How professional indemnity insurance can protect doctors against legal liability?

“Recently, the Surat District Consumer Disputes Redressal Forum held a doctor guilty of medical negligence and asked him to pay Rs 4.8 lakhs with 9% compound interest and Rs 1.5 lakh to relatives.”

After reading this news, many of you must be thinking, what is new in it? After all, the death of the patient due to a doctor’s negligence is a common thing of the today’s time. However, what differentiates this news from the rest of the cases is that the guilty doctor had bought a professional indemnity insurance cover from one of the leading insurance companies.

An alarming situation

A constant fear of getting caught in medical negligence cases and inane charges from patients and their relatives is driving doctors to get themselves insured for negligence. Many times, relatives become aggressive and even end up beating doctors. Some even come up with the mob and vandalise hospital or clinic.

According to a 2013 survey, by Dr. Ashish Jha of Harvard School of Public Health, India recorded 5.2 million medico-legal cases a year, ranging from incorrect prescription, wrong time, wrong surgery, wrong drug to the wrong dose.

Doctors are in the dock now. Lawsuits filed by patients and their relatives are jamming up courtrooms throughout the nation. As per NABH study, 98,000 deaths/year from medical injuries occurred in India a few years ago. According to Mr. Mahendrakumar Bajpai, Advocate, Supreme Court, New Delhi, more and more patients are now suing doctors for alleged negligence and challenging their expertise. He further added that such medical cases have doubled since 2014.

The names of doctors splashed across newspapers, television screens and internet across the country. It is the kind of ‘publicity’ that every doctor dreads. Thanks to the internet, many patients, and their relatives are challenging the treatment of their doctor on the basis of their internet research.

how-professional

With public awareness; claims and litigation are increasing at an unprecedented rate. According to Dr Girish Tyagi, Registrar of Delhi Medical Council, the authority who deals with such cases, the number of medico-legal cases from overcharging, needless procedures has increased from about 15 complaints in a month to 40.

The dismay number of doctors in India is also one of the reasons behind the rise in medico-legal cases. As per the Medical Council of India, the doctor-population ratio in India is 1:1681.

Patient power

It is not that a doctor is always at fault. There are good doctors and there are bad doctors, just as there are good patients and bad patients. In some cases, patients are filing cases of medical negligence only because they want their fees to be waved off.

Some scenarios of doctors facing litigation are a patient’s alleging negligent diagnosis or giving sub-standard course of medical treatment. In many cases, doctors face legal action, irrespective of whether they were at fault or not.

The dread of litigation is so high that now many corporate hospitals have also made it compulsory for doctors to buy professional indemnity insurance if they want to work as a consultant. At present, top surgeons, anesthetist and obstetricians are insured for medical negligence.

A way out: Professional indemnity insurance policy

It is always good to have a professional indemnity insurance because of the rise in the number of litigation. Many times, frivolous charges are foisted and physicians are left to fend for themselves in the court. During this time, professional indemnity insurance acts as a boon. The policy covers court cost like lawyer fees, compensation paid by doctors and other expenses incurred in the investigation. Insurance companies offer cover for bodily injury or death of the patient due to omission, error or negligence in the professional service of the doctor, malpractice, negligence, incorrect diagnosis and poor judgement. The policy gets triggered as soon as the notice is served to the insured doctor.

A quick look at benefits of a professional indemnity insurance:

  • Wide coverage against various kinds of risks and losses
  • Provides for legal expenses and cost incurred
  • Hassle-free documentation
  • Option of mid-term increase or decrease in the sum insured

How to choose the correct sum insured?

In doctor’s professional indemnity insurance policy, the sum insured is relatively known as the limit of indemnity. This limit is fixed per accident and per policy tenure, which is known as ‘Any One Accident’ (AOA) and ‘Any One Year’ (AOY) limit. You can choose the ratio of AOA limit to AOY limit from the following:

  • 1:1
  • 1:2
  • 1:3
  • 1:4

The AOA limit, which is the maximum amount to be paid for each accident, should be decided taking into account the nature of the accident and the doctor’s specialty, etc.

How premiums are determined?

The premium of a professional indemnity insurance policy depends on various factors like doctor’s specialty, seniority, practice, equipment used, etc. For a surgeon, the policy can cost anywhere between Rs 50,000 to Rs 1 crore. For physicians and other category of doctors, it is relatively cheaper. A majority of the insurance policies offer coverage for once a year. Every year, the doctor has to enter into a fresh agreement.

Exclusions

While doctor’s professional indemnity insurance offers wide coverage, here are some events which are not covered:

  • Any criminal act, fines and penalties
  • Use of drugs for hair transplants, weight reduction, cosmetic plastic surgery and the similar procedures
  • Any dishonest, fraudulent criminal or malicious act
  • Any condition associated with AIDS

“Doctors have an ethical duty to follow the practices and standards of care”: Bob Mcdonnell, An American Politician

Indian patients still treat their doctors as incarnation of God, but slowly, the situation is changing. At the end of the day, doctors too are human. Therefore, it makes complete sense to go for a professional indemnity insurance to secure your profession against all trivial complaints.

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