Liability Insurance Issues Still Vex Members

Abstract

One-quarter of AMDA members reported problems obtaining or renewing professional liability insurance coverage, with some carriers refusing coverage or imposing conditions on long-term care physicians, according to a recent AMDA survey of 409 members. More than 5% said they were refused coverage because they worked in nursing facilities, while 7% had carriers impose conditions on their coverage policies. This comes at a time when the insurance market seems to be stabilizing, with reports of carriers who ceased coverage down from 26% last year to 5% this year. In the results released last month, members indicated that they have pieced together coverage for their varied practices. The majority, or 73%, said they have in place coverage for their practices. Sixty-two percent said they have coverage in place for attending physician services, and (59%) for their administrative duties as medical director. Two-thirds paid for their own office practice policies, but facilities paid for two-thirds of medical director policies. When coverage was available, some carriers attached provisions to policies, including restricting practice to current patients, ceasing nursing facility work, or ceasing medical director work. When medical directors were covered for their administrative responsibilities, 46% were listed on the nursing facility policy by title as medical director. Others were covered by being listed on facility liability policy by name (8%), or by having responsibilities listed (11%). Still others were covered through an indemnity clause in the physician's contract with the facility (12%), or directly by an individual insurance carrier on a medical director policy (5%). Coverage for medical director responsibilities seems to be improving somewhat. In the past 3 years, there has been a 15% increase in nursing facilities adding medical directors to their institutional policies by name, title, or responsibilities. An additional 3% of facilities added an indemnity clause to the medical director's contract. Less than 2% reported that facilities removed medical director coverage from policies or removed an indemnity clause from the contract. Still, the informal survey showed that liability concerns influenced 17% of medical directors to modify their practices in the past year. More than 4% have stopped working as medical director at one or more facilities, while 8% said they have limited their work as medical directors. The issue of medical liability remains a concern for long-term care physicians. Still, only two indicated that they had had claims against them in their capacities as medical directors. More than 12% reported no coverage for their medical director responsibilities, and 27% said they believe they are covered but do not know how. “We remain concerned about the percentage of physicians who are without coverage for their medical director responsibilities, or those who are unsure how they are covered,” said Lorraine Tarnove, AMDA's executive director. Despite “modest reports of liability claims against medical directors, we believe it not prudent to ‘go bare’ in long-term care. Those physicians who have coverage should be very clear about how they are covered and any conditions that may be attached to their coverage,” she added.