A

Administrative issues are contributing factors related to organizational policies, systems, and staffing.

Allegation is the plaintiff’s assertion of what led to the patient’s injury.

Alternative Dispute Resolution is a formal malpractice case resolution process outside the jury trial system.

Answer is the written response to the initial complaint of the plaintiff, setting forth the grounds of the defense.

Assert year is the year in which a malpractice claim or suit is filed.

B

Binding Arbitration happens when both sides agree that a third party arbitrator will decide the matter in dispute.

C

Case: a malpractice claim or lawsuit. CRICO counts each case as a single entity regardless of how many defendants are named.

Causation: the causal relationship between the alleged act of negligence and the alleged damages.

Claim: A written or oral demand for compensation for damages caused by an alleged act of negligence.

Claimant: The person filing the claim.

Claim Representative: The CRICO employee who coordinates the activities of the defense team.

Clinical judgment issues are contributing factors related to clinical decisions independent of systems failures or technical problem.

Clinical Review: A review of the medical records pertinent to a malpractice claim or suit usually conducted by medical consultants prior to review by medical experts.

Complaint: Written material filed with the court to institute a civil action (suit).

Contributing Factors represent a broad area of concern or impact relating to circumstances which may have contributed to the allegation, injuries, or initiation of claim or suit.

CRICO: Controlled Risk Insurance Company

D

Damages: Refers to both the injury to a patient and the monetary compensation for those injuries.

Defendants: are individuals (e.g., physician, nurse) in malpractice cases who are named by the plaintiff in a lawsuit. In some CRICO cases, providers not insured by CRICO may also be named.

Defense Attorney: Legal counsel assigned by CRICO to represent your interest in a malpractice lawsuit.

Deposition: A method of discovery in which the lawyer for one side asks questions of a party or witness on the other side.

Diagnosis-related cases are those with a major allegation of missed, delayed, or incorrect diagnosis.

Discovery: A variety of legal mechanisms used by both sides in a case to obtain information from the other party.

Duty: An obligation to the patient who was (allegedly) harmed.

I

Indemnity: The monetary payment made to a claimant for damages under an agreement of insurance.

Interrogatories: A series of written questions from one party in the case to the other side to be answered under oath.

L

Lawsuit: A claim that has formally entered the civil litigation system.

Liability: Responsibility for conduct falling below the standard of care.

M

Medical Expert: A qualified individual providing evidence based on inference after reviewing available medical information, not personal knowledge of the situation being considered.

Medical Malpractice: Liability based on acts or omissions in the provision of health care or professional services.

Mediation: Both sides agree on a third party to help them reconcile differences or negotiate a resolution of the matter in dispute but retain the decision making power.

N

National Practitioner Data Bank: Federally established repository of information regarding malpractice payments and disciplinary actions against health care providers.

Negligence: A legal theory based on the duty of an individual to act and use such care as a reasonably prudent person would do in the same or similar circumstances.

P

Peer Review: Discussions, analyses, and recommendations of a physician’s diagnosis,care, and treatment of patients conducted by colleagues with similar training and background in the same practice setting.

Plaintiff: One or more individuals, or someone authorized to act on their behalf, who files a lawsuit seeking monetary damages or other relief.

R

Risk Manager: The person within a health care institution responsible for coordinating the institutional risk management program.

S

Settlement: The resolution of a formal claim or lawsuit by the parties involved, without judicial intervention or proceedings.

Standard of Care: The standard of care and skill of the average member of the profession practicing a given specialty, taking into account advances in the profession. Expert testimony is required in order to establish the relevant standard.

Statute of Limitations: The time period in which a lawsuit alleging malpractice must be brought.

Subpoena: An official order requiring a person to appear at a certain place and time to give testimony on a particular matter or to present certain documents in his/her possession.

Suit: See Lawsuit

Summons and Complaint: Notification that an action against the recipient has been filed in court.

T

Tribunal: A screening mechanism in Massachusetts for lawsuits alleging medical malpractice.

Total incurred losses: reflects money reserved for open cases, money paid on closed cases, and the costs incurred defending insured organizations and providers.