How to Report a Claim

Early Reporting
UMIA physicians are encouraged to report any event, however minor, they have reason to believe may lead to legal action or a claim for financial payment to a patient under their care. Early reporting offers an opportunity to discuss the issues with an experienced claim investigator and provides for early intervention by UMIA on behalf of the physician if appropriate. Good data supports selective, early intervention to minimize the overall claim costs and facilitate mitigation of the patient’s emotional, physical, and financial losses. Reporting of incidents does not result in underwriting action against a physician.

What to Report - Indicators of a Potential Claim
The following are clues a patient may initiate legal action against a physician.

Request for Records:

What to release: A copy of the complete record is all that needs to be provided. If there are extensive photos or x-rays, ask the patient if they desire copies of all the photos, etc. A reasonable charge for the cost for collecting and copying the records, photos, x-rays, etc. is appropriate. The physician should have a signed records release from the patient to comply with HIPAA.
Reason for request: If possible and appropriate, have an experienced office manager or the physician speak to the patient, attorney, or other party about the reason for the records request. If there is any indication the patient is unhappy, then the request should be reported to UMIA.
Who May Receive Records: The required records release should comply with HIPAA standards, name the person or entity authorized to received the records, and be signed by the patient, parent or guardian, or executor or administration of the patient’s estate. Records may be released to an attorney if a proper release is executed. If in doubt about whom to release the records, or who is authorized to sign the release, contact UMIA. Do not release any records without an appropriately executed release form.
Discussion of Care: Do not discuss the content of the medical records or the medical care rendered with anyone except with a UMIA claims manager or your attorney. Do not think that you can talk an attorney out of making a claim by discussing your care. You may be facilitating the claim against you. Remember that two out of three claims made against physicians have no medical basis or significant deviation from the standard of care. In cases where you believe you may have deviated from the standard of care, early reporting and intervention by UMIA may be helful in avoiding a formal claim. Do not make any offers for payment to the patient without contacting UMIA.

Potential Claim
The following are indicators of potential claims and should be reported to UMIA.

Serious and costly complications of care
Unexpected and adverse outcome
Unhappy patient or family members
Disputes over bills
Discourtesy toward physician or staff
Receipt of record request from an attorney

Actual (Formal) Claim

Oral or written request for money from attorney or patient
Receipt of a 90 day notice of Intent to Commence Legal Action
Receipt of a Request for Pre-Litigation Panel (Idaho)
Receipt of a Request for a Montana Medical Legal Panel
Receipt of a Summons and Complaint

Reporting a Claim or Incident
You may call and report an incident or claim between 8:30 AM and 4:30 PM, Monday through Friday by calling (801)531-0375. When you make the call, have the patient records and any other pertinent information and documents in front of you. If you have a formal claim, make a complete and accurate copy of your office record and be prepared to get it to UMIA as quickly as possible.

Assistance in Managing Disclosure of Serious, Acute Events and Physician Support
You can receive consultation and advice about managing disclosure of errors and adverse outcomes from UMIA physicians with experience in such matters. A support group for physicians going through a claim is also available through UMIA. You may request these services by calling UMIA at (801)531-0375.