2009
2010
2011
2012
2013
2014
Start policy
Treat client X
End policy
Client X sues
Claims-Made Policy
A claims-made policy covers you for any covered claim provided it meets two criteria :
You are insured when the claim is made. If you no longer need coverage, you can purchase a “tail” to protect you for the past (see below).
You have continually renewed the policy from the time the incident occurred until the time the claim is made.
In this example, you buy a claims-made policy in 2009 and renew it every year. You treat Client X in 2010. In 2013, Client X decides to sue for the services you provided in 2010. You are covered because: (1) you were continuously insured up to when the claim was made and (2) the treatment was provided after the policy started in 2009.
2009 | 2010 | 2011 | 2012 | 2013 | 2014 |
|---|---|---|---|---|---|
Start policy | Treat client X | Client X sues |
Most employer-provided liability insurance is explicitly for activities conducted under the terms of the employment agreement, so practitioners who may be inclined to “moonlight” in another setting or offer volunteer services domestically or internationally may find their actions unprotected by specific professional liability. Relying on an umbrella-type general personal liability policy is one option in this setting, if the policy specifically covers professional medical liability, but there are many others. It is critical to consult with a knowledgeable agent, providing him or her with a complete description of all of your activities and copies of all policies, so that he or she can assist in determining whether you are adequately covered.
Careful scrutiny of the extent of different activities being covered under the policy is also an important way to limit the cost of liability coverages. While some policy underwriters may not distinguish between activities solely devoted to the clinical laboratory and those involving cytology or surgical pathology , these activities all have rather different liability risk profiles, and savvy consumers and underwriters may wish to negotiate on these more explicit terms. In this arena then, it may make sense to deal with a policy provider who has more experience with pathology-specific underwriting to take advantage of potentially lower areas of risk for certain providers in the practice.
It is also important to determine whether the policy(ies) extends to the practice entity (the professional corporation, limited liability corporation, or other legal entity) as well as the individual pathologists. Because the practice entity has assets, even if a hospital-based practice (the accounts receivable are a significant asset), it is important that the practice entity also be covered by insurance.
Case: Risk Management
Southeast Pathology had the philosophy of giving back to the communities they served and derived their successes from . Hardly ever turning down a request for advertising support, their names, either as a group or just the practice, had appeared in playbills, on YMCA kids’ athletic teams, and other community venues. Over the years, board members of the local ballet company had acknowledged their particular support and invited members of the group to various gala events for donors and supporters. Then came the misadventure that started simply enough with a biopsy of a pigmented lesion on the thigh of a ballet board member’s young daughter. The sample encountered a processing glitch in the laboratory, resulting in poor-quality sections that were unreadable. The specimen was reprocessed and sectioned with little improvement, but eventually diagnosed after significant delay as a variant of melanoma. Unfortunately, the processing and sectioning mishap used all the lesional tissue, making it unavailable for molecular testing that might have qualified the girl for a promising clinical trial. Dr. Madoff, leader of Southeast Pathology, following the protocol for event management in their quality management plan, called the mother to express his apology for the mishap and less than optimal outcome and to explain what they had done to prevent such things from happening again to others. It was only then that he recognized the connection between the patient and his acquaintance on the ballet board. Because of their friendship and the group’s status as community contributors, established before the adverse event, and because of his apology, she chose not to file a complaint with the medical practice board or a negligence suit, even though it appeared her daughter might not do well as a consequence .
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