Practising medicine comes with immense responsibility and unforeseen challenges. Even a single oversight, delayed diagnosis or treatment complication can lead to patient dissatisfaction and, in some cases, legal action.
This is where professional indemnity insurance for doctors acts as a safety net, protecting doctors from potential legal liabilities that may arise due to professional mistakes or unintentional lapses. By having the right cover as a doctor, you can safeguard your reputation, finances and peace of mind while continuing to focus on providing quality healthcare services.
This blog discusses this cover in detail.
What is professional indemnity (PI) insurance for doctors?
Professional indemnity insurance for doctors is a specialised policy designed to safeguard medical practitioners against claims made by patients due to perceived negligence, errors or omissions in their professional services. It covers the cost of legal proceedings, compensation and any damages arising out of the legal complication.
Understanding coverage under indemnity professional insurance for doctors
The sum insured under this plan is based on the policy tenure or an incident. The coverage limit is classified into the Any One Accident limit (AOA) and the Any One-Year limit (AOY).
You need to choose the ratio of AOA and AOY while purchasing the policy. Let’s understand how this works with the help of an example.
Suppose the policy you are buying has an indemnity limit of ₹1 crore with a ratio of 1:2. That means the policy will cover up to ₹50 lakh for any one accident and up to ₹1 crore for all claims in one year.
Inclusions of professional indemnity insurance for doctors
This insurance covers instances when you cause injury, illness or death to your patient due to negligence, error or omission in your treatment or diagnosis.
Even if you are not at fault, you may have to face legal proceedings and investigations from your patients, their families or the authorities. PI insurance covers the legal expenses incurred in defending yourself.
As a doctor, you have access to sensitive and personal information about your patients. It is your duty to maintain confidentiality. If you accidentally disclose this information to a third party without their consent, you may face a claim for breach of privacy. This insurance comes in handy to deal with such issues.
Exclusions of professional indemnity insurance for doctors
As a doctor, you must know the circumstances where PI insurance for doctors won’t come to your rescue. These situations include the following:
You cannot raise a claim if you perform any cosmetic or aesthetic procedure that is not medically necessary or indicated, such as liposuction, Botox or breast augmentation.
Suppose your medical negligence results in genetic or hereditary damage to the patient or a third party, such as congenital disabilities, mutations or diseases. In that case, your personal indemnity insurance stands void.
There won’t be any coverage benefits if you transmit or contract AIDS or any related condition, such as HIV, ARC or HTLV-III.
If you treat a patient while under the influence of alcohol and they sustain an injury, this policy will not cover you.
Any fraudulent activities, such as concealing a patient’s information necessary for treatment or criminal acts of intentionally providing wrong treatment to the patient, are subject to policy exclusions.
Note: This is an indicative list. It is always wise to read policy wordings to learn about the complete list of inclusions and exclusions.
How to choose the right professional indemnity insurance for doctors?
Selecting the right PI insurance policy requires careful evaluation. Here are the key factors to consider:
- Coverage amount: Choose a sum insured that reflects the scale of your practice speciality and potential risk exposure. Higher-risk fields such as surgery or gynaecology may require greater coverage.
- Scope of coverage: Ensure the policy covers legal costs, compensation and other liabilities such as defamation or breach of confidentiality.
- Restorative date: Opt for a policy that includes a retroactive date, which ensures claims made for past incidents (after the policy start date) are covered.
- Exclusions: Review the list of exclusions carefully. Common exclusions include criminal acts, intentional negligence and claims arising from contract disputes.
- Reputation of the insurer: Select a reputable insurer with experience in handling medical indemnity claims and providing excellent customer service.
- Premiums vs. benefits: Compare plans based on coverage benefits, not just premium costs. A slightly higher premium may offer better protection in the long run.
Documents required to claim PI insurance for doctors
Filing a PI insurance claim involves proper documentation to ensure smooth processing. Commonly required documents include:
- Completed and signed claim form
- Legal notices received from the client
- Professional or institutional registration certificates (e.g., hospital registration)
- Detailed client information for financial loss assessment
- All claim-related correspondence (emails, letters, legal documents)
- Identification of the claimant and other involved parties
- Copies of PAN card, Aadhaar card and GST registration certificate
- Proof of insured location address
- Any additional documents requested by the insurer
Conclusion
Professional indemnity insurance for doctors is a crucial protection for medical practitioners who face the risk of legal claims and lawsuits due to errors or negligence in their field of work. It helps in legal assistance and financial compensation, ensuring peace of mind for doctors who strive to deliver quality healthcare to their patients.
FAQs
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Is professional indemnity insurance mandatory for doctors in India?
While not legally compulsory, many hospitals, clinics and professional associations strongly recommend that doctors have PI insurance.
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Who should opt for a professional indemnity policy for doctors?
Any licensed medical professional, including physicians, surgeons, radiologists, dentists, anaesthetists, gynaecologists, paediatricians and others who provide medical services to patients, can consider purchasing this policy for financial protection against potential professional risks.
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Can retired doctors benefit from PI insurance?
Doctors can opt for “run-off” cover, which safeguards against claims made for treatments provided before retirement.
Disclaimer: The information provided in this blog is for educational and informational purposes only. It is advised to verify the currency and relevance of the data and information before taking any major steps. Please read the sales brochure / policy wordings carefully for detailed information about on risk factors, terms, conditions and exclusions. ICICI Lombard is not liable for any inaccuracies or consequences resulting from the use of this outdated information.