Whenever you seek medical treatment at a health facility, something called a medical billing to your health insurance provider comes into play. This type of claims process where the healthcare provider treats you and sends a bill to your designated payer differs from patient claims arising from medical negligence.
In the former, an insurance company will look at the patient’s medical records, including treatment, medical specialty, diagnoses, procedures, age and discharge from hospital, among others to determine whether they can approve or deny the claim
Medical negligence claim
A medical negligence claim comes into play when a patient sues a hospital or their health practitioner seeking compensation as a result of negligence that causes bodily harm, adverse effects, or such other injuries so suffered.
To file a medical negligence claim, the patient needs to prove that their doctor or health practitioner provided services or care that either directly led to the injury or exacerbated the sickness; or that the standards of the provider were not professionally executed or were way below standards.
What should you know about patient claims?
If you are lodging a patient claim, then note that you need to do it within a specified time limit. For compensation, lodge your case with the court within three years after the moment you note a problem. To be specific, count the three-year period from the time you sought treatment that ended with a negligence action.
Although the time limits apply, exceptions are in place for patients younger than 18 years or if the patient has a mental problem.
Finding an attorney
In the US, claims data and litigation are primarily handled by attorneys (solicitors in other jurisdictions) to determine legal liability. It, therefore, means that one needs to find an attorney versed with patient claims and the insurance implications that can result in compensation or rejection of claims. The attorney will brief you on the claim and give you legal advice.
Settlement vs. trial
About 14% of negligence cases leading to adverse effects go before a judge. Most of the other medical negligence cases do not proceed to a full trial because defense attorneys almost always put forward an offer proposing a financial settlement.
Have documents to prove your case
For a claim to be successful and reach a settlement or have a trial judge rule for compensation, you need documents. Keep all and any records related to your case. You will also need professional and medical opinion supporting the negligence claim.
Insurance company’s investigations
When an insurance company receives a claim, it begins an investigation and tries to determine if the litigant should be compensated or not. If paid, the compensation usually provides for additional treatment where needed and income loss occasioned by the adverse effect or injury.
If you have a common medical complication, then you won’t get compensation even if you file a claim. Medical negligence claims can take anywhere between eighteen months and three years. In some cases, the complexity of a case and if it goes to trial can push determination much further.