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Frequently Asked Questions (FAQs)

Here are some of the most common questions NSO receives. If you don't see your question, please contact us. You'll find our contact information on this page, too!


Overview
There is no direct exclusion in your professional liability policy through NSO for communicable diseases like the Coronavirus. If you feel you have a claim that’s related to the providing of professional services and a patient being diagnosed with or infected by COVID-19, you should contact us so that we can review your claim and determine if coverage applies to your specific situation. We are unable to answer hypothetical “what if” questions as each claim must be evaluated on its unique facts and circumstances, as well as policy provisions and the allegations of a claim, in order to determine if coverage will apply.
 
We’ve developed the following for our individual policyholders, which generally discuss the relevant issues.
 

*Note:  Insurance companies issue insurance policies that specify definitions of key policy terms, triggers for coverage applicability and exclusions to the policy.  Each claim is evaluated by the insurance company that issued the policy.  The claim is evaluated with respect to policy provisions in order to determine coverage applicability.


COVID-19

It is important that you are covered appropriately during this unusual time. Depending on your situation you may want to change the status of your policy to part-time or even move into our “Leave of Absence” policy. Please call 800-247-1500 to discuss what is best for your specific situation.
Yes, it is important that you are covered appropriately during this unusual time. You will want to update your policy status to “professional”.  Please call 800-247-1500 or email us at service@nso.com to make this policy change.

If the work is not part of your nursing schools curriculum, then, yes, you need to update your policy to cover this exposure. The NSO policy for nursing students is designed to cover you for incidents while providing nursing services within the curriculum of your school’s nursing program.  If you choose to help assist during the pandemic but it is not part of your school’s curriculum, you need to do one of the following to be appropriately covered by the NSO policy:

  • Add a second profession of Nursing Assistant to your existing student policy.   To do this please call 1-800-247-1500 OR
  • If your student policy has recently lapsed, start a new policy with the profession of Nursing Assistant, apply online at www.nso.com
It is absolutely true that the pandemic is challenging each of us – especially nurses who are on the frontline of fighting this virus while caring for their patients. It is also true that there are certain state and federal regulations, declarations and orders that extend liability immunity in the fight against COVID-19. What’s not clear is the breadth and scope of these regulations and orders; e.g. will they extend to all providers in all areas of service or if such immunity will be limited and specific to those employing counter-measures in the fight against COVID-19? Since there is lack of clarity in terms of immunity, it is prudent to not presume you have any immunity. Further, plaintiff’s counsel can file suit, immunity or no immunity, if the plaintiff’s counsel believes the client was injured and that injury was the direct result of the nurse or other healthcare professional providing or failing to provide professional services. If a suit is filed, nurses will want to have their own malpractice insurance coverage to ensure their best interests are represented. In the best case scenario, the suit brought against the nurse will be deemed baseless and their insurer will work to get the suit dropped/dismissed.
If you are considering providing your professional services via tele-health, please know that the professional liability coverage, issued by NSO, does not have a limitation as to how professional services are provided (in person or via technology). Rather, the policy requires that you are appropriately licensed to provide professional services and that you comply with state, federal and facility guidelines relative to scope of practice and practice setting.

While older adults may be at a higher risk for developing more severe illness from COVID-19, no population or healthcare provider is immune. We recommend that all providers, staff, and patients exercise extreme precaution both in and out of the hospital environment to minimize the potential for transferring and contracting this illness. The best source of information related to the prevention and treatment of COVID-19 is the CDC. For infection prevention recommendations, the CDC has developed interim guidance for infection prevention and control specific to COVID-19. This guidance is the best, most up-to-date information available.

The best source of information related to the prevention and treatment of COVID-19 is the CDC. Within the CDC’s guidance, we recommend the following resources:

 

Because the onset, duration, and period of infectiousness for COVID-19 are not yet known, healthcare providers in every healthcare facility should take precautions, both in and outside of health care settings, to minimize the potential for transferring and contracting this illness. The CDC will update this interim guidance as needed and as more information becomes available.

The best way to address your questions and concerns at this time is to direct you to the best sources of up-to-date information and assistance: The best source of information related to COVID-19 is the CDC. For guidance, the CDC has developed interim guidance for healthcare providers who are coordinating the home care and isolation or quarantine of people confirmed or suspected to have COVID-19, as well as interim guidance for infection prevention and control. Further, the FDA would be the best source of information regarding PPE supply shortages, and reporting shortages.

As far as your company’s responsibility to you, employers of healthcare workers are responsible for following applicable OSHA requirements, including OSHA's Bloodborne Pathogens (29 CFR 1910.1030), Personal Protective Equipment (29 CFR 1910.132), and Respiratory Protection (29 CFR 1910.134) standards. See OSHA’s Standards page for additional information on OSHA requirements, or review OSHA’s recommendations specific to COVID-19: https://www.osha.gov/SLTC/covid-19/controlprevention.html#health

To get OSHA advice, file a complaint by phone, or report an emergency, contact your nearest OSHA office, or calling OSHA toll-free at (800) 321-OSHA (6742).

For additional resources and guidance, we recommend the following resources:

  • ECRI: Offer checklists, equipment recommendations, alternate suppliers, and infection control guidelines.
  • ANA: What nurses need to know about the coronavirus and best practice resources, as well as ethical standards
WHO: Rolling updates on COVID-19.
Always adhere to HIPAA regulations which include the Privacy, Security and Breach Notification Rules as well as the HITECH Act. Keep in mind that additional state and federal requirements under patient privacy standards apply, and these requirements do not change when practicing Telehealth/Telemedicine (e.g., behavioral health, alcohol/drug treatment and minors).  It is the provider’s responsibility to be appropriately equipped to perform services. Any questions regarding HIPAA or patient privacy regulations, please refer to the HHS website for guidance for providers: https://www.hhs.gov/hipaa/for-professionals/index.html

Because the onset, duration, and period of infectiousness for COVID-19 are not yet confirmed, employers and healthcare facilities should take the stance that screens are necessary to “mitigate risk.” All patients and visitors entering any healthcare facilities can and should expect to be screened. Facilities may choose to communicate this to visitors and patients by placing signs, sending letters, or stating this verbally with each appointment, to manage expectations.

Facilities should have a process is in place to triage, report and track patients, visitors, and staff who screen positively for COVID-19. Those individuals will also be taken through a complete protocol that helps them and protects staff and others.

While providers may encounter folks who do not wish to be screened, during this time of a national emergency and pandemic, they should not waver from established facility policy and direction from the CDC. If an individual refuses to allow screening, and is not in an emergent condition or status, I would refuse treatment and offer to reschedule that patient until they comply with protocols or the national emergency status has been lifted.

The CDC has guidance that is intended to address recommended infection prevention and control practices when these activities are performed outside of a hospital setting, which warrant additional considerations beyond those described for healthcare settings. This guidance includes interviewing and assessing persons with or without symptoms.

The CDC guidelines, which may be accessed at: https://www.cdc.gov/coronavirus/2019-ncov/index.html, note that when a patient presents with symptoms of an infection (e.g., fever, cough and shortness of breath), providers may consider postponing non-emergency/non-urgent or elective procedures / treatments until the patient is no longer contagious. If urgent treatment is necessary, healthcare providers should take appropriate precautions in order to avoid spreading COVID-19 among patients, visitors, and healthcare facility staff.

We encourage healthcare providers to use their professional judgment to determine when, where, and how to provide care, with the understanding this is not the optimal environment for care, for anyone involved. Given how quickly the situation around the novel coronavirus (COVID-19) is evolving, we suggest following your facility’s policies and procedures, CDC guidelines and the advice of local, state and federal health authorities regarding the following to best protect yourself and your patients / clients during this public health emergency.

For additional resources and guidance, we recommend the following resources:

  • ECRI: Offer checklists, equipment recommendations, alternate suppliers, and infection control guidelines.
  • US Department of Health and Human Services (HHS): Routinely monitor for federal government updates related to the provision of telehealth services, diagnostic testing, and vaccine trials.
  • WHO: Rolling updates on COVID-19.

Information and resources are constantly changing so we suggest checking back in on a frequent basis. Your employer policies and procedures, if available, may also have unique information on this topic for emergency situations like you’ve described.

Appropriate and complete patient/client documentation is vital in healthcare for a variety of reasons. Providers should follow their facility’s policies and procedures on patient/client documentation during emergency/disaster situations. Notably, during emergency/disaster situations appropriate patient/client documentation is most critical. Typically, an emergency/disaster situation would not represent an effective deterrent or defense in the event that a lawsuit arises.

First, telehealth treatment/services, practitioners may need to be appropriately licensed/certified/credentialed to practice in the state where the patient is located, and work under that state’s scope of practice. NSO does not exclude telehealth/telemedicine coverage provided you are working within the appropriate regulations and scope and standards of practice. Please refer to your professional association, state and/or federal government standards and requirements for more information about scope/standards of practice.

A patient-provider relationship can be established via telehealth in a similar manner in which it is established in an in-person office/hospital setting. However, some state laws restrict the setting in which a patient must be located in order to establish a patient-provider relationship (for example, limiting it to “established medical sites”), the modalities that can be used to establish such a relationship (such as via telephone or audio/video technology), and the types of services that can be provided via telehealth (especially as it relates to prescribing). It is advisable to review the relevant state practice act(s) as well as established professional standards prior to offering telehealth services. If a state practice act is silent regarding telehealth or published opinions, or interpretations regarding the subject of telehealth have not been issued by recognized sources, then contact the state professional licensing board for clarification.

The COVID-19 pandemic represents a dynamic challenge to the health care system, and as a result new guidance is being provided continuously. In general, telehealth reimbursement policies differ greatly across state Medicaid plans and private payers, and the Centers for Medicare and Medicaid Services’ telehealth coverage reimburses only for specific services when they are delivered via live video and is limited to strictly defined rural areas, for specific services, and when the patient is located in a specified health care facility by certain providers. However, over the last several weeks, the HHS Secretary has been granted the authority to allow telehealth to be more widely used for Medicare beneficiaries during the COVID-19 public health emergency period. CMS has also issued guidance so states can request a waiver of additional specific provisions under Medicare, Medicaid and CHIP to improve the health care response to COVID-19. It is advisable to check with your state Medicaid office for up-to-date information regarding the provision of telehealth services, including distance counseling, and to monitor US Department of Health and Human Services (HHS) website for federal government updates related to the provision of telehealth services.

CDC guidelines recommend rescheduling non-urgent or elective procedures / treatment as necessary, and eliminating patient penalties for cancellations and missed appointments related to respiratory illness. Guidelines also note that if urgent treatment is necessary, providers need to determine appropriate precautions to take on a case-by-case basis to avoid spreading diseases among patients, visitors, and staff. Symptomatic patients who need to be seen in a clinical setting should be asked to call before they leave home, so staff are ready to receive them using appropriate infection control practices and personal protective equipment. These guidelines through the CDC and otherwise are continuously adapting so we encourage you to check back frequently.

It is important to keep abreast of the changing dynamics and guidelines as they are being rapidly modified to address the changings needs of providers and their patients. Telehealth services must comply with the same HIPAA-related rules and regulations at the federal and state levels, as well as business policies, that apply to the delivery of in-person services. According to the FCC, if a patient provides a contact telephone number to a healthcare provider, the provision of that telephone number constitutes express consent for telephone calls to be made, subject to certain HIPAA restrictions. Consent applies to calls and text messages related to the provision of medical treatment.

To ensure that the technology is compliant with HIPAA rules and regulations, practitioners should be conversant with the HIPAA Breach Notification Rule and technology encryption requirements. In the case of interstate practice, if requirements for privacy, security and informed consent differ between states, practitioners are encouraged to follow the most restrictive laws and regulations.

There are many HIPAA-compliant telehealth solutions. NSO does not endorse any specific brand. Rather it is the responsibility of the provider to determine which option is both legal, cost effective, and available in their state and area of practice. Here are names of a few options in no particular order: Doxy.me , thera-LINK,  TheraNest, SimplePractice, Zoom for healthcare, and VSee. We also recommend you contact your professional association to see what they may recommend to fit your needs.

Some resources that may be useful to you as you offer more distance counseling:

While we cannot make the determination of which healthcare providers are essential or non-essential, we recommend you discuss this with your employer or professional state organization to get clarification on essential functions that may be appropriate for you to maintain operations and to protect your health and safety at this time.

For healthcare providers who are deemed as essential, we are reminding and recommending that providers, patients, and the public exercise extreme precaution, both in and outside of health care settings, to minimize the potential for transferring and contracting this illness. The best source of information related to the prevention and treatment of COVID-19 is the CDC. For infection prevention recommendations, the CDC has developed interim guidance for infection prevention and control specific to COVID-19.

Questions about coverage

Your coverage can begin once your completed application is approved and payment is received. In most cases, this can be done in one day if you apply online. If you decide to fax your application (1-800-739-8818), it can be processed within 2-3 business days. Your application processing time may be extended if we need additional information from you.
Yes, you are eligible for up to a 50% discount if you’ve graduated from school within the last 12 months. When you apply through our online quote process, your rate will reflect all discounts for which you are eligible.
A good way of knowing if you are considered an employee is whether or not your company takes taxes out of your pay and files a W2 form with the IRS at the end of the year. If this is the case, you can indicate that you are employed. Generally, self-employed professionals receive a 1099 Form from the entity for whom they have performed services.

If you are both (working for different companies in different capacities), then you can apply as "self-employed" to be insured for both your employed and self-employed work.

If your employer pays for your professional liability insurance coverage and continues to have you covered under the employer’s policy, please sign up as employed. However, if your employer has removed the employer’s insurance policy to cover you, please sign up as self-employed. If you are unsure, sign up as self-employed.

In nearly every case, we offer the same coverage and benefits to you whether you are employed or self-employed. Our policy is flexible enough to safeguard you when you change careers, so you can continue to preserve your livelihood.
As long as you have an active nursing license, you are eligible for coverage. Even if you’re not involved in hands-on care, it makes sense to insure yourself from a potential liability situation. For example, if you give advice to a friend, or aid a child in a schoolyard, you could be exposing yourself to a potential lawsuit.

However, our coverage is not intended to respond to incidents that may arise from duties that are purely administrative in nature. If you are not involved in hands-on nursing, but are still working in an administrative capacity, your employer most likely covers these types of errors and omissions. Consult with your facility’s risk manager or your supervisor for confirmation.
We provide coverage for over 80 different types of healthcare professional licenses and certifications. We will cover you for any of those licenses that you hold. Your premium will be determined by whichever of your licenses carries the highest exposure.

For example, you may be licensed as a Registered Nurse and an EMT-Basic. Your premium would be based on the higher exposure, in this case the EMT-Basic. Coverage for the other profession would be added to your policy for no additional cost.
NSO offers coverage to most nursing professionals. The only exclusions to the policy are Nurse Midwives and Nurse Anesthetists.

If you are an RN, no matter what your area of specialty is, you will pay the same premium as other RNs in your state. Click here for information about our rates.

We do rate your premium based on specialty if you are a nurse practitioner and may rate your premium differently if you have dual certifications like RN and Massage Therapy or RN and EMT. The good news is that when you take out coverage for both certifications, you have coverage for both. You also have coverage automatically if you are returning to school for refresher courses.

Claims

If you have been contacted in regards to a lawsuit, or you suspect that you may be contacted in the future, it is important to contact us immediately, so we can proceed in your defense, if necessary.

You can submit an online contact form​ or call us at 1-800-247-1500, between 8 a.m. and 6 p.m. ET. We will then forward your information to our underwriter, CNA. A CNA claim consultant will contact you by phone within 24-48 hours to explain next steps and discuss what attorney options are available to you.

It is important that you make no attempt to contact the patient or the patient's attorney to discuss the subpoena or any other paperwork you may receive. Avoid the temptation to talk with your friends and colleagues about the subpoena. Your insurance provider should be the first person with whom you discuss the details of the subpoena.
If you face professional disciplinary charges, you are eligible for defense reimbursement under our policy. This coverage may provide up to $25,000 for legal representation for covered disciplinary hearings (excluding the appeals process). Coverage will vary according to your policy provisions.
The fact is anyone can file a complaint against you with the state board for any reason—even your own employer—and it doesn’t have to be solely connected to your professional duties. You’ve studied and worked hard for your license, and it should be safeguarded. All complaints need to be taken seriously, no matter how trivial or unfounded they may appear.

Our current License Protection coverage reimburses you for your defense of disciplinary charges and other covered expenses arising out of a covered incident. We understand the importance of your license to your livelihood and will help you preserve it.
Our current insureds and potential clients should not be concerned about the cancellation of their policy solely due to the reporting of an incident or claim. We evaluate practice methods, continuing education, and risk management techniques along with the severity and frequency of any incidents or claims reported before taking such serious action.
Nurses Service Organization has been meeting the insurance needs of nurses since 1976 and provides professional liability insurance to well over 500,000 nurses nationwide. The professional liability insurance program offered through NSO is underwritten by American Casualty Company of Reading, Pennsylvania, a CNA company. CNA has earned an A (Excellent) rating from A.M. Best, the nation's leading authority on the financial well-being of insurance companies. CNA is a registered trademark of CNA Financial Corporation.

Your NSO account

You can easily retrieve your username and/or password by logging in and clicking the "Forgot Username or Password/Pin" link. You will then be prompted to answer questions to validate your identity and retrieve your username and/or password. If you forgot your username, it will be displayed immediately. If you forgot your password, you will be emailed a temporary password that will allow you to log in and reset your password.
Contact us to confirm coverage or begin a new policy, if you need to reactivate coverage.
Your username is the email address we have on file. You may have recently changed your email address and therefore we do not have your updated email address in our system. Please log in using your original email address, and once you are logged in, you can update your email address by selecting "View/Change My Personal Information". If you cannot recall which email address we have on file, you can click "Forgot Username or Password/Pin", to immediately retrieve your username.

Businesses and practices

Your insurance company is American Casualty Company of Reading, Pennsylvania, a CNA company. CNA is a registered trademark of CNA Financial Corporation.

Nurses Service Organization (NSO) and CNA have collaborated to bring you this coverage. NSO, a registered trade name of Affinity Insurance Services, Inc., is responsible for the marketing and administering of this professional liability insurance program.
A shared limit policy is issued in the name of your professional business or company. The policy provides professional liability insurance coverage for the business entity named on the certificate of insurance and any of the employees of the business entity, provided they are a ratable profession within our program. Coverage is also provided for locum tenens professionals with whom the business entity has contracted for services the locum tenens performs for the business entity.

The business, and all eligible employees and sub-contractors you regularly employ, will be considered when determining your practice’s premium calculation and share the same coverage limits you select for the business.
The policy covers your employees outside the office as long as they are performing covered professional services on behalf of your business.

If your employees are moonlighting, either for pay or as a volunteer, they should carry an individual professional liability insurance policy to cover those services.
When a shared limit policy is issued, "a picture" is taken of your company. During the policy year, all employees are covered while they are working for you. In the event new employees are hired, it is not required to report or pay an additional premium for this coverage—new employees are automatically covered. Additional premium will not be charged until the policy renewal, when another evaluation is conducted and the policy is rated for the next year based on this evaluation. Conversely, it is not required to report staff reductions, and premium is not refunded for staff that has left your practice.

Four months prior to your renewal, a renewal application will be mailed to your firm so that you can notify NSO of your total staff. A revised staffing count will generate an adjusted billing or premium that will be due upon renewal.
Your professional liability insurance policy does not provide coverage for direct physical loss or damage to your property or premise due to fire; such coverage should be sought under a fire insurance policy.

However, if a claim is made against you for damage to the property of another, caused by a fire that is due to your negligence, you may be covered by fire and water legal liability coverage. Such coverage is included under the Workplace Liability Coverage provided by the NSO Program. Fire and water legal liability coverage is intended to provide coverage for a tenant or lessee of a building who agrees under contract to be responsible for the building or a portion of the building that is under his care, custody and control. Included is coverage for property damage liability caused by fire, when the fire is due to the insured's negligence.

The property damage liability coverage provides up to $150,000 in coverage to a premises in which you do not have a financial or ownership interest.

Nursing schools

Yes. NSO offers coverage for many allied healthcare programs under one policy. If your school’s allied programs have separate coverage, you may want to consider consolidating them under one plan.
NSO offers schools a Claim-Free Discount and a Size-of-School Discount. Once you begin the application process, we can determine your school's eligibility.
Nursing students should get in the habit of maintaining their own professional liability policy – which may be required by the facility where they are practicing. Students should also be aware that when they enter the workforce, there could be gaps in coverage provided by their employer.

Student nurses

Yes, we offer a student discount that varies by state and profession. Find out your rate through our online quote process. Additionally, if you have completed training within the previous 12 months, you are entitled to up to a 60% discount off the regular full-time rate as a first-year graduate.
Our student policy is designed to safeguard you during clinical work as part of your school curriculum. After graduation you can take advantage of another benefit of our policy. We do not require that you increase your coverage to professional status until your policy's next renewal. You will be automatically covered after graduation, as a professional, until your renewal – at no additional charge.
If your school does not provide coverage for you while you're completing your clinical rotation, you should purchase a student nurse practitioner policy. Your registered nurse policy will not provide adequate coverage for your clinical work, which may include duties outside the scope of your RN license. Keep in mind, one of the benefits of our Nurse Practitioner and NP student coverage is that you can be covered for your RN duties at no additional cost.

If you have your nursing coverage through NSO, it is very easy to make the change to a Nurse Practitioner student. Simply contact us today.
Yes, if your state allows you to work under a temporary license, you can apply for coverage and have professional liability insurance for work right away. Also, you may be eligible to receive our first-year graduate discount – that's up to a 60% savings off the full-time professional rate.