Claims-Made vs. Occurrence Malpractice Insurance | ACP

Medical malpractice insurance is a specialized type of professional liability insurance that covers physician liability arising from disputed services resulting in the injury or death of a patient. Medical liability insurance is required in almost all states and in most medical systems as a requirement to practice.

malpractice insurance is often available through traditional insurance companies or through a medical risk retention group, which is a mutual organization of medical professionals organized to provide liability insurance (sometimes sponsored by corporations). state medical). furthermore, some large medical systems may be “self-insured”; Instead of buying commercial insurance, a medical liability trust fund is created that is used to pay for the defense of malpractice lawsuits and resulting lawsuits against your doctors. Although smaller medical groups and practices may be able to insure themselves, there are significant legal and business hurdles that make this a difficult option for most.

Reading: Medical malpractice insurance is a type of what insurance

Individual and group malpractice coverage plans are available for those in independent or small practices. For employed physicians, medical liability coverage is typically offered as part of a group plan purchased by the hospital or health system that employs them.

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The optimal type and amount of insurance you need to meet your state’s minimum malpractice insurance requirements and for adequate protection of personal and practice assets can vary greatly depending on your individual circumstances. therefore, it is important to consult with a professional health insurance advisor or institutional risk manager to determine the type and amount of coverage appropriate for your particular practice situation.

It is important to understand the two basic types of malpractice insurance: “claims made” and “occurrence.” A claims policy will only provide coverage if the policy is in force both when the incident occurred and when a claim was filed. As can be seen, this requires coverage to be extended for a significant period of time to provide adequate protection, as a considerable amount of time can elapse between when an incident may have occurred and when a claim is filed. Because of this, some claims-made policies are written to provide a period of coverage called a “tail” that extends coverage for a set period of time (such as five years) after the policy ends. if not offered as part of the original policy, tail coverage can also be purchased; The cost of additional insurance is usually a one-time assessment that can be 1.5 to 2 times the typical annual premium for malpractice insurance. however, final coverage is extremely important in situations where you have been covered under a claims policy but are changing insurance companies, moving to a new position, or retiring, to ensure continued coverage for malpractice during these times. for incidents that may have occurred in the last few years. Tail coverage costs may be covered by your former practice to ensure adequate protection of your group’s assets, or by your new practice, either as a benefit or an incentive to join the group. tail coverage may be an appropriate element of negotiation with a possible new practice.

Incident policies differ from claims insurance in that they cover any claim for an event that occurred during the coverage period, even if the claim itself is filed after the policy expires. Generally, this type of policy does not require additional coverage, although this type of insurance is often significantly more expensive and is offered less frequently by employers.

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It’s also important to understand the finer details of your medical malpractice coverage. Policies typically cover a variety of expenses associated with defending and settling negligence claims, including attorneys’ fees, court costs, arbitration and settlement costs, medical damages, and punitive and compensatory damages. Medical malpractice generally does not cover liability arising from criminal acts or sexual misconduct. it is essential to know what specifically your insurance policy would and does not cover to ensure that you are adequately protected. It is also important to know the amount of coverage for each occurrence and all claims that may be filed against you. Although some states require minimum coverage amounts for both the amount of each claim and the total of all claims that can be made, it is important to discuss the possible need for additional coverage above these minimums with a professional malpractice insurance consultant. or institution. risk manager to ensure your personal assets are protected.

If you enter a private practice, remember that in addition to medical liability claims, medical practices also face potential claims associated with other medical-related risks, such as cyber liability, and regulatory requirements, such as regulatory compliance. the portability and responsibility of health insurance. act (hypaa). Some medical malpractice policies may cover these types of exposures; otherwise, there are usually separate policies to protect against these risks.

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