Claims Reporting Tips

August 27, 2018

Suppose you receive an angry letter from a client stating that the care they received at your facility was terrible and they are still suffering from medical issues.  The next day you receive a phone call from a parent who is irate about the care provided to their child and are threatening to sue without giving specifics. Should you report this to your insurance carrier? Do you wait for an attorney to write a demand letter?  Do you wait for a formal lawsuit?


Four out of 10 doctors will face a malpractice in their career, but there’s no standard procedure for a customer claim.  It’s easy to brush off an irate phone call or throw away an angry letter, but you might put yourself at risk for your insurance carrier to decline coverage due to lack of timely reporting.


At J&R we advise that it’s crucial to report often and report early.  What we’re trying to avoid is a client thinking they can handle a claim internally or if we pay the X dollars we don’t have to report the claim and it won’t affect our premiums.  The problem with this is that if something goes haywire and you need help from your insurance carrier they might say that you violated the terms of timely reporting and decline coverage.

The reason that insurance carriers want to know right away about claims is trying to keep pace with plaintiff’s attorney.  The information and the minds of the involved parties are still fresh and that way the defendants can make the best determination of liability.

Another wrinkle would be if you decide to change carriers. In that case, you’d need to be sure all potential claims are reported so you don’t run into issues with carriers declining coverage. If a new carrier determines that the claim should have been reported to the prior carrier, they may flat out decline coverage.

Also, there’s a myth that if you report a claim, your rates will be impacted.  That may be true for auto and property, but since malpractice carriers encourage early reporting they won’t increase rates just due to the fact that you’re reporting claims as a precaution.

If you run into a potential claims situation that has you perplexed, please feel free to reach out to the people at J&R Agency.  We have over 40 years of claims experience so we can get you on the right path and provide advice that will put your mind at ease.

Expert Commentary articles and other online content do not purport to provide legal, accounting, or other professional advice or opinion. If such advice is needed, consult with your attorney, accountant, or other qualified adviser.