Other Useful NetLinks Handbook Contents Introduction Risk management Insurance program Legal system Medical records Incident reporting Physician-patient Informed consent Infectious disease Confidentiality Patient's rights Risk Home Page

Insurance program at Yale-New Haven Hospital In 1978, several other major teaching hospitals formed an insurance company (the "Company") chartered in Bermuda to underwrite medical professional liability insurance, commonly referred to as medical malpractice insurance, and general liability insurance for the participating hospitals and schools of medicine, physicians and dentists closely affiliated with each hospital, and the physician and non-physician employees of each hospital. Yale-New Haven Hospital and Yale School of Medicine joined the Company in 1979. The hospitals and their affiliated universities who participate in the insurance program (and who are the principal Named Insureds) are: The Presbyterian Hospital in the City of New York The Society of The New York Hospital Cornell University The University of Rochester (Strong Memorial Hospital) The Johns Hopkins Hospital The Johns Hopkins University Yale-New Haven Hospital Yale University In addition to the primary coverage provided through the program, the participating institutions purchase excess insurance from some of the largest and most reputable insurance companies issuing policies covering health care related risks in the United States. The policy is written on a claims made basis, which means it covers claims or adverse medical incidents actually reported to the insurer during the policy year resulting from services rendered during the policy year or after inception of an insured's coverage under this program (the retroactive date), whichever is earlier. Claims related to services rendered prior to an insured physician's or dentist's coverage under this program should be covered by the insurance carried by that insured at the time the service was rendered. The scope of the malpractice coverage provided by the insurance program's policy generally parallels that customarily included in medical professional liability policies. This generally includes coverage for such allegations as negligence, breach of patient confidentiality and lack of informed consent, for example. Coverage is extended for professional service of a medical nature performed anywhere in the world, provided suit is brought in the USA, its territories or Canada. Interns, residents and fellows are insured solely for activities performed within the scope of their formal program and approved affiliations. This does not exclude coverage for "good samaritan" activities, but does exclude coverage for "moonlighting". Non-physician employees, including nurses, therapists, social workers, and psychologists are automatically covered under the policy but only while acting within the scope of their employment. The general liability insurance provided under the program is limited to acts and conditions arising out of activities on behalf of the hospital (or Named Insured) and does not provide coverage in homes or private offices, except where such offices are located in a facility owned or controlled by a participating institution. Physicians and other insureds who terminate their insurance voluntarily, or who retire or leave a participating institution will continue to be covered for claims made subsequent to their departure but arising out of professional services rendered during the period of their participation in the program. This insurance coverage will be provided as part of the institution's policy in future years. The program will provide departing insureds this so-called "tail-coverage" for future unreported claims at no additional premium charge, as long as the insured's sponsoring institution remains a participant in the program. In the event an institution no longer participates in the program, it will be the possible for that institution to buy "tail coverage" for itself as well as current and prior staff. No coverage is provided for any claim arising out of services rendered after an individual terminates participation in the program. To be covered under the insurance program, physicians and dentists must participate under the sponsorship of a Named Insured institution, meet the eligibility criteria of the Company and be subject to and comply with the hospital's credentialing and reappointment process and requirements. Coverage may be withheld or terminated if a physician or dentist does not meet the required eligibility or underwriting standards of the Company. Insured physicians, dentists and other health care providers are required to participate in regularly scheduled risk management and quality assurance education programs either conducted or sponsored by the institution. Since the policy is written with a common aggregate limit of liability, each participating institution is listed as a "Named Insured" on the policy. Individual physicians and dentists are additional insureds and do not have an "individual" policy. Premiums are determined each year in the aggregate at a level deemed sufficient to cover anticipated claims and necessary reserves, plus certain costs such as reinsurance premium and administrative expenses. The institutions who comprise the Company have established procedures for the management and resolution of claims brought against the hospital, the School of Medicine or its insured physicians or employees. The participating institutions have engaged a company with expertise in the management of medical professional liability claims to assure adherence to these agreed upon claims management procedures. All insured physicians, dentists and other health care providers are have a duty under the policy to cooperate with the hospital's representatives, the Company and its agents, and to assist in the investigation, defense and resolution of claims. Insured physicians and dentists can obtain further information regarding the insurance program by contacting the Office of Legal Affairs.   Reporting Potential Claims/Lawsuits The policy requires that, in order to minimize costs and to insure the efficient handling of claims, physicians and other insureds promptly report the following circumstances: Any medical incident which could result in a claim; A request for information or medical records by a patient's attorney, unless the request is clearly related to worker's compensation or other non-professional liability related litigation; A threat of legal action or demand for compensation by the patient or his or her representative; or The service of formal suit papers. All such reports should be made to the Office of Legal Affairs, which administers the claims management program at the hospital and School of Medicine. Written communications to the Legal Office should be so addressed and marked privileged and confidential. Copies of this correspondence should not be directed to others outside the Legal Office.