Behind the scenes of a claim: What is the process? - Hamilton Fraser

It’s a moment every expert dreads – a patient makes a claim about a treatment they received. What actually happens when they do?

At Hamilton Fraser Cosmetic Insurance we aim to assist you with any potential or formal claims that may arise from treating a patient. Emma Bracchi, Hamilton Fraser Cosmetic Insurance Senior Claims Technician, un-cloaks the process to help you understand the claims procedure better.

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What is the claims process?

If a patient has come to you and expressed that they are dissatisfied following a treatment, because it did not provide the result they were hoping for, but there are no allegations of bodily injury or negligence or financial loss and they have not approached a solicitor, then this would not trigger the formal claims process.

At this stage, we can assist you in responding to a patient’s complaint by providing template letters relevant to your situation and discussing whether it would be appropriate to provide a refund or possibly further treatment. Please note that if either of these options are provided to your patient, where a formal claim has not been triggered, it will be at your expense.

A formal claim is considered to be an allegation of bodily injury, negligence or financial loss which can be received directly from your patient or via a third party solicitor.

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What to do when a potential claim has been made?

If you receive a solicitor letter requesting disclosure of medical records, this could be an indication of a potential claim and we therefore treat this in the same way as a formal claim.

Should you receive either of the above, then please notify us as soon as possible, as notification should be within 30 days of your receipt of the letter.

Following your notification to us, we will set up the details via telephone and ask you to send the following documentation to support the claim:

• Solicitors letter (where applicable) or letter of claim
• Patient notes including consent form and patch test (where applicable)
• Patient photos
• Any communication with the patient
• Leaflets/Booklets relating to the treatment
• Practitioners training certificate

Sometimes it is necessary to appoint a solicitor to represent you and assist in responding to any allegations. Prior to their appointment, we will discuss this with you and if there is a policy excess applicable, then this will be requested from you as your policy excess is subject to defence costs.

Thereafter, our solicitors will liaise directly with you, but they will continue to keep us informed of developments and any payments made to the claimant of their solicitors.

In rare and urgent instances, such as receipt of proceedings, we may have to appoint lawyers without having the opportunity to speak to you first, but we will only do so in your best interest.

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Our top tips when facing a claim

1. If you feel you may have a circumstance that gives rise to a claim, but are not sure if you need to make a claim, please call us on 0345 310 6370 and we can run through the situation with you and advise accordingly.
2. Always keep your patient records, including consent forms and other patient correspondence, for 10 years, in the event that a claim arises at some point in the future. If you work at a clinic and they keep the records, then it may be worth keeping your own copy in the event that the company goes into liquidation or you are unable get a copy in the future.
3. If you receive notice of a formal claim, please remember not to admit any liability at any point, enter into any correspondence without our prior consent or disclose that you have notified your insurers.
4. If you have received a complaint due to a reaction to a product, it may be worth you speaking with the product manufacturer to see if they have received similar complaints, whereby they may have some suggestions to assist you.
5. If you do not already do so, taking photos before and after a treatment can be really helpful to support you if a claim is brought against you.
6. Try not to take a formal claim too personally. Remember, most claims never end up in court and most claims can be dealt with swiftly and without admission of liability. Litigation is fast becoming a fact of life and most practitioners will experience some form of complaint or claim in their careers. Improve your processes and be as transparent with your patient with information as you can.

If you are a Hamilton Fraser Cosmetic Insurance customer and have a claim raised against you, please contact our claims team on 0345 310 6385.

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About the author

Emma Bracchi

Emma has 19 years of insurance claims experience and is Cert CII accredited. In 2007, Emma joined Hamilton Fraser as a claims handler, drawn to the position because of the dedicated claims team working to help customers throughout the claims process. Emma provides assistance to help guide our practitioners through difficult circumstances to prevent any customer dissatisfaction from developing into formal claims.