Understanding the Indiana Medical Malpractice Act

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Medical malpractice laws can vary widely from state to state, particularly as it relates to statutes of limitations, the legal process, liability, and damages.  Luckily for our Hoosier healthcare providers, Indiana is one of the best states to practice medicine in.

The Indiana Malpractice Cap on Damages

In 1975, Indiana was the first state in the nation to implement malpractice reform via the Medical Malpractice Act (MMA), a seminal feature of which is the Patient’s Compensation Fund (PCF).  The MMA offers protection to both patients and healthcare providers and has helped improve malpractice insurance rates, quality of coverage, and patient access to care.

The MMA governs malpractice claims against “qualified providers” in the state of Indiana. To become “qualified”, a health care provider must file a proof of financial responsibility and pay a surcharge assessed by the Indiana Department of Insurance that goes to the Indiana Patient’s Compensation Fund. The PCF is a state-sponsored excess insurance program that helps pay claims to benefit injured patients in the state.

One of the most important aspects of the MMA is the cap, or limit, on the amount of damages that can be recovered in a medical malpractice lawsuit.  The cap has been raised twice since 1975 and, pursuant to legislation passed in 2016, will see two increases by July 1, 2019.  As of July 1, 2019, providers will need to carry a $500,000 primary limit and the PCF will provide an excess limit of $1,300,000. The Indiana malpractice cap will be set at $1,800,000. As long as a provider carries the necessary limits, he/she will not have any personal exposure. Example: If a malpractice claim in Indiana pays out $1,000,000, the provider’s underlying insurance will pay the first $500,000 and the PCF will pay the remaining $500,000.

The Indiana Medical Review Panel

Under the MMA, all malpractice claims against a qualified provider must be reviewed by a medical review panel before proceeding to court (unless they are valued at $15,000 or less). The purpose of the panel is to review the details of the case and render an opinion as to the merits of the complaint. This process mitigates frivolous claims or quick payouts and allows only those with actual merit to proceed to court.

The parties work with the medical review panel chairman (who is an independent lawyer) to select the members of the panel, which typically consist of 3 doctors of same or similar specialty to the provider involved. Occasionally, nurses or mid-level providers will serve on the panel, but only if the case is relevant to their specialty. The panel members review the details of the complaint and within 180 days, must render an opinion on the complaint - Malpractice, No Malpractice, or Material Issue of Fact (not enough information to render a decision).

If a plaintiff chooses to move forward with filing a medical malpractice lawsuit, the panel's report is admissible in court, but it won't be considered conclusive when it comes to the health care provider's liability or the nature and extent of the patient's injuries. Expert witnesses are key to both the defense and plaintiff sides, as they seek to show whether or not the standard of care was met in the case. Panel members can be called to testify at court and can serve as expert witnesses for either side of the case.

If you practice in the state of Indiana, it is extremely advantageous to become a qualified healthcare provider so that you can enjoy the protection (and benefits) of the MMA. Talk to a knowledgeable malpractice insurance agent to make sure that you’re qualified today.  

Malpractice Insurance Considerations for Locum Tenens Providers

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Locum tenens is a Latin phrase that means “to hold a place”. A locum tenens physician is a “placeholder” or one who temporarily works in place of the regular physician when they are absent. Locum tenens physicians play an important role in healthcare because they allow for continuity of patient care when a practice is short-staffed or when a physician is gone for vacation, illness, sabbatical, training, etc.

Locum tenens can be a valuable experience for physicians all throughout their career. A new grad can try out different types of practices in different locations to see what they like before committing to a full-time position. Some physicians enjoy the opportunity to fill-in for a friend from medical school/residency or help a colleague who trusts them with their patients. Physicians who experience a sudden job loss or who may be looking to bridge the gap can work as locums to make some extra money. Physicians who are later in their career can use locum tenens to begin scaling back their practice or work locums after retiring to continue practicing on a limited basis.

Before you jump into your first assignment, however, be sure to consider the medical malpractice insurance implications of being a locum tenens physician.

Working for a Locum Tenens Placement Agency

If you are working through a locum tenens placement organization, that company will likely provide your medical malpractice insurance. Be sure to ask about the coverage that is being provided for you (what company, what limits, what policy type, etc.). If they are providing you with Claims-Made coverage, ask about tail insurance so that you’re clear on who will be responsible for purchasing it after you leave. If it’s not already spelled out in your employment contract, make sure you get it in writing so there is no confusion when the time comes. It’s also wise to keep a copy of your certificate of insurance or policy declaration page for each year that you work for the locums agency, so that you have record of the insurance that was provided for you during that time. You will need this information for future malpractice applications, credentialing forms, or in the event that you need to report a claim.

Filling in for a Friend/Colleague

If you’re not working for a locums agency, you can still work as a locum tenens physician on your own. The most common situation is filling in for a friend or colleague while they’re gone. Often, a physician’s medical malpractice insurance policy affords them a set number of free locum coverage days per year. This means that a locums physician can be endorsed onto their policy at no charge, and that locums provider would be covered in the event that a claim occurred resulting from services rendered while they were working for the insured physician. Most insurance companies will require underwriting approval before they allow a locums physician to be endorsed onto the policy.

If it’s not possible for the locums physician to be covered under the insured physician’s policy (due to state requirements, availability, or other issues), they can request their own individual coverage. Often insurance carriers are willing to write short-term policies for only the period of time in which the locums physician will be filling in, as opposed to the typical annual policy.

The Hidden Risks with Tail Insurance

As mentioned above, it’s important for locums physicians to learn about their tail requirements as part of their contract negotiation with a locums agency; however, there are other (often hidden) risks for locums physicians to be aware of. Before you fill in for your friend or colleague, be sure to check the tail requirements if the insured physician carries a Claims-Made medical malpractice insurance policy. As long as the primary physician keeps continuous coverage, there will be no issue with coverage for the locums provider. But if he/she cancels coverage, fails to pay, or drops coverage for any other reason and then fails to purchase a tail policy or secure ongoing coverage, there may not be coverage for the locums physician. Be sure to discuss this risk with the physician that you will be filling in for and get a statement in writing, if necessary, to make sure you will be protected.

Another hidden tail insurance risk for locums physicians affects those providers who have retired and then want to go back to work at a later time. As discussed in a previous blog post, many carriers offer free tail insurance for providers who are fully retiring from the practice of medicine. If a provider retires, earns their free tail, and then wants to go back to work (as a locum tenens physician or otherwise), the previously offered free tail can potentially be voided. Providers with Occurrence coverage will not have this issue, but those on Claims-Made policies should ask their insurance agent or carrier before jumping back into practice after retiring.

Locum tenens work can be a fun, fulfilling way to earn some additional income, travel, and gain more experience and knowledge, but before you jump in, make sure you’re asking the right questions. Talk to a knowledgeable malpractice insurance agent to make sure you’re prepared and protected as you venture into the world of locum tenens.

Malpractice Insurance Tips for Moonlighting Physicians

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Moonlighting occurs when an individual holds a second job outside of normal working hours. While moonlighting is not unique to the medical profession, it is common among residents and new physicians as a practical way to make additional income and continue honing their skills. Moonlighting is also becoming more common among career physicians; particularly those who work for hospitals or large health systems/medical groups. Many physicians see moonlighting as an opportunity to start a side business or begin diversifying their work to provide options for the future.

There are several key issues to consider from a malpractice perspective. Here are 4 tips for you to think about before you proceed with a moonlighting opportunity:

1.       Check your malpractice insurance policy to see how you’re covered

Most employed physicians’ malpractice policies are not written on a broad form; they are limited scope & duty policies. This means that your policy only covers you for claims related to the work that you do for that employer. If the incident that led to a complaint falls outside the scope of your job description or falls within a policy exclusion, you may not have coverage.

If you provide professional medical services outside the scope of your employment, even if it’s as a volunteer or a favor to your neighbor, you need to have a separate policy in order to be covered. Good Samaritan laws protect you only in emergency situations. Many carriers offer moonlighting policies or part-time malpractice insurance policies at discounted rates, so obtaining additional coverage is generally affordable.  

2.       Review your employment contract & talk to you administrator

Since moonlighting jobs are in addition to your primary work, you will need to obtain approval from your group/employer before you begin. Take the time to review your employment contract to see if there are any conditions that could affect outside work activity. For example, make sure that you can retain all compensation for your moonlighting. Some contracts state that any remuneration the employee receives from physician offices, facilities or organizations belongs to the employer. Talk to your practice administrator to see what your options are and consider all potential restrictions before taking the time to look for a job.  

3.       Compare costs + coverage and choose the best malpractice policy for you

As mentioned above, most employed physicians’ malpractice policies are limited to coverage for work done for that employer specifically. For this reason, most moonlighting physicians need to secure a second malpractice insurance policy. It's usually very simple and inexpensive to obtain a moonlighting policy to cover you for work that you do outside of your full-time job. While most insurance policies run for a full year, ask about short-term policy options (which are ideal for assignments that only last a few weeks or months) and part-time policy options. Also consider which policy type is best suited for you – Claims-Made or Occurrence. Remember that Claims-Made coverage requires a tail upon cancellation, so do the math to determine the most cost-effective solution for you.

4.       Keep good records

Record-keeping is never a fun task, but it's an important one - especially for moonlighting physicians. Keep record of your outside work activities, including where you worked, what dates you worked, and what malpractice insurance you carried. Ideally, you’ll want to keep a copy of your Certificate of Insurance (or a declaration page) for every malpractice insurance policy you have. While it might seem like a nuisance in the moment, you'll be glad that you kept good records when you need to recall your history for credentialing or report a claim down the road.

If moonlighting is something that you’re considering, be sure to talk to a knowledgeable malpractice insurance agent to help you compare coverage options and find the right fit for your unique situation.

Understanding Malpractice Policy Limits

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Medical malpractice policy limits describe how much money an insurance company will pay on your behalf in the event of a claim. The policy limit consists of 2 numbers, a "per claim" limit and an "annual aggregate" limit. If a provider had a malpractice insurance policy with $1,000,000/$3,000,000 limits, he/she would have a $1,000,000 limit per claim and a $3,000,000 aggregate limit for the year. So how, exactly would that work?

Example #1:

A surgeon has 3 claims in a year, each paying $500,000. Is he covered?

Yes, all 3 claims would be paid. $500,000 is below the $1,000,000 per claim limit and the total for the year ($500,000 x 3 = $1,500,000) is also below the $3,000,000 aggregate.

Example #2:

A surgeon has 2 claims in a year, the first pays out $1.2M and the second pays out $500,000. Is he covered?

Partially. $1.2M is $200,000 higher than the $1,000,000 per claim limit, so the provider will be personally responsible for any amount above the $1M limit. The second claim would be covered, since $500,000 is below the $1,000,000 per claim limit. The sum of both claims falls within the $3,000,000 aggregate limit for the year.

What malpractice limits should I carry?

Depending on your risk tolerance, there are a wide variety of limits of liability available; however, some states have minimum requirements that must be carried. In addition to state requirements, oftentimes hospitals and 3rd party credentialing organizations will require a minimum amount of coverage in order to have privileges.

So how do you choose what limits are right for you? Start by talking to your group/employer to find out what limits your colleagues are carrying. It’s generally recommended that all providers in a group carry the same (or similar) limits. Some malpractice insurance carriers will require the corporation to carry limits that match the highest individual limit within the group, so if everyone carries $1M/$3M limits, but one person carries $2M/$4M, the corporation will have to carry $2M/$4M, as well.

Another consideration for determining proper malpractice policy limits is your geographic area, specialty, and scope of practice. Metropolitan areas are generally more litigious and often have higher claim frequency and severity, so be mindful of that when choosing your limits. Also consider your specialty and any unique attributes within your practice. Are you doing a large number of surgical procedures? More than the average surgeon? Are you doing a lot of mammography reads?  More than the average radiologist?  These types of questions are helpful when discussing options for malpractice policy limits with your insurance agent.

While it’s certainly a risk to carry limits that are too low, it could also be a risk to carry limits that are too high. It’s often speculated that doctors who carry very high malpractice limits are more of a target for plaintiff attorneys, as they’re seen as “deep pockets” with more potential money at stake. This is certainly a risk, so it’s important for providers to carry appropriate limits – not too high, and not too low.

Can I change my malpractice policy limits?

It is possible for you to change your policy limits throughout the course of your career, but be considerate of the type of insurance that you have. With Claims-Made coverage, any changes to your policy limits (higher or lower) will be retroactive; whereas Occurrence limit changes will be done on a go-forward basis (not retroactive). It’s important that you talk to a knowledgeable malpractice agent before making any adjustments to your policy limits to understand potential long-term impacts to your coverage.

Be sure to review your policy limits regularly to ensure they continue to meet state and 3rd party requirements and that they are at an appropriate level for your unique practice setting. A knowledgeable malpractice insurance agent is a valuable resource, as they help monitor market changes and can make suggestions if/when you may need to consider adjustments to your coverage along the way.

Tail Insurance FAQs

Answers to the most common questions regarding tail coverage in medical malpractice insurance

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In last week’s blog post, we discussed tail insurance very broadly. As previously mentioned, tail insurance is required upon cancellation of a Claims-Made insurance policy. Since Claims-Made coverage triggers based on when a claim is made against you, the tail policy (also known as an extended reporting period or ERP) extends the reporting period for future filed claims. Essentially, tail coverage provides protection for medical malpractice claims that are reported after your policy is cancelled.

Here are some common questions regarding tail insurance along with answers/thoughts for you to consider.

How is tail premium calculated?

Tail insurance can be a costly expense. Generally, it is 1 ½ to 2 times your annual premium. Every insurance carrier has their own “tail factors” based on their underwriting guidelines and actuarial rules, so you may see a range in tail costs by carrier. A good rule of thumb is to plan for 2x your premium, but you can ask your agent for a quote well in advance of your policy cancellation to get a better idea of what to expect.

There are, however, a few ways in which you may qualify for free tail insurance. Most carriers offer free tail for death, disability, and retirement (usually there is an age minimum). Some carriers offer free tail if you move out of state or if you have been insured with them for a consecutive number of years (Example: free tail after being insured for 10 years, 20 years, etc.). Again, each carrier has their own rules.

How long does my tail cover me?

Tail insurance can be limited or unlimited. It could be a 1-year tail (giving you only 1 additional year of coverage), 2 years, 3 years, 10 years, or an unlimited tail. Rates will be different depending on the length of coverage.  

What limit will I have? Can I increase my limit if I want more coverage?

Your tail policy will be quoted at the same limit as your Claims-Made insurance policy, unless you request otherwise. Most carriers will let you reduce your tail limit (which would save you a bit of money), but it’s generally not advisable to do so; however, most carriers will not let you increase your tail limit – even if you want more coverage. If your policy limits fluctuated during the lifetime of your Claims-Made policy, generally the carrier will only let you obtain a tail policy at the highest limit held within the last 5 years of insurance.

Can I just buy a 2-year tail to cover me until the statute of limitations runs out?

Yes, it is possible for you to buy a 2-year tail, but it may not be wise to do so. Statute of limitation laws vary by state, and although these laws set a time limit on a plaintiff’s right to file a medical malpractice lawsuit, it’s not so simple. There are 2 common exceptions to the law that allow a patient to file a malpractice case beyond the standard window of time: 1) Date of Discovery, and 2) Age of Majority / Issues involving minors.

The first exception allows the statute of limitations to be extended until the patient discovers that he/she was a victim of medical malpractice or reasonably should have discovered the malpractice. The second exception allows for an extension until a minor child reaches the age of majority. In both of these instances, a 2-year tail may not be sufficient time to protect you for any future filed claims.

Do I really need to buy tail, if I've never been sued?

Although we’ve said that tail insurance is “required”, you can make the choice not to buy it; however, your malpractice insurance carrier has a legal obligation to offer it to you. If you choose to forego tail insurance, you are essentially uninsured.

I work for a group/network. Won't they take care of my tail for me?

In an ideal scenario, you have already negotiated the terms of your tail insurance with your employer before signing any employment contract. Hopefully you’ve determined if tail insurance will be required upon your departure from the group and if so, who will be responsible for buying it. If, however, you have not worked this out with your group beforehand, you’ll need to address all of these concerns promptly. If the group will be purchasing your tail insurance for you, be sure to get a copy of the endorsement for your files. Don’t just assume that your tail insurance will be taken care of.

What happens if I just go bare?

If you are uninsured or “go bare”, you are personally responsible for any claims that are filed against you. Consider the fact that not only are you footing the bill for any potential losses, but you are also responsible for claim administration (hiring a TPA or defense attorney, paying court fees and related defense costs, etc.). For most providers, tail insurance offers peace-of-mind after a long, successful career in medicine. It would be unfortunate to take a financial or reputational hit that could have otherwise been prevented.  

Do I have to buy tail every time I switch malpractice carriers?

Usually not. Most malpractice insurance carriers offer prior acts or “nose” coverage, which allows you to carry forward your current policy retroactive date – transferring liability to the new carrier for any potential claims for services provided back to that date. In some instances, you may have to tail out to make the switch (especially if you are switching because you are changing jobs, and your former employer requires that you buy tail) but be sure to ask your agent what your options are.

Can I shop around for tail quotes?

Yes. Many carriers now offer “stand-alone tail” policies, which means they are willing to offer you a tail policy covering you for your prior acts, even if they were not the company that you were originally insured with. Talk to your agent about options for tail to make sure that you are looking at quality coverage options and not just the cheapest price. Tail insurance does not expire and cannot be cancelled by you or the insurance carrier who issues it, so it’s important that you buy from a reputable, financially stable company.

How long do I have to buy it?

Buying tail coverage is a one-time purchase and payment is usually required promptly after your policy cancels. Most tail quotes are only good for 30-60 days and once the quote expires, you cannot have it reissued. It’s important that you plan ahead for the purchase of your tail insurance and begin considering outside finance options, if necessary. If you miss out on the opportunity to buy your tail, talk to you agent about other options. It may be possible to get coverage from the secondary market, but understand that coverage will likely be limited and the price will probably be much higher (if available, at all).

Do you have other questions related to tail insurance? Need a consultation to discuss your own coverage options?

Contact us or call 1-888-512-3447

What’s the Difference Between Claims-Made and Occurrence Malpractice Coverage?

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In the world of medical malpractice insurance, there are two types of coverage available: Claims-Made and Occurrence. It is important that you have a clear understanding of the coverage differences so that you can make an informed decision on which one is right for you. Although it can be a bit complicated, the easiest way to remember the differences is this: The names describe how the coverage is triggered.

Claims-Made coverage triggers based on when the claim is made against youOccurrence coverage triggers based on when the incident actually occurred.

Occurrence Coverage

How it works: An Occurrence policy provides coverage for incidents that “occur” during the policy period, regardless of when the claim is reported to the carrier. The policy will respond to claims that are reported even after the coverage has been terminated, assuming the incident occurred during the time in which coverage was in force; therefore, there is no need for you to buy tail insurance after the policy is cancelled.

Limits: An Occurrence policy provides a separate limit for each year the policy is in force. Its limits “restore” year after year so that claims paid for incidents arising from one policy year do not deplete the limits for other years. Occurrence limits have a “stacking” effect, so 10 years of coverage under a $1M/$3M limit policy would provide you with $10M/$30M in the aggregate.

Pricing: Occurrence premiums are usually 5-10% more expensive than fully mature Claims-Made premiums. The rates are generally flat year-over-year and there is no “stepping up” in rate, as with Claims-Made coverage.

Example: An OB/GYN obtains an Occurrence policy starting on 1/1/2000 with a $1M/$3M policy limit. She renews the policy every year for 10 years at the same limit. On 1/1/2010 she cancels the coverage. On 7/1/2011, a claim is filed for a surgery that she performed on 3/1/2009. She is covered for this claim, even though it was filed after the policy was cancelled because the incident “occurred” during the time period in which she was insured on the Occurrence form. Let’s assume the claim settles for $500,000. How much coverage does she have left?

1/1/2000 – 1/1/2001 = $1M/$3M

1/1/2001 – 1/1/2002 = $1M/$3M

1/1/2002 – 1/1/2003 = $1M/$3M

1/1/2003 – 1/1/2004 = $1M/$3M

1/1/2004 – 1/1/2005 = $1M/$3M

1/1/2005 – 1/1/2006 = $1M/$3M

1/1/2006 – 1/1/2007 = $1M/$3M

1/1/2007 – 1/1/2008 = $1M/$3M

1/1/2008 – 1/1/2009 = $1M/$3M

1/1/2009 – 1/1/2010 = $1M/$2.5M (she still has a $1M per claim limit; but the aggregate has been reduced to $2.5M after the claim settlement – however, notice that none of the previous policy limits have been affected)

Benefits of Occurrence Coverage:

·       Flexibility - No need for tail insurance

·       “Stacking” policy limits

Disadvantages of Occurrence Coverage:

·       Harder to find (not as accessible as Claims-Made)

·       Higher price

·       If the insurer goes out of business, you would have to rely on the Guarantee Fund to cover you, which usually provides lower limits and less than desirable services/defense capabilities.

·       Concerns regarding whether the past policy limits are adequate (inflation)

 

Claims-Made Coverage

How it works: A Claims-Made policy provides coverage when both the alleged incident and the claim happen during the policy period. Each year that the policy is renewed, the coverage period is extended. Once the Claims-Made policy is cancelled, you’ll need to either 1) continue the coverage with a new insurance company who is willing to pick-up your priors acts exposure or 2) obtain tail coverage (also called an ERP - extended reporting period). Tail insurance covers you into the future for any claims made against you for incidents that occurred back to the start of the coverage (the retroactive date). If tail insurance is not purchased, any future filed claims will not be covered – even if the incidents happened during the initial policy period.

Limits: Claims-Made limits do not “stack” as the Occurrence limits do, but rather, they “stretch” to cover the policy period as it extends year after year. After 10 years on a Claims-Made policy with $1M/$3M limits, you will have $1M/$3M limits. However, one advantage to the Claims-Made limit is that if the current level of coverage doesn’t seem sufficient, the limit can be increased and it will be retroactive to the inception of the coverage.

Pricing: Claims-Made premiums are less expensive than Occurrence premiums. The rate starts out very low (since the chances are low that there will be an incident and claim filed within the first year), but the premium “steps up” each year for approximately 5 years. After 5 years, the Claims-Made premium is considered mature, and will remain relatively flat thereafter. Tail insurance is typically 1.5-2 times the mature rate (unless coverage is cancelled before the policy matures; in that instance, the tail rate is less).

Example: An OB/GYN obtains a Claims-Made policy starting on 1/1/2000 with a $1M/$3M policy limit. She renews the policy every year for 10 years at the same limit. On 1/1/2010 she cancels the coverage and buys tail insurance. On 7/1/2011, a claim is filed for a surgery that she performed on 3/1/2009. She is covered for this claim, because she secured tail insurance and the incident occurred during the time period in which she was insured. Let’s assume the claim settles for $500,000. How much coverage does she have left?

1/1/2000 – 1/1/2010 = $1M/$2.5M (she still has a $1M per claim limit; but the aggregate has been reduced to $2.5M after the claim settlement; there is only 1 policy limit available for the entire tail period)

Benefits of Claims-Made Coverage:

·       Lower price, especially in the first 4 years  

·       Accessible

·       Flexibility – Increased policy limits and broadening coverage endorsements are retroactive

·       Less uncertainty about insurer’s financial stability (coverage can be switched to another carrier and prior acts can usually be picked up by another company if the insurer starts to have financial difficulties)

Disadvantages of Claims-Made Coverage:

·       Tail insurance required

·       “Less” coverage than an Occurrence policy in the long-run

 

Final Thoughts

There is no right or wrong type of malpractice insurance to buy – it just depends on your unique practice situation, accessibility, and personal preference. Some carriers offer only Claims-made. Others offer both but may limit Occurrence coverage to certain medical specialties or geographic areas. If you’re not sure which policy type is right for you, ask a knowledgeable malpractice insurance agent to help you compare options and find the coverage best suited for your practice.

How Malpractice Premiums are Calculated

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Medical malpractice insurance premiums are determined by a variety of factors. Each carrier has their own unique set of underwriting guidelines that dictate how to appropriately rate a risk. Premiums are generally calculated by determining the base rate (sometimes referred to as the manual rate) and then the price is either credited or debited to account for special risk factors.

To determine the base rate, malpractice insurance carriers generally look at the following information:

Specialty – Your specialty will be one of the biggest factors in determining your malpractice premium. Underwriters will look at your training, practice experience, and the procedures that you will be performing to determine the appropriate rate.  Most specialties have additional classifications to further refine the rate, based on the type of work that you’re doing.  For example, a Family Practice doctor could be rated as “No Surgery”, “Minor Surgery”, or “Major Surgery – Including Obstetrics”, depending on the carrier’s rating structure.

Area – The geographic area where you’ll be practicing will also have an affect on your malpractice premium.  Carriers use rating territories (usually state and county driven) to price coverage based on the claim experience in that particular location.  Larger metropolitan areas tend to be priced higher than more rural areas, but each state is different.  If you practice in more than one place, the underwriter will generally look at your percent of practice in each area to determine the appropriate amount to charge.

Policy Type – Claims-Made and Occurrence policies are priced differently, so your rate will be determined based on which type you choose.  If you are quoted a Claims-Made premium, the rate will also take into consideration any prior acts (or retroactive exposure) that the carrier may be picking up from a previous policy.   

Limits – The amount of coverage that you need will also affect the cost of the policy.  Generally speaking, the higher the limits, the higher the price.

Effective Date – The start date of coverage will also have an affect on the price, since rates can fluctuate year to year.  For example, if a carrier changes their rates on 7/1/2019, any policy with an effective date of 7/1/2019 or later will be priced at that new rate.

Once the base rate has been determined, the underwriter may apply credits or debits to modify the premium to more accurately price the exposure.  Key factors such as part time/full time status, number of years in practice, claim history, affiliation with societies/associations, board certification, etc. may be taken into consideration as the underwriter refines the price. 

Large groups can also be experience rated, which allows the underwriter to price their coverage based on that group’s loss experience as compared with the actual loss experience of similar risks in that segment.  Experience rating allows the underwriter to build the premium from the bottom up and is often a more accurate price, since it is unique to that group’s claim history.

When you compare quotes from carriers, be sure to look at all of the rating criteria to make sure it’s an apples-to-apples comparison.  As you can see, there are a variety of factors that may have an impact on your rate.  And if you need help with your assessment, contact a qualified Independent Insurance Agent to walk you through the options and help you find the coverage that’s the right fit for you.     

Understanding Consent-to-Settle in your Malpractice Insurance Policy

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One of the most important features of a malpractice insurance policy is the consent provision, which gives you the authority to settle (or not settle) a claim that you are involved in.  While this may feel like it does not concern you now, it could make a huge difference if/when you are involved in a malpractice case in the future. 

Settlement is often an appealing option because it allows the insurer to close a claim for a set amount, instead of taking the case to trial, where the final verdict could be much higher (and take much longer, resulting in higher attorney fees, court costs, etc.)  But settlements aren’t always good for doctors.  They can have many negative impacts, such as:

·       Bad press

·       Outcome reported to the National Practitioner Data Bank / viewable to future employers, credentialing agencies, etc.

·       State licensure may be jeopardized

·       Malpractice premiums may go up, coverage may be non-renewed, or future coverage may be difficult to obtain (will always have to disclose settlement on future malpractice applications)

·       May be pegged as “quick to settle” and seen as an easy target going forward

With a pure consent-to-settle provision in your malpractice insurance policy, the carrier must obtain your written permission before they can settle a case on your behalf.  Without your consent, the insurance company cannot settle; rather, it must allow the complaint to go through the formal legal process.  But be wary of snags in the consent provision or other limitations that may protect the insurance company’s interests. 

A “hammer clause” states that if you refuse to consent to a settlement recommended by the insurer, the insurer’s liability for the claim will not exceed the amount for which the claim could have been settled, and any additional defense costs incurred following your refusal to settle will not be covered.  Essentially, the hammer clause gives the insurance company the ability to limit its exposure to the amount for which the claim could have been settled (plus past costs and expenses) when reasonable consent is withheld. “Reasonableness” can be questioned by the carrier, so be sure to understand how they determine this along with other concerning factors.

Other limiting factors may have to do with unique state attributes, such as Indiana’s medical review panel process.  For example, in the state of Indiana, after a claim goes through the initial panel process, if the findings of the panel are 3-0 against the healthcare provider, the carrier can deny consent-to-settle rights that would have otherwise been allowed.

Top rated malpractice carriers are winning 90% of the cases that they take to trial; furthermore, they are closing 80% of their claims with no indemnity payment at all (in other words, they build such a strong case that the opposition decides not to proceed).  Doctors should talk to their defense teams to determine the proper course of action and take a proactive stance in the handling of their malpractice case to ensure the best possible outcome.  

Be sure to understand how your policy’s consent provision works so that you can have a voice in the handling of your claims.

New Grads: 5 Questions to Ask About Your Group Malpractice Coverage

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A lot is happening when physicians are looking for their first professional position: They are finishing training, taking the boards, and trying to decide where they may want to live and practice medicine.  As overwhelming as that may be, don't skimp on your due diligence as you decide which practice is the right fit for you - and make sure you know how you'll be protected from malpractice risks in the future. Here are 5 questions to ask about your group’s medical malpractice insurance coverage.

Question #1: What type of policy is it?

It’s important for you to know what type of malpractice insurance policy is being provided for you – Occurrence or Claims-Made?  Claims-Made coverage triggers based on when the claim is made against the provider; so a physician must carry the insurance while they are actively practicing and then obtain tail insurance (or nose/prior acts coverage from a new carrier) after the policy is cancelled to continue the coverage in the event that a claim is made after the termination date. Occurrence coverage triggers based on when medical incident actually occurred, even if the claim is filed after the policy has been cancelled.  Tail insurance is not necessary for Occurrence policies.

If your group is providing a Claims-Made policy for you, it’s important to find out who is responsible for purchasing the tail coverage when you leave.  This is an often-overlooked item that needs to be decided early in your contract negotiations and ideally written into your employment agreement so there is no confusion when you leave.  Tail insurance can be expensive (typically 1.5 – 2 times an annual premium), so you’ll need to be prepared for that expense if it will be your responsibility.

Question #2: Who is paying for your policy?

Ask your potential employer who will be paying for your malpractice insurance policy. It may be covered by the group, it may be deducted from your pay, or you may be individually responsible for paying the premium. If you are not satisfied with the coverage that is being provided, you may want to ask about obtaining your own separate policy.

Question #3: Are you covered on a shared limits basis? Or do you have your own individual policy limit?

Be sure to understand how much coverage you have in the event that you are named in a medical malpractice claim.  If you are covered on a shared limit policy, that means that you (and all the other named individuals) will be sharing the same policy limit, which potentially reduces the amount of coverage available to you.  It is generally recommended that physicians and higher-level practitioners have their own individual policy limits.    

Question #4: Is coverage limited to your scope & duty as an employee of X medical group?

As previously discussed, most employed physicians’ malpractice policies are not written on a broad form; they are limited scope & duty policies. This means that your policy only covers you for claims related to the work that you do for that employer. If the incident that led to a complaint falls outside the scope of your job description or falls within a policy exclusion, you may not have coverage.

If you provide professional medical services outside the scope of your employment, even if it’s as a volunteer or a favor to your neighbor, you need to have a separate policy in order to be covered. Good Samaritan laws protect you only in emergency situations. Many carriers offer moonlighting policies or part-time malpractice insurance policies at discounted rates, so obtaining additional coverage is generally affordable.  

Question #5: Do you have consent to settle?

Individual physicians and their employers may have different views when it comes to the impact of large verdict cases. Consent to settle becomes a key issue in these instances.  When your malpractice insurance policy contains a consent provision, the carrier must obtain your direct written consent before settling a claim on your behalf.

Consent to settle is important because it allows you to play an active role in the handling of your case. It gives you a voice in your defense.  Make sure you've read your malpractice insurance policy to know your rights when it comes to matters of individual consent or engage with a knowledgeable insurance agent to help.

 

Malpractice Insurance Considerations for Employed Physicians

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Healthcare providers who work as employed physicians for hospitals or other large networks face unique professional liability risks.  While it might seem convenient for your insurance to be taken care of by your employer, there may be limitations in your policy that you are not aware of.

Limited Scope & Duty

Most employed physicians’ malpractice policies are not written on a broad form; they are limited scope & duty policies. This means that your policy only covers you for claims related to the work that you do for that employer. If the incident that led to a complaint falls outside the scope of your job description or falls within a policy exclusion, you may not have coverage.

If you provide professional medical services outside the scope of your employment, even if it’s as a volunteer or a favor to your neighbor, you need to have a separate policy in order to be covered. Good Samaritan laws protect you only in emergency situations. Many carriers offer moonlighting policies or part-time malpractice insurance policies at discounted rates, so obtaining additional coverage is generally affordable.   

Individual Defense

If you are named in a malpractice lawsuit along with your employer, many times the same defense attorney will be appointed to represent all the parties involved. While there are certainly advantages to presenting a joint defense (reduced cost to the carrier, less “finger pointing” among providers, etc.), oftentimes physicians feel that they are not individually represented the way they’d like to be.

Fear of adverse judgements and negative public perception may increase a hospital's interest in settling claims where the potential damages are large, even when the involved physician believes his or her actions were appropriate and met the standard of care. This can cause issues in the future, since any award or settlement will be reported to the National Practitioners Data Bank and can affect credentialing, future employment, access to insurance, and more.  If you feel that your individual interests are not being served during a malpractice case, ask for your own attorney.

Consent to Settle

Individual physicians and their employers may have different views when it comes to the impact of large verdict cases. Consent to settle becomes a key issue in these instances.  When your malpractice insurance policy contains a consent provision, the carrier must obtain your direct written consent before settling a claim on your behalf.

Consent to settle is important because it allows you to play an active role in the handling of your case. It gives you a voice in your defense.  Make sure you've read your malpractice insurance policy to know your rights when it comes to matters of individual consent or engage with a knowledgeable insurance agent to help.

Conclusion

It's important for physicians contemplating hospital employment to understand the issues surrounding their malpractice insurance coverage at the onset of employment, during employment, and after employment has terminated. The time to ask those questions is before accepting any offer and signing your contract. Take the time to educate yourself and work with a trusted advisor (attorney or insurance broker) to make sure you understand the implications before taking the next step.

Changes in the Indiana Malpractice Landscape

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What every doctor needs to know in 2019

Medical malpractice laws can vary widely from state to state, particularly as it relates to statutes of limitations, the legal process, liability, and damages.  Luckily for our Hoosier healthcare providers, Indiana is one of the best states to practice medicine in.

In 1975, Indiana was the first state in the nation to implement malpractice reform via the Medical Malpractice Act (MMA), a seminal feature of which is the Patient’s Compensation Fund (PCF).  The MMA offers protection to both patients and healthcare providers and has helped improve malpractice insurance rates, quality of coverage, and patient access to care.

One of the most important aspects of the MMA is the cap, or limit, on the amount of damages that can be recovered in a medical malpractice lawsuit.  The cap has been raised twice since 1975 and, pursuant to legislation passed in 2016, will see two increases by July 1, 2019. 

The first increase to the malpractice cap took effect on July 1, 2017.  Malpractice claims that arise after that date are subject to a cap of $1,650,000, with providers responsible for the first $400,000 and the PCF providing excess coverage to a maximum of $1,250,000. The cap is set to increase again on July 1, 2019 to $1,800,000, and providers will need to carry a $500,000 primary limit and the PCF will provide an excess limit of $1,300,000. 

Primary Limit INPCF Limit Total Cap on Damages

< July 1, 2017 $250,000 $1,000,000 $1,250,000

July 1, 2017 to June 30, 2019 $400,000 $1,250,000 $1,650,000

July 1, 2019 + $500,000 $1,300,000 $1,800,000

 

What does this mean for you?

Whether your malpractice insurance policy renews before or after July 1, 2019, your carrier should automatically increase your policy limits to match the new amount on that date. Generally, premiums are not adjusted mid-term, but it is possible that your rate may change at the next year’s renewal.

If your malpractice insurance policy renews on July 1, 2019, your policy limits will be updated at renewal to match the new amount. It is possible that your rate may change at this time.

Comparing malpractice insurance options is a healthy exercise for all practices – from the solo provider to the large, complex healthcare network; and luckily there are resources available to help you do the legwork. Leveraging the expertise of a qualified independent insurance agent gives you access to multiple carriers and options, ensuring that you are getting the best coverage at the best price. 

Take this opportunity to re-assess your own malpractice insurance coverage and make sure that you’re prepared for 2019 and beyond.

Ready to get started? Contact us today.

Who Needs Medical Malpractice Insurance?

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Interacting with patients on a daily basis exposes you, your employees, and your practice to professional liability.  Generally, any provider of healthcare services (or anyone that provides direct/indirect patient care) needs medical malpractice insurance.  This includes doctors (medical students/residents/fellows), mid-level providers, allied staff, and their affiliated entities.  In most states, it is mandatory for doctors to carry malpractice insurance; furthermore, many hospitals require it in order to have privileges at their facilities.  It is also common for healthcare insurance plans to require any doctor who participates in their program to have malpractice insurance. 

Bottom line: It is wise to carry malpractice insurance, whether it’s required of your or not, due to the likelihood of you having a malpractice claim sometime in your career.

 

Questions to Ask

As you look for the right medical malpractice insurance coverage, work with your agent to determine:

1) Who needs to be insured?

2) In what capacity should they be insured? (individual or shared policy)

3) At what level do they need to be insured? (limits)

 

Key Considerations for Determining the Right Coverage

Insuring the Practice

In the event of a malpractice claim, many people can be named, including the “name on the door” i.e. the practice, itself. Corporate coverage is a frequently overlooked item when determining who needs to be insured. The practice has vicarious liability exposure that must be taken into consideration, as it may be held responsible for the acts of an employee committed within the scope of employment. Talk to a knowledgeable insurance agent to make sure that all affiliated entities are properly insured; such as solo corporations, DBAs, or any legal entity name that is affiliated with your practice.

Shared vs. Individual Policy Limits

After you have confirmed who needs to be insured, you’ll need to decide in what capacity they should be covered – individually or on a shared limit policy. Individual coverage gives the named insured their own unique policy and set of limits; whereas shared limit coverage is exactly what it sounds like, a policy that is shared among multiple people. It is generally recommended that doctors and higher-risk mid-level providers (such as CRNAs, Midwives, PAs, or NPs) carry their own individual policy limits; however, you can discuss all the available options with your agent to determine what is best for your practice. Most corporate policies will include coverage for nurses and allied staff on a shared limit basis, but you usually have the option to carve any of those providers out and insure them separately, if you feel that the risk necessitates it.

Malpractice Policy Limits

You’ll also need to decide how much coverage (what limit) is appropriate. Limits vary by state – some states have standard limits that all providers carry, and others allow you to select your own level of coverage. When determining the policy limit that is right for you, be cognizant of the varying levels of risk within your practice and be sure to comply with the requirements that may be imposed by your hospital or credentialing organization. It is possible for one provider to carry higher limits than another within the same practice, but work with your agent to ensure that the level of coverage is appropriate and acceptable with the carrier.

Tips for Mid-level Providers, Medical Students, Residents, and Fellows

Oftentimes providers do not have a choice when it comes to their malpractice insurance, particularly if it is provided for them through their employment, medical school program, etc. While you may not be able to control the type of coverage and carrier that you are using, be knowledgeable on the above topics so that you understand how you are covered in case you are ever named in a malpractice lawsuit. Be sure to obtain a copy of the policy under which you are covered and keep record of the dates of your employment. If you ever have questions about your coverage, don’t hesitate to ask your practice administrator or the appropriate person at the medical school/residency program – or contact a knowledgeable malpractice insurance agent.

Additional Coverage to Consider

Beyond medical malpractice, it may be prudent to consider billing errors & omissions coverage, cyber liability coverage, and medical director coverage, among others. Talk to your malpractice insurance agent to determine the right coverage options for your practice, and as always…the experts at Aegis are happy to discuss your unique practice needs to help you find the right malpractice coverage solution!

5 Simple Ways to Improve Bedside Manner

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Bedside manner plays a significant role in a patient’s overall healthcare experience. Good bedside manner can lead to higher satisfaction scores, a stronger patient-provider relationship and can lower the likelihood of a medical malpractice claim. Here are 5 simple ways to strengthen your relationship with patients and improve your bedside manner:

 

1.       Use Their Name: Using a patient’s name shows that you see them as an individual, and that you care enough to know who they are. It encourages them to be a part of the conversation about their health and helps build rapport. And if you don’t know how to pronounce their name – just ask! Showing your “humanness” can make you more relatable.  

2.       Introduce Yourself + Explain Your Role: When meeting a patient for the first time, be sure to introduce yourself and explain your role in their care. Take time to share how you’ll be working within the healthcare team so they know what to expect during the course of their treatment. If you are a specialist who is brought in for a consultation, it’s important that this is expressed to the patient so they do not feel abandoned or insignificant if you don’t visit them again.  

3.       Sit Down + Be Cognizant of Body Language: Sitting down next to a patient builds more connection. Instead of towering over them, it demonstrates that you are working “with” them and helps them feel valued and appreciated. Avoid defensive poses such as crossing your arms or giving the impression of being rushed (checking your watch or pager frequently). Being relaxed and confident in your body language will help the patient feel more relaxed and confident.

4.       Show Empathy + Listen: Taking a few extra minutes to get to know your patient helps form a better patient-provider bond. Listen for clues about their life and comment on them. For example, if your patient mentions plans for an upcoming vacation, say, “Tell me about your trip, that must be so exciting.” Seems simple but it’s impactful… and it’s another way to show your patients that you really care. When patients trust their providers and feel like they are heard, they are more willing to openly discuss an issue and they tend to feel happier and more understood.

5.       Offer Reassurance: Put yourself in your patient’s shoes. What might be a routine diagnosis for you could be a life-changing event for them. Be patient, observe their reaction and be available to answer questions ongoingly. If a patient mentions being worried about a procedure, use statements such as “I understand this must be scary for you.” Then offer reassurance and partnership statements such as “I am here for you” or “I will be with you every step of the way”.



5 Tips for Health Care Providers after an Adverse Outcome

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Adverse events can be unavoidable in the practice of medicine. Here are some tips for you to consider should you be involved in an adverse outcome:

1.      Talk to the Patient or Family (and remain accessible)

Speak with the patient and family members as soon as possible after an adverse event. Explain the situation and answer questions factually and directly. Show compassion and offer emotional support. Try not to be defensive, even if their remarks are hurtful or accusatory.  Be accessible for follow-up questions or further explanations – oftentimes there are more questions after the family/patient has had time to process things. Being absent or “hard to get hold of” leads to patient frustration.   

2.      Don’t Play the Blame Game  

It’s ok to acknowledge and apologize for the patient's emotional distress, but make sure that you do not accept blame or point the finger at anyone else.  Do not speculate with the patient as to how or why the adverse outcome occurred. Speculation only leads to further issues. Review the medical records and meet with the healthcare team to discuss the situation and what needs to be done in response. Coordinate with your medical provider colleagues to ensure that communication is consistent and that patient needs are being met.

3.      Contact Practice Administrator / Risk Manager

Don’t delay in contacting your practice administrator or risk manager. Be factual in explaining the situation so that you can determine the proper next steps. Contact your malpractice insurance carrier (to report the incident) or the FDA (in the event of a medical device failure), if appropriate. Proactively engaging your carrier and risk manager allows the team to “get in front of” any potential issue so that you can work together to resolve the situation as quickly as possible, to the patient’s satisfaction.

4.      Ensure Proper Medical Records

Record factual statements of the events in the patient’s medical record along with notes related to follow-up care. If you disagree with another provider, do not use the medical record to document your concerns; rather, thoroughly document the basis for your treatment. Do not backdate any entries in the medical record and avoid creating entries that could appear self-serving. Remember that medical records are admissible in court. Avoid writing anything in the file that is unrelated to the care of the patient (e.g. “family is mad” or “legal team notified”).

5.      Consider write-offs / no overly aggressive collections

In the event of an adverse outcome, it may be prudent to consider waiving all or part of the patient’s medical bill. Before proceeding with this option, however, be sure to discuss it with your malpractice insurance carrier and legal representative. While some patients will be satisfied with this result, others may be inclined to sue, regardless. Be considerate of collection call techniques. A slightly disgruntled patient could be further agitated with overly aggressive collection calls. 


Understanding the Medical Malpractice Claim Process

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Whether you are a new grad or a veteran healthcare provider, if you have never been involved in a malpractice lawsuit before, you may be curious as to what goes on in a typical claim. This article highlights the key events in a medical malpractice action and is intended to provide you with a better idea of what to expect if you are ever sued for alleged malpractice.

Key events in a Malpractice case

Malpractice cases typically begin with an adverse event during a procedure or medical event, or with the eventual discovery of an adverse outcome associated with the previously received treatment. Such discovery can sometimes come years after the procedure or medical event. The injured patient may choose to bring a lawsuit by filing what is known as a “Complaint.”

After a complaint is filed, the medical provider must be given notice of the claim. This is typically accomplished via certified mail. If you are named in a lawsuit, you should promptly notify your practice administrator, hospital risk manager, or the designated in-office person. You should also notify your malpractice insurance carrier.

Once the carrier has been advised of the suit, it will open a claim, collect preliminary information, and assign a defense attorney to represent your interests. The defense attorney will be your primary point of contact during the life of the lawsuit.

The defense attorney, working with the carrier, will collect data to assess the merits of the plaintiff’s claims. On the basis of the gathered information, the insurer will set a “reserve amount,” which is money that is earmarked for the eventual claim payment.

Throughout the litigation of the lawsuit, you will consult with your defense attorney and the carrier to determine how best to proceed. If your policy has a “consent to settle” provision, the carrier must obtain your consent before it can settle the claim.

If a pretrial settlement is pursued and an agreement is reached with the plaintiff, the plaintiff is paid the agreed-upon sum, in exchange for a release of all claims and a dismissal of the lawsuit.

If the case goes to trial, a jury will determine whether to render a defense verdict in your favor, or a verdict for the plaintiff. If the latter, the jury can award a monetary judgment that is typically paid by the insurance company. When the judgment is paid and satisfied, the claim is closed.

Malpractice claims that do not settle pre-trial generally take 18 to 36 months from the date suit is filed to reach trial; however, in some states, it can take 5 years or more.

Tip: Be proactive after an incident or adverse event – contact your practice administrator and malpractice carrier even if you have not yet received a formal claim notice. Most malpractice insurance companies have risk management programs in place and can provide guidance and suggestions on some immediate steps that you can take after an incident occurs. It may be possible to avoid further escalation of an issue if it is dealt with promptly and with the guidance of your insurance carrier and legal counsel.

What is Medical Malpractice?

Definition of Medical Malpractice

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Medical Malpractice is professional negligence by a healthcare provider that deviates from the accepted standard of care, resulting in harm.

Overview

The Journal of the American Medical Association (JAMA) has noted that medical malpractice is the third leading cause of mortality in the United States after heart disease and cancer. Forbes magazine recently reported that the cost of medical malpractice in the United States is approximately $55.6 billion a year. Medical malpractice is without a doubt, one of the most critical issues for healthcare and arguably one of the biggest “pain points” for providers today.

Medical Professional Liability Insurance, also known as medical malpractice insurance (or medmal insurance) provides coverage to physicians, surgeons, and other healthcare professionals for liability arising from a medical malpractice claim. In simple terms, it protects healthcare providers against claims filed by patients or their families who sue them, alleging harm by their medical negligence or harmful treatment.

The Standard of Care in Malpractice Cases

Healthcare professionals are not expected to be perfect – none of us are! They are, however, required to meet the appropriate standard of care; what a reasonably competent and skilled provider, with similar background and training would have done in the same situation. In order to prove that the standard of care was or was not met, attorneys on both sides may bring in an expert witness to testify. 

If, for example, an OB/GYN is being accused of a medical error, another OB/GYN or specialist in the given field may testify to show that the doctor failed to do something that he should have done or did something that he should not have done.

Establishing the Elements of Proof

A plaintiff alleging medical malpractice must prove the following:

1.     A duty of care was owed by the healthcare provider to the patient

2.     The duty was breached (standard of care was not met)

3.     The breach caused the injury in question

4.     The injury resulted in damages

The burden of proof lies with the plaintiff and their medical malpractice attorneys in a malpractice lawsuit and all 4 elements must be proven for a plaintiff to prevail at trial.

Physicians, dentists, nurses, and healthcare professionals owe a duty of care to those who seek their treatment. This element of proof is rarely disputed in medical malpractice cases, because once a provider agrees to treat a patient, he or she has a professional duty to provide competent care. More importantly, the patient must show that there was a real injury (physical or emotional) as a result of the alleged negligence from the medical procedure.

Causation is a critical element of proof in a medical malpractice lawsuit. While there may be injuries, if the injuries cannot be directly linked to the healthcare provider’s alleged misconduct, there is no case. There are several issues that can make causation difficult to prove in a medmal case, including:

·        Trying to separate the effect of an existing condition from the effect of the negligent medical treatment (did the doctor’s treatment cause the injury or was it already there?)

·        Predicting if the outcome would have been the same, regardless of the provider’s actions (a patient is treated for stomach pain and discharged in the morning, but dies of a stroke at home that evening)

·        Multiple factors attributable to the injury (many things could have caused the injury in question, but it cannot be directly linked to the provider’s care)

If all 4 elements are proven and the jury finds in favor of the plaintiff, a judgement is awarded to indemnify the patient for their losses. 

Types of Damages in a Malpractice Case

There are 2 types of damages in a malpractice case – compensatory and punitive.

Compensatory damages

·        Economic (examples: loss of income, medical expenses, future medical care)

·        Non-economic damages (examples: pain and suffering, scarring, humiliation, permanent loss of an organ or limb, reduced enjoyment of life, etc.)

Punitive damages

Punitive damages are only awarded if the provider’s conduct is found to be willful, wanton, and/or reckless. Whether a healthcare provider can be liable for punitive damages, which are intended to punish a defendant, varies from state-to-state.

Most malpractice insurance policies exclude coverage for punitive damages. Likewise, liability that arises from sexual misconduct, criminal acts, and inappropriate alteration of medical records is also typically excluded from coverage.

Summary

Medical Malpractice Insurance provides coverage to doctors and healthcare professionals for liability arising from allegations of negligent care. Medical malpractice occurs when there is a medical error by a healthcare provider that deviates from the standard of care, resulting in harm to the patient. Standard of care is what a reasonably competent and skilled provider, with similar background and training, would have done in the same situation. A health care professional is not expected to be perfect or practice perfect medicine.

A patient alleging medical malpractice must prove 1) duty of care by the provider, 2) a breach of the standard of care, 3) an injury proximately caused by the breach; and 4) the injury resulted in damages. The burden of proof lies with the plaintiff and their malpractice lawyers in a lawsuit and all 4 elements must be proven for a plaintiff to prevail.

If a jury finds in favor of the plaintiff, or if a malpractice case is settled, damages are awarded to indemnify the patient and/or their family. Damages can be compensatory (economic or non-economic), and in certain situations punitive. Most malpractice policies do not cover punitive damages or those related to sexual misconduct or criminal acts.

Malpractice Insights (the blog for Aegis Malpractice Solutions, LLC) is written to provide general information on medical malpractice insurance and related topics. It is not intended to provide specific legal/insurance advice. By using this blog site you understand that there is no insurance/client relationship between you and the Blog/Website publisher. The Blog/Website should not be used as a substitute for advise provided to you by your insurance agent or from a licensed professional attorney in your state.

Welcome!

Welcome!

Welcome to Malpractice Insights – the blog for Aegis Malpractice Solutions. Our goal with this blog is to share information that will help you better understand medical malpractice insurance and empower you to make the best decisions for yourself and your practice. So be sure to subscribe and follow us on your favorite social media platforms to stay in the loop and join in on the conversation!