CPHRM, Claims & Litigation Domain Overview

What is the initial step in the claims management process?

Which of the following best describes the role of a risk manager regarding insurance programs?

According to the material, what constitutes a claim?

Which element is described as being essential for a successful claims management program?

A systematic approach to claims management aims primarily to achieve which of the following?

During the 'investigation' phase of claims management, what is a crucial consideration when using outside investigators?

Which activity is part of the 'Identification' stage in claims management?

Which of the following is an element of formal risk assessment, versus informal risk assessment?

What documentation related to a claim is time-sensitive and is used to communicate representation?

What action should a risk manager take if a self-insured entity faces a major claim?

In the context of claims management, what is 'taxonomy' used for?

What is the primary purpose of 'setting reserves' in claims management?

What is the legal definition of "Res Ipsa Loquitur?"

In legal theories, respondeat superior refers to:

What is the key characteristic of ostensible agency?

Which of the following scenarios is most applicable to the legal theory of corporate negligence?

What is the primary focus of legal theories related to 'exposures of healthcare entities'?

Which scenario would most likely trigger a claim related to "Emergency Medical Services (EMS)"?

According to the material, what are the four major components of controlling losses to implement when involved with Due Diligence?

Which of the following is correct regarding Insurer and Insured roles?

Which of the following actions should the risk professional perform FIRST when a healthcare facility with a claims-made policy receives a request for demand?

What is the most relevant legal theory for not retaining a surgical sponge?

A hospital is being sued for the actions of one of its employees. That action resulted in hypoglycemia after a glucose level was dropped, and permanent brain damage. The hospital has already been deemed as vicariously liable. What now?

You're a risk professional working with defense council on selecting an expert witness in which to defend yourself for alleged brease cancer. Which specialist would you retain?

A hospital receives a subpoena for some Medical Records. What is the correct course of action?

According to the materials, what can a professional do to assist?

What is the primary goal of claims management strategies?

In the context of healthcare claims, what does the term 'PCE' stand for?

Which of the following best describes the role of 'reporting' in the claims management process?

During claims management, what is the role of 'analysis and classification'?

What is the significance of maintaining a 'claim file'?

Which of the following is a core tenet of Alternative Dispute Resolution (ADR)?

Which document involved in the pleading process commands the defendant appears before a judge?

Identify the advantage to using ADRs as an alternative to trial.

In pre-trial precedures, what is a joinder?

Why is the initial step of claims management so very crucial?

During Trial, there has been an incident in which the jury acted inappropriately. What do you do? What do you dooo?

What is the key factor that determines a risk manager's role in claims management?

What constitutes a formal claim?

What is the intended outcome of a systematic approach to claims management?

When using outside investigators during the investigation phase, what is extremely crucial?

What is an example of an informal risk identification system?

Which is NOT a formal document typically produced during initial claims documentation?

In claims management, what does ‘taxonomy’ aid in?

Which of the following is the LEAST important factor to consider during claim investigation?

What is the purpose of a documentation checklist in the claims management process?

During claims management, what does the ‘analysis and classification’ step primarily involve?

In healthcare claims, what does the term ‘PCE’ refer to?

According to insurers, what action may they take to validate accuracy of the claim?

What is the role of 'indemnity' in 'reserving'?

What is included in Claim File Management?

In General Liability, what does 'Slander' refer to?

What is the primary difference between 'Res Ipsa Loquitur' and 'Negligence per se'?

Which of the following examples would be best described as 'Negligence Per Se'?

How hospitals not reporting physician impairment to state licensing boards could lead to what?

In states where hospitals employ physicians, which legal doctrine could apply?

If a doctor who is not directly employed seems to work for a hospital, they may be considered what?

When organizations assess acquisitions in healthcare, what is one of key factors?

What action can and should an enterprise risk professional do in reaction to their company suffering litigation?

When a healthcare facilities has been served with a demand, who is the FIRST to notify?

What is the proper legal theory to use when hospitals are accused of negligence in retaining surgical sponges?

Which outside specialist would you retain given a lawsuit for breast cancer?

What is the BEST reaction when a medical staff reports they accidentally saw the name of a famous celebrity?

To completely stop losses when thinking about Due Diligence, what are the major components?

Which statement accurately highlights the roles/responsibilities of healthcare facilities in medical malpractice claims?

Many processes or stages will assist in claims management. Which of the following statements aligns to such?

In the lawsuit process, several things must occur. Which answer has the correct procedures (3)?

What would define: document reciting all the allegations against defendant?

What distinguishes a 'claim' from a 'potentially compensable event (PCE)' in healthcare risk management?

How would a risk manager's role differ between a self-insured healthcare organization and one that is commercially insured?

Which of the following actions would be most effective in supporting healthcare staff during a high-anxiety claim event?

What is the most critical element in ensuring an effective claims investigation when using outside investigators?

In what scenario would the 'corporate negligence' legal theory be most applicable?

In the context of legal claims, how does 'ostensible agency' most directly impact a healthcare facility?

Which statement best encapsulates the relationship between ‘benchmarking’ and claim taxonomy?

During claim file management, what is the primary rationale for meticulously organizing documentation in a logical order?

What's the primary role of insurance coverage information within a claim file?

What is the most accurate interpretation of insurer's 'duty to defend' in the context of claim management and litigation?

In the setting of claim file management, what is the correct order when arranging documents?

During the 'analysis and classification' phase of claims management, what would indicate the strongest and most suitable methodology for determining the claim?

Which of the following is the LEAST accurate statement regarding legal theories?

Why does Healthcare fail to report impairment to state licensing boards?

What would be NOT expected when thinking about EMS (Emergency Medical Services)?

If a lawsuit occurs, which Due Diligence option might prevent a legal issue from re-occuring?

During the lawsuit process, match the correct order of events.

Within ADR (Alternative Dispute Resolution) what is something you would NOT consider?

Which Healthcare Providers should an expert expect to treat carefully through contracting?

In the event that a healthcare entity's actions result in the misinterpretation of diagnostic imaging, leading to delayed treatment and subsequent harm, which legal theory would MOST likely be central to the ensuing claim?

A self-insured healthcare organization discovers a historical pattern of inadequate peer review processes stemming from poor taxonomy application, leading to delayed identification of systemic risks. How would a defense attorney leverage this discovery in a subsequent claim?

During the litigation process, plaintiffs' legal counsel requests the metadata associated with changes made to an electronic health record (EHR) after a Potential Compensable Event (PCE). The defense argues that the metadata is not subject to discovery due to privilege. Under what legal rationale would the defense prevail?

An organization's risk manager observes a pattern of Emergency Medical Services (EMS) personnel deviating from established protocols due to resource constraints. A patient subsequently experiences harm. What is the MOST relevant legal theory?

As an enterprise risk professional, you are tasked to assess the quality of external legal counsel during the litigation management process. Which metric offers the MOST insightful assessment of their efficacy beyond readily available litigation outcomes?

In a claims-made policy, what constitutes the MOST critical action for a healthcare facility upon receiving a demand letter, considering the potential implications for coverage?

A hospital's security system malfunctions, resulting in unauthorized access to employee files, including sensitive medical information. Which of the following legal theories would be the MOST directly relevant?

In the context of Alternative Dispute Resolution (ADR), what aspect of arbitration poses the MOST significant challenge for healthcare providers concerned with maintaining Standard of Care (SOC)?

A surgery resident accidentally cuts the common bile duct during a laparoscopic procedure, which was the third such incident in the last six months at the facility. What organizational failures would MOST likely be considered when litigating corporate negligence?

What factor most influences the extent to which a risk manager is involved in the actual claims management process?

During claim investigation, what is the MOST crucial consideration when using outside investigators, particularly with regards to potentially discoverable information?

Considering that a systematic evaluation of a claim is essential, what's an intended outcome a healthcare organization should look for in a claims management program?

What is a subtle way that hospitals can be corporate negligent when thinking about staff physicians who lose staff privileges due to alcohol impairment?

To have the most effective claims management and to review claims and potentially prevent them, what do many organizations rely on?

You are helping the defense council select an expert witness in a case regarding alleged breast cancer misdiagnosis. What would it be the ABSOLUTE BEST action?

A claim always involves a formal lawsuit filed in court.

The claims management process begins when an event occurs and concludes with the resolution of the claim.

In a commercial insurance coverage, the facility always bears the responsibility for covering losses.

The 'identification' step in claims management involves assessing coverage and setting reserves.

A risk manager's role is the same across different organizations, regardless of their insurance program.

A 'claim' is a formal demand for monetary damages due to an alleged injury.

A claim management program's success relies solely on the efficiency of its technology.

A systematic approach to claim management aims to increase the financial loss for a healthcare organization.

An insurance policy has no impact on the claims management process.

Internal investigations are optional in claims handling.

A goal of claim management is reducing negative impacts on a hospital's image.

After a claim, setting reserves involves identifying the claimant's attorney.

Claim file management involves the logical ordering and maintaining of all documents related to a claim.

'Respondeat Superior' means an employer is never responsible for the acts of their employees.

'Vicarious liability' means imposing the same liability the employee has to another person.

Internal investigations are an optional part of most claims resolutions.

There is no difference between ostensible and apparent agency in a healthcare setting.

Corporation negligences cannot impact medical malpractice lawsuits.

In claim management, healthcare entities face limited exposures, mainly related to medical malpractice.

The goal of due diligence is to complete legal and financial review of an organization.

A hospital following defense counsel does not need to select experts witnesses for medical negligence

A claims-made insurance policy is triggered by an occurrence during the policy period.

In the context of legal theories, 'strict liability' is typically the most relevant theory for cases involving retained surgical sponges.

The final step in a lawsuit is always an agreed upon settlement.

In investigation outside or outside, there is a need to get a written description of hippa in medical investigations.

A self-insured risk manager has major responsibility for their case.

The only essential element in assessing corporate negligence is determining whether the health facility was aware of similar past incidents

It is not required to clarify reporting PCEs.

In any medical setting, a claim that results in a case will require a 'pre trial' procedure.

The only role of a risk manager regarding outside counsel is ensuring the firm bills hourly and at or below an expected amount

If a provider is employed at a hospital, a patient and their family is authorized to sue a hospital even if they were not involved in the claim.

Integrated Delivery Systems (IDS) can cannot be held vicariously liable by anyone outside of contracts.

If a healthcare enterprise receives a written demand for compensation, a risk professional needs to first analyze the situation.

If there is an unintended surgical item in a patient, strict liability is automatically the result.

An 'unstructured process' in third party dispute resolution means that nobody is authorized to create documents.

In the list of "four Ds, the damage death for an employee is the 'duty' phase.

A hospital is responsible even though they were not involved if the lawsuit involves a contracted doctor instead of employed.

In the event that there is a subpoena, a lawyer knows the most so it should be directly passed with the lawyer rather than any action happening.

In corporate liabilities , it is most reasonable to hire an orthopedic surgeon to explain to the lawyer involving breast care cancer.

If HIPAA applies, compliance with medical records may proceed regardless of the circumstances.

A claim is a formal notification seeking monetary damages for an alleged injury.

The claims management program must have commercial insurance coverage.

In claims management, 'Identification' is the final step in the process.

The risk manager's role in claims is solely based on the organization's financial data.

A document checklist is not necessary when managing claims.

Analysis and classification of a claim involves using subjective opinions.

A 'Lawsuit' refers to informal settlement discussions outside of court.

Under the principle of Res Ipsa Loquitur, the burden of proof shifts to the defendant.

The insurer always waives its rights while a claim is being investigated and defended.

General liability covers professional malpractice.

'Loss Covered' refers to whether the cause of the incident is covered by the policy.

Liability determination aims to identify the responsible party, regardless of liability type.

In Res Ipsa Loquitur, the injured person can't sue the employer for the full amount.

A claim is best managed when reserves are set after sufficient data have been obtained.

The Respondeat Superior doctrine solely applies to intentional torts committed by employees.

Taxonomy is not relevant for benchmarking and loss runs.

The insurer and the insured have the same responsibilities when handling lawsuits.

A hospital cannot be sued for corporate negligence.

In a case of apparent agency, privileges for physicians are NOT considered to be an independent contractor

In an Emergency Medical Service, false imprisonment includes restraining someone.

In claims management, a Demurrer motion is when the plaintiff requests to admit allegations of the defendant.

Due diligence in litigation solely involves assessing the legal aspects of an organization.

Insurance coverage information, as part of claim file management, is not relevant to insurers.

A speedy driver hits a child while driving without headlights is a form of Res Ispa Loquitur.

The only advantage over a trial is the negotiation of the third party.

A notification of claims is when an ER physician dumps a patient.

Providing support through all phases of the litigation process will not mitigate negative effects, such as stress.

The risk of the professional is required to retain a legal counsel is there is a claim made policy in place.

Match the following steps for claims management in the correct order.

Match the type of healthcare entity with its common liability exposure:

Match the legal theory with its definition:

Match the following document requirements to the document in a claim.

Match the following terms related to reporting with the appropriate legal requirements.

Match the following terms liability determinations with its appropriate type.

Match the following phrases during litigation to its appropriate step in procedure.

Match each term to its corresponding description within coverage determination:

Match each formal vs informal system to its description:

Match the following elements of Claims File Management to its description:

Match the phrase to its description for ADRs.

Match the following list to its potential action to mitigate stress on employees.

Match the following items of a healthcare service to its common problem.

Match the following issues to a potential solution during a Due Diligence.

Match the following facts about a corporate to its impact.

Match the claims management process step with its description:

Match the legal theory with its correct description in healthcare claims:

Match the type of liability exposure with the healthcare entity where it is most commonly seen:

Match the actions that a risk manager can take to mitigate the negative impact of litigation stress on health care professionals:

Match the step with its description in defense firm performance:

Match the following elements of a claims management program with their appropriate description:

Match the following stages in the claims management process (as outlined in the 'new' model) with their correct description:

Match the following elements of 'Due Diligence' regarding financial processes with their appropriate next step:

Match the following 'Liability Areas' within Healthcare with a situation that would describe it:

Match the following 'Legal Theories' with their appropriate description:

Match each Alternative Dispute Resolution (ADR) method with its most defining characteristic:

Match the following elements to consider when selecting expert witnesses with their primary relevance to complex litigation management:

Match each stage of litigation management with its primary objective:

Match the document type from the pre-trial procedures with the content that ought to be present:

Match each type of Exposure of Healthcare Entities with a key aspect of loss mitigation