Certified Quality Auditor (CQA) Practice Exam

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A nurse tells risk management that a patient's family is threatening to sue after an unexpected severe injury. What is the most appropriate claims-management action?

Evaluate the event as a potential compensatory event and notify the carrier or claims administrator as required by policy Offer a settlement without investigation Wait until a lawsuit is formally filed before documenting anything Tell staff to delete related emails

Correct Answer:

Evaluate the event as a potential compensatory event and notify the carrier or claims administrator as required by policy

Explanation:

A credible threat of a claim after significant harm should be evaluated promptly as a potential compensatory event. Timely notice to the insurer or claims administrator may be required by policy and supports early investigation.

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