855-835-2160 [email protected]

Transcript – Episode 7: Pitfalls and Perils

Avoiding Malpractice Tips

Resources and References

Join Our Email Family

Receive our monthly newsletter, announcements, and notices to keep you informed and involved in your professional community.

Follow Us


Hello everyone. Thank you for joining our podcast today. This is Phil Lawson Vice President of Product Development and Risk. Today we will talk about pitfalls and perils of a policy. But before I go into the discussion about that I’d like to say to you healthcare professionals that you’re to be congratulated for the noble work that you do and be recognized for the positive difference that you bring to people’s lives every day. You are all healing change agents helping people throughout all walks of life to make a better life. There is no greater cause than your passionate and skilled contributions to people. That’s why we have your back here at the Risk Retention Group that the policyholders actually own that is insuring them. We are dedicated to your wellbeing and protection.

The nation truly values your services now and into the future as shown by the following statistics. You may be interested to know that the US Department of Labor, Bureau of Labor statistics in 2016 forecasted the following to occur for the next 10 years through 2026. The healthcare field is booming, a look at the fastest growing 30 occupations of all occupations in the United States indicate that eight are in the allied health sector. This sector contains a variety of healthcare and behavioral healthcare workers and a wide variety of related occupations and therapies. These eight occupations account for 4.9 million workers today and over 13 million workers in 10 years. That’s a 32% growth rate over the decade and that’s over four times the average growth rate compared to all occupations in the United States. So you’re truly working in a growing, highly important and very valuable field.

So let’s talk about pitfalls and perils of policy meaning an insurance policy. We’re looking to help you avoid malpractice and giving healthcare workers tips to manage their risk. I want to ask you are you absolutely sure that your insurance policy, probably issued by a Wall Street insurance company, protects you? You had better read your insurance policy contract to verify that. There are complex contracts offered by these companies with a lot of loopholes. We recommend here at the Risk Retention Group that you can conduct an audit of your insurance coverage at least once every six months and determine if your coverage gaps exist. Coverage gaps mean that you are personally responsible and that you will be standing alone.
Let’s talk about general liability and professional liability insurance since these are two of the most frequently purchased insurance policies by healthcare workers. Cyber liability is also growing in popularity since information breach first party as well as third party, first party meaning you, the third-party means maybe a mover who you hire to move your files, or a data warehouse, or the network that handles your client records, that’s a growing incident and claim category that we see.

First and foremost, beware of insurance brokers and insurance companies who do not disclose the full ramifications of an insurance policy contract to you. Insurance companies particularly those that are driven by Wall Street earnings expectations that are written by agents who worked for the commission they write strict coverage and often with very narrowly defined coverage parameters. Their intention is to maximize their own profits for Wall Street by narrowing and defining a covered claim. The insured, you, are not covered when the claim arises because it falls outside of that narrow scope of defined coverage. The insurance broker who is driven by commissions when the broker sells the policy just wants to make the deal, they just want to sell the policy regardless of really whether you’re insured for all the perils that you think you’re insured for.

So for example, consider the aforementioned motives baked into today’s general liability and professional liability policies because these are the two most frequently purchased policies by healthcare workers and behavioral health practitioners. Ask yourself some questions I’m going to relay to you in the context of example policies that we use for discussion and illustrator purposes and we’ll call the competition to the Risk Retention Group ABC carrier. Does ABC’s policy cover me for my general liability risk limits and my professional liability risk limits like other insurance carriers in the industry? No, the ABC policy limit is shared for POI and GL related perils. The limits are not stacked. There might be a carrier, ABC may say that they provide journal liability but they really don’t. So your coverage limits are bleeding.

If you buy ABC’s policy which says that it covers business liability and professional liability with one million and a three million dollar aggregate limit and you have a claim that is not professional liability related the benefit paid can exhaust all of your POI limits so you have no coverage at all for malpractice professional liability claims. If you have a malpractice professional liability claim that uses up all of the coverage limits then you have no general liability coverage at all. You are underinsured with the ABC policy. It is doubtful that your landlord would accept your ABC general liability coverage once the policy language is read by the landlord because there’s not a true general liability policy. It’s a professional liability policy with a few perils that you usually see in the general liability policy but it’s certainly not sufficient and many landlords reject that and understandably so.

The RG professional liability policy provides many of the clients related general liability perils at no additional cost plus the Risk Retention Group general liability policy provides an additional one million, three million dollar aggregate need coverage for all of the major general liability perils. So for example, if you buy him a one million, three million dollar Risk Retention Group professional liability policy and a Risk Retention Group one million, three million dollars general liability policy you actually have twice the coverage in place overall, two million six million, plus insurance covering many perils that are not even covered under ABC’s policy.

Here’s another question that we get, “If my client appears in my office for therapy and is accompanied by anyone else such as a parent, a relative, a friend or a guardian for example and that person slips and falls in my office or down the hall going to the bathroom and falls does ABC’s policy cover me?” No. The ABC policy only covers “business invitees.” That’s a defined term in the policy that is strictly and narrowly defined in the policy contract. A business invitee is only the person or the client who was at your office for therapy and actively in therapy with you at the time professional services are being provided when the incident occurs. The business invitee must be actively engaging in “professional services” which are defined in ABC’s policy as strictly and narrowly defined in the policy in order for you to be covered.

So for example, if the client slips and falls in your waiting room or gets injured in the bathroom you’re not covered because you weren’t providing professional services when the patient was going to the bathroom. If anybody else gets hindered you’re not covered because they are not a client and not inactive “professional services therapy.” There is a loophole, that’s a lot of loopholes in ABC’s policy. That’s a Wall Street company. The ABC policy is very narrow and leaves you without insurance coverage in many instances. The Risk Retention Group professional liability policy and the Risk Retention Group general liability policy cover all people in your office or in your building no matter what and even in hotel conferences, therapy and training sessions with clients, peers or anybody else who you are holding sessions with outside of your office or in your office. It does not matter if they’re clients or not and it does not matter if they are under active professional services therapy with you when the incident occurs, you are covered.

So for example, if a delivery person comes in with a package, slips on your carpet in your office, you’re covered. If a patient goes out, slips on your rug in your office, gets hurts, slip and fall, you’re covered. The patient goes down in the hall to the bathroom, there are no professional services being provided, slips and falls and gets hurt you’re still covered. We have a lot of questions from insurants who ask, “I have delivery people like a US mail carrier, a FedEx person, a UPS person, other people stopping by my office all the time for many reasons some are clients, some are not, some just visit unannounced or other people stop by my office just on behalf of my client. Does ABC’s policy cover me if any of these people get injured on my premises?” No.

ABC’s policy only covers you for strictly and narrowly defined people and events. There must be a business invitee, and active professional services, “professional services therapy session” during the incident otherwise you have no coverage. The Risk Retention Group’s professional liability policy and the Risk Retention Group general liability policy cover all people in and out of the office in your office building regardless of the reasons that they are in contact with you.

“So what locations am I covered for from a general liability perspective,” many people ask. Virtually all carriers except for the Risk Retention Group general liability policy charge an extra premium for each additional policyholder office. ABC’s policy only covers you for one single location. It does not cover you any place except for your office where the professional services are being delivered and of the business invitee to you, that’s the client only as of the defined term business invitee. That means it does not cover you if you have multiple offices unless you pay an additional premium. It does not cover you if you hold lectures and sessions in hotel conference rooms or other facilities for example. You are grossly exposed to risk. You are not covered at all because of these strict and narrow description definitions. There’s no definition of office locations because only a single location is allowed. By contrast, the Risk Retention Group general liability policy covers all general liability perils regardless of the number of offices that you have, regardless of where you deliver your session therapy. An unlimited number of offices are acquired with no additional premium.

Many insurants ask or people shopping for policies ask, “Is damage to my client’s personal property covered by ABC’s policy?” No, not even the client or anybody for any reason. The RRG, the Risk Retention Group, PLI policy, and the Risk Retention Group general liability policy covers all property from damage or loss from theft in or out of your office in hotel conference rooms where you are conducting sessions or lecturers in other locations.
“Are my associates’ covered such psychologists for example under ABC’s policy?” No. Do not count on coverage across related occupations to social workers. Psychologists are not named as insureds and not specifically listed as “professional services” in ABC’s policy. The Rest Retention Group’s PLI policy covers all psychologists, mental health workers, and allied health workers as defined. The RRG general liability policy covers all occupations in the allied health category.

“What are professional services defined as in the very strict and narrow ABC policy?” Well, their definition is only social workers and mental health services are permitted. No psychologists are covered, no allied health occupations are covered, they are explicitly excluded. Many carriers only cover three activities providing social work or mental health services with formal accreditation credentialing or standards review, from similar professional boards or committees or publishing articles or books or broadcasting on television or radio activities relating to those defined professional services or providing formal clinical teaching activities. This means that if you perform any other activities other than those strictly listed above you’re not covered so they box you in on the definition of occupation. By contrast, the Risk Retention Group professional liability policy covers all psychologists, mental health workers and social workers with a broad range of occupational coverage among a number of other listed occupations. The Risk Retention Group general liability policy covers all occupations and all allied health categories with very broad coverage, the same for all of these occupations.

“What exclusions hurt me in the ABC policy that we hear from shoppers?” Several exclusions will hurt you. Many carriers do not cover divorce mediation services. That’s a very popular claim, a very, very frequent incident that’s why they exclude that. And if they do include it’s in a very limited fashion where you must follow a strict and heavily defined procedure of notices and written statements to all parties and require that all agreements between the parties involved are reviewed by a lawyer and you are responsible for paying for those lawyer fees. That’s before you even provide treatment.

Many carriers do not cover you for anything arising from electronic dissemination of faxes, emails, text messages or similar communication to the prospective patient or “business invitee” or any other third party. So you are not covered for the dissemination of electronic and backup tapes, optical media or portable media. Many carriers exclude psychologists, they’re expressly excluded from any coverage offered to social workers. Many carriers do not cover fire damages over $150,000 per incident regardless of the number of claims presented on the policy. That means you are underinsured for each incident and the most probably only for part of one incident. The Risk Retention Group, the policy covers all psychologists, mental health workers, and social workers with very broad coverage. The general liability policy coverage covers all of these occupations in the healthcare category with very broad coverage the same for all of these occupations. The fire insurance coverage for the general liability policy that the Risk Retention Group issues go up to the limits, one million, three million, and there’s no limit on the number of fires compared to $150,000 from ABC and other carriers.

Some carriers require you to disclose your personal health information in order to buy a liability insurance policy including disclosing if you’ve ever been treated for a serious health problem that did or could impair your ability to treat clients. If you answer yes you have to provide full particulars to the ABC company. The Risk Retention Group professional liability and general liability applications do not ask these types of personal questions. The Risk Retention Group is very liberal and coverage and is devoted to the welfare and success of its insureds. Coverage benefits and excellent insurance coverage are more important to the Risk Retention Group then profits earned from its insureds.

Final pointers, again conduct an audit of your insurance coverage. That means read the policy contract, not just the declarations page. Make sure that you understand what you’re actually buying and what the coverage is for and first and foremost review your own existing insurance policies to determine what insurance coverage is stated compared to what you need and identify the gaps that exist for which you are not covered. It’s very helpful to apply what-if scenarios what if this happens, what if that happens, and then track that fact pattern through your policy to you see if you’re really covered. This applies to your professional activity as well as your auto and homeowners policies and even your life and health insurance coverage. The Insurance Services Organization is committed to the insureds and it’s not driven by Wall Street profit demands. The Risk Retention Group is owned by its insureds, unlike virtually all other carriers that are owned by Wall Street investors. We offer all kinds of insurance with generous liberal provisions including professional liability, general liability, cyber liability, and cyber device liability. Thank you for listening and that concludes our podcast today.

COVID-19 Notice

Preferra Insurance Company RRG, formerly NASW Risk Retention Group (NASW RRG) shares information based on our helpline inquiries, corresponding claims history, and an understanding of a varying nationwide professional state regulatory environment.

Due to COVID-19, many states have implemented or waived specific regulations; it is the individual professional's responsibility to research, implement, and monitor those regulations; and apply our risk management content as a consideration in your practice environment. Do not interpret this risk management material as any means to alter professional training, standards, nor any ethics information provided by your professional association.

Please understand, the NASW RRG makes no representations or warranties other than those stated to our current policyholders in the insurance policy contract. Please contact us if you have further questions.