Medical Malpractice Insurance Coverage

What Standard Insurance Package Is Right for You?

In Florida and nationwide, physicians have numerous choices when it comes to securing medical malpractice insurance. Understanding the differences between claims-made policies and occurrence policies is crucial for selecting the insurance that best suits your practice requirements.

 

Additionally, understanding the extent of coverage provided, including limits and exclusions, is crucial in selecting the right insurance package tailored to your professional needs and circumstances. Consulting with insurance providers specializing in medical malpractice coverage, such as PLI Consultants, can further assist in making an informed decision.

Claims-Made Policies

A claims-made policy covers events that occur during the policy period AND are reported while the policy is still in force.  A claims-made policy allows physicians to change insurance companies (for the purpose of lowering the premium, increasing limits or other benefits) as long as the original retroactive date is not changed.

Prior Acts Coverage

When changing insurance companies, one of the most important dates on a policy is the retroactive date.  When a policy is originally bound, a retroactive date will be established. This date will remain unchanged as the policy renews year after year. By maintaining the same retroactive date, a physician can transfer coverage to another insurance without the need to purchase “Tail” from the previous carrier.

Extended Reporting Period Endorsements (“Tail”)

The “tail” (extended reporting period endorsement) only applies to claims-made policies.  Since a claims-made policy only covers a physician if the incident happens and is reported to the carrier while the policy is active, a “tail” policy would need to be purchased to allow the physician to report a claim once coverage is no longer active. This only applies when coverage is no longer needed and the policy is canceled.

FREE “Tail” Coverage

Many standard insurance companies offer free “tail” coverage if certain criteria are met. For example, physicians can receive free coverage at retirement if they are 55 years of age, have 5 years of consecutive coverage at the same company (some carriers require less years), and they are completely retiring from the practice of medicine.

Occurrence Policies

An occurrence policy covers events that occur during the policy period regardless of when they are reported to the insurance company. Occurrence policies cover a physician indefinitely for services rendered during a 12-month time period. These policies are uncommon and are typically overpriced or simply not available in many states. For example, in Florida, The FMM JUA offers occurrence policies that are cost effective if the physician is working limited hours and cannot obtain coverage from a standard insurance carrier.

Vicarious Liability in Medical Malpractice Insurance

Vicarious liability refers to a legal doctrine where an entity (such as a medical facility or employer) can be held liable for the negligent actions of its employees or agents while they are performing their job duties. In the context of medical malpractice insurance, this means that a medical facility or practice can be sued for malpractice committed by its healthcare providers.

Coverage and Implications

Coverage for Employers and Facilities

Malpractice insurance policies for medical facilities typically include coverage for vicarious liability, meaning that if a staff member is sued for malpractice, the facility is also protected under the same policy. Additionally, group malpractice insurance policies are designed to safeguard both individual practitioners and the employing facility, covering claims against the staff as well as the organization itself.

Scope of Coverage

Medical malpractice insurance generally covers negligent acts committed by employees—such as doctors, nurses, and technicians—while performing their job duties. Some policies may also extend coverage to acts committed by independent contractors working under the facility’s supervision, depending on the specific terms of the policy.

Risk Management

Effective risk management includes implementing thorough vetting and credentialing processes for all healthcare providers to minimize the risk of malpractice. Additionally, providing continuous training and effective supervision helps maintain high standards of care within the facility.

Legal Defense

Shared Defense: In case of a claim, the insurance provides legal defense for both the individual provider and the facility, covering legal fees, settlements, and judgments.

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