Doctors need to ensure they have adequate and appropriate medical malpractice cover. How can you be sure that your cover is right for you? We’ll consider five of the most important questions you need to ask when sourcing your medical malpractice cover.

1. What are you covered for?

The NHS covers doctors for the vast majority of work conducted as part of their contract with them. There are several schemes in the UK that cover doctors in this situation. However, if a doctor conducts work outside of the NHS, they will need additional and appropriate cover. This includes private work and medico-legal work, as well as any criminal or GMC investigations.

2. Is medical malpractice cover an insurance policy?

It depends on which of the main two types of cover you have.

Discretionary Indemnity (not an insurance policy)

Discretionary cover is provided by membership of one of the major defence organisations, and included in the organisation's annual subscription fees. As the name suggests, cover is discretionary only – there is no guarantee that a claim will be accepted. If the organisation does not accept a claim, a physician may find themselves exposed to claim-related costs.

  • If a claim is accepted, there is no limit to the amount that is covered, or the expenses paid.
  • There is no legal redress if a claim is not accepted as defence organisations are not regulated.
  • Discretionary cover is always occurrence-based or losses-occurring (see below).

Contractual Indemnity (a regulated insurance policy)

Contractual indemnity refers to medical malpractice insurance that is covered by a contract. It is offered by commercial insurers, or via a broker such as Gallagher. The terms of the contract will set out conditions in relation to the maximum amount of cover provided and will detail situations that will not be covered by the contract.

  • Insurers are regulated by the Financial Conduct Authority, which has its own set of standards that it requires its members to abide by.
  • Complaints can be directed to the Financial Ombudsman.
  • Contractual indemnity is nearly always claims-made (see below).

3. Claims made vs occurrence based?

These terms are mentioned a lot and are quite often misunderstood.

Claims made policies provides cover for claims made during the period the policy is active. It does not matter when the actual incident occurred. This type of cover requires run-off to be in place to cover claims made when the policy is no longer active (see FAQ 4.). An occurrence-based policy is different because it provides cover for incidents that occurred during the policy’s period.

Remember that policies offered by the defence unions, whether claims made or occurrence based, offer discretionary cover – there is no guarantee that a claim will be accepted.

4. Is run-off cover included?

Run-off cover offers doctors and their families with security should a claim be brought after retirement or death. For many doctors, run-off cover can provide them with confidence that they are covered in their professional life, or after they have finished practising.

Doctors need to ensure that run-off is stipulated in claims made policies provided by commercial insurers or defence unions. This is so any claims made once they are unable to work can be covered.

5. Is your policy tied to one insurer?

If dealing directly with one insurance company, doctors may find themselves with limited options. This could result in a policy which doesn’t completely suit the individual, clinic or practice. Independent advice can therefore be advantageous as an independent advisor will not be tied to a specific company, and their advice will be impartial and unbiased. Options from various insurers can be considered.

With so many aspects to consider, doctors should seek a specialist opinion in order to have a full understanding of the options available. A specialist and independent provider of medical indemnity insurance will be able to identify the type of cover required in relation to practice specialties, can negotiate effectively with insurers, and will be able to fully explain the contract’s terms and conditions. In a time when clinical negligence claims are a regular occurrence, having adequate cover has never been more important.

Get in touch with Gallagher today for a comprehensive discussion on your current indemnity situation. Our independent service and balanced advice will help you find the appropriate cover for your practice.