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| Section | Weight | Objectives |
|---|---|---|
| Clinical/Patient Safety | 25% | - Error prevention and disclosure protocols - Risk assessment and mitigation in patient care - Patient safety culture and reporting systems |
| Legal and Regulatory | 20% | - Patient rights and informed consent - Accreditation standards and compliance - Federal and state healthcare laws and regulations - Privacy and security requirements |
| Health Care Operations | 20% | - Workforce and facility safety - Organizational risk policies and procedures - Technology and information management risks - Operational risk identification and control |
| Claims and Litigations | 20% | - Litigation process and defense strategies - Claims management and investigation - Settlement and resolution processes - Documentation and evidence management |
| Risk Financing | 15% | - Insurance structures and coverage types - Reserve analysis and actuarial concepts - Alternative risk transfer mechanisms - Total cost of risk analysis |
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NEW QUESTION # 82
An organization has recently changed insurance. The risk manager receives a claim from a former patient on July 3, 2004, claiming injury and alleging negligence by the surgery staff on September 5, 2003. Which of the following would apply to this claim?
* a claims-made policy for the period 1/1/03 to 1/1/04 with a retro date of 1/1/02
* an occurrence policy for the period 1/1/03 to 1/1/04
* a claims-made policy for the period 1/1/03 to 1/1/04 with a 1-year tail coverage
* an occurrence policy for the period 1/1/04 to 1/1/05
Answer: C
Explanation:
According to Health Care Risk Management standards supported by ASHRM and the American Hospital Association Certification Center, coverage determination depends on both the policy trigger and relevant dates. The alleged negligence occurred on September 5, 2003. Under an occurrence policy in effect from 1/1
/03 to 1/1/04, coverage applies because the event occurred during that policy period, regardless of when the claim was filed. Therefore, option 2 applies.
For a claims-made policy covering 1/1/03 to 1/1/04, coverage would require that the claim be made and reported during the policy period unless tail coverage is in place. Because the claim was received on July 3,
2004, after expiration of the 1/1/03 to 1/1/04 claims-made policy, coverage would apply only if a 1-year tail was purchased. Thus, option 3 applies.
Option 1 would not apply because the claim was made after the claims-made policy period ended, and no tail is specified. Option 4 would not apply because occurrence coverage from 1/1/04 to 1/1/05 would not cover an event that occurred in 2003.
Risk financing objectives emphasize understanding policy triggers, reporting requirements, and tail coverage.
Therefore, the applicable coverage scenarios are the occurrence policy for 2003 and the claims-made policy with tail coverage.
NEW QUESTION # 83
When CPOE is implemented, there is almost always a decline in:
Answer: A
Explanation:
Computerized Provider Order Entry (CPOE) reduces medication errors primarily by eliminating illegible handwriting, standardizing order fields, and enabling decision support (allergy checks, dosing ranges, interactions). Evidence indicates CPOE can significantly reduce prescribing errors and improve patient safety, though it can also introduce new error types (selection errors, alert fatigue), requiring careful design and monitoring. From a risk management perspective, CPOE is a high-impact control that strengthens medication safety defenses at the "front end" of the medication-use process. Risk objectives include governance for order sets, usability testing, monitoring override patterns, and continuous training to prevent workarounds. Properly implemented, CPOE supports safer, more reliable care and reduces preventable adverse drug events, aligning with enterprise safety goals and regulatory expectations for medication management.
NEW QUESTION # 84
A hospital is a defendant in a recently filed lawsuit involving a child with seizures and flaccid paresis, allegedly arising from negligent care during delivery 10 years ago. The plaintiff is seeking $10 million. At the time of the alleged negligence, the hospital had first dollar coverage through a commercial carrier.
Which of the following steps should the risk manager take to determine coverage before discussion with the hospital CEO and CFO?
* Review the current policy and the policy in effect for the year the delivery occurred.
* Determine whether the applicable policy is occurrence or claims made.
* Identify co-defendants insurance coverage.
* Discuss the coverage issues with the defense lawyer.
Answer: B
Explanation:
According to Health Care Risk Management standards supported by ASHRM and the American Hospital Association Certification Center, determining coverage requires careful review of the applicable insurance policies and policy structure. Because the alleged negligence occurred 10 years earlier, the risk manager must first review both the current policy and the policy in effect at the time of the delivery. Coverage depends on the specific policy terms, limits, endorsements, and retroactive dates applicable during the relevant policy period.
It is also critical to determine whether the policy is written on an occurrence or claims-made basis. Under an occurrence policy, coverage is triggered by the date of the incident, regardless of when the claim is filed.
Under a claims-made policy, coverage depends on when the claim was reported and whether appropriate tail or extended reporting coverage exists.
Identifying co-defendants' coverage may be relevant to contribution or indemnification but does not determine the hospital's own coverage. Discussion with defense counsel may assist in strategy but should follow preliminary internal coverage analysis.
Risk financing objectives emphasize accurate policy review and understanding of trigger mechanisms before executive discussions. Therefore, reviewing the relevant policies and determining policy type are essential first steps.
NEW QUESTION # 85
An indemnification clause in a contract is designed to
Answer: A
Explanation:
According to Health Care Risk Management standards supported by ASHRM and the American Hospital Association Certification Center, an indemnification clause is a contractual provision in which one party agrees to compensate or reimburse another party for specified losses, damages, liabilities, or claims arising out of defined circumstances. The purpose is to allocate risk between contracting parties and clarify financial responsibility if harm occurs.
Indemnification provisions often address responsibility for defense costs, settlements, judgments, and related expenses resulting from negligence, breach of contract, or other agreed-upon risks. The clause may include duty to defend language, limits on liability, or conditions triggering indemnification. Properly drafted indemnification language helps manage exposure and supports risk transfer strategies within contractual relationships.
Creating a forum for dispute resolution is addressed by arbitration or venue clauses, not indemnification.
Holding a party responsible for fulfilling contract terms relates to performance obligations, not indemnity.
Deferring all legal costs automatically is inaccurate, as indemnification depends on specific triggering conditions and negotiated language.
Legal and regulatory objectives emphasize careful contract review and risk allocation. Therefore, an indemnification clause clarifies commitments to compensate the other party for harm, liability, or loss.
NEW QUESTION # 86
An interrogatory requests insurance policy information. A risk manager should
Answer: C
Explanation:
According to Health Care Risk Management standards supported by ASHRM and the American Hospital Association Certification Center, insurance policy information is generally discoverable in litigation. Most jurisdictions require disclosure of applicable liability coverage, including policy limits, pursuant to civil procedure rules governing discovery. Therefore, when an interrogatory properly requests insurance policy information, the organization should provide the specifically requested information in coordination with defense counsel.
Providing more information than requested, such as automatically including excess limits if not asked, may exceed the scope of the interrogatory and should be guided by legal counsel. A certificate of insurance is not a substitute for responding to formal discovery requests, as it may not contain all required details regarding coverage, limits, and applicable policy periods.
Objecting to the interrogatory without valid legal grounds is generally inappropriate, as insurance coverage information is typically relevant to potential satisfaction of judgment.
Claims and litigation objectives emphasize cooperation with counsel, compliance with discovery rules, and accurate disclosure of coverage information. Therefore, the appropriate response is to provide the specifically requested insurance policy information in accordance with legal guidance.
NEW QUESTION # 87
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