Avoiding Malpractice Liability

The following checklist describes things an employer should consider when contracting with providers.

____ Contract between an employer, managed care company and provider clearly states who determines medical necessity.

____ Contract describes appeals procedures.

____ Contract includes quality of care disclaimers.

____ Benefit plan documents, employer handbooks and other communication material clearly conveys plan responsibilities, which services are  covered, and appeals procedures.

____ Providers in network are quality providers, qualifications of personnel have been checked, and physicians actively practice in the area in which they review cases.

____ Written materials state that responsibility for determining appropriate care is with employees and physicians.

____ Handbook explains that health plan only determines what will be paid for, not whether employee will receive care.

____ If employer offers several plans, employees have signed statements that they understand the plan they have selected and the implications of the plan.

____ Risk-sharing payment arrangements are constructed so they do not discourage providers from practicing good medicine.

____ Employers incorporate hold harmless agreements into contracts with providers.

____ Employer amends general liability policies to cover more than incidental medical malpractice or purchases separate vicarious liability coverage for contingent exposures.