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Claims made policy info


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#1 ventana

ventana

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Posted 20 September 2016 - 01:13 PM

So recently noticed a lot of PAs are getting job offers and posting on this forum about the claims made policy specifics

 

I am not an insurance person, or attorney, or paralegal, but have in fact have owned my own practice, and am aware of the "finer points" that i have learned.  So I figured I would share what I know

 

 

First - claims made versus occurrence.  

 

You auto policy is occurrence - if you have the insurance in effect when you get in an accident - you are covered - even if takes the injured party 3 years to file a claim.  The policy covers the  "occurrence".  These policies are usually a little higher premiums, but you never need a tail when you leave a place of employment.

 

 

 

 

Second Occurrence

This policy has to actually be active when a claim is made for it to cover - and the date of service has to be after the policy started.  

This is the policy where you need to purchase a "tail" to cover you if you leave the practice** - or stop the policy.

 

 

** is the biggest issue and this is where it gets sticky

This will not be your policy, it is the Doc's and you are listed(or possibly not) as an additional insured, but not THE insured.  Therefor when you leave the practice there  is no change in the employment status of the primary insured (the doc) and the policy remains in effect as long as the doc continues to pay it, and keep it going.  

This obviously creates a situation outside of the PAs control - if you wanted/needed to be 100% sure you were covered you would have to either 1) have your own tail - likely $5,000-$15,000 to purchase or 2) purchase your own policy where you (the PA) are the primary insured - (with the same decisions of Claims Made - v - Occurrence to be decided by you the PA.

 

As the Doc is protected as long as he/she continues to keep their claims made policy in effect they have ZERO interest in providing any further coverage to you.  Hence the very sticky dilemma.

 

One simple solution is to have in your written signed contract as simple statement that "employer will be solely responsible for providing and maintaining all medical malpractice policies to ensure there is always an active policy protecting the PA and will indemnify the PA for any injury sustained if this is not accomplished"

I am not an Attorney so this wording is probably wrong, but the idea that needs to get put across is that the employer is 100% responsible for medical malpractice coverage for ALL acts for ever that result from your employment.  This way if the doc ever drops the insurance, and does not have a policy that protects you - you can sue them and they will be liable for it.    

 

Another possible is to have written in your contract that the employer will pay for a tail policy - very reasonable given that they are the one's saving money by doing claims made instead of occurance 

 

Another possible is to have the employer pay for your own "occurrence" policy so that you are covered no matter what

 

A final option is one that I have personally used in the past.   Trust the doc is NEVER going to let the insurance lapse on themselves as they likely have a huge nest egg to protect and they could loose all that if they don't have insurance.  In my case it was for a sub specialty group, (very high paying speciality for the doc's not me) and I left in < 2 years.  I felt comfortable that they would never expose the doc to such liability, and it was after the fact that I learned all this.  So I crossed my fingers and moved on.  Not advisable to do this, but the statue of limitations is up so it worked out just fine.  Remember that we are "Dependent Practitioners" and we can not practice with out the doc, so the doc can be left holding ALL the responsibility.

 

 

 

It all comes down to $$ - sure it is best to carry your own policy - but that might be $3,000 to $20,000+ per year - and when our typical salary is $100,000 that is 3-20% of income - for a benefit which should be paid by the person/entity making money off your services. 

 

 

 

If I am wrong in any of this please let me know so that I can change it

 

If you have more info or specifics on costs please post

 


  • bk84nation, AbeTheBabe and mgriffiths like this

The Fine Print - you didn't pay for my advice so please consider this when reading it. I don't care about typos so don't tell me I can't type.:eek:

I vote for a PA-MD bridge program for IM with 1 yr academic then 2 years residency for IM board cert only, or Full Practice Responsibility and staged independent practice.

Jeff Kellogg, MBA, MS, PA
UMASS 2000, UNMC 2009, AMC/HVCC 2002
Founder Berkshire Mobile Medicine

 

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