Medical Professional Liability Claim

“Medical malpractice occurs when a hospital, doctor or other health care professional, through a negligent act or omission, causes an injury to a patient. The negligence might be the result of errors in diagnosis, treatment, aftercare or health management.” (Admin) One of the most common type of claims that pharmacies face are negligence claims. Negligence is one of the categories that falls under the area of law called Torts. In the Hundley v Rite Aid case, a tort was filed for injuries that were sustained by Gabrielle Hundley after she took medication from an incorrectly filed prescription. The case involved a jury trial verdict involving Gabrielle Hundley, a minor child, against Howard Jones, the pharmacist, and the Rite

Thank you for the signed retainer with our firm to handle your Workers’ Compensation Medical Provider Applications. The Workers’ Compensation Court allows us to recover for authorized and emergency treatment on behalf of your patients through the Workers’ Compensation Court. In our experience, most of these cases have been resolved amicably with the insurance carrier. However, there are various issues that we encounter as a part of our representation of Medical Providers in Workers’ Compensation Court.

Medical malpractice lawsuits are an extremely serious topic and have affected numerous patients, doctors, and hospitals across the country. Medical malpractice is defined as “improper, unskilled or negligent treatment of a patient by a physician, dentist, nurse, pharmacist, or other health care professional” (Medical malpractice, n.d.). If a doctor acts negligent and causes harm to a patient, malpractice lawsuits arise. Negligence is the concept of the liability concerning claims of medical malpractice, making this type of litigation part of tort law. Tort law provides that one person may litigate negligence to recover damages for personal injury. Negligence laws are designed to deter careless behavior and also to

There are many defendants in this case. First and foremost Dale, the loss prevention officer for Wal-Mart, is a defendant because he intentionally restrained Bob against his will and the restraint was unlawful. Dale also failed to follow company rules; Dale was supposed to watch a video that explained how to catch and deal with thieves but decided not to watch the video. The second defendant would be Dale’s supervisor. The supervisor recorded a pass on an exam that dale did not take. The exam Dale failed to write was based on the video that Dale did not watch. The third defendant would be Wal-Mart; Wal-Mart assumes liability because they could be at fault for not properly training staff. Bob would want to take action on

Healthcare providers should not be exempt from allegations of committing intentional torts. “The classic intentional tort in medical practice is forcing unwanted medical care on a patient ("Intentional Torts," n.d.).” Intentional torts can meet the requirements for civil and criminal action due to the nature in which the act was accomplished, and its qualified deliberate intent. To successfully sue another person for an intentional tort, intent, acting, and actual cause all have to be present (Legal Dictionary, n.d.).

Of the 18 open claims reviewed, I found the claim financials were posted within a reasonable time frame and reflective of the overall exposure. There was no evidence of reserve deficiencies or negative reserve trends in any of the files reviewed. With regards to the four closed claims; each claim involved a final settlement and my review found all claims were appropriately reserved prior to CAP’s settlement evaluation.

Ms. Larios claimed she was not sure if the Claimant was represented by legal counsel since she has not been served with legal documentation. She claimed she received Chiropractic invoicing from the Claimant’s physicians that she turned over to her claims adjuster at Am Trust North American. She does not recall any details about the invoices.

Findings from a 2012 Study of Medical Negligence Claiming in Scotland revealed that patient support and advice groups find that when a complaint is made to the NHS in relation to a medical injury a defensive attitude tends to be adopted in response to such complaints. According to Professor Sir Ian Kennedy, Chairman of the Independent Parliamentary Standards Authority, this defensive attitude is what leads to claims being raised against the NHS. He stated that the current clinical negligence regime is what prompts defensiveness within the NHS and that this problem will persist as long as the fear of litigation and stigma of settlement remains. In the literature reviewed there seems to be a general consensus that the requirement for the claimant

Worker’s Compensation programs first appeared a century ago in the U.S., introduced on a voluntary basis. At a time when few employers provided insurance or benefits for workers injured on the job it provided workers with insurance regardless of negligence at the cost of forfeiting one’s right to sue.

The workers’ compensation claim detailed the circumstances surrounding an injury that he suffered while at work. He confessed that while working on the job site he sustained severe burns to his lower body. His duties on this day included that he make some repairs to a leaky fuel line. During this process fuel spilled onto his pants. Additionally while making repairs pieces of steel become caught on his pants. Lastly as Mr. Martinez attempted to use a torch to cut free pipe a spark ignited the fuel on his pants. This resulted in burns to his lower body. This injury resulted in him to miss having to miss a considerable amount time from work. He filed a workers compensation to replace part of his lost wages. The suit accused the defendants of failing to maintain a safe work site for its subcontractors and in failing to provide personal protective clothing, personal protective equipment, and firefighting equipment.

The IHMD, Dr. Maria Tonel works along side the claims examiners on claims with expected disability in excess of six weeks to assure the injured worker’s medical care is properly managed. The IHMD acts as a liaison on behalf of the claim examiners directly communicating with the treating physician with regards to the injured worker’s medical treatment plan, the administration of prescription drugs, and whether the injured worker is a viable candidate to return to the work force. The implementation of the IHMD will positively impact the claims department on multiple levels. (1) the claim’s examiners will have the assurance the injured worker’s medical treatment is appropriate (2) target return to work dates will be more accurate, while also reducing

Michael, how would you go about making sure that your office is properly staffed and your coders have all the necessary information in order to properly code and process claims? For starters, "the American Health Information Management Association (AHIMA) grants the Certified Coding (CCA), Certified Coding Specialist (CCS), and the

A physician has the responsibility to determine the legitimacy of all work injuries and to report its finding accurately. If a physician prepares a report with the intent to use it in support of a fraudulent claim and knowingly submitted for payment under an insurance contract, the physician may be subject to fines or imprisonment and risks the possibility of having his or her medical license revoked. Presenting a claim for an item or services based on a code known to result in greater payment or submit a claim for services not medically needed is a violation of the false claim act.

You recently sent a package of claims to Horizon Behavioral Health for services rendered to your spouse John Stonelake, by Ronald S. Newman PhD, an out-of-network provider with your NJ DIRECT coverage. When you called to check on the status of the claims you were advised that they were not received. Additionally, you indicated that twice you have sent in a package of claims that were received and one of the dates of service included with the package was not

“We have always thought of causation as a logical, almost mathematical business. To intrude policy into causation is like saying that two plus two does not equal to four because, for policy reasons, it should not.” (Charles Foster NLJ 5/11/2004 page 1644).