Doctor’s professional indemnity insurance protects the insured against breach of professional duty, negligent acts and error or omission performed by doctors and medical establishments. The PI insurance policy saves the legal cost incurred against fighting professional liability claims.

It is important for doctors to scrutinize the scope of coverage offered by doctors professional liability insurance hence it is important to read the list of exclusions carefully. Following are the list of exclusions under doctors professional indemnity insurance:

1. Willful Conduct: Doctors liability policy does not cover fraudulence and intentional negligence. Malpractices like false certificates or if the insured provides incorrect information about clinical records in order to deceive the insurer or if someone is performing professional services without valid certification or registration. Such dishonesty will not be covered under doctor’s professional indemnity insurance.

Read About: How much Doctor’s Professional Indemnity Insurance Costs?

2. Weight reduction procedures (Bariatric Surgery): Doctor PI insurance does not cover any weight reduction surgery such as gastric bypass surgery.

3. Any surgery performed under the influence of alcohol or narcotics: Any consulting or operation done under the influence of drugs and intoxication will not be covered under the insurance.

4. Cosmetics procedures: Claims related to cosmetic plastic surgery, hair transplants or any kind of surgery related to cosmesis are not covered under the policy.

5. Unlawful Practices: Violation of any law compliance, for example, prenatal testing, is not covered under doctors professional indemnity insurance. If the information in the proposal form is different from actual practice you run, the risk of claim rejection is very high. Criminal abortion with the illegal method, trading of live organs for transplant or prescription of prohibited drugs are considered a criminal offence and it will not be covered policy.

6. Known Issues: Claims that come about from an issue that was known before the insurance was bought are rejected. The insurer will cross-examine the case closely to see when the doctor became aware of the matter. This can be addressed by clearly describing any known issues when you buy your first professional indemnity cover.
7. Prior Period exclusions: Claims occurred before the retroactive date are not covered. Retroactive date is the policy issuance date and the policy will cover claim which occurred on or after retroactive date. All prior period claim issues will not be covered under the policy.

Also Read: Importance of Doctors Professional Indemnity

Case Study: AR Hospitals Pvt Ltd has bought the professional indemnity insurance for the medical establishment and staff. The doctors and staff have been accused of prenatal sex determination or disclosure. The hospital is not accepting the accusation and claiming they are innocent. They reported the legal case filed against the clinic to the insurer.
Unfortunately, the insurer rejected the claim under the purview of a criminal offence. Since criminal offence like illegal sex determination is an exclusion in the policy, the insurer will not bear any defence cost.
Professionals like doctors may commit mistakes unintentionally which can cause financial losses and legal cases against them. It is important to opt for wider coverage and optimum sum insured.