BY LESLIE CHAMPLIN
WEB
EXTRA!
WEB
EXTRA! Writing malpractice insurance: Know the past,
forecast the futurePhysicians who have taken medical liability insurance companies to task over premium hikes or renewal refusals have demonstrated you can "beat city hall." Victory requires perseverance, factual backup and a willingness to educate the underwriter about family medicine.
Underwriters base premiums on a medical specialty's rating or score, which is determined by several factors.
"Make sure you are clear what rating you are receiving," said FP Robert Elliott, M.D., of Hurt, Va. "Are you being rated for what you're actually doing? Most (insurance brokers) don't know what you're being rated on. They just sell the policy."
That means you'll have to appeal to the underwriters, said Elliott. The process will require perseverance. Elliott corresponded with his underwriter for more than a year before the company agreed he incurred no additional risk for teaching prenatal care to residents.
Elliott's underwriters "were very helpful in wanting to understand what we were doing and what we were teaching," Elliott said. "It's important to talk to the underwriter. Underwriters need to be educated on what services in clinical practice we're actually providing. And we need to understand what they're willing to take on as risk."
Tom Banning, director of legislative affairs at the Texas AFP, advises physicians to question the underwriter's reasons for a higher rating or decision to refuse coverage renewal.
"Ask them whether the premium is actuarially sound," said Banning. "What are the data that went into the decision? Are there examples of situations in which teaching was the reason for a claim?"
Most likely, underwriters cannot produce evidence that precepting poses additional risk. That's where the FP can show data that patients give higher ratings to physicians who are also teachers.
In his correspondence with one national underwriter, George Kikano, M.D., chair of family medicine at Case Western Reserve University School of Medicine, Cleveland, and a member of the Ohio AFP Board of Directors, cited an article in the June 2002 Journal of General Internal Medicine as evidence that patient satisfaction rose with physician teachers. The article is available at http://www.blackwell-synergy.com/links/doi/10.1046/j.1525-1497.2002.10328.x/full/. Also, you can read a related editorial at http://www.blackwell-synergy.com/links/doi/10.1046/j.1525-1497.2002.20406.x/full/.
To reach writer Leslie Champlin, e-mail lchampli@aafp.org.
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Copyright © 2004 by
American Academy of Family Physicians.