Malpractice insurance, also known as professional liability insurance, provides defense, expenses, and indemnity coverage for acts or errors of omission or negligence by healthcare providers. It protects licensed medical professionals, facilities, and some non-licensed staff from costs associated with lawsuits. The document discusses the different types of malpractice insurance policies including occurrence and claims-made policies, and factors to consider when selecting a malpractice insurance carrier.

1. INTRODUCTION TO MALPRACTICE INSURANCE 9555 W. Sam Houston Pkwy Ste. 475 Houston, Texas 77099 www.medplusllc.com [email_address] t:713 995 1842 f:713 995 0692

2. “ Malpractice Insurance” The common term used in Healthcare for Professional Liability Insurance. Professional Liability Insurance Provides defense, expenses, and indemnity for acts or errors of omission or negligence specific to the healthcare provider or entity rendering professional services. medplusllc.com What is Malpractice Insurance?

3. Indemnity Monies generally awarded to the plaintiff to settle or close the claim. Defense Costs Attorney fees, expert witnesses, court costs. Expenses Includes copying of patient records, transportation, living expenses, etc. medplusllc.com What is Malpractice Insurance?

4. Who needs Malpractice Insurance? Licensed Medical Professionals: Physicians LVNs, RNs, NPs CRNAs Physician Assistants Perfusionists Anyone providing professional medical care Licensed Medical Facilities: Hospitals Surgery Centers Medical Offices Nursing Homes and Home Healthcare Providers Imaging Centers Laboratories Any other facility providing professional services medplusllc.com Non-Licensed Medical Professionals: Medical Technicians Autologous Blood Therapists Autotranfusionists

5. Who is providing Malpractice Insurance? The Employed Professional -- Covered by the employer -- Site specific coverage -- Covered while on the clock The Contract Professional -- May or may not be covered by the employer -- May require proof of insurance for credentialing The Self Employed Professional -- May have to provide your own policy -- May require proof of insurance for credentialing medplusllc.com

6. Why Do I need Malpractice Insurance? medplusllc.com What if there is a bad outcome? Who will defend you? Are you protected if you are named in a law suit? Who will pay for expenses? Who will pay your indemnity claim?

7. Why Do I need Malpractice Insurance? You are a Professional Medical Provider and the decisions you make effect people’s health and their lives You are part of the Medical Team providing care You work in the hospital, surgical center, medical office, nursing home, etc. Insurance may be required for credentialing Insurance may be required for managed care insurance carrier’s reimbursements Protect your assets Protect the assets of your estate and family medplusllc.com

8. Who files these claims? The patient The family of the patient The children of the patient The estate of patient Class action suit by a group of patients (pharmaceuticals) medplusllc.com

9. Why are claims filed A perceived or actual error is made Diagnosis Medicine Surgery Negligence Who in the practice can trigger a suit? Physician, NP, PA RN , LVN MA, X-ray Tech, Lab Tech Receptionist, Billing Department It truly makes no difference who is sued within the practice. Question is – Who will be there to respond to the suit? Hopefully your Malpractice Insurance carrier! medplusllc.com

10. Occurrence Policy Form medplusllc.com The occurrence policy form covers you for any incident or claim that occurs while the policy is in effect, regardless of when a claim is filed or if the policy was cancelled/non renewed. Thus, the “tail” is built into the premium. The premiums vary significantly because of the difficulty in projecting future claims expense. The occurrence policy generally has a higher premium rate than a claims made policy. Most carriers do not offer the occurrence policy form. Malpractice Insurance Policy Forms

11. medplusllc.com Occurrence Policy Forms Occurrence to Occurrence Occurrence to Claims Made 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Policy A Policy B Policy B – Claims Made Policy A Policy A Policy A Policy A Policy A Policy A Policy A

12. Claims Made Policy Form medplusllc.com The standard claims made policy is designed to respond only to incidents and claims that occur while the policy is in effect. Once the policy expires, it will not respond to any incidents or claims that occurred during the previous policy period. In order to insure that incidents and claims that occur during prior years are covered, the policy will refer to a prior acts date. The prior acts date establishes how far back the current policy will respond to any prior incidents or claims. Malpractice Insurance Policy Forms

13. medplusllc.com With a claims made policy, prior acts coverage must always be considered when moving from one carrier to another. Prior Acts Insurance Coverage ( nose coverage) Changing carriers and new carrier picks up the expiring policy’s prior acts Not required if extended reporting endorsement purchased Extended Reporting Endorsement ( tail coverage) Purchase at time of policy expiration or cancellation Can cost 2 to 3 times current premium Consider financial strength of insurance company Switching Carriers

14. medplusllc.com Claims Made Policy Form 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Policy A with Tail Coverage Policy B Policy A Policy B will pick up Prior Acts of Policy A Policy B does not pick up Prior Acts

15. Claims Made Policy Form Claims Made Policy form is generally less expensive at the initial purchase. The premium structure for claims made policy is determined by the length of time the policy has been in effect. A Mature Claims Made Policy is used to describe the age of the claims made policy, which is usually 4 to 5 years from the retro date. The retro date is the benchmark used in determining the premium to be charged by the carrier. Example of premiums of a prior acts inception to a mature claims made policy: Premium Prior Acts Policy Date Step 1 First year $2,000 1/1/2009 1/1/2009 Step 2 Second year $4,000 1/1/2009 1/1/2010 Step 3 Third year $6,000 1/1/2009 1/1/2011 Step 4 Forth year $8,000 1/1/2009 1/1/2012 Mature Fifth year $8,000 1/1/2009 1/1/2013 Mature Six year $8,000 1/1/2009 1/1/2014 The premiums are always subject to rate changes medplusllc.com

16. Claims Made vs. Occurrence Claims Made $2,000 $4,000 $6,000 (Mature) $8,000 (Mature) $8,000 (Mature) $8,000 (Mature) $8,000 (Mature) $8,000 (Mature) $8,000 Purchase Tail $16,000 Total $76,000 Occurrence $8,000 $8,000 $8,000 $8,000 $8,000 $8,000 $8,000 $8,000 $8,000 Cancel Policy $0 Total $72,000 medplusllc.com In this example we have a comparison of Claims Made (CM) and Occurrence (OCC) policy forms. It shows the costs over 9 years with a cancellation at the end of the 2009 policy period.

17. medplusllc.com What are limits of liability? $200,000/$600,000 - $500,000/$1.5mm - $1mm/$3mm First number represents coverage for each claim or each incident/occurrence Second number represents the aggregate or the total amount paid by the policy Defense and expenses coverage Board action coverage What limits should you carry? Hospitals, surgery centers, etc. can dictate coverage limits Managed care contracts can dictate minimum limits Personal assets must be protected, what is your comfort zone What does your accountant and your lawyer suggest carrying What are the effects of tort reform Legislation on limits of liability? Cap on non-economic damages (pain and suffering) No cap on economic damages (medical bills, lost wages, etc.) Selecting Limits of Liability

18. medplusllc.com Five Steps to Choosing A Medical Professional Liability Insurance Carrier Don’t buy on price alone Low price may translate to inefficient coverage Look at overall value of product Ask Questions Offer more than just a policy Offer exceptional service when claims arise Coverage features of the policy form, consent to settle, hammer clauses Good legal panel, their own risk management or claims department Do Research Opt for a carrier with a proven track record One that understands and addresses changing liability needs Does the insurance carrier understand your specialty Check Carrier Ratings The carrier's financial strength ---A.M. Best rating of A- or better Will the insurance carrier be around for “long tail” claims Other Sources of Information Make sure the carrier is highly regarded in the health care industry

19. Short term and Long term Disability Insurance Life Insurance - Term, Universal, Whole Group and Individual Health Insurance General Liability and Business Property Workers’ Comp Business Overhead Expense Insurance Long Term Care Insurance medplusllc.com Business Insurance and Other Insurance Products Life Insurance Funding for Buy-Sell Agreements Key Man Insurance Executive Bonuses Account Receivables Protection Premium Financing for Life Insurance Universal Life/Long Term Care Combo Medicare/Medicaid Audits (RAC)