Are you getting the most out of your Medical Indemnity Insurance?

Complaints and claims against healthcare professionals involved in abdominal wall reconstruction – including self-employed surgeons – are an unfortunate fact of life these days. That is why having excellent Medical Indemnity is so important. But, are you getting the most out of your Medical Indemnity?

This session will cover:

  • 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 Medical Indemnity insurance.
  • How to educate your medical secretary and other colleagues about getting the best out of your Medical Indemnity insurance.

Some surgeons seem to forget they have Medical Indemnity insurance, or treat it as a last resort. We hear anecdotally that some surgeons deliberately avoid informing their insurers about potential problems, assuming that this will automatically result in higher premiums at renewal. This is not the case. Medical Indemnity insurance does not work in the same way as car insurance, for example. 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. It does not carry any implication or inference that you accept you have done anything wrong. Insurers are much happier to have a dozen precautionary notifications on their books that never develop, than be told about a 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. Especially 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. 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. This presentation will explain and illustrate when you should involve your insurers, and why their early involvement can prevent a problem; which could waste your professional time or damage your relationship and reputation with patients and colleagues.

Of course, you can only get the best out of your Medical Indemnity 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. This presentation will highlight the most important features of Medical Indemnity insurance policies and how you can make sure you comply with them.

Here is a taster of the considerations we will discuss in the presentation. Like all insurance policies, your Medical Indemnity requires you to notify your insurers 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.

As a self-employed surgeon, you are likely to have to apply for and purchase your Medical Indemnity yourself. You will inevitably be asked whether you 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 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. We will use some case study examples in the presentation to demonstrate what sort of situations may need to be referred to insurers, and how to make sure your medical secretary and any other staff you work closely with is trained to recognise them.

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 precise 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 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 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.

About the author

Joanne Staphnill, Partner - DWF LLP

Joanne Staphnill

After reading Law at Cambridge, Joanne was called to the Bar in 2003 and her work in pupillage included many clinical negligence and high-value personal injury cases. She re-qualified as a solicitor in 2006, and since then has regularly defended clinical negligence claims and has excellent experience in resolving claims through the pre-action protocol, alternative dispute resolutions and through the courts. Joanne always aims to understand whether a claim may affect the clinician’s professional reputation and takes pride in guiding clients who are unfamiliar with the legal process. Joanne and the DWF team continue to provide legal assistance and support and she produces extensive risk management materials for Incision members.