One of the most important employment benefits is good professional liability (malpractice) insurance. Make sure you have insurance coverage when you start work - preferably your own personal policy rather than being covered under your employer's policy (rider). Why should you have your own personal policy?

1. Each health provider is responsible for his or her own negligent acts. Even though PAs are dependent practitioners and your supervising physician is responsible for your actions, this does not exonerate you from risk of individual liability. While in most cases you are covered under your employer's policy, you may still be liable for your own negligence and may still be liable for all or part of a plaintiff's award or settlement. You may have to compensate the employer who has paid damages to the claimant. You either assume that liability yourself or buy an insurance policy to transfer that risk. Insurance companies accept the transfer of risk in exchange for the payment of premiums.
2. PAs are sued. You may be told that PAs are not sued, but it is not true. Public education is a two-edged sword. As more patients, their friends, and malpractice lawyers become aware of PAs, they see a potential malpractice target if they believe they've received a poor standard of care. Current legal theory of medical malpractice dictates that as many people as possible will be named in a suit. This can and does include PAs.
3. A policy of your own provides you with separate limits of liability. You select your limits of liability to meet your type of practice and needs.
4. The policy is owned by you, the named insured. No one else is listed on the policy. There is no conflict of interest between you and your employer in the event a claim is filed.
5. Your own defense attorney is provided in the event of a claim. The attorney looks after your interests alone.
6. If you decide you want to work at a part-time position (moonlighting) in addition to your full-time position, an individual policy can be written to cover you for your duties at both positions.
7. If you accept a position and then decide you want to take a position elsewhere, your individual coverage can follow you to your new position, even if your previous employer paid the premiums for your coverage. (Note: Your previous employer may request reimbursement.)

As with any insurance policy, the most important reason to have professional liability insurance is for your own peace of mind. Just as you would not consider being without health or automobile insurance, you should not be without malpractice insurance.

How Do You Find Malpractice Insurance?

Malpractice insurance is an important service AAPA provides for its fellow and student members. AAPA Insurance Services has obtained an excellent policy offered by an A++ rated insurance carrier/underwriter. AAPA staff and PA volunteers constantly review the terms of the policy and monitor the annual premiums that are charged. This policy is the best AAPA has identified for its members.

As an AAPA member, you are eligible to apply for insurance coverage. Call AAPA Insurance Services toll free, 877/356-2272 to obtain an application form and rate chart.

Know What Your Insurance Is All About

Now for some nitty-gritty details and the definition of malpractice terms you need to understand so you are well informed.

Types (Forms) of Coverage

There are two different forms of malpractice insurance available to health care providers - "occurrence" and "claims-made."

The occurrence form has been used for several decades to provide medical malpractice insurance. The occurrence form covers incidents that happen during the policy period without regard to when the claims are reported. Occurrence coverage provides protection for each policy period indefinitely. Because of upheaval in the malpractice insurance market, occurrence coverage is becoming a rare commodity.

The claims-made form was introduced during the mid-1970s as an alternative form of coverage. Under a claims-made form, a medical incident must have happened and be reported to the insurance company while the policy is in force. Once the policy has been terminated, coverage no longer exists. If coverage is desired for claims reported after the policy has been terminated, then an Extended Reporting Endorsement (known as a "tail") must be purchased.

Some PAs may change policies from one insurance company to another every year or so. This can cause serious problems with possible gaps in protection because of differences in provisions of the various policies. There are two ways to eliminate gaps in coverage - to purchase tail coverage or prior acts coverage. Tail coverage allows the insured to continue to report incidents and claims beyond the termination date of the policy.

Prior acts coverage protects the insured retroactively for those events that may have already occurred but have not yet been reported.

PAs often face decisions regarding continuing their current form of coverage or choosing an alternative form. Now more than ever, PAs must be fully informed to obtain the best available protection without coverage gaps.

Your Insurance Premium

How much you pay for your premium depends on your responsibilities, the location of your practice setting, and the limits of liability you choose.

For AAPA's insurance purposes, PA responsibilities are divided into three classifications:

• Class A: A physician assistant who assists a qualified licensed physician in the diagnostic management of patients.
• Class B: A physician assistant who is involved in any of the following:
  
  1. Assisting in Surgery - Any exposure to an operating room, other than for observation, with GP/FP or general surgeon.
  2. Any exposure to trauma/emergency room procedures or responsibilities thereof (less than 10 hours a week).
  3. Obstetrics exposure limited to prenatal or postnatal care.
  4. Assisting in anesthesiology.
• Class C: A physician assistant who is involved in any of the following:
  
  1. Assisting in Surgery - Any exposure to operating room, other than for observation, with orthopedic surgeon, ob/gyn surgeon, cardiovascular surgeon and/or neurosurgeon, thoracic surgeon and/or plastic surgeon.
  2. Any exposure to trauma/emergency room procedures or responsibilities thereof (more than 10 hours a week).
  3. Exposure to obstetrics, including delivery room responsibilities.
  4. Exposure to cardiac catheterization lab.

Limits of Liability

The limits of liability you choose depend on your practice specialty and location. For instance, if you spend the majority of your time assisting a cardiovascular surgeon, you should choose the higher limits of liability. On the other hand, if you routinely assist in the diagnostic management of patients (i.e., histories, physicals), your exposure is lower and therefore, you may only require limits of $100,000/$300,000. If your geographic location has a high incidence of malpractice claims, you may need to choose higher limits. The limits of liability you purchase from AAPA Insurance Services cannot exceed those of the supervising physician.

Legal Fees and Court Costs Coverage

If a malpractice claim is filed against you, your AAPA professional liability policy will pay legal fees and court costs in addition to your policy limit, even if you are not liable for the charges brought against you.

What If Your Employer Insists That You Be Covered Under His/Her Insurance Policy (Rider)?

If your employer wants you to be covered under their policy and you can't afford to purchase your own personal policy, ask the employer for a copy of the certificate of insurance for your analysis. Here is a checklist of items to use when analyzing your employer's policy:

1. Is the rider's form occurrence coverage or claims-made?
2. If you decide to change employers and are covered under a claims-made policy, will your former employer be responsible for paying the cost of the tail coverage?
3. Are legal costs included in the limits of liability, or will they be paid in addition to policy limits?
4. Are you listed by name on your employer's policy?
5. Is the policy available in all 50 states?

Better yet, investigate purchasing your own individual policy through the AAPA professional liability program. Do it today for your own protection.

What is the Difference Between Occurrence and Claims-Made Coverage?

Occurrence protects you against any claim of negligence for the time period that the premiums were paid, regardless of when the claim is actually filed with the insurer. As an example, you have occurrence insurance from 1993 to 1995. A claim is filed against you in 1997 for perceived negligence you demonstrated in 1993. Because you were insured with an occurrence policy in 1993, you are protected.

If you had owned a claims-made policy in 1993 (which you terminated in 1995) and are sued in 1997, you would not be protected in 1997. Claims-made policies only cover claims reported while the insurance is in force, unless a special extended reporting period policy (or tail) is purchased.

With occurrence coverage, the premiums in the first few years are more expensive. Depending on how long you practice, the tail needed to supplement a claims-made policy may be very expensive because it is covering many potential suits for a lengthy period.

Due to the current malpractice insurance climate, claims-made is often the only available alternative today. If that is the case for you, insist that your employer foot the bill for a tail - and put that understanding in writing before you start working.

Protect Yourself Today

Medical malpractice lawsuits in today's society are on the rise. Injured patients, either on their own or encouraged by others, eventually take recourse in the courts. Situations involving injuries or damages that generations ago would have been ignored by the injured person are now regularly the basis for lawsuits. Liability is a major risk for professionals such as physician assistants.

For your own protection and peace of mind, purchase AAPA malpractice insurance today. For information about purchasing AAPA malpractice insurance contact:

AAPA Insurance Services
11 South LaSalle Street
Chicago, IL 60603-1333
Toll-free phone: 877/356-2272, ext. 5029