Getting Your Locum Insurance Claim Paid – A Potential Problem

Another bit of “policy small print” has raised its ugly head.

You automatically assume that so long as you have provided all that was necessary to claim on your practice’s Locum Insurance policy you would be paid the amount that was insured for the period of the illness less the deferred period that was chosen.

Here is a good example of what can go wrong if you are not careful.

Let us just suppose that your practice makes a claim in September 2014 and the policy was due for renewal in November 2014. Which option would you choose?

Option 1 -You renew the policy and all goes well and the claim is paid.

Option 2 – This is what can happen – You decide to move, for whatever reason, your Locum Insurance to another provider? Your claim will cease if you do not renew your Locum Insurance policy with your current provider.

Fortunately there are not many providers that operate Option 2, but you need to be aware that it does exist and check your policy wording.  Medical Insurance Consultants do not operate such a policy!

Medical Insurance Consultants

Comparing Interpretation – Locum Insurance: “Normal Terms” – part 2

‘Normal Terms’ – these two words can cost your practice a lot of money. It seems ridiculous to make such a statement but it is true.

Here is an example:

You are changing your Locum Insurance cover to another provider as they have quoted a premium that is lower than what you have been paying.

You have been told that you will receive “normal terms”. To the uninitiated this suggests that everybody is fully covered. What it really means is that everybody is covered as per the policy conditions and exclusions and there can be some nasty little clauses in the policy that changes everything.

It goes like this – The Practice Manager gets a cheaper Locum Insurance quote and is told by that potential new provider that even though the practice had made a recent claim the condition that was claimed for would be covered and would be given “normal terms”. When challenged on this point (the practice manager has been alerted to a particular policy exclusion) the potential new provider admitted that as the policy had a “pre-existing condition exclusion” there would be a period before the condition that was previously claimed on could be covered. This situation did happen and the Practice Manager made the right call and kept the cover they had.

Remember – The policy conditions and exclusions determine what locum insurance cover you have. If it seems too good to be true it probably is.

Medical Insurance Consultants

Is there a shift in thought over Private Practice Indemnity cover?

For a long time now when asked who provides your medical indemnity cover the answer was simple, it was either the MDU, MPS or MDDUS.  It was a given that you were with one of the traditional mutual defence bodies, but have times changed and what other options are available?

The three traditional medical defence bodies have been around for a long time and operate in a unique way when compared with the insurance market.  Cover is provided by an occurrence based membership, giving discretionary assistance in the event of a claim to the member who requests it.  Much is made by the defence bodies of the flexibility and unlimited nature of this type of cover, however, is it all it is cracked up to be?  My experience is in the insurance market, working with many types of healthcare individuals and businesses for their property, liabilities, legal, personal and medical indemnity insurance, allowing me to question certain aspects of the cover compared with indemnity insurance cover.

The first point to consider is the basis of cover, this being the ‘discretionary’ basis given at the discretion of the board.  It contrasts quite significantly with the contractual obligation provided under an insurance contract and affords little recourse to the member should anything arise the member is not happy with, such as assistance not being provided.  This won’t happen I hear you say, but unfortunately it does happen and was referenced to in the MDU press release dated 14th December 2010, whereby it mentions two members who were first told they would get assistance and this was later withdrawn.  No reason was given for this, as according to the membership agreement, they don’t have to tell you.  Insurance contracts don’t and can’t operate in this manner, as it goes against the Financial Conduct Authority regulations and would be a breach of contract, with recourse options available to you through financial regulatory bodies and the courts.

The second point is the notion of unlimited cover as part of the membership of an MDO.  Is it really unlimited?  Simple answer is no, as with any mutual organisation the amount of cover is limited to the financial assets of that organisation, but when you offer discretionary cover you can say pretty much what you like.  The MDO’s are understandably very protective of their claims history, however, with the majority of membership fee’s increasing each year above inflation the funds available aren’t keeping up.  A medical indemnity insurance policy gives a defined limit of indemnity usually up to £10,000,000 per claim and policy year, which is more than enough to satisfy private hospital requirements and very often with a zero excess, the same as the MDO’s.

The third point is about cover when moving between medical indemnity providers or switching from occurrence based MDO cover to a claims made indemnity insurance policy or vice versa.  Occurrence based means that you are covered for circumstances that occur while you were a member, albeit on a discretionary basis.  A claims made policy provides cover for circumstances notified during a policy period, therefore, moving from an MDO to an insurance contract you would be covered by the MDO for circumstances during your membership period and any circumstances notified after this would be covered by your insurance policy.  The insurance policy would then cover you for as long as it is renewed for circumstances that occur from the date you left the MDO, known as retroactive cover, and is shown by the retroactive date on your policy.  Switching your cover between insurers is a simple process, as the new insurer will follow the retroactive date on your policy, providing seamless cover, similar to switching between MDO’s. I have heard a lot of comments from clients about how they have been told by their MDO that they would be left high and dry by an insurance policy if they decided to move back to them.  This is not that simple, as when or if you decide to move back to an occurrence based discretionary membership from an indemnity insurance policy it is an obligation of the new provider to ensure that you are not left without cover.  The MDO, if it wants you back, should provide cover for the periods that the insurance policy was covering, the same that would happen when you switch insurers, and when working on a discretionary basis this should be a simple task.  If for some reason the MDO will not give this cover then your insurer can offer run-off cover for you, but if the MDO is not willing to help why are you going back to them in first place.  I have found with our clients that to date none have requested to move back to the MDO’s, they have either remained with us or moved to another insurer.  A good medical indemnity or malpractice insurance policy will also provide run-off cover when you retire from private practice or die, covering you and your estate should a claim arise.

It may be that you like the reassurance of being able to contact your MDO for advice on matters, but this is no longer the unique aspect of the MDO’s as insurers are now providing medico-legal helplines with their policies allowing you to talk medico-legal experts when you need advice.

A more competitive and active indemnity market can only be to the benefit of consultants in private practice, allowing more choice of provider and the costs they have to bear to carry on practising.  Hospital groups are realising this and putting support behind insurance based indemnity policies, as they can provide that extra level of certainty that the MDO discretionary cover can’t.  Each method of cover does have its own merits and it is down to the individual to decide what elements they deem important when deciding where they place their indemnity cover.  Who knows, it may be that this decision is taken out of our hands and the UK follow the vast majority of other countries in requiring the cover to be on a contractual level of cover, not just discretionary.

If you would like to see which may suit you best, contact Medical Insurance Consultants (MIC) on 0800 163870 or click for a quote here.

Completing A Medical Confirmation Form on Behalf of Partners/Staff

Here is the classic case through the eyes of a Practice Manager:

Just filled out the form for our Locum Insurance and as far as I am aware none of the individuals that are being insured have had any anything wrong with them in the period requested. Insurance now in place – On to the next job.

Some months later – One of the partners has been off sick with a stress related condition for the last 3 weeks and it looks as though he will be off for another 8 weeks at least. Contacted our insurance broker/company and requested a claim form. The claim form has been completed and has been sent to the insurance broker/company. I am now waiting to be paid as we are already employing a locum.

To my amazement I have received an email/letter from the insurance broker/company saying that they will not be paying the claim due to non-disclosure. I now find out that the partner who is off sick had suffered from a stress related condition in the preceding x months. Not a happy bunny at the moment to say the least!

The partners reason for not disclosing this to me  – He/She did not think that the previous condition warranted a mention.

Make sure you stress the implications of not fully disclosing medical condition.

Comparing Interpretations – Locum Insurance

Have you ever noticed that when companies compare their product against a competitors theirs always appears miles better.

What is the comparions based on?  INTERPRETATION is the word.

I recently saw a Locum Insurance comparison which stated that their comparison was “based upon their interpretation” – basically this is a “get out of jail” phrase that enables them to write more or less what they want to compare, as well as extracting selective wording from the Locum Insurance policy.  A good example of this relates to claiming for a mental illness – according to the comparison the person claiming “will have to see a psychiatrist” whereas the policy wording actually says “will have to see a psychiatrist when requested by the insurer”.  Two totally different meanings.  This also doesn’t mention that the insurer has the general right within the policy to request the insured to provide all information required for the claim and co-operate with insurers request in order to administer the claim (i.e. attend a medical examination).

Beware of comparisons!!

Always ask the specific questions you want answered.

An interpretation of an interpretation made on Wednesday 21st May 2014!!!!

Medical Insurance Consultants

MIC Surgery Insurance awarded 5 Star rating

We are proud to announce that the MIC Surgery Insurance policy has been awarded a 5 Star rating by Defaqto, the independent financial rating company.  This rating confirms to our clients that the cover we offer is at the top of the pile, backed up with excellent customer support and advice.

We will not stop there however, as we are constantly looking at ways in improving the cover we can provide without costing our clients more in premium.  If you don’t have a Medical Insurance Consultants Surgery Insurance policy why not contact us on 0800 163870, email us on [email protected] or visit our website www.m-i-c.co.uk to receive your quote.

Dentists Indemnity Cover – Discretionary or Contractual?

There have been quite a few articles recently on the merits of indemnity arrangements for dental and medical professionals.  The providers of indemnity, both defence organisations and insurers, pointing out the shortcomings of each others proposition.  Who is right and who is wrong?  Simple answer is they are both right, but being transparent on the facts is a different matter.

It does seem that the insurance option is getting a bit of a bashing currently, but is this justified?  Well one of the problems I can see in the comparison the MDO’s are making at present is the way in which they treat the whole insurance market/policies the same.  Creating a picture that insurers will cover you year by year with high premiums to pay should you wish to leave to go to another provider.  This is not correct, as any good insurer or broker will ensure that the cover you get year on year provides cover for you from the point you first took out an insurance policy.  This is shown as the retroactive date on your policy and means that your policy will repsond to claims notified during a period of insurance for incidents that occurred after this retroactive date.  Similar to the way in which MDO membership will cover you instances that occur from when you were a member (occurrence based cover).  An insurance policy can also provide cover when you retire or die (run-off cover), usually at no additional premium as this would have been rated for in the cover you had in the previous years.  If in doubt just ask if it is included.

I think a key point here is the level of transparency to each option, with very little from the MDO’s as they are not required to do so legally.  I feel there is a degree of nervousness buidling within the MDO’s as the appetite of insurers for Medical Indmenity insurance is growing, with more and more competitive and comprehensive schemes coming on stream each year.  Personally I am still at a loss as to why the UK still accepts MDO membership as adequate cover, when it is at the descretion of the MDO whether or not they will provide cover to a member.  The lack of financial regulation of the MDO’s also raises concerns for me, because if there were a deterioration of the balance sheet for these organisations we may find out too late or its members will be hit with large increases to make up the shortfall.

I would say however, each has its merits and insurance is not right for all as is the case for discretionary cover.

Simon Downing – Managing Director MIC Ltd

Claiming and Changing – Locum Insurance

A practice claims £55,000 for an illness to an insured GP on the practice Locum Insurance policy and they have just returned to work. The practice then decides to place their Locum Insurance with another provider who offered a lower premium. Not only is the premium cheaper but the new insurer says that they will cover the GP without exclusions or conditions for the illness that was just claimed for. I just hope that the illness doesn’t return!  The devil as always is in the detail and the level of transparency your insurance provider gives you.  Seeing the policy wording does not necessarily mean you understand what it is saying and I would always recommend asking for an explanation to points you are concerned about.

Cost should not always be the main driver behind selecting your policy, as a history of having your claims paid is by far the best indicator of a good policy.  After all that is the reason you took the policy out in the first place, not just to show that you have got a policy for less than last year!

Locum & Absence Insurance Marketing – Getting It So Wrong!

How can you compare the merits of one policy over the other? The only way is if you have the most up to date information on both products.

Unfortunately there have been several very recent occasions when out of date information has been used to undermine the MIC Locum/Absence Insurance cover. Obviously this gives a very false picture of MIC but makes our competitor’s products seem that much better. Has this been done as a deliberate marketing tool or is just done in error? If it were just one or two points being incorrect then I would say that it was an error. In fact there were in excess of 15 points raised in one comparison that were inaccurate or bore no relation to the policy in question, which makes me think that it was a deliberate marketing tool. As the old phrase goes “A little knowledge is dangerous”

As MIC has been arranging insurance for some 16 years we take all of this in our stride but it does make you wonder how these companies “get away with it”. Practice Managers and GPs are being given inaccurate information to make their decision upon. This is very worrying when you consider the costs that could fall on the practice if their Locum Insurance failed to perform the way they thought it would. If any Practice Manager has had a comparison including MIC products I would be delighted to hear from them.

If you would like to see what our policies actually cover, visit our website www.m-i-c.co.uk or call us on 0800 163 870.

MIC Charity Golf Day 16 May 2013

Over 80 golfers made the MIC sponsored Golf Day at the Salisbury and West Wilts Golf Club and helped to raise over £3000.

The money raised went to supporting the Weldmar Hospicecare Trust and Julia’s House Childrens Hospice.

Although the weather was terrible – wet, windy and cold all participants completed their round of golf and a good day was had by all!

If you are a client of MIC for Locum Insurance, Surgery Insurance or any of our Medical Liability products and would like to take part in next years event please get in touch and we can put your name down.