HAPI Medical Professional Liability Case Study

There are several features to the case of the burned patient which could leave the doctor culpable in a court of law. Given the high probability of infection from the operation and her already-compromised vision in the right eye, the doctor's actions in advising her to elect surgery seem extremely unwise. The patient specifically inquired about the risks of the procedure and the physician said there was nothing to worry about, which a layperson would be very likely to interpret as no risk at all (as the patient did). He did not inform her of the high risk of infection which, based upon the presentation of the case study, seems to be a widely-known risk of the procedure in the medical community.

The lifecycle of physician-based claim (CMS 1500) is something that we not only need to know, but also how to do from start to finish.

To conclude this report, there are four considerations of a legal and valid insurance contracts that patients may present at the provider’s office or clinic. The guide to understand and remember are as follows: (a) the patient or person insured must be a mentally competent adult and should not be under the influence of drugs or alcohol; (b) the insurance company must have a signed application and offer the policy to the patient, then the patient or person should accept the issuance of the policy without misrepresentation of facts on the application of the person being insured; (c) the services produced and sold or the exchange of value and the first premium payment should be submitted with the application considered must be presented together; and (d) there should be a legal purpose which is an insurable interest in the case of a person’s healthcare insurance policy. These are good guidelines to know and understand for the success of an administrative life cycle of a physician-based claim (CMS

When the referral is received from a physician outside the healthcare provider’s network, paper medical records relating to the health issue are requested, including office notes and test results. After the patient’s paper medical records are received by the scheduling office, the scheduler manually reviews the records for the diagnosis and reason for the referral to determine how to appropriately schedule the office visit. For example, if the patient recently suffered a stroke, the patient would be scheduled with a stroke specialist rather than a general neurologist.

This loss falls within our 2015 contract year, our cover is 27% of $750,000 xs $250,000 (Limit is $202,500). HAPI issued a Claims Made and Occurrence Medical Professional Liability policy with limits of $1,000,000 per occurrence and $3,000,000 aggregate effective 01/01/15 – 12/31/15

Medical malpractice claims have risen dramatically over the past 40 years alongside the financial claim awards (Kessler, 2011). Currently, America’s medical tort system is regulated and enforced primarily by the states (“Medical Tort System,” 2016). The main focus of tort law is to preserve the peace between two parties, to determine fault and discourage wrong doing (Pozgar, 2016). Most physicians today carry medical malpractice insurance to protect themselves from the high defense costs of claims and potential financial awards (Kessler, 2011). As the number of medical claims increase and jury awarded punitive damage skyrocket, medical malpractice insurance premiums have also risen dramatically (Kessler, 2011). Malpractice insurance

Overall, this program benefits from the longstanding business relationship between HAPI’s Executive Vice President, Norm Slaustas and CAP’s, Sr. Claims Specialist, Steve Weitzer, who been working together managing the HAPI program for nearly two decades. Mr. Slaustas

There are many defendants in this case. First and foremost Dale, the loss prevention officer for Wal-Mart, is a defendant because he intentionally restrained Bob against his will and the restraint was unlawful. Dale also failed to follow company rules; Dale was supposed to watch a video that explained how to catch and deal with thieves but decided not to watch the video. The second defendant would be Dale’s supervisor. The supervisor recorded a pass on an exam that dale did not take. The exam Dale failed to write was based on the video that Dale did not watch. The third defendant would be Wal-Mart; Wal-Mart assumes liability because they could be at fault for not properly training staff. Bob would want to take action on

HAPI’s claim program is exclusively managed by CAP’s Sr. Claims Specialist, Steve Weitzer who has been administrating this program for eighteen years. Mr. Weizter is an attorney and has experience defending medical professional liability claims. Currently, he manages a caseload of 75 claims (55 HAPI and 20 CAP claims), which is well with in the norm for a medical malpractice program. Communication between CAP and HAPI is extensive and well documented

The conference offers workshops that will clarify changes in the new Medicare policies as well as provide information detailing the supplemental insurance policies available to patients. This training offers a wonderful benefit to North Shore because when all care coordinators are educated about the new Medicare policies and can calculate the correct supplemental insurance plans for each patient, coordinators can recover treatment costs for the clinic. While the total cost to attend this conference is $18,000, this amount pales in comparison to the treatment costs that will be recovered due to the education of the clinic’s patient coordinators. Knowledge of the Medicare changes can help coordinators recover, for the clinic, up to or exceeding $50,000, per patient, in some cases. Therefore this one time cost will reap large returns down the

The Plaintiff attempted to cross three lanes of oncoming traffic to enter a gas station. The defendants' driver was speeding and ran a yellow light then struck the plaintiffs' car.

As previously commented, HAPI’s Executive Vice President, Norm Slaustas and CAP’s, Sr. Claim Specialist, Steven Weizter have been managing the HAPI claims program for nearly two decades. Over the years, both parties have developed an excellent working relationship with one another helping to foster an open line communication, encouraging effective claim strategies all in an effort to manage their claim exposure, mitigate damages and control claim cost.

Findings from a 2012 Study of Medical Negligence Claiming in Scotland revealed that patient support and advice groups find that when a complaint is made to the NHS in relation to a medical injury a defensive attitude tends to be adopted in response to such complaints. According to Professor Sir Ian Kennedy, Chairman of the Independent Parliamentary Standards Authority, this defensive attitude is what leads to claims being raised against the NHS. He stated that the current clinical negligence regime is what prompts defensiveness within the NHS and that this problem will persist as long as the fear of litigation and stigma of settlement remains. In the literature reviewed there seems to be a general consensus that the requirement for the claimant

The issue that many healthcare administrators seem to miss these days is what is currently happening behind the scenes when their hospital’s doctors are filing claims. This issue is very important to address considering your healthcare staff could be filing claims illegally to the Center for Medicaid and Medicare (CMS), and be subjected to the False Claims Act (FCA). Administrators need to make sure claims are filed correctly and not for the benefit of the doctors own pocket. Healthcare providers need to take caution and be aware of this situation occurring in their own hospital, as all healthcare organizations could be subjected to the False Claims Act. The Federal Claims Act is “one of the most powerful tools in the

“Medical malpractice occurs when a hospital, doctor or other health care professional, through a negligent act or omission, causes an injury to a patient. The negligence might be the result of errors in diagnosis, treatment, aftercare or health management.” (Admin) One of the most common type of claims that pharmacies face are negligence claims. Negligence is one of the categories that falls under the area of law called Torts. In the Hundley v Rite Aid case, a tort was filed for injuries that were sustained by Gabrielle Hundley after she took medication from an incorrectly filed prescription. The case involved a jury trial verdict involving Gabrielle Hundley, a minor child, against Howard Jones, the pharmacist, and the Rite