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Claims Guide​​​​​​


 


NSO Claims Guide​

In this Claims Guide, you will find descriptions of the claims handling process at CNA. This guide includes steps you need to take in the event of a medical incident claim and the response you can expect to receive from CNA. 

NSO will investigate your claim based on the facts provided. With over a century of expertise in the insurance industry, and over 40 years providing professional liability insurance to nursing professionals, you can count on CNA when faced with a claim. 

You can count on us to guide you through the claims experience 

Your policy is designed to provide coverage against allegations of negligence (true or false) that arise from "covered medical incidents" while you perform your professional services. 

The policy defines a medical incident as "any act, error or omission in your providing or failure to provide professional services. This includes your responsibility for anyone acting under your direction and control." 

Your policy may also provide the following additional coverages: disciplinary defense, personal liability, personal injury, and first party assault. To learn more about these coverages, please see An Explanation of Coverage​

Your policy will be written either on an occurrence or claims-made basis. Both policies are in force for a set time frame – typically one year. However, they differ on the type of event that triggers coverage. 

Occurrence policies provide coverage for a medical incident that takes place during the policy period – regardless of when the claim is reported. It provides long-term insurance for any covered claim that may arise at any time in the future – up to the limits of the policy in force at the time the incident leading to the claim occurred. 

Claims-made polic​ies provide coverage for claims made during the period for medical incidents that take place while the policy is in force. A claims-made policy offers coverage on a year-to-year basis – up to the limits of the in-force policy. 

An insurance policy is much more than a piece of paper – it's a commitment to deliver the claims service that stands behind the policy. CNA's commitment is to: 

  • Provide timely coverage analysis 
  • Make prompt assignments to defense counsel 
  • Bring healthcare experts into the evaluation process early 
  • Pay claims fairly and promptly while defending baseless claims aggressively 
  • Appropriately consult with you on the issues of defense, settlement, and claim resolution. 

 

Our staff is highly trained in appropriate claim procedures and the handling of litigation management. We encourage continuous education of our staff and provide on-site training by medical experts in specific areas of practice to ensure that we have working knowledge of the profession, the standards, and the services being provided. We also stay up-to-date on the latest trends in claims and legal environment so you know we’re providing the most accurate information. 

What you need to know about medical incident claims 

Spotting and reporting incidents is an essential first step in the medical claims process. But how do you know when you've experienced an incident? 

Medical incidents are specific events where any error or omission in professional services may lead to a claim. Incidents also include any event indicating a patient may be considering filing a claim relating to your professional services, even when you cannot find an error in your treatment. 

Clinical concerns such as adverse treatment results and medication errors would be considered incidents. Incidents also include signs of patient displeasure, such as a letter of complaint, a heated disagreement, or repeated failure to keep appointments without adequate explanation. Your policy defines a claim as… 

"A claim means a demand for money or services. Claim also means filing of a suit or the starting of arbitration proceedings naming you and alleging injury or damage." 

That means a claim could be any one of the following: 

  • A summons or complaint alleging an act or omission in the rendering of professional services. 
  • A letter, or any other document, or demand for services or money from you because of acts or omissions arising from professional services you provide. 
  • An oral threat or complaint indicating that a party is holding you responsible for damages arising from professional services rendered. 
  • Notice of arbitration filed against you for damages alleged from your professional services.  
 

What you need to know when filing a medical incident report 

Timely reporting ensures that an incident, if it develops into a covered claim and is not excluded for other reasons, will be covered. While most medical incident reports never move beyond this stage, it’s difficult to predict which ones will develop into a claim. Having the events on record safeguards you, the patient, and the Insurer. 

To report a claim, contact NSO as soon as possible. NSO will confirm your policy was in force during the alleged date of loss, and forward the materials on to CNA for immediate claims handling. We can also receive your claim information through electronic transmission for faster processing. 

When contacting NSO, please provide: 

  • Your policy number 
  • The telephone number and best time you can be reached 
  • An address where you can receive mail 
  • The date you received the claim 
  • The date of the incident 
  • The claimant name (if available) 
  • A brief description of the facts of the claim (if available) 

 

Nurses and nurse practitioners should call (800) 247-1500 or use our online incident report to report a claim.  

Remember, the sooner you give notice, the sooner we can take action. 

After you report the claim, make sure you take the following steps throughout the claims process: 

  1. Do not discuss your claim with anyone, including the patient. Limit all discussion of the claim to your NSO representative, your CNA claims consultant, or your attorney. 
  2. Do not sign or accept any document related to the claim from any party without obtaining approval from your CNA claims consultant. 
  3. Avoid discussing, commenting upon, or taking issue with any information you receive regarding judicial or administrative proceedings. 
  4. Be sure you do not admit liability, consent to any arbitration or judgment, or agree to any settlement proposal. 
  5. Be prepared to spend a substantial amount of time with counsel and your CNA claims consultant to aid in the investigation of your claim. 
  6. Report any communication you receive from the patient, patient's attorney or any state or federal administrative agency, licensing or regulatory authority, immediately to your CNA claims consultant. 
 

What we will do for you 

  1. Assign your case to a claims consultant with claims-handling experience in the territory in which you are located. Your CNA consultant handles healthcare professional liability claims exclusively and will bring in-depth knowledge and understanding to your individual situation. 
  2. Acknowledge receipt of your notice of a claim by promptly contacting you to discuss the issues surrounding the incident in question. Be prepared to provide the CNA claims consultant with information regarding the claim. If CNA elects to open a claim file, they will inform you of the file number and the name of the consultant who will be managing the case on your behalf. CNA will acknowledge receipt whether or not a claim file is opened. Either way, CNA will provide the guidance you need to address any concerns as well as a means to keep in contact with us if your circumstances change. 
  3. Review your insurance policy and advise you as to coverage issues that may be presented by the allegations. Occasionally, a claim is presented which falls outside of the coverages afforded to you in your policy. If this occurs, we will promptly confirm this with you by sending you either a Denial or a Reservation of Rights letter. 
  4. Appoint qualified and experienced defense counsel to represent you when necessary, in the event of a lawsuit. CNA will discuss attorney options available to you that meet the individual needs of your specific situation. 
  5. Supervise counsel's representation as long as the claim is pending, communicating directly with counsel and you as needed. Counsel is always instructed to regularly contact you directly to keep you informed throughout the process. 
  6. Consult with defense counsel to consider the defense, settlement and resolution of the claim and advise you as to our recommendations. 
  7. Keep you informed every step of the way. Claims may be active for several years with little or no activity. However, CNA is committed to timely and regular communications with you to keep you apprised of the current status of your claim. You are encouraged to call CNA at any time for an update or if you have any questions. 
 

We’re here when you need us most 

You can expect our staff to deliver responsive, reliable claims service to all nursing professionals. We have consistently earned high ratings from the top insurance rating services for offering high quality products and services you can count on now and in the future. 

If you have any questions about what to expect in the event of a claim, please call CNA at (800) 262-4454, or to learn more about CNA, visit their website at www.cna.com 

This guide is provided for illustrative purposes only and is not a contract. It is intended to provide a general overview of the services described. Remember that only the policy can provide the actual description of services, terms, coverages, conditions, and exclusions. Program availability is subject to state insurance department approval.​​​​​​

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