MedMalMonthly: Malpractice Insurance Basics
Thu, 11/15/2018 - 7:00am
- Policy - Insurance is purchased through this contractual agreement.
- Premium - Policy is purchased in exchange for this payment, a premium.
- Malpractice insurance provides reimbursement to the third party (injured person or family) called indemnity; most policies provide coverage to the doctor for cost incurred in defending a claim (first party coverage).
- Liability limit (example 1 mil/3 mil) means you are covered up to 1 million per event and up to 3 million per policy period.
Types of Policies:
- Occurrence Policy - The insurance company is responsible for covering a claim if that event that gave rise to that claim takes place during the term of the policy (even if you are no longer currently under that policy).
- Claims-Made Policy - The date on which the event took place that gave rise to the claim does not matter; only the date on which the claim is made matters.
- Tail coverage - Converts a claims made policy to an occurrence policy.
When Will My Insurance Carrier Not Cover Me?
- Emergency Physician policies are site specific and patient specific - ED doctors are covered for care in the emergency room; check with your insurance company before you provide care to a non-emergency room patient like if you volunteer at an event or a camp.
- Good Samartian is an exception to the above! There are 3 criteria to meet this:
- You do not bill for services.
- No pre-arranged doctor-patient relationship.
- Services provided in a situation for which you were chanced upon.
- No Chart = No Coverage
- Altering a medical record negates the credibility of your chart and my void your insurance coverage (and you may find yourself in trouble with the medical board).
- Beware of medical care, medical advice and writing prescriptions to friends and family as you often do not have a chart if something goes wrong.
- Not following your state laws:
- Know your mandatory reporting laws as you have an obligation to the known and predictable third party (child abuse, infectious disease, Tarasoff, etc.)
- Intentional Torts/ Criminal Charges:
- Willful or gross negligence
- Assault, especially sexual assault - always remember your chaperones
- Battery - remember informed consent for procedures
- Concealment of physician impairment
- Insurance fraud
- Illegal use of controlled substances
What happens if the verdict is greater than my policy limit?
- Common misconception that a doctor can lose house and life savings in a runaway jury verdict when in fact it is rare for a physician to pay out of pocket even when a verdict exceeds the policy limit; almost all cases settle without the doctor having to pay anything.
- For emergency medicine, most payments are less than $500,000.
- It is rare for a plaintiff to pursue a physician for excess damages and the plaintiff's will typically target the limits of all defendants named in the suit and will often go for the deep pockets (hospital).
- Data is sparse, however, as legal system publishes information about filed cases and judgements rendered but doesn't publish data about collection of these judgements.