Insurance Solutions

Medical Professional Liability Insurance

Designed to protect healthcare professionals and corporations against liability resulting from errors & omissions in the performance of their professional services. Medical Professional Liability coverage is a crucial consideration in the comprehensive protection of every healthcare professional.

Lawsuits alleging medical professional liability (commonly referred to as “medical malpractice”) allege acts or omissions by health care professionals that were not in line with the accepted standards of medical practice and either caused death or injury to a patient. The regulations and standards for malpractice will vary by jurisdiction within the United States. That is why it is important that medical professionals obtain the best protection possible.

There are a multitude of programs and options available in the marketplace, such as: retention options ranging from first dollar coverage (no deductible) to large, self-insured retentions, primary limits of liability designed to address predictable scenarios, and high excess levels of liability in place to deal with catastrophic occurrences. These are only a few available options/programs, hence an immense amount of attention to detail must be employed when analyzing all viable solutions.

The Prevail teams are experts in this field of insurance, thus providing an abundant supply of resources accessible to your organization. Our insurance specialists will work closely with you to ensure that all your organization’s expectations and issues are considered when designing and securing the most applicable healthcare professional liability insurance program.

Workers Compensation Insurance

Every business in the United States that has employees must handle the problem of workers’ compensation. Most states (with a few important exceptions) require employers to purchase an insurance policy to handle their statutory obligations to workers who are injured or made ill due to a workplace exposure. Whether your business is small or large, handling the expense and effort of meeting those statutory obligations is an ever-present challenge.

Workers’ compensation is a form of insurance providing wage replacement and medical benefits to employees, or the employee’s family, because of an injury (accident or occupational disease) occurring in the course of employment in exchange for mandatory relinquishment of the employee’s right to sue his or her employer for the tort of negligence. However, in recent developments, new legal practices have not prevented employees from suing, consequently bringing workers compensation matters into the tort system.

Employers’ liability coverage, which is typically included within a workers compensation insurance program, addresses the need for coverage associated with these lawsuits. It pays all sums that the employer shall become legally obligated to pay as damages due to a covered loss on behalf of the employer.

Property & General Liability

There are some key differences between property and general liability insurance:

Property Insurance

Commercial property insurance protects the tangible assets you need to do your job. This may include a physical location, equipment, or parts. Or it may just be your computer and office equipment. Property insurance pays to replace or rebuild property destroyed by a covered loss such as fire, vandalism, theft, and equipment breakdown. Often, this includes coverage for lost revenue due to the loss. This helps your company keep up with bills as your company rebuilds.

General Liability Insurance

General business liability insurance protects your business from every day risks such as bodily injuries, property damage, and advertising injury. It is a critical form of coverage to protect your finances and public image. General liability insurance policies typically include coverage for medical payments when a third-party is injured as a result of your negligence, property replacement costs to replace damaged property that doesn’t belong to you, and settlement expenses if you are found guilty of libel, slander, or advertising theft.

Excess Insurance Coverages

An excess liability policy provides limits in excess of your underlying liability policy. The underlying liability policy can be, and often is, an umbrella liability policy. An excess liability policy typically covers the same things as your underlying umbrella liability policy, it simply provides additional limits of insurance.

Employment Practices Liability Insurance

It is a fact that employment practices liability (EPL) lawsuits constitute the most common type of liability lawsuit today, and once a claim gets rolling, it is difficult to stop the financial devastation. EPLI covers wrongful acts of the employer arising from the employment process. This coverage protects the company against damages for events relating to their workforce, including but not limited to: wrongful terminations, harassment, discrimination, defamation, and unfair hiring/firing practices; and provides defense costs associated with responding to employment related lawsuits. Full and part-time independent contractors can be included in its definition of “employee.” Federal and state laws protect the rights of employees. Unfortunately, an increased litigious society has resulted in a greater frequency and higher severity of employment-related lawsuits, consequentially furthering the need to insure against this type of litigation.

Most employers do not intentionally condone practices of discrimination or harassment – the two leading allegations brought by plaintiffs – and may follow good employment practices. Yet even employers that are innocent of wrongdoing can be targets of EPL lawsuits, which can be devastating – and not just to a company’s bottom line. A charge of discrimination, for example, may cost millions, but it can also tarnish a company’s image and hurt employee morale, negatively affecting revenues as well as its employee recruiting and retention efforts and potentially causing concern for shareholders. Even an innocent company may be strongly tempted to settle out of court.

Directors and Officers Liability Insurance

This insurance provides financial protection for the directors and officers or partners of your company in the event they are sued in conjunction with the performance of their duties as they relate to the company. Think of Directors and Officers Insurance as a Management Errors and Omissions policy. The directors and officers of a corporate or other business entity, whether publicly traded or privately held, hold highly visible positions of great fiduciary responsibility. Increasingly, courts are holding such people personally liability for abuse of authority, libel, slander, financial mismanagement, and other acts in suits brought by shareholders, creditors, customers, or employees.

Directors & Officers (D&O (Directors & Officers)) liability insurance and Management Insured Coverage (MIC) covers the litigation costs and damages resulting from such lawsuits. Generally designed to help protect both the assets of the company and the personal assets of the individual, D&O and MIC insurance normally covers liabilities that arise when an individual or group acts in the capacity of a director or an officer of the firm.

Difference in Conditions Insurance (Flood, Earthquake)

Typically purchased in conjunction with a commercial property insurance program, difference in conditions coverage addresses those perils not generally insured against in the prior policy, most often being flood and earthquake.

Proper analysis of the environmental characteristics and historical occurrences of your organization’s immediate and general surroundings will help determine if this insurance is needed. Prevail Insurance Management Services has access to the resources necessary to complete these studies and will advise your organization of the potential implications associated with deciding whether to secure this coverage.

Stop Loss Coverage

Stop loss coverage is a form of reinsurance also known as “aggregate excess of loss reinsurance.” Under this coverage, a reinsurer is liable for all losses, regardless of size, that occur after a specified loss ratio (equal to incurred losses divided by earned premium) or after a total dollar amount of losses has been reached.

Commercial Property Insurance

Commercial property insurance can be used to protect you against loss of real and personal property as well as resulting loss of income that occurs in conjunction with a direct property loss.

Commercial property insurance is first-party coverage for both physical assets such as buildings, machinery, and contents in addition to loss of income and expenses suffered when the loss or damage is caused by a covered peril, such as fire or explosion.

The most vital component of a well-designed property insurance program is the insurer’s timely response in a claim situation. This is because most major losses are catastrophic in nature and could completely shut down the functionality of your organization. In relation to the healthcare industry, the demand and need for patient care is severely elevated following natural disasters and the neither the facility nor the surrounding community can afford to suspend operations. Prevail Insurance Management Services and Associates employs in-house property analysts and claims handlers that will quickly engage the insurer in a loss situation and work to resolve all issues as quickly as possible.

Many programs are available in the marketplace and Prevail Insurance Management Services will continuously assess and analyze your facility’s current values and operations to ensure that you are insured and that the proper loss control and risk management measures are being employed. Our experts will also accompany insurance carrier representatives during their site visits and inspections.

Fiduciary Liability and ERISA

Under Employee Retirement Income Security Act (ERISA), fiduciaries are personally liable for losses to benefit plans incurred because of their alleged breach of duties. Trustees of employee benefit plans are expected to act in the best interests of the plan participants. If this duty is compromised, either intentionally or unintentionally, trustees can be held personally liable. In today’s litigious society, people who perceive they have been wronged react with lawsuits that can cost millions of dollars to defend and settle. This makes fiduciaries potential lightning rods of liability, particularly considering the amount of money held in retirement plans today, and the valuable protection those plans afford to their participants.

Most fiduciary claims are brought by past or present employees or their families. However, claims may also be brought by another fiduciary or by the Department of Labor (DOL), which enforces the provisions of the Employee Retirement Income Security Act of 1974 (ERISA). When the DOL brings an action, fiduciaries can face civil penalties as well.

The most frequently alleged claims against fiduciaries include:

• Denial or change of benefits
• Administrative error
• Incorrect benefit calculation
• Improper advice or counsel
• Misleading representation
• Wrongful termination of plan
• Civil rights denial or discrimination
• Failure to fund a benefit program
• Conflict of interest
• Imprudent investment
• Cash balance plan conversions
• Lack of investment diversity

Inappropriate selection of advisors or service provider

Companies can reduce the liability exposure of fiduciaries by employing good loss prevention procedures, such as seeking and following the advice of independent experts, selecting diverse, financially sound investments, and so on. However, in today’s changing and unpredictable world, companies cannot eliminate fiduciaries’ personal liability. Understanding the need to help protect companies, their fiduciaries, and the benefit plans they manage against fiduciary liability claims.

Crime Insurance

This covers a variety of forms of employee theft and dishonesty. It can be challenging to maintain a robust system of internal controls and even with them in place, employee crime happens. Additionally, the expansion of computers has drastically changed the speed with which fraud can occur. As a result, employee theft is on the rise.

Cyber Liability and Privacy Insurance

Cyber Liability and Privacy Insurance coverage is written to protect organizations that have access to any individuals’ personally identifiable information (PII) from an unauthorized person(s), technically, physically, and administratively. Beyond protecting PII, organizations are responsible for the collecting, handling, use, transfer, and destruction of this information in accordance with state laws and regulations.

This coverage helps companies monitor security breaches and provides defense costs associated with responding to lawsuits and investigations.

Who Should Buy Cyber Liability and Privacy Insurance?

Any organization that has:

• Confidential patient data
• Confidential employee data
• Customer information, such as credit card data
• Confidential client information

Why Companies Should Consider Buying Cyber Liability and Privacy Insurance?

• Cost of defending lawsuits may exceed the net worth of most companies
• Judgments can be financially crippling
• Companies face new exposures that are not covered by a standard Professional Liability policy
• What are the Sources of Cyber Liability and Privacy Claims?
• Theft by malicious third parties / computer hackers
• Virus threats and physical and/or administrative mishandling
• 1st party “inside jobs” by an insured’s rogue employee (according to the 2004 CSI/FBI computer crime security survey, inside jobs represent 80% of reported security incidents)
• Violation of federal, state or local privacy laws including the Gramm-Leach-Bliley Act and HIPPA

What Is Covered by Cyber Liability and Privacy Insurance Policies?

• Privacy – covers your liability when private information is disclosed:
• Notification Expenses – when data is lost, you must notify all potential victims within 9 days in multiple states.
• Credit Monitoring – policies will cover up to 1 year of credit monitoring services for those exposed.
• Credit Repair Services – Covers 1 year of services to repair credit damage resulting from actual identity theft.
• Crisis Management – public relations sublimit to protect the image of the insured.
• Web Media Services / Electronic Media – covers libel, slander and other forms of disparagement with respect to display of material online. Coverage will pick up where a GL policy’s advertising injury coverage stops.
• Technology / Network Security – covers your liability when hackers use your system to inflict damage on others.
• Regulatory Defense and Penalties – provides defense cost coverage and in some cases covers penalties where insurable.
• Technology / Cyber Extortion – covers expenses and ransom if a hacker threatens to shut you down.
• Data Restoration-Recovery / First-Party Data Asset – covers expense to recover lost data (depending on the risk).
• First-Party Business Interruption – covers lost business income in the event a virus infection interrupts your business operations.

Physicians Regulatory Liability (Billing Fraud and Abuse, RAC Audit)

Today’s healthcare environment has been defined by rising regulatory complexity for physician practices. In this dynamic marketplace, it is important that physicians protect themselves from regulatory claims made against their practices.

Physicians Regulatory Liability insurance is designed to respond to actions brought by or on behalf of governmental entities for billing errors and omissions. Policies can also respond to billing claims brought by Commercial Payors. While policies are designed to provide coverage for defense reimbursement and external forensic audit expenses, many also include civil fines and penalties as covered damages.

Coverage can include defense reimbursement and external forensic audit expenses, civil fines and penalties (where applicable) for various billing errors and omissions, as well as other regulatory violations including:

• Medicare and Medicaid Audit and Billing Investigations
• False Claims Act Allegations
• Commercial Payor Audit Coverage
• STARK Coverage
• EMTALA Coverage
• HIPAA Compliance Coverage

Areas Typically Not Covered: Business disputes, restitution, disgorgement, criminal actions, corporate integrity agreements, moral hazards, known losses or circumstances, internal costs for auditors and coders.

Excess Umbrella Insurance

Umbrella/Excess Liability insurance provides protection against catastrophic liability claims. This type of policy acts as excess coverage over your primary liability policies which could include your general liability, auto liability, and employer’s liability policies. The liability limits on these primary policies are typically $1 million which may not be adequate for many companies. An umbrella / excess liability policy can provide you with additional protection from $1 million to $100 million or more depending on your needs.

Business Owners Policy (BOP)

Business Owners Package (BOP) insurance programs typically address the property and general liability insurance needs of small businesses. Within the healthcare industry, this “package” policy is typically purchased by small to mid-sized medical groups because it provides a more affordable alternative to securing two mono-line insurance policies. In addition, the coverage offered under a BOP policy is usually more comprehensive and flexible, enabling the insured to add such provisions as business income, employee dishonesty, fiduciary liability, hired and non-owned automobile liability, extra expense, and electronic data processing.

Captive Insurance and Self Insurance

Commercial automobile insurance covers liability and property damage resulting from the use of a covered auto. A covered auto is defined within the policy and can be restricted to scheduled autos only or broadened to include all autos used during your organization’s operations. Typically, this insurance program also addresses the exposure associated with the use of non-owned and hired vehicles.

Specifically related to the healthcare environment, an endorsed commercial automobile liability policy or standalone coverage will insure patient and emergency transport vehicles. However, in most situations, the emergent ambulances are owned and operated by an outside agency, leaving only the non-urgent patient transport exposure to be contemplated, which is a readily available placement to secure.

Another important aspect of a commercial automobile liability insurance program is monitoring the covered drivers. Prevail Insurance Management Services utilizes in-house resources to assist in minimizing the use of drivers with unfavorable driving histories.

Finally, fleet safety programs and various driving seminars can be either conducted or arranged to continuously educate employees on new legislation, defensive driving techniques, and the proper procedures to follow in a loss situation.