The Lifecycle of a Claim: What you need to do (Clinical Indemnity Scheme)

In the State Claims Agency, we are often asked by employees working in our State authorities in the health and social care sector, who are involved in managing their organisation’s claims, about their role in the claims resolution process.

During a claim, your health and social care service remains the legal defendant in the claim and the State Claims Agency will be solely responsible for resolving the claim on your behalf, from initiation to resolution. We also provide risk management advice around learning from pertinent individual claims, and on a national basis, to help mitigate risk and enhance patient safety.

Key stages of the claims lifecycle

Under section 11 of the NTMA (Amendment) Act 2000, as amended, State authorities must furnish all necessary and requested information and documentation to the State Claims Agency in a timely manner, and permit and assist us to investigate incidents on their behalf.

In general, the Clinical Indemnity Scheme claims lifecycle flows as follows:

Claim Notification
Claim Investigation
Claim Liability Determination
Claim Resolution Approach
Claim Outcome
Claim Learning

At each stage of the lifecycle, both the State Claims Agency and the health and social care service have an important role to play.

Your role/involvement will include, but not be limited to, locating and providing medical records records, relevant guidelines or other internal documents, arranging meetings, making witnesses available for interview, providing of any witness statements or copies of any internal/external investigations that may have been carried out in relation to the incident/claim, and examining opportunities to learn from certain claims.

Visual overview

We have developed a visual overview of the lifecycle of a claim which sets out the key tasks of health and social care services at each stage of the process. We hope you find this quick reference guide useful as we continue to work together to resolve claims.

Clinical Indemnity Scheme - Lifecycle of a Claim

Clinical Indemnity Scheme: The Lifecycle of a Claim - What you need to do Download 0.59 MB

Further resources

For further information on the claims resolution process, you will find a range of Frequently Asked Questions here, and for the risk management process, you will find our Frequently Asked Questions here. These are reviewed and updated on an ongoing basis.

You can also keep up-to-date with the latest claims and risk learning articles, publications and events in our State Authority Learning and Events Hub.