Kaiser Medical Malpractice Representation: Holding HMOs Accountable

Health Maintenance Organizations (HMOs) are designed to help control medical costs. In Southern California, Kaiser is the largest HMO, with almost one quarter of all patients who have some form of health insurance belonging to the plan. Kaiser consists of a system of hospitals, clinics and doctors which provide services exclusively to Kaiser members. When a Kaiser member is injured at a Kaiser facility or through the negligence of a Kaiser professional, he or she does have the right to pursue a claim for malpractice against Kaiser. However, special rules and procedures apply to such a claim, which is handled in a different manner than one against other medical providers.

If you or a loved one is a Kaiser member and was injured because of negligence on the part of a Kaiser professional, it is important to work with an attorney who has experience handling claims against Kaiser. We help the injured throughout San Diego County, including La Mesa, Otay Mesa, San Marcos, La Jolla, and Encinitas.

Kaiser Malpractice Arbitrations

Kaiser is comprised of three separate entities: the Kaiser Foundation Health Plan, the Kaiser Foundation Hospitals, Inc., and the Permanente Medical Group. Kaiser is different from most insurance plans in that it collects premiums and pays for medical services, but maintains an exclusive contract with the Kaiser Hospitals for hospital care and the Permanente Medical Group for physician care. Although Kaiser entities are nonprofit corporations, the physician members share in the profit at the end of the year.

In exchange for receiving medical services by Kaiser physicians and at Kaiser facilities, members are required to sign a form giving up their right to sue for malpractice. Instead, members agree that all such claims will be submitted to arbitration. In some instances, a single arbitrator will decide the case. In others, an arbitration panel will render a decision. Generally, there is no right to court or appellate review.

If you would like to learn more about malpractice claims against Kaiser, contact us online or for a free consultation call 619-894-7357. We can help you understand more about your rights as a Kaiser member.