Claims Management Flashcards

Under a claims-made insurance policy, coverage applies when:

Answer: Both the incident and report occur during the policy period

A claims-made policy provides coverage only when both the alleged incident and the claim are reported while the policy is active.

A risk manager is asked to preserve all records related to a patient who has threatened litigation. This obligation is known as:

Answer: Litigation hold

A litigation hold (or legal hold) is a directive to preserve all relevant documents and records once litigation is reasonably anticipated.

Which type of damages compensates a plaintiff for lost wages, medical expenses, and future care costs?

Answer: Economic damages

Economic damages are quantifiable monetary losses including medical bills, lost income, and costs of future medical care.

An independent medical examination (IME) in a claims context is typically used to:

Answer: Obtain an objective assessment of the claimant's injuries and prognosis

An IME provides an independent clinical opinion on the claimant's condition, causation, and future care needs to inform claims valuation.

What is the purpose of a subrogation clause in a healthcare liability policy?

Answer: To allow the insurer to recover payments from a responsible third party

Subrogation allows the insurer, after paying a claim, to seek reimbursement from a third party who was actually responsible for the loss.

A 'high-low agreement' in claims settlement means:

Answer: The parties agree to a minimum and maximum payment regardless of the jury verdict

A high-low agreement caps the defense's maximum payout and guarantees the plaintiff a minimum recovery, reducing uncertainty for both parties.

Which discovery tool requires a party to answer written questions under oath before trial?

Answer: Interrogatories

Interrogatories are written questions submitted to an opposing party who must provide sworn written answers within a specified time frame.