Advice on what to do in the event of a Complaint or Claim

By David Balen MD Balens Specialist Insurance Brokers

None of us know when we may find ourselves in a potential claim situation.  You have purchased your insurance to give you peace of mind, knowing that should you ever find yourself in such a situation, you will have the back up to help and support you through the process.  However the reality is that regardless of the insurance, a complaint or claim against you or your business can be very stressful, time consuming and costly, with potential unexpected knock on effects that are hard to quantify, but may include such areas as harm to your personal or business reputation.

It is vital to ensure that you have good insurance coverage that includes solicitors’ costs for both pre disciplinary and full disciplinary hearings, vital for Osteopaths who may find themselves unwittingly in such a situations with the GOsC.  Added benefits such as legal helplines, counselling help lines, and loss of reputation cover, to help repair any damage caused by a complaint or claim being made against you are also very helpful within the insurance package.  However, as we are all aware, prevention is better than cure, and whilst you will never be able to completely eradicate the risk, there is much you can do to mitigate the potential of a complaint or claim being made against you.

  • Good quality communication (especially listening skills) and developing a quality therapeutic relationship is key (please also see Negotiating the Boundaries – Managing difficult situations with your clients at www.balens.co.uk/cpd.aspx lecture recording from Balens CPD Training event 2012).
  • Keep your boundaries; respect your patient’s autonomy.
  • Please remember that you have a patient practitioner relationship with you client, and keep your communication style professional.  Familiarity could become a double edged sword.
  • Try to keep personal relationships away from professional ones- don’t get intimate with your patients- it still happens and inevitably can cause problems.
  • If you are asking someone to remove their clothes for your therapy, remember to ensure they are comfortable to do so.  Vacate the room, or provide a screen for them to get changed behind. Provide a robe and/or offer a chaperone if possible.
  • Towels and discretion should be used at all times to maintain dignity.
  • Gain consent before you touch your client, and throughout the treatment, and note this in your records.

 

You will find a list of Do’s and Don’ts in some common Complaint situations available available at the bottom of this short article, with further information available on our website at http://www.balens.co.uk/claims.aspx

In the unfortunate event of someone making a complaint against you, please contact your Insurance Broker in the first instance, in order that they are able to support you through the process, they are there to help.  All Insurance Brokers will have their own systems and procedures, however at Balens we will need you to formally notify us in writing, submitting your case history notes and treatment records, along with your own detailed version of the events of the situation.

None of us are perfect, and clients will inevitable be dissatisfied with us at some point during our working careers, however the key is in how that dissatisfaction is managed.  This can make the difference between facing a fully-fledged complaint or claim and having a now happy customer who will be all the more loyal in the future.   I hope that the above has been a useful reminder of what to do, should the unfortunate ever occur.  Should you have any questions please visit our website or contact events@balens.co.uk

 

Do’s and Don’ts in some common complaint situations.

Verbal Complaint
  • Do Listen. Regarding pain or perceived lack of progress – empathise, explain, reassure, make earlier follow-up appointment and maintain goodwill.

·         Consider whether the complaint is about a “notifiable safety incident” thereby triggering the statutory Duty of Candour (see below).

  • Do notify us if your customer appears still to be unhappy There is a difference between a “moan” about something and the threat of taking it further
  • Don’t panic, get defensive, admit liability, indicate you are insured, show annoyance or anger.  It is Ok to apologise if someone is in pain, another matter to say you are responsible for it.
 Letter of Complaint
  • Do notify Balens immediately and pass on all correspondence to our claims team (claims@balens.co.uk) unanswered together with patient notes and your response to the allegation.
  • Don’t Admit liability or respond directly in any way.
 No show – missed appointment
  • Do ring the patient to identify reason for no show.  Most common reasons are that patient feels better, it did not help, or they forgot, but it’s important to follow up missed appointments to ensure that there isn’t another lurking reason.  Treat as a verbal complaint.
  • Don’t do nothing.
Refund request
  • Do ask why.  Request that your client puts the nature of the complaint in writing to you so that it can be fully investigated.  Contact Balens for further advice.

·         Consider whether the complaint is about a “notifiable safety incident” thereby triggering the statutory duty of candour (see below).

  • Don’t get annoyed, angry or defensive.
No Payment
  • Do ask why.  If the patient is not happy, give reassurance and explanation – offer another appointment, complimentary if necessary, as a gesture of goodwill.

·         Consider whether the complaint is about a “notifiable safety incident” thereby triggering the statutory duty of candour (see below).

  • Don’t get annoyed, angry or defensive, admit liability or indicate you are insured.
Request to see Notes
  • Do give access, offer to copy or write a report from your notes.

·         Consider whether the complaint is about a “notifiable safety incident” thereby triggering the statutory Duty of Candour (see below).

  • Do ask why, although this request is rarely to do with a complaint it is important to understand your clients reasons. Usually the patient is moving or has an insurance claim as a result of an accident.
  • Don’t get annoyed, angry or defensive, admit liability or indicate you are insured (unless asked).
Notifiable Safety Incident – Statutory Duty of Candour   (Note: this will only apply if you provide a service that is required to be registered with the Care Quality Commission)
  • Do notify Balens of the incident immediately
  • Do arrange to meet with the patient (or, if they are deceased or lack capacity, someone able to lawfully act on their behalf) as soon as reasonably practicable. At that meeting the patient/service user should be provided with:
  • A factual account of what has occurred to the best of your knowledge at that time.
  • Details of the further enquires that will be  undertaken;
  • An apology which expresses sorrow or regret that the incident has occurred.
  • Do ensure that there is a record of this meeting and that the patient is subsequently written to confirming what was discussed.
  • Do provide Reasonable support for the patient/service user in relation to the incident.
  • At the conclusion of the investigation write to the patient confirming the outcome of this and ensure that a detailed record of this is kept.
  • Don’t Speculate about what may have occurred when you first meet the patient; instead keep to the facts as known at the time.
  • If you are concerned that an apology may amount to an admission of fault or liability, contact Balens for further advice in advance of the meeting.

 

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