Malpractice & Liability Claims

As we all know, the climate of complaint and blame has evolved over the last decade, assisted by no win no fee solicitors, and legislation. When we first started to roll out our specialist and in many ways, pioneering multitherapy covers for Complementary Health Practitioners over 16 years ago, the number of claims we saw were few and far between. Now we are daily advised of new incidents across the disciplines.

CLAIMS HANDLING AND PROCEDURES

Increasing numbers of claims involve potential or actual Disciplinary Hearings cases, and can only hope that organisations involved can evolve a system that uses mediatory techniques to deal with complaints in dialogue, rather than the potentially confrontational and the adversarial process which is sometimes the case.

So is their anything you can do to help play your part in turning the tide? As a reality of practise, situations can arise that are a cause for complaint from the patients’ perspective. Some of these may not be your fault, and are more to do with the patients attitude and process than you. However, how you handle such complaints is critical in ensuring that it does not develop into a disciplinary or malpractice complaint. Complaints very often arise from a miscommunication and can enhance your goodwill if judiciously handled.

Whilst we have covered in more depth some of the risk management issues that may be able to reduce the likelihood of a complaint against you, we can offer you a few situations that occur time and again:

1. Poor or inadequate communication
2. Failure to form a comfortable therapeutic relationship that works well for both parties
3. Lack of adequate information at outset, resulting in expectations of patient not being fulfilled
4. Issues around money, length of treatment and perceived value
5. Patients complaining that they feel worse after treatment
6. Complaints that the treatment hasn’t worked
7. Serious reactions after treatment, patient goes to a different practitioner and compares/complains
8. Complaints about Behaviour or Style of practitioner, or unprofessional conduct etc

There are of course many ways one can head off complaints, but there is not enough space to explore these here. There is however one thing that does exacerbate an already delicate situation:- the delay factor! Don't put your head in the sand- do notify us! It will save you problems later on!

Following are some procedures to be followed to ensure that you have the full back up of Balens and the Insurers as quickly as possible and hopefully to avoid making matters worse.

REQUESTS FOR A REFUND

If you feel there is a potential complaint about to arise or a patient formally complains and requests either reimbursement or an explanation contact us to request guidance before replying or refunding any fees.

• Always make sure that you do not get defensive with clients, particularly if they become aggressive with you. If they try and force you to agree to a refund, simply tell them that you will consider the matter once you have received details of their complaint in writing, and that you will get back to them in due course.
• Please do not admit that you are insured, or mention your insurance company in conversation as this tends to give people ideas.
• Please send us a copy of the request for refund, together with copies of the relevant case history record and treatment notes.
• Please also send us a draft response to the request for refund, which addresses the points raised in a factual way.
• If you wish to offer a refund, you should include the phrase “as a gesture of goodwill, in full and final settlement of any further claim in connection with this matter, and is in no way an admission of liability” in your letter. This is to minimise the potential of any problems later on. Balens have a template letter, suitable for your use
• We will refer your draft response to insurers for approval, as they will need to make sure that you are not inadvertently compromising either their position or yours.
• Please bear in mind that your insurers may require at least 5 working days in order to process your information, so if you haven’t heard by that time please do bear in mind that they do have substantial flows of business to deal with at times – but they will always try to prioritise where things are very urgent.
• Once you have sent the letter making an offer of refund, you may need to get a signature that this is in full and final settlement from your client or patient.
• Please send us a copy of your response when you have sent it to your client.

CLAIMS INVOLVING ALLEGATIONS OF MALPRACTICE OR PROFESSIONAL NEGLIGENCE

• We need all the paperwork regarding the complaint whether it is from a solicitor or from your client.
• We will need a draft letter from you, dealing with all the points raised in a factual way.
• We will need copies of the case history record and treatment notes.
• Please bear in mind that solicitors or clients have the right to ask for sight of the patient notes, but you should only release these on receipt of a signed request or form of release from your client.
• Advise your professional body if you want to as they may have additional facilities to help and support
• Please do not enter into any correspondence or communication unless we or insurers have said that it is in order to do so, and of course please do not mention that you are insured at this stage or that you are dealing with insurers.
• Acknowledgement letters are acceptable where you are at least letting the solicitor or the client know that you are dealing with their communication- we will need copies of these.
• We will then come back to you and in some instances will give the ok for your draft letter to be sent to the client, and we will ask you to keep us fully informed of any further developments.
• If the matter has gone beyond the exchange of letters then your insurers will become involved to defend you, up to and including court if necessary.

POTENTIAL OR ACTUAL DISCIPLINARY COMPLAINT

• Have an internal complaints procedure for your practice and display it. Whilst it may be a requirement of the Code of Practice and Standards of Proficiency of your profession, it should be considered anyway, as a suitably worded structure can protect you by allowing you and the patient to handle the situation “In house”.
• Please send us a copy of the official notification of complaint, together with a copy of the relevant case history record and treatment notes. A draft response to the allegations and comments made against you will also be needed.
• Some associations have facilities to help you if the Complaint may end up with an external regulator
• Please send us a copy of your final response to the official complaint as we will need to forward this to your insurers.
• Should the matter proceed to a Disciplinary Hearing, your legal expenses insurer mayinstruct a solicitor to defend your case.
• If things are not going to plan from your point of view, or you are experiencing delays, please let us know so that we can intervene on your behalf.

This section should help you decide when to notify us...