• What is a “Consent to Settle Clause”? How Does it Impact Me?

Every individual currently searching or in possession of a medical malpractice insurance plan should be aware of the “Consent to Settle Clause.” This gives the owner of the plan the ability to decline their insurance agency from settling claims against them without proper consent. Malpractice suits can be born from a number of unique circumstances, so having the means to fight these cases not only protects your reputation but can give better peace of mind.

  • Understanding the Feared “Hammer Clause”

For those who do not know, hammer clauses can be particularly damaging when included in an insurance plan. While you still have every right to contest claims against you, this clause allows for insurance companies to pay up to the initial proposed settlement cost. Therefore, if a case cannot be settled, all additional expenses above and beyond the initial settlement cost are liable to be paid by the insured. Of course, this can create real financial strain as legal expenses are known to quickly climb. It is in a physician’s best interest to avoid these hammer clauses to the best of one’s ability. At the very least, awareness regarding their existence is of the utmost importance to the insured.

  • “Claims-Made” Vs. “Occurrence”? Which is Right for Me?

When applying for an insurance policy, be aware that every plan will outline a period during which claims can be filed. For the most part, these time periods are defined by the occurrence, but in the world of medical malpractice insurance, claims-made policies are frequently common.

  1. Occurrence
    1. Occurrence policies allow for claims made for injury and malpractice throughout the duration of the policy. Even if the policy has been canceled, claims filed regarding incidences during the lifespan of the policy are covered. Essentially, an occurrence is detailing the event that leads to an insurance claim being filed.
  1. Claims-Made
    1. The other likely option is a claims-made policy, which covers any claims made after a selected “retroactive date.” This is particularly useful for medical professionals, as it allows for one to change policies or providers without having any gaps in coverage during the transition period.

Each policy type has its respective strengths and weaknesses that cater to the individual’s unique circumstances. When selecting your plan, understanding these two scenarios is extremely beneficial. For more information regarding these types of plans, the American College of Physicians has posted a number of articles regarding malpractice insurance.

  • How are Claims Triggered for My Insurance Policy?

Claims can be triggered in one of two ways, written demand triggers an incident triggers. A written demand trigger allows for insurance carriers to avoid responsibility even if they have knowledge of an incident. However, once a written document has been filed for a lawsuit or settlement price, then the carrier must accept responsibility for the claim. The issue with this system is that physicians and medical professionals may get boxed in by their carrier. If both parties have knowledge of an incident but no legal action has yet been taken, there is an incentive for the physician to stay with their current provider. During this time, it is not unheard of for insurance companies to raise rates or modify coverage plans.

The other option, which is significantly more favorable, is called an incident trigger. Whereas written demand triggers require the third party to act before a claim can be processed, incident triggers force insurers to take responsibility the moment you report to them an event, regardless of significance. This way, your insurer must take responsibility for all claims based on that incident.

  • Privacy Liability: Checking with Your Provider

We live in a digital age. Almost all forms of information are stored electronically, and medical records, private information, and data are available at the touch of a button. However, with this new streamlined form of storage, there comes the risk of electronic security and breaches in privacy. It is important to understand your insurance plan and its relationship with privacy liability. Remember to check with your provider if they cover privacy and exposure violations. Unfortunately, most providers do not cover this, so standalone plans with other agencies are always an option.

  • What If My Insurer Cannot Pay?

Before picking a plan, make sure you understand your targeted provider’s current financial situation. Certain institutions may not be able to fulfill their agreed obligations to their clients and the responsibility of bill payment may fall onto you. Likewise, if your provider collapses and is unable to pay their debts, then the financial weight is transferred over to your shoulders. Make sure to gather some strong information about whichever carrier you decide to create a plan with.

For new physicians, picking out your first malpractice plan can be quite intimidating. However, there are more than enough insurance carriers for you to find one that fits your unique needs. Leveragerx.com has a great list of their top physician insurance agencies, but make sure to do extensive research before deciding anything.

Kelsey-Seybold Clinic, Houston’s premier multispecialty group practice, provides malpractice insurance for their providers at no cost. While employed, their coverage is $1M per claim/$3M aggregate. Upon departure, providers receive tail insurance at no cost. Kelsey-Seybold Clinic is rapidly growing with over 450 physicians, 55 medical specialties, and 24 clinics. For more information on Kelsey Careers visit https://kelsey-seyboldproviders.com/providers/

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