According to your policy, all claims must be reported to PICA by written notice as soon as practical. If you fail to do so, you could void your professional liability insurance coverage. A claim includes a demand for money, services or a waiver of an outstanding balance. Examples of claims are:

• Notification or service of a summons and complaint (also known as a lawsuit).
• A written or verbal request from a patient or his attorney for waiver of an outstanding balance.
• A written or verbal request from a patient or his attorney seeking reimbursement of payments made.
• A written or verbal request from a patient or his attorney for payment of money.
• A written or verbal request from a patient or his attorney that you pay for medical expenses incurred subsequent to your care.
• A written or verbal request from a patient or his attorney that you provide free medical services in the future.
• A Notice of Intent to sue or letter specifically stating a claim is being made written by the patient or the patient’s attorney.

The PICA Claims Department should also be notified of any event or incident which results in or is likely to result in a claim for damages. An incident may include:

• A threat of a lawsuit by a patient or family member.
• A request for records by a patient or a patient’s authorized representative (e.g., an attorney), if the policyholder believes the request is related to the quality of care issues or a potential professional liability claim.
• Verbal or written allegations of misconduct such as sexual harassment, discrimination, etc.
• Verbal or written allegations of invasion of privacy/breach of confidentiality.
• Unexpected outcomes or deaths.
• Patient injury as a result of care, especially catastrophic injury, serious burns or any injury resulting in partial or permanent disability.
• Errors in the policyholder’s judgment or treatment.
• Injuries related to equipment or supplies.
• Any serious adverse event for which opinions or advice regarding liability exposure and management are needed.
• Governmental or Board of Podiatry investigations.
• Data breaches, lost or stolen laptops, network related issues.

If in doubt, contact the PICA Claims Department at (888) 444-7422 for guidance. Once notified, a PICA Claims Department representative will advise you if additional action needs to be taken and if additional information and/or documents will be needed.

For information regarding communication with patients who are unhappy with their care or who have experienced an unexpected outcome or undesirable result, see “What do I tell a patient that has suffered an unexpected outcome?” in the Communication section.

According to your professional liability insurance policy, you must, as soon as practical, give written notice to PICA of any claim made against you and, in the event of a lawsuit, you must immediately forward to PICA every demand, notice, summons or other process received. If you try to settle a claim without involving PICA, your actions could void your professional liability insurance coverage. Therefore, consult with PICA before attempting any settlement on your own.

PICA does not encourage the use of such forms. Mandatory arbitration contracts mean that in the event of a malpractice claim the patient and the physician agree to a hearing where a neutral third party will listen to both sides and give a binding opinion or judgment. While this may at first seem like a good idea, there are many claims of medical malpractice that are without merit. If defensible claims are taken to arbitration, the ability to defend the case is limited. Also, the use of these forms may breach your insurance contract with PICA.

PICA encourages policyholders to notify the claims department of any incident, claim or lawsuit as soon as practical. A claims specialist will evaluate the situation, provide guidance as necessary and appoint a defense attorney if needed and where permitted.