The vast majority of patients or families who file medical malpractice claims or suits allow them to expire after the initial stages of the investigative or legal process. Analysis of CRICO’s CBS database indicates that 72 percent of 46,000 medical malpractice cases analyzed were dropped, denied, or dismissed without a trial or settlement.
In some cases, claimants may learn enough through the process of initiating the claim or suit to satisfy their need for an explanation of what happened. In other cases, they may determine that proceeding is unlikely to lead to either a financial settlement or a day in court. But, in all instances, the act of naming a physician, nurse, or other caregiver in a malpractice claim or suit exacts a burden on those individuals who live and work in emotional limbo while the case lingers in the insurance and legal proceedings.
The primary sentiment underlying an individual’s decision to file a malpractice claim or lawsuit after an upsetting medical outcome is a perceived lack of caring or collaboration on the part of the providers they name. More specifically, claimants—either patients or their proxies—are most frequently triggered to seek restitution by the following perceptions:
- The patient’s expectations for diagnosis, treatment, or medical technology were not met.
- They are angry about a “bad” result and want to exact accountability and/or punishment.
- They do not feel that they were “cared” for.
- No one has adequately explained what happened, or why.
- They were advised to seek financial compensation by a friend or attorney.
So why do the majority of claims and suits triggered by these perceptions “go away”? Here is what happens after the initial claim letter or Summons & Complaint is delivered that results in a case being dropped, denied, or dismissed.
|The claimant abandons (drops) the claim, which is subsequently closed by the insurer.|
|Based on an investigation of the (pre-suit) claim, it is denied by the professional liability insurance provider covering the caregivers.|
|A formal complaint or lawsuit is subsequently dismissed—either voluntarily by the plaintiff, or by a court order.|
Relatively few of the dropped/denied/dismissed cases are “frivolous.” Generally, they reflect patients who have suffered an unfortunate outcome, and they often reflect care that—while not negligent or egregious—identifies opportunities for better communication. And before and after their case is dropped, denied, or dismissed—which can take years—both patients and caregivers pay a hefty price.
Mistrust of health care providers—or the entire system—and may put claimants and those they influence at additional risk. Physicians, nurses, and other providers named in these cases endure many of the same fears and anxieties experienced by colleagues named in cases that are settled or taken to trial. Malpractice insurers, and those who pay the premiums, bear a significant financial cost (approximately $22,000 in expenses) for each case that has to be investigated and defended until it is formally closed.
Driven by those ramifications and the desire to reduce the volume of claims and suits that will eventually be dropped, denied, or dismissed, CRICO and other insurance providers are digging deeper into their databases to better understand why such cases are filed and why they are eventually dropped, denied, or dismissed. The June edition of Strategies for Patient Safety will explore some of the findings from that analysis.