Principles of medical professional liability insurance

Published on 07/02/2015 by admin

Filed under Anesthesiology

Last modified 07/02/2015

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Principles of medical professional liability insurance

Brian J. Thomas, JD

Medical professional liability insurance is provided by third-party liability insurance companies and is purchased by an insured to protect against potential tort liability, a civil wrong, to others. When civil wrong occurs, it creates liability against the wrongdoer (tortfeasor) in favor of the injured party. The civil wrong in a medical malpractice case typically involves an alleged breach of the standard of care by a physician or other health care provider in the form of a negligent act or omission that substantially leads to the patient’s injury or death. In the case of a physician, the physician-patient relationship gives rise to the “duty” owed by the physician to the patient. A patient can recover money from a physician if the patient can prove that the physician’s conduct both fell below the accepted standard of care and caused the patient’s injury or death. Most physicians purchase medical professional liability insurance to defend and pay claims resulting from medical negligence or malpractice lawsuits.

Scope of coverage—what is covered?

The purpose of medical professional liability insurance is to protect the insured physician’s personal assets. Medical professional liability insurance generally provides coverage for a physician’s legal liability for “injury” that results from professional services provided or that should have been provided by the physician. “Injury” might include bodily injury and intangible injury such as pain, mental suffering, and loss of consortium (conjugal fellowship of husband and wife including not only material services, but also such intangibles as society, guidance, companionship, and sexual relations). “Injury” might also include purely economic losses, such as lost past and future wages, past and future medical expenses, and funeral expenses, as long as the loss derives from an act or omission of a professional nature. The protection provided by medical professional liability insurance varies and is typically defined by a policy’s “scope of coverage” provision.

Exclusions—what is not covered?

Medical professional liability insurance policies generally contain exclusionary language expressly limiting coverage in specifically defined situations. Although the exclusionary language varies among different policies, most medical professional liability policies routinely exclude coverage for specific situations (Box 249-1).

Box 249-1 Typical Exclusions by Medical Professional Liability Insurance Policies

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