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after the policy period ends but which allege claims based on acts or omissions occurring dur- ing the policy period (including from any pre-pol- icy period retroactive date, if applicable, through the end of the policy period). Some insurers offer modified claims-made policies which may furnish tail coverage at no additional premium payment upon specified events, such as a physician’s retire- ment from the practice of medicine.
Scope of Coverage and Exclusions.
When a professional liability claim is asserted against the physician, the claim must fall within the scope of coverage afforded under the poli-
cy for the claim to be insured. To fall within the scope of coverage, a claim must typically allege professional negligence related to the furnishing of professional services. Some professional liability policies may also provide legal defense cover-
age for licensing investigations and enforcement actions by state or federal agencies. Physicians should review their professional liability policies to determine the types of claims which may be cov- ered. In addition, physicians should understand any exclusions that may prevent coverage of a
claim, such as failure to comply with the terms and conditions of the policy (e.g., timely reporting the claim or paying applicable premiums), if the claim occurred or was asserted before or after
the dates covered under the policy, or if the claim alleges matters that are specifically excluded from coverage (e.g., sexual abuse during the furnishing of professional services).
Physicians should periodically review their profes- sional liability insurance policies with their insur- ance agents to ensure that they understand the adequacy of their available limits of coverage, the scope of coverage, the exclusions, the need for and potential cost of tail insurance, and whether the physician has or lacks the right to consent
to a settlement by the insurer and the related consequences. A physician’s professional liabili- ty insurance needs may vary depending on the physician’s specialty and practice structure. Like- wise, physicians who rely upon a hospital or other organization to furnish professional liability insur- ance should request a copy of the policy to ensure they understand the available coverage afforded to the physician and any limits of coverage.
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