Liability Insurance Carriers Research Articles

Medicolegal Sidebar: Telemedicine-New Opportunities and New Risks.

Medicolegal Sidebar: Telemedicine-New Opportunities and New Risks.

Simulation of Shoulder Dystocia for Skill Acquisition and Competency Assessment: A Systematic Review and Gap Analysis.

Mastery of shoulder dystocia management skills acquired via simulation training can reduce neonatal brachial plexus injury by 66% to 90%. However, the correlation between simulation drills and reduction in clinical injuries has been inconsistently replicated, and establishing a causal relationship between simulation training and reduction of adverse clinical events from shoulder dystocia is infeasible due to ethical limitations. Nevertheless, professional liability insurance carriers increasingly are mandating simulation-based rehearsal and competency assessment of their covered obstetric providers' shoulder dystocia management skills-a high-stakes demand that will require rapid scaling up of access to quality shoulder dystocia simulation. However, questions remain about differing simulation training schemes and instructional content used among clinically effective and ineffective educational interventions. This review of original research compares curricular content of shoulder dystocia simulation and reveals several critical gaps: (1) prescriptive instruction prioritizing maneuvers shown to decrease strain on the brachial plexus is inconsistently used. (2) Proscriptive instruction to avoid placing excessive and laterally directed traction on the head or to observe a brief hands-off period before attempting traction is infrequently explicit. (3) Neither relative effectiveness nor potential interaction between prescriptive and proscriptive elements of instruction has been examined directly. (4) Reliability of high-fidelity mannequins capable of objective measurement of clinician-applied traction force as compared with subjective assessment of provider competence is unknown. Further study is needed to address these gaps and inform efficient and effective implementation of clinically translatable shoulder dystocia simulation.

The Сonceptual Basis of Liability Insurance Carrier in Defending Passengers of the Rail Transport

In terms of the railway reform and opening the access for private operators to railway facilities on the rights of operators of the infrastructure call for urgent research of conceptual bases of liability insurance carriers secured in the passenger rail transport.The necessity of insurance protection of the passenger rail traffic due to the fact that the existing system of insurance relations, which was formed in the process of implementing compulsory personal insurance of passengers against accidents on the railways, do not meet modern requirements and cannot provide adequate protection and guaranteed compensation for damage caused to passengers. It is believed that the compulsory insurance of liability of the rail carriers for damage to life, health, or property of passengers is a more effective defense mechanism and increases the rail business entities responsible for the safety of the railway routes. The introduction of the liability insurance of the rail carrier allows for the establishment of the legal framework of insurance protection of passengers and determines the mechanism of its implementation. Therefore, this study focuses on improving the mechanism of insurance protection of passengers in the rail transport to address important social and economic problems securing the passenger rail traffic on the basis of the balance of interests of all subjects if the rail and insurance relations.Achieving this goal is viewed as forming a system of benefits of the insurance coverage of the passenger rail to the rail on liability insurance carrier, and determining the features of its implementation during activation of the railway reform.Article received 01.05.2017

Characteristics of Orthopaedic Malpractice Claims of Pediatric and Adult Patients in Private Practice.

Medical liability exposure varies based on scope of practice, patient demographics, and location of practice. There is a generally held belief that treatment of pediatric patients increases one's medicolegal risk. We examined a large national database of orthopaedic malpractice claims to determine if pediatric malpractice claims were associated with a less favorable medicolegal outcome compared with adults. Physician Insurers Association of America is an association of medical liability insurance carriers providing liability coverage for 60% of private practice physicians in the United States. The Physician Insurers Association of America data registry of closed medical liability claims was examined, including all orthopaedic claims between 1985 and 2012 in this review. Claims were categorized based on the age of the claimant (pediatric: less than 21 y, adult: 21 y or older). These groups were compared based on percentage of claims resulting in payment, indemnity paid, and years between occurrence of incident and filing of claim. In addition, the top 10 most prevalent claims were identified and compared between groups. A total of 25,702 closed orthopaedic claims were included. Pediatric claims accounted for 13% of the data. The average time from incident to claim filing was 1.92 years for pediatrics and 1.59 years for adults. Pediatric claims resulted in a higher percent of payment (33% vs. 30%) and average indemnity paid ($189,732 vs. $180,171) compared with adults. Five of the top 10 conditions resulting in a claim in each group were the same. Comparing these 5 conditions, in general there were minimal differences in the average time to claim filing between the groups, but larger average indemnity paid in the pediatric group. There appear to be moderate differences in outcomes of orthopaedic malpractice claims between adult and pediatric patients. The longer statute of limitations associated with pediatric claims does not appear to portend a less favorable medicolegal outcome or excessively longer time to claims filing for pediatric patients.

Grant award program partnerships with your professional liability insurance carrier: An innovative approach to loss prevention and improved patient safety

The financial success of a malpractice insurance program is directly influenced by how effectively the covered providers respond to risk. This article describes a University Self-Insurance Program partnership to provide small grants to providers who have the expertise and passion for a specific risk reduction activity that is cost effective and measurable and has a high probability of improving patient care and reducing claims or lawsuits. Implementation of this small grant concept can be tailored to become operational in virtually any setting from an independent medical practice to a multistate healthcare system.

Malpractice claims for endoscopy

To summarize the magnitude and time trends of endoscopy-related claims and to compare total malpractice indemnity according to specialty and procedure. We obtained data from a comprehensive database of closed claims from a trade association of professional liability insurance carriers, representing over 60% of practicing United States physicians. Total payments by procedure and year were calculated, and were adjusted for inflation (using the Consumer Price Index) to 2008 dollars. Time series analysis was performed to assess changes in the total value of claims for each type of procedure over time. There were 1901 endoscopy-related closed claims against all providers from 1985 to 2008. The specialties include: internal medicine (n = 766), gastroenterology (n = 562), general surgery (n = 231), general and family practice (n = 101), colorectal surgery (n = 87), other specialties (n = 132), and unknown (n = 22). Colonoscopy represented the highest frequencies of closed claims (n = 788) and the highest total indemnities ($54 093 000). In terms of mean claims payment, endoscopic retrograde cholangiopancreatography (ERCP) ranked the highest ($374 794) per claim. Internists had the highest number of total claims (n = 766) and total claim payment ($70 730 101). Only total claim payments for colonoscopy and ERCP seem to have increased over time. Indeed, there was an average increase of 15.5% per year for colonoscopy and 21.9% per year for ERCP after adjusting for inflation. There appear to be differences in malpractice coverage costs among specialties and the type of endoscopic procedure. There is also evidence for secular trend in total claim payments, with colonoscopy and ERCP costs rising yearly even after adjusting for inflation.

A Survey of Central Association Members About the Definition, Management, and Complications of Shoulder Dystocia

Clifton, New Jersey Financial Disclosure: Dr. Kreitzer has been a paid ob-gyn risk-management consultant for a professional liability insurance carrier, and he is paid for medico-legal consulting.

Malice/Gross Negligence

(2006). Malice/Gross Negligence. Baylor University Medical Center Proceedings: Vol. 19, No. 4, pp. 417-418.

Not-So-Obvious Considerations for Professional Liability Insurance

September 1, 2005, was the 2-year anniversary of the effective date of the Texas medical malpractice tort reform laws. These provisions are primarily set forth in Section 74.001 et seq. of the Texas Civil Practice and Remedies Code. Available and affordable professional liability insurance for health care providers was a primary reason behind the drive to pass this legislation. Now that this legislation with its damages caps is in place, additional professional liability insurance carriers have made, or are considering making, a return to the Texas market. New competition in this area of business will hopefully result in better premium rates. Since health care providers may now have more insurance carriers to choose from, I wanted to take this opportunity to mention some not-so-obvious factors to consider when selecting a professional liability insurance carrier. In simplest terms, professional liability insurance provides a policyholder two benefits. First, this insurance provides a specific amount of money (the insurance policy “limits”) from which to pay a settlement or adverse judgment in a professional liability claim. This benefit is referred to as “indemnity,” or the “duty to indemnify.” Second, this insurance pays for legal representation in the context of a health care liability claim. This is referred to as the “duty to defend.” The duties to indemnify and defend are universal in professional liability policies. Many times, in determining which insurance and carrier to select, health care providers look only at the limits offered and the premium required to obtain those limits in making their final decision. However, they may also want to consider some particulars about additional coverage, the scope of duties and benefits provided under the policy, the insurance company itself, and the manner in which the company handles professional liability claims. Serious problems can arise in each of these areas that can make a health care liability claim even worse than imagined.

General Liability Insurance Coverage for Mold Claims

Although humans and mold have coexisted for centuries, the effects of mold on health and property have recently received considerable attention. Members of the construction industry and commercial property owners are, with increasing frequency, finding themselves defending claims of property damage or personal injury due to indoor mold growth. These designers, builders, and property owners frequently turn to their general liability insurance carriers for defense and indemnification without having a full understanding of the protections afforded by their commercial general liability policies. This article provides an introduction to the typical coverages and exclusions applicable to mold related claims submitted for general liability coverage. This article also discusses maximizing the potential for coverage by notifying and cooperating with one’s insurer and provides guidance on the avoidance of indoor mold growth and claims. Questions concerning the meaning and effect of particular insurance policy provi...

The malpractice liability crisis

Most medical malpractice cases are tried under the civil tort of negligence and are often triggered by adverse outcomes. These proceedings are aimed primarily at determining whether the conduct of a health care provider was reasonable. Such legal actions have mostly been subject to state jurisdiction. Increasingly, a number of factors are converging that are threatening the continued practice of medicine in some states and hence patients’ access to care. These include higher amounts of monetary damages awarded to successful plaintiffs, consequent rising malpractice premiums, and the threatened economic insolvency of medical liability insurance carriers as a result of the broader economic downturn. The result is a serious public health dilemma. The national scope of the problem has been considered a crisis, which has prompted unprecedented federal legislative proposals directed toward providing new and preemptive parameters for capitated noneconomic damages, restrictions on certain civil procedures affecting lawsuit outcomes, and methods for attorney compensation, which some states have either not previously addressed or found unconstitutional. A survey of different states’ problems and common issues should assist the reader in understanding the nature of the crisis and proposed solutions.

The Sounds of Silence: Waiting for Courts to Acknowledge that Public Policy Justifies Awarding Damages to Third-Party Claimants when Liability Insurers Deal with them in Bad Faith

A long-standing and virtually unchallenged doctrinal rule provides that a liability insurance carrier owes no duties in tort or contract to a third-party claimant who has been injured by its insured. As a matter of doctinal consistency and logic, the traditional rule makes some sense. The liability insurer has no contractual relationship with the claimant, and third-party beneficiary doctrine is not easily used to impose duties. Moreover, by stepping into the shoes of the insured tortfeasor to whom it owes a heightened duty of good faith, the insurer is in an adversarial relationship with the claimant that makes it difficult to argue that the insurer also owes a duty of good faith and fair dealing to the claimant. Nevertheless, liability insurers can compound the injuries suffered by claimants by refusing to make prompt and fair payments for injuries suffered. For a brief time, the infamous Royal Globe decision provided a cause of action to claimants in California, but the decision was prospectively overruled only nine years later. I contend that Royal Globe was misconceived because it was premised on questionable statutory interpretation, leading to an impossible task for lower courts to articulate the details of a private right of action in the language of a regulatory statute. However, the clearly articulated public policy that injured parties receive compensation from insurers suggests that the motivations of the Royal Globe court were basically sound. I argue that courts should address the problem of reverse insurance fraud - in which a liability insurer stonewalls payment to a third-party claimant in bad faith, which is to say solely for the purpose of minimizing its payments on the claim and without any legal justification relating to questions of liability or the measure of damages - by focusing on the public policy in issue. thesis is that courts should award tort damages to third-party claimants only in those cases where the public interest in prompt and fair payment to injured parties is undermined by the insurer's conduct. In making this case, I analogize to the tort of wrongful discharge in violation of public policy in the employment law setting, where courts have held that employers should be liable in tort if they discharge employees for reasons that offend public policy, even if the employer owes no tort or contract duties regarding the duration of employment. I conclude that courts should similarly recognize the tort of bad faith settlement practices in violation of public policy, even if they continue to adhere to the baseline common law rule that a liability insurer owes no duties directly to third-party claimants. I conclude the article with an appendix that includes a hypothetical judicial opinion that embraces my doctrinal argument. This article was solicited for inclusion in a Symposium published by the Nevada Law Journal on the topic, My Favorite Insurance Law Case, and so I took the liberty of creating my own court opinion for purposes of the Symposium.

Settling a Claim Within Policy Limits

In many health care liability claims, especially after the parties begin to discuss a settlement, it is not unusual for plaintiffs to make a demand on the defendant health care provider to settle the claim within policy limits. In Texas, this demand is known as a Stowers demand, after the Texas Supreme Court case G. A. Stowers Furniture Co. v. American Indemnity Co., which recognized that a policyholder had a cause of action against his liability insurer for negligently refusing a settlement offer within policy limits (1). A Stowers demand is an important development in the case and requires action by the health care provider, his counsel, and his professional liability insurance carrier. This article describes the background of this doctrine, its application, and how to respond to such a demand.

Multiple Chemical Sensitivity: Treatment and Followup with Avoidance and Control of Chemical Exposures

Reducing unnecessary chemical exposures, particularly pesticides and other petrochemicals, shows promise for reducing illness episodes in the chemically sensitive. Because similar types of exposures have been associated with the onset of chemical sensitivity, such precautions could have wider preventive value for the rest of society as well. Many uses of chemicals have dubious social benefits, and reduced use should be achievable. The chemical industry will likely bitterly contest the reduced use of chemicals because it stands to lose substantial sales. Compensation and liability insurance carriers also stand to lose if the environment is found problematic, rather than individual psychology, for example. Professionals should also recognize conflicts of interest for the chemical and insurance industries by openly acknowledging funding sources for research. The author believes that research on chemical sensitivity that blames the psyche of the victim rather than the chemical will more likely be funded by the insurance or chemical industry than will other research. Study designs should be developed in an atmosphere removed from financial conflicts of interest. This means a substantially larger role for government funding of research on chemical sensitivity to avoid biasing the knowledge base by financially interested parties. The time is critical for government funding of research on chemical sensitivity because the illness is being defined and characterized. If preliminary research is flawed by improper design and focus, our understanding of the problem could be delayed for years.

Introduction to Symposium on Newer Developments in Medicolegal Problems

The possibility of involvement with a medical liability problem threatens all physicians. Since the so-called malpractice crisis in the 1970s, increased attention has been given to risk management. Liability insurance carriers, as well as professional organizations like the American Academy of Ophthalmology, have been active in this area and have followed all the latest developments in medicolegal problems. The history of casualty and liability insurance is interesting. Although such insurance has been available since the thirteenth century when marine insurance was offered to shipowners through underwriters gathered in London coffee houses, the first record of casualty insurance in the United States occurred in 1864 when the Traveler's Insurance Company offered accident insurance for railroad

The Advent of Clinical Standards for Professional Liability

The development of clinically based written standards to reduce the frequency and severity of medical malpractice loss appears to be gaining in popularity among provider specialty groups and professional liability underwriters. To date, such standards have addressed problems in specialties such as obstetrics and anesthesia where dollar losses associated with malpractice claims have been high. Guidelines can be developed and used by providers on a purely voluntary basis or mandated on an involuntary basis by third parties such as malpractice insurance companies or legislators. Because the advent of risk-control standards is a relatively new phenomenon, formal scientific studies on the long-term benefits of such guidelines have not yet been published. However, it appears that sharp reductions of malpractice losses in specialties such as anesthesia have coincided with the implementation of formal written standards specifically designed for liability control. This has led some liability insurance carriers to decrease premiums associated with specialists following such standards. Many providers are understandably concerned about the potential use of written standards by plaintiff attorneys in medical malpractice suits. Although it is possible that such policies and guidelines could be admitted into evidence to show that a provider breached the legal duty or standard of care owed to a patient, it is uncertain whether these risk-control standards could ultimately pass the evidentiary rules of relevancy or materiality in a given lawsuit. It is clear, however, that the consensus-based process of creating clinical standards and guidelines specifically for controlling professional liability losses is itself a powerful and emerging standard for health care risk management programs.

Insurers had duty to defend utility

A New Jersey court concluded that a general liability insurance carrier has a duty to defend and indemnify its insured when the insured has been charged with negligently contaminating and polluting groundwater.