The following information contains answers to frequently asked questions related to claims. If you need additional assistance, or your specific question does not appear, please contact us.
After reporting an incident, you will be given a list of precautions to follow. It is important that you adhere to these admonitions, as they will help to preserve the integrity of your case:
- Do not discuss the circumstances surrounding the incident with anyone other than the attorney representing you or a ProAd Claim Representative
- Do not make any additions or deletions to the patient's records
- Do not respond to any inquiries regarding the patient before contacting ProAd
- Do not respond to any legal papers before contacting ProAd
- Do not review any medical literature specific to the alleged or potential claim. Defense counsel advises such actions are potentially discoverable and should be undertaken only upon specific direction of counsel
ProAd has a listing of law firms throughout the region that have been approved by our Claims Department. These firms specialize in the advocacy of physicians and their performance is monitored to ensure that they follow our guidelines and defense philosophy. We will make every effort to work with the Insured to provide counsel with whom he or she feels comfortable.
Requests for Claims Histories must be in writing and signed by the Insured. The request should include the Insured’s name, license number, policy number (if not insured under your own name), and the specific years which the history should address. The Claims History will be mailed or faxed to the current address on your policy, as requested. The Claims History will also be mailed directly to the requesting institution. In the event further information is required regarding a closed claim, please write to the Claims Department, Professionals Advocate, 225 International Circle, Box 8016, Hunt Valley, MD 21030 and specify what further information is required. In the event you need additional information regarding a pending claim, contact the attorney retained to represent you in that case.
Contact the ProAd Claims Department and provide the needed preliminary information. Contact can be via telephone (800-492-0193), fax (443-689-0263), or mail (Claims Department, Professionals Advocate, 225 International Circle, Box 8016, Hunt Valley, MD 21030). Please include:
- Patient’s name, gender, age, marital status, address and employment status .
- Names of any other physicians involved in care .
- Names of any involved hospitals, clinics, etc.
- Chronology of medical treatment including dates of treatment.
- Any information available regarding the nature of the claim.
As a general rule you must release a copy of the records upon receipt of an authorization signed by the patient. You should not prepare new or additional chronologies or reports, even if requested. Some states have specific statutes governing this. If you have any questions about releasing your records, call the Claims Department at 800-492-0193. Should you have any suspicion that your treatment could lead to a claim or suit for medical negligence, you should request ProAd's assistance prior to further action.
Initially you will be contacted to schedule an initial interview with your attorney and/or the ProAd Claims Representative. During this meeting you will be advised what to expect from the litigation process as well as discussing your case specifically. It is helpful if you have available the original medical chart and a copy of your CV.
In general, to prove a claim of medical malpractice three basic elements must be present. These are:
- Negligence – defined as a departure from the accepted standard of care.
- Causation – there must be a causal link between the negligence of the defendant and the damages suffered by the claimant.
- Damages – which must be verifiable and suffered by the claimant(s).
An Insured should immediately notify ProAd of any incident that may lead to or trigger a medical negligence claim. In the event the Insured receives a claim letter from an attorney or a lawsuit, swift reporting is crucial to allow ProAd adequate time to respond within the allotted time frame. Insureds are encouraged to contact ProAd with any questions or concerns regarding an incident.
The information is reported to the NPDB only when the company makes a payment on behalf of an Insured. A situation could exist where there is a judgment against an Insured and the Insured chooses to pay that himself/herself. In that case, it is not reportable. The same would apply if the Insured pays a settlement himself/herself.
ProAd will not settle your case without your knowledge. It is the policy of ProAd not to settle without the express written consent of the Insured.
Simply reporting an incident has no impact on your premium.