malpractice insurance

[randomdoc1]

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Hey,

I was wondering if anyone has any input on malpractice insurance companies they'd recommend? I am a soon to be attending in psychiatry and there are so many companies I'm not sure where to start. I will only be working part time and practice in WI if that helps. I am not as much concerned about price. I am more concerned about ensuring there is good coverage and service should a patient ever file a claim against me (no one in mind of course, but you never know, I've still got my whole career and decades to practice so the day may come someday!). I know that people keep recommending occurrence based over claims made, but that's all I really know right now. Thanks.

 

[Shikima]

Talk with your employer first.

 

[milesed]

Mine is through The Medical Protective Company of Ft. Wayne IN. They offer reduced rates if you take some risk mgt CME also. I've not been sued yet so cannot comment on that side of things. It's paid by my employer, but runs about $7k - been working 15 years in child/adol.

 

[TexasPhysician]

I use The Doctor's Company which I'm pleased with thus far.

 

[westlaker]

I compared Professional Risk Management Services (PRMS) and The Doctor's Company (TDC). PRMS lures you with a super cheap 1st year premium, but the 5- and 10- year total is much higher than TDC (like 20-30K more). However, I end up with PRMS due to the group I joined.

 

[liquidshadow22]

any other malpractice options these days- PRMS quoted me at 5k for doing outpatient telepsych work.

 

[romanticscience]

any other malpractice options these days- PRMS quoted me at 5k for doing outpatient telepsych work.

A lesser-known option is the EPIC psychoanalysts program which is a couple of thousand dollars less than alternative programs. Granted, you have to be a member of either the American Psychoanalytic Association or the Academy of Psychodynamic Psychiatry & Psychoanalysis.

On the application, you do have to document how much medication you prescribe, how much general medical care you practice, and whether you do ECT. These would affect the rate.

 

[splik]

any other malpractice options these days- PRMS quoted me at 5k for doing outpatient telepsych work.

there are many areas where you want to keep costs low, but malpractice insurance is not one of them. Do not skimp on this or consider only the cost. Malpractice insurance is not just for when you get sued but a resource for practice management questions for medico-legal issues. The kinds of things that might come up are reviewing forms for intakes or ongoing care, forms for any contractors related to confidentiality/HIPAA policies, advice on managing liability in split treatment or for supervising NPs, navigating the no surprises act, support if you get subpoenaed for deposition or trial for one of your patients, questions related to managing termination, managing patient suicide, dealing with confidentiality issues after pt death etc. PRMS emphasizes this given risk management is in the name.

The PRMS policy is quite expansive compared to some other insurances and helpful for those of us who wear multiple hats - it covers claims related to advertising and online behavior, medical director duties, forensic activities, consultation, utilization review, teaching, publications, media appearances, good samaritan acts, and they cover some expenses if a patient assaults you, fire damage to your office (up to $150k), HIPAA violations, claims if a pt is injured in your office, they will pay for an attorney to accompany you to a deposition (for cases where you are not being sued but asked to attend as a percipient or hybrid witness), and they cover $150k of expenses if you have to defend yourself against the medical board. (At least this is my policy). They also provide a lot of helpful guidance, forms, and risk management CME. If all of this is fluff to you you may be fine with a cheaper policy that covers less.

The main problems that I see with PRMS is the coverage for any medicare/medicaid investigations is low, they have a low cap for any sexual misconduct claims ($25k for coverage include to represent you) and they don't cover anything that falls under the scope of neurology (probably irrelevant for most psychiatrists tho). It is relatively rare, but it only takes one aggrieved borderline pt to accuse you of sexual misconduct to professionally ruin you. While it is vastly more common for psychiatrist to be the perpetrators rather than victims of a sexual misconduct case (the old studies suggested 10% of psychiatrists did so but that was in the era of psychodynamic psychiatry), there are definitely pts or family members who make false claims. I have seen enough pts with factitious disorder to know one manifestation of this is factitious sexual assault claims. I can see malpractice carriers being reasonable not to want to pay out for settlements or judgements of sexual misconduct but to limit fees to even litigate these cases is troublesome.

Definitely shop around for the policy that you think will be most helpful to you but I think it is a mistake to focus only on the cost. you get what you pay for.

 

[liquidshadow22]

there are many areas where you want to keep costs low, but malpractice insurance is not one of them. Do not skimp on this or consider only the cost. Malpractice insurance is not just for when you get sued but a resource for practice management questions for medico-legal issues. The kinds of things that might come up are reviewing forms for intakes or ongoing care, forms for any contractors related to confidentiality/HIPAA policies, advice on managing liability in split treatment or for supervising NPs, navigating the no surprises act, support if you get subpoenaed for deposition or trial for one of your patients, questions related to managing termination, managing patient suicide, dealing with confidentiality issues after pt death etc. PRMS emphasizes this given risk management is in the name.

The PRMS policy is quite expansive compared to some other insurances and helpful for those of us who wear multiple hats - it covers claims related to advertising and online behavior, medical director duties, forensic activities, consultation, utilization review, teaching, publications, media appearances, good samaritan acts, and they cover some expenses if a patient assaults you, fire damage to your office (up to $150k), HIPAA violations, claims if a pt is injured in your office, they will pay for an attorney to accompany you to a deposition (for cases where you are not being sued but asked to attend as a percipient or hybrid witness), and they cover $150k of expenses if you have to defend yourself against the medical board. (At least this is my policy). They also provide a lot of helpful guidance, forms, and risk management CME. If all of this is fluff to you you may be fine with a cheaper policy that covers less.

The main problems that I see with PRMS is the coverage for any medicare/medicaid investigations is low, they have a low cap for any sexual misconduct claims ($25k for coverage include to represent you) and they don't cover anything that falls under the scope of neurology (probably irrelevant for most psychiatrists tho). It is relatively rare, but it only takes one aggrieved borderline pt to accuse you of sexual misconduct to professionally ruin you. While it is vastly more common for psychiatrist to be the perpetrators rather than victims of a sexual misconduct case (the old studies suggested 10% of psychiatrists did so but that was in the era of psychodynamic psychiatry), there are definitely pts or family members who make false claims. I have seen enough pts with factitious disorder to know one manifestation of this is factitious sexual assault claims. I can see malpractice carriers being reasonable not to want to pay out for settlements or judgements of sexual misconduct but to limit fees to even litigate these cases is troublesome.

Definitely shop around for the policy that you think will be most helpful to you but I think it is a mistake to focus only on the cost. you get what you pay for.

Thank you for your insight.

On a negative note, communication with prms is usually very difficult. However I did speak to their risk management team re: a difficult patient one time and they were very helpful.

 

[Ironspy]

I use American professional agency. You have to be an American psychiatric assoc member. The rates are very reasonable and I’ve contacted risk management 6-7x with a variety of questions since 2019 and always get a timely & thorough response

 

[Zyprexa100]

Did anyone use Aspen insurance?

 

[Sushirolls]

PRMS with the better Occurrence based policy.
Also look into the rates of part time practices and how they define part time and when the transition to full time is.
PRMS told me 20 patient care hours is the dividing line. So until I have 20 clinical hours - I keep track - I'm paying the lower part time rates.
I have been pleased with their customer service, and ability to call and talk with them in ... more concerning moments.

 

[Nitya2]

there are many areas where you want to keep costs low, but malpractice insurance is not one of them. Do not skimp on this or consider only the cost. Malpractice insurance is not just for when you get sued but a resource for practice management questions for medico-legal issues. The kinds of things that might come up are reviewing forms for intakes or ongoing care, forms for any contractors related to confidentiality/HIPAA policies, advice on managing liability in split treatment or for supervising NPs, navigating the no surprises act, support if you get subpoenaed for deposition or trial for one of your patients, questions related to managing termination, managing patient suicide, dealing with confidentiality issues after pt death etc. PRMS emphasizes this given risk management is in the name.

The PRMS policy is quite expansive compared to some other insurances and helpful for those of us who wear multiple hats - it covers claims related to advertising and online behavior, medical director duties, forensic activities, consultation, utilization review, teaching, publications, media appearances, good samaritan acts, and they cover some expenses if a patient assaults you, fire damage to your office (up to $150k), HIPAA violations, claims if a pt is injured in your office, they will pay for an attorney to accompany you to a deposition (for cases where you are not being sued but asked to attend as a percipient or hybrid witness), and they cover $150k of expenses if you have to defend yourself against the medical board. (At least this is my policy). They also provide a lot of helpful guidance, forms, and risk management CME. If all of this is fluff to you you may be fine with a cheaper policy that covers less.

The main problems that I see with PRMS is the coverage for any medicare/medicaid investigations is low, they have a low cap for any sexual misconduct claims ($25k for coverage include to represent you) and they don't cover anything that falls under the scope of neurology (probably irrelevant for most psychiatrists tho). It is relatively rare, but it only takes one aggrieved borderline pt to accuse you of sexual misconduct to professionally ruin you. While it is vastly more common for psychiatrist to be the perpetrators rather than victims of a sexual misconduct case (the old studies suggested 10% of psychiatrists did so but that was in the era of psychodynamic psychiatry), there are definitely pts or family members who make false claims. I have seen enough pts with factitious disorder to know one manifestation of this is factitious sexual assault claims. I can see malpractice carriers being reasonable not to want to pay out for settlements or judgements of sexual misconduct but to limit fees to even litigate these cases is troublesome.

Definitely shop around for the policy that you think will be most helpful to you but I think it is a mistake to focus only on the cost. you get what you pay for.

Helpful and informative. Some articles like these raise doubts about APA endorsement:

Lawsuit Raises Questions About APA Liability Insurance Program​

Lawsuit Raises Questions About APA Liability Insurance Program

Psychiatrist Bennet B. Braun, who claims his career was destroyed when his APA liability insurance provider settled a malpractice suit against his wishes, has now sued the APA, holding them liable for his losses.

www.psychiatrictimes.com

 

[splik]

Helpful and informative. Some articles like these raise doubts about APA endorsement:

Lawsuit Raises Questions About APA Liability Insurance Program​

Lawsuit Raises Questions About APA Liability Insurance Program

Psychiatrist Bennet B. Braun, who claims his career was destroyed when his APA liability insurance provider settled a malpractice suit against his wishes, has now sued the APA, holding them liable for his losses.

www.psychiatrictimes.com

This is actually not relevant to anything at all. Back in the day the APA used to have its own product. It does not anymore. They change their endorsements. Currently they endorse the APA insurance (which is not connected to the American Psychiatric Association) but have endorsed PRMS in the past. The case described in the article was 25 years ago. The psychiatrist was one of the leaders in creating the multiple personality disorder epidemic of the 1980s and 90s. The psychiatrist's conduct was grossly egregious including convincing patients they were victims of satanic ritual abuse, sexually inappropriate conduct, and violating confidentiality in the media. He wasn't just sued by one patient, but by a double digit number of patients. He tried suing the insurance company and the superior court, appeals court, and supreme court of Illinois all affirmed that the insurance company was in their rights to settle the case over his objection. The case was precedent setting in Illinois.

Again, this case is not related to the American Professional Agency, Inc.

He also alleged that it was the insurance company settling the case that led to the loss of his license but that was not true and actually, left Illinois for Montana where they gave him a license to practice and where he practice without malpractice coverage until a few years ago when the DEA came after him for his shady patterns of controlled drugs.