The Claims Department is primarily responsible for accepting reports of claims made against insureds and investigating those claims.
The Claims staff works very closely with defense counsel to determine the best strategy for each case. Insureds should contact the Claims Department to report the following types of claims noted below. The caller must have available the legal papers, if any, and the medical and billing records of the patient. Only written notice triggers coverage under the policy:
The service of any legal papers in a medical malpractice action requires prompt notice to the Claims Department in order to properly protect your interests. A Summons is served to initiate the commencement of an action (lawsuit). A Subpoena issued by a Court requiring a witness to produce records or requiring testimony in a medical malpractice action.
Letters of Claim
Oftentimes a patient or their representative will make a written claim, excluding a SUIT for monetary damages. This type of ASSERTED CLAIM is treated similarly to a lawsuit.
PRI provides defense coverage for a physician who receives an investigatory letter from a State licensing agency, i.e., Office of Professional Medical Conduct.
For credentialing purposes, PRI is able to provide a loss run/claims history for individual practitioners or facilities. To request a loss run/claims history, please contact or email the Claims Department.
Potential Incidents, Adverse Outcomes, and Related Record Requests
PRI encourages the reporting of an incident that may give rise to a future medical malpractice latwsuit such as an adverse outcome in treatment or the request for the records by an attorney. This is particularly favorable to insureds with Claims-Made Policies. If you would like to report a potential medical malpractice incident, you may complete and sign the “Incident Reporting Form” – IRF.
All types of claims or record requests require the completion of an Incident Reporting Form. For record requests, be sure to include with your completed IRF a copy of your medical and billing records. All materials should then be forwarded to the PRI Claims Department via mail, email or fax.
Claim Filing Instructions: Claims should be reported directly to the Claims Department. Download, fill out, and save the
above. You can report a claim via email, by phone, fax or in writing. A Claims representative will be available to take your call.