A Reported and Claims-made 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 Reported and Claims-made 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 Reported and Claims-made 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.
Reported and Claims-made 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.