When a claims-made policy recognizes a claim.

A claims-made policy may respond only when its claim definition, reporting rule, retroactive date, and other conditions are met. Read the issued policy and endorsements. If you are unsure, contact the reporting contact identified in the policy promptly and ask how to submit written notice. A phone discussion does not replace notice unless the policy says it does.

Separate the incident, claim, and lawsuit

An incident is an event or circumstance that may lead to a claim. A claim may begin with a demand, notice of intent, arbitration request, or another event defined by the policy. A lawsuit begins when a court action is filed. These events may happen months or years apart.

One form may define a claim as a written demand for money or services. Another may include a request for arbitration or a formal notice of intent. The exact words control. Do not borrow the trigger from another carrier's policy.

An incident-reporting provision can let a physician notify the carrier about a circumstance that may later become a claim. It can affect which policy responds to a later claim only when the issued form allows it and the notice identifies a qualifying circumstance, contains the required facts, and is received when and how the form requires. The form states which events qualify, what information is required, where notice must go, and when it is due.

Read three provisions together: the definition of a claim, the notice requirement, and the incident or circumstance provision. Mark the required reporting address and method. A message to the wrong person may not satisfy the written notice requirement.

Know which events need a reporting check

The Doctors Company's public instructions, which apply to its own members rather than every policy, tell them to report demands for money, threats of legal action, notices of intent, arbitration requests, subpoenas, summonses, complaints, and similar formal papers. Its instructions also identify serious outcomes and patient or family threats as incidents that may lead to claims.

That list shows the range. Use the reporting provision in your policy to identify the defined event, notice method, and deadline.

A records request alone does not prove that a claim is coming. The Doctors Company advises its members to notify its Claims Department when they suspect that a request relates to a professional-liability action. Another policy may treat the facts differently.

When the facts are uncertain, use the policy's reporting contact and ask which written process to use. Record the date, contact, and instruction. Then make the reporting decision under the actual policy rather than assuming a conversation completed notice.

Use the required notice process

A report gives the insurer notice. It does not itself decide whether there was an error, liability, or coverage.

The Doctors Company's instructions make an important distinction. A discussion with its patient safety risk manager does not constitute notice to the company. Its initial notice must be in writing. Other carriers may use another process.

A useful first-report file includes:

The policy number and named insured.
The physician, entity, facility, and location involved.
The dates and a factual description of the event.
The demand, notice, subpoena, complaint, or other paper received.
The written acknowledgment from the carrier.

Follow the carrier's instructions about records. The Doctors Company's online guidance asks for documents related to the claim or incident, but tells members not to send medical records with the first online report. Do not add to, delete from, backdate, or otherwise alter an existing clinical record after an event. Follow the practice's record-correction process for any necessary correction or late entry.

Keep claim communications outside the clinical record and the carrier's acknowledgment with the policy file. Confirm the practice's privacy and legal-advice processes separately.

Keep patient safety and insurance notice separate

Insurance notice and patient-safety reporting serve different purposes. Follow the practice's patient-safety process for an adverse event and the insurer's written notice process for possible coverage. A discussion with a risk manager may help with patient safety, but it does not necessarily give the insurer notice.

Resolve known events before a policy changes

The trigger question becomes decisive during a transition. A physician may know about a difficult outcome, an angry family, or a records request while preparing to change carriers. The old policy, the new application, and any tail or prior-acts terms can treat that event differently.

Before the old policy ends, ask its reporting contact for a list of reported claims and incidents. Compare that list with the practice's own event register. Document a reporting decision for every known event that remains unresolved under the old policy's instructions. Do not treat silence, broker advice, or an oral carrier conversation as proof that notice was accepted.

An application may ask about known claims, incidents, circumstances, demands, or adverse outcomes. Answer each question completely and accurately from the information it asks for. Do not assume a prior report, tail, or prior-acts request removes a disclosure duty.

An extended reporting endorsement may allow reporting of certain claims first made after the old policy ends. Its duration, qualifying acts, exclusions, and notice conditions control. Prior-acts coverage can make the new policy respond to claims from qualifying earlier care. A new application can require disclosure of known claims, incidents, and circumstances under either arrangement.

Read the claim definition before an event occurs. Use the carrier's required reporting method, keep the written acknowledgment, and identify each unresolved event's reporting route before the policy ends.