Report a Medical Malpractice Claim/Suit

Please use this form to report any medical malpractice claims or suits.

It is important that you notify us of any lawsuits as soon as possible to ensure we meet the deadline to file an appearance on your behalf.

* = required field

NOTE: This claim reporting portal is to be used ONLY by the insured person/physician and/or their representative to report a third-party claim/lawsuit (or potential claim) to the insurance company covering the insured person/physician. *

I attest that I am the insured person/physician or a representative of the insured person/physician.

Date *

Does this lawsuit, claim or potential claim pertain to a former ECHN entity or physician? *

If YES, which former ECHN entity does this claim pertain to?

Contact Name *

Contact Phone *

Contact Email *

Matter Type *

Incident Date *

Insured Group Name (if applicable)

Insured Provider Name(s) (if applicable)

Name of Patient (if known)

Patient Medical Record Number (if known)

Patient Date of Birth (if known)

Description of Incident *

Upload Optional Documents (i.e., letter of representation, photographs, medical records, incident report, etc.)

Optional Document

reCAPTCHA *

Contact HHCISL

Coverage Questions

Sharon Daust-Deleeuw
Marsh Senior Vice President, HealthCare Practice
Sharon.L.Daust-Deleeuw@marsh.com
248-945-5328

Trent Sullivan
Senior Director, Insurance & Risk Financing
Trent.Sullivan@hhchealth.org
Office: 860-545-4841
Mobile: 860-713-8211

Medical Malpractice or Tail Insurance Quotes for Independent Physicians

Sharon Daust-Deleeuw
Marsh Senior Vice President, HealthCare Practice
Sharon.L.Daust-Deleeuw@marsh.com
248-945-5328

More Information

To Report an Incident That Could Result in a Claim or Lawsuit

Tara DeGros, DNP, BPH, RN
Clinical Risk Management
Cell: 959-799-1558
Email: Tara.DeGros@hhchealth.org

To Report a Medical Malpractice Claim or Lawsuit

Report a Medical Malpractice Claim or Lawsuit

If you have issues with the form, you may also email: NewClaimsReports-VAP@HHCHealth.org

Additional Information Regarding Medical Malpractice or Lawsuits

Kristi Gardner
Associate General Counsel
Kristi.Gardner@hhchealth.org
Office: 860-545-3319
Mobile: 860-549-3941

Hartford HealthCare Offices

100 Pearl Street, Hartford, CT 06103 • Contact Us

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