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By Vinay Pandaram
Senior Claims Manager and Medico Legal Advisor
Avant Insurance

 

Optometry Australia, through its partnership with Avant Insurance, provides professional indemnity insurance to all qualified optometrist and final year student members of Optometry Australia, who are eligible to request assistance under this policy.

Your cover

Under this insurance, members are covered for claims (including legal defence costs relating to the provision of health care) made by patients and other third parties against them.

What should you notify?

You should notify facts or circumstances which you first become aware of during the policy period, which you know or where it would have been reasonable to know, and have the potential to lead to a claim for compensation or a formal disciplinary complaint against you to a complaints body.

It is wise to be alert to common behaviours displayed by patients who may seek financial compensation or make a complaint.

Written demands for compensation

Commonly, the patient will send you a letter raising concerns about your clinical care. They may use language which expresses an intention to pursue a civil claim for compensation against you. For example:

Dear Ms White,

I write to voice my frustration about the eye problems I have had to live with for the past five years. After numerous attempts to correct my vision, to no avail, I am left with no choice but to seek reimbursement for all my fees and financial compensation. In fact, I believe you have made my eyesight worse.

Kind regards,
Mr Grey

Mr Grey is clearly not very happy. The fact he has taken the time to write to you about his concerns is a clear sign he is motivated to pursue a claim against you and the matter has the potential to go further. You should tread carefully.

If you receive a letter like this one, Avant should be notified without delay.

Formal disciplinary complaints

You may also receive a letter from a patient raising concerns about your clinical care which demonstrates an intention to file a formal complaint with the complaints body in your state. For example, the patient may write the following:

Dear Mr Blue,

I write to voice my frustration about the eye problems I have had to live with for the past five years. After numerous attempts to correct my vision, to no avail, I am left with no choice but to make a formal complaint about you to the authorities. In fact, I believe you have made my eyesight worse.

Kind regards,
Ms Green

Ms Green has clearly indicated her intention to report you to the authorities. You can interpret this to mean that she intends reporting you to the complaints handling body in your respective state.

If you receive a letter such as this, Avant should be notified, without delay.

Verbal complaints

There may be circumstances where the patient has only made a verbal complaint and the optometrist is personally managing the situation in an effort to resolve the issue.

A notification to the insurer should be considered given the threat of a potential civil claim or formal complaint. It is best to consult with your insurer in these circumstances as they may be able to offer you strategic advice to resolve the complaint before it becomes a formal claim or complaint.

When should you notify?

The policy operates on a claims made and notified basis. This means you should notify facts and circumstances when you first became aware of them, within the policy period.

Key take-aways

  1. It is important that any fact or circumstance which might give rise to a claim is notified within the policy period.
  2. In your notification to Avant, include a factual account of the incident together with any correspondence or documentation you have in relation to the incident.
  3. If you include medical records, please send copies only and ensure you keep all records and documentation regarding the matter separate from your clinical file.
  4. A delay in notifying or indeed a failure to notify may prejudice your rights and entitlements under the policy.
  5. Ensure you consult Avant – a claim which could have been resolved at an early stage may go further due to mishandling. It is vital you seek Avant’s views prior to making any attempts to settle a claim or dispute with a third party.
  6. If you are not sure about any aspect of an incident, please contact Avant.

If you need advice on your obligations to report an event to AHPRA, call Avant’s Medico-legal Advisory Service (MLAS) on 1800 128 268 for expert advice, 24/7 in emergencies.

Disclaimer: This article is not comprehensive and does not constitute legal advice. You should seek legal or other professional advice before relying on any content, and practise proper clinical decision-making with regard to the individual circumstances. Avant is not responsible to you or anyone else for any loss suffered in connection with the use of this information. Information is current only at the date initially published.

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