Proficient Kaiser Medical Malpractice Lawyers Serving Fresno, CA
Malpractice cases arise from care provided by various types of healthcare providers, including doctors, nurses, dentists, surgeons, pharmacists, and the staff members who assist these providers. In California, it should come as no surprise that many medical malpractice claims involve Kaiser Permanente, one of the largest healthcare organizations in the state. Speak with a Fresno Kaiser Medical Malpractice Attorney to discuss these medical malpractice claims.
However, malpractice claims against Kaiser healthcare providers don’t proceed in the way “normal” medical malpractice cases do. Because of the mandatory arbitration clause contained in Kaiser’s California insurance contracts, its members are required to arbitrate claims instead of filing lawsuits. California courts have upheld Kaiser’s arbitration process, and thus, Kaiser has its own internal judicial system.
In some ways, Kaiser’s arbitration system is similar to a court of law, and in other ways, it is dramatically different. For that reason, if you are considering filing a medical malpractice claim against Kaiser in Fresno, Clovis, Sacramento, or Modesto it is imperative that you consult with an attorney who is experienced with the Kaiser arbitration system.
Kaiser Permanente in Fresno and Clovis
California is Kaiser’s largest market, with the bulk of its business and headquarters being located within the state. Within the Fresno and Clovis area, Kaiser operates the following locations:
Fresno Medical Center
7300 N. Fresno St.
Fresno, CA 93720
Spruce Medical Offices
7300 N. Fresno St
Fresno, CA 93720
Cedar Avenue Medical Offices
7415 N. Cedar Ave., Ste. 102
Fresno, CA 93720
First Street Medical Offices
4785 N. First St.
Fresno, CA 93726
Clovis Medical Offices
2071 Herndon Ave.
Clovis, CA 93611
Oakhurst Medical Offices
40595 Westlake Dr.
Oakhurst, CA 93644
Selma Medical Offices
2651 Highland Ave.
Selma, CA 93662
Kaiser Permanente’s Unique Legal Identity
When a Kaiser member signs on to the Kaiser insurance plan, they agree to take part in Kaiser’s healthcare managed organization (HMO) plan which requires members to receive care from Permanente Medical Group (PMG) doctors. By this arrangement, Kaiser is able to provide care at lower costs than a hospital that bills to external insurance companies. Kaiser is also able to provide insurance at more competitive premiums than other insurance companies.
Under Kaiser’s arbitration clause, any dispute arising from Kaiser’s services, including medical malpractice claims, must be resolved through an arbitration process, meaning that Kaiser generally cannot be sued by a member in a court of law.
Kaiser Permanente Malpractice Arbitration
Arbitration is a private process by which disputes are resolved. While a lawsuit is presided over by a judge and liability decided by 12 jurors, an arbitration is decided by an arbitrator, who is a neutral party appointed to solve the dispute. No public record is kept of the proceedings, and the evidence raised is kept completely secret. The entire process is opaque to outsiders.
The private nature of arbitration is desirable to Kaiser, as it enables it to avoid receiving bad press from potentially damaging information that may come out in a lawsuit.
Kaiser’s arbitration process enables it to maintain a good reputation while resolving disputes in private. If a Kaiser physician is found to have committed malpractice, the finding is made behind closed doors and with the protections afforded by the private arbitration process.
What happens in a Kaiser arbitration?
A Kaiser arbitration begins with a “Demand for Arbitration” being sent to the Kaiser corporate legal department, which lists the allegations being made with respect to a malpractice claim. The demand functions similarly to a complaint in a lawsuit. From there, Kaiser involves the Office of the Independent Administrator (OIA), which is an independent entity set up by Kaiser to handle Kaiser arbitration cases.
The OIA is Kaiser’s private, internal court system for resolving disputes between Kaiser and its members. After the OIA gets involved, the claim proceeds in a similar fashion to a civil lawsuit. Kaiser will assign itself an attorney, and the parties proceed with discovery, which involves collecting evidence about the dispute.
Arbitration may proceed in a similar fashion to a court case. In that event, the arbitration looks very similar to a trial. The parties call witnesses, question witnesses, introduce evidence, and make arguments. But instead of a jury, the arbitrator makes the final call.
Who selects the Kaiser arbitrator?
After a case is filed, the OIA sends each party a list of potential arbitrators. If the parties agree to an arbitrator, they can mutually select one from the list or have one appointed who is not on the list. If the parties do not agree (which is most common), the parties rank their preferences from the list and then the OIA chooses the candidate that received the highest ranking from both parties.
If a Kaiser arbitration claim is for more than $200,000, the Kaiser rules provide that the claim can be heard by a panel of three arbitrators – one being the OIA’s neutral arbitrator, and one being appointed by each party. In many cases, though, the parties choose only to proceed with a neutral arbitrator, and they are encouraged to do so for purposes of cost savings.
An experienced Fresno Kaiser Medical Malpractice Attorney will have a vast knowledge base about Kaiser arbitrators. In the Fresno and Clovis area, the Kaiser arbitrators are well known to the attorneys who frequently practice before them, and the Walkup, Melodia, Kelly & Schoenberger Kaiser team knows how to craft your case in a way that maximizes your likelihood of success before your specific Kaiser arbitrator.
Timeline for Kaiser Arbitration Cases
Kaiser’s arbitration rules require that cases conclude within 18 months of their beginning, and most Kaiser arbitration cases conclude in 12 to 14 months.
Kaiser Arbitration and California Malpractice Law
In a Kaiser arbitration, California law applies in the same way that it would apply in a court of law. California evidence rules, and California rules of procedure are used. Because of that, in a medical malpractice claim, the legal elements are the same in a Kaiser arbitration as they would be in a California court.
Appealing a Kaiser Arbitration Decision
In a medical malpractice lawsuit, if the case doesn’t turn out the way you think it should, you can appeal to a court of appeals. But in a Kaiser arbitration, no right to an appeal exists. That means even if an arbitrator makes a mistake or gets the case wrong, his or her decision is final. California courts are generally very deferential to arbitration proceedings and are thus very reluctant to get involved in an arbitration process.
Because a malpractice claimant only gets one chance at an arbitration process, it is very important that no mistakes are made. For that reason, you should make sure that you consult with a highly experienced Fresno Kaiser Medical Malpractice Attorney when considering a Kaiser Permanente medical malpractice claim.
Statute of Limitations for Kaiser Malpractice Cases
The statute of limitations for medical malpractice claims in California applies to Kaiser arbitration claims. Under California law, an injured adult patient is required to file suit (or send their demand letter in a Kaiser case) within one year of discovering their injury. In some cases, the statute of limitations can be extended by 90 days by sending a letter indicating one’s intent to sue.
For cases filed on behalf of children, California’s statute of limitations in malpractice cases is three years from the date of injury, or for children under six years old when their injury occurred, before the child’s eighth birthday.
Damage Caps in Kaiser Arbitrations
Under California law, which governs damages in Kaiser arbitrations, damage caps for pain and suffering exist. Economic damages, such as lost wages, medical bills, or loss of earning potential, are not capped in California, meaning they can be recovered at any amount.
Non-economic damages, which consist of pain and suffering, are capped, but the amount depends on whether a case is brought by a living patient or on behalf of a deceased patient. In a wrongful death action, the cap on non-economic damages is currently $500,000 (as of 2022) and will increase by $50,000 each year until reaching $1 million. In an injury case by a living victim, non-economic damages are capped at $350,000 (as of 2022) and will increase by $40,000 each year until reaching $750,000.
Contact a Fresno Kaiser Medical Malpractice Attorney
While California law is applied in Kaiser arbitrations in the same way that it is applied in California courts, Kaiser arbitrations present unique challenges that require an experienced Kaiser arbitration attorney. Because Kaiser arbitrations are final with no opportunities for appeal, it is essential that your claim is handled with skill from the start.
If you are considering filing a malpractice claim against a Kaiser Permanente healthcare provider, you should contact Walkup, Melodia, Kelly & Schoenberger as soon as possible. We have the knowledge, resources, and reputation to maximize your chances of success.
Contact our office today to set up a free consultation on your Fresno Kaiser medical malpractice claim.
