Doctors often undertake life-saving treatments and diagnoses. However, mistakes can occur in their diagnosis of an illness or in its treatment. In such cases, the patient may suffer severe consequences. These often lead to liability claims against doctors who are held responsible for the patient’s financial losses. So, How to file a claim under a doctor’s professional indemnity policy?
Key Takeaways
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Notification is Time-Critical: In 2026, most DPI policies require you to notify the insurer as soon as you become aware of a potential claim. Waiting until the first court hearing to tell your insurer can lead to claim rejection due to “Delayed Intimation.”
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Reimbursement vs. Cashless: While many policies traditionally work on a Reimbursement Model (you pay the lawyer first, then the insurer pays you), some modern insurers offer Cashless Defense if you use their pre-approved panel of medico-legal experts.
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The “Retroactive” Filter: Before processing a claim, the insurer will verify if the medical incident occurred after the Retroactive Date and during the policy period. If you had a break in your policy, an incident from that gap period will not be covered.
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Evidence is Everything: The court summons is only the start. To win (or settle) a claim, you must provide the original Patient Consent Forms, treatment records, and discharge summaries. Incomplete medical records are the #1 cause of lost malpractice cases.
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Avoid “Direct Settlements”: Never admit liability or offer a private financial settlement to a patient without the insurer’s written consent. Doing so can void your policy, as insurers have the “Right to Defend” the case themselves.
Such claims come in the form of lawsuits and put doctors under financial stress. A doctor’s professional indemnity insurance helps doctors cover legal costs as well as pay for third-party settlements.
Claims that can be filed under a doctor’s professional indemnity insurance include medical malpractice, negligence, breach of duty, misdiagnosis, and errors or omissions in treatment. The policy may also cover legal expenses and compensation for damages or injury caused to patients as a result of the doctor’s actions or inactions. So, if you face malpractice litigation, you need to raise a doctor’s professional indemnity insurance claim. Do you know the process?
Here are a few simple steps that you need to follow –
Inform the insurance company
The first step is to inform the insurance company as soon as a lawsuit is filed against a doctor or a medical establishment. The company then registers the claim and begins the process.
Arrange for legal defense
You can hire your own defense counsel or allow the insurance company to do so if the same is covered under the policy. The legal costs will be covered by the doctor’s professional indemnity policy.
Seek reimbursements
This policy works on the reimbursement model. It requires you to first incur the expenses and then file the claim. However, with some insurers that have their own panel of lawyers, the process can also be cashless.
File the claim under a doctor’s professional indemnity
The final step is to file a detailed claim with the insurance company. Fill up the claim form and submit it along with the supporting documents. This will help the insurer to process your claim and settle it at the earliest.
Additional Read: Which doctors suffer the highest malpractice claims?
Supporting documents
The documents you will need to submit along with the claim are as follows:
- Duly filled and signed claim form
- Copy of professional indemnity insurance policy
- The court notice or summons received
- Original proof of costs incurred in defending the lawsuit
- Court order or any written proof specifying the settlement amount
- Bank details of the policyholder for sending reimbursement
- Any other document the insurer may seek depending on the nature of the claim
Rejection of claim under a doctor’s professional indemnity
There are some instances when the claim gets rejected. This happens when the claim is made for a policy exclusion or for a period during which the coverage was not available.
The claim can also be rejected if the policy has lapsed or the process has not been followed properly. It could also happen if all policy documents have not been submitted.
To summaries, doctors are prone to lawsuits due to the nature of their work and the high standards of care expected of them. Medical procedures and treatments can have serious consequences, and patients may file lawsuits if they feel they have been harmed due to a doctor’s negligence, malpractice, or failure to meet professional standards.
Summary: The DPI Claim Process
How SecureNow can help in filing the claim under a doctor’s professional indemnity?
You can contact SecureNow’s claim advisory for easy settlements, even if you are not a client. SecureNow has the technical expertise required to get your rejected or delayed claims settled.
We can provide you with information about the claim process and the documents required to file the claim. Moreover, SecureNow enjoys deep ties with all insurance companies and can coordinate with these companies to get your claim settled. So, to buy a suitable doctor’s professional indemnity policy or to get assistance with claims, you can visit www.securenow.in or call 96966 83999.
Frequently Asked Questions (FAQs)
Q1: What happens if a patient threatens me with a lawsuit but hasn’t filed it yet?
A) You should still notify your insurance company. Most policies include a “Notice of Circumstances” clause. If you inform them of the threat now and a lawsuit is filed six months later, it will be treated as a valid claim linked to your current policy.
Q2: Will the insurance company pay the compensation directly to the patient?
A) In most cases, if there is a court order or a signed settlement agreement, the insurer will pay the third party (the patient/family) directly. If you have already paid the amount under a court directive, the insurer will reimburse you.
Q3: Why would a DPI claim be rejected even if I have a valid policy?
A) The most common reasons for rejection include:
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The act was deemed willful or fraudulent.
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The doctor was under the influence of alcohol or drugs.
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The procedure performed was outside the doctor’s declared specialty.
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A “Retroactive Date” breach (the incident happened before you started the insurance).
Q4: Does the policy cover the cost of an “Expert Witness”?
A) Yes. If your defense requires a specialized medical expert to testify that your line of treatment was standard protocol, the professional fees and travel costs of that witness are usually covered under the “Defense Costs” section of the policy.
Q5: Can I choose my own lawyer, or must I use the insurance company’s lawyer?
A) Most policies allow you to choose your own counsel, provided their fees are “reasonable and customary.” However, using the insurer’s panel lawyers is often smoother as they are already familiar with the insurer’s billing and reporting requirements.
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.
