SOUTH AUSTRALIAN PUBLIC HEALTH SECTOR EXPLANATION OF INSURANCE ARRANGEMENTS

Transcription

1 SOUTH AUSTRALIAN PUBLIC HEALTH SECTOR EXPLANATION OF INSURANCE ARRANGEMENTS

2 INTRODUCTION This document has been prepared for reference purposes for the South Australian public health system and is intended as a summary only of the various insurance programs managed by SA Health s Insurance Services. Each section describes in a general way the coverage provided under each category of insurance. The full terms and conditions (where applicable) are detailed on the Policy documents held by Insurance Services and/or SAICORP. Please note that a copy of the Explanation of Insurance Arrangements document is maintained up to date and accessible on SA Health s Intranet at INSURANCE SERVICES - CONTACTS Manager, Insurance Services: John Markic Phone: Mobile phone: john.markic@health.sa.gov.au Senior Insurance Officer: Catherine Robinson Phone: catherine.robinson@health.sa.gov.au Insurance Services isuhealth@health.sa.gov.au Insurance Services fax: Postal Address: PO Box 287 Rundle Mall ADELAIDE SA 5000 Claims Procedures Manual Revised August 2008 Page 2

3 DETAILS OF INSURANCE INDEX PAGE Professional Indemnity (Medical Malpractice)... 4 Directors and Officers Liability... 7 Products and Public Liability... 8 Professional Indemnity... 9 Property Loss/ Damage (including Machinery Breakdown) Consequential Loss Fidelity Guarantee Motor Vehicles Volunteers and Directors Personal Accident and Illness Liability Corporate Travel Claims Procedures Manual Revised November 2009 Page 3

4 DETAILS ON LIABILITY COVER - PROFESSIONAL INDEMNITY (MEDICAL MALPRACTICE) PROGRAM SCOPE OF COVER The legal liability to third parties for any claim for breach of professional duty, by reason of any act, error or omission committed or alleged to have been committed in the treatment or nursing of patients (referred to as malpractice) by participating health services and their employees. EXTENSIONS: Services provided by full time and part time health professionals under Rights of Private Practice Deed of Agreements, duly approved between The Employing Authority and the health professional. The services may be provided at a public or private hospital in South Australia where approved and are to be within the scope of the Deed. Services provided by Visiting Medical Officers to public patients only in metropolitan hospitals, in accordance with industrial arrangements. Services provided by Visiting Medical Officers to hospital initiated private patients in metropolitan hospitals (if cover is required). Cover for this purpose is not automatic and must be individually arranged by the Visiting Medical Officer with SA Health. Services provided to public patients by medical practitioners or other health care professionals who are dual employees of both a University and a metropolitan hospital. Services provided to private patients by medical practitioners or health care professionals who are dual employees of both a University and a metropolitan hospital and who have approval to exercise the right of practice under a Rights of Private Practice Deed of Agreement. Rotation of General Practitioner trainees, who are employed by the public health system, to general practitioner placements. Services provided by trainees and non-specialist medical staff in a private hospital provided that services are at the direction of the participating health service and remuneration for the services is not paid to the individual provider of the service. Services to public patients, provided by fee for service rural medical practitioners who have entered into an agreement with SA Health under the indemnity arrangements for rural medical practitioners. Services provided by general practitioners who participate in the provision of a locum service through the Rural Doctors Workforce Agency Inc. Claims Procedures Manual Revised November 2009 Page 4

5 Good Samaritan acts by persons covered under these arrangements. Advice to and representation of health professionals indemnified by SA Health, at Coronial Inquests. Services provided to patients overseas where they are a result of: A specific program supported by a participating health facility (eg Cranio Facial Unit) Health Professionals attending overseas health facilities with the approval of SA Health to enhance their skills, or impart their knowledge. Specific services provided to third parties that have been approved by a participating health service s Executive (eg provision of rehabilitation services to injured clients as an authorised WorkCover provider). Services provided to public patients in participating health facilities by overseas and interstate health professional officers and health professional students who are placed in the health facilities for further training and experience, are not employed and; are not part of the health service s authorised training program and are not supported by an university. The indemnity is provided in accordance with the Protocol for Indemnity Arrangements for Interstate and Overseas Health Professional Officer and Health Professional Students. Medical practitioner contractors who were engaged by Healthscope Ltd for provision of services to public patients at Modbury Public Hospital between 6 February 1995 and 30 June 2007, as approved by the Government. University medical and nursing students on placement at a public hospital, approved by SA Health. Research activities, where the Authority is a public hospital and the activities have been reviewed and endorsed by SA Health s Insurance Services. EXCLUSIONS Advice and services provided gratuitously which are outside the employment contract and Rights of Private Practice Deed of Agreement, Liability incurred outside of South Australia (unless specifically agreed), Disciplinary proceedings, Enquiries by quasi-judicial agencies (e.g. Health and Community Services Complaints Commissioner) Claims Procedures Manual Revised November 2009 Page 5

6 Misconduct, Fraudulent, dishonest or criminal acts or omissions and their consequences. CONDITIONS Incidents must be notified in writing to the claims manager of SA Health s Professional Indemnity (Medical Malpractice) Program immediately, when known. Immediate notice is to be given to the claims manager of any claim, writ, summons, proceeding or FOI application in respect of which there may arise liability. EXCESS: For metropolitan and large country hospitals: $5,000 for claims less than $20,000 $10,000 for claims greater than $20,000 For small country hospitals and non-procedural health facilities $1,000 for claims less than $20,000 $2,000 for claims greater than $20,000 Claims Procedures Manual Revised November 2009 Page 6

7 DETAILS ON DIRECTORS AND OFFICERS LIABILITY INSURANCE SCOPE OF COVER Where a Board or Committee is deemed a Corporate Agency or Advisory Body for the purpose of Section 74 of the Public Sector Management Act 1995, no civil liability attached to the Board or Committee member for an act or omission in the exercise or purported exercise of their official powers or functions. Any action that would lie against the member will lie instead against the corporate agency or the Crown. Members of other Boards or Committees may be covered in accordance with the Department of the Premier and Cabinet publication Government Boards and Committees Guidelines for Agencies and Board Directors EXCLUSIONS Acts or omissions not in good faith. CONDITIONS Incidents must be notified in writing to Insurance Services immediately, when known. EXCESS $500 on each and every claim Claims Procedures Manual Revised November 2009 Page 7

8 DETAILS ON PRODUCTS AND PUBLIC LIABILITY COVER SCOPE OF COVER The legal liability to third parties for personal injury or property damage arising out of the operations of the health facility including liability as property owners or occupiers. The cover includes liabilities arising out of products manufactured, constructed, erected, installed, treated, serviced, repaired or sold (including food/drink). Cover includes legal costs incurred with the permission of the Insurer. EXCLUSIONS Legal liability arising out medical malpractice, construction works liability, worker s compensation, liability assumed under contract unless agreed with Insurers, liability outside of Australia (unless specifically agreed),, Joint Venture liability (unless specifically agreed). CONDITIONS In order to ensure that any entitlement to indemnity is protected, all incidents that may give rise to a claim against your health facility must be reported as soon as possible after such incidents come to the health facility s attention, but within 30 days. EXCESS $500 on each and every claim $1,500 where settlement is greater than $50,000. Claims Procedures Manual Revised November 2009 Page 8

9 DETAILS ON PROFESSIONAL INDEMNITY (EXCLUDING MEDICAL MALPRACTICE) COVER SCOPE OF COVER The Legal Liability of the health facility for the financial losses by third parties caused by a breach of professional duty occasioned by reason of an act, error or omission in the conduct of the business and profession (eg negligent professional advice). CONDITIONS In order to ensure that any entitlement to indemnity is protected, all incidents that may give rise to a claim against your health facility must be reported as soon as possible after such incidents come to the health facility s attention, but within 30 days. EXCESS $500 on each and every claim Claims Procedures Manual Revised November 2009 Page 9

10 DETAILS ON PROPERTY LOSS/DAMAGE COVER (INCLUDING MACHINERY BREAKDOWN) SCOPE OF COVER Loss, damage or destruction of all health facility property, including buildings, plant and machinery, contents and other goods anywhere in Australia for their full replacement cost, caused by, but not limited to: fire storm and water damage (including lightning) accidental damage burglary and theft explosion or collapse of boilers and/or pressure vessels fraudulent embezzlement or misappropriation earthquake damage impact by vehicles and aircraft riots and malicious damage machinery or computer breakdown fusion, glass breakage EXTENSIONS Fire extinguishment costs, cost of temporary protection of undamaged property, removal of debris, architects and other professional fees, extra building costs due to government regulations. (covered elsewhere under travel policy) Personal effects, excluding negotiable items (cash, etc.) of long term residents in hostel type accommodation (defined as a person who has been resident in excess of 35 days) for damage or loss due to fire, vandalism or burglary (limited to $1,000 any one item; $5,000 in total any one resident). Household and personal effects for approved employee movements while in transit involving carriage by land, sea or air up to $ 100,000 per conveyance. EXCLUSIONS Damage caused to property through/by: o Wear and Tear o Moths, vermin termites or other insects o Corrosion, erosion or rust or wet rot or mould o Livestock Property more specifically Insured (eg motor vehicles) Employee s effects Betterment Claims Procedures Manual Revised November 2009 Page 10

11 CONDITIONS Incidents giving rise to claims must be notified promptly to Insurance Services but no later than 30 days of the incident occurring either verbally or in writing. Matters which give rise to substantial damage (eg flooding, fire) must be notified within 24 hours of the event occurring. All theft and malicious damage losses must be reported to the Police. Details of the Police report should be noted on the claim form. Where computing equipment is stolen, Insurance Services must be notified immediately if sensitive/confidential information was stored on the stolen computer. EXCESS Generally: $500 for damage and breakdown on each and every claim. $2,000 for theft or loss on each and every claim. Unless otherwise advised. Claims Procedures Manual Revised November 2009 Page 11

12 SCOPE OF COVER DETAILS ON CONSEQUENTIAL LOSS Loss of revenue and/or additional expenditure necessarily and reasonably incurred by the health facility in order to maintain supply or services following the loss, damage or destruction of the property insured under the Property Loss/Damage Cover. This includes, but is not limited to, cost of temporary accommodation costs, overtime costs, reconstruction of records and the like. CONDITIONS Incidents giving rise to claims must be notified to Insurance Services within 30 days of the incident occurring either verbally or in writing. EXCESS $500 on each and every claim. Claims Procedures Manual Revised November 2009 Page 12

13 SCOPE OF COVER DETAILS ON FIDELITY GUARANTEE Loss of money or goods belonging to the health facility sustained as a direct result of fraud or dishonesty committed by an employee of the health facility acting alone or in collusion with others. CONDITIONS Incidents giving rise to claims must be notified to Insurance Services within 30 days of the incident occurring either verbally or in writing. EXCESS $500 on each and every claim. Claims Procedures Manual Revised November 2009 Page 13

14 DETAILS ON MOTOR VEHICLES INSURANCE SCOPE OF COVER Section 1 Section 2 Loss or damage to insured vehicles and accessories arising out of the use of the insured vehicles, for motor vehicles owned or leased by health facilities and insured through SA Health s insurance arrangements (but excluding motor vehicles leased through FleetSA). Cover is limited to cost of repair of damage up to the market value of the vehicle. Legal liability to third parties arising out of the use of the insured vehicles for motor vehicles owned or leased by health facilities and insured through SA Health s insurance arrangements (but excluding motor vehicles leased through FleetSA). Cover is limited to the legal liability to third party including legal costs. EXCLUSIONS Compulsory Third Party (Bodily Injury), Liability claims, damage to tyres by road cuts, bursts, etc., wear and tear, depreciation, loss of use, mechanical or electric breakdown. CONDITIONS Accidents must be notified to Insurance Services or Lumley General Insurance (the claims manager) in writing with full details as soon as possible after an event that may become the subject of a claim. EXCESS $500 on each and every claim. Nil on windscreen losses Claims Procedures Manual Revised November 2009 Page 14

15 DETAILS ON VOLUNTEER INSURANCE For the purpose of this cover, a volunteer is regarded as being a person involved in undertaking defined activities: of their own free will without payment (other than out-of-pocket expenses), and which will be of benefit to the community and the health facility concerned Volunteers include members of Boards of Management and voluntary workers, who have been engaged by SA Health and associated health facilities which participate in SA Health s indemnity and insurance arrangements. SCOPE OF COVER PERSONAL ACCIDENT AND ILLNESS INSURANCE Generally in line with the philosophy underlying the Workers Rehabilitation and Compensation Act, 1987 but modified where appropriate to reflect the circumstances of volunteers. Benefits are paid on an out-of-pocket basis after other entitlements have been used. A volunteer is required to first claim on Medicare, private health cover, personal insurance, superannuation, employment sick leave entitlements, compulsory third party bodily injury insurance, etc. SA Health then meets any non-recompensable expenditure with regard to: medical costs reasonable rehabilitation costs cost of lost or damaged apparel or other personal effects. Lump sum payments for death or serious disability are paid on the same basis as the WorkCover schedule. Weekly income is paid to a volunteer who can demonstrate a loss of income. The benefit payable will take account of actual lost income up to WorkCover ceiling of twice State Average Weekly Earnings. For long term incapacities, benefit reduction in line with WorkCover rules apply. In special circumstances, where volunteers necessarily incur costs as a result of incidents arising out of their volunteer involvement, additional benefits may be paid if considered appropriate by the Treasurer. All benefits, except weekly income benefits for long term incapacities, are payable regardless of age. Claims Procedures Manual Revised November 2009 Page 15

16 DETAILS ON VOLUNTEER INSURANCE SCOPE OF COVER (cont d) LIABILITY (A) Public Liability (of volunteers to third parties) Legal liability for personal injury or property damage arising out of the acts,omissions of volunteers. (B) Professional Indemnity Legal liability of volunteers for the financial losses of third parties caused by a breach of professional duty, eg. negligent advice. CONDITIONS Health facilities must keep a register of the names and dates of attendance of all volunteers and will, if required, submit the register to Insurance Services for inspection. On the occurrence of an incident likely to given rise to a claim, the health facility will: Advise Insurance Services and within thirty (30) days provide a claim form and medical certificate detailing particulars of the Incident. Forward to Insurance Services documents, information and evidence that may be required in respect to the Incident. Health facilities must give Insurance Services written notice as soon as practicable of every claim, writ, summons or proceedings, including any prosecution or request, and all information in relation to such matters from which there may arise any liability. Claims made fraudulently or benefits obtained by fraudulent means will not be recognised under this cover. SA Health may take action available to it at Law to recover payments where fraud has been detected. For full details on the Government s policy on Volunteers, reference should be made to Commissioners Standard 1 Attachment A EXCESS $500 on each and every claim. Claims Procedures Manual Revised November 2009 Page 16

17 SCOPE OF COVER DETAILS ON CORPORATE TRAVEL Insurance cover is provided for overseas and interstate travel approved by a person with delegated authority. The cover applies to the person travelling only, therefore not extending to a person s spouse or partner. The benefits of cover are: Overseas Medical Expenses, Additional/Cancellation and Curtailment Expenses including Loss of Deposits - $ 5,000,000 ($50 excess) Death and Capital Benefits - to a maximum of $500,000 Loss or Damage to Baggage and Personal Effects - $20,000 ($5,000 per item) ($50 excess) Money, Travellers Cheques and Credit Cards - $10,000 ($50 excess) Loss or Damage to Business Equipment - $10,000 ($100 excess) Collision Damage and Theft Waiver - $3,000 Emergency Travel Assistance Personal Liability - $ 5,000,000 The policy is effected by SAICORP (the Government s captive insurance agency) through its insurance broker. LIMITS OF COVER Permanent Disability, Chartered Aircraft, Light Aircraft, Helicopter: $5 Million on any single event. Claims Procedures Manual Revised November 2009 Page 17