Professional Liability Closed Claims Industry Statements
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Statement by affected HMOs
Not all claims against HMOs are included on this site. For example, five of the
seven largest HMOs in Florida do not appear in this listing as having claims. The
fact that an HMO has no or few claims may be due to the absence of professional
liability insurance. Likewise, claims against HMOs in amounts below their liability
policy deductible may not be reported.
Further, HMOs that employ doctors (staff-model HMOs) are subject to lawsuit for
the alleged acts of their doctors. HMOs that contract with outside doctors (group-
or IPA-model HMOs) aren't as likely to be sued even when its doctors are. As
a result, there may be fewer claims involving HMOs that contract with doctors.
In some instances, although a service provider or institution believes it isn't
liable, it may nevertheless choose to settle disputed claims quickly rather than
incur sizable legal costs in lengthy litigation.
Inappropriate use of such malpractice information or closed claims reports may violate
various provisions of law, including Section 641.3903(9), F.S., which prohibits:
"Knowingly making any misleading representations or incomplete or fraudulent
comparisons of any health maintenance contracts or health maintenance organizations
or of any insurance policies or insurers for the purpose of inducing, or intending
to induce, any person to lapse, forfeit, surrender, terminate, retain, pledge, assign,
borrow on, or convert any insurance policy or health maintenance contract or to
take out a health maintenance contract or policy of insurance in another health
maintenance organization or insurer."
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Statement by the Florida Medical
The Florida Medical Association cautions that the settlement of malpractice claims
occurs for a variety of reasons, which do not necessarily reflect negatively on
the professional competence or conduct of the individual provider or institution.
Payment of a claim should not be a presumption that malpractice has occurred. Physicians
often have little control over whether the insurance company pays an award. An insurance
company may pay a claim on behalf of the insured physician, even when there is no
liability, if the cost of defending the claim might exceed a potential settlement.
A large payment in a malpractice case does not necessarily indicate the provider
or institution made a serious error. It could indicate, instead, that the patient
suffered significant economic damages as a result of alleged malpractice.
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Statement by the Florida Hospital
The Florida Hospital Association strongly supports providing meaningful data to
consumers. However, liability claims information can be misleading. Insurance companies
may settle claims for business reasons without consideration of fault and certain
physicians are more prone to lawsuits because of the specialty in which they practice.
These issues are complex. Medical incidents, like medical malpractice suits, are
often not clear cut. Experts disagree on medical practice and whether a result could
have been prevented or was within the range of expected outcomes. Not all patients
react the same to identical treatment.
Hospitals have checks and balances in place to reduce the potential for human error.
Hospitals have policies, procedures and training to help prevent mistakes. They
have teams of physicians, nurses and licensed risk managers who examine, identify
and correct problems. The liability claims on this site should not be used as a
measure of quality care.