67% of medical indemnity claims settled for under $100,000 - 43% settled for under $10,000

Claims in excess of $500,000 constituted less than 3% of all finalised medical indemnity claims in the public and private sectors in 2005-06, according to a report released today by the Australian Institute of Health and Welfare (AIHW).

'About 67% of claims that were settled were settled for less than $100,000, and 43% were settled for less than $10,000,' said Jenny Hargreaves, Senior Executive of the AIHW's Economics and Health Services Group.

In almost 20% of finalised claims, no payment was made or costs incurred.

'The proportion of claims settled for less than $100,000 decreased from 77% to 67% between 2004-05 and 2005-06, and the proportion of claims where no payment was made increased from almost 13% to just over 19%,' Ms Hargreaves said.

Adults were the subjects of the majority of claims (62%). Babies were the subject of about 6% of new claims, while around 5% of claims related to children. For about 28% of claims, the age of the claimant was not available.

According to the report, Public and private sector medical indemnity claims in Australia 2005-06: a summary, the most common incident type or allegation leading to a new claim was 'procedure' (33.9%), followed by 'diagnosis' (21.4%) and 'treatment' (11.2%).

Examples of 'procedure' allegations could include failure to perform a procedure; having the wrong procedure performed; having a procedure performed on the wrong part of the body; post-operative complications; and failure of a procedure.

Diagnosis incidents could include failure to diagnose or misdiagnosis.

Treatment issues could include delayed treatment, failure to provide treatment, and complications arising from treatment.

'Claims citing movement-related functions and structures (neuromusculo-skeletal), such as loss of function resulting from inappropriate casting of a joint, or restricted blood flow causing nerve damage, were the most commonly recorded new claims (18%),' Ms Hargreaves said.

The next most common category for new claims (16%) was functions and/or structures of the digestive, metabolic and endocrine systems (injury to gall bladder, bowel or pancreas) followed by injury to the reproductive organs, kidneys or bladder (10.5%).

This is the second AIHW report to combine Australian public and private sector medical indemnity claims data. AIHW will continue to work with stakeholders to improve the usefulness of this reporting.


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