The Challenge of Medical Malpractice 

Medical malpractice cases are typically lengthy and resource-intensive, the average case lasting four to six* years and requiring considerable effort from all involved. A subrogation medical malpractice case is an equal challenge. These cases are hard to identify, present difficulty in determining the relationship to the alleged malpractice, and require significant patience on the part of the Plan in waiting for settlement. Also, other health insurance, like stop-loss, is typically involved. And worse yet, plaintiff’s attorneys automatically and aggressively demand large reductions on the lien.

SRP Diligence Uncovers Almost-Missed Opportunity

Strategic Recovery Partnership (SRP), a healthcare subrogation specialist, uncovered a medical malpractice case during a quarterly claim data review that is routinely performed for its health claim paying clients. SRP found a high-dollar claim that a plan member was pursuing against a physician and hospital. This particular case was not brought to attention earlier because it was not apparent from the claim records that malpractice was committed. In fact, an accident questionnaire was never sent to the member who was claiming malpractice.

Although the lawsuit was not yet initiated, the member’s attorney had already filed a claim with the physician’s malpractice insurance carrier. Through SRP’s data mining and investigation, it became evident that the member’s attorney was in the middle of an extensive investigation of his own. SRP took immediate action and later positioned the Plan as another plaintiff in the case. SRP’s surprise involvement put more pressure on the defendants (the physician and hospital), and significantly weakened arguments against the lien from both the defense and member’s attorneys.

The Outcome: Six-Figures within Two Years

SRP identified this case seven months after the alleged malpractice, and within two years settlement was reached for a total recovery of $226,431 for the Plan. The recovery was also a victory for the TPA, which not only made the Plan aware of the opportunity after SRP’s discovery, but critically assisted SRP by providing claim data and records.

*Source