How to Make a Notification

How to Make a Notification

What is a Claim, Circumstance, Other Requests for Indemnity plus key contact info for notification.

What to notify?

When deciding whether to make a notification, it is helpful to view the matter from the Patient’s or their representative’s perspective. A policyholder's own opinions and findings may assist in responding to a complaint or Claim but will not prevent one from being asserted against them.

1. A Circumstance is defined as any situation, incident, or event which could reasonably be expected to give rise to a Claim. This may include, complaints (verbal and written) where the standard of care provided is criticised or there are allegations of medical malpractice or breach of duty, solicitor’s medical records requests (in the context of considering a Claim), a Duty of Candour incident where there has been an adverse outcome for the Patient, Serious Untoward Incidents and unexpected Patient deaths (these would all be situations where a financial demand has not yet been made).

Examples:

• Patient was seen at a GP Practice for severe headaches a day before unexpectedly passing away from a subarachnoid haemorrhage. This matter is treated as a serious untoward incident requiring investigation.
  
  
• A formal complaint is lodged against a plastic surgeon regarding sub-standard breast augmentation surgery. Whilst there is no demand for compensation, the Patient confirms that they are contemplating bringing a clinical negligence claim against the surgeon.
  
  
• An incident has arisen with regard to the failure to identify an ectopic pregnancy following an ultrasound scan. A number of weeks after the scan, the Patient’s fallopian tube ruptures requiring emergency surgery. Whilst there has been no complaint, there was an adverse outcome for the Patient and the matter is being treated as a Duty of Candour incident.

2. A Claim is defined as any financial demand or assertion of a financial right or entitlement against the Insured, which is communicated to the Insured. This includes, Pre-action Protocol letters, any requests for compensation, Legal Proceedings (e.g. a Writ or Claim Form or Particulars of Claim).

Examples:

• A Patient alleges that her GP was negligent in failing to properly investigate symptoms of stomach bloating, discomfort in her pelvic area and loss of appetite. The Patient was subsequently diagnosed as suffering from ovarian cancer. The Patient alleges that the GP was negligent and that the delay in diagnosis has impacted on life expectancy. The Patient demands compensation for what they consider to be a breach of duty of care.
  
  
• A plastic surgeon receives a Letter of Claim sent in accordance with the Pre-Action Protocol for the Resolution of Clinical Disputes, alleging that there was a failure to obtain adequate consent from the Patient prior to rhinoplasty surgery. It is alleged that had they been aware of the risks, the Patient would not have proceeded with the surgery and thus would have avoided injury.

3. The Policy also provides cover for additional risks such as Loss of Documents, Patient Recall Costs, Breach of GDPR, Sexual Harassment or Abuse and Defence Costs for Regulatory Investigations and Coroner Inquests. Any such incidents should also be reported as soon as practicable in line with policy terms and conditions.

It is important for our Corporate Policyholders to remember that they could be held to be vicariously liable for the acts of any self-employed (and so self-insured) practitioners engaged on their behalf. If a Circumstance or Claim relates solely to the activities of such a practitioner, Corvelia would still need to be notified so that if required, the policyholder’s interests can also be protected.

When to notify?

Our policy operates on a “claims made” basis which means, the policy is triggered when you first become aware of a Circumstance or Claim (or other reportable incident), irrespective of the date the treatment was undertaken. A policyholder must report any Claim, Circumstance or other reportable matter as soon as practicable and within the policy period.

Who to Notify?

A policyholder should provide details of any reportable matter to their broker who will then submit the same to claim@corvelia.com. A completed Corvelia Notification should be used where appropriate but completion of this form should not delay notification (this can follow).