Q. What should I report to OMIC, and when should I report it?
A. Contact our Claims Department at (800) 562-6642 whenever any incident, unexpected result, or complication occurs that may result in a claim or suit. Notify us immediately if you receive any letters of representation from an attorney or threats of pursuing a claim or legal action against you. Tell us also about any notice, either formal or informal, alleging that there was an act or omission on your part during the performance of professional services which caused an injury. The sooner you report a problem to us, the faster we can assist you in its resolution and the easier it is for us to protect your coverage.
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Q. What should I do if I receive a request for medical records from an attorney?
A. First, call OMIC as this could be an indication of a potential claim. Then, cooperate and release appropriate records, but only if there is a properly executed letter from the patient authorizing the release.
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Q. If I report an incident before it becomes a claim, won't it look bad on my record and cause my premium to go up?
A. The reporting of a patient problem or an incident (an occurrence with the potential of developing into a claim) that does not develop into a claim will have no effect on your premium and will not be included in reports to hospitals or other third parties of your claims history. Early notice of potential claims shows that you are proactive and risk management conscious. When you call us immediately after an incident occurs, we may be able to advise you of steps you can take to keep the situation under control. Additionally, your report to the Claims Department will serve as "official notice" and may protect your coverage should it turn into a claim in the future.
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Q. If I have a claim, will it increase my premium or allow you to cancel my coverage?
A. Since we are a Risk Retention Group owned by and managed for ophthalmologists, we do not focus exclusively on frequency or severity when we evaluate a judgment or a settlement. We also want to know whether there has been a breach in the standard of care and why. That evaluation will decide our course of action. The mere filing of a claim will not result in a policy surcharge. Reporting a claim won't even jeopardize your eligibility for the "loss free" discount; however, if the claim closes with payment of damages, this discount will no longer be available to you until you are once again "loss free" for two years.
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Q. What happens to the claim once I report it?
A. OMIC is committed to professional and responsive claims management. This can only be achieved by frequent communication between you, our claims representative, and your attorney, if one is assigned. Our approach to claims management, regardless of whether a suit has been filed, is to identify any exposure or liability on your part and to move the claim to a satisfactory resolution. To do that, we must first confirm coverage. Then we establish a claim file and provide you with general advice and further instructions on how to proceed. Typically, we'll also ask you to forward a copy of the medical records to us.
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Q. What general advice will you give?
A. Only with the details of the matter can we provide you with complete, appropriate advice. However, general suggestions to remember are as follows:
- Call OMIC immediately.
- Keep your sense of perspective.
- Don't alter, amplify, or otherwise change your medical records.
- Keep the original record in a safe, secure location.
- Don't create an alternate set of records.
- Don't discuss the incident with anyone except OMIC, the legal counsel we assign to you, or others who have been cleared by OMIC or your legal counsel. (Especially do not talk to the plaintiff's attorney; refer them to your OMIC claims representative or attorney.)
- If you need to discuss the case with other health care providers, limit the conversation to the medical facts concerning the patient's care and treatment.
- Don't perform your own investigation or try to settle the claim on your own. (It could ultimately jeopardize your coverage.)
In addition to this routine advice, you will receive a copy of
Litigation
Handbook for the Ophthalmologist, a reference guide OMIC developed to assist physicians named in claims. In the event you are deposed, either as a defendant or as an expert witness in a claim against another physician, you will find OMIC's
Deposition Handbook for the Ophthalmologists helpful, both for the general information it provides about depositions and for the guidelines and suggestions it offers insureds who are being deposed. OMIC insureds may contact the Risk Management Department to request a complimentary copy of the Litigation Handbook or the Deposition Handbook. Non-insureds may purchase these publications from OMIC.
Recognizing that being a defendant in a malpractice suit can take an emotional toll on a physician, OMIC has several resources available to assist the physician through this challenging time. Several of our ophthalmologist Board members, some of whom have been through the litigation process themselves, are available to assist other OMIC insureds currently going through litigation. As an OMIC insured, you will also have access to our reference materials and related web sites in the event you are sued.
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Q. What happens to the claim after a file is created?
A. Our representative will contact you to review the medical records and discuss any other aspects of your care and treatment of the patient. As needed, we'll communicate directly with the claimant or the claimant's attorney to request related medical records, x-rays, or reports from subsequent treating physicians, as well as to obtain information about the injury and damages actually sustained. We'll do everything necessary to thoroughly and properly evaluate your claim. After we complete our initial investigation, an ophthalmologist on the OMIC Board or Claims Committee will review your medical records to ultimately help defense counsel evaluate whether the care given is supportable, as well as to identify strengths and weaknesses in the case, and if possible, determine whether your treatment meets the acceptable standard of care. This review is done in anticipation of litigation and with your assigned attorney or claims associate.
If the claim is or develops into a lawsuit, your attorney will keep you involved in all aspects of your case, including significant developments and expert selection. Your attorney will conduct all meaningful discovery, confer with us and with you on defense strategy, and ultimately try the case if it goes to trial.
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Q. Who will be my legal counsel in the event of a claim?
A. If a lawsuit has been filed, you are served with a summons and complaint, or there are other circumstances requiring legal assistance, we will appoint qualified legal counsel to represent you. We're strongly committed to the principle that the insured, not OMIC, is the defense counsel's client and that counsel should be responsive to and act in the best interest of the insured.
OMIC has established a panel of leading defense firms across the country to defend you. Each firm has agreed to name a partner with at least ten years of medical malpractice defense experience to represent our insureds. If you would like the names of the defense firms OMIC routinely uses in your area, please call us.
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Q. Can I choose my own legal counsel?
A. OMIC is willing to consider your recommendations for defense counsel; however, selected defense counsel must meet our rigorous eligibility requirements.
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Q. What is OMIC's position on settling cases?
A. Our philosophy is to vigorously defend all cases in which we feel our insured has rendered appropriate care. We do not believe in settling nuisance claims or claims without merit; we believe nuisance settlements, or "economic settlements" only encourage frivolous litigation. However, if we believe it is in our insured's best interest to settle, we'll attempt to settle promptly. Settlement can occur at any time during litigation -- during the discovery process, prior to trial, during trial, or even after trial -- as a result of facts that develop as the case proceeds.
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Q. Will the company settle a claim without my consent?
A. No. Your consent will be requested before OMIC will settle a claim against you.
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Q. Will my claim be reported to the National Practitioner Data Bank?
A. Only if damages are paid on your behalf. The National Practitioner Data Bank represents a depository of information available to state licensing boards, hospitals, and other health care entities and professional societies to provide data to those involved in credentialing or regulating physicians. All medical malpractice insurers, state licensing boards, hospitals and other health care entities, and professional societies are required to report information to the National Practitioner Data Bank. Therefore, if OMIC pays any damages on your behalf due to settlement or award of a claim, we are obligated by law to report the payment to the National Practitioner Data Bank and to send a copy of that report to your state. For this reason, we take great care in advising you about the ramifications of any settlement
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Q. If I report a claim to OMIC and subsequently cancel my policy, will OMIC cover the claim?
A. Yes. Even if you don't purchase a "tail," OMIC will insure you for all covered claims reported to us while your policy was in force. OMIC also will insure you for all covered potential claims reported while your policy was in force, even if they don't develop into claims until after your policy is cancelled. Unlike some carriers, OMIC considers all potential claims reported to us to be reported claims for coverage purposes.
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Q. Is OMIC's ability to pay claims limited by the amount of capital it has?
A. No. OMIC has three sources of funding for the payment of claims. First, OMIC collects premiums that are actuarially developed to cover anticipated losses. In addition, OMIC purchases its own insurance, called "reinsurance", to cover the costs of very large claims. We obtain much of our reinsurance from one of the most well-respected reinsurers in the world: Lloyds of London. Furthermore, OMIC maintains significant surplus to act as a buffer against an unlikely instance in which the premium and reinsurance are insufficient to cover the company's actual losses.
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Q. Does OMIC participate in state Insurance Guaranty Funds?
A. Most states have Insurance Guaranty Funds to provide coverage for claims made against policies issued by an admitted insurance carrier that has subsequently become insolvent and isn't able to pay its obligations. However, the Risk Retention Act does not allow Risk Retention Groups to participate in such funds. While OMIC is not eligible to participate in a guaranty fund, OMIC, like admitted carriers, is subject to review by regulatory agencies for the specific purpose of ensuring solvency. As an RRG domiciled in Vermont, OMIC is regulated by the Vermont Department of Banking, Insurance, Securities, and Health Care Administration (BISHCA). Vermont has a solid reputation as a conservative, careful domicile. OMIC's financial status is reviewed quarterly and audited every three or four years by BISHCA and audited annually by outside CPAs. In addition, OMIC is "registered" in all states and the District of Columbia and annually files with each state financial statements and other requested information. Because OMIC operates under very conservative financial guidelines and is fully reinsured for losses above $650,000, we believe the likelihood of insolvency is very low. We will continue to maintain very conservative guidelines and will take all necessary precautions to prevent financial instability or insolvency.
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