‘More than 17000 malpractice suits are filed each year in the United States.
‘U.S doctors expected to be sued once every seven years for medical malpractices’ according to Medical Scribe Journal’
The reports also reveal that 50% of trials come up with strong pieces of evidence, while 70% are borderline cases. The average malpractice payment was $348,065 in 2018 as compared to $30000 in 2017. Considering these facts, medical malpractice coverage for doctors becomes necessary to protect themselves from such suits.
What is medical malpractice?
Medical malpractice is when a health care personnel willfully or unwillingly neglects in providing appropriate treatment to a patient or gives a substandard treatment or omits to take an appropriate action leading to harm, injury, or even death.
The scope of medical malpractice involves medical error which could be in medication dosage, diagnosis, treatment, health management, or aftercare.
What is medical malpractice insurance?
Medical malpractice insurance is meant for the medical practitioners to give financial coverage against the financial losses arising while discharging their professional duties. These policies are meant to provide coverage against the patient’s claim of negligence.
Here is the scope of such Medical Malpractices Insurance policies and their inclusions:
Claims-made
There are claims-made forms that cover the most medical malpractices. Any claim brought against the insured physician during the policy period is settled with a claims-made policy.
However, once the policy expires, the medical professionals need to buy tail coverage to get them insured against such claims.
There is a retroactive date attached to many insurance policies as well. If the act of medical negligence arises after the retroactive date, you get covered! However, the acts committed before the date debarks you from any such insurance coverage.
What are occurrence policy claims?
Certain medical malpractices are insured under occurrence policies. These claims are valid irrespective of the date of the act of medical malpractice and when the claims are filed. Even if the policy is expired, the claims are covered if they resulted from the acts when the policy was in force.
What are the sources of coverage?
CNA and AIG are the standard insurers while MedPro and NORCAL are the specialty insurers. Applied Medico-Legal Solutions (AMS) and The Doctors Company are some of the member physicians owned groups that provide medical malpractice insurance as well.
It is advised to check the financial rating of the insurer before buying the insurance policy.
What is the scope of Medical Insurance – Inclusions?
The National Institute of Health has provided detailed information on what could be covered under Medical Insurance claims. Here is the brief overview:
Insuring Agreement
Like any other insurance contract, Medical Malpractice Insurance includes an insuring agreement to describe all the provided coverage in broad terms.
Insuring Agreement
The malpractices policies are inclusive of ensuring agreement which describes the coverage of the broad term. The coverage of the policy is narrowed down by including definitions.
The medical malpractice insurance policy covers the damage which the insured is obligated legally to pay at the occurrence of a medical incident for which claim is made within the policy period. In order to define the policy Definition Sections, terms like ‘professional incidents’ and ‘medical incidents’ are included in the policy coverage agreement.
This could be explained precisely by an example as follows:
A physician is insured under a liability policy covering the damages from any ‘professional incident’. The term ‘Professional incident’ is described as any act, omission, or error committed by the Physician leading to the harm, injury, or death of the patient.
However, if the term denotes that the error, act, or omission committed by the Physician is limited to dental service, the policy defeats the purpose and is ill-suited. This policy is designed for the dentist and not for physicians.
Hence, it is significant to understand the meaning of the terms used in insurance to determine the scope of the policy’s coverage.
Vicarious Liability
There are some medical malpractice policies that give you cover against the acts of other people. In the event of hiring medical practitioners as independent contractors, this type of insurance is highly recommended. You, as an employer, shall be held liable for any medical malpractice conducted by these contractors.
What are the aspects to be looked at in any Medical Malpractice Insurance Policy?
Before finalizing any medical malpractice insurance as a healthcare professional, here are certain aspects you need to look in:
Exclusions
Every policy contains some exclusions. Here are some of them which you should look in:
- Sexual misconduct
- Illegal, dishonest, criminal, or fraudulent acts
- Claims arising from any business you manage or own which is not included in the policy
- Acts committed in the influence of alcohol or drugs
- Any claim arising from unauthorized disclosure of the concerned patients’ record
- Claims arising out of specific procedures such as general anesthesia administration
- Injuries arising due to loading or unloading of patients
Defense and Settlement
All malpractice policies are deemed to cover the cost associated incurred in your defense. The attorney assigned by the insurer is also covered in the cost. But, if you hire a lawyer, it is not covered under the policy. Depending on the cost, the cost of defense varies.
There are certain malpractice medical insurance policies that are settled as deemed fit by the insurer irrespective of your agreement with the settlement. There are also a few which state that the claim will not be settled without your consent. Often there are certain restrictions in claim-to-consent policies
There is also a clause that is often included in claim-to-consent policies which state that in case of refusal of the settlement agreed by the plaintiff, you are eligible to claim no more than the proposed settlement amount plus the defense cost incurred till the date of consent.
Extended Reporting Period (Tail)
In claim-made policies, you cannot claim once the policy is expired. If the policy is replaced by an occurrence policy, non-renewed or canceled, you can be in big trouble. An extended reporting period is meant to provide coverage for such claims.
Also known as tail coverage or ERP, it provides you extra time for reporting such claims resulting due to the acts committed before the policy expiry. The typical period is between one to five years. However, there are some insurers who offer unlimited tail coverage.
Limits
There are generally two limits assigned to medical malpractice policies – Individual limit and an aggregate (annual) limit.
Depending on the type of policy, an individual limit applies to every event or claim. Consider your location and specialty before choosing the type of limit. Say, some branches of medicine like obstetrics have more malpractice claims as compared to others. Similarly, some states are more litigious than others.
