FAQs
Claims - Frequently Asked Questions
Any incident—whether a precautionary matter or not—that suggests a medical malpractice claim may be filed, should be reported to LAMMICO as soon as possible. Early reporting may provide an opportunity to obtain advice for managing the situation, which could prevent a formal claim from being filed in the future. There are definite advantages to reporting such incidents to LAMMICO as soon as practical after they occur. The most important advantage is that when you give notice to LAMMICO that an incident has occurred, you can be sure that your coverage is in effect at the time that the incident is reported. Examples of incidents to report to LAMMICO include: Some policyholders may be hesitant to report incidents; however, LAMMICO encourages you to report incidents as soon as possible. Incidents that remain incidents and do not end up as claims will not be reflected on a credentialing claims history, nor should it affect your insurability at that level. When notifying the Claims Department about a new claim, contact the office that serves your area. As a policyholder, you can benefit by reporting any incident that suggests that a medical malpractice claim may be filed. You can obtain advice on how to manage the situation, which could prevent a formal claim from being filed. If necessary, LAMMICO can investigate the matter while it is still fresh in everyone’s mind and witnesses are available. But the most important advantage is that when you give notice to LAMMICO that an incident has occurred, you ensure that your coverage is in effect at the time the incident is reported. Incidents that remain incidents and do not end up as claims will not be reflected on a credentialing claims history, nor should it affect your insurability at that level. When notifying the Claims Department about a new claim, contact the office that serves your area. If a claim is filed against you, management of that claim ensues. You, the insured healthcare professional, will participate in the process along with your defense team, comprised of your claim representative and your defense attorney. As a policyholder with LAMMICO, you may take part in the selection of a defense attorney from a list of approved counsel. And, as a physician whose primary coverage is with LAMMICO, you can be assured that no claim against you will be settled without your consent. LAMMICO has the responsibility under the insurance policy for payment of any settlement or judgment on behalf of you, the insured, up to the policy limit. The company also has the responsibility of investigating and defending the claim. You can be assured that no medical professional liability claim against you will be settled without your consent, subject to the terms of your policy. A third party claim is when someone who is not your patient makes a claim against you regarding a medical incident arising from the performance of your professional services. Some examples of when this may occur are: If your insurer does not cover these types of claims, you, personally, may be responsible for damages. This is especially important in Louisiana where the Supreme Court has taken the position that the Patient's Compensation Fund covers injury to patients only, not to third parties. If you have any additional questions, please contact us at 800.452.2120. To receive a copy of your claims history, please contact our Underwriting Department at 800.452.2120. View the article on How To Be More Effective at Your Deposition by Marc Judice, J.D., of Judice & Adley in Lafayette, LA. Frequency refers to the number of claims filed per healthcare provider. High frequency means that more than the average number of claims are being filed. Severity is the judgment/settlement component of the cost of a claim. High severity indicates that the judgments/settlements are large. In Louisiana, LAMMICO separates claims into two broad categories. 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. Examples If you have additional questions, visit our Frequently Asked Questions section or contact our Underwriting Department at 504.831.3756 or 800.452.2120.
Keep in mind that coverage will depend upon the allegations raised and particular facts and circumstances of each claim. We provide the following coverage examples to clarify how this works for policyholders who purchase limits of $1 million/$3 million: