RMS handles General Liability and Medical Malpractice claims. These services include, but are not limited to:
Receive and process all claims, including input into the electronic claims management system, open and maintain a hard file, conduct appropriate investigation, prepare and send appropriate government tor t code statutory notices, reserve both loss and expense and track claims on diary.
Investigation includes contact and interface with County department staff, on-site visits and witness statements, obtaining all appropriate documentation—police reports, damage appraisals, medical records, wage/employment information.
Provide and maintain an electronic claims management system- RMS utilizes MicroNiche and provides County Counsel and Risk Management remote read-only access. We also prepare and provide regular and AdHoc reports. The system tracks all claims by type and department (utilizing County department codes), keeps all financials (reserve and expense payments) and manages a diary. RMS manages six electronic claims management systems for its clients and over the years has found MicroNiche to be the most economical and user friendly.
RMS is highly experienced in working with the California Government Code and utilizing the advantage it affords the County in the area of rejection, timeliness and sufficiency and immunities. RMS has developed creative approaches in utilizing the government codes, such as the “triple threat” notice which addresses claims late beyond 1 year, claims not filed within 6 months and rejections all covered in one letter.
Reserving: RMS is keenly aware of the importance of proper reserving. As an auditor of public entity claims handling, we realize that full reserves that take into account –degree of liability, venue, historical exposure, plaintiffs’ bar and alleged damages—are critical to solid claims administration. It allows the County to predict costs, maintain its risk trust fund properly and provide actuaries accurate data.
Excess Reporting: RMS is very familiar with the importance to CSAC/Excess Insurance Authority in reporting both General Liability and Medical Malpractice claims. We have a long-term and excellent relationship with CSAC/Excess Insurance Authority and over the years have established a high level of confidence in our claims handling with CSAC/Excess Insurance Authority.
RMS also works well and has established a solid relationship with the reinsurers that provide coverage above the CSAC/excess Insurance Authority layer. On large exposure cases we regularly communicate with claims representatives from AIG, Ironshore, AMTRUST, and Lexington.
Regular claims reviews: RMS conducts a monthly telephonic claims review, scheduled for the third Thursday each month. The review includes hospital staff, County Counsel and Risk Management. A review of the current status of all open Medical Malpractice claims, discussion on upcoming mediations and settlement strategy is discussed. After the Medical Malpractice claims are reviewed, a specific department or type of claim (i.e. employment, auto accidents, large personal injury) related to General Liability exposures are reviewed with County Counsel and Risk Management. These claims reviews not only keep all involved informed about existing claims and allows for new input relative to liability, but allows for discussion of new incidents and a proactive action plan to be established.
Attend as the entity representative, all settlement conferences and mediations. Over the years RMS has provided added benefit to these negotiations due to its knowledge and relationship with mediators and district court magistrates. Additionally RMS, in cooperation with Defense Counsel and County Counsel, will contact Plaintiff Counsel direct and negotiate favorable resolutions that save on future litigation costs.
RMS has extensive experiences in handling not only routine claims, but sophisticated and politically sensitive claims and litigation. RMS regularly handles for the County and its other public entity claims’ employment cases, ADA, civil right violations and serious personal injury cases, involving deaths and severe neurological damage.
RMS has handled to conclusion:
- Occupy Oakland class action.
- Meserling verdict riots class action.
- Several complicated in-custody death cases.
- Employment matters involving major department heads and managers.
- Several excessive force shooting cases.
- Multi-claimant damage cases, due to storms, flooding and auto accidents.
- Complex litigation, involving numerous defendants with conflicting interests.
RMS’ experiences as a litigation manager, working with outside counsel, County Counsel and City Attorney’s is unequalled. We strive to create a triangular relationship between counsel, the client and our office. Working together for a favorable resolution and being on the same page is our utmost goal. We, when appropriate, will manage conference calls with all involved to discuss strategy and resolve issues. We have designed a Defense Evaluation tool (DCE) that we send to counsel. The form has been well received by both clients and counsel, in that it defines and quantifies the exposure. This helps to advise departments and boards of upcoming mediations or settlement conference and the expected resolution. (Please find a copy of our DCE as Exhibit A).
Subrogation: RMS is aggressive in its subrogation accounts for the County and will continue to do so.