Claim & Litigation Services

The Claim & Litigation Services Department manages the defense of professional and general liability claims covered by FOJP's insurance program.

Claim Management

Each claim is handled by an FOJP team consisting of a team leader, a claim examiner, and an investigator. When an insured notifies the Claim Department of an incident, claim, or lawsuit, the team confirms coverage, assigns defense counsel, investigates, selects experts, develops litigation strategy, and establishes case reserves to reflect exposure. 

FOJP’s claim philosophy is to aggressively defend claims without merit and fairly and efficiently resolve claims with merit. If the defense team concludes that the case has merit, efforts are made to negotiate a fair settlement, as early resolution helps control both indemnity and expense costs for our insureds. Claims that do not appear to have merit are vigorously defended. Taking the right cases to court lets the plaintiff's bar know that "nuisance suits" will not succeed.

Creating Defense Strategies

Defense attorneys are assigned from a list of law firms approved by the clients. The Legal Technical Unit monitors and evaluates the cost and activity of defense counsel and conducts audits to ensure top-quality work at optimal cost.

Decisions related to defense strategy in medical malpractice cases are made at regularly conducted claim conferences attended by members of the insured’s risk management and general counsel offices and physician leadership, defense counsel, and FOJP’s Claim Department.

Claim conferences for general liability are attended by members of FOJP’s General Liability Claim Unit, as well as by defense counsel. General liability conferences are not specific to a particular insured, but where a general liability claim presents a high exposure, the department meets separately with the insured agency or hospital.

Clinical Risk Management

The program’s Clinical Risk Management group works collaboratively with our insured hospitals, physicians, nurses, allied health professionals, and risk managers to improve health care quality and safety and reduce malpractice risk.

Supporting Positive Changes

Under the direction of our chief medical officer and chief nursing officer, the program supports our clients’ efforts to improve patient safety across all areas of medicine. Clinical initiatives are designed to encourage positive changes in culture and practice, support new technologies, and enhance operational efficiencies, all with the goal of achieving the best possible outcomes and increasing patient satisfaction.  Initiatives are developed with input from clinical committees, analysis of internal and external data, evaluation of medical literature, opinions from experts, and interactions with clinical leaders from our insured institutions. Funding is provided from the program.

Creating Engagement

The department engages both senior clinical and administrative leadership and front line providers to develop interventions and teaching opportunities in high-risk areas. The risk management staff access data from a variety of sources, including clinical records, state and national research databases, surveys, and claims information. Research and findings help define and inform the department’s focus, objectives, and communication with clients. Areas of focus include team and simulation training, development of best practice guidelines, documentation standards, and reducing risks and optimizing benefits of electronic medical record systems. The department also conducts office assessments and develops on-line education courses for insured physicians. 

Insurance & Client Services

Insurance & Client Services provides program-related information to clients and responds to inquiries concerning the nature and scope of their coverage.

The department also directs the program’s brokers on placement and renewal of insurance policies, oversees development and distribution of client risk information, and establishes coverage specifications and proposals for quotes by potential carriers. 

The department maintains client risk profiles, schedules of insured locations and motor vehicles, and other data required to place coverages, along with a library of program insurance policies.

Building Relationships

Client Services provides support for workers’ compensation and disability insurance, including hiring on-site workers’ compensation case managers. The department includes a safety and security specialist who provides advice to clients on environmental safety and compliance with federal, state, and local health and safety regulations, helps identify risks that could lead to losses, and offers suggestions for mitigation. 

The department coordinates agency meetings and site visits, maintains a user manual for clients, and obtains certificates and schedules of insurance.

Underwriting & Data Quality Control

The Underwriting Department works with actuaries and consultants to design and structure insurance programs, review and approve quotes, and seek new business opportunities. The department tracks, organizes, analyzes, and presents financial data relating to the professional and general liability programs.  Underwriting staff also monitor and report on operational aspects of the program’s captive insurance companies.

The Data Quality Control Unit works with consultants, actuaries, and the Information Technology Department to ensure the accuracy and integrity of data provided by the program.