Professional Indemnity Insurance .

 

Professional Indemnity insurance provides financial protection for doctors and hospitals in case of claims made by patients for perceived or actual negligence. It covers the doctor (indemnitee) from liability for financial losses incurred by patients. The insurance company (indemnitor) assumes the financial and legal responsibility for these claims.

Doctors and hospitals face increasing financial liability from medical negligence lawsuits due to the Consumer Protection Act's consumer-biased provisions. A robust professional indemnity insurance is essential to protect them from financial ruin. The rise in negligence cases and the Act's liberal interpretation have made doctors more vulnerable, with compensations based on patient income rather than the severity of negligence. Small and medium healthcare facilities are struggling to survive in this competitive environment, exacerbated by impractical state health schemes.

Unlike other insurance policies, the compensation amounts awarded by courts are often excessive and lack objective criteria, putting professionals at risk of blackmail. The insurance covers unintentional errors and omissions by doctors and their staff, but excludes criminal liability and limits coverage to the insured amount.

Professional Indemnity insurance for doctors and hospitals covers incidents within the policy period, with a limit of indemnity per accident and year. Continuity of coverage is crucial, as any break in the policy will result in denied claims. It is advisable to obtain insurance through reputable insurance companies or medico-legal defense groups for comprehensive services and group discounts.

Professional Indemnity insurance for medical professionals provides legal assistance and coverage for both medical negligence and non-medical legal issues. These groups offer direct support and legal representation, including the option to choose one's preferred advocate. Collective negotiation can lead to lower premiums and tailored terms, such as expanded coverage, direct compensation payments, and legal assistance beyond medical negligence cases.

Therefore, irrespective of the ills of the insurance companies, one has no choice but to take Professional Indemnity for doctors and for Hospitals. One cannot escape incidences of dis-satisfied patients and litigations during the course of medical practice in today’s context. Since the stakes in CPA have been set highly against doctors, one needs to take preventive and pre-emptive actions to safeguard his professional reputation and practice. Professional indemnity does take care of the financial loss on account of adverse judgment under Consumer Protection Act, to a large extent. It should be taken as a necessary evil and hope for the best.

To address grievances against doctors and hospitals, reforms to the current system are proposed:

* Screening complaints by a medical board before admission.
* Defining and penalizing false complaints.
* Adopting a no-fault liability system, similar to models in other countries, which compensates based on treatment-injury connection without requiring proof of negligence.

A proposed no-fault liability system for medical malpractice aims to reduce medical errors by focusing on causation rather than fault. This system would establish a compensation fund or mandate third-party insurance, streamlining the claims process and ensuring fair compensation for patients. The process involves submitting claims, having them reviewed by a medical liability committee, and receiving compensation based on predetermined criteria. Patients can appeal decisions through civil courts if desired.

In the no-fault system either a fund is created or the (mandatory) 3rd party insurance is taken. It delivers the compensation according to predetermined criteria. The suggested procedure could be like,

 

Step 1. Filling the forms: A form for the patient and for the doctor/hospital is filled. Hospital coordinators can help in the process for both. 

Step 2. The claim forms and the medical records are sent to the statutory medical liability committee

Step 3. The committee examines the records, may call either/both parties to get more information, if required

Step 4. It decides on the quantum of the compensation

Step 5. The decision is communicated to the patient/family.

Step 6. If the patient rejects the compensation, he has the right to approach the civil court for the regular proceedings

Step 7. If the patient accepts the decision, the decision is sent to the relevant insurance company which has the 3rd party insurance taken by the concerned doctor / hospital. If a special fund had been created for it (through mandatory contributions from the doctors, hospitals, state) the award amount is disbursed from it.

Alternatively, but NOT simultaneously, patients can file a complaint of professional misconduct before the SMC / NMC or file criminal complaints, if desired. Hospitals are also expected to undertake internal audits, training and upskilling of staff as well as CAPA, to improve their standards of care.

 Professional indemnity insurance protects doctors and hospitals from financial loss due to adverse court outcomes. However, the system has been exploited, necessitating reforms to ensure the profession remains attractive and maintains its noble reputation. 

Note: IMA HQ & IMA AP State offering good tailored policies for types of private hospitals and doctors with  very reasonable premium. provides hand holding support and expert guidance during alleged suit. plz contact respective state secretary of AP IMA & HSG IMA HQ.