Healthcare

An insurance contract is a legally binding document, which binds two parties to an agreement. If one party doesn’t fulfil their side of the agreement, then the other party can bring legal action against it.  In this case, the insurance contract is the agreement between CFC and the surgeon/medical practice to provide cover for claims of medical practice, in exchange for the premium paid. Insurance companies are strictly governed by prudential regulators to ensure that they have enough funds in reserves to pay claims. Parties to the insurance contract can also take disputes to external bodies, such as financial ombudsmen, if they have a dispute about a claim.

Discretionary cover is not as binding as a contract, and the indemnity provider can decide when the claim arises whether or not to pay it. Mutual organisations generally provide malpractice cover on this basis. They are also not governed in the same way as other financial institutions.

Doctors and consultants can be sued by their patients, generally alleging that the treatment or surgery was not performed to the standard of care expected. Other common claims against doctors are a missed or delayed diagnosis, or a failure to warn of the specific risks associated with treatment. 

The most common claims are regulatory matters, defending a doctor’s licence to practice, in front of disciplinary and registration boards like the GMC. In addition, practitioners are also exposed to cyber-attacks by criminals, who specifically target medical professionals due to the amount of valuable patient data they hold.

Healthcare providers are attractive targets for hackers as they store huge amounts of valuable patient data. The stored data is highly detailed, including demographic data, financial information and medical and clinical data, and that information can be easily monetized in the wrong hands.

In addition to the liability to patients for the loss of their data, practitioners are also exposed to ransom threats from hackers, regulatory investigations, business interruption and losses in revenue arising from the temporary cessation of practice due to loss of patient records, liability to third parties (such as clinics, hospitals and medical insurers) and costs of rebuilding the patient database.

The statute of limitations for clinical negligence claims is currently 3 years from the date of awareness or, in respect of minors, 3 years after they have turned 18. UK courts have been known to allow claims that have exceeded the statute of limitations. With this in mind, CFC provide up to 25 years extended reporting period.

Practitioners can be the cause of patients or hospital staff members having an accident while in third party premises. Furthermore, practitioners are also allowed access to third party owned expensive equipment which can be very expensive to replace if accidentally broken.

CFC’s policy covers surgeons for claims made against them by patients and which they notify to CFC within the policy period, when the treatment giving rise to the claim occurred after the retroactive date. For a claim to be covered, the treatment the surgeon provided which led to the claim must have occurred after the retroactive date. 

The retroactive date is a date in the past and could be before the start of your current policy.