Consider the case of a Gujarat-based physician whose affected person, after a profitable emergency caesarean part, skilled extreme issues due to a nurse’s oversight—a towel left inside her stomach. This medical negligence led to a requirement for ₹30 lakh in compensation. Fortunately, the physician had skilled indemnity (PI) insurance, which offered essential monetary help throughout the authorized dispute.
“The doctor was our client. Our legal team helped the doctor prepare all the necessary legal documents required to be submitted to the insurance company for the settlement of the claim. The doctor chose to engage his own lawyer to negotiate the claimed amount, successfully reducing it from ₹30 lakh to ₹15 lakh,” says Deepankar Mahajan, chief govt, CoverYou, a Gurgaon-based insure-tech agency.
The significance {of professional} indemnity insurance
In extreme instances, claims can attain exorbitant quantities.
For occasion, the Supreme Court awarded ₹5.96 crore, the best ever, in compensation for Anuradha Saha, a US-based psychologist who died due to medical negligence throughout her go to to India. With curiosity, the overall compensation reached ₹11 crore.
While massive hospitals typically mandate PI insurance for his or her practitioners, unbiased docs would possibly overlook its significance. Even those that buy it could not totally grasp the coverage’s options.
PI insurance covers monetary prices for hospitals, docs, nurses, or different medical practitioners sued for bodily harm or loss of life attributable to error, omission, or negligence. “In many jurisdictions PI Insurance is mandatory for doctors to procure and maintain their medical licence. Not only financial protection, but this insurance also provides them peace of mind, boosting their confidence to have safer practice,” says Mahajan of CoverYou.
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Features and concerns
The sum insured, or restrict of indemnity, is accessible as soon as per coverage 12 months and is determined by elements similar to specialization, expertise, and affected person profile. Premiums are paid yearly, and insurance policies embrace a ‘obligatory extra’ clause, requiring the policyholder to bear a set quantity earlier than the insurer covers the remaining declare. For instance, if a declare is ₹5 lakh and the obligatory extra is ₹20,000, the insurer pays ₹4.8 lakh.
Some policyholders go for ‘voluntary extra’ to cut back premiums, agreeing to cover a part of the declare earlier than the insurance prompts.
Prominent insurers providing PI insurance embrace ICICI Lombard, Reliance General Insurance, Bajaj Allianz General Insurance, Future Generali India Insurance, and United India Insurance. Additionally, insurtech platforms like SecureNow, CoverYou, and Policybazaar facilitate the acquisition of those insurance policies.
“A medical practitioner should consider three things before buying a PI plan: benefits offered in the plan, the lawyer panel of the service provider, and claims settlement ability of the service provider. A doctor’s professional indemnity is a specialized plan, and should be bought from a specialized consultant with deep domain experience,” says Abhishek Bondia, principal officer and managing director at SecureNow.in.
While SecureNow and Policybazaar are complete insurance broking corporations, CoverYou focuses on medical professionals.
“Our medico-legal team can help out doctors with legal requirements but they are free to choose their own lawyer. We also provide a wide network of senior doctors who can advise medical practitioners for what should be done. Such advice coming from a doctor boosts their confidence,” notes Mahajan.
Filing a declare
When a criticism is filed, the insured ought to instantly lodge a declare with the insurance firm. Required paperwork embrace the declare type, coverage doc, authorized discover, lawyer replies, medical registration certificates, and all patient-related paperwork.
“Medico-legal instances have a tendency to be advanced, involving the well being and lifetime of the sufferers. Often, docs are accused of poor outcomes, that are fully past their management. It is necessary to work with medico-legal specialists, who’ve prior expertise in responding to such instances,” says Bondia. “Two specific aspects stand out. First, substantial loss mitigation can happen through pre-litigation intervention. Second, out-of-court settlement can help minimize protracted legal battle and linked reputational damage for the doctor. Both the aspects should be covered in the policy to ensure a smooth claims settlement experience.”
In a latest case, Bondia’s group dealt with an allegation of negligence towards a radiologist for failing to detect congenital defects throughout being pregnant scans. “While the fault could not be clearly established, we helped settle the case out-of-court on humanitarian grounds. Against a claim of around ₹50 lakh, it was finally settled for ₹20 lakh,” he says.
Professional indemnity insurance, thus, is indispensable for medical practitioners, providing very important safety and peace of thoughts in a high-risk career.
