Chiropractic Products asked two malpractice insurance experts about coverage for your practice

In a country obsessed with litigation, practicing without good malpractice insurance is playing Russian roulette with your career. After all, no matter how scrupulous a doctor you are, there is always a chance you may be sued.

However, choosing the right insurance for your chiropractic practice is no easy feat. Coverage details vary with each company, so it is crucial to do your homework. What are the unique aspects of malpractice insurance? What qualities should chiropractors expect in a malpractice insurance company?

Chiropractic Products discussed malpractice insurance with two industry experts, who offered advice and perspective on your practice’s needs.

Kiran Patel is the marketing specialist for the OUM Chiropractor Program, based in Brentwood, Tenn. She has been marketing malpractice insurance for OUM since 2001 and handles advertising management, trade show logistics, and press release management, in addition to market research and sales.

Louis Sportelli, DC, has been president and a director of NCMIC Group Inc since 1995. He is a past president of the World Federation of Chiropractic and served as chairman of the board of the American Chiropractic Association from 1989 to 1990. He has coauthored several risk-management and patient education textbooks and has lectured extensively throughout the United States, Australia, Canada, Europe, and Mexico. Sportelli currently serves on the advisory board of The Chiropractic Report newsletter and has been a member of the Palmerton Hospital board of trustees since 1992.

What are some important aspects of malpractice insurance that all chiropractors should know?
Patel: When shopping for malpractice coverage, it is imperative to ask the prospective carrier about the specific coverage and exclusions their policy provides. A low price for malpractice coverage is insignificant if the policy does not grant the appropriate level of coverage necessary for quality protection against a lawsuit. Financial stability, longevity, consistency, and experience in the chiropractic malpractice industry are also significant factors when selecting a carrier.

Sportelli: When selecting malpractice coverage, the adage “the devil is in the details” could not be more appropriate here. The fine print in many policies often makes the biggest difference in the coverage a company will actually provide. For example, some companies say they have a consent to settle policy, which means the doctor must consent before the insurance company can settle a claim. But read the fine print: You’ll see buried clauses and hidden terms that force you to face an arbitrator (of the insurance company’s choosing) if the insurance company thinks you’re being unreasonable.

Other companies simply don’t allow you to have any say in how your case is handled or require that your patients sign an arbitration agreement prior to treatment. This compromises your reputation.

Beyond reading the fine print, there are a number of things a chiropractor should look for when choosing a malpractice insurance company. These include:

• Easy accessibility. A chiropractor needs to decide whether to work with an insurance company directly or through a broker. Why is that important? An insurance company provides your malpractice protection directly, while a broker places your business with the company of his or her choice; many times the choice is based on a commission or availability.

• Focus on chiropractic. If you’re sued for malpractice, it just makes sense to have a company that knows the nuances of defending chiropractic on your side. Many malpractice companies are knowledgeable about general medical malpractice, but do they really understand and appreciate chiropractic?

• Financial stability. The company’s number of years in the chiropractic malpractice as well as its rating with AM Best (an insurance-rating and information agency) can give you an indication of whether the company is deserving of your confidence.

• Scope of practice coverage. Make sure you’re covered for your entire scope of practice, including pediatric care and all philosophies, techniques, and approaches.

How much can chiropractors expect to pay for coverage?
Patel: The cost of a malpractice policy varies, depending on which state and county the chiropractor chooses to practice in and also the discounts that the chiropractor is eligible to receive. Experienced full-time chiropractors can expect to pay anywhere from $188 to $3,886, depending on the two factors mentioned.

Sportelli: The good news is that chiropractors pay a much lower rate for malpractice coverage than other primary health care providers. The rule of thumb is said to be a 6:1 to 10:1 ratio for general practitioners to chiropractors. This means general medical practitioners typically pay six to ten times more than chiropractors for their malpractice coverage. It can be said that chiropractic is probably the least expensive malpractice coverage for any primary health care provider.

What should chiropractors expect from their insurance companies?
Patel: Chiropractors should expect their insurance carrier to provide a comprehensive policy that provides quality protection at an affordable price. The company should help to advance chiropractic, provide excellent customer service, and offer exceptional claims service with defense attorneys experienced in chiropractic litigation.

Sportelli: The first thing a chiropractor should look for is trust. Beyond this, there are a number of things chiropractors should expect from their insurance company, including easy accessibility, financial stability, reputation, and ongoing service to the profession.

What are unique services you offer to chiropractors?
Patel: Besides providing a comprehensive malpractice policy, our policyholders receive Stature, our semiannual risk-management and chiropractic issues magazine. In the Policyholder Spotlight section of Stature, we recognize our policyholders for their achievements and accomplishments in chiropractic. We also offer an annual home-study risk-management course that can be ordered through data trace for further risk-management study. Through the Wellness Works Scholarship Program, we are able to give back to the chiropractic community by distributing scholarships to chiropractic students in the United States.

Sportelli: When chiropractors talk about NCMIC, there are some recurring themes about our services: 1) premium dividend checks: although this valuable feature can’t be guaranteed, chiropractors protected by NCMIC’s professional liability coverage have collected a dividend check each year since 1996; 2) more protection at no extra cost: this is automatically built into NCMIC’s malpractice coverage, including protection for utilization and peer-review opinions and professional discipline. At NCMIC you’re generally covered in all states for your entire scope of practice. NCMIC makes no distinction as to a chiropractor’s philosophy, technique, or approach—in fact we insure 17 of the 18 chiropractic colleges. We do not establish standards of practice; 3) free claims advice hotline: chiropractors can call us anytime to confidentially discuss a concern or situation you’re not sure of how to handle; 4) NCMIC will not settle without a chiropractor’s permission. Protecting a chiropractor’s name and reputation are top priorities with NCMIC; 5) expert legal counsel: our legal counsel is specifically trained in chiropractic malpractice defense. NCMIC pays legal fees no matter how high they might be without reducing limits of coverage; 6) commitment to the chiropractic profession: as of January 1, 2004, NCMIC has provided more than $7 million for chiropractic research and more than $600,000 to the National Chiropractic Legal Action Fund; and 7) comprehensive portfolio of financial products and services: our portfolios are specifically tailored and negotiated to meet the needs of chiropractors, including equipment leases and loans, credit cards, credit-card processing, long-term disability, business owners’ protection, SBA loans and health savings accounts (HSAs).

What are legal issues that all chiropractors should know?
Patel: Patients can sue for a variety of reasons, so it is crucial that the chiropractor chooses a malpractice company that is experienced and dedicated to chiropractic. Many chiropractors do not realize that they can contact their malpractice company for legal advice regarding an incident that has not yet been filed as a formal claim. Chiropractors also need to understand that they can work together with the claims examiner and attorney to resolve the claim.

Sportelli: We’d all like to believe that lawsuits only arise from major mistakes—gross examples of negligence or incompetence. But malpractice statistics paint a much different picture. The truth is chiropractic malpractice cases often stem from simple oversights and common errors.

No one is immune from a lawsuit. The key is to have insurance with a malpractice company you can trust.

What are some ways chiropractors can avoid lawsuits?
Patel: By taking risk-management courses, building an appropriate doctor-patient relationship, and informing patients about the treatment options available to care for their specific condition. Keeping patient records in compliance with HIPAA regulations and detailed documentation of each visit, including subjective complaints and changes in objective findings, are essential elements to avoiding lawsuits.

Sportelli: From a legal perspective, the most important factor in avoiding a lawsuit is communication—by doctors through advertising, from the staff during the initial telephone call, by the staff during the initial office visit, and by doctors during the examination, history, and report of findings. Chiropractors can better reduce their risk of a malpractice allegation by practicing within their limitations, keeping accurate records, and supervising staff.

What is your company’s commitment to the chiropractic profession?
Patel: We are committed to diligently protecting and defending our policyholders against malpractice claims, even if the charges are groundless, false, or fraudulent. We are also committed to promoting the advancement of chiropractic by offering scholarships to chiropractic students through our Wellness Works Scholarship Program.

Sportelli: We have contributed more than $7 million to chiropractic research, which has aided the advancement of the profession. In the past 8 years, we have returned more than $55 million in premium dividends to our policyholders.

Since NCMIC centers our business around chiropractic, we also serve the profession with many value-added programs and services that truly distinguish the company from other commercial companies. These programs offered by NCMIC include: sponsoring business-training programs for graduating students; providing a complementary speakers’ bureau for state associations—experienced professional experts to heighten chiropractor awareness of the clinical, legal, professional, and personal aspects of clinical practice (NCMIC pays all speakers’ costs to help ensure association profitability); sponsoring the free Buyers and Hires Web site, which connects established doctors with prospective associates; offering comprehensive and authoritative HIPAA training specifically for chiropractors; offering products and services specifically directed to the unique needs of the chiropractor, such as long-term disability insurance, business-owner’s protection, equipment financing, credit-card processing, and more.

In addition, NCMIC has conducted defense counsel seminars, providing CLE credits for our defense counsel for the past 12 years. At NCMIC, we believe it’s important for our policyholders to have attorneys who are supportive of the chiropractic profession. This is why the focus of the NCMIC program is to provide our key attorneys with access to the world’s authorities, offer them the latest trial strategies, and research and enhance their expertise on the nuances of defending a chiropractic malpractice case. Experts on CVA, disc herniation, and other allegations are speakers at these conferences. Defense strategies are shared, and information on the latest cases is discussed, all resulting in the best defense for any NCMIC policyholder who is involved in litigation.

Any last words of advice?
Patel: Be cautious when selecting a malpractice carrier. Evaluate your practice and determine what type of policy, limits of liability, and policy coverage are necessary for you to practice with peace of mind. Do not choose a carrier based only on low prices, because the low-priced policy may be an indication of lower quality coverage.

Sportelli: The fact that we have more than 36,000 policyholders and have been in business nearly 60 years speaks volumes about the kind of confidence our policyholders have in us. We have doctors who have been with the company since it began in 1946, and the security of being with NCMIC is one area they do not have to worry about. We have built our reputation on trust and service. CP

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