What to do in the event of a Claim or Circumstance

What constitutes a notifiable claim or circumstance under the policy?

This would be an indication that a claim for compensation may be intimated on behalf of the patient, or anything that makes it possible that a claim or regulatory proceedings could result.  You should look out for formal requests for medical records for the purposes of investigating a claim, or any other letter from solicitors acting on behalf of a patient. Be alert to threats from patients to report you to the GMC, especially as it is difficult to know which patients will carry out such threats. There are some incidents that will almost inevitably trigger an external investigation (eg GMC or Inquest) or an internal investigation. Therefore you should think of serious patient safety incidents (regardless of whether harm to a patient resulted), unexpected patient deaths or internal disciplinary issues arising out of care provided to a patient as having the potential to become a claim or formal regulatory proceedings.

When should I notify underwriters of a notifiable claim or circumstance under the policy?

Underwriters should be informed at the earliest possible opportunity. This is because late notification could prejudice the Defence of the claim and may result in cover being withdrawn. As soon as you believe there may be the possibility of a claim it is safer to inform your insurers (via the medico-legal helpline provided by DWF). It is very risky to ‘wait and see’, because any delay on your part could prejudice your position in relation to your insurers. You should notify via the DWF medico-legal helpline irrespective of your own assessment of the relative merit of the claim, complaint or allegation.

Why is early notification necessary?

Early notification of any potential claim or incident which could result in a legal claim will mean that it can be properly investigated at the outset and we, DWF and your insurers can provide you with advice and support to ensure that your position is protected from the outset.

Can I correspond with the patient’s solicitors myself?

Any correspondence from a patient’s solicitors should be passed to DWF (using the medico-legal helpline service), whereupon your insurers may appoint solicitors to act on your behalf and protect your interests.  You should not liaise with representatives for any patients without prior discussion with DWF, because your insurers might need to give their express approval to your proposed response to the patient’s solicitors. Under no circumstances should you make any admission of liability without your insurers’ express permission.  This could prejudice the Defence of any claim.

Do I have input into the Defence of the claim?

As soon as solicitors are appointed to act on your behalf they will be in contact with you to update you on the position and discuss a strategy for how to proceed.  These panel solicitors will report to your insurers and will keep you informed and seek your assistance and instructions where necessary to ensure that the claim is defended appropriately.

What will I have to pay if a claim is made?

You will only be responsible for a sum up to the value of your policy excess (if one applies). This could be used to pay for defence solicitor costs and / or damages and claimants solicitors costs if the case is settled. Once your policy excess has been exhausted you will not be responsible for any further payments as these will be met (up to the applicable Limit of Indemnity) by underwriters

How do I notify a claim or circumstance?

In the first instance, all claims, incidents or circumstances should be notified via the dedicated DWF notification and medico-legal hotline on 0333 010 2826. It would be helpful to have your policy number and any relevant details to

About the author

Joanne Staphnill, Partner - DWF LLP

Joanne Staphnill

After reading Law at Cambridge, Joanne was called to the Bar in 2003 and her work in pupillage included many clinical negligence and high-value personal injury cases. She re-qualified as a solicitor in 2006, and since then has regularly defended clinical negligence claims and has excellent experience in resolving claims through the pre-action protocol, alternative dispute resolutions and through the courts. Joanne always aims to understand whether a claim may affect the clinician’s professional reputation and takes pride in guiding clients who are unfamiliar with the legal process. Joanne and the DWF team continue to provide legal assistance and support and she produces extensive risk management materials for Incision members.