Claims Management Philosophy

Coordination between Claims Administration and Risk Management is essential to the goal of reducing claims activity and improving the care in today's Healthcare organizations. CAC recognizes the challenges in achieving a seamless relationship between these functions and works with clients to foster an environment that encourages growth and autonomy while seeking this common goal.

It is well recognized a breakdown in communication is an underlying source for many claims. Coupled with the blame culture nurtured by the tort system there can be found a tendency to minimize or hide mistakes. The combined effort of Risk and Claims Managers can bring latent problems to the surface. Mistakes can happen - but there is a professional way to address these problems.

It is the philosophy of CAC to recommend the obvious legitimate claim be identified as early as possible, evaluated and brought to conclusion. The underlying cause is shared with Risk Management who then has the challenge of taking corrective measures. Those events that fall into a grey area require a coordinated investigation and quite often the opinion of experts. This is often time consuming - but there should always be a guided focus.

At the end of the day we like to see movement towards optimal health care and for that reason CAC-MedMal strives to work with clients having a similar goal.