Ohio Administrative Code
Title 3364 - University of Toledo
Chapter 3364-10 - Reporting and processing job injuries; legal counsel
Section 3364-10-16 - Professional liability claims reporting and management
Universal Citation: OH Admin Code 3364-10-16
Current through all regulations passed and filed through September 16, 2024
(A) Policy statement
The university of Toledo ("UT") will promptly report all professional liability claims for UT and the university of Toledo physicians ("UTP"), that meet the criteria outlined in this policy, to the university of Toledo insurance program ("insurance program"). UT and UTP will promptly provide information related to actual or potential claims as required by this policy to the office of legal affairs, health science campus ("office of legal affairs").
(B) Purpose of policy
To assure that all professional liability claims and anticipated potential professional liability claims of UT and UTP are appropriately managed to improve quality of care, reduce the financial impact to both UT and UTP and are properly reported to the insurance program for insurance coverage.
(C) Scope
This policy applies to all UT employees, residents and students and to all UTP practitioners (collectively "staff").
(D) Procedure
(1)
Classification of claims
(a)
Class three
claims:
Lawsuits - summons and complaints served, regardless of court in which the action was filed.
(b)
Class
two claims:
(i)
One hundred eighty-day letters (Ohio) or notices of intent (Michigan) that give
notice of consideration of suing; or requests from patient, family or legal
representative for medical records where the request form indicates that the
party is considering filing a lawsuit; or
(ii)
Any written
demands for compensation by patient, family or legal
representative.
(c)
Class one adverse
events (potential claims): Procedures or treatments that are not yet class two
or class three claims and which may meet the following criteria:
(i)
The event has
resulted in an unanticipated death or major permanent loss of function, not
related to the natural course of the patient's illness or underlying condition,
including but not limited to unexpected deaths or unexpected outcomes of a
serious nature:
(a)
Unanticipated neurological, sensory or systemic
deficits: including but not limited to brain damage, spinal cord injury,
paralysis or nerve injury, organ failure or sepsis;
(b)
Severe burns,
including but not limited to thermal, chemical, radiological or electrical,
resulting in extensive hospitalization and/or skin grafting;
(c)
Severe internal
injuries, lacerations, infectious processes, foreign body retentions, or
sensory or reproductive organ injuries;
(d)
Substantial
disabilities, including fractures, amputations or
disfigurements;
(ii)
Any outcome that
is classified as a sentinel event (per rule 3364-100-50-38 of the UT medical
center (sentinel events/adverse events)) and requires a root cause analysis to
be performed.
(2)
Reporting of
claims to UT
(a)
Any staff who has knowledge of a claim or potential claim,
regardless of where the medical care was provided, is to report it to the
office of legal affairs.
(i)
Immediately hand deliver a copy of any lawsuit summons
and complaint in which the staff, UT or UTP may be involved to the office of
legal affairs the same day it is received.
(ii)
Forward a copy
of any one hundred-eighty-day letter/notice of intent to the office of legal
affairs within two days.
(iii)
Forward a copy
of any written demand for compensation or information regarding a verbal demand
to the office of legal affairs within two days.
(b)
If it is a
potential claim as described above, follow the sentinel events/adverse events
rule (3364-100-50-38) to report the event to the administrator on-duty as well
as complete an on-line patient safety net event report (occurrence report). The
office of legal affairs will be notified of the potential claim through the
sentinel event/adverse event communication process.
(c)
If a claim or
potential claim involves staff at non-UT facilities, the office of legal
affairs will advise that facility's legal department and seek their
collaboration in claims management as deemed necessary.
(3)
Management of claims
(a)
If the claim is a lawsuit (class three claim):
(i)
The office of
legal affairs and risk management will:
(a)
Prepare a claims
file and enter the claim in the claims database with initial information and
provide any subsequent updates in information, reserves, defendants,
settlements, dismissals, or other relevant information.
(b)
If the suit
involves UTP or a UTP insured, inform the UTP chief financial officer and any
UTP insured named in the action of the suit and provide them with a copy of the
summons and complaint, if they were not the ones who originally received the
documents.
(c)
Immediately impound any paper medical record in
accordance with UTMC policy 3364-100-50-35 (impounded medical
records).
(d)
Within a reasonable time period, retrieve any related
occurrence reports and related documents, such as root cause analysis, relevant
to the event. If the event may meet criteria of a sentinel event, follow policy
3364-100-50-38 (sentinel events/adverse events).
(e)
Within a
reasonable time period following the receipt of the lawsuit, have an initial
review of the medical record and preliminary interviews conducted with staff
who are involved in the case; develop a case summary with an initial summary
and assessment of the event.
(f)
Within ninety
days, or as records become available, present the case summary to the standard
of care committee for review and determination of standard of care
issues.
(g)
Ensure that reserves are set by the claims management
committee, if appropriate per rule 3364-10-04 of the Administrative Code,
following the determination by the standard of care committee.
(h)
Reserves may be
established for involved parties, even though not specifically named as a
defendant.
(i)
Select defense legal counsel if the matter is not
handled by the court of claims defense section.
(j)
Coordinate
litigation with defense legal counsel.
(k)
Coordinate with
risk management to develop and prepare loss run reports from the claims
database as needed. Month-end reports will be submitted to the insurance
program broker.
(l)
Collaborate with defense legal counsel in quarterly
reporting on any significant changes in the status of litigation to the claims
management committee.
(ii)
Defense legal
counsel will:
(a)
Collaborate with and report no less than quarterly to
the office of legal affairs regarding the status of case management and defense
strategy.
(b)
Involve and collaborate with necessary parties in
settlement discussions as required by the applicable policies.
(c)
Report, as
necessary, to the office of legal affairs any major discoveries or changes in
defense strategies that could affect the reserve and/or outcome of the
case.
(b)
If claim is a one
hundred-eighty-day letter, notice of intent or a written demand for
compensation by patient, family or legal representative (class two
claim):
(i)
Office of legal affairs and risk management will:
(a)
Prepare a claims
file and enter the claim in the claims database with initial information and
provide any subsequent updates in information, reserves, defendants,
settlements, dismissals, or other relevant information.
(b)
If the claim
involves UTP or a UTP insured, inform UTP executive director and any UTP
insured addressed in the claim of the correspondence and provide them with a
copy if they were not the ones who originally received the
documents.
(c)
Immediately impound any written medical record in
accordance with UT medical center policy 3364-100-50-35 (impounded medical
records).
(d)
Within a reasonable period of time, retrieve any
related occurrence reports and other documents, such as root cause analysis,
relevant to the event. If the event may meet the criteria of a sentinel event
follow policy 3364-100-50-38 (sentinel events/adverse events).
(e)
Within a
reasonable time period following the receipt of a class two claim, have an
initial review of the medical record and preliminary interviews conducted with
staff who are involved in the case; develop a case summary with an initial
summary and assessment of the event. If the case did not take place at a UT
facility and records are not available, then a partial case summary is
completed.
(f)
Evaluate whether there is enough information or the
event rises to the level of concern where it should be presented to the
standard of care committee for its review. Present the case summary to the
standard of care committee for review and determination of standard of care
issues.
(g)
Ensure that reserves are set by the claims Committee,
if appropriate per rule 3364-1004 of the Administrative Code, following the
determination by the standard of care committee.
(h)
Reserves may be
established for involved parties, even though not specifically named as a
defendant.
(i)
Coordinate with risk management to develop and prepare
loss run reports from the claims database as needed. Month-end reports will be
submitted to the insurance program broker.
(c)
If the
claim is a potential claim (class one claim):
(i)
Office of legal
affairs and risk management will:
(a)
Retrieve any related occurrence reports and other
documents, such as a root cause analysis relevant to the event.
(b)
If an event may
meet the criteria of a sentinel event but was not previously identified as
such, communicate with quality management to determine if it had previously
been reported and whether a root cause analysis had been done or should be
done.
(c)
If a root cause analysis is not being done by quality
management, conduct an initial review of the medical record and make an initial
assessment of the event.
(d)
Following the review, determine whether the event
should be reported on the loss run for insurance purposes and if there is a
need to impound any written medical records at this time.
(e)
Determine the
nature of the potential claim and evaluate its validity, its potential of
evolving into an actual claim. Evaluate whether there is enough information or
the event rises to the level of concern where it should be presented to the
standard of care committee for its review.
(f)
Coordinate any
claims management strategy or resolution with the claims management committee,
if appropriate, per rule 3364-1004 of the Administrative Code.
(4)
Office of legal affairs contact information:
(a)
Phone number:
419-383-4577
(b)
Fax number: 419-383-3896
(c)
Mail stop ("MS"):
MS one thousand one hundred six
(5)
Confidentiality:
All committee minutes, assessments, reports and other documents concerning the
reporting and management of claims are considered confidential as attorney work
product and peer review.
Disclaimer: These regulations may not be the most recent version. Ohio may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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