Claims Made Policies

ADVANTAGES OF CLAIMS-MADE AND REPORTED COVERAGE

A Claims-made and Reported policy triggers coverage at the time a claim is made against you and subsequently reported to the Insurer during the current policy period. For example, assume you had a Claims-made and Reported policy in force for the calendar year 2013. If a claim is made against you in 2013, based upon treatment you performed on a patient in 2011, then your insurance policy that you have in place for 2013 would respond, assuming the treatment was performed after the 2013 year policy’s retroactive date, and you reported the claim to your Insurer during the 2013 year policy period. If a claim is made against you based upon treatment you performed prior to the 2013 year policy’s retroactive date, the 2013 year policy would not provide coverage. The policy’s retroactive date is the date after which professional services must be rendered in order for claims arising from those professional services to be covered.

An advantage of a Claims-made and Reported policy is that the consultant has the ability to change his/her limit annually. For example, if in 2015 a consultant buys a £5m Claims-made limit and wants to change or increase that limit to £10m in 2016, the consultant may do so, which would mean that any claim made in 2016 arising out of a 2015 medical incident would be protected by his new 2016 £10m limit. On the contrary, if the consultant had an Occurrence policy with a £5m Occurrence limit in 2015 and was sued in 2016 for a 2015 medical incident, his £5m limit would apply to the claim, as the Occurrence policy claim relates back to the policy which was in force at the time of the treatment giving rise to the claim was performed.

Claims-made and Reported coverage thus provides the consultant with flexibility and control as his practice changes, or as hospitals change their minimum required credentialing limit in the future as related to the amount of coverage the consultant needs or wants.

 

  1. RUN OFF COVER

If covered under a Claims-made and Reported policy, it is important to consider how your professional reputation and assets will be protected after the expiration of the policy for claims that arise from professional services rendered between the retroactive date of the policy and the expiration date of the policy.

Insureds covered under a Claims-made and Reported policy can purchase extended reporting coverage after authorised policy cancellation or expiration. This coverage is also known as ‘run-off cover’ or ‘tail coverage’. Unless an Insured had previous Occurrence policies in place an Insured would have no coverage for any claims reported after the cancellation or expiration of a Claims-made and Reported policy. For peace of mind, we offer free, indefinite run-off cover in the event of death, permanent disability or illness and in some retirement circumstances. Otherwise, securing run-off cover often requires an additional premium.

 

  1. LIMITS OF LIABILITY

For Claims-made and Reported coverage (like Occurrence) you receive one set of limits that apply in the aggregate to claims reported during your policy term arising from professional services rendered between your retroactive date and the expiration date of your policy. The consultant has the ability to change his/her limits each year that the coverage is in place. If run-off cover is in place, it is governed by the terms and conditions of your last purchased Claims-made and Reported policy, including the limits of liability (i.e., if you purchased a £10m limit, then this limit is available to pay all damages and defence costs arising from claims reported during the last purchased policy term, as well as those reported after the expiration date of the policy).

 

*Subject to terms & conditions.