CPHRM Claims Management 5 — Questions and Answers
Question 1: A patient signs a general consent form upon hospital admission. This consent is MOST relevant to which type of claim defense?
- Assumption of risk for all treatments
- Informed consent for routine and standard care procedures (Correct answer)
- Waiver of all negligence claims
- Authorization for experimental procedures
Correct answer: Informed consent for routine and standard care procedures
General consent upon admission covers routine and standard care, but does not substitute for procedure-specific informed consent for invasive or high-risk treatments.
Question 2: Which legal concept allows a defendant physician to argue that the patient's outcome would have been the same even with proper treatment?
- Superseding cause
- Loss of chance doctrine
- But-for causation defense
- Causation in fact challenge (Correct answer)
Correct answer: Causation in fact challenge
Challenging causation in fact means arguing that even if there was a breach of care, it was not the actual cause of the patient's injury or outcome.
Question 3: When a risk manager conducts a 'mock trial' or focus group before a case goes to trial, the PRIMARY goal is to:
- Practice witness examination techniques
- Assess how jurors might perceive the case and evaluate settlement value (Correct answer)
- Train new risk management staff on courtroom procedures
- Identify expert witnesses for the defense
Correct answer: Assess how jurors might perceive the case and evaluate settlement value
Mock trials and focus groups help predict juror reactions to the evidence and arguments, informing settlement decisions and trial strategy.
Question 4: Under HIPAA, protected health information (PHI) may be disclosed to a plaintiff's attorney in a malpractice case:
- Only with the patient's written authorization or a valid court order (Correct answer)
- Freely, because litigation is a public matter
- Only after the case is settled
- At the discretion of the treating physician
Correct answer: Only with the patient's written authorization or a valid court order
HIPAA requires either a valid patient authorization or a court order (such as a subpoena with proper notice) before PHI can be disclosed in litigation.
Question 5: A 'consent judgment' in a malpractice claim differs from a standard settlement because:
- It is entered by the court as a formal judgment with the parties' agreement (Correct answer)
- It requires jury approval before becoming effective
- It waives all future claims against the defendant
- It is only available when the defendant admits liability
Correct answer: It is entered by the court as a formal judgment with the parties' agreement
A consent judgment is a negotiated settlement that is entered into the court record as a formal judicial judgment, combining settlement agreement with court enforceability.
Question 6: Which risk financing strategy requires the healthcare organization to retain all financial risk for claims below a set dollar threshold?
- Occurrence-based insurance
- Self-insured retention (SIR) (Correct answer)
- Captive insurance
- Umbrella coverage
Correct answer: Self-insured retention (SIR)
A self-insured retention (SIR) requires the insured organization to pay all costs — including defense and indemnity — for claims up to the retention amount before insurance responds.
Question 7: In healthcare claims management, 'disclosure and apology' programs are designed primarily to:
- Eliminate the need for malpractice insurance
- Reduce litigation by fostering transparency and early resolution with patients (Correct answer)
- Transfer liability to the treating provider
- Comply with mandatory state reporting requirements
Correct answer: Reduce litigation by fostering transparency and early resolution with patients
Disclosure and apology (or 'sorry works') programs aim to reduce litigation and claim costs by openly communicating with patients about errors and offering early resolution.
CPHRM Claims Management 5
A patient signs a general consent form upon hospital admission.
This consent is MOST relevant to which type of claim defense?