The Doctor’s Professional Indemnity policy has various clauses. Here we will look at the ‘Claims Series’ clause.
The claims series clause plays a crucial role in determining the limit of deductible payable for the insured.
Key Takeaways
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Single Deductible Advantage: If a patient sues you twice for the same surgical error—once for the initial pain and later for a permanent disability—the Claims Series Clause ensures you only pay the deductible for the first notice. The second claim is treated as an extension of the first.
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The 3-Year Boundary: This clause has a “time-out.” If a related complication arises after 3 years from the date of the first claim, it is no longer bundled. You may have to pay a fresh deductible, and it might be treated as a separate incident altogether.
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The “One Cause” Anchor: The insurer’s surveyor will investigate if the multiple claims are truly related. As seen in the case study, because the organ damage was a direct result of the same wrong medication as the initial allergic reaction, the second deductible was waived.
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Aggregation of Loss: When multiple claims are bundled, they are usually capped by a single AOA (Any One Accident) limit. This is why having a robust 1:1 AOA: AOY ratio is so important in 2026.
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Universal Application: While we are discussing doctors here, this clause is a standard feature across all professional liability lines, helping consultants and establishments manage “serial losses.”
Accumulated claim amount
This clause is applicable when different claims arise from the same cause of neglect, error, or omission. In such cases, the insurer adds all claim amounts. This determines the allocation of deductibles.
Let’s look at this instance. A hospital got a Rs 50,000 compensation demand for negligence. However, the patient suffered a complication and had to undergo an operation. This cost the patient an additional Rs 2 lakh. Since both claims arose from the same case of negligence, the hospital was asked to pay a single deductible for the first claim. The deductible limit was not applicable for the second claim.
This clause, however, works on one condition. It will not be applicable for any other claim that arises due to the same cause after 3 years of the first claim.
Read About “Claims Made and Reported” Clause in Professional Liability Insurance Policy
Let’s look at another instance. A hospital reported a claim under the DPI Insurance policy in 2010. It later renewed the policy for 6 years and made another claim due to the previous incident in 2015. This claim was, however, raised after 3 years. So, the deductible limit did not apply to the second one.
Summary: The Claims Series Clause
Case Study
A doctor at A.B. Hospital is accused of prescribing the wrong medication, leading to an allergic reaction in a patient. The doctor’s professional indemnity policy covered the claim amount after the insured paid the deductible. However, six months later the patient came to know that excessive intake of prescribed medicines had damaged an organ.
However, this time the insured doctor was not asked to pay the deductible amount since the second claim was related to the previous incident. Thus, the insurer bore the legal costs without the insured paying any deductible.
The Claims Series Clause is applicable in all liability insurance policies. It determines the coverage amount that the insured has to pay due to a series of losses.
Frequently Asked Questions (FAQs)
Q1: What happens if ten different patients sue me for the same technical error?
A) If a single systemic error (like using a contaminated batch of medicine) affects ten patients, the Claims Series Clause treats all ten lawsuits as one single claim. You pay the deductible only once, but the total payout for all ten patients will be limited by your single AOA (Any One Accident) limit.
Q2: Does the “3-year rule” apply to the date of surgery or the date of the first claim?
A) The 3-year clock typically starts from the date the first claim was reported to the insurer. Any subsequent claims arising from that same original cause within the next 36 months will be bundled into the same series.
Q3: If I change my insurer after the first claim, will the new insurer honor the “Claims Series” for the second claim?
A) This is a complex scenario. Generally, the insurer who was “on risk” at the time of the first claim (the one who received the first notice) is responsible for the entire series, even if you have since moved your policy to a different company.
Q4: Is the 3-year rule standard in all 2026 policies?
A) While 3 years is the industry standard, some premium “tailor-made” policies for large hospitals might offer a 5-year window. Always check your specific policy schedule to confirm your “Series Window.”
Q5: Can the insurer reject bundling if the second claim is much larger than the first?
A) No. The size of the claim doesn’t matter. What matters is the Proximate Cause. If the legal and medical investigation proves both claims stem from the same “neglect, error, or omission,” the insurer must bundle them according to the clause.
About The Author
Saloni Mishra
MBA Insurance Management
With an illustrious career in the insurance sector, Saloni is a distinguished writer specializing in articles concerning doctor professional indemnity policies for SecureNow. Leveraging 12 years of hands-on experience, she understands the intricate nuances of professional indemnity insurance tailored specifically for medical professionals. Her articles offer invaluable insights into the significance of doctor professional indemnity coverage, addressing the unique risks and challenges healthcare practitioners face. Renowned for their expertise and attention to detail, Saloni is committed to providing readers with informative and actionable content that empowers them to make informed decisions regarding their insurance needs.
