FAQs About Claims Process

  • How can I receive a copy of my medical malpractice claims history, or have it sent to a requesting institution?

    CRICO-insured can receive their 10-year claims history from CRICO/RMF. Insureds must submit their request in writing via postal mail, fax, or e-mail. Please provide the following:

    • Physician's full name, typed or clearly printed*
    • Social Security Number or Physician ID*
    • Physician's contact information (i.e., e-mail address, fax number, phone number)
    • Additional parties and their contact information, if you want your claims history forwarded.
    • Physician's signature* (by fax or, if request is sent by e-mail, scanned attachment)

    *required information

    Submit request via:

    • Postal Mail:
      Claims Histories
      Attn: Claims Department
      CRICO/RMF
      101 Main Street
      Cambridge, MA 02142; or
    • FAX: 617.679.1328; or use
    • CRICO/RMF Customer Service Form

    For more information call: CRICO/RMF Claims Department, 617.679.1350

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  • What is the difference between a malpractice claim and a malpractice suit?

    A formal claim is an actual demand for compensation made by a claimant (the patient, or a representative) who indicates an intent to pursue the demand. Such notice may be made orally, or by letter. A claim may arise anytime, even several years after the medical incident(s) on which it is based. (See related FAQ re: Statute of Limitations)

    After being made, claims can be:

    • Dropped by the claimant
    • Denied by CRICO/RMF, and not pursued by the claimant
    • Denied by CRICO/RMF, and pursued by the claimant as a suit
    • Settled by CRICO/RMF with payment

    Filing of a lawsuit (Summons and Complaint) can either follow from a claim or simply serve as the first notification of a malpractice allegation. Receipt of suit papers requires an official response by the clinicians named in those legal documents.

    Suits can be:

    • Dropped by the plaintiff at any time
    • Dismissed by the court
    • Settled before or during trial
    • Closed by a jury verdict
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  • Are my interests really protected by my malpractice insurance carrier?

    Yes.

    The medical institutions that are shareholders in the CRICO insurance program have an inherent interest in the well-being of the insured physicians (and other health care providers) who care for patients in their facilities. Although conflicts may occasionally arise among multiple defendants, such differences are usually resolved by assignment of separate legal counsel for defendants with potential conflicts.

    By law, ethics, and mandate of the CRICO shareholders, the defendant--not the insurance company--is the client of the attorney asked to represent a CRICO-insured defendant in a medical malpractice claim. Within tripartite systems such as CRICO's, the insured defendant and the attorney work together to provide the best defense against a malpractice claim. The assigned attorney is--to the fullest degree--the defendant's advocate.

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  • Should I hire my own attorney, and at whose expense?

    This is rarely necessary for CRICO-insureds.

    The experienced medical malpractice trial attorney assigned by the insurer has full responsibility for litigating the medical malpractice action. When multiple defendants are named, each may be assigned a separate attorney. In the rare case where damages and expenses are estimated to be greater than the policy coverage, defendants are advised to consider obtaining their own attorney (at their own expense).

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  • What are some common reasons for settling malpractice cases?

    Most settlements involve cases in which the clinical care fell below the applicable standard of care. This is typically determined by the inability to obtain any credible expert testimony that the standard of care was met. CRICO/RMF's philosophy is to defend all cases supported by expert reviewers. However, some circumstances make cases difficult to defend even when the clinical care was appropriate. These include:

    • Altered medical records: documentation altered after an adverse event has occurred severely compromises the clinician's credibility
    • Conflict among caregivers: finger pointing among defendants makes taking a case to trial much more difficult
    • Characteristics of the defendant clinician(s): a clinician who would make a poor witness in his or her own behalf may lead the insurer to settle the case
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  • What criteria are used to select medical experts?

    Careful research is necessary when obtaining expert medical witnesses whose role is to educate the jury about all pertinent issues relating to the case and to provide the basis for the standard of care established by the defense.

    CRICO/RMF considers the following factors when selecting expert medical witnesses:

    • Is the individual a hands-on expert (i.e., clinician), or an academician who can testify on a purely scientific level?
    • Can the expert communicate technical information clearly and simply to a lay jury? Can he or she be an "expert" without appearing arrogant or indifferent?
    • Is the expert willing and available to testify in court?
    • Has the expert testified on this subject before? CRICO/RMF strives for an objective opinion by a knowledgeable and articulate witness who has ongoing clinical or research experience which has bearing on the case at hand.
    • Has he or she written specifically on the medical issues pertinent to the case? The expert will need to be prepared to explain anything he or she has authored which can be construed to contradict the basis of his or her testimony in this case.
    • Was the expert board certified in the same specialty as the defendant at the time of the incident? Does the expert belong to the appropriate professional organizations and societies?
    • Does the expert live and practice in the same state as the defendant physician? Local experts are more likely to be recognized by jurors. They also incur fewer travel and scheduling conflicts.
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  • What happens if one defendant wants to settle a claim and another one doesn't?

    All of the CRICO-insureds named in a claim are included in the process of how that claim will be resolved. In recent years, fewer than one-third of CRICO/RMF's claims have been closed with settlements involving indemnity payments and very few disputes about settlement decisions have occurred. For those cases in which defendants do disagree with the decision, CRICO/RMF has been authorized by its Board of Directors--after consultation with the chief executive of the relevant insured institution--to settle cases notwithstanding the objections of the defendants. Disagreements in which the defendant wants to settle a case the defense team considers defensible are resolved in a similar manner. In practice, neither situation arises often.

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  • What will I need to do during the course of a medical malpractice lawsuit against me?

    Claims can be dropped or dismissed shortly after the original filing or take more than 10 years to go through the entire trial and appeal process. In Massachusetts, the majority of cases take between three and five years to complete. Occasional spurts of activity take place during the otherwise slow and deliberate process. While this may be frustrating, it is typical of civil litigation. Legislative and judicial attempts to speed the process in Massachusetts have yet to meet the goal of a three-year timeframe. For CRICO-insured defendants, your involvement will include:

    • Meeting with a CRICO/RMF claim representative to review events surrounding the claim
    • Meeting with the defense attorney assigned to defend you
    • Assisting the defense team in preparation for the tribunal
    • Preparing answers for the plaintiff's interrogatories
    • Preparing and testifying at the deposition (where the plaintiff's attorney will ask you specific questions about your background and the events involved in the allegation of negligent care). Depositions last anywhere from a few hours to more than a day

    If the case continues to trial, you will need to spend as much time as necessary with your defense attorney and CRICO/RMF claim representative preparing your testimony. Trials can run from a few days, to weeks in length. Defendants are asked to be present at as much of the trial as possible.

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  • What is the tribunal?

    The tribunal process is a screening mechanism adopted by Massachusetts and several other states with the aim of reducing and/or eliminating frivolous lawsuits alleging medical malpractice. A tribunal finding in favor of the defendant(s) does not necessarily end the case. In this state, plaintiffs (or their attorneys) can post a $6,000 bond (the amount can be lowered by the court) in order to proceed with the lawsuit.

    The tribunal comprises a health care provider of the same type as the defendant, a lawyer, and a judge. The purpose of the tribunal is not to decide fault or weigh the credibility of evidence, but only to determine whether the plaintiff has presented sufficient evidence to raise at least one issue for further review by the court system. The plaintiff's evidence at the tribunal is called the "offer of proof," and ordinarily contains a letter from a medical expert offering an opinion favorable to the plaintiff's claim.

    Although Massachusetts does not allow the defense to present evidence, it does not preclude arguments which highlight or expose weaknesses in the plaintiff's case. Usually the tribunal is held fairly early in the "life cycle" of a lawsuit. Because the results are not binding, the value of tribunals in Massachusetts is, primarily, limited to discouraging only claims so frivolous that no expert testimony is available.

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  • Do practice guidelines help or hurt the defense of a malpractice claim?

    The legal ramifications of practice guidelines--developed for the evaluation and improvement of patient care--is mostly unknown. They have the potential to be either beneficial or damaging if you are involved in an adverse medical event. Most guidelines outline general practice, so how they are interpreted in specific situations will determine how they are applied in legal matters.

    Individuals considering malpractice claims can use practice guidelines to inform their decisions. Guidelines that were followed may serve to discourage meritless claims at the outset, preventing litigation. However, guidelines may also prompt claims if the care provided does not appear to be consistent with published practice guidelines. Guidelines can also have a mixed role once a malpractice lawsuit has been filed. When brought up by either side's expert, guidelines have been generally accepted by courts as evidence. They may serve as a "snapshot" of the standard of care at the time of an event, especially if the standard has changed significantly in the interim. However, guidelines can be damaging if you did not comply with them and did not record the medical rationale for the treatments chosen. Documentation of rationale and best judgments made is more important than ever.

    Practice guidelines may hinder defense of a malpractice case by appearing to be definitive in areas with no genuine medical consensus, or exhaustive when in fact they implicitly allow for physician discretion. Fortunately, at this point, appropriately developed guidelines are much more likely to help improve and evaluate patient care than to come up in a malpractice claim.

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  • Who has access to my malpractice claims information?

    From CRICO

    Physicians may request their own CRICO claims history.

    For credentialing purposes, the sponsoring institution can request access to your complete CRICO claims history. Institutions other than your insuring institution requesting your CRICO claims history must have your signed approval before the records will be released. The following information is provided:

    • The fact and date that a claim has been made against you, and a brief description of the case and allegations.
    • Tribunal information and current status of the claim.

    From the National Practitioner Data Bank

    • Physicians may access their own information.
    • State licensing boards may access this information as necessary.
    • Professional societies may access it for screening applicants, and in support of professional review activity.
    • Hospitals must, and other eligible health care entities may request information for credentialing (initial and reappointment) and may request information as they deem necessary.
    • Plaintiffs' attorneys bringing a claim of negligent credentialing against a hospital may request information about that hospital only if they can show evidence that the hospital failed to conduct an appropriate query.
    • Medical malpractice insurers may not access this information.

    From Medical Licensing Boards in Massachusetts

    • Malpractice history is available from the Board of Registration in Medicine (BRM) to state and federal law enforcement agencies for investigative purposes.
    • If the BRM formally investigates a malpractice report and makes findings, these are available to inquiring individuals.
    • An individual can find out from the BRM if a malpractice action has passed the tribunal stage and been assigned a court docket number. A suit's status can be ascertained by checking the docket number.
    • Profiles of a physician's background, credentials, and medical malpractice claims (for the past 10 years) are available to the public via telephone and the Internet.

    From Medical Licensing Boards in Rhode Island/New Hampshire

    • Medical malpractice history, as reported to the Rhode Island Board of Medical Licensure and Discipline and the New Hampshire Registration Board in Medicine, is not accessible to individuals. After receiving reports of medical malpractice actions, either board may conduct an investigation of a physician. The formal agreement arising out of any actions taken by either board is published in the local newspaper and is available to individuals on written request.

    In all states, a verdict in a medical malpractice trial becomes a matter of public record.

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