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Claims

Claims Handling

Loss Prevention

For over 35 years, HAPI has worked closely with CAP/MPT, using their expertise for risk management services.

In 1998, HAPI conducted a review of Third Party Claims Administrators (TPA's) to assist us in handling our claims. The purpose of hiring a TPA was to assist in both managing claims and reducing claims costs. In February 1999, HAPI concluded its review and hired the services of CAP/MPT.

CAP is actively involved in HAPI's claims administration and is in daily contact with HAPI staff. CAP's duties, on behalf of HAPI, include the following:

1 CAP has set up a 24 hour, toll free hotline for HAPI members to report new claims incidents.
2 CAP has created a dedicated computer database for HAPI claims. The database tracks pertinent case information, including case summary, incident date, claimant information, physician information, co-defendant information, alleged damages, collateral sources, experts, lawsuit information, potential exposure and settlement demand/offers. The database also has the capability of providing a variety of specialized reports;
3 CAP retains counsel, on behalf of and subject to HAPI's prior approval, who prepare for and attend the Medical Claim Conciliation Panel (MCCP) hearings. (It should be noted that HAPI's own staff members also attend these hearings.) CAP submits a copy of HAPI's Defense Attorney Guidelines to the attorneys to ensure a thorough investigation in compliance with the guidelines. CAP also takes all actions necessary and appropriate to assist the retained counsel with their representation of HAPI;
4 CAP reviews, negotiates and approves all case legal budgets and legal fees, subject to the review and approval of HAPI. CAP also oversees the defense counsel's workup of the files;
5 CAP presents open claims to HAPI's Claims Review Committee and its legal counsel. CAP provides HAPI with a recommendation for each file presented and prepares a comprehensive report to the HAPI Claims Review Committee, which details the facts, liability analysis and potential damages exposure, along with a recommendation to defend or settle the claim.



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