Can You Sue Kaiser Permanente?

Posted in Medical Malpractice,Personal Injury on March 12, 2019

Kaiser Permanente is one of the United States’ largest not-for-profit health plans, comprising dozens of hospitals and millions of members. For the most part, medical personnel across the country provide care at or exceeding the standard of care expected by their patients, but when patients suffer injury as the result of substandard care, they may pursue medical malpractice claims against the hospital. Can patients sue Kaiser Permanente for malpractice?

In a word: no. Kaiser Permanente’s system for resolving claims is different and requires patients to proceed through a strict set of steps.

How Is Kaiser Permanente Different From Other Hospitals?

Kaiser Permanente is a managed care consortium, or HMO. Patients choosing Kaiser Permanente may use any of Kaiser Permanente’s managed hospitals and medical groups, but the care must be within the Kaiser Permanente system. Typically, patients receive a primary care provider, but can receive care within the system without a copay.

When users decide to choose Kaiser Permanente as their HMO, they must sign an arbitration agreement before receiving membership. The agreement outlines all steps necessary for pursuing claims against the organization. Members must follow the arbitration procedure instead of filing malpractice lawsuits in court.

How Does the Arbitration Process Work?

First, the injured patient must submit a form stating the demand for arbitration to the Office of the Independent Administrator. The administrative office responsible for your arbitration varies by area, but most arbitration contracts list the correct mailing address of the appropriate office. Overall, demands for arbitration involve gathering all information relevant to your case.

  • A statement describing your injuries and how you believe Kaiser Permanente personnel caused the injuries
  • The damages you seek as compensation for your injuries
  • Your contact information, as well as contact information for your lawyer
  • The names of all individuals you believe responsible for your injuries

The administrator has three days to generate and send you a list of twelve arbitrators to choose from. You must return your selection to the administrator within 20 days. At this time, the administrator selects an arbitrator based on your and the responsible parties’ selections.

Within 60 days, the arbitrator must hold an arbitration management conference. At this time, the arbitrator will discuss the incident leading to the injuries. The arbitrator also sets the dates for the remaining portions of the arbitration process.

First, the mandatory settlement meeting gives the arbitrator and both parties the chance to meet and discuss the incident. If no settlement occurs, the arbitrator schedules an arbitration date. You and the physician, along with your lawyers, will make your cases before the arbitrator.

Is Arbitration Like a Lawsuit?

Though similar to a traditional malpractice courtroom setting, the arbitration process can feel a bit less formal – arbitrations have no jury, the arbitrator stands in for the judge, and often takes place in a meeting room rather than a courtroom. However, both parties must exchange information before the arbitration, similar to the discovery phase of a trial. Then, each will present information and evidence regarding the incident before the arbitrator.

After weighing the evidence, the arbitrator presents a decision. The arbitrator’s decision consists of a ruling regarding whether or not malpractice occurred, and whether you should receive damages as compensation for injuries caused. At this time, the arbitrator will determine the amount of compensation, if any.

What If You Disagree With the Results of the Arbitration?

If you believe the decision made by the arbitrator was wrong and a court should overturn it, you may appeal the decision in court. However, most courts are reluctant to overturn arbitration unless clear evidence of poor judgment or other wrongdoing exists. Although the process does not take place in court, legal rules still apply. If you believe the other party or their lawyers did not follow legal rules of the arbitration process, consult with your medical malpractice lawyer in Philadelphia regarding an appeal.