0
Want this question answered?
Be notified when an answer is posted
Add your answer:
Earn +20 pts
Why is tail coverage in a claims made policy important?
Claims made policies must have an occurrence occur and be reported to the carrier within the policy period. The tail protects against claims made subsequent to the effective termination date of the occurring policy period.
Is tail coverage sufficient to have to continue to see patients?
NO! Tail allows you to continue to report claims that the policy period, but does not extend the policy period.
Can you explain the difference between an occurrence form policy and a claims-made policy and when I need a tail policy?
If you need more information on your limits of liability make sure you check your reports for how much your policy has been used in the past year. Also, make sure you speak with the company who holds your insurance policy to get their advice.
What is the difference between occurrence based insurance and claims based insurance?
There are two basic policy forms offered by malpractice insurers, claims made and occurrence. Occurrence coverage is the most desirable form of coverage, but it is not available in all states. An occurrence policy is complete when you purchase it and on cancellation continues to provide coverage for future claims based on conduct that took place during that policy term. The limits that are available to pay a claim are the limits that were in place during that policy term that the service was rendered. Premiums for this product are level except to the extent that a company may increase or decrease premiums over time. Claims made policies provide coverage only so long as the insured continues to pay premiums for the initial policy and any subsequent renewals. If one is insured by a claims made policy for five years and stops paying premiums, coverage ceases for any cases that the company did not accept during the policy term. To lock in coverage forever under this policy form, an insured must purchase an Extended Reporting Endorsement (called a "tail"). This endorsement allows an insured to continue to report claims after the policy is cancelled. Tail premiums usually range from 100% to 500% of the mature premium (see below) and the premium is usually due as a single payment shortly after cancellation of a policy. However, one can move between claims made insurers without purchasing a tail. If a professional desires to change insurance companies, often the new insurer will take over the predecessor insurance company's responsibilities by writing its policy retroactively over the previous insurer. It picks up the retroactive date, the first date of coverage, offered by the previous insurer and charges a premium based on the number of previous years of coverage needed. Claims made policies have premiums that increase annually usually over a period of five years; the fifth-year premium is referred to as the "mature premium." When writing retroactive coverage, the new insurer's premium usually does not exceed its mature premium for this specialty. Many insurers offer a free tail if an insured dies, is totally disabled or retires from practice after five years of coverage with that company at a minimum age of 55. If this feature is not included in your policy, you ultimately need to purchase a tail to maintain indefinite coverage after you stop working. Moving from one claims made insurer to another may be difficult for health care professionals relocating to a new state because many malpractice insurers are regional and do not want to assume retroactive coverage out of its geographic area. As with any overview, this insurance information is general and intended to help you make informed decisions. The actual policies available in your state may contain features not discussed above. An insurance policy is a contract between you and an insurance company. You should read and understand any policy that you purchase. If you have any questions, have the company or insurance broker or agent take as much time as you need to explain policy terms to your satisfaction.
Claims made versus occurrence policy?
When a policy is written on a "claims-made" basis, it means that the policy in force at the time a claim against the insured is asserted applies to the claim, regardless of when the occurrence forming the basis of the claim occurred. Correlatively, the policy must be in force at the time that the claim is make for coverage to apply. The insured must also timely report it and follow all conditions precedent outlined in the policy while it is in force. There is a variant of a claims made policy, which may be set forth in an endorsement to the policy, that provides for a "retro" date. This means that the policy will apply to occurrences that took place prior to the inception of the policy (if they otherwise fall within the ambit of coverage).With an "occurrence" based policy, even though the policy may have expired as of the time the insured received notice of the claim, the policy will afford coverage if the claim otherwise comes within the scope of coverage. This type of policy also has claims reporting provisions to which the insured must adhere, as well as a cooperation clause. The latter means that the insured must cooperate with the insurer (and the attorney it selects to defend that claim) in the defense.Both forms of coverage have advantages and drawbacks, depending on the circumstances. It is difficult to predict whether, in any particular instance, it will be advantageous to insure using one form or the other. Only in hindsight can a judgment be made.Advantages of "occurrence" policies"Occurrence" policies are sometimes like "money in the bank," in that you can go back to old policies, years after they have lapsed and put a claim against them for incidents that happened while they were in force. Old policies should never be thrown away. They should be kept in a place of safekeeping.You don't have to worry about canceling an "occurrence" policy and moving to a different insurer. Coverage remains locked in for incidents occurring while the policy was in force, as long as the insurer is in business. In contrast, once a "claims-made" policy is cancelled, it is possible that purchasing insurance for past events will become difficult, expensive or perhaps not possible.Sometimes courts will find occurrences in successive policies if there is continuing harm. This can have the effect of accumulating limits over a period of years. With "claims-made," only one limit applies; that in force when the claim is actually made.Disadvantages of "occurrence" policiesInsurance companies that wrote policies in previous years may no longer be in business. With "claims-made" policies, the insurer is much more likely to be around when a claim becomes payable. The length of time between an occurrence and resolution in court can be 20 or more years. An insurer in business 20 years ago may not be in business today. The only way to mitigate this risk with "occurrence" insurers is to change to a different one every few years so that you do not keep "all your eggs in one basket."The limits on an "occurrence" policy are likely to be inadequate if a claim is made twenty years after a policy has expired. With "claims-made" it is easier to arrange a limit which is adequate for today's exposures.For malpractice exposures written on an "occurrence" basis it is important to arrange limits which are somewhat more than is necessary in order to meet tomorrow's exposures. On a "claims-made" basis, one does not need to project twenty years or more into the future when setting limits; 7 years is usually the longest time it takes for a case to go through the court system, so even though you still need to project into the future, the length of time is much less.Advantages of "claims-made" policiesLimits can be predicated on today's exposures more accurately than with "occurrence" policies, so there may be less of a likelihood of being underinsured.Disadvantages of "claims-made" policiesCoverage is triggered by an actual claim for damages, not a notice of an "occurrence" or "incident." However, the date of the occurrence or incident must be more recent than the retroactive date of the policy. This retroactive date determines the cut-off date for claims: if the incident occurred before the retroactive date, the insurer has no obligation and the insured no coverage. While the claim has to be made during the policy period, the occurrence which gave rise to the claim has to fall after the retroactive date of the policy. A "claims-made" policy wording covers as follows:This insurance does not apply to "bodily injury" or "property damage" which occurred before the retroactive date, if any, shown in the Declarations.A "claims-made" policy can have:No retroactive date (the broadest coverage).A retroactive date that pre-dates the policy inception date (this may range from days to years). Ideally, it should go back at least to the expiration date of your last "occurrence" policy. If it goes back further it can be designed to provide top-up cover in the case of different limits.A retroactive date that is the same as the policy inception date - this is the most limited coverage and excludes any claim for damages that occurred prior to the policy inception. It is acceptable only if prior to this policy "occurrence" coverage was in force or full "tail" coverage has been purchased on any previous "claims-made" policy.Ideally, you want no retroactive date or one that includes the entire period that you have had "claims-made" coverage. Anything less makes you effectively self-insured for any claims for injuries or damage that occurred during prior claims-made policy periods which you have not reported to your insurer at the time of the occurrence (unless such claims are covered by supplemental "tail" coverage).The first claim for damages determines which policy applies. For example, if a person first makes a claim for medical payments in 1986, then files for additional damages in 1988, both claims activate the 1986 claims-made policy.With "claims-made" basis of coverage, should the policy ever be allowed to lapse or be cancelled, the insured is generally given the option of purchasing coverage, for a stated period following the expiration of the policy (extended reporting period). Any "claims-made" during this extended reporting period month period would then be covered if it otherwise comes within the scope of coverage. With "occurrence" policies you can be less concerned with coverage lapses or insurer changes.If coverage terms ever become more restrictive on subsequent renewal of a "claims-made" policy, the new terms apply retroactively to the original retroactive or inception date.
Can someone tell you what exactly is a Manifestation occurrence Form Liability coverage And how it is different pro or con to a claims made policy?
* The occurrence policy is designed to cover occurrencesthat take place during the policy period. * The claims made policy is designed to cover claims that are reported during the policy period. * The manifestation occurrence policy is designed to cover occurrences that first manifest during the policy period. The occurrence policy has been around for centuries, but faced challenges in the 1900's due to enormous claims arising out of occurrences that were ongoing or continuous in nature. Claims Made and Manifestation Occurrence policies were created in response to these challenges. To explain the introduction of Claims Made and Manifestation policies, let's first look at the problems that Occurrence policies faced in the 1900s. Imagine that an insurance company writes a $1 Million liability insurance policy for a coffee shop and this policy renews every year from 1940 to 1970 where $1 Million is the most they will pay during the policy period (aggregate limit) and the most they will pay for any one occurrence (the per occurrence limit). The insurance company probably thinks that their liability exposure for insuring the business is limited to a maximum of $1 Million and they should collect the appropriate premium to offset this risk. William and Edith visit the coffee shop for a cup of coffee every morning for 30 years. If they slip and fall or have a horrible coffee incident in 1965, the most the insurance company should have to pay is $1 Million because it would be one bodily injury occurrence during one policy (1965) and the maximum limit for this is $1 Million. But. . .what if in 1971 we learn that the coffee shop has been filled with asbestos for the past 30 years and William and Edith are dying of cancer and it is determined that their exposure to the coffee shop's asbestos is the cause of their cancer. In what year did the occurrence take place? Didn't it take place in 1940 and 1941 and 1942 and in every year in which they were exposed to the asbestos at the coffee shop over the past 30 years? Suddenly, the insurance companies (and courts) realized that this is not a $1 Million claim, but perhaps 30 separate $1 Million claims because we are looking at 30 policies each designed to cover occurrences that take place during a policy period. This is where the Claims Made and Manifestation Occurrence Policies come into the story as well as an introduction to a complete asbestos exclusion to just about all occurrence policies. Whereas the occurrence policy mentioned above might have to pay $30 Million under 30 separate policies, a $1 Million Claims Made policy would pay only $1 Million because that is the maximum amount that the insurance company would pay for any claims during that one year period when the claim is reported. Once the Claims Made policy ends, there is no coverage unless an extended reported period or "tail" is purchased to cover claims into the future. Therefore, in the example above, if the coffee shop had a Claims Made policy every year and the coffee shop closes in 1970 and there is no coverage in 1971 when the claim is filed, there is no insurance coverage unless they purchased a coverage extension. The manifestation occurrence policy would also only pay $1 Million because the occurrence could only first manifest itself during one policy. Different policies might have different definitions of "manifest" including something like "to become apparent to a common observer." However manifest is defined, it is clear that it can only FIRST manifest once and so only the policy in which it first manifests will have an obligation to pay. If, in the example above the bodily injury is first manifested during 1965, the 1965 policy would be the only manifestation occurrence policy that will pay for the bodily injury occurrence. If it manifests itself again in 1966, this would not be the first manifestation of the occurrence and the 1966 policy would have no obligation to pay. Notice that in the example of the occurrence policy, it did not matter when the claim was reported or when the coffee was poured. What mattered is when the occurrence took place. The occurrence policy insuring agreement states that they will pay for occurrences that take place during the policy period. PERIOD. It is true that your policy might have products and completed operations, but again, the occurrence form insuring agreement states that it will pay for occurrences that take place during the policy period. PERIOD. If an insurance agent tells you that you are covered in the future with your occurrence policy, ask for this in writing along with a copy of the agent's own professional liability insurance policy because this may be the only policy that will provide you with future coverage.
Cost of tail coverage?
The cost of tail coverage is typically around $200.00 monthly. For a medical practice that has been around for a long time it will usually cost about $50,000 all together for tail coverage.
Can someone tell you what exactly is a Manifestati?
The occurrence policy is designed to cover occurrencesthat take place during the policy period. The claims made policy is designed to cover claims that are reported during the policy period. The manifestation occurrence policy is designed to cover occurrences that first manifest during the policy period. The occurrence policy has been around for centuries, but faced challenges in the 1900's due to enormous claims arising out of occurrences that were ongoing or continuous in nature. Claims Made and Manifestation Occurrence policies were created in response to these challenges. To explain the introduction of Claims Made and Manifestation policies, let's first look at the problems that Occurrence policies faced in the 1900s. Imagine that an insurance company writes a $1 Million liability insurance policy for a coffee shop and this policy renews every year from 1940 to 1970 where $1 Million is the most they will pay during the policy period (aggregate limit) and the most they will pay for any one occurrence (the per occurrence limit). The insurance company probably thinks that their liability exposure for insuring the business is limited to a maximum of $1 Million and they should collect the appropriate premium to offset this risk. William and Edith visit the coffee shop for a cup of coffee every morning for 30 years. If they slip and fall or have a horrible coffee incident in 1965, the most the insurance company should have to pay is $1 Million because it would be one bodily injury occurrence during one policy (1965) and the maximum limit for this is $1 Million. But. . .what if in 1971 we learn that the coffee shop has been filled with asbestos for the past 30 years and William and Edith are dying of cancer and it is determined that their exposure to the coffee shop's asbestos is the cause of their cancer. In what year did the occurrence take place? Didn't it take place in 1940 and 1941 and 1942 and in every year in which they were exposed to the asbestos at the coffee shop over the past 30 years? Suddenly, the insurance companies (and courts) realized that this is not a $1 Million claim, but perhaps 30 separate $1 Million claims because we are looking at 30 policies each designed to cover occurrences that take place during a policy period. This is where the Claims Made and Manifestation Occurrence Policies come into the story as well as an introduction to a complete asbestos exclusion to just about all occurrence policies. Whereas the occurrence policy mentioned above might have to pay $30 Million under 30 separate policies, a $1 Million Claims Made policy would pay only $1 Million because that is the maximum amount that the insurance company would pay for any claims during that one year period when the claim is reported. Once the Claims Made policy ends, there is no coverage unless an extended reported period or "tail" is purchased to cover claims into the future. Therefore, in the example above, if the coffee shop had a Claims Made policy every year and the coffee shop closes in 1970 and there is no coverage in 1971 when the claim is filed, there is no insurance coverage unless they purchased a coverage extension. The manifestation occurrence policy would also only pay $1 Million because the occurrence could only first manifest itself during one policy. Different policies might have different definitions of "manifest" including something like "to become apparent to a common observer." However manifest is defined, it is clear that it can only FIRST manifest once and so only the policy in which it first manifests will have an obligation to pay. If, in the example above the bodily injury is first manifested during 1965, the 1965 policy would be the only manifestation occurrence policy that will pay for the bodily injury occurrence. If it manifests itself again in 1966, this would not be the first manifestation of the occurrence and the 1966 policy would have no obligation to pay. Notice that in the example of the occurrence policy, it did not matter when the claim was reported or when the coffee was poured. What mattered is when the occurrence took place. The occurrence policy insuring agreement states that they will pay for occurrences that take place during the policy period. PERIOD. It is true that your policy might have products and completed operations, but again, the occurrence form insuring agreement states that it will pay for occurrences that take place during the policy period. PERIOD. If an insurance agent tells you that you are covered in the future with your occurrence policy, ask for this in writing along with a copy of the agent's own professional liability insurance policy because this may be the only policy that will provide you with future coverage.
What if your firm has claims made malpractice insurance and claim is submitted 15 years later by a minor is there a provision that affords coverage if you have changed carriers?
Yes, Typically, If you changed companies without any lapse in coverage, the company or your agent will have maintained your retroactive date. If so, then you are covered by your current policy. If you had a lapse in coverage between insurance companies, then you may have lost your retro-date resulting in no coverage under your current policy for losses that occurred prior to that time.Look at you policy declarations page for the term "Retro Date". Any claims presented for occurrences after this date will be covered under the current policy, even if it was over 15 years ago and regardless of who your insurer was at the time.It is very important to maintain our retroactive coverage date when changing companies with professional liability insurance.AnswerYes. Either you were covered by the tail coverage you purchased when changing to the new company (effectively converting that original policy from claims made to occurrence), or you set up the new policy with dates such that claims made in year 15 from occurrences happening in the prior policy were still covered. Taking the latter course would mean that you weren't paying significantly less for coverage in the first year you made that change. Please ask again if you have a follow up question regarding this scenario.
What is the best liability insurance for an nurse practitioner?
The one that gives the best quality product at the best price. Quality is a function of policy service, claims service and, I believe, risk management analysis and education. Before shopping, understand the difference between claims made and occurrence policies. Claims made will be cheaper in your first year, but you need to understand tail coverage. The costs are about equivalent in the long run when you consider the tail coverage. There are very few carriers out there. Talk to your state professional association about what carriers operate in your state. They may also have a group discount for members, as may some of the national NP associations. In some setting, you can be added onto the group's policy as a named insured, but you may choose to carry your own. For a more personal answer, I've had NSO and now I have CMF.
What is tail coverage?
This supplemental insurance covers incidents that occurred during the "active" period of a claims-made policy but are not brought as claims against an insured, nor reported to the insurer, by the time the claims-made policy has been terminated. Needed at various times including when leaving a claims-made carrier, upon the decision to change claims-made carriers, at the time of retirement, or due to death or total disability of the member. Tail coverage is purchased from an insured's previous claims-made carrier.
Is there a time frame that you can make a claim on gap insurance?
Every insurance policy has what is called a claims tail, its like a statue of limitations, I would make the claim without regard to how long ago it was, and a good reason for doing so is that you had no idea that you would need to use gap coverage and you just found out.
