More Information About the Office Of The Independent Administrator
Since 1997, the Office of the Independent Administrator has supervised the claims handling process in any case brought by a health plan member against Kaiser or the Permanente medical group for medical malpractice and negligence against Kaiser.
The opposite of the independent administrator is currently located in the law firm of Marcella Bell in Southern California. The most recent year for which Kaiser has produced accurate statistics is 2015. During 2015, 267 of 603 pending cases were settled. This represents 44% of the cases closed during the year. The average time to settlement was 344 days, just over 11 months.
Approximately 80% of club Kaiser patients who brought medical malpractice claims were represented by lawyers. “The remaining 20% of Kaiser members proceeded “in Pro per” as their own attorney. In 2015, 10% of the cases were disposed of by summary judgment-where a judge decides in favor of one side or the other making a final determination without going through an arbitration hearing. In the vast majority of those cases (33 out of 37 cases) Kaiser won a dismissal of the case, and the patient lost their claim, by way of summary judgment.
Other ways cases terminated included withdrawal, dismissal and abandonment and entry of judgment after an arbitration hearing. In 2015, the OIA received notice that 159 claimants had withdrawn their claims. In 57 (36%) of these cases, the claimant was in pro per, meaning that the Kaiser member was attempting to go forward without a lawyer.
In 6% of cases, the party who filed them simply abandoned prosecution of the claim.
In 29 of the 38 cases which were abandoned, the patient was in pro per, proceeding without a lawyer. Neutral arbitrators have the power to dismiss cases if the claimant fails to respond to hearing notices or otherwise to conform to the Rules or applicable statutes. In more than half of these cases the claimant did not have a lawyer .
Failing to have an expert witness (19 cases), failing to file an opposition (23 cases), exceeding the statute of limitations (5 cases), and no triable issue of fact (11 cases) were the most common reasons given by the neutrals in their written decisions granting summary judgment in favor of Kaiser and against the Kaiser health plan member.
Ten percent of all cases closed in 2015 (62 of 603) proceeded through a full arbitration hearing to an award. Judgment was in favor of Kaiser in more than half of the cases that went to hearing ( 61%). In cases where the patient prevailed at arbitration, every patient who was successful was represented by counsel.
Importantly, not a single Kaiser patient who attempted to go forward in an arbitration hearing as a pro per claimant won at arbitration. This statistic points out the need for a competent Kaiser arbitration lawyer for any Kaiser member who intends to prosecute a case all the way through a disputed arbitration hearing.
