Sample Certificate of Insurance
||Your policy number is listed here
||Your coverage effective dates are here |
|Named Insured and Address:
Program Administrator: |
||Healthcare Providers Service Organization 159 East County Line Road
Hatboro, PA 19040 |
Insurance Provided by: |
American Casualty Company of Reading, Pennsylvania
33 South Wabash Avenue
Chicago, Illinois 60604|
This is the maximum amount available to be paid on your behalf if a demand for money or services is made alleging injury or damage arising from a single act, error or omission in the rendering of your professional services as stated on your certificate of insurance.
This is the maximum amount available to be paid on your behalf regardless of the number of claims or entities making claims against you.
The Bottom Line: the most we will pay for any single covered malpractice lawsuit is the each claim limit. The total amount we will pay for all covered malpractice lawsuits will not exceed the aggregate limit.
A. PROFESSIONAL LIABILITY COVERAGE PART
Professional Liability (PL)
Your Professional Liability coverage is the "backbone" of your policy. Most likely, this coverage was your reason for purchasing this policy in the first place.
If a patient was injured while in your care, they can sue you (along with any other healthcare professional involved in their care) for malpractice. If they are successful in their suit and it is determined that you were negligent in the providing of professional services (by the way, several healthcare professionals can all be found negligent and contributing to a single patient's injuries) this policy will pay all amounts up to the Professional Liability limit of liability stated on your certificate of insurance. The amount available is identified in the each claim section of your certificate of insurance (defined above) and the aggregate section of your policy (also defined above). If you even suspect that you could be named in a lawsuit because a patient suffered an injury, you should contact us right away- even if you have other insurance through an employer. The sooner we know about a potential claim, the more prepared we are to protect your interest in case you need us.
Good Samaritan Liability
You've heard the horror stories about Good Samaritans; a healthcare provider stops to help at the scene of an accident, something goes wrong, and that provider is sued despite the goodwill that provider showed while trying to help. Many states have enacted laws intended to protect you from liability claims if you provide reasonable care in an emergency situation (while you're off duty). However, just because there are laws to protect you doesn't prevent an accident victim or his family from initiating a claim against you.
The bottom line is you will still need to defend yourself in the lawsuit and your employer's policy likely won't be there to protect you. You can feel more comfortable knowing that your Professional Liability coverage can be activated in the case of your Good Samaritan action. If appropriate, an attorney will be assigned as your counsel in the lawsuit. This policy will pay all amounts, up to the Good Samaritan Liability limit of liability stated on the certificate of insurance, that you become legally obligated to pay. Again these amounts are stated in the each claim and aggregate sections of your certificate of insurance (both are defined above). Keep in mind that, especially in an emergency situation, it is important to stick with what you know- don't try to provide care that you're not qualified to provide.
Personal Injury Liability
This coverage section protects you if it is alleged that, in the course of your providing professional services, you have inflicted personal injury. Personal Injury is not necessarily a physical injury. For example, suppose a patient you're treating shares information with you that is very private in regard to his or her medical condition. You know that you should not share this information with anyone, but somehow you find yourself telling your family about it at the dinner table anyway. The next day, your child tells someone in school, and soon everyone in town knows about your patient. This scenario is an obvious case of violating your patient's privacy rights, -- an offense which could cause "personal injury". Another example of a personal injury is the case when, based on a patient's appearance or symptoms, you reach a conclusion about a patient's physical condition or mental state. For example, if you see a patient who looks or acts a certain way, you may believe that patient is abusing drugs or alcohol without having the physical proof to confirm this suspicion. If you write in that patient's file that they are a substance abuser, or share that information with a colleague verbally and it is not true, you may be sued for libel (written) or slander (spoken)- both of which are offenses that could cause "personal injuries".
If you are involved in a scenario which you feel may be considered personal injury, and that scenario evolved from your professional services, your best bet is to contact us. We will put you in touch with a claims consultant to analyze your situation and determine if and how your coverage will respond.
This is another coverage included in your Professional Liability limits. This coverage relates specifically to your responsibilities for arranging and qualifying suitable work for eligible healthcare providers. It is a valuable coverage for supervisors and charge nurses.
Let's say you are working in a hospital and you are responsible for distributing assignments to the other nurses on the shift. You unknowingly send a nurse into an area of the hospital that she's not really well-trained in. A lawsuit could occur if a claim arises from the nurse's unfamiliarity with the procedures of the area she worked in that evening- this happens all too often. You might be held responsible in the lawsuit because it was your decision to send that nurse to that area. This can also apply in a home health setting- if you are coordinating home visits for a staffing agency, for example, and you inadvertently send a nurse or an aide somewhere where their role exceeds their education and training, you might be held responsible for the consequences.
It's difficult in today's nursing climate to always have the adequate staff, both in numbers and in skill, to address the needs of your organization, and this coverage addresses that reality.
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B. COVERAGE EXTENSIONS
This policy's license protection coverage is an invaluable feature for any healthcare provider who holds a license. Where would you be without your license?
Simply put, anyone can file a complaint against you with your licensing board- a patient, patient's family, a colleague, even your employer. You may have done nothing wrong, but this does not stop anyone from filing a complaint. The board has the responsibility to investigate these complaints. That's where your insurance policy kicks in. This policy will pay you up to the License Protection limit of liability stated on the certificate of insurance, for attorney fees incurred by you, for your investigation and defense of complaints. You can select your own legal defense counsel.
In addition to attorney's fees, this policy will provide reimbursement for travel, food, lodging, and even your lost wages - incurred by you while defending an action from your licensing board. Also, keep in mind that this coverage part will respond to medical and non-medical incidents related to your practice.
Defendant Expense Benefit
OK, one of the worst things that could happen to you as a provider has actually happened - you find yourself named in a professional liability lawsuit! This will be stressful for you. There are no two ways about it. We want to be sure that we help to minimize your stress as best we can. We do this in several ways. First, we strive to ensure good communication between you and your claim consultant so that you know what is going on with your case at all times. We also prepare you for depositions and for cross-examinations. And, we have included the defendant expense benefit coverage in the policy to help limit your financial concerns during a lawsuit.
This coverage reimburses you for travel, food, lodging and lost wages, up to the limit of liability stated on the certificate of insurance, incurred as a result of your being required by us or by the defense attorney to attend a trial, hearing, or proceeding. We will need written documentation from you for these expenses. Please be sure to include your name, the date and the reason you were traveling. It would also be helpful if you would include the name of the court and those involved in the lawsuit (for example: Bucks County Court House - Healthcare Provider versus Plaintiff).
A patient is injured at the facility you work in. You were not caring for the patient at the time they were injured, but you did see the patient earlier in the day. The patient initiates a lawsuit. The good news is you are not named in the lawsuit. But, you do receive a subpoena for testimony. This can be scary - especially if you have never been deposed before. Deposition Representation coverage will pay, up to the aggregate limit of liability stated on the certificate of insurance, for you to be represented, if necessary, at the deposition by an attorney we designate. Your claim consultant and the attorney will coach you on how to prepare for the deposition and how to approach the actual deposition. The attorney will be there if you have any questions and to make sure the deposition goes as smoothly as possible. The amount of money available for reimbursement is stated on your Certificate of Insurance.
Violence in the workplace - it's a reality - you see it in the headlines of both local and national newspapers. Healthcare professionals are high on the list of those affected by workplace violence. Fortunately, you now have some additional coverage if you become the victim of a violent action at work or on your way to or from work.
This coverage extension will pay for medical expenses you incur or for damage to your personal belongings, resulting from an assault on you at your workplace. This policy won't reimburse you for goods lost or stolen during an assault.
This benefit provides that we will pay up to the Medical Payments limits of Liability, for necessary medical expenses caused by an incident, other than a medical incident. Simply put, if someone were to hurt themselves at your primary personal residence or your business premises (typically the address listed on your certificate of insurance, your income tax statement, your registered voting address) and they require medical attention, they can receive reimbursement, up to the limit of liability stated on the certificate of insurance. The injured person does not need to sue you to receive this reimbursement! All the injured person would need to do is to give us written proof of the claim as soon as practical and give us permission to obtain copies of the medical documents that relate to this injury. It's really pretty simple! Of course, this coverage is not available to an employee of yours or to you or one of your family members. This coverage is not provided to student or retired healthcare providers.
This benefit provides reimbursement for expenses you incur while rendering first aid to a person (other than yourself). This can include reimbursement, up to the limit of liability stated on the certificate of insurance, for supplies from your personal first aid kit that you used to help a victim of an automobile accident.
Damage to Property of Others
This coverage extension will pay up to the limit of liability stated on the certificate of insurance for unintentional damage you cause to someone else's property while at your primary personal residence or your workplace. Let's say that you go to a patient's home to provide care, and you break a vase while you're there. Because that home was your "workplace", this coverage can respond and pay for damages that result. This policy can provide reimbursement for the patient's damaged property. All we would need you to do is to notify us (typically a written statement) within 60 days of damaging their property (your patient's vase) and we need you to show us the damaged property (your patient's vase).
In the past, while your coverage through NSO would pay to defend you against allegations of sexual misconduct related to your professional services, there was no coverage for a settlement. This endorsement provides you with a $25,000 aggregate sublimit for covered sexual misconduct claims.
Workplace Violence Counseling***
While your Assault Coverage pays for the medical expenses resulting from an attack at work or on your way to or from work, this endorsement broadens your coverage to include $25,000 aggregate limits for the payment of any emotional counseling needed as a result of a covered incident.
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Information Privacy Coverage
People today are very conscious about their privacy. Most are aware of the protection they receive under the new HIPAA laws. This endorsement extends your coverage to pay for HIPAA fines and penalties arising from a HIPAA proceeding subject to a $25,000 aggregate limit.
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C. Workplace Liability - This coverage does not apply if coverage part D. General Liability is made part of this policy.
Workplace liability coverage will pay amounts, up to the limit of liability stated on the certificate of insurance, which you become legally obligated to pay as a result of injury or damage caused by an occurrence that happens at your workplace. For example, let's say you go to a patient's home to provide care, you leave your equipment by the front door and the patient's daughter comes in, trips on the equipment and injures herself.
This coverage can also be used if you rent or lease your own office space. If you have a patient come to your office and they slip on a wet tile in your waiting area and injure themselves, you can use this portion of the policy to respond to any lawsuit that may occur as a result. Other coverages included in this coverage part are products liability coverage (claims caused by machinery that you have built or modified for direct patient care, rather than for sale) and host liquor liability (liability you might incur as a result of serving alcohol at a function incidental to your business -an office party for example).
Fire and Water Legal Liability
This coverage provides for liability you incur as the result of damage to other's property caused by fire or water at your workplace (subject to policy conditions). The damaged property cannot be owned, rented or leased by you, on your premises, or in your safekeeping. If there is a fire in your office space, for example, and that fire causes damage to a neighboring property, this policy could pay for that neighbor's damages. Keep in mind that the limit on this coverage is limited in relation to your Workplace Liability coverage part. The sub-limit for this piece of your coverage is indicated on your certificate.
Your personal liability coverage will provide coverage, up to the limit of liability stated on the certificate of insurance, that you become legally obligated to pay for injury or damage to a third party that happens at your personal residence and arises out of non-business activity - unrelated to your professional activities.
Personal liability coverage complements your medical payments coverage. Medical payments coverage will provide reimbursement for medical expenses, while the personal liability coverage will provide coverage in case the accident results in a lawsuit. If you suspect, or have received notice of, a claim for personal liability, you can contact us to analyze your coverage and determine the proper course of action. Keep in mind that both the personal liability coverage and the medical payments coverage are meant to support, not replace, your homeowners liability coverage.
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D. General Liability - This coverage part does not apply if coverage part C. Workplace Liability is made part of this policy.
General Liability (GL)
General Liability is an optional coverage, which replaces the Workplace Liability Coverage part, and responds to claims of injury or damage caused by an occurrence that happens anywhere in the world. General Liability is available to self-employed individuals and business owners only. Included in this coverage part is an increased sub-limit for Fire and Water Legal Liability.
*** Applicable in states where approved. Assault Coverage and Workplace Violence not available in TX.