Claims FAQS
In general, a 'claim' is a demand received by a client for money including the notice of a lawsuit, or any other similar legal proceeding to which the policy applies. Since 'claim' is defined in your Fair American Insurance and Reinsurance Company (FAIRCO) policy, the definition may vary by policy year and we recommend that you review the terms of your policy for the technical definition. Or, to make things easier, we recommend that you send us whatever you think might be a covered claim and we will review it for coverage.
Having a good basic understanding of the litigation process helps our clients to reduce the anxiety and uncertainty that accompanies the traumatic experience of being named as a defendant in a lawsuit. Also knowing what to anticipate helps the client to assist their attorney in preparing a strong defense on their behalf. The phases of litigation are generally as follows:
- 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.
- 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 period of time. 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.
- Discovery: A pre-trial process in which the plaintiff and the defendant obtain facts and information from each other and conduct an investigation in order to fully ascertain the facts and to 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 device is a deposition, which is a formal question and answer session in which one party to the lawsuit asks oral questions of the other party or parties or witnesses. A deposition is conducted under oath, usually in one of the lawyer’s offices, with a court reporter present who is recording the testimony.
- Trial: Once all discovery is completed, the matter then proceeds to trial. 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.
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PRMS utilizes a nationwide panel of experienced psychiatric malpractice attorneys to represent the interests of Program participants. A large number of firms that are currently on panel have been involved with Program since its inception. 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.
PRMS' claim philosophy is to provide a quality defense which yields excellent results by utilizing cost effective means. This can best be accomplished by using a team approach involving 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 the team members; early development of a plan or strategy to identify and prioritize issues to better focus discovery activities to evaluate liability and damages promptly; coordination of tasks among team members; a joint decision-making effort to arrive at a reasonable course of action to expeditiously and successfully resolve the claim.
