Your Malpractice Insurance Covers More Than You Think

By Gregg Moore | Posted November 5, 2014

Your medical professional liability policy is no longer just a contract to protect and defend should you, or your practice, be involved in a malpractice action. It is also a portal to information and services to help you understand and mitigate your professional and regulatory liability exposures, and in some cases, even increase practice revenues.

Are You Aware of What is Included in Your Insurance Policy?

We recently encountered a physician who did not realize there was coverage endorsed to their standard malpractice insurance policy for defense costs, should there be an encounter with a Medicare/mMdicaid auditor from a government payer.

We find there are many insureds who are unaware that basic coverage for this exposure may be included in their policy, or the estimated cost to defend, should this exposure turn into a real liability. With the inception of Medicare’s Recovery Audit Contractor (RAC) program in 2009, many professional liability insurance companies sought to fulfill a need by extending legal defense coverage to their insureds, whose practice may be faced with an audit for billing errors. Policy endorsements typically include limits between $25K-$50K, depending on the insurance company. The aggregate limit is determined by the number of physicians in the practice.

However, the average cost to appeal a RAC audit is about twice as much, between $50K-$80K, and the average time to appeal is about two years. While most medical malpractice policies are endorsed to include some coverage for this type of event, you could find yourself “self-insuring” if additional coverage is not purchased.

This is just one of the coverage enhancements added as an endorsement to many standard policies in the last few years.

Other Coverage Enhancements

If you are in a specialty or territory that is being aggressively audited, now is the time to take a look at your insurance policy and determine if you would like to “buy-up” or upgrade this coverage endorsement–a new option for many standard insurance companies. This will help bridge the gap between the basic coverage and limits in place and the actual cost to defend, and is often less expensive than purchasing a separate policy with the same coverage components.

Insurance companies have become more physician-oriented as evidenced in the new breed of MPL insurance policies. You may also have coverage for cyber liability exposures, access to an HR consultant and resources specifically geared toward the healthcare industry, availability of Risk Management for CME credits, and much more. Gone are the days of even having to purchase tail coverage when you retire from the practice of medicine, depending on your contract with your employer and the insurance company with whom you are insured.

Why Have An Agent?

As physicians and practices focus on providing high quality care to their patients, and meeting the requirements of an ever-changing regulatory world, having an insurance agent is vital to help save time and money when it comes to one of the biggest purchases of your practice. The physician mentioned in the scenario above, might have put a retainer on a lawyer should any audits arise for their defense, not knowing they had some basic coverage already in their policy if they need it. An important focus of Professional Risk Associates is identifying the best professional liability insurance program for our clients and assisting them in understanding and utilizing all of the benefits and services provided by their insurance company. If you have any questions or would like to speak with an agent about your policy, contact us today! Toll free: 800-318-9930 or visit us online.