CPHRM Claims Management 2 — Questions and Answers
Question 1: Which document formally notifies a healthcare organization that a patient intends to pursue legal action?
- Incident report
- Notice of intent (Correct answer)
- Summons and complaint
- Subpoena duces tecum
Correct answer: Notice of intent
A notice of intent is a pre-suit document that formally alerts a healthcare provider of a patient's intent to file a malpractice claim.
Question 2: In claims management, 'excess exposure' refers to a situation where:
- A claim involves multiple defendants
- Potential damages exceed available policy limits (Correct answer)
- The claimant has filed in multiple jurisdictions
- The statute of limitations has been exceeded
Correct answer: Potential damages exceed available policy limits
Excess exposure occurs when a claim's potential verdict or settlement value surpasses the organization's insurance policy limits, creating personal financial risk.
Question 3: A healthcare risk manager discovers a pattern of similar medication errors across three departments. The BEST first action is to:
- File individual claims for each incident
- Conduct a root cause analysis and implement system-wide corrective action (Correct answer)
- Notify the insurer of each incident separately
- Settle with affected patients immediately
Correct answer: Conduct a root cause analysis and implement system-wide corrective action
Identifying systemic issues through root cause analysis and implementing corrective actions addresses the underlying problem and prevents future claims.
Question 4: Which legal doctrine holds a hospital liable for the negligent acts of its employees performed within the scope of their employment?
- Res ipsa loquitur
- Respondeat superior (Correct answer)
- Corporate negligence
- Contributory negligence
Correct answer: Respondeat superior
Respondeat superior ('let the master answer') makes employers vicariously liable for employees' negligent acts committed within the scope of employment.
Question 5: When evaluating a claim for early resolution, which factor MOST influences the decision to offer a settlement?
- The claimant's attorney reputation
- Liability exposure combined with potential damages (Correct answer)
- The patient's insurance coverage
- The number of witnesses available
Correct answer: Liability exposure combined with potential damages
Settlement decisions are primarily driven by assessing the strength of liability and the magnitude of potential damages if the case proceeds to trial.
Question 6: The primary purpose of a claims reserve is to:
- Fund patient compensation funds
- Estimate the financial liability for pending claims (Correct answer)
- Pay defense attorney retainers
- Cover deductible payments
Correct answer: Estimate the financial liability for pending claims
A claims reserve is a financial estimate set aside to cover the anticipated cost of settling or litigating a pending claim.
Question 7: Which element is NOT required to establish a medical malpractice claim?
- Duty of care
- Breach of the standard of care
- Causation
- Intent to harm (Correct answer)
Correct answer: Intent to harm
Medical malpractice is a negligence-based claim requiring duty, breach, causation, and damages — intent to harm is not an element of negligence.
CPHRM Claims Management 2
Which document formally notifies a healthcare organization that a patient intends to pursue legal action?