Malpractice insurance, although unpleasant to consider, is an important aspect of your practice that should not be put aside or ignored. Chiropractic Products asks insurance industry leaders about policies and coverage.

Malpractice insurance is a part of your practice that cannot be compromised. Yet, choosing an insurance company to represent your needs seems to be a nonpriority for many chiropractors. “While most doctors put more thought into tables than the insurance they choose, finding the best insurance program available may be one of the most important decisions chiropractors will make,” says Timothy Feuling, president of Chiropractic Benefit Services.

But the field of insurance is complicated with a variety of options, packages, and prices. And as policies continue to evolve, chiropractors at all stages of their career find choosing malpractice insurance overwhelming. Why make it difficult? Chiropractic Products talks with two experienced professionals to guide you through the thorny field of malpractice insurance.

Timothy J. Feuling is president of Chiropractic Benefit Services (CBS). Feuling combines his personal experience as a chiropractic patient with his education and expertise in business to offer new perspectives on creating successful, principled practices.

Susan Jones is the professional services coordinator-chiropractic for OUM and PACO, providers of chiropractic professional liability insurance based in Brentwood, Tenn. She has been marketing professional services for more than 12 years, and specifically health care-related services for more than 8 years.

What are some important aspects that chiropractors should know about malpractice insurance?

Feuling: Doctors need to know that they definitely need insurance. The number of lawsuits filed against chiropractors is increasing, as is the amount awarded to plaintiffs by the juries. Doctors can lose everything with just one lawsuit. Second, it is vital to compare the policies available. No two policies are the same.

Jones: First, remember all malpractice coverage is not the same. Ask questions when shopping for coverage and ask to see a sample policy. Second, look for a carrier with a stable history. Third, consider the historical use of the underwriting insurance company. Many brands of insurance have an unstable history of underwriting companies. A number of carriers have withdrawn from the market or become insolvent, creating problems for current policyholders. And fourth, be aware of the “hammer clause”—this is the practice of settling out of court because it is less expensive than representing the policyholder.

What coverage options should chiropractors look for in their policies?

Feuling: In my experience, I have found that the two most important coverage options are Full Consent-to-Settle and Sexual Misconduct Defense. A Full Consent-to-Settle provision gives chiropractors the final authority on whether an allegation will be settled out of court or defended in a courtroom. Only a few policies include this. Many companies that advertise Consent-to-Settle really have a hammer clause, which is a provision that tries to coerce you into accepting a settlement offer.

With a hammer clause, if the settlement offer recommended by the insurer is refused, the insurer’s liability is limited to the amount of the recommended settlement offer. For example: If your insurance company wants to settle a claim out of court for $50,000, but you want to clear your name by fighting the claim, the insurer will pay a maximum of $50,000 if you lose the case. If the plaintiff is awarded $100,000, you would have to pay $50,000 plus all defense costs beyond the point the company wanted to settle—even if the policy has a $1 million coverage. This clause is often referred to as a “blackmail provision.”

Sexual Misconduct Defense coverage is the most common policy option left out of malpractice policies. Most underwriters either exclude this protection from the policies or state they will only cover the sexual misconduct allegation if it is filed in conjunction with a malpractice allegation, which is rarely the case. Sexual misconduct is the number one frivolous lawsuit filed by patients and employees. Approximately 25% of our closed claims fall into this category.

Jones: Some common options to consider are 1) type of insurance policy: claims made or occurrence, 2) limits of liability, and 3) additional general liability coverage.

What costs can chiropractors expect with a malpractice policy?

Feuling: Chiropractors in the United States will pay anywhere from a few hundred dollars during their first year of practice to $3,500 in counties and states with high litigation rates. Malpractice premiums have undergone tremendous rate increases in recent years, yet chiropractors still pay among the lowest of any health care providers.

Chiropractors with previous malpractice suits who have paid an indemnity will typically pay surcharges based on the number of years since the claim and/or the amount of the settlement. Group practices can often save from 2% to 10% off each doctor’s premium.

It is important to remember, however, that chiropractors should never choose a policy based primarily on price. Policy coverage should always be the main factor.

Jones: Premiums and discounts vary by territory and policy type, claims-made, and occurrence. A custom quote is the only way to get an accurate estimate of the premium charged and the only way to compare one company’s rate to another.

What financial solutions do you recommend for chiropractors just starting out?

Feuling: Look for various discounts you might qualify for, as well as advantageous payment arrangements. Chiropractors can often pay premiums monthly or quarterly, rather than annually. This allows newly licensed doctors the opportunity to spread out the payments and maintain the policy limits they need to practice.

What customer service features should chiropractors expect from their insurance companies?

Feuling: Every chiropractic program should include risk management tools, such as newsletters and recommended office forms, easy access to insurance professionals who can answer questions and address concerns, and direct access to the program leaders to report incidents and/or allegations. If you call your insurance program and talk with someone who does not understand chiropractic, that is not a good sign. Your malpractice program should also invest part of the money it makes from chiropractors back into the profession.

Jones: Chiropractors should expect courteous, knowledgeable, professional agents and representatives who are able to respond promptly to questions and needs in regard to professional liability insurance. Do not forget that representatives are not only the individuals who help you acquire a policy, but are also the professionals who are there for you should you have a claim or questions regarding your premium payment and renewal policy.

What are some risk management solutions for chiropractic practices?

Feuling: The number one risk management tool is to set clear expectations. It is important to inform patients of exactly what you plan to do in your relationship. Patient education materials should be congruent with your practice objective. I also recommend using a terms of acceptance form for all patients, which carefully lays out your objectives. This helps avoid accusations later that you failed to diagnose or cure a nonchiropractic related ailment.

Jones: Some companies offer risk management home study courses, many of which also earn CE credits, to educate policyholders on topics that could impact their practice.

Any last words of advice for DCs?

Feuling: Thoroughly research the company and policy you are planning to buy. Does the policy protect in every possible contingency? Do company representatives understand and appreciate chiropractic the way you do? Do they have enough experience in underwriting chiropractors to properly defend you? Do they have underwriting criteria aligned with your chiropractic philosophy and practice objective? Is the company endorsed by reputable chiropractic leaders, consultants, and technique developers? Is the company owned by medical doctors or chiropractors? Will they always act in your best interest or their own?

Jones: Do not take malpractice insurance for granted. More chiropractors need to acknowledge the fact that they need malpractice coverage. Many without coverage are risking their livelihood and personal financial stability.

When choosing coverage, make the effort to educate yourself and understand your options before you purchase a policy. If you have already purchased insurance, it is never too late to investigate alternatives. You may have gotten lucky and chosen a product by a quality provider, but how will you know unless you investigate, or worse, have a claim and find your decision was not the wisest? CP

Julie Z. Lee is a contributing writer for Chiropractic Products.