Claims Management

Philosophy

Advocate, D.O. is dedicated to providing quality claims management to our doctors, establishing sound, team-based relationships, and dedicated to early investigation, evaluation, and disposition of claims and lawsuits.

This is easily accomplished because our claims department works closely with our doctors from the day a claim is reported. We keep you informed of the status of the claim and establish a working relationship that makes it easy to reach our goals of promptly investigating, realistically evaluating and expeditiously disposing of claims and lawsuits.

Our claims and litigation management strategy is based on the following principles:

1. Efficient resolution of claims and lawsuits depends on a constructive partnership and effective communication between the doctor, Advocate, D.O., defense attorney, and risk management.
2. The insured must be actively involved with Advocate, D.O. and the defense attorney in the evaluation, strategy, and disposition of each case.
3. Cases that will be vigorously defended and probably tried will be identified early, and an aggressive strategy will be developed and followed. These cases will be assigned to a defense attorney selected from our approved list of highly experienced medical professional attorneys throughout the state.
4. Each case will be reviewed and re-evaluated frequently.

Reporting a Claim

The Advocate, D.O. policy requires our Insured to notify Advocate, D.O. as soon as possible after becoming aware of a "Medical Incident." A "Medical Incident" is defined in the policy as, "professional services, acts, or omissions arising out of treatment to a patient which could or did result in bodily injury, sickness, disease, disability, or death to any person for which damages may reasonably be expected or should have known to be sought against the Insured."

Accordingly, Advocate, D.O. should be notified immediately upon receipt of any of the following:

1. Notice of Claim: A Notice of Claim letter that refers to Texas Civil Practice & Remedies Code Section 74. Upon receipt of a Chapter 74 letter, the Insured and Advocate, D.O. have 60 days to investigate and evaluate the claim. Any letter from a patient which indicates an intent to pursue a claim or lawsuit should also be reported immediately. Please complete the Notice of Claim form and fax that along with any other correspondence to 512.275.1855.
2. Lawsuit: A lawsuit can be served upon the Insured either in person or by mail. The Insured and Advocate, D.O. have a limited time within which to engage counsel and file an Answer. Thus, the Insured is requested to forward a copy of the lawsuit to Advocate, D.O. within 24 hours of receipt of service.
3. Subpoena for Testimony: A subpoena or a verbal request may also be received from an attorney representing your patient in a lawsuit involving a third party. If our Insured receives a subpoena or a verbal request from an attorney requesting the Insured's deposition (testimony under oath), please contact Advocate, D.O. immediately. Advocate, D.O. will review the subpoena and make an inquiry as to the basis of the request. If it appears that there is a potential for a claim to be pursued against the Insured, Advocate, D.O. may engage counsel to represent the Insured at the deposition.

How To Report A Claim

1. Call the Advocate, D.O. Claims Department at 800.686.2734 within 24 hours to advise that a lawsuit, a notice of claim, or a subpoena has been received.
2. Fax the lawsuit, notice of claim, or subpoena to Advocate, D.O. at 512.275.1855 Attention: Claims Department.
3. Please copy your agent with the correspondence to Advocate, D.O..