This internal website is strictly for UCSF employees, please do not share this information with non-UCSF individuals. Please refer them to our public website at: healthriskmanagement.ucsf.edu
Process Overview
The claims process may be initiated by the service of a 90-day notice of intention to commence litigation or a patient’s written request for monetary compensation arising out of the delivery of healthcare services. The 90-day notice of intent an NOI, is intended to provide early notification of potential litigation, but it is not filed with the court. The main benefit to plaintiffs in serving a 90-day notice is that it may extend the potential statute of limitations for the filing of an actual complaint. Many plaintiffs’ attorneys send out 90-day notices while they are still investigating a potential case for this purpose. 90-day notices are referred to the University’s third-party claims administrator (Sedgwick CMS) for review and handling. The assigned claims administrator is responsible for reviewing the medical records, speaking with the involved providers, and interacting with opposing counsel. They will also check court filings of the lawsuit and close the matter if there is no filing by the time the statute of limitations has expired. The service of a 90-day notice does not necessarily mean that actual litigation will ensue.
A complaint is the official notice of a lawsuit that may be served upon the UC Regents and/or individually named providers. The Risk Management department is not authorized to accept service of civil complaints. However, in the event you are served with a complaint, it is crucial that you notify the Risk Management department immediately so that defense counsel may be assigned. Defense counsel has limited time in which to respond to a complaint so timely notification is imperative. In the event a complaint is served upon the UC Regents on behalf of a patient that you have treated, you will be notified by the Risk Management department.
Following service of the complaint an answer will be filed by defense counsel on behalf of all parties served.
Defense counsel assigned to a case will wish to meet with all health care providers involved in the patient’s course of treatment at UCSF Health. All of your communications with assigned defense counsel are privileged and confidential. While defense counsel will undertake all efforts to keep you apprised of significant developments that may occur during litigation, we encourage you to contact them or the Risk Management department at any time if you have any questions about the status of the underlying case.
The discovery process is initiated after an answer to a lawsuit is filed and is a mutual exchange of information. The discovery process entails service on the parties of written questions (known as interrogatories), requests for production of documents and/or requests for admissions. Defense counsel may need your assistance in obtaining the information needed to respond to these requests. Responses to these requests must be served within certain time parameters and verified for accuracy and truthfulness by the hospital risk manager.
A deposition is the examination (questioning) of an individual, under oath. Although the setting is not a courtroom, the testimony has the same force and effect as if it were given in a court of law. In the event your deposition is requested by opposing counsel, defense counsel will contact you prior to the deposition to prepare you and answer any questions you may have.
Under California law expert testimony is necessary to establish the standard of care for a health care provider and to determine whether any providers’ act, or failure to act, fell below the applicable standard of care. The standard of care is the standard according to which professional liability is determined. It is the degree or skill associated with the actions of a reasonable, prudent practitioner acting under the same or similar circumstances. Expert testimony is further necessary to establish the issue of causation, i.e., that a provider’s act, or failure to act, caused or contributed to the alleged injury. Defense counsel will retain experts in the appropriate clinical specialties to review the case and express their opinions on both standard of care and causation.
Damages: There are two types of damages that are potentially recoverable in professional liability actions against health care providers. General damages (also known as “non-economic damages”) are those types of damages that have intangible value, such as pain and suffering, disfigurement, physical impairment, grief, loss of consortium (loss of a spouse), and emotional distress. In California, the MICRA law limits recovery of these damages. That amount varies depending on the year the lawsuit is filed and the type of case, with wrongful death claims having slightly higher general damages caps. Prior to January 2023, the general damages cap was limited to $250,000 per party (with a single recovery of $250,000 in a wrongful death case.)
Special damages (also known as “economic damages”) are those types of damages that have verifiable, tangible value, such as loss of past, present and future wages, past, present and future medical expenses, burial and funeral expenses and household services. There is no cap on special damages.
Case resolution may be accomplished in several different ways. A case may be voluntarily dismissed by the plaintiff if for example, opposing counsel is unable to secure expert testimony to support the allegations in the complaint. A case may be dismissed on procedural grounds if for example, opposing counsel fails to comply with applicable court orders. A motion for summary judgment may be filed by our defense counsel that would include expert declarations supporting the treatment rendered and a request to the court that the case be dismissed for failing to establish professional liability. Settlement of a case may occur at a settlement conference, mediation, or by agreement among all parties involved. Finally, a case may proceed to trial for resolution by way of jury verdict. In the event a case proceeds to trial you may be asked to testify or otherwise participate in the defense of the matter.
Allocation Committee: The Medical Center’s Allocation Committee is responsible for reviewing all cases settled for an amount in excess of $30,000 for the purpose of allocating responsibility among the involved providers and/or relevant systems issues that may have contributed to the patient’s outcome. If the percentage of responsibility allocated to a physician exceeds $30,000, the University is required to file a report with the California Medical Board on their behalf. A Physician Assistant has a similar reporting threshold of $30,000. If the percentage of responsibility allocated to a nurse exceeds $10,000, a report must be filed with the Board of Registered Nursing. A Dentist has a similar reporting threshold of $10,000. Reporting to the licensing board is not determined by whether a provider is named as a party to the underlying litigation. In the event you are reported to and subsequently contacted by either of these entities please contact Risk Management for assistance at (415) 353-1842 opt 3, or at [email protected].
A report of the case settlement to the National Practitioner Data Bank will be mandated regardless of the settlement amount if you are a named party to the litigation at the time of the settlement and are individually named in the release signed by the plaintiff (or, if the case goes to trial, you are a party to the final judgment rendered.) The Risk Management department will advise you whether a report of a settlement to the NPDB will be made on your behalf. If so, the NPDB will automatically send you a copy of the report and you will have the opportunity to post your own comments in the final report on file.
Click download and print:
For subpoenas, legal documents and/or requests questions, please call us at (415) 353-1842 opt 3, or email us at [email protected]. Our office hours are Monday through Friday, 7:30am to 5:00pm PST.