This document discusses the potential benefits of collaborative defense between large hospital systems that self-insure and traditional medical professional liability (MPL) insurers that are often co-defendants in MPL litigation. As consolidation in healthcare has increased, these organizations find themselves as co-defendants more frequently. Collaborative defense aims to promote open communication and a unified defense strategy between co-defendants. This can help build trust, promote timely resolution of cases, and reduce litigation expenses through strategies like sharing expert witnesses and discovery materials. The document recommends initial meetings between regional MPL insurers and hospital systems to discuss establishing collaborative defense approaches going forward. While collaborative defense presents some legal risks, establishing expectations of conduct between future potential co-defendants can
This document provides an overview of insurance markets in Latin America and the Caribbean. It discusses how insurance facilitates economic activity by allowing individuals and businesses to manage risks. The survey presented analyzes perceptions of the insurance industry in the region to identify factors affecting its development. Key findings include that insurance penetration and availability remain low compared to other regions. The document concludes by calling for further research to inform policies to strengthen insurance markets.
The document discusses micro-insurance practices and prospects in India. It introduces micro-insurance and describes common product types like loan-linked insurance, health insurance, and long-term insurance. It also examines the micro-insurance supply chain and popular distribution channels in India like MFIs, NGOs/CBOs, and government programs. Loan-linked life insurance dominates the Indian micro-insurance market.
Small-ticket Insurance point of view - VFRiaan Singh
Small-ticket insurance has grown significantly in recent years while other insurance sectors have struggled. It is being driven by rising incomes in emerging markets, new technologies, partnerships between insurers and other sectors, and improved operating models. While small-ticket insurance varies between mature and emerging markets, the mechanisms of product design, distribution, and administration share similarities that allow for integration and innovation across different markets. Insurers that succeed with small-ticket insurance improve their overall performance by interacting more frequently with customers and deepening their understanding of customer needs.
India is the global leader in microinsurance. Innovation is blooming and new products and delivery models are being explored. More than 300 million low-income risks are insured. Indeed, more than 60% of microinsurance policyholders are to be found in India! What are the catalysts for the success of microinsurance in India? What role has the government as well as market forces played in the exponential growth of the sector? What can insurers learn from India's experience? The webinar focuses on "Insights from India's Microinsurance Success", one of the chapters of the newly launched "Protecting the Poor: A Microinsurance Compendium, Volume II" published by the Munich Re Foundation and the International Labour Office.
This document discusses factors influencing Indian consumers' decisions to invest in life insurance. It finds that demographic factors like education, income, family size, and employment have a major impact. Specifically, it finds that education increases understanding of insurance needs, higher income allows for greater insurance purchasing, larger families increase needs for protection, and employment makes insurance more affordable. Additionally, the study finds that tax benefits are the primary reason consumers invest in life insurance, followed by risk coverage and savings opportunities. Overall, the document analyzes what drives Indian consumers' life insurance purchasing behaviors and investment decisions.
Marsh Risk Consulting has a team that assists companies in locating historic liability insurance policies dating back 60+ years that could provide coverage for long-tail exposures like asbestos, pollution, and product liabilities. These old policies may have broader coverage and higher limits than modern policies. However, many companies' records are incomplete. Marsh's insurance archaeologists use extensive research methods to help clients find lost insurance assets, including searching broker and insurer archives and interviewing former employees.
This document discusses trends in fiduciary liability insurance for employee benefit plans. It notes that standard policies now provide expanded coverage, including for pre-claim investigations, settlor functions, voluntary compliance programs, and risks from new legislation. Plans should evaluate if their current coverage is sufficient given these changes.
Diagnostic Error Reprint PLUS Journal April 2015Paul Greve
This document discusses diagnostic errors in medicine based on analysis of closed malpractice claims data from 2008-2012. Some key points:
- Diagnostic errors accounted for the second highest number of closed claims and highest average indemnity payments of all chief medical factors.
- Diagnostic errors occurred across medical specialties, including 9% of claims involving surgeons and 22% involving hospitalists.
- Radiologists were most commonly named in diagnostic error claims, which often involved missed cancers. Obstetricians had the highest indemnity payments.
- With more physicians employed by hospitals, diagnostic errors potentially expose the full limit of hospital professional liability policies, emphasizing the need for hospital safety programs addressing this
This document provides an overview of insurance markets in Latin America and the Caribbean. It discusses how insurance facilitates economic activity by allowing individuals and businesses to manage risks. The survey presented analyzes perceptions of the insurance industry in the region to identify factors affecting its development. Key findings include that insurance penetration and availability remain low compared to other regions. The document concludes by calling for further research to inform policies to strengthen insurance markets.
The document discusses micro-insurance practices and prospects in India. It introduces micro-insurance and describes common product types like loan-linked insurance, health insurance, and long-term insurance. It also examines the micro-insurance supply chain and popular distribution channels in India like MFIs, NGOs/CBOs, and government programs. Loan-linked life insurance dominates the Indian micro-insurance market.
Small-ticket Insurance point of view - VFRiaan Singh
Small-ticket insurance has grown significantly in recent years while other insurance sectors have struggled. It is being driven by rising incomes in emerging markets, new technologies, partnerships between insurers and other sectors, and improved operating models. While small-ticket insurance varies between mature and emerging markets, the mechanisms of product design, distribution, and administration share similarities that allow for integration and innovation across different markets. Insurers that succeed with small-ticket insurance improve their overall performance by interacting more frequently with customers and deepening their understanding of customer needs.
India is the global leader in microinsurance. Innovation is blooming and new products and delivery models are being explored. More than 300 million low-income risks are insured. Indeed, more than 60% of microinsurance policyholders are to be found in India! What are the catalysts for the success of microinsurance in India? What role has the government as well as market forces played in the exponential growth of the sector? What can insurers learn from India's experience? The webinar focuses on "Insights from India's Microinsurance Success", one of the chapters of the newly launched "Protecting the Poor: A Microinsurance Compendium, Volume II" published by the Munich Re Foundation and the International Labour Office.
This document discusses factors influencing Indian consumers' decisions to invest in life insurance. It finds that demographic factors like education, income, family size, and employment have a major impact. Specifically, it finds that education increases understanding of insurance needs, higher income allows for greater insurance purchasing, larger families increase needs for protection, and employment makes insurance more affordable. Additionally, the study finds that tax benefits are the primary reason consumers invest in life insurance, followed by risk coverage and savings opportunities. Overall, the document analyzes what drives Indian consumers' life insurance purchasing behaviors and investment decisions.
Marsh Risk Consulting has a team that assists companies in locating historic liability insurance policies dating back 60+ years that could provide coverage for long-tail exposures like asbestos, pollution, and product liabilities. These old policies may have broader coverage and higher limits than modern policies. However, many companies' records are incomplete. Marsh's insurance archaeologists use extensive research methods to help clients find lost insurance assets, including searching broker and insurer archives and interviewing former employees.
This document discusses trends in fiduciary liability insurance for employee benefit plans. It notes that standard policies now provide expanded coverage, including for pre-claim investigations, settlor functions, voluntary compliance programs, and risks from new legislation. Plans should evaluate if their current coverage is sufficient given these changes.
Diagnostic Error Reprint PLUS Journal April 2015Paul Greve
This document discusses diagnostic errors in medicine based on analysis of closed malpractice claims data from 2008-2012. Some key points:
- Diagnostic errors accounted for the second highest number of closed claims and highest average indemnity payments of all chief medical factors.
- Diagnostic errors occurred across medical specialties, including 9% of claims involving surgeons and 22% involving hospitalists.
- Radiologists were most commonly named in diagnostic error claims, which often involved missed cancers. Obstetricians had the highest indemnity payments.
- With more physicians employed by hospitals, diagnostic errors potentially expose the full limit of hospital professional liability policies, emphasizing the need for hospital safety programs addressing this
Michael Marick - Breaking down barriers in policyholder- insurer disputes ove...Michael Marick
Corporate policyholders/insureds who have been sued share a common interest with their liability insurers—successfully defending those lawsuits. Yet insureds and insurers often disagree on the choice of defense counsel and how much the insurer must pay toward legal bills. These disputes are costly and, in most instances, can be avoided.
Matthew Williams answers the following question: Can my commercial client get ATE legal expenses insurance for
an appeal? (Their ‘solid’ claim most unexpectedly lost at trial – there is no policy currently in place.)
The document discusses sexual molestation litigation and recovering costs through historic insurance policies. As sexual abuse claims increase due to lifted statutes of limitations, organizations face significant financial impacts. Coverage is more likely found in older policies from 1960-1980 that lack modern exclusions. However, locating and negotiating with multiple historic insurers presents challenges in determining injury dates, triggered policies, cost allocations, and insurer participation. Willis Towers Watson provides services to help clients overcome these challenges through insurance archaeology, claim dispute resolution, loss allocation modeling, and insurance asset valuation.
This document provides an overview of the Summer 2015 edition of the Public RM magazine. It includes:
- A preview of sessions at the upcoming Alarm National Educational Forum, including a session challenging conventional approaches to defending claims.
- A summary of the Chairman's comments, where he discusses recent governance failings in local councils and questions if lack of resources has led to corners being cut in important areas like governance and risk management.
- The contents page listing various articles in the magazine on topics like insurance, charities, children's services, and cyber security.
Insurance intermediaries serve as the critical link between insurance companies and consumers. They facilitate the placement and purchase of insurance and provide services to both insurers and policyholders. There are two main types of intermediaries - insurance agents, who represent insurers, and insurance brokers, who represent policyholders. Intermediaries advise consumers, present insurance options, and assist with placing coverage, claims management, and risk management. They are an essential part of insurance supervision and distribution.
Workers Compensation Insurance - Securing Your Employees' Future.pptxBonano Insurance
This intricate interplay between state guidance and employer responsibilities ensures a system that, when adhered to, exemplifies our societal stride towards justice and care for every worker.
1) CPAs and other financial professionals are now considered fiduciaries under new regulations, requiring them to put their clients' interests first.
2) Record keeping is crucial to demonstrate that all work was conducted within compliance guidelines, including documenting all client meetings and the process for insurance transactions.
3) A lawsuit awarded $14.2 million to a plaintiff after two reputable firms provided dramatically different calculations for life insurance premiums to maintain the same benefits, illustrating the risks of relying on common industry practices. Proper application of prudent investor principles could have avoided litigation.
Fiduciary liability insurance covers plan sponsors and fiduciaries for liability arising from managing employee benefit plans, such as 401(k) plans. While premiums have historically been low, several factors are increasing risks for plan sponsors of smaller defined contribution plans, including conservative investment choices by participants, low returns, and investment fees. As a result, more lawsuits are being brought against smaller plans claiming excessive fees reduced returns. Plan sponsors should review their fiduciary liability coverage and ensure proper oversight of retirement plans.
This document summarizes a lecture on the general business environment for life assurance companies. It discusses how the economic, legal, regulatory, and professional environments can impact insurer expenses, risk levels, and opportunities. Specifically, it notes that inflation can influence expenses, developing or volatile economies present higher risks, and legal/regulatory changes may constrain product design or contract terms over long time periods.
Workers' compensation insurance provides critical financial protection for employees who are injured on the job. It offers a comprehensive safety net that covers medical expenses, disability benefits, and lost wages. While mandated in most states, it also benefits employers by shielding them from lawsuits. The system balances the needs of employers and employees to support injured workers while promoting compliance with state regulations.
The document examines the characteristics of insurance contracts, defining insurable risks as risks that can be pooled and calculated to determine premiums, and insurance contracts as agreements where insurers take on risks from policyholders in exchange for premiums. It also discusses the benefits of insurance in reducing uncertainty through risk pooling and diversification, as well as the costs of moral hazard and adverse selection, and how insurers use mechanisms like deductibles, limits, and coinsurance to mitigate these costs.
November 2017 Reprint - Actively Manage Your Risk with a Captive Insurance Co...CBIZ, Inc.
Captive insurance companies allow companies to insure and manage their own risks. They provide benefits for commercial real estate companies who deal with risks like workers compensation, general liability, floods, and loss of rents. Captive insurance structures include pure/single parent captives, group captives, and micro-captives. Micro-captives in particular provide tax benefits and flexibility for smaller companies. While captives provide advantages like tailored coverage and tax benefits, they also involve additional costs and regulatory requirements. Commercial real estate companies should evaluate whether a captive insurance company fits with their risk management strategy.
Fiduciary liability insurance covers plan sponsors and fiduciaries for liability arising from managing employee benefit plans, such as 401(k) plans. While premiums have historically been low, several factors are increasing risks for plan sponsors of defined contribution plans and lawsuits alleging excessive fees are being brought against smaller plans. As legal strategies evolve, plan sponsors should review their fiduciary liability coverage and ensure prudent management of retirement plans.
Who are today's consumers of Legal Expenses Insurance?Demi Edmunds
Jacqueline Harvey talks about who today's consumers of legal expenses insurance are, in short - An increasing range of those using dispute resolution services.
Controlling Workers’ Compensation Costs by as Much as 20% - 50%Richard Swartzbaugh
What is Workers’ Compensation?
Who Benefits from Workers’ Compensation Cost Control? Everyone!!!
Worker’s Comp costs can be one of your Company’s greatest “out of control” costs, or, YOU can but in a proven 19-step system to reduce Workers’ Comp costs by as much as 20% - 50%, and utilize critical metrics to address:
- Why workers’ compensation metrics are important
- The formulas for how to calculate 5 critical metrics
- How to leverage these metrics to make an impact at your organization
Following the step-by-step instructions in 19-Step system for the calculation and application of critical metrics will address:
- Workers’ comp viewed as a cost of doing business
- Getting management to understand value of return to work
- Convincing policy holders to embrace a worker recovery program
- Lack of informed and effective employer involvement in WC claims issues
- Stakeholder apathy
- Managers and supervisors not taking seriously their duty to protect workers
Avoiding Workers’ Comp mistakes & loopholes will help drive three major points:
- Drivers of human behavior
- Disincentives to “Return to Work”
- Most common employer mistakes
Finally:
- Evidence-based medicine will create better Workers’ Comp claim outcomes.
- In organized environments, executing successful return to work programs with Unions (and members) is essential.
- As part of a comprehensive workers compensation program, employers should maintain close communications with injured employees to ensure they recover quickly, do not drop out of the workforce and return to work rapidly. Get Well Cards are part of a positive, proactive communication strategy.
1) The document discusses using insurance as part of the default waterfall for central counterparties (CCPs). It argues that insurance can help absorb credit losses and provide liquidity if structured properly.
2) It proposes an insurance consortium made up of diversified insurers to mitigate single counterparty risk. The consortium would have clear policy wording and designated managers with expertise in clearing.
3) Insurance could be cost-effective for CCPs if placed correctly in the default waterfall. Bringing in the claims-paying ability of insurers could strengthen the financial system overall.
Willis Towers Watson provides liability claim consulting services to help clients manage complex liability claims and maximize insurance recoveries. Their services include insurance claim dispute resolution, loss allocation modeling, insurance archaeology, and insurance asset valuation and coverage analysis. They have expertise in claims related to asbestos, chemicals, medical devices, pollution and other issues. Their goal is to help clients avoid litigation, develop strong insurance recovery strategies, and strengthen their organization.
How should I prepare an ATE application? MLM 4Demi Edmunds
The document discusses preparing an application for after the event legal expenses insurance (ATE). It provides guidance on the key information insurers will need, including a brief case summary, financial details, and estimates of costs. It recommends being realistic about the appropriate level of cover and notes insurers are conscious of risk alignment. Common types of cover include adverse costs, own disbursements, and sometimes own costs, though the latter is less common.
Week #5-To Do List-CCHWeek 5 IntroductionIntroduction To Co.docxcelenarouzie
Week #5-To Do List-CCH
Week 5: Introduction
Introduction To Compliance Documentation & Reporting
Proper documentation is an inherent component of delivery of care, not an add-on. One of the oldest battles in healthcare is that between the hospital Medical Records department and the admitting Physician to complete necessary documentation for the Patient’s Chart. The most common cause of loss of admitting privileges has been from this source. This process has only become more important and necessary with the increasing recognition of the importance of proper documentation for legal and ethical defense purposes.
Documentation also serves a number of financial aspects of patient care delivery, including billing, grant writing for research projects, medical research to discover future tests, procedures, and cures, and funding for government supported agencies and programs.
Objectives
To successfully complete this learning unit, you will be expected to:
Identify the uses for health care documentation.
Learn the essential components of quality documentation.
Categorize the document guidelines under the federal False Claims Act.
Identify the documentation required for compliance under the Federal Stark Law.
List the aspects of documentation compliance with regard to electronic health records.
Identify the important issues regarding ethical coding practices.
Learn the most common illegal practices for HIM reporting.
Identify the key concerns under the federal False Claims Act that relate to reporting.
Determine the impact of the Physician Quality Reporting Initiative (PQRI) on HIM processes in physicians’ offices.
Identify the circumstances in which a health care professional is mandated to report a patient’s diagnosis.
Week 5: Discussion
Answer the following questions:
Review the various uses for health care documentation and discuss how each has an impact on the health care delivery system
Discuss procedures you might enact in your facility to avoid violating the False Claims Act
Discuss why physician offices should participate in PQRI
Week 5: Case Study Assignment
Please read and choose one of the following case studies:
Case study on page 111 of your textbook. (This Case Study is in the section for Securing EHR and starts with "NOTE: In each CMP (Civil Monetary Penalties) case resolved through a settlement agreement, . . . ")
Case study on page 127 of your textbook. (This Case Study is in the section for Phantom Patients and starts with "Two Charged in False Claims to Medicaid."
Case study on page 128 of your textbook. (This Case Study is in the section for Services not Performed and starts with "WASHINGTON—April 14, 2008—A board-certified radiologist, Fred Steinberg, M.D., his imaging centers . . ."
Case study on page 131 of your textbook. (This Case Study is in the section for Upcoding and starts with "July 2007: In Florida, a doctor was sentenced to 78 months in prison .
Arbitration in Insurance Coverage Disputes: Pluses and MinusesNationalUnderwriter
The document analyzes the perceived advantages and disadvantages of arbitration in insurance coverage disputes. Some key advantages of arbitration include finality due to limited appeals, enforceability of decisions internationally, flexibility in procedures, and neutrality of venue. However, arbitration can also limit legal protections for the weaker party, decrease precedent from favorable rulings, and eliminate principles such as construing ambiguity against the insurer. While arbitration may be faster and cheaper, these benefits are limited in complex cases. Policyholders should consider negotiating arbitration provisions or avoiding policies with mandatory arbitration clauses.
More Related Content
Similar to Collaborative Defense PLUS Journal 10-16
Michael Marick - Breaking down barriers in policyholder- insurer disputes ove...Michael Marick
Corporate policyholders/insureds who have been sued share a common interest with their liability insurers—successfully defending those lawsuits. Yet insureds and insurers often disagree on the choice of defense counsel and how much the insurer must pay toward legal bills. These disputes are costly and, in most instances, can be avoided.
Matthew Williams answers the following question: Can my commercial client get ATE legal expenses insurance for
an appeal? (Their ‘solid’ claim most unexpectedly lost at trial – there is no policy currently in place.)
The document discusses sexual molestation litigation and recovering costs through historic insurance policies. As sexual abuse claims increase due to lifted statutes of limitations, organizations face significant financial impacts. Coverage is more likely found in older policies from 1960-1980 that lack modern exclusions. However, locating and negotiating with multiple historic insurers presents challenges in determining injury dates, triggered policies, cost allocations, and insurer participation. Willis Towers Watson provides services to help clients overcome these challenges through insurance archaeology, claim dispute resolution, loss allocation modeling, and insurance asset valuation.
This document provides an overview of the Summer 2015 edition of the Public RM magazine. It includes:
- A preview of sessions at the upcoming Alarm National Educational Forum, including a session challenging conventional approaches to defending claims.
- A summary of the Chairman's comments, where he discusses recent governance failings in local councils and questions if lack of resources has led to corners being cut in important areas like governance and risk management.
- The contents page listing various articles in the magazine on topics like insurance, charities, children's services, and cyber security.
Insurance intermediaries serve as the critical link between insurance companies and consumers. They facilitate the placement and purchase of insurance and provide services to both insurers and policyholders. There are two main types of intermediaries - insurance agents, who represent insurers, and insurance brokers, who represent policyholders. Intermediaries advise consumers, present insurance options, and assist with placing coverage, claims management, and risk management. They are an essential part of insurance supervision and distribution.
Workers Compensation Insurance - Securing Your Employees' Future.pptxBonano Insurance
This intricate interplay between state guidance and employer responsibilities ensures a system that, when adhered to, exemplifies our societal stride towards justice and care for every worker.
1) CPAs and other financial professionals are now considered fiduciaries under new regulations, requiring them to put their clients' interests first.
2) Record keeping is crucial to demonstrate that all work was conducted within compliance guidelines, including documenting all client meetings and the process for insurance transactions.
3) A lawsuit awarded $14.2 million to a plaintiff after two reputable firms provided dramatically different calculations for life insurance premiums to maintain the same benefits, illustrating the risks of relying on common industry practices. Proper application of prudent investor principles could have avoided litigation.
Fiduciary liability insurance covers plan sponsors and fiduciaries for liability arising from managing employee benefit plans, such as 401(k) plans. While premiums have historically been low, several factors are increasing risks for plan sponsors of smaller defined contribution plans, including conservative investment choices by participants, low returns, and investment fees. As a result, more lawsuits are being brought against smaller plans claiming excessive fees reduced returns. Plan sponsors should review their fiduciary liability coverage and ensure proper oversight of retirement plans.
This document summarizes a lecture on the general business environment for life assurance companies. It discusses how the economic, legal, regulatory, and professional environments can impact insurer expenses, risk levels, and opportunities. Specifically, it notes that inflation can influence expenses, developing or volatile economies present higher risks, and legal/regulatory changes may constrain product design or contract terms over long time periods.
Workers' compensation insurance provides critical financial protection for employees who are injured on the job. It offers a comprehensive safety net that covers medical expenses, disability benefits, and lost wages. While mandated in most states, it also benefits employers by shielding them from lawsuits. The system balances the needs of employers and employees to support injured workers while promoting compliance with state regulations.
The document examines the characteristics of insurance contracts, defining insurable risks as risks that can be pooled and calculated to determine premiums, and insurance contracts as agreements where insurers take on risks from policyholders in exchange for premiums. It also discusses the benefits of insurance in reducing uncertainty through risk pooling and diversification, as well as the costs of moral hazard and adverse selection, and how insurers use mechanisms like deductibles, limits, and coinsurance to mitigate these costs.
November 2017 Reprint - Actively Manage Your Risk with a Captive Insurance Co...CBIZ, Inc.
Captive insurance companies allow companies to insure and manage their own risks. They provide benefits for commercial real estate companies who deal with risks like workers compensation, general liability, floods, and loss of rents. Captive insurance structures include pure/single parent captives, group captives, and micro-captives. Micro-captives in particular provide tax benefits and flexibility for smaller companies. While captives provide advantages like tailored coverage and tax benefits, they also involve additional costs and regulatory requirements. Commercial real estate companies should evaluate whether a captive insurance company fits with their risk management strategy.
Fiduciary liability insurance covers plan sponsors and fiduciaries for liability arising from managing employee benefit plans, such as 401(k) plans. While premiums have historically been low, several factors are increasing risks for plan sponsors of defined contribution plans and lawsuits alleging excessive fees are being brought against smaller plans. As legal strategies evolve, plan sponsors should review their fiduciary liability coverage and ensure prudent management of retirement plans.
Who are today's consumers of Legal Expenses Insurance?Demi Edmunds
Jacqueline Harvey talks about who today's consumers of legal expenses insurance are, in short - An increasing range of those using dispute resolution services.
Controlling Workers’ Compensation Costs by as Much as 20% - 50%Richard Swartzbaugh
What is Workers’ Compensation?
Who Benefits from Workers’ Compensation Cost Control? Everyone!!!
Worker’s Comp costs can be one of your Company’s greatest “out of control” costs, or, YOU can but in a proven 19-step system to reduce Workers’ Comp costs by as much as 20% - 50%, and utilize critical metrics to address:
- Why workers’ compensation metrics are important
- The formulas for how to calculate 5 critical metrics
- How to leverage these metrics to make an impact at your organization
Following the step-by-step instructions in 19-Step system for the calculation and application of critical metrics will address:
- Workers’ comp viewed as a cost of doing business
- Getting management to understand value of return to work
- Convincing policy holders to embrace a worker recovery program
- Lack of informed and effective employer involvement in WC claims issues
- Stakeholder apathy
- Managers and supervisors not taking seriously their duty to protect workers
Avoiding Workers’ Comp mistakes & loopholes will help drive three major points:
- Drivers of human behavior
- Disincentives to “Return to Work”
- Most common employer mistakes
Finally:
- Evidence-based medicine will create better Workers’ Comp claim outcomes.
- In organized environments, executing successful return to work programs with Unions (and members) is essential.
- As part of a comprehensive workers compensation program, employers should maintain close communications with injured employees to ensure they recover quickly, do not drop out of the workforce and return to work rapidly. Get Well Cards are part of a positive, proactive communication strategy.
1) The document discusses using insurance as part of the default waterfall for central counterparties (CCPs). It argues that insurance can help absorb credit losses and provide liquidity if structured properly.
2) It proposes an insurance consortium made up of diversified insurers to mitigate single counterparty risk. The consortium would have clear policy wording and designated managers with expertise in clearing.
3) Insurance could be cost-effective for CCPs if placed correctly in the default waterfall. Bringing in the claims-paying ability of insurers could strengthen the financial system overall.
Willis Towers Watson provides liability claim consulting services to help clients manage complex liability claims and maximize insurance recoveries. Their services include insurance claim dispute resolution, loss allocation modeling, insurance archaeology, and insurance asset valuation and coverage analysis. They have expertise in claims related to asbestos, chemicals, medical devices, pollution and other issues. Their goal is to help clients avoid litigation, develop strong insurance recovery strategies, and strengthen their organization.
How should I prepare an ATE application? MLM 4Demi Edmunds
The document discusses preparing an application for after the event legal expenses insurance (ATE). It provides guidance on the key information insurers will need, including a brief case summary, financial details, and estimates of costs. It recommends being realistic about the appropriate level of cover and notes insurers are conscious of risk alignment. Common types of cover include adverse costs, own disbursements, and sometimes own costs, though the latter is less common.
Week #5-To Do List-CCHWeek 5 IntroductionIntroduction To Co.docxcelenarouzie
Week #5-To Do List-CCH
Week 5: Introduction
Introduction To Compliance Documentation & Reporting
Proper documentation is an inherent component of delivery of care, not an add-on. One of the oldest battles in healthcare is that between the hospital Medical Records department and the admitting Physician to complete necessary documentation for the Patient’s Chart. The most common cause of loss of admitting privileges has been from this source. This process has only become more important and necessary with the increasing recognition of the importance of proper documentation for legal and ethical defense purposes.
Documentation also serves a number of financial aspects of patient care delivery, including billing, grant writing for research projects, medical research to discover future tests, procedures, and cures, and funding for government supported agencies and programs.
Objectives
To successfully complete this learning unit, you will be expected to:
Identify the uses for health care documentation.
Learn the essential components of quality documentation.
Categorize the document guidelines under the federal False Claims Act.
Identify the documentation required for compliance under the Federal Stark Law.
List the aspects of documentation compliance with regard to electronic health records.
Identify the important issues regarding ethical coding practices.
Learn the most common illegal practices for HIM reporting.
Identify the key concerns under the federal False Claims Act that relate to reporting.
Determine the impact of the Physician Quality Reporting Initiative (PQRI) on HIM processes in physicians’ offices.
Identify the circumstances in which a health care professional is mandated to report a patient’s diagnosis.
Week 5: Discussion
Answer the following questions:
Review the various uses for health care documentation and discuss how each has an impact on the health care delivery system
Discuss procedures you might enact in your facility to avoid violating the False Claims Act
Discuss why physician offices should participate in PQRI
Week 5: Case Study Assignment
Please read and choose one of the following case studies:
Case study on page 111 of your textbook. (This Case Study is in the section for Securing EHR and starts with "NOTE: In each CMP (Civil Monetary Penalties) case resolved through a settlement agreement, . . . ")
Case study on page 127 of your textbook. (This Case Study is in the section for Phantom Patients and starts with "Two Charged in False Claims to Medicaid."
Case study on page 128 of your textbook. (This Case Study is in the section for Services not Performed and starts with "WASHINGTON—April 14, 2008—A board-certified radiologist, Fred Steinberg, M.D., his imaging centers . . ."
Case study on page 131 of your textbook. (This Case Study is in the section for Upcoding and starts with "July 2007: In Florida, a doctor was sentenced to 78 months in prison .
Arbitration in Insurance Coverage Disputes: Pluses and MinusesNationalUnderwriter
The document analyzes the perceived advantages and disadvantages of arbitration in insurance coverage disputes. Some key advantages of arbitration include finality due to limited appeals, enforceability of decisions internationally, flexibility in procedures, and neutrality of venue. However, arbitration can also limit legal protections for the weaker party, decrease precedent from favorable rulings, and eliminate principles such as construing ambiguity against the insurer. While arbitration may be faster and cheaper, these benefits are limited in complex cases. Policyholders should consider negotiating arbitration provisions or avoiding policies with mandatory arbitration clauses.
Similar to Collaborative Defense PLUS Journal 10-16 (20)
Arbitration in Insurance Coverage Disputes: Pluses and Minuses
Collaborative Defense PLUS Journal 10-16
1. JournalYOUR SOURCE FOR PROFESSIONAL LIABILITY EDUCATION AND NETWORKING
October 2016 PLUS Journal 1
October 2016
Vol. XXIX
Number 10
PLUS Journal Reprint
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written permission.
Collaborative Defense in MPL: The New Era
by Paul A. Greve, Jr., JD, RPLU
Paul A. Greve, Jr., JD,
RPLU is Executive
Vice President at
Willis Towers Watson.
He can be reached
at paul.greve@
willistowerswatson.
com.
Consolidation in the health care
industry has impacted literally every
segment of the medical professional
liability industry: Hospitals and health
care systems; physician and groups;
long term care; managed care
organizations/health plans, and
miscellaneous facilities (anything not
acute care or long-term care). Hospital
mergers and acquisitions, and the trend
towards purchasing physician practices
by hospitals, have resulted in far fewer
hospital organizations and individual
physicians/group insureds in most
geographic areas.
More of these larger hospital and health
system organizations have self-insurance
programs for medical professional
liability coverage, with the most
common risk financing vehicle utilized
being a captive insurance company
typically domiciled in the Cayman
Islands or Vermont, as well as other
domiciles. Usually there is a significant
self-insured retention, often ranging
from $3M to $15M and even higher.
With fewer free-standing hospitals,
especially in metropolitan areas and
select geographic regions, these large
self-insured hospital systems are
co-defendants with traditional physician
and other insurers with more frequency
than ever before. Part of what is driving
this is the creation of accountable care
organizations (ACOs) and other
contractual networks such as clinically
integrated networks (CINs) and
clinically integrated organizations
(CIOs), and myriad versions of each, as
well as joint ventures (JVs).
The parties to these arrangements more
than ever share a common interest that
can be of strategic value in the defense
of MPL litigation. Collaborative defense
potentially builds trust, promotes
communication, aids in a more timely
resolution, and eases the exchange of
information beneficial to the defense of
a case. Collaborative defense is primarily
an attitude: let’s work together as much
as we can as codefendants while
recognizing our duty to defend our
respective clients and with an awareness
of issues like privilege and discovery.
There has never been a time with both
greater need and opportunity for the
collaborative defense of medical
professional liability (MPL) claims.
Claim frequency is low but claim
severity continues to rise, albeit
manageably. There are still very large
dollar amounts potentially exposed in
MPL litigation.
The Goal of Collaboration/Initiation
The goal of the approach to a collaborative
defense is to create clear communication
between large hospital systems and
traditional physician insurers and other
carriers in MPL segments most likely to be
codefendants in claims with hospitals/
systems (e.g. miscellaneous facilities, long-
term care facilities). The collaboration of
codefendants promotes a vigorous defense.
Collaboration may also save expenses
by sharing costs whenever possible, as
with the copying of records. Shared
ideas on defense, shared expert
witnesses, shared costs and time saved
can all be the fruits of a more
collaborative approach to MPL
litigation. Trust is foundational. There
are to be no surprises sprung by
codefendants throughout the pre-suit
and litigation process that furthers the
plaintiff’s case, chiefly testimony by
defense expert witnesses for the purpose
of blaming other codefendants.
If nothing else is achieved, a personal
relationship between the systems’
in-house legal and risk management
staff with responsibility for claims and
the carrier’s local and regional claims
staff goes a long way to opening
communication and helps avoid issues
that prevent the best possible defense,
thereby benefiting the plaintiff. This
means an introductory meeting of the
appropriate representatives of entities
that are most likely to be recurring
codefendants in malpractice litigation:
the hospital/system and regional
insurers most likely to be codefendants
in MPL litigation. This is especially true
with independent physician groups and
with contractual networks like ACOs,
CIOs and CINs.
Collaborative Defense and Joint
Defense
A collaborative defense can be
distinguished from a joint defense
strategy but the two approaches share
2. 2 Professional Liability Underwriting Society
certain goals. The main goal is to avoid
infighting and thereby promote the best
possible outcome for codefendants.
Joint defense strategies are more
formalized than collaborative defense
strategies and can be defined as follows:
“…a joint defense agreement is an
agreement among attorneys for different
defendants in a case who agree to share
confidential information that would
otherwise be protected by the attorney-
client privilege to further a common
defense goal…”1
There are risks to these types of joint
defense agreements or collaborative
defense arrangements. Defining the
scope of any collaborative defense
agreement can be helpful to promote
communication among the parties but it
need not be formalized by written
agreement. An outline of main points
that promote collaboration would
suffice, and such an outline could be
used as an agenda for meetings to discuss
collaboration. What is most important is
fostering a collaborative attitude on the
part of potential future codefendants.
Introductory Meetings: Regional
MPL Carriers & Hospitals/Systems
Regional insurers of physicians and
miscellaneous facilities are most likely
to be codefendants with hospitals/
systems in MPL litigation, particularly
when there are local contractual
networks in place. Accordingly, those
insurers should take the initiative to
meet with local hospitals/systems
inhouse staff responsible for overseeing
and coordinating litigation and risk
management. The larger traditional
physician insurers have now expanded
their coverages and services, and
hospitals/systems are potential buyers.
Without a track record of having a
collaborative approach to claims and
litigation in physician claims, it is
highly unlikely such insurers would be
considered for a hospital/system excess
layers of MPL coverage or other lines of
coverage and unbundled services.
The focus of the initial meeting(s) is to
find multiple ways to collaborate
whenever the parties are codefendants in
MPL litigation. The parties need to have
an expectation of conduct in future
cases.2
Collaboration among the
codefendants to the greatest extent
possible throughout the litigation is the
goal. That goal must be communicated
and accepted by all defense lawyers for
potential future codefendants.
Here are some possible agenda items for
aninitialmeetingtodiscusscollaborative
defense:
• Past relationships/conduct of
defense when codefendants
• Past areas of disagreement/
dissatisfaction
• Identification of common
goals
• Review future scenarios that
create potential for
collaboration and/or conflict:
e.g. unfavorable defense
expert opinions
• Review possible participation
in mediation/arbitration
• Discuss conduct expected
going forward: e.g. no
“finger-pointing”, cross-
claims, etc.
• Discuss potential for shared
expenses going forward
It is possible to memorialize the
aforementioned points but this can
create risk, as discussed below.
Collaborative Defense: Minefield
Collaborative defense approaches, like
joint defense, are not without some risk
to those who choose to participate.
Simply put, the main issue is
discoverability during the course of the
litigation in question and potentially in
any insurance coverage dispute. The
parties should be aware of any applicable
local laws. However, these risks need not
always be controlling.
Conclusion
Consolidation in the health care
industry has brought disparate
organizations together more closely
than ever before. So has the creation of
many types of contractual networks in
the form of CINs, CIOs, partnerships,
and joint ventures. Inevitably, these
organizations will be drawn into
medical professional liability (MPL)
litigation.
There is a unique opportunity in today’s
changing health care industry
environment to be creative in anticipating
litigation and collaborating once MPL
litigation is filed in order to promote the
best possible outcome for the
codefendants and thereby save money for
all parties.
The plaintiff’s bar shares information
and collaborates to further their
purposes. The MPL carriers and MPL
defense bar can do likewise.
Endnotes
1 Ziffer, Lee. “Joint defense agreements: the benefits and the risks” ABA
News Archive, July 2013,http://www.americanbar.org/news/abanews/aba-
news-archives/2013/07/joint_defense_agreement, accessed 8/1/2016.2 811
F.3d 282 (9th Cir. 2015).
2 Hermes, Dwayne and Lay, Erica R., “Collaborative Law Strategies for the
Insurance Defense Bar”, Dallas Bar Association, June 2016 Headnotes: Tort
& Insurance Practice, http://www.dallasbar.org.book-page/collaborative-law-
strategies-insurance-defense-practice, accessed 8/1/2016.