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Insurer Checklist


When investigating a claim of malpractice or negligence for an injury involving an unnecessary cardiac procedure, the insurer should carefully evaluate the actions of the health provider and others. The insurer should look for the following “red flags” and consider how they impact the insurance coverage and the liability for payouts.

 

The Health Provider’s Failure To:

[] Review the patient’s medical history, including any history of cardiac defects, disorders, conditions, illnesses, or similar history

[] Evaluate the patient completely

[] Provide or order appropriate testing, including an angiogram

[] Determine the correct diagnosis

[] Provide the proper treatment

[] Refer the patient to a specialist, such as a cardiologist or cardiovascular specialist

 

The Hospital’s Failure To:

[] Follow protocols or mandated guidelines when caring for patients with cardiac defects, disorders, conditions, illnesses, or similar history

[] Follow protocols or mandated guidelines for emergency department or other health care

[] Provide the proper treatment

 

The Patient’s Failure To:

[] Disclose complete and accurate information about the patient’s medical history

[] Undergo necessary testing or monitoring

[] Take any prescribed drug therapy or medications properly

 

Review of the Professional Liability Coverage

[] Review carefully and understand the policy coverage provisions

[] Consider the duty to defend the physician or other health care provider, the policy exclusions, and non-covered conduct

 

See: Heart attack following exertion or exercise as within terms of accident provision of insurance policy, 1 A.L.R.4th 1319; Couch on Insurance §§ 88:30 to 88:33, 136:35, 136:36, 141:57, 143:90.

 

 

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