The Hospital Risk Manager and/or Insurance Company is Calling Me to Negotiate a Settlement – What Should I Do?

You’re just home from the hospital, and you’re starting to get phone calls…. the health care risk manager from the hospital, a claims adjuster, an insurance company representing the hospital,  some insurance company claims adjuster representing… ?—it’s hard to keep track of who these people are and what they want.

Well, they want to talk to you about the injuries you suffered at the hospital that appear to be the fault of the doctor or the organization. And they want you to say that it wasn’t their insured’s fault. The doctor didn’t make a mistake. The hospital isn’t liable. Anything you can say to help their case.

You shouldn’t take these calls. Instead, work with an experienced Grand Rapids injury attorney.

What’s a Health Care Risk Manager?

This is a position at a hospital or healthcare facility that’s tasked with continually assessing and minimizing various risks to staff, patients, and the public at their facilities. A health care risk manager will assist with incident management involving minor, daily problems, as well as major, unexpected events, such as an injury suffered by a patient where there’s possible liability and exposure for the hospital.

What’s a Claims Adjuster?

A claims adjuster works for an insurance carrier. He or she investigates insurance claims to determine the extent of the hospital’s or physician’s liability. Insurance companies have different types and levels of benefits for a patient’s claim based on age, health conditions, patient history, and many other factors.

Claims adjusters handle liability claims involving personal injuries, including medical claims where an injured patient says that a physician, surgeon, staff, or the healthcare facility as a whole acted negligently in the treatment, care, or procedures that caused their injuries.

A claims adjuster will examine a case by interviewing the claimant and witnesses, researching medical records, and inspecting any the details of the incident. In reviewing a medical claim, a claims adjuster will consider each policy’s benefits to be certain that a patient’s claim is valid. An essential component of a medical malpractice case for a claims adjuster is speaking with the patient.

What Questions Might a Claims Adjuster or Health Care Risk Manager Ask Me?

Again, these people are not on your side. They represent the doctor, the hospital, and their insurance company. Their objective is to settle your claim for as little money as possible. They aren’t looking after your best interests and aren’t looking to give you just compensation for your injuries.

Just in case you’re talking to a claims adjuster or health care risk manager—which again DO NOT DO—here are some of the questions they might ask and how to respond:

• Is it OK if I record this conversation? The answer is NO. Absolutely not. Under no circumstances, should you consent to having your conversation recorded by an insurance adjuster.
• Who do you think was responsible for causing your injuries? The claims adjuster will ask this question to deflect the responsibility away from the insurance company’s policyholder – i.e., the doctor, the surgeon, the nurse, the phlebotomist, the lab, or the hospital. Another way of getting you to help avoid liability for his or her client is to ask, “this could happen to anyone doing this surgery, don’t you think?” Don’t speculate, and don’t answer that question.
• Can I get your permission to see all of your medical records? An adjuster may want to collect additional medical records in an attempt to poke around in your medical history to see if there is anything they can use against you. Ask the adjuster to tell you why the additional records are needed, and say that you’ll check with your attorney.
• What type of injuries do you now have as a result of the procedure? You’re not a doctor, and you don’t have a firm understanding of the extent of your injuries. You also don’t what types of damages you can recover, such as economic damages that include medical bills, home health care, physical and occupational therapy, lost wages, lost earning capacity, along with non-economic damages such as pain and suffering.
• How much work do you think you’ll miss? Again, you’re not a doctor, and you don’t have an accurate picture of the extent of your injuries. There may be long-term effects from the medical mistake that impact your earning capacity or quality of life. An experienced Michigan medical malpractice attorney will hire economists and vocational experts to determine the amount of damages in your case. Your opinion really isn’t helpful to anyone and can only harm your case.
• Did you know that you can only really recover $ _______ ? Michigan caps non-economic damages in personal injury claims. These are things like “damages or loss due to pain, suffering, inconvenience, physical impairment, or physical disfigurement, loss of society and companionship, … loss of consortium, or other noneconomic loss.” You have no way to gauge what your damages really are, so don’t get into a discussion about damages caps and how they might apply to your case.
• Would you be willing to sign a release regarding your claim? The answer is NO. Absolutely not. This has critical implications for your right to recover compensation, and if you sign, you’re forfeiting your rights to bring a legal action against those responsible.

Answering any of these questions (and many others) from a claims adjuster or a health care risk manager may be extremely detrimental to your case.

An experienced Michigan medical malpractice attorney like those at Buchanan Firm will represent you and your interests. They will examine all of the facts and circumstances surrounding your injuries and make sure you receive the compensation you need. This includes addressing a potential medical lien. This is a demand for repayment that can be attached to your personal injury case. Buchanan Firm will thoroughly investigate every aspect of your case to provide you with the best legal representation.

Takeaway

Remember that the adjuster works for the insurance company and the health care risk manager works for the hospital—not for you. Their objective is to keep any payment to you for your medical error injuries as low as possible. The less they pay, the more profitable the hospital and the insurance company will be.

Let Your Attorney Handle These Calls!

If you or a loved one has suffered harm due to an error at the hospital or clinic by a doctor, nurse, or staff, you should speak with a Grand Rapids medical malpractice lawyer at Buchanan Firm. We can discuss your situation if you believe you’ve been serious injured as the result of medical malpractice.

Our firm proudly serves people all across Michigan, including major cities like Grand Rapids, Muskegon, Detroit, Lansing, Holland, St. Joe, and Ann Arbor, and rural towns such as Lowell, Ada, Fremont, Newaygo, Grand Haven, Rockford, and Cedar Springs. We will meet you after-hours, at home or in the hospital to accommodate you.