Non-Disclosure Deliberate or Accidental?

When it comes to insurance claims the answer is not always quite so clear cut.

If a material fact has not been disclosed it may well alter the way that a particular risk is assessed.

Example 1: A Locum Insurance policyholder submits a claim, medical information is requested and this persons GP stated that he had not seen this patient for a particular condition for which the claim is being made – fairly straight forward so far.  However, this person had been treated by another doctor for the same condition and had failed to disclose this on the Locum Insurance application form.  If this information had been declared it would have affected the assessment of this persons Locum Insurance application.  My assessment – non-disclosure.

Example 2: A practice manager signs a declaration for Locum Insurance on behalf of the GP Partners who are insured.  This declaration requests information about all of the insured persons.  To the practice managers knowledge nothing has changed since the application forms were signed.  Unfortunately one of the insured GPs had not told any of the partners or practice manager that he had received treatment for a particular illness.  This would have altered the terms that this GP had received under our Locum Insurance policy.  My assessment – this is an awkward one as the practice manager had acted in good faith and declared what he thought was correct. Was enough done to verify information?

What can be learnt from the above?  Non-Disclosure whether deliberate or accident can cause real financial problems for an individual, as well as a practice.  If in doubt, giving more information is better than less!

Budget increase kicks in tomorrow

You may or nor may not remember, but in the last budget there was another attack on insurance premiums from the Chancellor of the Exchequer.  Not as you may wish from the insurers, unfortunately the increase is for all policy holders on the standard rate of Insurance Premium Tax.  We first saw it increase from 6% to 9.5% and now it will increase to 10% from the 1st October 2016.

If you are looking to take out a policy now would be a good time to achieve that little extra saving.  At MIC we always try and mitigate the increases imposed upon our clients as best we can on policies such as Locum Insurance or your mandatory Surgery Insurance and Medical Indemnity cover.

Get your quote before the price goes up.

GP’s Indemnity costs for extended/weekend working hours

Recently read an article in Pulse titled ‘ GPs paying £35 per hour for indemnity fees as LMC leaders vote for full costs to be covered’.  Interesting read, however, it included some muddled examples perhaps perpetuating a common misconception regarding the medical defence unions.  To clear it up, the three main medical defence unions, MPS, MDU and MDDUS are NOT insurance companies, nor are they providing insurance cover in respect of the individual indemnity they offer to members.  They are mutual organisations who offer membership and as a part of that membership they could make available their support if needed.

In my time as an insurance broker I have provided many an medical indemnity insurance policy for healthcare entities and individuals and in the vast majority of cases they thought that the defence union’s cover was insurance.  Of course I put them right and in some cases they were quite shocked at the lack of transparency and recourse available to them in relation to a defence union.

The rising cost of medical indemnity for GP’s has been on the cards for some time now, but with their numbers accounting for a good proportion of the defence unions membership costs are being spread.  What I mean is that the risk spreading nature of the defence unions works to large respect, however, it is distorting the actual medical indemnity costs of many GP’s out there.  Out of hours work is in it its nature a higher risk element of GP’s work, however, extended working hours is not out of hours, as those patients seen are registered at that practice.

My experience of the defence unions of the last 10 years or so is that they are becoming more heavy handed with their members.  Perhaps a clearing out exercise to try and off load those individuals that no longer fit their membership criteria.

So should indemnity go over to the crown?  You may think I am bias in my opinion, but I don’t believe this to be the best option for GP’s, as the cover is very limited and not always in the best interests of the GP involved.  What is required is competition in the market.  It is currently dominated by the three defence unions, offering cover on a discretionary basis, unregulated and not accountable to anybody outside of the unions.  Many other countries actually put in a minimum requirement for indemnity cover and that it is insurance based, therefore, regulated and accountable in a court of law.  I know competition can sometimes be a dangerous word in areas of healthcare, but if you think about it, many already view the indemnity as insurance cover.  The only difference is that it is not working in a competitive market, such as the insurance market that is global and highly competitive in it nature.  Perhaps it is time that the indemnity question is revisited, as the last outcome only rubber stamped the current method, but many things have changed since then.

Medical Insurance Consultants are able to assist you individually and as an entity/company in all indemnity requirements.  Call us today on 0800 163870 or visit our website www.m-i-c.co.uk

How Much Longer Will It Keep Going? – Medical Indemnity costs

The ways things are going at the moment the chances of reducing the amount that individuals pay to Medical Defence Organisations for medical indemnity or malpractice cover, over the next few years, are very slim indeed.  It seems that the Consultants who provide a good professional service to their patients without any problems are being penalised by those that are not so good and do have problems.  A fairly sweeping statement, but one I am sure that is at the root of a problem that will not go away.

Why should trouble free consultants not benefit individually when they have an clean track record?  Does this ring a bell – do the words co-operative or insurance spring to mind? They should do because this is one of the simple definitions defining co-operative and insurance.  But there is light years difference when comparing these two words.  One gives you a guarantee – the other does not.

Which one would you choose and which one do you think costs less? You would have thought that the medical indemnity offered by the cooperative would cost less.  In fact it is the insurance guaranteed cover that in most cases is cheaper.  How can this be?  It is not rocket science!  Individuals are assessed as individuals and from there insurers are able to establish the “risk factor”.  If say a consultant has not had any claims he/she will obtain a better premium than somebody (in the same speciality) who has had claims. The greater the risk to the insurers the greater the premium will be.

The other point to make is that the insurance cover gives you “a contract” that states exactly what you are insured against and the amount that you are insured for.  The other is discretionary.  Insurance provides guaranteed recourse options, the other does not.

How long will the “bulk assessment” continue?  The answer is – so long as the people in the co-operative are prepared to fund the people who make claims.  There is a good comparison in everyday life – Would you expect to pay the same premium, having not made a claim for the last 10 years, as a newly qualified driver driving the same type of vehicle as you?  I suspect you would not be too happy if you did.

So, how do you feel about the amount you pay for medical indemnity cover?

Contact Medical Insurance Consultants to discuss your medical indemnity options.

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

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

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!

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.

Consultants Private Practice Medical Indemnity Insurance Savings!

MIC recently released their new Medical Indemnity Insurance product to Consultants with a great reception. The product covers all indemnity needs for private practice and gives medico-legal helpline if you need it. We don’t blanket rate specialities, like most MDO’s, we look at you as an individual and quote you a price based upon your roles, income and history. Indemnity limits are available to suit your needs or the limits set down by the private hospital you may work for, be it £1 million, £3 million, £5 million or £10 million.

Current savings being achieved are at least 25% off your existing membership rates/premium.

To see what you could be saving just give us a call on 0800 163870 or email [email protected] .

Remember that MIC is not a one trick pony and can assist you in all your business insurance needs as well as many personal ones.