Kaiser Permanente is a managed health care organization or HMO. It offers patients care at Kaiser-owned-and-operated facilities and hospitals with membership but accepting a Kaiser Permanente membership means agreeing to its terms of service. Kaiser Permanente members sign away their rights to sue Kaiser Permanente in the event of a medical injury, and injured patients must instead use the company’s binding arbitration process.

Arbitration is a commonly used alternative to a court-based lawsuit. Like a typical lawsuit, the parties in arbitration share their evidence during discovery and conduct several settlement negotiation meetings. A neutral third party or arbitrator acts as a mediator for the case, scrutinizes the elements of a plaintiff’s claim, and awards damages appropriately.

Anyone considering membership with Kaiser Permanente should carefully weigh the risks and benefits. While Kaiser Permanente can offer a great standard of care to many patients, all members should know that their membership is contingent upon their agreement not to sue Kaiser Permanente in the event of a medical injury.

Kaiser Permanente’s Arbitration Process

The Office of the Independent Administrator handles claims for arbitration filed against Kaiser Permanente. An injured Kaiser patient must start the claims process by filing the appropriate paperwork with the administrator. The initial demand should include a description of the patient’s injury and an explanation as to why Kaiser Permanente is responsible for the injury. The demand should also include the amount of compensation the claimant expects and the claimant’s personal contact information. This demand should also include the names of all parties the claimant believes bear any responsibility for the claimant’s injury.

The administrator must respond to these claims within three days, and the response will include a randomly generated list of 12 arbitrators. The claimant must select an arbitrator from this list, or both parties can agree to an outside neutral arbitrator within 20 days. Once selected, the arbitrator must conduct a management conference within 60 days. The arbitrator will also set dates for different deadlines and meetings for the rest of the arbitration process.

If the arbitrator cannot successfully facilitate a settlement, then the arbitrator will conduct a “trial” and reach a binding resolution. This system exists with the goal of resolving any complaint against Kaiser Permanente within 18 months. While arbitration offers a speedy resolution compared to other methods, the final ruling is binding, and appealing an arbitration ruling is very difficult.

There are only a few cases in which a court would consider overturning an arbitrator’s decision. The first would be if any type of fraud played a role in the arbitrator’s decision-making. A claimant may also prove that the evidence does not support the arbitrator’s decision in any way, or that the damage award was grossly disproportionate to the level of liability in the case.

How to Handle Your Kaiser Permanente Injury Claim

Although the arbitration process is different than a typical medical malpractice lawsuit, a claim against Kaiser Permanente will still require proving that the defendant failed to meet the standard of care for your situation. Your attorney should consult with expert witnesses who can provide the arbitrator with a clear understanding of the defendant’s liability and how his or her treatment fell outside the scope of the standard of care for the patient.

If you are unsure about your legal options after sustaining an injury in a Kaiser Permanente treatment facility, an experienced West Virginia medical malpractice lawyer will be your best resource. Even though a claim against Kaiser Permanente must go through the arbitration process, having a reliable attorney review the elements of your claim can help tremendously. An attorney can inform you as to the strength of your claim, the damages you may be able to secure, and advise you as to what to expect from an arbitration process.