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Insurance companies have the best data on claims, but the data are not as complete or comprehensive as might be expected. Companies have extensive records on the amounts paid in individual cases, but they may not collect detailed information about the medical care leading to the claim. This information is not cost-effective to collect and analyze. Understanding claims is valuable only if it is used for individual underwriting decisions or claims prevention. Since most medical malpractice insurance is not experience rated, physicians with increased claims do not pay higher rates, obviating the need for individual underwriting decisions. Using claims data for prevention is controversial because it requires insurance companies to set standards for medical practice. Some companies have done this in limited situations, but most shy away from setting standards that might be used by plaintiff's attorneys suing their insureds. (See Chapter 6.)

Insurance company data are hard to compile because most states have several insurers at any given time, and these companies enter and leave the market over time. The most common technique is to study the claims closed during one or more years (GAO I-VII). These closed claim studies are valuable if every closed claim is available for study; unfortunately, many studies have been done on poorly defined subsets of closed claims. Even if the complete set of claims is available, most claims take several years to close. (A claim closed in 1986, for example, may have resulted from medical care rendered in 1980.) This makes closed claim studies insensitive to trends and changes in medical malpractice claims.

Like all other retrospective studies, closed claim studies are limited because important data are often missing from the files. Ideally, claims studies would be conducted on all claims--not just those that are closed--but few companies allow researchers to analyze open claims. This is partly out of concern with the loss of proprietary information that might influence the resolution of open claims. It also stems from the desire to prevent state regulatory commissions from obtaining complete information about the companies' real financial exposure.

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