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Medical Malpractice

The Role of Insurance Companies in Medical Malpractice Claims

— October 19, 2023

By remaining aware of these dynamics, patients can better navigate the complexities of their medical malpractice case and ensure their voices are heard.

Did you know that when a doctor is sued for medical malpractice, the doctor is often not directly involved in the legal proceedings?

Instead, their malpractice insurance carrier appoints an attorney to defend them. This attorney, paid by the insurance company, fights on behalf of the doctor. And if the patient wins the lawsuit, the insurance company will usually cover the full amount of the judgment.

So, in reality, when a patient files a medical malpractice lawsuit, they are actually going up against the insurance company rather than the doctor or healthcare facility responsible for the mistake.The doctor is the named defendant and will participate in certain legal procedures, but it’s the insurance carrier who takes on the day-to-day battle.

Keep reading to learn more about the role insurance companies play in medical malpractice cases.

The Investigation Process

Medical malpractice insurance providers participate in many of the steps of the medical malpractice claim, including the investigation phase. 

Victims of medical malpractice are often optimistic that the investigation process will work in their favor. They hope that the insurance provider will take into account the harm caused by the medical care provider and the fact that they received treatment from them, and award the compensation they deserve.

Unfortunately, it’s not always that simple. The insurance provider will search for evidence to prove that the medical care provider didn’t act negligently or that your damages weren’t caused by their actions.

To successfully pursue a medical malpractice claim, there are three important factors to consider:

  • Doctor/Patient Relationship: Only individuals who were under the care and treatment of a specific doctor can file a medical malpractice claim against that doctor. If there was no established relationship, then a claim cannot be made.
  • Departure from Standard Treatment: In order to prove medical malpractice, it is necessary to demonstrate that the healthcare provider did not adhere to the expected standards of treatment. This means showing that their actions deviated from the practices that other providers would have followed in similar circumstances when diagnosing and treating a patient.
  • Damages: It is crucial to have suffered damages as a result of the healthcare provider’s negligence in order to pursue a medical malpractice claim. If there were no additional damages beyond negligence, then the right to file a claim may be limited.

Throughout the process, you may have frequent communication with the insurance adjuster, who will request access to your medical records and ask for statements about your recovery and the damages you suffered. The purpose of these requests is to find evidence to dispute your right to file a claim or reduce the amount of compensation you’re entitled to.

For this reason, make sure you seek the guidance of a lawyer. They can provide valuable assistance in understanding what information you need to provide and how to handle any questions that may arise during your claim.

The Negotiation Process

Handshake: image courtesy of geralt via Pixabay,
Handshake: image courtesy of geralt via Pixabay,

Often, the medical malpractice insurance company will launch the negotiation regarding the damages you will ultimately recover for your medical malpractice claim. You may, for example, receive a settlement offer from the insurance company soon after the medical malpractice event. That settlement offer will often include a meager amount: just enough to entice you to accept but not enough to fully cover the damages you may have sustained due to the doctor’s negligent actions.

You may go through several negotiation rounds before you reach a reasonable settlement agreement regarding your injuries. The medical malpractice insurance provider may only slowly increase that settlement offer or try to make it as difficult as possible to get the full compensation you may feel you deserve for those injuries.

By working with a lawyer, you can get a better idea of how much compensation to expect, what the medical malpractice insurance provider should cover, and how you should deal with a settlement offer that does not reflect your financial needs following the damage you sustained.

What to Expect From Their In-House Attorneys 

Insurance companies often rely on their own in-house attorneys to handle medical malpractice cases. This has a few important implications. 

The first is that using in-house counsel helps keep the insurance company’s legal costs down. Since the insurance company doesn’t have to pay the attorney by the hour, there’s less pressure to rush the case. This means more time can be spent on the pretrial process.

Second, in-house attorneys have experience with numerous similar cases. Unlike a doctor who may be personally invested, an insurance company’s attorney will make decisions based on careful consideration of various economic and strategic factors.

By leveraging their in-house legal expertise, insurance companies can effectively handle medical malpractice cases in a cost-efficient and tactical manner.

What to Expect from Expert Witnesses

When it comes to medical malpractice cases, insurance companies often utilize expert medical witnesses to support the doctor’s actions and treatment choices. These witnesses are aware that they are being paid by the insurance company, so their opinions are typically biased in favor of the doctor.

Therefore, patients should be cautious when an insurance company claims that their case is weak because an expert has confirmed the doctor’s actions were correct. While this may accurately reflect the expert’s opinion, it’s important to recognize that the expert is likely aligned with the insurance company.

To counter the insurance company’s position, the patient (with the help of their attorney) will hire their own expert witnesses who can demonstrate how and why the doctor’s conduct amounted to medical malpractice. This creates a scenario where the outcome of many medical malpractice cases often hinges on a “battle of the experts,” particularly during the trial phase.

Seek Guidance from an Experienced Medical Malpractice Attorney 

By remaining aware of these dynamics, patients can better navigate the complexities of their medical malpractice case and ensure their voices are heard.

If you are a victim of medical malpractice caused by a negligent care provider, expect a tough battle against the powerful legal team of the medical malpractice insurance company. However, you don’t have to fight alone. 

By hiring a skilled lawyer, you can increase your chances of obtaining the compensation you rightly deserve. Reach out to a medical malpractice attorney without delay to understand your rights and explore your options.

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