Medical Indemnity & Insurance PDF

Definitions a. Indemnity – works on the basis that the claim is covered as long as the cover was in place when the incident occurred, rather than when the claim is made. b. Insurance – only provides cover for claims arising during the period of cover. It is necessary to purchase additional “run off...

Definitions a. Indemnity – works on the basis that the claim is covered as long as the cover was in place when the incident occurred, rather than when the claim is made. b. Insurance – only provides cover for claims arising during the period of cover. It is necessary to purchase additional “run off” cover. Good Medical Practice, para 63, requires doctors to have adequate insurance or indemnity cover in place where necessary. The GMC now has statutory powers to check registrant’s indemnity/insurance status and to remove or refuse a licence to practise. The law says appropriate cover is cover against liabilities that may be incurred in practising as a doctor having regard to the nature and the risks of practising as such. What constitutes “adequate” is therefore dependent upon the doctor’s individual circumstances. The onus rests with the individual doctor to ensure they have insurance or indemnity cover for their full scope of practice and that this cover continues following cessation of practice so that patients can be adequately compensated. GPs – independent contractors, locum GPs, salaried GPs. Varies across the jurisdictions: England: Clinical Negligence Scheme for General Practice (CNSGP), operated by NHS Resolution Wales: General Medical Practice Indemnity (GMPI), administered by Shared Services Partnership – Legal and Risk Services; OOH cover administered by Welsh Risk Pool (in Wales – GP locums must register on the All Wales Locum Register to qualify) In Scotland & NI, GPs must organise their own indemnity/insurance NHS/HSC Trust employees Locums working in NHS/HSC Trusts Indemnified for NHS work through their employing organisation. Need to consider the extent of cover for NHS work E.g. cremation certificates, insurance claim forms and medico-legal reports may not be covered. No cover for GMC/disciplinary/criminal investigations. Doctors undertaking private work Must organise their own indemnity/insurance State-backed indemnity for GPs in England & Wales was introduced in April 2019. All GPs and their staff are automatically covered by the schemes if they are providing NHS services. The scheme covers all NHS commissioned work, including out of hours. GPs still need to be alert to the potential for vicarious and corporate liability. Therefore, it is advised that they organise cover from Medical Defence Organisations. There is currently no provision for state-backed indemnity for GPs in Northern Ireland or in Scotland. Medical Defence Organisations (MDOs) provide discretionary indemnity which provides only the right to request assistance. To guarantee cover would equate to provision of insurance, and as MDOs are unregulated, this would represent a criminal offence. There is no obligation for the MDO to provide reasons for refusal of cover, as there is no contract of indemnity. The 3 main MDOs are the Medical Protection Society (MPS), the Medical Defence Union (MDU) and the Medical and Dental Defence Union Scotland (MDDUS). Insurance is regulated, and provides a contractual right to assistance, subject only to the terms of the policy. Redress can be sought through the Financial Ombudsman Service (FOS) and the courts/arbitration. The Financial Services Compensation Scheme will pay claims in the event that the insurance company fails. CLAIMS OCCURRING COVER CLAIMS MADE COVER Any covered incident occurring during the period of cover, regardless of when the claim is reported & even if cover has lapsed or cancelled Any covered incident when the claim is made during a period of cover. Fine if continue to renew with the same provider. If cover lapsed or cancelled – cover stops INDEMNITY INSURANCE Trust Medical negligence claims Medical negligence claims Medical negligence claims arising in course of employed work. Type & level depends on: Type & level depends on: Where work Where work Employed/selfEmployed/selfemployed employed Type of work Locums & employees NHS organisations. Type of work Criminal and GMC investigations Criminal and GMC investigations Discretionary Regulated No additional cover beyond clinical negligence Not regulated Three Medical Defence Organisations: Medical Protection Society (MPS) Multiple private insurers England: Clinical Negligence Scheme for Trusts (CNST) Medical Defence Union (MDU) Medical and Dental Defence Union Scotland (MDDUS) Wales: Welsh Risk Pool Services (WRPS) Scotland: Clinical Negligence and Other Risks Indemnity Scheme (CNORIS) N.Ireland: Health and Social Care Trust The term ‘Crown Indemnity’ is often used. In reality, this does not exist. England Clinical Negligence Scheme for Trusts (CNST), administered by NHS Resolution Wales Welsh Risk Pool Services (WRPS) Scotland Clinical Negligence and Other Risks Indemnity Scheme (CNORIS) Northern Ireland Each Health and Social Care Trust assumes the role, funded by the Department of Health PRIVATE WORK For healthcare provided in the private sector, the patient has a contract with the doctor and/or the clinic or hospital where they receive treatment. The nature of the contracts vary, but will contain terms implied by statute e.g. compliance with the Supply of Good and Services Act 1982 for medical devices.