A Doctor’s professional indemnity insurance (PI) protects the insured against breach of professional duty, negligent acts and errors or omissions by the doctor and medical establishment. The PI insurance policy saves the legal cost incurred while fighting professional liability claims.
It is important for doctors to scrutinize the scope of coverages offered by doctors professional liability insurance hence it is necessary to read the exclusions carefully.
The following are the list of exclusions under doctors professional indemnity insurance:
1. Willful Conduct:
Doctors indemnity policy does not cover fraudulent and intentional negligence. Malpractices like false certificates issued by the insured, 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 is not be covered under the PI policy.
2. Weight reduction procedures (Bariatric Surgery):
Doctor professional indemnity insurance does not cover weight reduction surgery such as gastric bypass surgery.
3. Practice under the influence of alcohol or narcotics:
Any consultation provided or operation done under the influence of drugs or intoxicants will not be covered under the insurance.
4. Cosmetic procedures:
Claims related to cosmetic or plastic surgery, hair transplants or any kind of surgery related to cosmesis are not covered under the policy.
5. Unlawful Practices:
Violation of any legal compliance, for example, prenatal testing, is not covered under doctors professional liability insurance. If the information in the proposal form is different from actual practice you run, the risk of claim rejection is very high. Illegal and criminal abortion, trading of live organs for transplant or prescription of prohibited drugs are considered criminal offences and will not be covered under the policy.
6. Known Issues:
Claims that arise 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 or incidents that occurred before the retroactive date are not covered. Retroactive date is the policy issuance date and the policy will cover claims which occurred on or after retroactive date. All prior period claim issues will not be covered under the policy.
AR Hospitals Pvt Ltd has bought a 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 have 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 legal cases against them and financial losses. Hence it is important to buy doctors professional indemnity insurance opting for wider coverage and optimum sum insured.