Navigating The Claims Process: A Step-By-Step Guide

Medical indemnity is a legal requirement for all healthcare professionals in the UK and a vital aspect of your role (1,2). However, it can also be slightly confusing to get your head around.

From knowing which type of coverage is right for you to how to fill out a claim, there are several aspects to consider and, without having the right level of prior knowledge, indemnity-related issues may seem complicated and even overwhelming to deal with.

That’s why here at THEMIS, we’re here to change that narrative.

In this informative guide, we take a more detailed look at why you might need to file a medical indemnity claim and highlight what navigating that process will involve.

Why you might need to file a medical indemnity claim

Medical indemnity claims are generally the result of a negative patient experience, leading to patients potentially filing a medical negligence claim against their healthcare provider, hospital or clinic.

When this occurs, healthcare professionals can face legal charges as well as hefty compensation fees and settlements.

Understanding why a patient may file a malpractice lawsuit is vital as it can help you minimise the risk of it occurring. So, let’s take a look at some of the main reasons why it happens.

Medical negligence

One of the most common reasons you may need to file a medical indemnity claim is if a patient brings a lawsuit against you for medical negligence.

Some of the main examples of medical negligence include (3):

  • Misdiagnosis
  • Surgical errors
  • Improper treatment
  • Medication mistakes
  • Patient fatalities

In addition to this, a patient may also raise a claim of medical negligence if they believe their healthcare provider has directly caused them physical or emotional harm, and seek compensation through a lawsuit against the healthcare professional or hospital.(4)

Inadequate post-operative care

If a surgeon does not provide adequate post-operative advice to patients and it leads to complications such as infections, patients may decide to raise a lawsuit.(5)

An example of inadequate post-operative care can be if wound care instructions are not provided to the patient or if follow-up appointments are neglected, leading to complications.

Birth injuries

If an injury occurs to a mother or child during labour that results from a failure to address complications correctly or a mistake is made, a malpractice lawsuit may be raised against you.(6)

Lack of informed consent

Patients have a legal right to be informed of the risks, benefits and alternatives of any medical procedure they’re offered (7). If you perform a procedure and the patient does not have informed consent, they may raise a malpractice lawsuit.

To learn more about how to do this effectively, take a look at our dedicated article on the importance of gaining informed consent.

Failure or delay in diagnosis

Some health conditions are time-sensitive and only get worse if left untreated. Therefore, if you fail to diagnose a condition despite results from an investigative test confirming it – or there is any other delay in the diagnosis – this may lead to a medical malpractice lawsuit. (8)

How to make a medical indemnity claim with THEMIS

If you’re facing a malpractice lawsuit from a patient, knowing how to make a medical indemnity claim is crucial. At THEMIS, we want the process to be as simple as possible to keep you from experiencing any additional stress during this challenging time.

Take a look at the step-by-step guide below to learn how easy it is to deal with a medical indemnity claim through THEMIS.

Step one - get in touch

We know that facing a malpractice suit can be incredibly distressing, and you need someone you can trust by your side every step of the way. That’s why, with a THEMIS policy, you will always be looked after by one of our expert in-house claims management team.

If you have received a medical malpractice lawsuit and want to claim on the medical indemnity policy you hold with us, the first step is to get in touch with our in-house, expert, claims handling team.

You can get in touch with us by:

  • Telephone: 0203 411 3898
  • Email: [email protected]
  • The live chat function on our website

After contacting us, a member of our team will listen to your claim and begin processing it for you. We’ll also need some information from you before we can process your claim.

Aside from your full name, we’ll also need:

  • Your policy number
  • Confirmation of the incident date so we can ensure it falls within the time you’ve been insured
  • Brief details of which hospital the incident occurred in (private or NHS)
  • A copy of the claims information (including any allegations and comments) so we can check it’s within the speciality you are covered for
  • If it’s a regulatory claim, we may ask you for a letter from the General Medical Council that confirms they’re investigating
  • If it’s a medical malpractice claim, we’ll request a copy of the complaint

Step two - your claim is assessed

Once you have provided us with all the information we need, your claim will begin processing.

We manage everything in-house and receive exclusive legal opinions from Legal 500, tier 1 firms and independent expert evidence from TMLEP. With our comprehensive approach, you can be certain that your claim assessment is in the right hands.

At THEMIS, we only offer contractual, regulated indemnity that provides you with a clear understanding of your protection. (9)

Unlike discretionary indemnity, contractual indemnity ensures that the decision of your claim is based on your agreed terms. This means that, as long as the claim falls within the scope of your policy, we’re under a contractual obligation to provide you with the financial support you need.

We’ll let you know the outcome of your claim

Once your claim has been processed, we’ll let you know what the outcome of your claim will be.

Your medical indemnity claim will either be approved or rejected based on the terms of your policy. However, unlike mutual defence organisations (MDO), this won’t be due to a discretionary refusal – the decision will be made based on the terms laid out in your policy.

If your claim is rejected, this means you will need to cover the costs you face during the malpractice lawsuit.

If your claim is approved, your medical indemnity may cover:

  • Legal fees including defence costs
  • Court ordered compensation
  • Settlements
  • Other costs that may arise during the malpractice lawsuit process

Common mistakes to avoid with medical indemnity

Most of the time, the mistakes you may make when submitting a claim are down to human error, such as inputting incorrect policy information. However, there are some other mistakes you may make before submitting a claim that can affect or delay the process.

When you first apply for medical indemnity, you’ll need to provide:

  • Your job role (including any specialisms)
  • Your specialisms
  • Your experience and qualifications
  • Where you work
  • Your track record with previous claims or complaints in respect of what you are being insured for

If any of this changes or is incorrect when you come to submit a claim, your claim could be rejected so you must ensure material information in your applicaiton remains accurate.

You also need to ensure you have the right type of medical indemnity. If you work in the private sector, for instance, you may need personal indemnity even if your employer has corporate indemnity in place already.

So, make sure you have everything you need when applying for medical indemnity and be sure to always keep us updated if your roles or responsibilities change.

Get in touch with THEMIS to make a medical indemnity claim

Medical indemnity is a vital part of your healthcare career and is there to protect you should you ever need to face a malpractice lawsuit.

While this may feel complicated and overwhelming to deal with at first, our committed team of experts are always available to guide you through the process and answer any questions you may have.

If you want to safeguard your career and financial wellbeing as a medical professional, get in touch with THEMIS. We’re here to provide you with all the support you need, whenever you need it most.

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