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The Advocate
First quarter 2007
Commentary: Claims Advocacy and What it Means to Do The Right Thing
By Terrance J. Sheehan, MD
President & CEO
Medical Mutual’s fundamental reason for being is to help doctors, hospitals and other providers move forward with their practices and their personal lives in the event of a claim against them. It is the area of Company operations in which we can all be both proud and grateful.
Let’s face it. Despite the high quality of care provided by the medical community of Northern New England, some claims have merit. In those situations, we do our best to assess the claim and pay a fair settlement, showing compassion to all parties involved. It’s simply the right thing to do. And to that end, in 2006, Medical Mutual made indemnity payments of over $16 million, plus nearly $8 million in expenses on behalf of our insureds to patients throughout Maine, New Hampshire and Vermont.
Not all cases are settled, however. Indeed, if the medicine was good, the extent to which Medical Mutual will advocate for its policyholders is unrivaled in the Northern New England market. In one recent case, for instance, we defended a hospital and two doctors who were sued for negligence and accused of both colluding against the plaintiff and falsifying material reports, charges which they flatly denied.
The five-year old case came to a head last year. After unsuccessful mediation, the Company won the court case, rejected an attempt by the plaintiff to settle during a lengthy appeals process and eventually won the appeal. In all, the claim cost the Company nearly half a million dollars to defend.
Due to the allegations, it was an intensely emotional case. Both doctors confided that from the moment the claim was filed, not a day passed when the gutwrenching nature of the lawsuit did not cross their minds.
Similarly, Medical Mutual recently tried a case on behalf of a physician who had taken a new position in the South, outside our service area. Prior to trial, the plaintiff had demanded a settlement that represented the full limits of the physician and the OB/GYN practice. After winning the trial earlier this year, the physician wrote an unsolicited thank you to the Company, expressing her gratitude for the fact that the Medical Mutual team handling the case did not attempt to cut corners and even hired a nationallyrenowned expert from the other side of the country to testify on the procedure in question.
In all, on a tail policy which cost the doctor $64,000, Medical Mutual spent over $200,000 to defend the case. In the doctor’s post-trial letter, she wrote, “I wanted to make sure you and your superiors at Medical Mutual of Maine know how very appreciative I am of the opportunity to try the case. I had your unyielding support... I pray that I will never need your service again. But if I do, I know I am in good hands.”
To be sure, not every case carries such high stakes. And, luckily for all of us, the reality is that only five percent of the claims we handle actually go to trial. But on behalf of the Company, I, for one, take great pride in relating these stories because they demonstrate the extent to which Medical Mutual goes to defend care that meets the high standards of American Medicine.
We do it because we firmly believe it is the right thing to do. And we remain committed to doing it better than any other medical professional liability insurance carrier in the market.