This presentation outlines the steps involved when submitting a claim to your medical malpractice insurance carrier. The claim process may take a few months or several years. You will be required to participate in several steps of the process (such as giving a deposition), but often months may pass without the need for the policyholder's involvement.

1. What every physician
needs to know:
the medical malpractice
claims process

2. 1 Notification
Notify your carrier if you receive:
• notice of a claim letter;
• a lawsuit; or
• a written demand from a patient for monetary compensation

3. 1 notification
• If a policyholder reports something else, such as an unusual
incident, medical record request, or oral threat, the claims
department makes note of the report but does not open a
claim file, in most instances.
• Once a claim file is set up, the loss is assigned to a claims
supervisor and coverage is entered and verified.

4. 2 response
A response letter is sent to the policyholder and the plaintiff’s
attorney.

5. 3 investigation
The claims supervisor investigates the claim over the next
several months. This includes collecting and reviewing the
medical records and referring the case to independent
medical consultants for evaluation. During this time, the case
may become a lawsuit or it may remain as a claim.

6. 3 investigation
If a suit is not filed, the case remains a claim. After the
investigation, the claim is re-evaluated on a routine basis. At
this time, a claim is closed if:
• no lawsuit is filed;
• no response from the plaintiff’s attorney;
• your carrier denies the claim; or
• the statute of limitations expires.

7. 4 defense
assignment
If a lawsuit is filed, then a defense attorney is assigned. The
policyholder receives a letter advising of the attorney assignment.

8. Under the direction of the claims supervisor, the defense attorney
prepares the case for trial by conducting discovery, locating
expert witness testimony, and taking depositions. The claims
supervisor, the attorney, and the policyholder work together to
develop a defense strategy.
5 defense
strategy

9. 6 settlement
After the investigation, the policyholder, the attorney, and the
claims supervisor may decide to settle the case. It’s important
to determine if your carrier requires policyholder consent before
settling.

10. 7 negotiation
• If settlement is warranted and physician consent is granted
(when applicable), negotiations begin. If acceptable terms are
reached during negotiations, the case is settled.
• The case may also be settled before trial during mediation. At
mediation, all parties meet with an independent mediator who
may help resolve the case.

11. 8• If the decision is made to proceed with the trial, a date
is scheduled.
• The length of a trial varies by complexity and the
number of parties involved.
trial

12. 8• If the defense wins at trial, your carrier may be able to close
the claim file. However, the plaintiff may appeal the verdict.
• If the plaintiff wins at trial, your carrier and defense counsel
evaluate the case to determine if there is a legal basis
to appeal. Such an appeal may result in a new trial or an
opportunity to settle the case.
• If it’s decided to appeal a jury verdict, your carrier will
continue to defend you throughout the appellate process.
trial

13. 9 indemnity
If a claim is closed with indemnity payment to the plaintiff, it
is reported to the National Practitioner Data Bank.

14. 10 protection for
a new era of
medicine
about tmlt:
With more than 18,000 physicians in its care, Texas Medical Liability Trust (TMLT)
provides malpractice insurance and related products to physicians. Our purpose is to
make a positive impact on the quality of health care for patients by educating, protecting,
and defending physicians. www.tmlt.org
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