What do I have to notify my insurers about and when?
Insurers and their policies are often considered to be somewhat on the ‘dark side’: both in terms of perceived financial burden and expectations around notification. In fact, the contract you enter into when you purchase medical indemnity is highly transparent. The problem often lies in lack of communication around and understanding of the detail; and how many consultants can put hand on heart and say they have read their policies from cover to cover?!
Contrary to popular myth, notification does not equal automatic increase in premium. Underwriters have a sophisticated understanding of the nuances of medical complaints and claims and would in fact be more concerned if a client never notified an issue than if that client made a few notifications a year.
They look at each notification on its merits and would far prefer (and indeed the policy demands it) to be informed of a complaint or niggle or incident which you are worried about even if the patient has not raised a concern - in order to intervene at an early stage - rather than you trying to deal with the issue alone or ignoring it and potentially compromising or prolonging things in so doing. They build a certain allowance for minor notifications into their quotes.
What does this mean in practice then?
Your policy requires you to notify insurers as soon as possible and in any case no later than 30 days – sooner if you are renewing your insurance policy imminently - through the helpline supplied in your policy documentation of:
Any event which you believe may give rise to a claim – examples include: you have to use a different product to that which you stated you would use during the procedure; you had to take a different course of action - eg incision in a different place -to that agreed in the consent form; the patient is demanding care which you do not think you can provide – especially pertinent for cosmetic surgeons who often find themselves under pressure to over operate
Any intimation of a claim – eg a letter requesting your medical records and those of Spire or a verbal or written threat to seek legal advice
A patient complaint relating to alleged harm or loss to that patient
If you intend to refund a patient for treatment.
any merit in the claim. A consultant’s belief that the claim is spurious is often what gets them into trouble further down the line; assuming the issue will go away.
Patients can be very tenacious, especially when backed up by no win no fee ambulance chasing law firms who advertise on day time television and radio and even in private hospitals!
Throw into the mix the fact that since 2013 patients have been able to bring claims which, even if they lose at Trial, do not require payment of the defendant’s costs (ie your legal fees of going to Trial and winning), then it unfortunately makes for a very imbalanced situation where there is no real downside to the patient continuing down a contentious path for some time.
This is sadly the reality and why you need the best advice from the outset. When you notify these circumstances it enables you to benefit from early legal intervention (often ‘ghostwritten’ for you at this juncture to avoid escalating issues or making patients and their lawyers assume that solicitors are instructed because there is indeed an answerable claim) which can often close down the potential claim promptly at considerably less cost to you and your insurers.
Another aspect which is often overlooked is the emotional support that you will gain from being able to speak to experienced legal practitioners at this stage.
The policy also – and more obviously – requires immediate notification of:
GMC correspondence even it only relates to the initial investigation stage
Communication relating to inquests
Again, this must be notified ahead of renewal. If these documents arrive after you have filled in your renewal form but before the policy actually renews you should promptly forward them to us.
Lockton are here as your advocate and sit in between you and your insurers to represent your interests and voice any concerns. If you are unsure of whether you are obliged to notify, we are always here to help guide you and answer any queries.
Likewise, if you have any issues with how your claim is being handled by the legal advisors, then we can assist.
Our head of healthcare claims is a 12 year qualified clinical negligence defence lawyer with vast experience in handling complex medical malpractice claims and insurance coverage disputes and can assist in ensuring that your claim is being handled in the most efficient and effective (cost and strategy wise) way possible.
If you take nothing else away from this article please remember that if in doubt – notify!