Filing a Malpractice Claim with Kaiser Permanente: Your Lawyer’s Role

While most health care patients are aware that mistakes made by doctors and other health care providers are unacceptable and worthy of compensation, many are unaware of the special system that exists for Kaiser Permanente members. In a nutshell, California patients who are insured through the managed healthcare plans of Kaiser Permanente cannot pursue medical malpractice claims through litigation.

Instead, insured members are required to seek compensation for medical errors through binding arbitration. This involves a process outside the public court system, where claims of malpractice are reviewed by an independent arbitrator. While there are critics of the system — many arguing that it favors the insurer over patients — it is part of the member agreement and has been in place for decades. In other words, use of arbitration is non-negotiable. The patient who has a legitimate malpractice claim has no other option.

While this may appear to favor the insurer over the patient, the medical malpractice attorney representing a plaintiff should be able to work within this system. Points to consider:

  • A traditional jury trial would take longer, while arbitration can usually be settled in a timeframe favoring ill patients and their families.
  • Kaiser selects the arbitrator, which suggests bias in favor of the insurer. But the track record of the arbitrator is publicly available and the plaintiff’s attorney has some choice in the selection.
  • In some cases, Kaiser covers all costs of arbitration. Otherwise, costs are split.

Because of this “wiggle room” in the process, working with an experienced California medical malpractice attorney is highly advisable. The lawyer is still an essential advocate for the patient and should be able to cite past successes in his or her case history of working with the arbitration system.

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