The claims handling process
NPE obtains medical opinions in a number of different ways, depending on the complexity of the case and other matters. At the preliminary assessment stage, the institution where you were treated will issue a statement concerning the treatment provided.
Many cases are considered by a consultant physician employed by NPE. This may take the form of a multi-disciplinary meeting between the physician and the claims officer, or notes forwarded by the physician to the claims officer. Before a multidisciplinary meeting (medical meeting) is held, the claims officer will have studied the case carefully, paying particular attention to the injury report form submitted by the patient, the medical records and the statement issued by the treatment provider.
Based on this information, the claims officer prepares a case summary and a set of questions. The claim officer then discusses the claim with a consultant physician within the appropriate field. If required, a claim officer with long experience of case assessment work will also take part in the discussion.
At the meeting, the claims officer will present the case. The participants will have full access to all case documents and are free to seek out other relevant information. The case is discussed as the meeting progresses. Finally, the physician will respond to the questions prepared by the claims officer, and the claims officer will record the answers in writing.
Some cases will be assessed by a number of consultant physicians with different medical backgrounds. In a number of cases, NPE will obtain an external expert opinion in addition to, or instead of, the assessment provided by the consultant physician. The review below describes this type of medical opinion.
How does NPE choose the medical expert?
The medical expert must be a specialist within the appropriate field of medicine. Over many years, NPE has worked up substantial experience and knowledge of competent medical experts who are willing to take on this type of work. Furthermore, NPE uses a number of consultant physicians who will be in a position to recommend appropriate experts.
NPE considers it important to ensure that the expert is impartial. It is a matter of course that the chosen consultant works at a hospital other than that which provided the patient’s treatment. Efforts are also made to ensure that the expert chosen has not previously worked at the hospital in question.
What is a good expert evaluation?
Based on his/her specialist medical background, the expert must provide an assessment of the medical aspects of the case. A good medical evaulation is thorough, sheds light on all key aspects of the treatment and arrives at a reasoned conclusion. It is also important that the questions put forward by NPE are in fact answered.
How long may the expert take?
NPE expects a specialist opinion to be formed within a period of 4-5 weeks. Some consultants ask for longer, and this request must be considered by the claims officer on a case-by-case basis. The factors to be considered will include the difficulty involved with finding a replacement expert, whether NPE has a positive experience of the expert’s previous work and how long an extension the expert will need.
What about experts from abroad?
NPE generally makes use of medical experts who work in Norway. This is because the expert will need to address Norwegian circumstances. This is an important point because treatment guidelines and methods, e.g. with respect to surgery and cancer treatment, may vary from country to country. Practical matters such as available technical equipment and other resource-related issues will also vary.
In special cases, if the issues at hand refer to advanced medical science and the Norwegian medical community is too confined, it may be appropriate to refer to an international expert. NPE will therefore occasionally refer to medical experts in Sweden and Denmark.