PLI Claims Notification Guide

Transcription

1 PLI Claims Notification Guide 4th October 2013

2 PLI Claims Notification Guide Contents Introduction... 3 Triggers for Claim Notification... 3 Scope of Practice. 5 Members Obligations. 5 Important Note... 5 Claims Process.. 6 Responding to Claimants.. 8 Contact Details. 9 Guidance for Completing the Claim Form. 10 Detailing of Treatments or Advice

3 Introduction Any claim or incident that challenges the professional integrity of CSP Members creates stress and anxiety for the Members concerned. Following these simple guidelines will ensure that expert help is engaged at an early stage of the proceedings. This is a guide to the procedures for claims notification only. It is not intended to be exhaustive and does not in any way alter the Terms and Conditions of the Medical Professional Liability Policy or the Public Liability Policy. In the event of any conflict, the Terms and Conditions of the CSPs Medical Professional Liability Policy and/or the Public Liability Policy will take precedence over the guide to the procedures for claims notification. Triggers for Claim Notification It is a requirement of the policy that you notify Insurers of any actual or potential claim, circumstances or incidents that may reasonably be expected to give rise to claim. The statement can be interpreted very broadly and may depend on individual circumstances. You should seek the advice of the CSP brokers if you are unsure whether to report an incident or not. 3

4 The following list is illustrative, but not exhaustive, of the types of incidents and events that require notification under the CSP s insurance scheme. Claim Circumstance Letter from patient/client informing you that proceedings have been commenced against you Letter from Solicitor informing you that proceedings have commenced against you Letter from a patient or solicitor stating that proceedings are intended against you An indication that the patient intends to pursue enquiries which may lead to a potential claim for inappropriate treatment or advice Letter from a patient, solicitor (or other legal representative acting on the patient s behalf) requesting you to release your patient s records for investigation, unless an assurance is given in writing that no claim will be made or is intended against you Coroners verdict on a deceased patient where the verdict suggests some lack of care or other failings in care A patient withholding fees due on some clinical grounds e.g. failure to diagnose, misdiagnosis, inappropriate treatment or failure to refer on Formal patient complaint on some aspect of the care given by the physiotherapist e.g. failure to diagnose, misdiagnosis, inappropriate treatment or failure to refer on Publication by a third party (e.g. a newspaper) of allegations about standards of care given by a named physiotherapist to named patient Where the Member is aware of any adverse incident that could give rise to a claim e.g. falls, personal injury, burns from electrotherapy devices, damage to third party property etc. Notification from the HCPC that a complaint has been received where patient harm is alleged or suspected If a Member is unsure whether an incident or circumstance should be reported, please contact the CSP s insurance brokers with as much information as possible. 4

5 Scope of Practice If you are unsure whether an activity or modality is within the overall scope of the profession, please contact the CSP on The CSP insurance scheme does not cover activities that are considered to be outside the scope of physiotherapy practice. Members Obligations There is a requirement under the insurance scheme for Members to act quickly and notify insurers via the CSP immediately they become aware of a claim or of an adverse incident which may give rise to a claim. Failure to do so may prejudice Members Rights under the policies. Important Note It is not possible to register potential claims with insurers unless the claims process on the following pages are followed. Failure to register circumstances which might lead to potential claims, or the reporting of actual claims as soon as practicably possible may prejudice members rights to cover. 5

6 Claims Process Members should initially contact the CSP s Enquiry Handling Unit preferably by on enquiries@csp.org.uk or by post to the Enquiry Handling Unit Chartered Society of Physiotherapy 14 Bedford Row London WC1R 4ED or by telephone on If the notification involves a claim under the CSP insurance scheme, details will be passed to the CSP s Insurance Brokers for the following action: The brokers will send the Member an acknowledgement letter enclosing a claim form for completion and a copy of these guidelines The completed claim form should be returned to the CSP s brokers at the following address: Graybrook Insurance Brokers Limited 8 Chandlers Way South Woodham Ferrers Chelmsford Essex CM3 5TB Or by to enquiry@graybrook.co.uk For assistance in any aspect of the notification, please speak to one of the broker s professional advisors on

7 Claims Process (continued) The claim form should be returned with as much information as possible including: Copies of all correspondence Contracts of Employment/Terms of Engagement where applicable Copies of Medical Records (anonymised when circumstances only are being reported) Copies of s Notes of any telephone conversations etc. The brokers will submit a copy of the claim form to the CSP for verification of Membership and Scope of Practice The brokers will confirm HCPC Registration together with any other regulatory obligations for treatments undertaken outside of the United Kingdom Subject to satisfactory replies, all documents will then be submitted to the relevant insurer, for registering as a potential claim under the MPLC Limited Medical Malpractice policy or Travelers Insurance Co. Ltd. Public Liability policy. The insurer s own Medico Legal Team or Kennedys Solicitors on behalf of the MPLC will then be engaged to manage the claim direct with the Member until finalised or closed. It should be noted that the CSP are not involved with the management of the claims process other than initial verification of Membership and Scope of Practice. The majority of allegations received by Members are unfounded, but the process of resolving the various issues and establishing whether or not negligence has taken place, can be a long and slow process. 7

8 Responding to Claimants The Ministry of Justice governs the process of all Civil Proceedings in England. The procedure is governed by the Civil Procedures Rules: The process for managing clinical disputes is covered in the Pre action Protocol for the Resolution of Clinical Disputes and can be found at Once you have received notification from the patient or their solicitor that proceedings have started, you must act within defined time frames. The CSP s insurance brokers and/or the underwriters or solicitors acting on their behalf, will advise you what to do. You should not enter into correspondence with the claimant or their solicitors once insurers have been notified apart from: Acknowledging receipt of any correspondence received Informing the claimant or their legal representatives that your insurers have been notified of the matter Providing the contact details of your insurers or the CSP s insurance brokers so that all future correspondence can be directed to them and not yourself Providing copies of clinical records to solicitors if written consent is provided to you by the patient Invoicing for the cost of releasing clinical records where appropriate The Member should not at this stage comment on the treatment or advice given, nor on any allegations made, or make any offer of compensation, or make any admission of liability without the insurers consent. 8

9 Contact Details CSP Insurance Brokers The Chartered Society of Physiotherapy Graybrook Insurance Brokers Limited 8 Chandlers Way South Woodham Ferrers Chelmsford Essex CM3 5TB enquiry@graybrook.co.uk Enquiry Handling Unit Chartered Society of Physiotherapy 14 Bedford Row London WC1R 4ED enquiries@csp.org.uk Telephone: Telephone: Medical & Professional Indemnity Insurers The MPLC Claim Solicitors The MPLC Limited Regal House Queensway P.O. Box 1446 Gibraltar info@the mplc.com Kennedys Solicitors 25 Fenchurch Avenue London EC3M 5AD Telephone: Telephone: Public Liability Insurers Travelers Insurance Co. Ltd London Road Redhill Surrey RH1 1NA ukcall@travelers.com Telephone:

10 Guidance for Completing the Claim Form Failure to complete the claim form correctly may result in delays in processing your claim and may result in the forms being returned to you for correction. On completing the claim form please follow these simple rules: Use block capitals or type your form Write legibly Complete all sections Do not leave blanks write N/A or N/K if unable to complete the information Include all addresses where asked for all parties named in the form Enclose all Employment Contracts or other Contracts relating to your Terms of Engagement Enclose copies of all correspondence from the claimant and/or their solicitors If a Medical Malpractice claim, please enclose copies of all clinical records relating to the incident, if however, you are reporting only a potential claim or circumstances which may lead to claim, any such records must be anonymised. Do not submit any records which will be in contravention of the Data Protection Act Enclose a copy of the patient s written consent where received to release records to third parties Enclose copies of all information and advice sheets given to patients Do not use terms such as see notes enclosed or see enclosed documents or see attached. Forms completed using these terms will be returned to you for amendment If the claim involves equipment, you should also notify the MHRA (please see their website The Underwriters and their Solicitors will use the contents of your claim form to process your claim. 10

11 Detailing of Treatments or Advice The CSP is not able to receive and process any clinical records which may be attached to the claim, therefore, the details of your assessment, treatment and advice must be stated on the Claim Form. You may describe the treatment/advice given in any manner you feel appropriate, however, you may find it helpful to consider the four pillars of physiotherapy practice and describe your treatment/advice accordingly. The pillars of physiotherapy practice are: Massage covering all forms of massage and soft tissue handling techniques Exercise and Manual Therapy including all forms of exercise prescription (with or without equipment) and manual treatments encompassing mobilisation and manipulation to the body structures (with or without equipment) Electrotherapy use of any electro physical agent Kindred Treatments other modalities or interventions for example but not limited to acupuncture, injection therapy, prescribing actions, cognitive modalities and other means used to deliver physiotherapy You are also asked to detail any products supplied and advice given: Products describe any taping, strapping, support, splint, brace, cast, sling, bandage or dressings etc. given or used Advice describe what the advice related to: it might be advice relating to a pillar of practice, a product or something else determined by assessment e.g. workplace or lifestyle advice. If you gave an advice or exercise sheet, state the date and version of the document given to the claimant on the form and enclose a copy of the document for the insurer s records. 4th October

12 Notification of Claim, Circumstance or Incident That may lead to a Claim Privileged and confidential Prepared For Underwriters And/Or Their Legal Representatives In Contemplation Of Actual Or Anticipated Legal Proceedings To be completed by the CSP Member. Underwriters require the following basic information in order to confirm Policy response on new notifications and for compliance with Practice directions and Pre-action Protocols issued and approved from time to time by the Civil courts. No offer of payment or admission of liability must be made by you or anyone acting on your behalf. If the claimant is a patient you have treated who is making a claim in respect of that treatment, please forward a copy of your treatment notes/records relating to that treatment. Your Details Members Name Policy Number Renewal Date Contact Details First Name Title Telephone No Mobile No Address Address Last Name Occupation Fax No Pager No Post Code The MPLC All Rights Reserved. info@the-mplc.com Gibraltar - Main Office: Regal House, Queensway, PO Box 1446, Gibraltar Tel: +44 (0) Fax: UK Contact Office: 107 Fenchurch Street, London EC3M 5JF, United Kingdom Tel: +44 (0) Fax: +44 (0) Th MPLC i h di fth Mdi lp f i lli bili C Ld d ii i di li di Gib l b h Fi i ls i

13 Employment Details Employers Name Address Post Code Employment Status Employed Self-Employed If you are employed please also attach a copy of your employment contract. Current CSP Membership Details Membership Number Start Date Full Practising Member Student Member Overseas Member Non-Practising Member Retired Member Other (please specify) Were you a full practising member of the CSP at the time of the alleged incident? Yes No If No, please provide full details. Current PhysioFirst &/or AACP Membership Details (if applicable) PhysioFirst Membership No Start Date AACP Membership No Start Date Treating Physiotherapist Details (if someone else) First Name Last Name Title Occupation Address Post Code Employment Status Employed by You Self-Employed CSP Membership Practitioners own Indemnity/Insurance details (if known) Employed by another business The MPLC All Rights Reserved. info@the-mplc.com Gibraltar - Main Office: Regal House, Queensway, PO Box 1446, Gibraltar Tel: +44 (0) Fax: UK Contact Office: 107 Fenchurch Street, London EC3M 5JF, United Kingdom Tel: +44 (0) Fax: +44 (0) The MPLC is the trading name of The Medical Professional Liability Company Ltd, an underwriting intermediary licensed in Gibraltar by the Financial Services Commission, under licence number FSC00659B. All indications, quotes, acceptances of Proposals and issuances of policies are made by The MPLC in Gibraltar. The MPLC s insurances underwritten by certain underwriters at Lloyd's. 2

14 Claimant/Complainant Details First Name Title Last Name Occupation Date of Birth Male Female Address Post Code Marital Status Number of Dependants Has the claimant/complainant instructed solicitors? Yes No If Yes, please provide full details of solicitors and copies of all correspondence. Solicitor Name Address Post Code Telephone Solicitor Reference If No, have you been advised that a claim will or may be made against you? Yes No If Yes, please provide full details. Have you received a Letter of Claim or any other court documentation? Yes No If Yes, please provide full copies. Have you, or anyone acting on your behalf, said anything to the claimant about the incident, claim or problem that has arisen? Yes No If Yes, please provide full details The MPLC All Rights Reserved. info@the-mplc.com Gibraltar - Main Office: Regal House, Queensway, PO Box 1446, Gibraltar Tel: +44 (0) Fax: UK Contact Office: 107 Fenchurch Street, London EC3M 5JF, United Kingdom Tel: +44 (0) Fax: +44 (0) The MPLC is the trading name of The Medical Professional Liability Company Ltd, an underwriting intermediary licensed in Gibraltar by the Financial Services Commission, under licence number FSC00659B. All indications, quotes, acceptances of Proposals and issuances of policies are made by The MPLC in Gibraltar. The MPLC s insurances underwritten by certain underwriters at Lloyd's. 3

15 Are there any other Medical Practitioners or Medical Professionals included in the allegations of negligence? Yes No If Yes, please provide full details Dates When did the incident/problem occur? When did you first become aware of the incident/problem? When did the claimant first indicate that a claim would be made? Claim Details Please provide full details of treatment/advice provided or products supplied & any documentation which may be relevant. Please provide full details of claim or incident Please provide full details of the alleged injury, damage or loss. The MPLC All Rights Reserved. info@the-mplc.com Gibraltar - Main Office: Regal House, Queensway, PO Box 1446, Gibraltar Tel: +44 (0) Fax: UK Contact Office: 107 Fenchurch Street, London EC3M 5JF, United Kingdom Tel: +44 (0) Fax: +44 (0) The MPLC is the trading name of The Medical Professional Liability Company Ltd, an underwriting intermediary licensed in Gibraltar by the Financial Services Commission, under licence number FSC00659B. All indications, quotes, acceptances of Proposals and issuances of policies are made by The MPLC in Gibraltar. The MPLC s insurances underwritten by certain underwriters at Lloyd's. 4

16 Who do you think was at fault? Please give full details. Are there any other potential claimants who could bring a claim arising out of the same incident? Yes No If Yes, please provide full details Declaration I/We hereby declare that: The above statements are true, and I/we have not suppressed or mis-stated any facts and should any information given by me/us alter after the date of this Claim Form or should I/we receive any further communication in relation to this matter I/we shall immediately notify The MPLC Ltd. I/We also confirm that the undersigned is/are authorised to act for and on behalf of all persons who may be entitled to indemnity under any policy. Signature Date On Completion, this form and attachments should be returned to: Claims Department LFC Graybrook Limited MKM House, Baron Road, South Woodham Ferrers, Essex CM3 5XQ The MPLC All Rights Reserved. info@the-mplc.com Gibraltar - Main Office: Regal House, Queensway, PO Box 1446, Gibraltar Tel: +44 (0) Fax: UK Contact Office: 107 Fenchurch Street, London EC3M 5JF, United Kingdom Tel: +44 (0) Fax: +44 (0) The MPLC is the trading name of The Medical Professional Liability Company Ltd, an underwriting intermediary licensed in Gibraltar by the Financial Services Commission, under licence number FSC00659B. All indications, quotes, acceptances of Proposals and issuances of policies are made by The MPLC in Gibraltar. The MPLC s insurances underwritten by certain underwriters at Lloyd's. 5