policy. For exclusions, compensation should be pursued using other available channels. Some common exclusions to a liability insurance policy include:
Medical professionals who administer care when under the influence of drugs/alcohol
Cases of sexual misconduct by a healthcare provider towards a patient
Some injuries from use of hospital equipment
Dishonesty and fraud committed by medical professionals towards patients
Negligence from the insurer
There are also cases where an insurance company overlooks important information relevant to a patient’s claim. For example, the insurer may issue a denial due to insufficient medical evidence, overlooking the actual records that have actually been included in a claim.
You should be prepared to file an appeal for any wrongfully denied medical claim. Have the policy statement of the insurance company handy to compare any inconsistencies that may be present.
Increasing the Chances of Your Claim Being Successful
There are several ways you can further strengthen your claim or appeal for liability compensation. First off is by gathering medical evidence. In addition to all relevant medical records, also collect additional evidence such as photographs, testimonies from people who witnessed your injury, and testimonies from other doctors who treated you at a later date.
In addition, follow all the instructions given by your former or current doctor, which were issued as a corrective measure for your injury. For example, if you were directed to take certain medication to correct an initial complication, take the medication as long as you have ascertained its safety. This will show your level of cooperation in attempting to correct the initial damage caused.
Being denied liability insurance following medical malpractice can be emotionally and financially crippling. Insurance companies may give you a hard time before providing compensation. In addition, your healthcare provider may also avoid working with you so they don’t have to pay higher premiums or have their reputation affected.
At Stop Health Insurance Denial, we have experience in handling liability denials by insurance companies. We devote our effortstowards working with patients and helping them obtain the coverage they deserve. Are you facing a denied claim for liability insurance for medical malpractice? Contact us todayat 310-695-5241 or fill out our contact form