Claims not covered in a doctor’s professional indemnity
A Doctor’s Professional Indemnity Insurance (PI) protects the insured against breach of duty or negligence. It saves the legal cost incurred while fighting liability claims.
Thus, doctors need to scrutinize the scope of the coverage offered and understand the exclusions carefully.
Following claims not covered in a doctor’s professional indemnity :
The Doctor’s Professional Indemnity Policy does not cover intentional negligence or malpractices like the insured doctor issuing false certificates.
Moreover, the policy does not apply to instances where the insured has provided misinformation about clinical records for deceiving the insurer. It also does not protect someone who provides professional services without valid certification or registration.
Weight reduction procedures (Bariatric Surgery)
This insurance does not cover weight reduction surgeries like gastric bypass surgery. However, if you inform the insurer upfront that you conduct these surgeries you have a possibility of being covered.
Practising under influence of alcohol or narcotics
Consultation provided or operations done under the influence of drugs or intoxicants will not be covered under this insurance.
The policy does not cover claims related to cosmetic or plastic surgery, hair transplants or cosmesis. However, cosmetic surgeons can declare before buying the insurance and get coverage. Many insurers do not insure this speciality or will charge a high premium as cosmetic surgery is considered the riskiest of specialities.
The policy will not cover violation of legal compliances, for instance, prenatal sex determination. Besides, if the information in the proposal form doesn’t match the doctor’s actual practice there are high chances the claim will be rejected. Coverage will not be provided for criminal offences like illegal abortion, organ trade or prescription of prohibited drugs.
The insurer will investigate if the doctor became aware of an issue before the policy was bought or the retroactive date. Hence, while buying the policy the insurer must be informed of all known issues.
Prior period exclusions
Claims for incidents that have taken place before the retroactive date (policy issue date) will be rejected.
AR Hospitals Pvt Ltd filed a professional indemnity insurance claim. The hospital’s doctors and staffers were accused of conducting prenatal sex determination. Although the hospital denied the accusation, the insurer rejected the claim. There appeared to be compelling evidence that sex determination was being conducted. The insurer denied the coverage as it is a criminal offence and is excluded under the policy. However, the insurer did state that if the courts were to absolve AR Hospitals, they would pay the claim.