A Doctor’s Professional Indemnity insurance policy covers instances of death, physical injury, or disability due to medical negligence or unintentional errors. The policy covers legal costs in case of lawsuits. It also bears settlements associated with such cases.
The Doctor’s PI Policy claims are of the type known as legal liability. This policy covers only civil liability claims. The claim will not be payable if there is criminal liability involved.
Key Takeaways
-
Immediate Intimation is Mandatory: In 2026, insurers are strict about timelines. You must notify the company the moment you receive a legal notice or summons. Delaying this notification can give the insurer grounds to reject your claim.
-
The Duty of Care Principle: A successful claim requires proof that the incident happened while you were professionally responsible for the patient. If the negligence is proven to have caused suffering or death, the policy covers the resulting financial fallout.
-
Continuous Coverage Matters: Your Retroactive Period is your most valuable asset. It allows you to claim for an incident that happened 3 years ago, provided you have been renewing your policy without a single day’s break.
-
AOA:AOY Calculation: Every payout is deducted from your total annual limit (AOY). For example, if your AOY is ₹1 Crore and you settle a case for ₹40 Lakhs (AOA), you only have ₹60 Lakhs left for any other claims that might arise during the same year.
-
Written Records are Proof: When raising a claim, your first interaction must be in writing. This creates the “documentary proof” required for auditors and legal teams to start the reimbursement or cashless defense process.
Conditions
A civil liability claim will fall under this policy when the patient or the family provides prima facie evidence of the doctor’s negligence that resulted in injury or death.
Besides, the negligence should have occurred while the doctor was on duty to care for the patient. The claim also covers negligence causing death or suffering to the patient.
How to raise a claim under a Doctor’s PI Policy?
In case of liability, the insurance company should be immediately notified. The insured must submit all notices and summons received.
The doctor can either hire a legal defense or ask the insurance company to do so. However, the policy should cover the same.
The incident should take place during the policy period of the retroactive period. The latter is the period when the doctor has had continuous coverage.
The insured should make the first claim in writing for documentary proof. The AOA (Any One Accident) limit determines the claim amount.
The claim amount is removed from the AOY (Any One Year) limit. This is termed AOA: AOY under the policy.
The insurance company will accept multiple claims provided the aggregate amount does not cross the policyholder’s AOY limit.
Summary: The DPI Claim & Coverage Framework
Exclusions
The policyholder should also be aware of the exclusions in this policy and avoid making claims for them. Moreover, the insurer rejects such claims.
A Doctor’s PI Policy covers a medical practitioner’s personal financial liability. This policy is available for various types of medical establishments and consultants like General Physicians, and specialists such as Radiologists, Pediatricians, Cardiologists, and various kinds of Surgeons and Dentists.
However, policyholders should acquaint themselves with instances that lead to a successful claim under the policy and the relevant process. This will help in settling a claim successfully.
Frequently Asked Questions (FAQs)
Q1: What exactly is “Prima Facie” evidence in a medical claim?
A) It refers to the initial “on the face of it” evidence that suggests a mistake was made—such as an X-ray showing a forgotten surgical instrument or a report showing a wrong dosage. This evidence is needed to start the legal claim process.
Q2: Can I hire my own lawyer or must I use the one provided by the insurer?
A) Most policies in 2026 allow you to choose. You can hire a lawyer you trust and seek reimbursement, or you can use the insurer’s specialized medico-legal panel, which is often more convenient as the insurer pays them directly.
Q3: What happens if I have three small claims in one year?
A) You can make multiple claims throughout the policy year as long as the total aggregate amount (including all legal fees and settlements) does not exceed your AOY (Any One Year) limit.
Q4: Will the policy pay if a patient dies, but I am cleared of negligence?
A) Yes. Even if you win the case and are found “not negligent,” the policy still pays for your Defense Costs (the lawyer’s fees and court expenses incurred while proving your innocence).
Q5: Is there any scenario where a civil claim would be rejected?
A) A claim can be rejected if the procedure was outside your declared specialty, if you were intoxicated, or if the incident occurred before your Retroactive Date (the start of your continuous insurance history).
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.
