Quality, client-specific claims handling
Reserve setting and maintenance of loss information
Development and compliance with Litigation Management
Reporting of claims to state licensing and regulatory agencies
Reporting payments to the National Practitioners Data Bank, Boards
of Medicine, Departments of Insurance, and Medicare/Medicaid
Typically, the handling and processing of professional liability claims is handled by the
individual Gateway personnel assigned to a client, with support available from all of
Gateway's staff. This method of service is designed to provide a client with a main contact,
someone well-versed in the client's needs and wishes, making it easy for the client to receive
assistance without having to decide which Gateway team member to call for specific
Review and Investigation: When notification of a claim or potential claim is provided to
Gateway by the client, we review the claim and advise the client as to what, if any, further
steps should be taken. When investigation is required, Gateway investigates the nature of the
incident, including interviewing appropriate personnel by phone or face-to face, reviewing
records and other related documents, and other fact-finding as required. Throughout the
investigation process, there is ongoing communication between Gateway and the client.
Negotiations: If a claim is made prior to the initiation of suit, the Gateway representative
assigned to the client will be responsible for conducting negotiations in all non-litigated
matters. Any such negotiations will, of course, be in consultation with the client and will be
based on perceived liability and alleged damages. No settlements will be agreed to without
the express consent of the client.
Reserve Setting: Whenever a claim is made, Gateway will establish a preliminary reserve
based upon an initial evaluation of the negligence of the parties involved, the extent of the
injury to the claimant, the defense posture of the client, and the claim venue. A summary of
the claim and reserve information is reflected on the client's loss run maintained by
Gateway. Thereafter, reserves may be adjusted, either up or down, based upon claim
developments. Reserve changes are also reflected on the loss run.
Compliance with Litigation Management Guidelines: When suit is initiated and
reported to Gateway, the matter is assigned to the defense counsel identified by the client.
Gateway's assigned claims personnel actively participate in the management of the legal
defense of the matter, including consulting with defense counsel as to the processing of the
claim and assuring compliance with Litigation Management Guidelines developed by
Gateway for the client's program.
The Guidelines will be designed to govern the processing of claims and assure that all
participants in the process are aware of applicable standards and expectations.
Reporting to Appropriate Entities: If a state in which a claim is filed requires reporting
to a licensing or regulatory agency, Gateway does this reporting on behalf of the client.
Additionally, Gateway personnel are available to notify any applicable excess carrier should
the value or type of a claim warrant. The Gateway staff is also available to serve as a client's
liaison with the state agency or excess carrier should the need arise. Additionally, Gateway
will prepare all reports of payments on behalf of individual health care providers for
submission to the National Practitioner Databank, the appropriate State Board of Medicine,
the appropriate State Department of Insurance, and/or pursuant to Section 111 of the
Medicare, Medicaid and SCHIP Extension Act (MMSEA) of 2007.
Flexible Services: Because we find that client needs may differ, we are flexible in the
provision of our services. We will, of course, comply with all the specific requirements
established, with specific emphasis on aggressively investigating and managing events and
GATEWAY RISK SERVICES, LLC
1946 Menold Drive · Allison Park, PA 15101 · Phone (412) 318-2888 · Fax (412) 367-4990
CLAIMS ADMINISTRATION SERVICES
"OVER A CENTURY OF CLAIMS
1946 Menold Drive
Allison Park, PA 15101
Phone: (412) 318-2888
Fax: (412) 367-4990