Medical indemnity DSS 2012-14
Identifying and definitional attributes
|Metadata item type:||Data Set Specification|
|DSS type:||Data Set Specification (DSS)|
The Medical indemnity data set specification (DSS) describes the data items and standardised data outputs for medical indemnity claims for the Medical Indemnity National Collection (MINC).
The MINC contains information on medical indemnity claims against health providers. These are claims for compensation for harm or other loss allegedly due to the delivery of health care. This health care may occur in settings such as hospitals, outpatient clinics, general practitioner surgeries, community health centres, residential aged care or mental health care establishments or during the delivery of ambulatory care. Adverse events or harm due to medical treatment, which do not result in a medical indemnity claim, are not included in the MINC.
In 2002, Australia's Health Ministers decided that a 'national database for medical negligence claims' should be established. In 2003 the Medical Indemnity Data Working Group (MIDWG) came into existence with its membership drawn from health authorities, the Department of Health and Ageing and the Australian Institute of Health and Welfare (AIHW). The MIDWG collaborated on establishing a Medical Indemnity National Collection (Public Sector), comprising data from the jurisdictions. In 2006 private medical indemnity insurers agreed to have their data on medical indemnity claims included in the MINC. In 2008 the Australian Health Ministers' Advisory Council approved funding for data development work. The data items and recording specifications proposed for DSS development are based on those endorsed by the MIDWG for the 2009-10 data transmission period.
Medical indemnity claims fit into two categories, i.e. actual claims (on which legal activity has commenced via a letter of demand, the issue of a writ or a court proceeding) and potential claims (where the health authority or private medical indemnity insurer has placed a reserve against a health-care incident in the expectation that it may eventuate to an actual medical indemnity claim). Information in the MINC relates to actual and potential medical indemnity claims and the alleged or reported health-care incidents leading to medical indemnity claims.
The MINC includes basic demographic information on the patient at the centre of the alleged health-care incident; related information such as the type of incident or allegation and the clinical specialties involved; the reserve amount set against the likely cost of settling the medical indemnity claim; the time between setting the reserve and closing the medical indemnity claim; and the cost of closing the medical indemnity claim and the nature of any compensatory payments.
Compensatory payments may be made to the patient and/or to an other party claiming collateral loss as a result of the loss or harm experienced by the patient.
As a general guide, the main steps in the management of public sector medical indemnity claims are:
1. An incident that could lead to a medical indemnity claim is notified to the relevant claims management body. In some jurisdictions medical indemnity claims are managed by the relevant state or territory health authority; however, in others, most of the claims management process is handled by a body external to the health authority. Occasionally, some of the legal work may be outsourced to private law firms.
2. If the likelihood of a medical indemnity claim eventuating is considered sufficiently high, a reserve is placed, based on an estimate of the likely cost of the claim when closed.
3. Various events can signal the start of a medical indemnity claim, for example, a writ or letter of demand may be issued by the claimant’s solicitor (this can occur before an incident has been notified) or the defendant may make an offer to the claimant to settle the matter before a writ or letter has been issued. In some cases no action is taken by the claimant or the defendant.
4. The medical indemnity claim is investigated. This can involve liaising with clinical risk management staff within the health facility concerned and seeking expert medical advice.
5. As the medical indemnity claim progresses the reserve is monitored and adjusted if necessary.
6. A medical indemnity claim is closed when, in the opinion of the health authority, there will be no future unforeseen costs associated with the claim's investigation, litigation or a payment to a claimant. If a claim is closed and the possibility of future costs arises, the claim may be reopened.
7. A medical indemnity claim may be finalised through several processes—through state/territory-based complaints processes, court-based alternative dispute resolution processes, or in court. In some jurisdictions settlement via statutorily mandated conference processes must be attempted before a medical indemnity claim can go to court. In some cases settlement is agreed between claimant and defendant, independent of any formal process. A medical indemnity claim file that has remained inactive for a long time may be finalised through discontinuation.
The detail of this process varies between jurisdictions, and in some jurisdictions there are different processes for small and large medical indemnity claims. Private medical indemnity insurers follow a similar process in managing claims reported to them that are covered by the insurance they provide to private medical practitioners.
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