In the increasingly complex landscape of Indian healthcare, doctors face a growing risk of medical malpractice lawsuits. Despite the potential financial devastation these suits can cause, many doctors still overlook the importance of medical malpractice insurance or professional indemnity insurance for doctors. This oversight can leave them exposed to significant financial risks, especially for younger consultants and residents.
An online survey reveals that only 35% of the specialists were aware of the AOA (any one accident):AOY (any one year) ratio, a critical factor in determining insurance coverage. This lack of understanding can lead to inadequate protection, leaving doctors vulnerable to financial ruin.
The financial stakes involved in medical malpractice lawsuits are substantial. Recent cases have seen compensation awards ranging from Rs 1 crore to Rs. 11 crore. A single malpractice suit could have a devastating impact on a doctor’s finances.
It’s important for Indian doctors to prioritize professional indemnity insurance to safeguard their careers and financial well-being. By understanding the concepts related to professional indemnity insurance, doctors can make informed decisions about their coverage and ensure adequate protection. This article will cover the ins and outs of professional indemnity insurance for doctors in India.
What is Professional Indemnity Insurance?
Professional indemnity insurance, also known as malpractice insurance, is a type of liability insurance that covers doctors against legal claims arising from their professional services.
This insurance protects doctors from the cost of defending themselves in court, paying compensation to patients, or settling out of court. It typically covers legal costs, settlements or judgements, investigation costs, regulatory fines or penalties, or defense costs.
It is important to note that this specific coverage can vary depending on the insurance provider and the terms of the policy.
Who can obtain Professional Indemnity Insurance?
Professional indemnity insurance is available to a wide range of medical professionals, including physicians, surgeons, cardiologists, pathologists, and dental surgeons. Additionally, medical establishments like hospitals and nursing homes can also obtain this type of insurance.
Check Out: Insurance For Doctors In India: A Critical Investment
Key Features of Professional Indemnity Insurance for Doctors
Before purchasing professional indemnity insurance, it’s crucial to carefully review the policy’s key features to ensure it adequately meets your needs. Here are some essential aspects to consider:
Coverage Limit
It is the maximum amount the insurer will pay for any claim during the policy period.
Scope of Coverage
The scope includes a wide range of procedures, such as misdiagnosis or delayed diagnosis, surgical errors, prescription errors, negligence in treatment or management of a patient, and other errors, such as failure to obtain informed consent.
Deductibles
It determines the amount you’ll be responsible for paying out-of-pocket before the insurance covers claims.
Exclusions
You must be aware of circumstances or events that are not covered by the policy.
Retroactive Date
The retroactive date is the date from which the policy provides coverage for incidents.
Run-off Coverage
This coverage is a protection of doctors from future claims. Further, run-off cover safeguards you against those losses or damages that may arise after your profession or business has ceased to trade.
Claims-Made vs. Occurrence Basis
It determines whether the policy covers claims made during the policy period or incidents that occurred during the policy period, regardless of when the claim is made.
Consent to settle
It means that the insurer cannot settle a claim without the doctor’s consent. This further ensures that the doctor has control over the outcome of the claim and can make an informed decision about whether to settle or fight the claim.
Additional Features
Geographical Coverage
Geographical coverage refers to the regions or countries where the insurance policy is valid. For doctors practicing in India, it’s crucial to ensure that their PII policy provides adequate coverage within the country.
Claim Handling Procedures
It outlines the process for resolving claims and provides options for alternative dispute resolution, such as negotiation and settlement, as opposed to going through a full legal process. For example, out-of-court settlement is one such feature that allows for the resolution of claims without going through a formal legal process.
Group policies
Group policies are available for multiple doctors within a profession, often with discounted premiums.
While PII protects doctors against civil lawsuits arising from professional negligence or errors, it does not provide coverage for criminal actions. If a doctor is found guilty of a criminal offense related to their medical practice, they may face criminal penalties and fines, which are not covered by PII.
It’s important for doctors to be aware of this limitation and to maintain separate legal counsel for any criminal matters that may arise. Let us have a look at what is typically not covered under professional indemnity insurance for doctors in India.
What is not Covered under Professional Indemnity Insurance for Doctors?
Professional indemnity insurance policies often exclude certain types of claims. Here’s a breakdown of common exclusions:
- Any liability arising from criminal actions or violations of laws or ordinances.
- Services rendered while under the influence of intoxicants or alcohol.
- Procedures performed under general anesthesia outside of a hospital setting.
- Intentional failure to comply with legal requirements.
- Liability arising from harm to third parties not directly related to medical services.
- Claims related to conditions caused by or associated with AIDS.
- Claims arising from libel, slander, false arrest, wrongful eviction, wrongful detention, defamation, or resulting mental anguish.
- Claims related to infringement of plans, copyrights, patents, names, trademarks, or registered designs.
- Liability incurred through agreements that would not have existed otherwise.
- Failure to adhere to professional standards, legal requirements, or regulations.
- Losses such as loss of goodwill or market share.
- Fines, penalties, punitive or exemplary damages.
- Services rendered before the policy’s retroactive date.
- Injury to employees or contractors arising from their employment.
Factors Affecting the Amount of Insurance
- Type of medical practice: Family practitioner, specialist, super specialist.
- Nature of specialization: Physician, surgeon, anesthesiologist, etc.
- Geographical location: Rural, urban, or elite area.
- Patient population: Literacy levels, nationality, socioeconomic status.
- Quality of patient care: Standards of care provided by the hospital.
- Staff availability: Qualified medical, paramedical, and nursing staff.
- Adherence to ethical and legal requirements: Commitment to professional standards.
- Preparedness to provide claimed services: Ability to deliver promised care.
- Pecuniary jurisdiction of consumer courts: Understanding local legal jurisdiction.
How Should You Proceed with the Claim?
- Report the claim: Doctors should notify their insurance provider as soon as they become aware of a potential claim or lawsuit. The doctor should provide detailed information about the incident, including the patient’s name, date of treatment, and nature of the alleged malpractice.
- Receive acknowledgement: Upon reporting a claim, the insurance company will acknowledge receipt of the claim and assign a claim number for tracking purposes.
- Get the claim number: The claim number will be used to identify and track the claim throughout the process. It’s essential to keep this number for reference.
- Legal notice or summons: If a lawsuit is filed against the doctor, the insurance company will receive a legal notice or summons. This document outlines the allegations and the legal proceedings initiated.
- Arrange defense: The insurance company will take charge of arranging legal representation for the doctor. They will appoint a qualified lawyer to defend the case. The lawyer will review the allegations, gather evidence, and prepare a defense strategy.
Key Tips for Managing Professional Indemnity Insurance
- Provide accurate information: Always ensure that the information you provide to the insurance company is accurate and up-to-date. This includes details about previous claims, the number of beds in your facility, and the qualifications of your staff.
- Retain a copy of your proposal form: Keep a physical or digital copy of your insurance proposal form for future reference. Don’t rely on the insurance company to maintain a copy.
- Verify policy accuracy: Carefully review the policy document upon receipt to verify the accuracy of the information. If you find any errors, report them immediately for correction.
- Check the retroactive date: Confirm the retroactive date mentioned in the policy each year. If it’s incorrect, have it corrected promptly.
- Maintain policy records: Preserve copies of all your previous and current insurance policies to prove continuous coverage, as claims are often retrospective.
- Renew policies in advance: Avoid lapses in coverage by renewing your insurance well before the expiration date. Don’t rely solely on your insurance agent for renewals.
- Utilize the look-up period: Take advantage of the 15-30 day look-up period to review the policy details carefully. If you’re not satisfied, you can cancel the policy for a full refund.
Conclusion
Professional indemnity insurance is a vital investment for Indian doctors. Given the rising risk of medical malpractice lawsuits, it’s essential to have adequate coverage to safeguard your career and finances.
By understanding the importance of this insurance, choosing the right policy, being aware of exclusions, and managing your coverage effectively, you can ensure that your professional indemnity insurance provides the necessary protection for your medical practice.
Reference:
Gadhe, Siddhata & Kale, Sachin & Chalak, Ajit & Vatkar, Arvind & Doshi, Suraj & Dey, Joydeep. (2023). Professional indemnity/medical malpractice insurance- Awareness among medical students and consultants of India: An online survey study. MGM Journal of Medical Sciences. 10. 10.4103/mgmj.mgmj_4_23.
