Managed Care Professional Liability. Liability claims against managed care
organizations (MCOs) are increasing in both frequency and severity. Pegram v. Herdrich
and other recent court decisions continue to erode the protection that ERISA
once afforded MCOs. These developments impact all MCOs, making it critical that
your Managed Care E&O coverage be as broad as possible.
The threat of a lawsuit is always a possibility for any professional organization,
regardless of actual liability. A risk management program may be a health care
organization's optimum defense against liability claims. An effective risk management
program works like preventive medicine by helping to identify potential
problems and ward off liability claims. Our health care clients receive:
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A quarterly newsletter that provides specific sections of
information about risk exposures for MCOs.
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A series of educational workbooks for clients to use as templates for operational
development and to proactively review areas of liability exposure or to
review or audit existing operations.
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Informational releases sent via fax on an as-needed basis to inform
them of cutting-edge issues in the marketplace.
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Directors and Officers (D&O) Coverage
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Credential/peer review coverage
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Option entity coverage
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Employment Practices coverages
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Non-cancellable policy, once the premium is paid
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No medical malpractice exclusion
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Credential/peer review coverage
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Coverage for anticompetitive acts
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Subsidiary coverage
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Extended reporting period
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Errors and Omissions (E&O) Coverage
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Broad definition of covered managed care activities, including
administration/management and marketing of health care plans,
provider selection (peer review, credentialing, and contracting),
utilization review, case management, disease management, claims
administration, establishment of provider networks, and reviewing
the quality of medical service or providing quality assurance
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Coverage for medical malpractice allegations involving managed care
activities
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Specific coverage for medical information protection (including breach
of confidentiality or improper disclosure)
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No ERISA exclusion
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No contract exclusion
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Expanded definition of defense expenses (includes arbitration,
mediation, and injunction)
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Automatic coverage for 90 days in the event of a merger or acquisition
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Vicarious liability coverage for sexual misconduct of contracted practitioners
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Six-year "run-off" coverage at 50% of existing premium if entity ceases
business activities
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