
Occupational Therapy Claim Report A Guide to Identifying and Addressing Professional Liability Exposures CNA OCCUPATIONAL THERAPY Claim Report 2 INTRODUCTION���������������������������������������������������������������������������4 Purpose��������������������������������������������������������������������������������������4 DatasetandMethodology��������������������������������������������������������������������4 Definitions�����������������������������������������������������������������������������������5 DATA ANALYSIS AND INCIDENT SCENARIOS������������������������������������������6 OverviewofClosedClaims��������������������������������������������������������������������6 AnalysisofClosedClaimsbyTypeofInsuredandCoverage������������������������������������7 AnalysisofSeveritybyLocation ���������������������������������������������������������������8 AnalysisofSeveritybyPatientAge������������������������������������������������������������9 CaseScenario:ImproperPerformanceUsingaBiophysicalAgent . .9 AnalysisofSeveritybyAllegation�������������������������������������������������������������10 AllegationsbyCategory���������������������������������������������������������������������10 CaseScenario:ImproperPerformanceUsingTherapeuticExercise andImproperBehaviorbyaPractitioner . 13 AnalysisofSeveritybyInjury �����������������������������������������������������������������14 AnalysisofOccupationalTherapyPracticeClosedClaims��������������������������������������15 CaseScenario:SuccessfulDefenseofanOccupationalTherapist���������������������������16 LOOKING FORWARD��������������������������������������������������������������������17 InformationTechnology(IT)������������������������������������������������������������������17 SocialMediaandInternetUsage�������������������������������������������������������������17 Fee-for-servicePaymentRegulations ���������������������������������������������������������18 StudentOversight���������������������������������������������������������������������������18 IndependentContractorStatus���������������������������������������������������������������19 NewTechnology ����������������������������������������������������������������������������19 RISK CONTROL RECOMMENDATIONS�������������������������������������������������20 RISK CONTROL SELF-ASSESSMENT CHECKLIST ��������������������������������������25 PRACTICE AND CLAIM RESPONSE TIPS �����������������������������������������������30 CNA OCCUPATIONAL THERAPY Claim Report 3 Introduction CNAandHealthcareProvidersServiceOrganization(HPSO)areamongthenation’sleadingproviders ofprofessionalliabilityinsuranceforoccupationaltherapypractitioners,withmorethan22,000 policiesinforce�Ourinsuredsdeliverservicesinanincreasinglybroadarrayofsettings,including hospitals,clinics,outpatientandambulatorycenters,agingservicesandrehabilitationfacilities, patients’homes,practitioneroffices,schools,workplaces,spasandfitnesscenters�Wearecommit- tedtohelpingtheseprofessionalsprotectthemselvesagainstlossnotonlybyofferingspecialized insurancecoverage,butalsobyenhancingtheirriskawareness� Aspartofourongoingeducationaleffort,wearepleasedtopresentthisexaminationanddiscussion ofcurrentandemergingliabilityexposuresconfrontingoccupationaltherapyproviders�This10-year report,thefirstofitskindissuedbyCNA,focusesonCNAoccupationaltherapyprofessionalliability claimsthatclosedbetweenJanuary1,2006andDecember31,2015� Purpose Thisresourcefeaturesanalysisofclosedmalpracticeclaimdata,incidentscenariosandriskcontrol recommendationsaddressingmajorareasofvulnerabilityforoccupationaltherapyprofessionals�Our goalistoprovideusefulinformationandpracticalsuggestionsthat,ifintegratedintodailypractice, canhelppreventincidents,increasepatientsatisfaction,andreduceexposuretocomplaints,law- suitsandlicensure/certificationactions�Aself-assessmentchecklistisincludedtoaidoccupational therapistsinreviewingtheirpatientsafetyandriskcontrolprotocols� Dataset and Methodology Between2006and2015,therewere289professionalliabilityclosedclaimsandincidentsattributed toCNA-insuredoccupationaltherapyprofessionalsintheHPSOprogram�Professionalliabilityclaims wereincludedinthefinaldatasetonlyifthey… --Involvedindividuallyinsuredlicensedoccupationaltherapists(OTs),occupationaltherapyassis- tants(OTAs),certifiedoccupationaltherapyassistants(COTAs),oroccupationaltherapyaidesor students,whetherself-employedoremployedbyaCNA-insuredoccupationaltherapypractice� --ClosedbetweenJanuary1,2006andDecember31,2015� --Resultedinanexpenseand/orindemnitypaymentequaltoorgreaterthanonedollar� Thesecriteriageneratedadatasetof72closedclaims. Thisreportexaminestheseverityofoccupationaltherapyclosedclaims,focusingonsuchclaim characteristicsasincidentlocation,patientage,allegationandinjury�Italsocategorizesclaimsby practitionerandcoveragetype(i�e�,individuallyinsuredversuspracticepolicy)� CNA OCCUPATIONAL THERAPY Claim Report 4 ThelistedindemnitypaymentsorexpenseswerepaidbyCNAonbehalfofaninsuredanddonot includeanyadditionalpaymentsbyemployers,otherinsurancecompaniesorotherparties�This analysisreflectsCNAdataonlyandisnotnecessarilyrepresentativeofallclosedclaimsforOTsand/or occupationaltherapypractices� Itmaytakeseveralyearstoresolveaprofessionalliabilityclaim�Therefore,claimsincludedinthis reportmayhaveresultedfromeventsthatoccurredpriorto2006,althoughineverycasetheclaim closedbetweenJanuary1,2006andDecember31,2015� Please note that the methodology used in this report differs from claim reports issued by other organizations. For this reason, its findings should not be compared with other studies. Definitions Forpurposesofthispublication,pleaserefertothedefinitionsbelow: --Aging services–Specializedfacilitiesororganizationsthatprovidehealthcareprimarilyto aseniorpopulation,includingnursinghomes,assistedlivingcentersandindependentliving facilities�(Alsoknownaslong term care�) --Allegation–Anassertion,notyetproven,thattheprofessionalororganizationhasdone somethingwrongorillegal� --Expense payment–Moniespaidintheinvestigation,managementand/ordefenseofaclaim� --Indemnity payment–MoniespaidbyCNAtoaplaintiffonbehalfofaninsuredinthesettle- ment,arbitrationorjudgmentofaclaim� --Patient–Anypersonreceivingtreatmentorprofessionalservicesfromaninsuredoccupational therapyprofessionaland/oroccupationaltherapypractice� --Vicarious liability–Alegalprinciplethatassignsresponsibilitynotsolelytotheindividualwhose negligentactoromissioncausedaninjury(suchasanoccupationaltherapistoroccupational therapyassistant,studentoraide),butalsotothatperson’semployerorsupervisoriftheactor omissionoccurredduringthecourseandscopeemploymentorsupervision� The report’s dataset consists of 72 closed claims. CNA OCCUPATIONAL THERAPY Claim Report 5 Data Analysis and Incident Scenarios Overview of Closed Claims Figure1reflectsthetotalcosts(i�e�,indemnityand/orexpense,asnotedinthecolumnheadings)for professionalliabilityclaimswithindemnitypayment,professionalliabilityclaimswithexpenseonly, depositionandrecordrequests,andlicenseprotectionclaims�Theseclosedclaimsarecategorized bythetypeofresponsivecoverage� AsillustratedinFigure1,themostsevere(i�e�,mostcostly)actionsareprofessionalliabilityclaims withindemnitypayments,incurring$2�44millionintotalcost�Aspreviouslynoted,professional liabilityclaimstypicallyresolveoveraperiodofseveralyears�Forthepurposesofthisreport,all indemnityandexpenseamountsareattributedtotheyeartheclaimclosed� Seventeenpercentoftheclosedprofessionalliabilityclaimsincludedinthedatasetincurredexpenses (includingattorney,investigationandexpertwitnessfees,plusrelatedadministrativecosts),but closedwithoutindemnitypayment�Theseexpense-onlyclaimstotal$212,885�Therearemanyreasons whyaclaimmayincurexpenseswithoutanindemnitypayment,includingthefollowingscenarios: --Theclaimwassuccessfullydefendedonbehalfoftheinsured� --Theclaimwasabandonedbythecomplainantand/orthestatuteoflimitationsperiodpassed withoutlegalactivity� --Thecourtdeterminedthattheinsuredshouldberemovedordismissedfromthelawsuit� --Theadverseeventwasinvestigatedandaclaimfileopened,buttheinsuredwasnotnamed inthelawsuitandtheclaimwasclosed� --Athirdparty,suchasanemployeroremployer’sinsurancecarrier,madeanindemnitypayment onbehalfoftheinsured� 1 Closed Claims by Type of Legal Action Percentage of Total paid Total paid Coverage category closed claims indemnity expense Total incurred Professionalliabilitywithindemnitypayment 44% $1,988,439 $451,808 $2,440,247 Professionalliabilityexpenseonly 17% - $212,885 $212,885 Depositionandrecordrequest 14% - $12,562 $12,562 Licenseprotection 25% - $51,935 $51,935 Overall 100% $1,988,439 $729,190 $2,717,629 CNA OCCUPATIONAL THERAPY Claim Report 6 Analysis of Closed Claims by Type of Insured and Coverage --Figure2providesanoverviewofclaimresultsbytypeofinsuredandpolicy–i�e�,individually insuredversuspractice-insuredOTs,OTAs,COTAsandotherrelatedhealthcareproviders� --IndividuallyinsuredOTshavethehighestaveragepaidindemnity,duetoseveralclaimsthat closedwithanindemnitypaymentof$150,000ormore�High-severityallegationsasserted againstindividuallyinsuredOTsincludefailuretoprovideasafeenvironmentandimproper performanceusingaphysicalagent,asinthefollowingexample: --AnOTusedahotpackonapatient�Thehotpackcausedaburn,whichinturn ledtoaninfectionandtheamputationofthetipofthesmallfinger�Thisclosed claimisdiscussedindetailonpage 9� --IndividuallyinsuredOTAshavethehighestaveragepaidexpense�Allegationsagainstindivid- uallyinsuredOTAsincludefailuretofolloworganizationalpolicesandinappropriatebehavior, asdescribedbelow: --AnOTA’sformeremployerfiledaclaimallegingthatshehadmadefraudulent statementsregardingtreatmentandbillingofpatients,andhadgivenpatients
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