Claims Management

Claims management is a process of early identification, investigation, and resolution of potentially compensable events. Potentially compensable events are poor patient outcomes that are usually associated with a patient's request for monetary damages. A claims management process involves a programmatic approach that outlines the institutional philosophy of how adverse events are communicated and handled in anticipation of litigation. The development of policies should guide staff regarding [Page 73]notification, classification, and disposition of information that has been identified as entailing potential or actual liability. This handling of information is a risk management function. The risk manager receives reports of professional and general liability claims against the institution, its employees, and agents and manages them to conclusion.

Figure 1