Kaiser Permanente’s model allows patient members to choose their care from any of the professionals or facilities affiliated with Kaiser. Notes and other details of their care are shared across the system — a feature that Kaiser says makes delivering healthcare easier and more streamlined.
However, filing a medical malpractice claim against Kaiser is not necessarily convenient or easy. When you need to submit a Kaiser malpractice claim, the process involves key differences compared to traditional malpractice claims. Here is what you can expect in this complex legal landscape.
Kaiser Malpractice Claims Are Subject to Arbitration
Malpractice claims in California are challenging enough. But one of the chief reasons why Kaiser malpractice claims can be even more complicated is because you are subject to binding arbitration as a Kaiser patient.
When you joined Kaiser, you agreed to arbitrate any claim you might otherwise bring against a doctor or facility affiliated with Kaiser. Although the substantive rules applicable to malpractice lawsuits still apply, the procedure for resolving your claim through arbitration is different.
Binding Arbitration Defined
Arbitration is one form of alternative dispute resolution — a means of resolving disagreements in a more informal setting rather than having a trial by jury. The arbitration process is less formal than a traditional courtroom proceeding. It is intended to allow for the swift resolution of claims without the expense and time that often accompany trials.
After selecting an arbitrator, you and the other party in your dispute each submit evidence and information to the arbitrator. The rules of evidence are typically more relaxed, allowing the arbitrator to receive the information they need to resolve the dispute more easily.
The arbitrator’s function is to receive and review evidence that you and the other party submit to them. Once this is finished, the arbitrator renders a decision, deciding either that you are entitled to damages or that you have not shown that you are the victim of malpractice.
If you have proven your claim, the arbitrator will decide the amount of damages to which you are entitled. The arbitrator must find that the medical professional or facility involved provided you with deficient care and that you sustained an injury as a result of the deficient care. These are the same elements that need to be proven in a traditional malpractice suit.
Arbitration in a Kaiser malpractice claim is considered binding because both you and Kaiser will have previously agreed (under the Kaiser Arbitration Agreement) to accept the arbitrator’s decision. You generally do not have the ability to refuse an arbitrator’s decision unless there is evidence of fraud, if the arbitrator’s decision is contrary to all of the evidence submitted, or if the damages awarded are grossly disproportionate to your actual losses.
The Process for Submitting a Kaiser Malpractice Claim
If you have been hurt by a Kaiser provider or injured at a Kaiser facility, the Office of the Independent Administrator (OIA) will oversee the arbitration of your claim. The process begins by filing a demand for arbitration with the OIA. Along with a demand for arbitration, you need to include:
- Your name, address, telephone number
- The name and contact information for any attorney you have hired
- The names of all individuals you believe contributed to your medical injury
- A demand for a specific amount of money as damages
- A brief statement of facts describing how you were hurt and why you believe Kaiser is responsible for your injuries
Once your letter is received, OIA will send you (or your attorney) and the other party a list of potential arbitrators. From the list that is sent to you, each party selects an arbitrator they wish to hear the case. OIA will appoint an arbitrator after the forms indicating the parties’ choices are returned.
Within 60 days after receiving their appointment, the arbitrator assigned to your case will hold a case management conference. This conference aims to set deadlines for other hearings and events that must take place so that your claim can be resolved within 18 months from the date you submitted your demand letter.
An Experienced Medical Malpractice Lawyer Is Key
Much is at stake when you bring a claim against a Kaiser doctor or facility, so it is best to approach the situation with skilled and informed legal counsel. While there are no judges or juries involved in Kaiser cases, these medical malpractice claims are every bit as challenging and complex as those cases that are presented to a judge or jury, and having competent legal counsel is paramount.
The Trial Law Offices of Bradley I. Kramer, M.D., Esq. is an experienced malpractice plaintiff’s firm in California. As both a doctor and lawyer, our principal attorney, Bradley I. Kramer, M.D., Esq., is uniquely positioned to develop a comprehensive and effective strategy for your case. Contact us to schedule your free consultation today.