Importance of notifying complaints and claims Importance of notifying complaints and claims

Importance of notifying complaints and claims

7 August 2020 | Health Sector

A health practitioner has provided treatment to a patient and the patient has expressed dissatisfaction about the outcome of the treatment. What should the health practitioner do?

It is important for a health practitioner to maintain a positive professional relationship with their patients, especially in circumstances where the patient’s expectations have not been met.

Some examples of facts or circumstances that may lead to a patient making a claim and/or complaint against the health practitioner in the future include requesting a refund of treatment costs or compensation. The health practitioner should liaise with their insurance broker who will notify the health practitioner’s insurance company of the facts or circumstances. Depending on the health practitioner’s insurer and terms of the insurance policy, the health practitioner may have the opportunity to access legal and/or clinical assistance at this stage.

What should a health practitioner do if they receive a complaint or claim against them?

We understand that health practitioners experience high levels of stress when they receive complaints and/or claims against them – this is completely natural. It is important for health practitioners to:

  • take steps to manage this stress to ensure it does not affect their treatment of other patients; and
  • not take steps which may be detrimental to their position, such as correcting or ‘cleaning up’ any record-keeping. It is essential that the contemporaneous records are kept intact. Rarely will records that have been altered in any way be looked upon favourably by a regulator, court or tribunal.

If a health practitioner receives a complaint made by a patient to a regulatory body, such as the Health Care Complaints Commission or the Australian Health Practitioner Regulation Agency, in many instances, the health practitioner’s initial instinct will be to liaise directly with the regulator and provide their position in response to the complaint.

Rather than immediately responding to the complaint or claim, we consider it is in the best interests of the health practitioner to contact their insurance broker and inform them of the complaint or claim. The insurance broker will notify the insurance company of the complaint or claim. The insurance company will then determine if the complaint or claim is covered by the health practitioner’s professional indemnity insurance policy and, where appropriate, will appoint solicitors to provide legal assistance to the health practitioner and/or a clinician to provide clinical assistance.

It is important for health practitioners to understand that they are not alone when they receive a complaint and it is best to notify their insurance broker who will take the necessary steps to ensure that the health practitioner is aware of their options moving forward, which may include access to legal and/or clinical assistance.

Author

Lauren Rickersey

Lauren Rickersey

Special Counsel

Annaliese Williams

Annaliese Williams

Associate