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FAQ

CLAIMS

Q – Who will be responsible for handling claims for EMPAC RRG?

A – EMPAC RRG’s board is fortunate to have three physicians with personal experience in managing their group’s claims. Of those three, two have worked for years in the litigious environments of Miami-Dade and Cook Counties. Additionally, EMPAC has selected a recognized third party claims administrator in ProClaim America, Inc. ProClaim, along with Quality Medical Risk Management, the company responsible for overseeing Risk Management and Patient Safety issues, coordinate all claims processing issues.

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Q – Who will represent me? Can I choose my own attorney?

A – Members can recommend an attorney of their choosing. As long as their credentials are excellent and they otherwise meet EMPAC’s requirements for all defense counsels, EMPAC will most likely grant such a request. If the requested counsel does not qualify or is conflicted out, a local attorney will be retained based upon the expert knowledge of ProClaim America, QMRM and other insureds.

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Q – Will EMPAC RRG grant Consent to Settle Authority to insureds?

A – No. EMPAC wishes to avoid the rare, but inevitable situation of having an intractable insured physician behave detrimentally to the greater good of the RRG. Where EMPAC faces such issues, the insured group will be asked to join EMPAC in reviewing the issues at hand to determine the final course of action. Determinations to settle can be appealed to the Claims Committee and the Board.

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Q – Who will review the adequacy of EMPAC RRG’s loss reserves?

A – QMRM. EMPAC RRG’s Claims Committee will interact with ProClaim America in the investigation of each claim and determine together the proper reserve amount for each claim. All claim reserves will be reviewed by EMPAC RRG’s Claims Committee in preparation for its reporting at each Board meeting. Annually, EMPAC’s independent actuarial firm, Milliman, will perform a loss reserve valuation study and certify the adequacy of the loss reserves.

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Q – How are settlement offers determined?

A – QMRM will work with ProClaim’s adjusters to determine recommended settlement amounts. All recommended settlements over $50,000 will be approved by the EMPAC RRG Claims Committee, and those in excess of $500,000 by the Board within a general review of each claim.

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Q – Will this program offer risk management services?

A – Yes. Effective risk management is a primary goal of EMPAC RRG. Since EMPAC is specialty specific, it is able to examine targeted losses and discover which risk management factors result in the most impact to claims reduction. EMPAC also benefits from the ability of its physician members to share ideas specific to the risk management programs in place at their emergency department, thus creating an ideal setting for innovative and customized plans to flourish.

An extensive members-only online Risk Management and Patient Safety webpage is available with short monthly mandatory online presentations on critical issues. Through the management of claims from across the country, QMRM, which manages the content of the site, is able to identify trends in malpractice litigation and loss prevention strategies.

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