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Q&A: Is there a simple method for verifying malpractice insurance claims history?

Credentialing & Verification Update, August 15, 2007

A: An individual query to the professional liability carrier(s) is the only way to verify professional liability coverage on a practitioner.

The National Practitioner Data Bank (NPDB) is the first and quickest resource for malpractice claims that have been settled or judgments that have been rendered. However, not all claims are reported to the NPDB for a variety of reasons allowed by NPDB regulations. In addition, there is no information in the NPDB on open claims.

Therefore, a best practice is to contact the individual malpractice carrier to determine if any claims have been paid out or filed for the individual. This avenue then provides much more comprehensive information.

The organization should have a medical staff policy on how far back it will go in obtaining such information. Notably, most organizations go back five to 10 years. Only one carrier (in Arizona) that I know of has taken steps to electronically automate this query and response to selected clients.

Contacting the individual malpractice carrier(s) is a labor-intensive effort, but it is an excellent risk-management and quality-improvement measure that increasingly is being done by a majority of organizations.

Editor's note: Carol S. Cairns, CPMSM, CPCS, a senior consultant with The Greeley Company, fielded this reader question. Questions and topic suggestions can be e-mailed to CVU at mcoler@hcpro.com. We'll find an expert or resource to tackle the credentialing or verification issues that are challenging you.

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