Medical liability claims can prove costly both in terms of money and the impact on the physician/healthcare system. According to the 2010 American Medical Association survey covering the period 2007 – 2008 more than 42% of physicians has been sued in the course of their careers. Healthcare providers facing a malpractice lawsuit should ideally get in touch with their medical liability insurer. Typically, the plaintiff’s attorney may contact the provider to request the relevant medical records for review purpose. The insurance carrier when informed would assign a claims representative to guide the provider through the process, assist in getting the relevant records and supervise the case coordination.
What are the major factors a medical liability insurance company considers before deciding to settle the malpractice case or go to trial?
The first and foremost thing they would look for are the plaintiff’s medical records. Are the records comprehensive, accurate and unaltered? A solid defense can be built only if these records are error-free, complete and reliable. If not, the insurer may consider settling the case.
Another important consideration would be the intensity of the adverse outcome. There are factors such as the deformity caused to the patient, severity of damages, and loss of quality of life that may have an impact on jury decision.
Defensibility of the case is the next major concern provided the medical records are excellently maintained. This is where the insurance company would enlist the services of a medical record review company to review the medical records and provide their judgment whether the standard of care was met. The medical experts would also be looking for causation, i.e., evidence whether the negligence of the physician caused the resulting injuries. The medical opinion of the experts in favor of the physician/provider is one of the most important factors that help determine whether a claim should be brought to trial or settled outside court. This highlights the importance of finding a reliable and reputable medical review company to partner with.
The nature of the defendant is another important aspect. Defendants who maintain their calm and communicate clearly have more of a chance to relate to the jury. On the other hand, defendants who emerge as hostile, patronizing, and insensitive may not succeed in winning jury support and are more likely to receive an unfavorable court verdict.
The insurance company would also be giving serious thought to what a jury might award in the case, i.e. the claim amount if the decision is in favor of the plaintiff. If that amount is in excess of the insurance policy’s limits, a settlement would be a better decision. This evaluation of jury award is difficult and involves many factors such as the plaintiff’s damages, judgments in similar cases, etc.
For a medical liability case to prove successful in the courtroom there should be a perfectly coordinated team comprising the healthcare provider, his/her insurer and an experienced medical malpractice attorney.