Guidance note for notifying claims and circumstances

These guidelines are intended to assist you in identifying what you need to report to us under your Medical Professional Liability, Public & Professional Liability Insurance policy. They are not intended to replace the policy terms and conditions in any way.

Claims Process

Swift resolution of claims is reliant upon the quality of the initial information CNA receives. The more complete the information is, the more quickly CNA can move to resolve a claim.

A Claim/Circumstance Notification Form should be completed in respect of all new notifications and should be sent to: insurance@challenge.ie

What needs to be notified

You are responsible for notifying CNA of Claims and Circumstances which may give rise to a Claim under the policy. Such notice should include:

a. details of what happened and the services and activities that you were performing at the relevant time; and

b. the nature of any, or any possible, bodily injury; and

c. details of how you first became aware of the Claim or

Circumstance; and

d.all such further particulars as CNA may require.

Claims

Under the terms of your policy, any Claim must be reported to CNA in writing immediately.

The definition of a “Claim” is any:

“ 1. written or verbal demand made of you; and/or

2.assertion of any right against you, including but not limited to any proceedings, including any counter-claim; and/or

3.invitation to you to enter into alternative dispute resolution, alleging any occurrence, negligent act, error or omission that may give rise to an entitlement to damages.”

Examples of a Claim are:

•A letter of claim from solicitors.

•A letter or verbal demand from a patient or third party,alleging wrongdoing and requesting compensation.

•Legal proceedings (e.g. a Summons/Particulars ofClaim, etc.).

Circumstances

Under the terms of your policy, any Circumstance must be reported to CNA in writing immediately.

A “Circumstance” is defined as:

“any circumstances of which you become aware, or should reasonably have become aware, that may reasonably be expected to give rise to a Claim.”

Examples of a Circumstance are:

•Any complaint, written or verbal, in which the patient orpatient’s representative expresses dissatisfaction regardingthe treatment received and alleges that, as a result, thepatient suffered bodily injury.

•A request for access to medical records received from asolicitor or third party on the basis that a Claim against you/your service (to include any of your employees) is beingcontemplated.

•Any incident in which a Serious Untoward IncidentReport is generated.

•Any unexpected or unusual death of which you becomeaware.

•Any adverse outcome or clinical “near miss” in which youbelieve there may have been a negligent act, error oromission, irrespective of whether or not the patient is awareof this or whether the patient or patient’s representative hasmade a complaint.

A loss of patient records (which after a relevant search cannot be found).

These examples are for general guidance only and this is not an exhaustive list. If you are in any doubt regarding whether an incident is reportable then you are encouraged to notify the matter to CNA as a precaution