Complaints and claims against healthcare professionals – including surgeons/doctors in private practice – are an unfortunate fact of life these days. That is why having excellent medical indemnity insurance is so important. But are you getting the most out of your medical indemnity insurance? Do you know:
- Why using your medical indemnity insurance pro-actively can save you time and money – and help protect your professional reputation?
- How to avoid breaching the terms of your medial indemnity insurance – and losing cover altogether?
- How to educate your medical secretary and other colleagues about getting the best out of your medical indemnity insurance?
Some surgeons/doctors seem to forget they have medical indemnity insurance, or treat it as a last resort. We hear anecdotally that some surgeons/doctors deliberately avoid informing their insurers about potential problems, assuming that this will automatically result in higher premiums at renewal. But this is not the case! Medical Indemnity Insurance does not work in the same way as, say, car insurance. Reporting a precautionary notification is not the equivalent of getting points on your driving licence. Reporting a potential error, a complaint or a potential claim to a Medical Indemnity Insurer is a confidential process, and it does not carry any implication or inference that you accept you have done anything wrong. Insurers are much happier for you to have a dozen very precautionary notifications on their books that never develop into anything, than be told about one full blown claim far too late.
In reality, you should pro-actively involve your medical indemnity insurer as soon as you know about a potential error, complaint or claim. And this is especially so where your insurance arrangements include access to a proper medico-legal advice line. Medical indemnity insurers, and the medico-legal advisers who work alongside them, are very experienced in dealing with these issues, so they can help and guide you to resolve or mitigate the situation as quickly as possible. Also, your medical indemnity insurers and medico-legal advisers have the expertise to know when specialist lawyers are needed, so you get legal help at exactly the right time. Far too often, healthcare professionals delay in informing their medical indemnity insurers about a potential problem, thereby denying themselves access to specialist assistance that could save them time and money.
Of course, you can only get the best out of your medical indemnity insurance if you comply with all its terms and conditions. You need to know how to avoid inadvertently breaching the terms of your personal insurance policy, especially as some breaches can lead to you losing cover altogether. Like all insurance policies, your medical indemnity insurance requires you to inform your insurers (“notify” them, in the jargon) of any allegation of negligence, or anything which could indicate that a claim might be made in due course. The duty to notify without delay is sometimes so strict that if you fail to do so at the right time, your insurers can refuse to cover the claim at all. This could leave you liable to pay your own defence costs and any compensation due to the claimant; potentially eye-watering sums if they had to come out of your pocket.
Most self-employed surgeons/doctors have to apply for and purchase their medical indemnity insurers themselves. They will inevitably be asked whether they know of any errors, complaints, claims or issues that could give rise to a claim later on, and will no doubt answer honestly. If errors, complaints or claims come to your attention during the policy, Insurers have to be told straight away, and all surgeons should make sure they understand what their policy requires of them in that regard.
But are you always made aware of complaints or potential claims against you? Do you ever find yourself asking a colleague, “why didn’t you tell me sooner?” A really important way to get the most out of your medical indemnity insurance is to make sure your medical secretary also recognises when a problem might need to be referred to your medical indemnity insurers. Similarly, if you work in a private hospital or clinic, you may need to be pro-active in getting the hospital’s management or legal department to keep you properly up to date about patient complaints as they develop. The patient may have indicated to the hospital that a claim against you is contemplated (for example in the course of requesting medical records), but time and time again nobody at the hospital actually informs the self-employed surgeon/doctor.
So what do Insurers need to be told about? Experienced practitioners will be used to dealing with patients who voice some dissatisfaction. You need to recognise when things have gone further and become something that Insurers might need to know about. Depending on the exact features of your practice and the exact wording of your policy, you will probably have to notify insurers as soon as you become aware of a claim or a ‘circumstance which could lead to a claim’. A claim can include any allegation of negligence, or even just an assertion from a patient that they are entitled to compensation. You (and your secretary or colleagues) need to be alert even to spurious allegations or assertions, whether made in writing, over the phone or in a consultation. As for ‘circumstances that could lead to a claim’, examples could include a situation where you or a colleague notice that a mistake has been made in a procedure that could have consequences for the patient in due course. Insurers may need to be informed even if the patient has not yet complained. Most surgeons/doctors have the Duty of Candour at the forefront of their minds, but too many forget that their insurers also need to be informed of these incidents straight away.
How can Incision help?
Incision insureds have access to a dedicated medico-legal/notifications service staffed by specialist dual-qualified doctors/lawyers. For Incision members, help and guidance about any of these issues is only ever a call or email away. Incision members also have access to detailed guidance and learning materials, and this article is a shortened version of more detailed materials available only to Incision members.
*Article originally published in February 2020