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OFFICE OF RISK MANAGEMENT. REGIONAL CONFERENCE 2008. General Liability and Medical Malpractice Kathleen Gasser Claims Manager. 225-342-8433. General Liability Team. FRANK FORET, 225-342-8463 Tom Bluff Penny Buchanan Barbara Burns Jimmy Martin Bynie Wells

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OFFICE OF RISK MANAGEMENT

REGIONAL CONFERENCE 2008


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General Liability and Medical MalpracticeKathleen Gasser Claims Manager

225-342-8433


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General Liability Team

  • FRANK FORET, 225-342-8463

  • Tom Bluff

  • Penny Buchanan

  • Barbara Burns

  • Jimmy Martin

  • Bynie Wells

  • Diane Williams


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General Liability Team

  • JAMES LEA, 225-342-8399

  • Bertha Meisner

  • Lynda Colomb

  • Geneva Blake


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WHAT DO WE COVER?

  • The State of Louisiana provides insurance coverage for third party bodily injury and property damage claims for which the agency could be held legally liable.


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General Liability Claims

  • Claims alleging damages in tort due to negligence by the state of Louisiana and/or state agencies.


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Premises and Operations

Completed Operations and Products Liability

Elevator and Escalator

Watercraft under 26’

Contractual Liability

Wrongful Acts

Errors and Omissions

Professional Liability

Public Officials

Custodial

Garage Keepers

Foster Parents

Protective Liability

Fire Damage Legal Liability

Publisher’s Media

The General Liability Policy covers:


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How a claim is processed

An Adjuster is assigned.


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CUSTOMER SERVICE

  • One adjuster will handle CGL claims for the entire agency in order to provide more effective customer service.


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The adjusting process:

  • 1. Investigation

  • 2. Evaluation

  • 3. Negotiation

  • 4. Settlement


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Investigation of Claim

  • The adjuster investigates to determine coverage by ORM

  • Liability and exposure are determined after obtaining the facts of the incident.


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Limitation of Liability for Public Entities

  • R.S. 9:2800

  • …No person shall have a cause of action based solely upon liability imposed under CC Article 2317 against a public entity for damages caused by the condition of things within its care and custody unless it had actual or constructive notice of the vice or defect, had reasonable opportunity to remedy it and failed to do so.


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R.S. 9:2800 H.(1)-(4)

  • …Except for gross negligence or willful and wanton misconduct, no person shall have a cause of action based solely upon liability imposed under Civil code Art. 2317 & 2317.1 against a public entity for any damages arising from hurricanes Katrina or Rita, including aftereffects…

  • Retroactive to August 26, 2005

  • Expire on August 30, 2008


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Immunity of state related to Hurricanes Katrina and Rita

  • R.S. 9:2800.17 effective June 15, 2006

  • Operational decisions or activities after Katrina and Rita not civilly liable for death, injury to person or damage to property

  • Except for gross negligence or willful misconduct


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Immunity of local school district

  • R.S. 9:2800.17 also includes immunity of local school districts affected by Hurricanes Katrina and Rita for causes of action for damages for failure to warn, notify, remediate, clean-up or repair in decisions or operations after the hurricanes.



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Louisiana Governmental Claims Act

  • R.S. 13:5101 et seq. states this applies to any suit in contract or for injury to person or property against the state, a state agency, an officer or employee of the state or a state agency arising out of the discharge of his official duties or within the course and scope of his employment…


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EMPLOYEE COVERAGE R.S.13:5108.1

  • Indemnification of officers and employees of the state; civil rights; representation by the Attorney General.

  • ORM is the insurer.

  • State employee is the insured.

  • DOJ is defense counsel.


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Who is Covered?

  • R.S.13:5108.1(e)

  • 1. An official, officer, or employee holding office or employment:

  • Executive branch

  • Legislative branch

  • State Supreme Court, courts of appeal, family, juvenile or judicial district courts

  • Deep-water ports



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YOU MUST:

  • Send a cover letter to Attorney General requesting representation

  • Send a copy of the petition

  • Provide information regarding service of the petition

  • Within 10 days of date of service of petition


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Our Duty to Defend:

  • The state shall defend and indemnify a covered individual against any claim, demand, suit, complaint or petition seeking damages filed in any court over alleged negligence or other act by the individual, including any demand under any federal statute when the act that forms the basis of the cause of action took place while the individual was engaged in the performance of the duties of the individual’s office or employment with the state.


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FY07 CGL Claims by Cause

  • Struck by or against 361

  • Professional Liability 255

  • Civil Rights 245

  • Struck by debris 206

  • Failure to provide care/protection 202

  • Fall/Slip 111


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Hurricane Katrina Claims

  • 287 claims in CGL

  • 15 different agencies named

  • 12 Class Actions requested


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Hurricane Rita

  • 5 claims




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Performance Overview General Liability

  • New claims:941

  • Closed: 839

  • Paid claims:$2,895,831.91

  • Pending: 2,149


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New Claim

How you can help ORM


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High Exposure Potential Claim

  • Serious injury

  • Death

  • Fire

  • Explosion

  • Major private property damage


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Immediate Notification

  • Call ORM Contact

  • Send Email

  • Send Facsimile



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Trip and Falls

  • Take pictures of area of fall.

  • Note whether claimant was wearing glasses, carrying things, type of shoes worn.

  • Provide witness information.


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Falls that Involve a Chair

  • If chair broke, remove it from service, save it and label it with name of person who fell and date of incident.

  • Note the manufacturer and supplier of chair.

  • Take pictures.

  • Provide witness names.


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Loss of personal property

  • Must determine care, custody and control.

  • If property was left behind and then discovered to be lost, it would be abandonment on the part of the owner, not negligence on the part of the state.


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Damage to Private Cars By

  • Falling tree branches? Depends on whether it was live or visibly dead. Need photos.

  • Gate arm? If it malfunctioned.

  • Vandalism by unknown person? No.

  • Our mower? Yes if the auto is insured.

    • Need proof of liability insurance required by LA Law.


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Theft or Burglary of Privately Owned Auto

  • The state is not liable for theft or burglary of a privately owned automobile on its premises.


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Do We Cover Injuries or Damages Caused by Wildlife?

  • Vehicle traveling on state highway hits a deer

  • Visitor to state park receives insect bite/snake bite


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Reporting CGL Claims

  • In writing to:

    Frank Foret or Kathleen Gasser

    Office of Risk Management

    P. O. Box 91106

    Baton Rouge, LA 70821-9106

  • If loss is serious in nature, also telephone it in to (225) 219-0168.


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Preserve Evidence

  • Tag and label damaged items, do not discard

  • Photographs with date, claimant name and photographer’s name

  • Diagrams, measurements

  • Witness names and contact information


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What to say to claimant

  • You will report the incident to your insurer, ORM.

  • Do not promise that claim will be paid.

  • Do not send anyone to a doctor or promise to cover medical bills.

  • Coverage of the claim and liability issues are determined by ORM.



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MEDICAL MALPRACTICE

KATHLEEN GASSER

CLAIMS MANAGER

Office of Risk Management


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Medical Malpractice Team

  • SUSAN COUVILLION, 225-342-8432

  • Nancy Daigle

  • Sandy Pittman

  • Percy Williams

  • Dr. Roy Lee, Medical Director


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Medical Malpractice Team

  • ANNE WHITTINGHILL 225-342-0868

  • Sylvia Clower

  • Pam Deslatte

  • Jim Richard

  • April Williams


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WHAT DO WE COVER?

  • Medical Malpractice insurance coverage is extended to state health care professionals providing health care services on behalf of the State.

  • Includes medical, surgical, dental or nursing treatment of patients.


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HURRICANE KATRINA

  • KATRINA RELATED MEDICAL MALPRACTICE CLAIMS: 19

    • MCLNO 17

    • UNIVERSITY 1

    • LSUMC 1


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Medical Malpractice Statute

  • The State of Louisiana provides Medical Malpractice coverage in accordance with the provisions of R.S. 40: 1299.39


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What is Malpractice?

  • The failure to exercise the reasonable standard of care specified and required in the provision of health care, when such failure proximately causes injury to a patient.


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Standard of Reasonable Care

  • The standard of reasonable care for licensed physicians and dentists shall be the same as that required to be proven with respect to them under R.S.9:2794…

  • Knowledge or skill or degree of care ordinarily exercised


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Breach of Standard of Care

  • Plaintiff must prove negligence

  • Injury alone does not raise a presumption of negligence

  • Plaintiff must prove proximate cause of each injury


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Medical Review Panel

  • Composed of three medical providers of the same specialty as named defendant

  • Plus an attorney chairman selected by plaintiff and defendant counsel.

  • The attorney chairman supervises the activities and deadlines for the panel


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Panel Decision

  • Evidence is submitted by plaintiff and defendants in writing.

  • Panel has the sole duty to express its expert opinion as to whether or not the evidence supports the conclusion that the defendant(s) acted or failed to act with the appropriate standards of care as charged in the complaint.




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MM CLOSED CLAIMS Review Panel.


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Surgery related 260 Review Panel.

Treatment related 215

Diagnosis 143

Obstetrics 89

Medication 43

Nursing related36

Informed Consent 13

Fall related 12

IV and Blood 9

Anesthesia 8

Miscellaneous 6

Biomed Eq./Prothesis 6

Contributing Factors 3

FY07 MM Claims by Cause


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Comparison To Last Year Review Panel.

  • New claims are down from 224 to 200, an 8% decrease.


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