Causes Of Claims Research Articles

Aplicación de seis sigmas integradas con AMEF y QFD en el proceso de fabricación y distribución de muebles

La siguiente investigación se realizó en una empresa cuya actividad principal es la fabricación y comercialización de muebles, con el objetivo de identificar acciones que mitiguen las no conformidades o quejas y reclamos por parte de los clientes, para este análisis se implementó la metodología de seis sigmas integradas con herramientas de gestión de la calidad tales como QFD, AMEF, diagrama de Pareto y la métrica diagrama de flujo de procesos. Para identificar las causas principales de reclamos. Este estudio permitió identificar cuatro etapas críticas en el proceso que afectan en mayor dimensión la calidad de los productos, primero la calidad dentro del proceso productivo, calidad de insumos, servicio posterior a la entrega y logística y transporte.

Claim Causes and Types in Indian Construction Industry - Contractor’s Perspective

The number and frequency of claims in the current context of very complex and heavy budgeted projects in India are noticeably high which have negative impacts on the budgetary of owners and cause losses of liquidities and restrictions in cash flow for contractors. This study is conducted to determine the main causes of claims and their sources in Indian construction industry. Further, the study is conducted to determine the frequency of different claim types in Indian construction projects, and to provide recommendations and suggestions to avoid/mitigate claims in Indian construction industry. The objectives of the study have been achieved through a valid questionnaire that was distributed and obtained from different contractor’s construction organizations working in Indian construction industry. The results showed that the most important factors that contributed to the generation of claims are delay in handing over site, variation between actual and original quantities, excessive change orders by owner, delay of shop drawings approval by owner’s representative, and scope change of the project. The results also showed that the most frequent claim type in Indian construction projects is extra-work claims.

Compensation Claims for Sub-substandard Care of Patients with Gastroentero-pancreatic Neuroendocrine Tumors: A Nationwide Descriptive Study of Cases Between 2005-2016 in Norway.

Management of patients with neuroendocrine tumors of the gastrointestinal tract or pancreas (GEP-NENs) poses diagnostic and therapeutic challenges. This study described the medico-legal claims reported to a national governmental system that oversees compensation to patients with GEP-NENs Materials and Methods: An electronic search of the Norwegian System of Compensation to Patients database was performed to identify claims evaluated between 2005-2016. The clinical information and the medico-legal evaluation were reviewed. We identified seven patients, five women and two men, with a median age of 57 (range=47-73) years. Delayed diagnosis (median diagnostic delay of 18 (range=6-48) months) was the main cause for claims in six out of the seven patients). Four patients received financial compensation based on the claim judgement. This review of claims that were evaluated by the Norwegian System of Compensation to Patients showed that a timely diagnosis of GEP-NENs remains a clinical challenge.

Statistical Evaluation for claims and disputes in construction contracts

This research aims to diagnose and identify the causes of claims and disputes between the contractor and the employer, also review the methods used to resolve disputes in construction contracts. In order to achieve the goal of the research, scientific methodology is followed to collect information and data on the subject of claims and disputes in construction projects in Iraq through personal interviews and questionnaire form. The most important results in this research are: the price schedule contract as a kind of competitive contracts is the most important and guarantee for the completion of minimum level of claims and disputes with relative importance of (84.1), compared with the (cost plus a percentage of the cost contract) as a kind of negotiating contracts is the most relative importance of (79.6), and the turnkey contract as a kind of special contracts is the most relative importance of (74.2). The contractor and his agents are one of the most influence sources in occurring claims and disputes in construction contracts with relative importance of (77.4) followed by the contract documents with relative importance of (74.2) and then the employer with relative importance of (73.2). In addition to the long period of litigation and the multiplicity of veto grades are most negative when contractual disputes have resolved by it, and with relative importance of (86), followed by the large number of issues and lack of efficiency and specialty of Judges with relative importance (78.4). Finally, the direct negotiation method (relative importance of 77) is one of the most friendly settlement ways favored by conflicted parties, while the resolution of disputes and claims board (relative importance of 10) occupied the last rank in the friendly settlement ways.

Outcomes of medical malpractice claims in assisted reproductive technology over a 10-year period from a single carrier.

Medical malpractice claims vary by specialty. Contributory factors to malpractice in reproductive endocrinology and infertility (REI) are not well defined. We sought to determine claims' frequency, basis of claims, and outcomes of settled claims in REI. This is a retrospective, descriptive review of 10years of claims. The setting is private practices. Claims were monitored within one malpractice carrier between 2006 and 2015 covering 10 practices and 184,015 IVF cycles. Total claims, basis of claims, and indemnity paid were evaluated. There were 176 incidents resulting in 30 settled claims with indemnity payments in 21. Categories of claims settled included misdiagnosis (N = 4), lack of informed consent (N = 5), embryology errors (N = 8), and surgical complications (N = 4). Total and average awards were $15,062,000 and $717,238, respectively. Misdiagnosis and lack of informed consent had highest total award amount at $11,583,000 accounting for 76% of award dollars. The two highest awards were $4.5 million and $3.0 million for cancer and genetic misdiagnosis, respectively. Excluding these two awards, payments totaled $7,562,000, ranged from $6000 to $900,000 and averaged $170,363. Errors in handling of embryos were highest in frequency accounting for 38% of claims paid for a total of $1,593,000 with average payment of $199,188. Settlements for surgical complications totaled $1,855,000 and averaged $463,750 per claim. Misdiagnosis and lack of informed consent are the highest award categories. Embryology lab errors are the most frequent causes of claims with the lowest award per settlement. The average cost for claims settled is relatively high compared to settlements in other specialties.

Claims about medical malpractices resulting in maternal and perinatal mortality referred to iranian legal medicine organization during 2011–2012

Background:Obstetricians, gynecologists, and midwives are the most common specialists of the medical sciences group against whom medical malpractices are claimed, many of which are avoidable and preventable. Therefore, the present study was conducted to investigate the causes of claims regarding medical malpractices resulting in maternal and perinatal mortality.Materials and Methods:A descriptive cross-sectional study was conducted and 7616 claims of medical malpractices in the field of obstetrics, gynecology, and midwifery that were referred from all 31 provinces to the central commission of legal medicine were studied during 2011–2012. Therefore, the present research is a national inclusive study covering all the provinces across Iran. To collect information from the transcript of medical malpractices cases, a researcher-made checklist was used, and the collected data were analyzed.Results:The results of the present study showed that among all the medical malpractice claims regarding pregnancy and childbirth (42.24%), the majority concerned perinatal death (71.82%) and maternal death (28.16%).Conclusions:Medical malpractice complaints are increasing; although, most of these claims are preventable. To achieve this aim, it is necessary for obstetricians, gynecologists, and midwives to try to reduce the complaints by paying more attention to the signs and symptoms of diseases, performing all the diagnostic and therapeutic measures according to the scientific criteria, and fully document patients' records. In addition, patients' acquaintance with the importance of measurements and examinations, before and during pregnancy care and even after childbirth is crucial.

Causes of claims in road construction projects in the UAE

Claims are inevitable in construction projects and road construction projects in the United Arab Emirates (UAE) are no exception. A claim is a request for time and/or monetary compensation for damages incurred by any party to the contract. The number and frequency of claims have increased over recent years due to the increase in the size and complexity of these projects. These claims result in cost overruns, schedule delays and adversarial relationships amongst the contracting parties. The objective of this paper is to identify and assess the most frequent causes of claims in road construction projects in the UAE in addition to the root causes that contribute to the occurrence of claims. Sixteen causes were identified through a literature review. A survey was then developed and distributed to construction professionals experienced in claims in road construction projects. Fifty-one surveys were completed. The reasons and their root causes were ranked based on the weighted average of the responses. Variation was identified as the most frequent cause of claims, followed by contractor's delay and inadequate site investigation before bidding. The results show that consultants and clients have strong agreement on the ranking of the claims and weak agreement with the contractors.

Rank-Order Analysis of Factors Causing Claims on Road Construction Projects in Botswana

Claims are considered to be one of the most serious disruptive forces to successful project delivery in the construction industry. In a small developing economy like Botswana, it is germane to identify the sources and the frequency of occurrence of claims so that the burden of project cost overrun, a hallmark of the country’s construction industry is substantially reduced. Detailed literature review and preliminary field investigations were used to identify causes of claims related to road construction projects. The study identified six major types of claim and twenty seven causes of claims. Using questionnaire as research instrument, respondents (construction industry major stakeholders i.e. clients, consultants and contractors) were asked to rank the frequency of occurrence of the types and causes of claims in road construction projects on a Likert-type scale. Relative importance index (RII) method was used to analyze the data collected from the questionnaire survey. The analysis was carried out for each group of respondents and on the overall results (all the parties combined). A total of 27 useful responses made up of nine clients, ten consultants and eight contractors) were analyzed. Findings indicated that the clients and consultants specified delay claims followed by extra work claims were the most frequent type of claims in the construction of roads in Botswana. Contractors perceived differing site conditions followed by delay claims as the most frequent type of claims. From the overall response, delay claims were ranked first followed by extra work claims. Acceleration claims were ranked least. The top five most frequent causes of claims based on overall ranking were: variation in quantities, design errors, poor site management and supervision by contractor, ineffective planning and scheduling of project by contractor, and low price of contract due to high competition. Construction industry research in Botswana has never looked into the issue of claims and yet it is one of the hidden sources of construction project failure in the country. It is perceived that hedging against the most adverse causes of claims will stem the tide of incessant cost overrun, litigation and project abandonment on road projects in Botswana.

Obstetric and gynecologic malpractice claims in Saudi Arabia: Incidence and cause

IntroductionThe occurrence of a bad outcome, injury or death of a patient during treatment increases the chance of malpractice litigation, increases legal responsibility and leads to increased fees for malpractice insurance. Physicians practicing obstetrics and gynecology face among the highest risks of malpractice litigation, and such litigation has led to an increase in the practice of defensive medicine and has made this specialty less appealing. Previous clinical data from Saudi Arabia have shown that more malpractice litigation concerns claims in obstetrics and gynecology than claims in any other field of medicine. ObjectiveTo identify the main causes of obstetrics and gynecology (OBGYN) professional liability claims in Saudi Arabia to have a better understanding and management of risks. MethodsAll OBGYN claims opened in Saudi Arabia between 2008 and 2013 were analyzed to identify the most common causes of claims. The results of these claims and the times until a final judgment made were also analyzed. ResultsOut of a total of 463 malpractice claims that were closed during the study period, 114 (24.6%) claims were in obstetrics and gynecology, and 92 (80.7%) of these claims concerned complications related to delivery room events. The most common causes of obstetric malpractice litigation were shoulder dystocia (brachial plexus injury) and fetal distress (hypoxic ischemic encephalopathy). Urinary system injury was the most common cause of gynecology cases. Most cases were decided in favor of the defendants with the exception of cases for which maternal and/or fetal death was the cause of litigation; nearly all of those cases were decided against the defendants. ConclusionObstetricians face a high risk of malpractice claims in Saudi Arabia, although most claims do not end in payments to plaintiffs. However, the effects of such claims on obstetric care should not be underestimated. Adherence to standards of care and careful documentation may decrease litigation and the number of indefensible malpractice claims.

Medical Malpractice Claims Investigated By the Medicolegal Consultation Center, Tanta University, Egypt (2008-2015)

Medical malpractice is defined as lack of reasonable care and skills or negligence on the part of a medical practitioner in the treatment of a patient whereby the health or life of a patient is endangered. This study aimed to throw light on medical malpractice claims investigated by the Medicolegal Consultation Center (MLCC), Tanta University in order to understand the underlying causes of their events which is crucial to prevent their occurrence in the future. Characteristics of defendant physicians (gender, qualifications and specialty) were tabulated. Locations of health care settings were checked up. The causes of claims and the outcomes of the cases were graded (death, permanent infirmity or complications), then judgment on cases as positive or negative for malpractice was done based on several criteria. The studied claims showed that 88.2 % of defendant physicians were males. It was found that 47.1 % of defendant physicians were consultants, 35.3% were specialists, 5.9% were residents and the whole medical team was accused in 11.8% of the cases. Different specialties were claimed in this study; 23.5% of them were gynecologists and 17.6% were general surgeons. It was found that private hospitals and clinics were presented by 41.18%. Death was the outcome of 29.41% of the studied claims and 35.29% of the cases ended with permanent infirmities, also 35.29% ended with complications. Positive claims for malpractice were 23.53%, while 76.47% were negative for malpractice. The present study concluded that detailed investigation of medical malpractice claims revealed important data and offered an opportunity to physicians to benefit from previous recorded medical errors to be avoided.

A Framework for Analyzing Malpractice Cases to Improve Healthcare Systems

This study develops a framework for analyzing the judgments handed down by courts in malpractice cases. We analyzed 215 cases that included awards for damages caused by medical negligence, handled by Israeli courts from 2005 to 2011. The Pareto principle coupled with the mean square error criterion supports the selection of the vital hospital departments and the vital causes of claims. A quality function deployment matrix is used to translate the desired improvement in malpractice costs into relevant medical decisions and diagnostic tests. Based on the analysis, we can conclude that the essential part of all malpractice claims submitted to and found legitimate by the courts was related to the obstetrics field. We reveal that most claims have elements in common. When we based the analysis on the malpractice compensation, covering costs of corrective treatment, suffering, future medical treatment, and associated legal fees, based on court data, we found that the group of vital causes decreased. In this study, we analyze claims related to the obstetrics department. Other departments where errors are frequently made should be addressed in turn, with the objective of continuously improving the medical system. Copyright © 2015 John Wiley & Sons, Ltd.

Model and parameter uncertainty in critical illness insurance ‐ Abstract of the Edinburgh Discussion

AbstractCritical illness (CI) insurance involves cover that pays out on the diagnosis of an illness which is deemed to be critical. Estimation and graduation of CI insurance claim rates has been challenging, partly because of the diagnosis of the insured event often being unclear or not recorded. This introduces additional uncertainties in the evaluation of claim rates. In this work, which was funded by an Institute and Faculty of Actuaries research grant, we have addressed the issue of model and parameter uncertainty in claim rate estimation, when the date of diagnosis is missing, aiming at obtaining graduated rates that can be applied to estimate the future cash flow of CI policies and determine insurers’ liability more accurately. Better understanding of uncertainty in rate graduation and pricing is important for insurers, not least because of future changes in the interpretation of the “definition” of an illness or advances in medical practice leading to more efficient diagnosis and treatment.Estimation of claim rates was addressed in this project using a parametric Poisson model for the number of claims, which accounts for claims that have not been settled by the end of the observation. This was achieved by considering probabilities of the distribution of the delay period between diagnosis of insured illness and settlement of the corresponding claim. We have developed appropriate generalised-linear-type models (including lognormal, Burr, generalised gamma and generalised beta) to investigate this delay, using data supplied by the Continuous Mortality Investigation (1999–2005). The analysis includes various claim risk factors (e.g. gender, benefit amount, policy duration and so on) and was performed under a Bayesian framework, using Markov chain Monte Carlo estimation techniques.Based on this experience, our analysis suggests that estimates of the claim delay distribution are model sensitive, but claim rates and pricing are not. Under the best claim delay distribution fitting, the following risk factors are considered important for predictive purposes: policy duration, selling office, benefit type, benefit amount, policy type and cause of claim.

Civil liability related to imaging exams in Brazil

Aim: To analyze all court lawsuits in Brazil in relation to civil liability involving radiographic and tomographic images up to February 2014. Methods: All Brazilian courts were surveyed for “civil liability,” “error,” “radiology,” “radiography,” and “tomography,” returning 3923 second-instance lawsuits. Out of them were excluded labor legislation, health insurance coverage of radiological examinations, and criminal liability cases and 359 were selected. Compliance with expert reports, involvement of imaging exams, the defendant professional, the reasons of claims and convictions, and indemnity were evaluated. Results: Of the 359 selected lawsuits, physicians were defendants in 71%, radiologist physicians in 10.6% and dentists in 18.4%. The prevalence of physicians found liable was related to the lack or delay in requesting the imaging exams (49.6%), and among radiologist physicians, misdiagnosis (47.1%). Considering the dentists, imaging exams had mostly an indirect involvement, and failure of the proposed treatment (73.8%) was the most prevalent cause of dentists found liable; no radiologist was sued. Regarding indemnity, 50% of lawsuits resulted in compensation up to R$ 20,000 (US$ 8,583). Conclusions: Misdiagnosis was the main cause of claims and radiologists were found liable. The medical field showed the largest absolute number of claims and physicians were found liable, but the highest proportion was directed to dentists.

Causes of Road and Bridge Construction Claims: Analysis of Colorado Department of Transportation Projects

AbstractRoad and highway construction projects are plagued by unanticipated conditions and changes, which cause claims and cost overruns due to diverse causes. This study identified a set of project factors that might affect the rate of claim occurrence in different projects and used data from Colorado Department of Transportation projects to test the potential causes of claims to assess which project management attributes are most likely to lead to claims. A total of 780 projects were selected from a data set of 1,060 projects completed in a time window from 1997 to 2012. These showed 213 claims within a subset of 62 claim-contained projects. Results showed that delays are the main cause of claims in the projects studied and are more important than the effects of added items and change orders. The study also showed that projects with fixed completion date schedules are more susceptible to claims than projects with more flexible schedules. Actions indicated are for transportation project planners to adopt...

Knee arthroplasty and lawsuits: the experience in France.

Data regarding knee arthroplasty and lawsuit are scarce. With the expected increase in knee arthroplasty over the next 25 years, the number of claims might follow the same trend. Therefore, the most frequent causes of litigation after knee arthroplasty in France, and what is considered as malpractice by the expert, were determined. Over 8-year period, data gathered from a French private insurance company specializing in malpractice for private practitioners were analyzed. Demographics, type of knee arthroplasty, reason for claim, details of the legal procedure and the expert's decision were reviewed. One hundred and five claims were processed by four jurisdictions. Most of the cases concerned primary total knee arthroplasty. Surgeons and anesthesiologists were charged in 84 and 16 % of claims, respectively. The most frequent causes of litigation were infection, neurological deficit and unsatisfactory result, whereas the most common reasons for the surgeon's liability, as stated by the expert, were delay in diagnosis or treatment of a complication, infection and technical error. Our findings show that frequent complications are not those which raise most of the claims. Patients sue the surgeon when the outcome of the surgery is different from what they were expecting. An unsatisfactory result, according to the patient's point of view, is the second most frequent cause of claim. IV, Economic and Decision Analysis. See the Guidelines for Authors for a complete description of levels of evidence.

Causes of common and frequent claims in oil, gas and petrochemical projects of Iran

Over recent years, frequent involvements in claims have been inevitable due to unpredictable economic changes and increasing complexities in construction industry. Therefore, even appropriately made contracts are not exempted from claims. On the other hand, construction contract claims are time-consuming, expense-involving and most likely leading to unsatisfactory results. However, there may be some positive outcomes, such as time extension or compensation of damages. To launch investigations, a list of important and frequent claims in oil and gas industry projects of Iran was extracted after a succinct documents review. Further, the most important claim causes were identified through conducting a questionnaire survey among contractors, consultants, owners and lawyers involved in such projects. Reliability of responses has been examined, accordingly. The study reveals that the external risks like political, social, cultural and economical issues are the most important causes for claims in this industry. Moreover, inadequate financial resources on the part of owner and contractor, failure in performing contractor’s obligations and vague contract conditions resulted in formation of different interpretations; are some of the most important root causes of claims in this context.

A nine-year review of medicolegal claims in neurosurgery.

Neurosurgery remains among the highest malpractice risk specialties. This study aimed to identify areas in neurosurgery associated with litigation, attendant causes and costs. Retrospective analysis was conducted of 42 closed litigation cases treated by neurosurgeons at one hospital between March 2004 and March 2013. Data included clinical event, timing and reason for claim, operative course and legal outcome. Twenty-nine claims were defended out of court and twelve were settled out of court. One case required court attendance and was defended. Of the 42 claims, 28, 13 and 1 related to spinal (0.3% of caseload), cranial (0.1% of caseload) and peripheral nerve (0.07% of caseload) surgery respectively. The most common causes of claims were faulty surgical technique (43%), delayed diagnosis/misdiagnosis (17%), lack of information (14%) and delayed treatment (12%), with a likelihood of success of 39%, 29%, 17% and 20% respectively. The highest median payouts were for claims against faulty surgical technique (£230,000) and delayed diagnosis/misdiagnosis (£212,650). The mean delay between clinical event and claim was 664 days. Spinal surgery carries the highest litigation risk versus cranial and peripheral nerve surgery. Claims are most commonly against faulty surgical technique and delayed diagnosis/misdiagnosis, which have the highest success rates and payouts. In spinal surgery, the most common cause of claims is faulty surgical technique. In cranial surgery, the most common cause is lack of information. Claims may occur years after the clinical event, necessitating thorough contemporaneous documentation for adequate future defence. We emphasise thorough patient consultation and meticulous surgical technique to minimise litigation in neurosurgical practice.

Health and safety in the NHS

Accidents at work cost the NHS some billion pounds every year. Over half of these accidents are due to avoidable slips and falls-the most common cause of claim for compensation faced by the NHS. Under the Management of Health and Safety at Work Regulations 1999, the NHS as an employer and nurses as employees have a legal obligation to manage health and safety and to ensure that others are not put at risk by work-related activities. The first of a series, this article on health and safety law sets out the duties imposed on NHS organisations and their employees.

Causes of successful medico-legal claims following amputation

The causes of successful medico-legal claims following amputation were reviewed. A retrospective analysis of claims handled by the National Health Service Litigation Authority, from 2005 to August 2010, was performed. Under the Freedom of Information Act, the National Health Service Litigation Authority provided limited details on closed claims, settled with damages, following a search of their database with the term "amputation." No demographic data were provided. During this period, 174 claims were settled by the National Health Service Litigation Authority, who paid out more than £36.3 million. The causes of the claims were the need for a lower limb amputation due to a delay in the diagnosis and or treatment of arterial ischaemia (56), an iatrogenic injury (15), the development of preventable pressure sores (15), the delay and or failure to diagnose a limb malignancy (6) and the delay in the management of an infected pseudo-aneurysm (1). Complications following orthopaedic surgery resulted in 25 successful claims as did the delayed diagnosis or mismanagement of 10 lower limb fractures. Additional claims followed the amputation of the wrong toe (1), a retained foreign body (2), an unnecessary amputation (4), inadequate consent (4), failure to provide thrombo-prophylaxis following amputation resulting in death (2) and a diathermy burn injury during an amputation (1). Delay in the diagnosis of and/or failure to manage an injury or infection resulted in 21 upper limb amputations. There was insufficient information provided in the remaining 11 claims to determine how the claim related to an amputation procedure. The largest single payout for damages (£1.9 million) resulted from the failure to diagnose and treat a femoral artery injury following a road traffic accident leading to an eventual below knee amputation. Delays in the diagnosis and or treatment of arterial ischaemia were the commonest reasons for a settled claim. Lessons can be learnt from potentially preventable cases that can be incorporated in medical education and training programs with the aim of reducing both amputation rates and litigation costs.

Claims of malpractice investigated by the Committee of Medical Ethics, Egyptian Medical Syndicate, Cairo

Files of medical malpractice claims represent a valuable source of information on medical errors. Therefore, a greater understanding of the claims may highlight their causes and thus help to prevent them.This study aims to revise the closed claims of malpractice investigated by The Committee of Medical Ethics in the Egyptian Medical Syndicate in the years 2008 and 2009 in order to determine the causes of claims and their characteristic distribution. MethodsThis study included 91 claims. The claims’ files were investigated for the causes, the resulting injuries, and litigation outcomes, as well as their distribution regarding locations of the claims’ events and defendant physicians’ characteristics. ResultsImproper performance of the procedure was the most frequent cause (21%), followed by unethical conduct (19%) and surgery in a non-equipped place (16%). Regarding the location of the claims’ events, urban areas were more frequent than rural areas. There were no significant differences either in the frequency or severity of injuries between claims caused by events that occurred in outpatient health care settings and those that occurred in inpatient health care settings. The private health sector was a more frequent site of claims’ events compared with the public health sector. Obstetrics/gynecology was found to be the most frequent specialty of the defendant physicians of the claims. ConclusionAlthough most of the events of the claims resulted in severe injuries, they are preventable. This indicates the great need for more effort to increase patient safety in all health care settings.