When does a claim occur under DPI and how to raise a claim?
A doctor’s professional indemnity insurance policy covers instances of death, physical injury or disability suffered by patients due to negligence or unintentional errors committed by their doctors. If a doctor faces a lawsuit, the doctor’s professional indemnity policy will cover the legal costs and any cost of settlements associated with such lawsuits.
The claims allowable under this policy should be of the type known as a legal liability. Legal liability implies the financial liability faced by the doctor which is enforceable under law. Legal liabilities can be of two types – criminal and civil. A doctor’s professional indemnity insurance policy covers only civil liability claims. If there is any criminal liability involved, the claim would not be payable.
A civil liability claim would occur under a doctor’s professional indemnity policy when a prima facie evidence of the negligence of the insured doctor can be furnished by the patient and/or his family. This negligence should have resulted in injury or death of the patient. Negligence would be said to occur in the following circumstances –
- When the doctor had the duty to care for the patient
- When the doctor breached this duty
- When the patient of the doctor suffered from a physical injury or death due to the breach of the duty on the part of the doctor
If any of the above-mentioned things have happened, a claim would be said to have occured under the doctor’s professional indemnity insurance policy.
How to raise a claim?
When the claim is received by the Doctor, the insurance company should be immediately notified about the liability faced by the doctor. If the doctor or the medical establishment receives any legal notice or summons with respect to the civil liability faced, the notice or summons should be submitted to the insurance company. The doctor can then hire her own legal defence or the insurance company can arrange for the defence of the medical professional, if the same is covered under the policy.
The claim should incur during the policy period or during the retroactive policy period, which is the period in the past years for which the Doctor has kept herself covered by a Doctors PI policy without a break in coverage. The insured doctor or medical establishment should make the first claim in writing for documentary proof. The claim amount would be limited to the AOA (Any One Accident) limit selected by the policyholder. Once the claim is paid, the AOY (Any One Year) limit would reduce by the amount of claim which has already been paid. Multiple claims made during the policy period would be honoured by the insurance company provided the aggregate claim amount does not cross the AOY (Any One Year) limit selected by the policyholder.
The policyholder should also keep in mind that there are exclusions associated with the doctor’s professional indemnity policy. They should know these exclusions and avoid making claim for them. A claim made for an excluded instance would be rejected.
A doctor’s professional indemnity insurance policy covers the personal financial liability faced by doctors and medical practitioners. However, policyholders should acquaint themselves with the instances which lead to a successful claim under the policy and the relevant claim process, so that they can get any claim successfully settled.
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