Q&A: Common Claims Questions Answered by the PRMS Claims Team

An insurance policy with PRMS provides peace of mind, and should a client find themselves facing a claim, our professional claims managers are here to continue that service, providing counseling and support every step of the way, whether brief legal guidance or robust full-court defense is needed. Our experienced staff has a proven track record of delivering exceptional service for nearly 30,000 psychiatry-specific claims, lawsuits, and events since 1986, more than any other company in the U.S. So we asked the experts on the PRMS Claims Team to answer some of the most frequently asked questions about the claims process, including when to reach out and what to expect if faced with a lawsuit.

What makes PRMS’ claims handling perspective unique?

Your psychiatry insurance coverage with PRMS includes an expert claims team focused on achieving excellent results by providing quality defense through cost-effective means. This can best be accomplished by using a ‘team approach’ to involve the defense counsel, the claims representative, and our client – each team member contributes significantly to the development, investigation, analysis, and resolution of a claim. The process involves frequent communication among all parties, early strategy development to identify and prioritize issues that will help focus discovery activities to evaluate liability and damages promptly, coordinating tasks among team members, and a joint decision-making effort to arrive at a reasonable course of action that will expeditiously and successfully resolve the claim.

What is considered a claim?

In general, a 'claim' is a demand for money, received by an insured, which includes the notice of a lawsuit or any other similar legal proceeding to which the policy applies. Since 'claim' is defined in each client’s policy, the definition may vary by policy year. We recommend that you review the terms of your policy for the technical definition, or send our PRMS claims representatives whatever you think might be a covered claim and we will review it for coverage.

What happens after a claim is reported to PRMS?

Having a good basic understanding of the litigation process can help our clients reduce the anxiety and uncertainty that accompanies the traumatic experience of being named as a defendant in a lawsuit; and knowing what to anticipate can help clients assist their attorney in preparing a strong defense on their behalf in the event of a claim. The phases of litigation are generally as follows:

1. Notice: Some states require that the patient or a legal representative notify the physician that a claim for malpractice is forthcoming. This notice can take the form of either a letter from an attorney or a standard notice form promulgated by the state.
2. Summons and Complaint: A document that is served upon you that formally initiates a lawsuit. You should contact PRMS® immediately upon being served with a Summons and Complaint. The Complaint lists the plaintiff’s allegations of malpractice, and a formal answer must be filed by an attorney on your behalf within a specified time period. Failure to file an answer may result in a default judgment against you. Never attempt to answer the complaint on your own or contact the plaintiff or the plaintiff’s attorney directly. An attorney will be retained to assist you from this point forward.
3. Discovery: A pre-trial process in which the plaintiff and the defendant obtain information from each other and conduct an investigation to fully ascertain the facts and further develop the legal and medical theories involved in the case. One means of obtaining this information is by serving interrogatories, which are formal written questions answered under oath, on each party to the action. Another discovery method is a deposition – a formal question-and-answer session – in which one party to the lawsuit asks oral questions of the other party, parties, or witnesses. A deposition is conducted under oath, usually in one of the lawyer’s offices, with a court reporter, present to record the testimony.
4. Trial: Once all discovery is completed, the matter then proceeds to trial if a dismissal is not obtained or a settlement is not reached. The trial process involves the impaneling or selection of a jury, opening statements, the introduction of evidence through testimony of witnesses on both direct and cross examination, closing statements, jury instruction and deliberation, and the rendering of a verdict.

How are defense attorneys chosen to represent a PRMS client?

PRMS works with a nationwide panel of experienced psychiatric malpractice attorneys to represent the interests of our clients – in fact, a large number of firms that are currently on panel have been involved with PRMS since the inception of The Psychiatrist’s Program. Given the excellent reputation that PRMS has established over the years, we receive numerous requests from firms nationwide to be admitted to panel. Only the firms that have demonstrated expertise in defending psychiatric malpractice actions are considered on an as-needed basis.

When and how should I contact the Claims Department?

While we hope our clients never have to face a claim, the PRMS Claims Department is available and ready to assist you when needed. Contact your claims examiner when you have been sued, served with a subpoena, contacted by your state board of medicine or other governmental agency, notified of an adverse outcome about a patient, or contacted by an attorney requesting your medical records. And if you are unsure of whether or not to report a claim, you may always email ReportaClaim@PRMS.com or call 800-245-3333 and press ‘0’ so we may route your call to the appropriate PRMS representative.

If you have any questions or are interested in receiving a quote, contact us at (800) 245-3333 or TheProgram@prms.com.

Authored by PRMS.