Presentation Objectives

Transcription

1 The American Association of Nurse Attorneys October 2015 Philadelphia, PA Loretta D Antonio,MBA Vice President Presentation Objectives Discuss Claim metrics for the Allied program. Create awareness of allegations, expense payments for paid claims and factors that may contribute to claims. Provide risk management recommendations to support managing professional liability risks. Who is Aon? Affinity? NSO? HPSO? CNA? Aon Corporation is the largest insurance broker worldwide. Affinity is a subsidiary of Aon Corporation specializing in affinity groups such as Nurses, APNs, Pharmacists, Physical Therapists and other Allied Health practitioners, Dentists, Attorneys, Accountants, Travel Agents. Nurses Service Organization (NSO) is the brand name for our nurses program and as a broker we provide insurance solutions to 600,000+ Nursing Professionals and Nursing Students as well as 30,000 Nurse Practitioners. Healthcare Providers Service Organization (HPSO) is the brand name for our Allied Health program and provides insurance solutions to 350,000+ Allied Health Professionals CNA is not the California Nurses Association or a Certified Nursing Assistant. It is not an acronym. CNA is the insurance underwriter for the NSO and HPSO professional liability programs. It

2 NSO and HPSO Leaders in Professional Liability Individuals Small group practices - Schools Nurses Nurse Practitioners Clinical Nurse Specialists Physical Therapists Counselors Pharmacists Social Workers Legal Nurse Consultants Nurse Educators More than 60 state and specialty association partners Types of Practices Home Health Agencies Staffing Agencies PT and OT Rehab centers Mental health counseling centers Case Management Aesthetics Practices Pharmacies Medical corporations Healthcare Consulting And more LET S TALK ABOUT LICENSE DEFENSE

3 Agenda License defense overview Coverage Triggers Is it covered? Claims process License Protection defense statistics LP Case discussion License Protection Coverage We will pay you up to the License Protection limit of liability stated on the certificate of insurance, for attorney fees incurred by you, for your investigation and defense of complaints. Such complaints must: arise from a license protection incident which occurred on or after the effective date of coverage, and before the expiration date of the policy period stated on the certificate of insurance; and be filed against you with a state or federal administrative agency, licensing or regulatory authority responsible for regulating your professional conduct. 8 We is CNA Insurance Company License Protection Coverage License Protection Reimbursement for Legal Fees Reimbursement for Non Legal Fees $25,000 per incident / aggregate $200/hr. $500 per claim 9

4 Coverage Trigger Medical or non-medical incident which results in a board or regulatory agency complaint and Incident must have occurred during an active policy year It is covered or eligible for reimbursement If it is the result of a complaint filed with a board or regulatory agency for any reason; If as a result of a criminal conviction a board complaint results then as long as the original incident occurred during an active policy year; DUI Shoplifting Spousal abuse Animal abuse THE CLAIMS PROCESS

5 How it works Our customer calls to report A possible incident A contact from the board letter, phone call, visit by an investigator We provide a claims packet which includes A list of available TAANA attorneys in their geographic area The list comes from TAANA we do not provide them names of other attorneys that defend our customers who are not TAANA members A suggestion to interview the attorney(s) as part of the selection process An assignment of benefits form which must be returned to us for us to pay you when you send in a bill of your fees Reimbursement Return assignment of benefits form to us signed by our insured practitioner Send in a copy of the complaint, if possible and where possible the final decision letter from the board We pay annually or when the final order comes in whichever comes first CLAIM METRICS 15

6 Paid Claims Reports Specialty RN X X o Physical Therapist X X o Nurse Practitioner X X X Pharmacists Counselors Small Group Practices X X X 2015 Plans Each contains PL paid claims analysis LP paid claims analysis Self-Assessment Checklist Risk Control Recommendations Work Survey 16 Latest versions available at License Protection Facts Total Program First reported LP claim Sept 1997 First LP claim paid Jan 1999 $1,665 Reported incidents 16,198 Paid Claims 5,295 Paid expense reimbursement $ 19,490,960 Average cost reimbursed $3,681 Average reimbursement since 2011 $4, Status of total reported incidents Status % of Total Closed w/o payment 45% Pending 15% Declined 7% Paid - Closed 3% 18

7 Incidents - Closed Claims - Paid Claims 19 Top 10 States by Incident 20 Most Common License Allegations LPN/LVNs - Medication Errors - Abuse/Patient s rights - Improper Treatment and care Nurses Substance Abuse (Professional Conduct) Improper treatment and care Medication Errors

8 Most Common Allegations Physical Therapists Improper Management over the course of Treatment Improper Behavior Fraudulent Billing Pharmacists Medication Mismanagement Drug Diversion Failure to Supervise Most Common Allegations Counseling Professionals Sexual Misconduct Breath of Confidentiality Beyond scope of practice 23 CLAIM SCENARIOS 24

9 RN in NC Hospital setting - ED Claims scenario #1 Insured through NSO for 7 years at time of complaint 34 years of age at time of incident Social media Claims detail Breach of confidentiality Circumstances of the allegation Nurse manager received an anonymous note advising FB posts were seen Nurse manager researched FB and tracked back to the dates of the posts identifying two facts: Posts were related to patients assigned to our nurse Some of the posts were entered while nurse was on duty Nurse found out about investigation, deleting posts and telling the board that they did not recall what was posted until the board showed the copies (20 different posts) Board Decision Settlement agreement TAANA attorney defended 30 hours of defense work 2 years to resolve $6,545 paid

10 Claim Scenario #2 Supervising RN in NY Nursing and Rehab Facility 3 years as an NSO insured at the time of the incident; remains an NSO insured 35 years of age at time of incident Claim details Our nurse was called to the shower room where the pt was in a Sara lift supported by CNAs because pt could not bear weight Care plan indicated pt to be attended by two CNAs and to use a Hoyer lift for transfers however, our nurse found the pt was lowered to the floor by the CNAs Our insured nurse assessed pt was not injured and left Did not follow up Did not file an incident report Claims details - continued Did not chart incident Did not reporting to her supervisor Did not report to next shift Shifts for the next two days were unaware of the issue Two days later pt was diagnosed with a spiral fracture of the leg

11 Board outcome Our insured nurse waived the hearing Non-TAANA attorney 10 hours billed for defense 2 years from incident to board decision $1,508 paid Ordered to pay a $500 civil penalty Board Outcomes for Nursing Specialties How about your cases? What are you seeing? Any sense of the contributing factors?

12 Coming attractions New RN paid claim report December 2015 New PT paid claim report February RN report 16% increase in total paid claims 20% increase in average payment ($4,000) 60% of RNs work in hospitals 58% of LPNs work in Aging services facilities Top categories for RNs and LPNs (not in priority order) Medication errors Improper treatment/care Professional Conduct Violation of Patient s rights/abuse Disclaimer The purpose of this presentation is to provide general information, rather than advice or opinion. It is accurate to the best of the speakers knowledge as of the date of the presentation. Accordingly, this presentation should not be viewed as a substitute for the guidance and recommendations of a retained professional and legal counsel. In addition, Aon, Affinity Insurance Services, Inc. (AIS), Nurses Service Organization (NSO) or Healthcare Providers Service Organization (HPSO) do not endorse any coverage, systems, processes or protocols addressed herein unless they are produced or created by AON, AIS, NSO, or HPSO, nor do they assume any liability for how this information is applied in practice or for the accuracy of this information. Any references to non-aon, AIS, NSO, HPSO websites are provided solely for convenience, and AON, AIS, NSO and HPSO disclaims any responsibility with respect to such websites. To the extent this presentation contains any descriptions of CNA products, please note that all products and services may not be available in all states and may be subject to change without notice. Actual terms, coverage, amounts, conditions and exclusions are governed and controlled by the terms and conditions of the relevant insurance policies. The CNA Professional Liability insurance policy for Nurses and Allied Healthcare Providers is underwritten by American Casualty Company of Reading, Pennsylvania, a CNA Company. CNA is a registered trademark of CNA Financial Corporation. CNA Financial Corporation, NSO and HPSO are registered trade names of Affinity Insurance Services, Inc., a unit of Aon Corporation. Copyright 2015, by Affinity Insurance Services, Inc. All rights reserved. 36

13 Questions?