What is a claim?
A claim is demand for money. The most obvious example is when you are being
sued. From time to time a client gets angry with you. However, it is not a
claim until you have a demand for money.
What is a licensing board investigation?
A licensing board investigation is any investigation by your state licensing
board. If the board contacts you and it is not a part of your standard license
renewal then it is an investigation.
What is the difference between a formal and an informal
investigation
by the licensing board?
Nothing. Licensing boards are mindful of the stigma of a formal investigation so
when they receive a complaint or decide to investigate a psychologist, they
first like to gather information. The licensing board or its investigator may
call this initial phase an informal investigation or indicate that they are
only asking questions and have not started a formal investigation. Regardless
of what the action is called, the psychologist should take all actions by the
board seriously and treat them as a formal complaint.
What should I do if I think I have a claim or board
complaint?
Call Trust Risk Management Services (TRMS) at 877-637-9700. Talk to a licensed
professional and let them help you determine the best course of action. You
will not jeopardize your coverage for asking if you have a claim or
investigation. TRMS may help you use your coverage to its fullest advantage or
point you to resources you may not have been aware you had.
How much time do I have?
Timing is crucial. When you receive a claim or are under investigation by your
licensing board, you often have a limited time to respond. Normally you will
have from two weeks to one month. The sooner you report the situation, the
sooner someone can help you prepare a response. Often your attorney will need
most of that time to help you craft the best defense. Any delay in reporting
hurts your defense and limits the time your attorney has to help you.
What should I do if I know I have a claim or am being
investigated
by my licensing board?
You should report it to TRMS immediately. The carrier is going to require that
the report be in writing, so you should prepare a cover page that lists your
name, the date, and your policy number. Address the cover page to Attn: Claims
Department. You should include the claim letter, subpoena or letter from the
licensing board. Because time is of the essence, most people prefer to fax it
to 877-251-5111. If you do not have access to a fax then you can mail it to:
Trust Risk Management Services, Inc., 1791 Paysphere Circle, Chicago, IL 60674.
What does my policy do if I have a claim?
If you are being sued for a covered claim, the insurance company defends
you. You notify the carrier that you have been sued. A claims manager from the
carrier will contact you in one to two business days. The claims manager will
assign you an attorney to defend your case. Since the policy covers defense
costs, you do not need to pay the attorney.
What do I do if I have a licensing board complaint?
Licensing board complaints are handled differently than claims. You still
report to TRMS that your licensing board has contacted you.
The difference is that you hire an attorney to defend you and the carrier
reimburses you for reasonable expenses. Licensing board complaints are not like
lawsuits, so you will want to hire an attorney accustomed to defending
psychologists before licensing boards. Your local psychological association may
be able to help you determine which attorneys are most successful with the
licensing boards.
I did not do anything wrong. Do I really need a lawyer to
respond
to a licensing board investigation?
The licensing board is there to protect the consumer, not the psychologist. The
investigator if often not a psychologist, and he or she asks questions within a
narrow interpretation of the law. You need the experience of an attorney
familiar with licensing board investigations. Even seemingly innocuous
questions can be fraught with pitfalls for a psychologist unfamiliar with
licensing board investigations.
Is there anything wrong with handling a claim yourself?
The most important portion of your coverage is the legal defense. Each year the
carrier spends more on defense than on paying damages. The carrier is
experienced at handling claims to your benefit. However, they cannot help you
if they are not aware of the claim. If you do not report your claim promptly,
you compromise your defense and by extension jeopardize your coverage. When you
interfere with the carrier’s ability to properly defend a claim, you have
violated the terms of you policy and the carrier can deny coverage.
