Professional Liability Coverage Research Articles

Analysis of Closed Claims Among All Medical Specialties: Importance of Communication and Other Non-Clinical Contributing Factors.

Medical malpractice claims represent patient dissatisfaction of care delivered by their healthcare provider. Evaluation of contributing factors (CFs) associated with claims provides important information to optimize the patient-provider relationship. A total of 21,101 closed claims with 54,479 CFs (2.2 contributing factors per claim) from a large medical professional liability coverage provider were analyzed from 2010 to 2019. Four clinical CFs (technical performance, management of therapy, patient assessment, and patient factors) and four nonclinical CFs (communication between providers and patient, communication among providers, failure or delay in obtaining a consult, and insufficient documentation) were identified >1,500 times. Nonclinical CFs increased as a percentage from 50% in the first part of the study period to 54% in the second part of the study period (p < 0.01), and were more frequent in cases associated with indemnity when compared to clinical CFs (Nonclinical: 57% vs 43%; p < 0.001). Poor communication as a CF increased steadily during the study period (3-year average; 2010-2012: 777 CF/year vs 2017-2019: 1207 CF/year; p < 0.001). In claims associated with high severity injury, poor communication among providers was more significant than poor communication between the provider and patient (63% vs 29%; p < 0.001), mainly due to failure to convey the severity of the patient's condition. For non-surgical specialties except psychiatry, communication was the highest CF and the second or third CF for psychiatry or surgical specialties. Clinical and nonclinical CFs are equally important for malpractice claims. Communications issues are particularly important regardless of specialty. While focusing on clinical quality is important, implementing strategies that account for nonclinical issues, with a particular focus on communication, would have significant benefits particularly in an environment of increased consolidation of healthcare delivery systems.

Taking on the Medical Director Role: Risk Management Considerations

Back to table of contents Previous article Next article Government & LegalFull AccessTaking on the Medical Director Role: Risk Management ConsiderationsGloria Umali, R.N., M.S., C.P.H.R.M.Gloria UmaliSearch for more papers by this author, R.N., M.S., C.P.H.R.M.Published Online:25 Feb 2023https://doi.org/10.1176/appi.pn.2023.03.3.18AbstractBeing a medical director as well as a treating psychiatrist may be an exciting career move, but it raises a number of liability issues that you need to think through before accepting the position.iStock/SinenkiyIt is not uncommon to hear of psychiatrists taking on a medical directorship role while providing direct care to their own patients. Psychiatrists have many reasons for assuming this role; however, the passion to serve, loyalty to and a strong connection with an organization, and financial freedom are often cited as the main motivators.While being a medical director is undoubtedly rewarding, there are aspects of the role that psychiatrists need to consider from a medical malpractice standpoint. It is imperative that psychiatrists understand the legal, regulatory, and professional liability coverage issues associated with being a medical director. Although the role of a treating psychiatrist and the role of a medical director both fundamentally require clinical training and competency, each role may differ. Psychiatrists performing a dual role may believe that the coverage from the existing professional liability insurance policy automatically extends to their role as a medical director without realizing that certain arrangements compound their liability exposures and therefore leave an unintended gap in coverage.Furthermore, what it means to be a medical director and how to acceptably stay within the agreed-upon scope of responsibilities can be confusing and tricky to navigate. To decrease the risk of practicing outside of scope, psychiatrists need to understand the usual responsibilities of a medical director and take the time to thoroughly review the scope of responsibilities outlined in their specific contract. A medical director’s typical responsibilities include administrative duties such as management of medical staff matters, development of organizational policies, oversight of clinical operations and compliance with regulatory requirements, and quality improvement activities. Depending on the arrangement, it may not be easy to discern that a medical director might also be held accountable for everything that happens in the facility.If you are thinking about taking on a medical directorship role, here are some points for your consideration:Ensure you have insurance coverage for the dual role as a medical director and treating psychiatrist.Identify duties and responsibilities not covered under your basic professional liability coverage agreement to delineate the coverage necessary for the medical directorship role.Do not assume that your medical professional liability insurance policy covers your actions as a medical director. Notify your medical malpractice carrier if considering a medical directorship position to review possible changes in the current coverage.Confirm that the duties and responsibilities outlined in the contract are within your scope of practice and expertise.Delegate and oversee only those medical tasks and clinical operations that are consistent with your scope of practice and specialty.Verify that your contractual arrangements do not violate state or federal laws.Conduct proper due diligence by performing research on the facility’s quality rating, care standards, and performance before accepting the position.Ensure resources are available to adequately fulfill and execute your assigned duties and responsibilities. Being a medical director is both an honor and a privilege. It gives psychiatrists the perfect opportunity to satisfy the passion for serving their patients while fulfilling civil community responsibilities. However, performing the dual role as a psychiatrist and a medical director requires due diligence to avoid needless risk and liability exposures. ■This information is provided as a risk management resource for Allied World policyholders and should not be construed as legal or clinical advice. This material may not be reproduced or distributed without the express, written permission of Allied World Assurance Company Holdings, Ltd, a Fairfax company (“Allied World”). Risk management services are provided by or arranged through AWAC Services Company, a member company of Allied World. © 2023 Allied World Assurance Company Holdings, Ltd. All Rights Reserved.Gloria Umali, R.N., M.S., C.P.H.R.M., is assistant vice president of the Risk Management Group of AWAC Services Company, a member company of Allied World. Risk Management services are provided as an exclusive benefit to insureds of the APA-endorsed American Professional Agency Inc. liability insurance program. ISSUES NewArchived

Current Topics in Health Care Law

Current Topics in Health Care Law

Artificial Intelligence in Emergency Medicine: Benefits, Risks, and Recommendations

BackgroundArtificial intelligence (AI) can be described as the use of computers to perform tasks that formerly required human cognition. The American Medical Association prefers the term ‘augmented intelligence’ over ‘artificial intelligence’ to emphasize the assistive role of computers in enhancing physician skills as opposed to replacing them. The integration of AI into emergency medicine, and clinical practice at large, has increased in recent years, and that trend is likely to continue. DiscussionAI has demonstrated substantial potential benefit for physicians and patients. These benefits are transforming the therapeutic relationship from the traditional physician–patient dyad into a triadic doctor–patient–machine relationship. New AI technologies, however, require careful vetting, legal standards, patient safeguards, and provider education. Emergency physicians (EPs) should recognize the limits and risks of AI as well as its potential benefits. ConclusionsEPs must learn to partner with, not capitulate to, AI. AI has proven to be superior to, or on a par with, certain physician skills, such as interpreting radiographs and making diagnoses based on visual cues, such as skin cancer. AI can provide cognitive assistance, but EPs must interpret AI results within the clinical context of individual patients. They must also advocate for patient confidentiality, professional liability coverage, and the essential role of specialty-trained EPs.

Professional Liability and Gynecology-Only Practice: ACOG Committee Opinion Summary, Number 790.

Fellows of the American College of Obstetricians and Gynecologists may choose to limit the scope of their practices to gynecology and, accordingly, may choose not to carry professional liability coverage for obstetrics. The American College of Obstetricians and Gynecologists considers early pregnancy care to be within the scope of gynecology and gynecologic practice. Liability insurers that provide coverage for gynecology-only practices should provide coverage for clinical practice activities that involve the management of first-trimester and early second-trimester pregnancy and its complications.

Professional Liability and Gynecology-Only Practice

Fellows of the American College of Obstetricians and Gynecologists may choose to limit the scope of their practices to gynecology and, accordingly, may choose not to carry professional liability coverage for obstetrics. The American College of Obstetricians and Gynecologists considers early pregnancy care to be within the scope of gynecology and gynecologic practice. Liability insurers that provide coverage for gynecology-only practices should provide coverage for clinical practice activities that involve the management of first-trimester and early second-trimester pregnancy and its complications.

Urgensi Asuransi Profesi Dalam Perkembangan Bisnis Di Indonesia

Professional liability insurance (PLI), also called professional indemnity insurance (PII) but more commonly known as errors & omissions (E&O) in the US, is a form of liability insurance that helps protect professional advice- and service-providing individuals and companies from bearing the full cost of defending against a negligence claim made by a client, and damages awarded in such a civil lawsuit. The coverage focuses on alleged failure to perform on the part of, financial loss caused by, and error or omission in the service or product sold by the policyholder. These are potential causes for legal action that would not be covered by a more general liability insurance policy which addresses more direct forms of harm. Professional liability coverage sometimes also provides for the defense costs, including when legal action turns out to be groundless. Coverage does not include criminal prosecution, nor a wide range of potential liabilities under civil law that are not enumerated in the policy, but which may be subject to other forms of insurance. Professional liability insurance is required by law in some areas for certain kinds of professional practice (especially medical and legal), and is also sometimes required under contract by other businesses that are the beneficiaries of the advice or service.

TU‐A‐206‐00: Professional Liability Insurance ‐ What You Need to Know

Professional liability insurance is an important tool to manage risks to a medical physicist's assets that can result from errors or omissions in the course of professional practice. AAPM has partnered with Mercer Consumer to offer coverage tailored to the professional activities and specific risks encountered in medical physics practice. This program has specific eligibility criteria, benefit options, exclusions, and enrollment options for both self‐employed medical physicists and those who practice in an employment setting.There are important nuances to the form of coverage chosen and the determination of the coverage period for individual policies. The need for and role of professional liability insurance varies for each individual physicist, and one of the most important factors is the physicist's employment or self‐employment status and involvement in consulting activities.This session will provide an overview of the AAPM‐sponsored program (administered by Mercer) and the various options available to consulting and employed physicists. The fundamental concepts of professional liability insurance in general will be reviewed, and the roles of occurrence and claims‐made coverage forms within the AAPM program will be explained. Information drawn from claims data from the AAPM program will be used to illustrate the role of professional liability insurance benefits in realistic cases involving losses and liabilities due to errors and omissions in medical physics practice. Learning Objectives: Explain how professional liability insurance protects a medical physicist in the event of a lawsuit. Understand the basic concepts of the professional liability insurance coverage forms: occurrence and claims‐made. Explain AAPM's professional liability insurance program for the consulting and non‐consulting medical physicist. Understand the recent claim/expense data from AAPM's professional liability insurance program.Graham Fuller is an employee of Mercer Consumer.

TU‐A‐206‐02: Is Professional Liability Insurance Really Necessary

Professional liability insurance is an important tool to manage risks to a medical physicist's assets that can result from errors or omissions in the course of professional practice. AAPM has partnered with Mercer Consumer to offer coverage tailored to the professional activities and specific risks encountered in medical physics practice. This program has specific eligibility criteria, benefit options, exclusions, and enrollment options for both self‐employed medical physicists and those who practice in an employment setting.There are important nuances to the form of coverage chosen and the determination of the coverage period for individual policies. The need for and role of professional liability insurance varies for each individual physicist, and one of the most important factors is the physicist's employment or self‐employment status and involvement in consulting activities.This session will provide an overview of the AAPM‐sponsored program (administered by Mercer) and the various options available to consulting and employed physicists. The fundamental concepts of professional liability insurance in general will be reviewed, and the roles of occurrence and claims‐made coverage forms within the AAPM program will be explained. Information drawn from claims data from the AAPM program will be used to illustrate the role of professional liability insurance benefits in realistic cases involving losses and liabilities due to errors and omissions in medical physics practice. Learning Objectives: Explain how professional liability insurance protects a medical physicist in the event of a lawsuit. Understand the basic concepts of the professional liability insurance coverage forms: occurrence and claims‐made. Explain AAPM's professional liability insurance program for the consulting and non‐consulting medical physicist. Understand the recent claim/expense data from AAPM's professional liability insurance program.Graham Fuller is an employee of Mercer Consumer.

TU‐A‐206‐01: Professional Liability Insurance ‐ Protecting You and Your Practice

Professional liability insurance is an important tool to manage risks to a medical physicist's assets that can result from errors or omissions in the course of professional practice. AAPM has partnered with Mercer Consumer to offer coverage tailored to the professional activities and specific risks encountered in medical physics practice. This program has specific eligibility criteria, benefit options, exclusions, and enrollment options for both self‐employed medical physicists and those who practice in an employment setting.There are important nuances to the form of coverage chosen and the determination of the coverage period for individual policies. The need for and role of professional liability insurance varies for each individual physicist, and one of the most important factors is the physicist's employment or self‐employment status and involvement in consulting activities.This session will provide an overview of the AAPM‐sponsored program (administered by Mercer) and the various options available to consulting and employed physicists. The fundamental concepts of professional liability insurance in general will be reviewed, and the roles of occurrence and claims‐made coverage forms within the AAPM program will be explained. Information drawn from claims data from the AAPM program will be used to illustrate the role of professional liability insurance benefits in realistic cases involving losses and liabilities due to errors and omissions in medical physics practice. Learning Objectives: Explain how professional liability insurance protects a medical physicist in the event of a lawsuit. Understand the basic concepts of the professional liability insurance coverage forms: occurrence and claims‐made. Explain AAPM's professional liability insurance program for the consulting and non‐consulting medical physicist. Understand the recent claim/expense data from AAPM's professional liability insurance program.Graham Fuller is an employee of Mercer Consumer.

I Should Have Known (Better?)

I Should Have Known (Better?) Giles R. Scofield, J.D., M.A. Context Like all stories, this one neither arises ex nihilo nor exists in a vacuum. In order to situate it in its proper context, one needs to know only three things. The first is that clinical is and for some time now has been, in its own words, ‘big business’. The second is that, accordingly to sociologists of the professions, one of the most means for securing professional ‘conformity’ consists of informal methods, such as peer pressure, the silent treatment, whisper campaigns, and the like. The last is that, to the extent I know anything about professions and professionalizing it is because, before I became known as a ‘right–to–die’ advocate I studied and wrote about health care professions and professionals in law school, and represented them for several years as a health care attorney. Text Once upon a time health care ethics consultation was born and named a nascent, fledgling profession. Having spent a good portion of my law school days studying the health care professions, and having represented both health care and legal professionals in the early days of my legal career, the moment I heard that health care ethics consultants were on the way to professionalizing, my curiosity was piqued and my professional liability/responsibility radar got turned on. Mind you, being a veteran of the culture war that attended legitimating a patient’s right to forgo life–sustaining treatment in the run–up to the Cruzan case, and having worked with hospitals and hospital ethics committees in post–Quinlan New Jersey, I knew that there was work to be done, and that this involved knowing something about ethics. But a new profession? Had this new profession really thought about what it means to be a profession? About what it would mean, for example, to obtain professional liability insurance coverage, which requires, among other things, a well–defined scope of practice? Instead of trying to tackle these questions in all their complexities, I chose to focus first on an important, but all too often neglected issue: the problem of the impaired professional, of the professional that every profession needs to find some way to do something about, but that few professions ever take as seriously as they should. Partly because I thought it would shed light on a problem all professions face; partly to alert those who were interested in and dedicated to creating this new profession that there was considerably more to being a profession than having a scope of practice, a standard of care, and a code of ethics. At the time, I was living and working in a city where I had access to a group of clinical bioethicists who regularly got together to discuss papers we were working on. When I thought that “the problem of the impaired ethicist” was ready to be looked at, I sent it along. As I recall, there wasn’t much discussion of the content of the paper. That is to say, others found it interesting and no one slammed it. Perhaps there was a discussion about whether ‘impairment’ was the right lens for viewing the problem I had identified, which also had something to do with an ethicist’s being compromised, but if there was any discussion of that point, it did not amount to much. What I do recall is this. Some of those present wanted to know who I was talking about; others professed to know—or intuit—who it was that I must be talking about. In other words, I couldn’t just be writing about some theoretical problem concerning a hypothetical impaired ethicist. Rather, I must have—must have had—someone specific in mind, in their minds, at least. What a chatty, catty little clique, I thought to myself. What an interesting display of nascent, fledgling professional solidarity. Anyway. The problem of the impaired ethicist made its way into print, without very much notice or fanfare, which is not surprising, given the scant attention most professions and professionals pay to the problem of professional impairment. Thereafter I turned my attention, among other things, to a more robust discussion of some...

Protect Yourself with ASTA's Professional Liability Coverage

Protect Yourself with ASTA's Professional Liability Coverage

Committee Opinion No. 567

Fellows of the American College of Obstetricians and Gynecologists may choose to limit the scope of their practices to gynecology and, accordingly, may choose not to carry professional liability coverage for obstetrics. The American College of Obstetricians and Gynecologists considers early pregnancy care to be within the scope of gynecology and gynecologic practice. Liability insurers that provide coverage for gynecology-only practices should provide coverage for clinical practice activities that involve the management of first-trimester and early second-trimester pregnancy and its complications.

Professional liability insurance in Obstetrics and Gynaecology: estimate of the level of knowledge about malpractice insurance policies and definition of an informative tool for the management of the professional activity

BackgroundIn recent years, due to the increasingly hostile environment in the medical malpractice field and related lawsuits in Italy, physicians began informing themselves regarding their comprehensive medical malpractice coverage.MethodsIn order to estimate the level of knowledge of medical professionals on liability insurance coverage for healthcare malpractice, a sample of 60 hospital health professionals of the obstetrics and gynaecology area of Messina (Sicily, Italy) were recluted. A survey was administered to evaluate their knowledge as to the meaning of professional liability insurance coverage but above all on the most frequent policy forms ("loss occurrence", "claims made" and "I-II risk"). Professionals were classified according to age and professional title and descriptive statistics were calculated for all the professional groups and answers.ResultsMost of the surveyed professionals were unaware or had very bad knowledge of the professional liability insurance coverage negotiated by the general manager, so most of the personnel believed it useful to subscribe individual "private" policies. Several subjects declared they were aware of the possibility of obtaining an extended coverage for gross negligence and substantially all the surveyed had never seen the loss occurrence and claims made form of the policy. Moreover, the sample was practically unaware of the related issues about insurance coverage for damages related to breaches on informed consent. The results revealed the relative lack of knowledge--among the operators in the field of obstetrics and gynaecology--of the effective coverage provided by the policies signed by the hospital managers for damages in medical malpractice. The authors thus proposed a useful information tool to help professionals working in obstetrics and gynaecology regarding aspects of insurance coverage provided on the basis of Italian civil law.ConclusionItaly must introduce a compulsory insurance system which could absorb, through a mechanism of "distribution of risk", the malpractice litigation and its costs. This will provide compensation in accidental cases where it wouldn't be possible to demonstrate carelessness, imprudence and/or lack of skill.

Professional Liability Insurance and Medicolegal Education for Pediatric Residents and Fellows

The American Academy of Pediatrics believes that pediatric residents and fellows should be fully informed of the scope and limitations of their professional liability insurance coverage while in training. The academy states that residents and fellows should be educated by their training institutions on matters relating to medical liability and the importance of maintaining adequate and continuous professional liability insurance coverage throughout their careers in medicine.

Hartford Financial Services Group Inc.

AbstractInsurance (MIC: SIC: 6411 NAIC: 524210)Hartford Financial Services is an insurance and financial services company. Co. has two major operations. Through its Life operations, Co. provides retail and institutional investment products, life insurance for wealth protection, accumulation and transfer needs, group benefits products, as well as fixed and variable annuity products. Through its Property &amp; Casualty operations, Co. provides workers' compensation, property, automobile, liability, umbrella, specialty casualty, marine, livestock and fidelity and surety coverage, professional liability coverage, homeowners and home‐based business coverage, and insurance‐related services. At Dec 31 2007, Co. had total assets of $360.36 billion.

Hartford Financial Services Group Inc.

AbstractInsurance (MIC: SIC: 6411 NAIC: 524210)Hartford Financial Services is an insurance and financial services company. Co. has two major operations. Through its Life operations, Co. provides retail and institutional investment products, life insurance for wealth protection, accumulation and transfer needs, group benefits products, as well as fixed and variable annuity products. Through its Property &amp; Casualty operations, Co. provides workers' compensation, property, automobile, liability, umbrella, specialty casualty, marine, livestock and fidelity and surety coverage, professional liability coverage, homeowners and home‐based business coverage, and insurance‐related services. At Dec 31 2007, Co. had total assets of $360.36 billion.

Hartford Financial Services Group Inc.

AbstractInsurance (MIC: 8.2 SIC: 6411 NAIC: 524210)Hartford Financial Services is an insurance and financial services company. Co. has two major operations. Through its Life operations, Co. provides retail and institutional investment products, life insurance for wealth protection, accumulation and transfer needs, group benefits products, as well as fixed and variable annuity products. Through its Property &amp; Casualty operations, Co. provides workers' compensation, property, automobile, liability, umbrella, specialty casualty, marine, livestock and fidelity and surety coverage, professional liability coverage, homeowners and home‐based business coverage, and insurance‐related services. At Dec 31 2007, Co. had total assets of $360.36 billion.

Hartford Financial Services Group Inc.

AbstractInsurance (MIC: 8.2 SIC: 6411 NAIC: 524210)Hartford Financial Services is an insurance and financial services company. Co. has two major operations. Through its Life operations, Co. provides retail and institutional investment products, life insurance for wealth protection, accumulation and transfer needs, group benefits products, as well as fixed and variable annuity products. Through its Property &amp; Casualty operations, Co. provides workers' compensation, property, automobile, liability, umbrella, specialty casualty, marine, livestock and fidelity and surety coverages, professional liability coverage, and automobile, homeowners and home‐based business coverage. As of Dec 31 2006, Co. had total assets of $326.71 billion.

Can Private Markets Provide Professional Liability Insurance Coverage?

To insure against the financial claims of patients injured while receiving medical treatment, physicians, hospitals, and nursing homes in the United States have traditionally purchased professional liability insurance coverage. The insurance has been sold mainly by commercial carriers operating in the private market seeking to match insurance buyers and sellers. However, the experience of the last 30 years would indicate that insurance provided by private markets may not be a satisfactorily efficient means to compensate victims of medical injury. Given the involvement of state-established insurance mechanisms which seek to support private market coverage, perhaps the private market should be abandoned altogether in favor of public programs which seek to provide funding for compensation of medical injury victims.