The Number One Thing The Malpractice Insurer Does Not Want You To Know

What is the number 1 thing the malpractice insurer does not want you to know? The insurer’s internal report containing the opinions of its medical expert.

The one document the insurance company will never let you see

Here’s how it works: when you file a medical malpractice lawsuit, the defendant physician’s insurance carrier will retrieve the medical records and send them to a physician for an “internal review”. The purpose of the internal review is to assess the strengths and weaknesses of your case by an “in-house” physician for the malpractice insurance carrier.

The insurer’s in-house medical expert will prepare a report assessing the merit of the case and the report will be disseminated among the claims examiners at the malpractice insurance company. You will never see the internal report, but it exists in every case. The malpractice insurer will use the internal report to determine whether it should settle your case or go to trial.

In the internal report, the in-house medical expert for the malpractice insurer assesses two issues: #1: Whether the defendant physician deviated from the standard of care; and if so, #2: Whether the deviation from the standard of care caused harm to the patient (this is known as “proximate cause”).

What the malpractice insurer doesn’t want you to know

It is a tightly guarded secret of malpractice insurance carriers that they do not like to take cases to trial where there is a clear deviation from the standard of care. Even in cases where there is a question whether the deviation from the standard of care caused harm to the patient, the insurance carrier will almost always settle the case.

Let’s say the defendant physician misinterpreted a chest x-ray and the patient was diagnosed with lung cancer four months later. The in-house medical expert for the insurer acknowledges the deviation from the standard of care but believes an earlier diagnosis of lung cancer would not have increased the patient’s likelihood of survival. The malpractice insurer will almost always try to settle this case. It’s a hard sell for a jury to believe the defense that “yeah we screwed up but it didn’t make a difference”.

Can the defendant physician refuse to settle against the wishes of his insurer?

Almost all medical malpractice insurance policies require the consent of the policyholder, i.e., the physician, to settle the claim–this is known as a “consent policy”. Many physicians have been told from an early age that they can do no wrong and regardless of the obvious nature of their mistakes, they often refuse to settle. Isn’t this an impediment to a settlement? Rarely.

In cases where the medical errors are clear and obvious and the doctor refuses to settle, the malpractice insurer will often gently inform the defendant physician that he should settle or his malpractice insurance might not be renewed. This almost always solves the problem and the physician gives his consent.

If you have any questions, I welcome your phone call

If you have any questions or want more information, I welcome your phone call on my toll-free cell at 866-889-6882. You can always request my FREE book, The Seven Deadly Mistakes of Malpractice Victims, on the home page of my website.