Liability Insurance What You Don t Know Can Hurt You Larry Hornsby, CRNA, BSN Liability Insurance Defined Contractual Relationship Insurance Company agrees to provide a service CRNA/MD/Company agree to terms Secured with premium payment Insurance Company Agrees to: Pay all expenses related to a filed claim Attorney fees Expert witness Time out of work to testify Investigation Judgment or Settlement Typical CRNA Coverage Individually Purchased Employer Purchased May share limits with MD May share limits with group Individual Limits Corporate Limits 1
Limits of Liability Usual $1,000,000/$3,000,000 May add separate corporate limits May have facility or state mandated limits May purchase additional coverage limits Beware of DEEP POCKETS Shared Limits CRNA and MD share limits of policy May have entire group sharing limits KNOW your coverage CRNA may purchase personal policy Moonlighting Coverage Most employer policies will NOT cover work outside the practice AANA Insurance offers moonlighting policy Inexpensive insurance based on State Ask for written Certificate of coverage if facility is covering insurance listing YOU as a named insured Occurrence Coverage Covers incident that occurred while policy was in force Coverage is NOT based on WHEN the claim is filed No Tail Coverage Hard to find in current market Claims Made Coverage Covers CLAIM that occurs during policy Claim MUST be filed during policy period Tail MUST be purchased to cover claims filed after term of policy BEWARE of definition of Claim Beware of Time limitation on Tail coverage Claims Made Coverage Premium Low first year Increases each year until 5 th year Always ask for the current 5 th year rate Budget based on increasing premiums Premium increases as risk of claim increases with each year s case load 2
Limits of Liability Claims Made Concerns Per Occurrence Max per CLAIM $1 Mil/$3 million New Limits with renewal Aggregate Max for ALL Claims $1 mil/$3 MILLION New limits with renewal Unlimited Time on Tail Some Limit to ONE YEAR!! KNOW WHAT YOU HAVE!! Definition of Claim Suit filed and Served vs ANY Communication regarding an incident with POTENTIAL for claim KNOW WHAT YOU HAVE!!!!!!!! Denied Coverage Open or existing claim Loss History Substance Abuse Physical Limitations Gaps in Practice Licensing/Credential Issues No Tail purchased with last policy Special Considerations New Graduates may be denied coverage outside of hospital setting Substance abuse may require upto five years clean Large judgment may require prolonged investigation prior to new coverage Pending litigation makes new coverage difficult Punitive Damages Intended to PUNISH Usually LARGE award To deter future similar actions Quality Control Liability Insurance General Assumptions Must work within Licensure and Scope of Practice Must work within Policy and Procedure of Facility Must provide care commensurate with facility credentials Must meet defined supervision requirements 3
An Incident Occurs What to do Follow reporting requirements of policy File incident report with facility ALL other written documents are discoverable Do not discuss the case with ANYONE other than legal counsel and/or your insurance carrier Other Things I Should Do Review the chart for accurate documentation immediately Maintain professional relationship with patient/family Never agree to any statement that implies wrongdoing Consider independent legal representation The Reality You may have done everything right and still pay a judgment Your insurance can and likely will either become more expensive or be dropped completely in the event of a judgment OR settlement High Risk insurance is available but very expensive Good News MOST Medical Malpractice Suits are won by the provider AANA Insurance is Profitable CNA Insurance has an A+ Rating AANA Insurance offers Moonlighting coverage as well as personal representation coverage for CRNAs insured by other companies Rating The Company A.M. Best: Oldest independent rating Based on ability to pay claims Superior: A++ or A+ Excellent: A or A- Very Good: B++ or B+ Anything less is problematic!! Rule to Live By If it is too good or too cheap or too easy to acquire.don T BUY IT!!!!! Many CRNAs have been hit by Insurance Companies exiting the market and were left with no coverage and no potential to purchase tail coverage. Be careful!! 4
Questions to ask the Company Deductible: A predetermined cost that may be assessed at the time of the claim or at the time of a judgment Covered Cost: Are ALL defense costs covered under your policy including lost wages due to depositions and required presence at hearings? Consent to Settle Company MUST have your written consent before making a decision to settle a case. Important due to National Data Bank ANY Settlement may also trigger investigation by State Board of Nursing Employer Provided Coverage Things you should know Occurrence vs Claims Made Is tail coverage available should you leave Who will pay for the tail Will you get documentation of paid tail How much will it cost if you must pay Will you be able to purchase new policy if no tail is available Employer Provided Coverage More Questions Do you get a certificate of insurance Who is the company/underwriter Do you have separate limits of liability Do you have separate legal counsel Is there a consent to settle clause Are you a named individual on the policy Final Comments Maintain AANA Membership Maintain CE Credits ACLS/PALS Certification Subscribe to Anesthesia Journals Documentation/Penmanship Know your Liability Coverage VIGILANCE 5
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