In Australia, there is an increasing need for medical practitioners, medical centres and day clinics to have medical indemnity insurance. With the ever changing healthcare industry, doctors and health administrators need choice, innovation and greater flexibility in protecting their business.
There are many facets to Medical Indemnity Insurance
An average of 11 Australian medical practitioners a day face allegations that result in a medical indemnity insurance claim, according to recent figures from the Australian Institute of Health and Welfare (AIHW). Here are the top quite common 15 specialty areas that medical practitioners deal with medical indemnity claims and costs. These medical practices are closely involved in incidents that have led to new medical indemnity claims over the years.
1. General practice
2. General surgery
3. Orthopaedic surgery
4. Obstetrics and gynaecology
5. Emergency medicine
6. Anaesthesia
7. Plastic and reconstructive surgery
8. Psychiatry
9. Diagnostic radiology
10. Cardiology
11. Gynaecology only
12. Ophthalmology
13. General medicine
14. Neurosurgery
15. Paediatrics
Medical Indemnity Claim Tips
Here are some practical tips to help you avoid the aggravation and stress that a medical indemnity claim can bring:
1. Always refer your patients to other specialists to seek a second opinion
2.Take a full patient history that includes pertinent social, psychological, and cultural issues.
3. Recognise and respect the patient's right to make their own decisions and encourage them to manage their own healthcare.
4. Stay within your limits of scope of practice and competency
5. Keep adequate records and always have a clear channel for communication.
6. Be kind and empathetic
7. Never let your personal views adversely affect your patient's care.
Two Core Elements of Cover
For registered healthcare professionals (doctors, dentists, optometrists, nurses etc), medical indemnity has two core elements of cover:
1. Civil claims - the policy covers the practitioner's legal liability arising from demands for compensation alleging a breach of professional duty (e.g. error during treatment of a patient). Cover includes legal defence costs to defend or settle the claim and the compensation awarded to the plaintiff. Doctors are usually insured for $20 million any one claim and in total for the policy year, other practitioners usually purchase $5m, $10m or $20m.
2. Non-civil matters - the policy will usually also extend to cover the costs of legal representation for disciplinary (eg. a medical board matter), and coronial inquiries. Some insurers further extend cover to matters such as VMO and employment disputes, medicare and health fund audits. The policy usually has a sub-limit and this varies widely by insurer. The sub-limit can be as low as $100,000 but most insurers provide $250,000 to $500,000+
Is there a 'Rolls Royce' policy?
Policy coverage and amounts vary considerably by insurer and there is no single policy that is 'better' than any other policy in every respect. On top of this, the practitioner's individual circumstances and needs will mean looking at policy coverage against your needs and practice risks. Some other considerations outside of what's in the policy include:
Quality of claims service and the philosophy of the insurer.
Experience of in-house and panel legal firms.
History of the insurer's ability to provide stability of pricing
Does the insurer provide any discounts for getting started in private practice, loyalty, or any other discount that may be relevant.
Access to medico-legal advice.
Other benefits provided outside of the insurance policy.
Medical indemnity legislation and environment
Medical Indemnity is one of the most complex areas of general insurance and is often the most misunderstood. There is a raft of legislation which is designed to protect registered healthcare practitioners (and patient's rights to seek compensation when mistakes occur). Some of this includes:
National Registration - Professional Indemnity Insurance (PII) Registration Standards
Registered healthcare professionals in Australia are required to hold medical indemnity cover that complies with the 'PII Registration Standard' set by the relevant board. The standards can be found on APHRA website. Some of the features of the standards can include:
1. The insurer must be an approved or APRA regulated insurer (see below)
2. A certain cover amount (usually $5m, $10m or $20m) or an amount 'sufficient for the risk'.
3. A requirement for retroactive cover to cover all past practice and availability for run-off cover.
