Claims Insight: The Value of Early Reporting

In addition, if you receive a medical board complaint or are notified of a HIPAA violation (including any caused by a cyber breach) be sure to notify Copic as soon as possible. When in doubt, give us a call and we’ll walk you through these situations.

How Do I Report An Incident?

• Ideally, the provider involved should report the incident—we recognize that some systems may have specially trained risk managers to assist in reporting and we can accept a report from these managers on behalf of an insured.
• Make every effort to report within a reasonable time (usually 24 to 48 hours) after the provider or practice becomes aware of the incident.
• Report incidents by calling Copic or initiating the process on our website. The best way to report an incident is by using one of these two ways that alerts us of the incident and reduces discoverability of information:
  • Call Copic to report an incident at 720.858.6395. Copic’s business hours are Mon–Fri, 8am–5pm (Mountain Time).
  • Initiate the reporting process on our website, which will result in a follow-up call by an occurrence nurse specialist. To submit an online incident report, log in to the Customer Portal and select “Incident Reporting.”
• Have the following information ready: patient identification, policy number, date(s) of service or incident, and procedure/medical services provided to include a summary of the incident.
  • Please note that you do not need to obtain a patient’s consent—written or otherwise—to share HIPAA Protected Health Information (PHI) with Copic in an incident report.

What Happens After Reporting An Incident?

Once you’ve reported an incident, our team will review your report and analyze the situation. Just because you reported an incident doesn’t mean it will turn into an actual claim or lawsuit, and we will determine the best course of action and follow up with you.

If there is the potential of an incident becoming a claim or lawsuit, Copic’s next steps may include reviewing the patient’s medical records, personally discussing the matter with you, securing an objective review by another healthcare professional of the appropriate specialty, and other evaluative processes.

What Should I NOT Do After Reporting An Incident?

• Never change the patient’s medical record. Inappropriate alteration of records may jeopardize your defense and coverage. EHRs track every keystroke and create an audit trail that can be used against you.
• Don’t discuss the case with others. This is an important precaution—later on, a plaintiff’s attorney could ask you to name everyone you’ve discussed the matter with in order to subpoena them. Because of this, we strongly advise that you limit your communications to Copic claims consultants and defense attorneys as these conversations are privileged (which means they’re protected from becoming evidence). There may be special circumstances where it is okay to have conversations with others (e.g., peer review), but always ask your claims consultant or defense attorney prior to any discussions.
• Don’t post any information on social media. You should never share any details about your medical care or patient information on social media platforms. Besides being used against you, it can also create a HIPAA violation and is easily discoverable with online search tools (even if you delete a post).

What's The Difference Between An Incident, A Claim, And A Lawsuit?

An incident is the term used to describe a situation when it is first reported to Copic. Not all incidents will become a claim or a lawsuit. A claim is a written or oral demand for money or other relief made against you. It is evaluated (and possibly resolved) before a lawsuit is filed and served. In a lawsuit, the plaintiff files a formal complaint with the court and serves a summons and complaint to the healthcare provider and/or professional corporation.