Medical Malpractice insurance question

[ShannonO]

One of my attorney clients has a suit against a hospital. The hospital has sent an Acord certificate outlining their coverage which is a group policy where this particular hospital has a slice of the overall policy limit (total policy limit is over $100M but this Insured has limits of $1M/$3M). As my client has asked additional questions about this policy, they told my client they don't have an insurance policy but they have an "insurance trust". This is not a term I have heard used before. Has anyone else?

The certificate of insurance lists a known insurance company so I'm wondering if by "trust" they mean the national group policy where they have sublimits on the policy. Or if there is some kind of "insurance trust" that can be used like a self insurance policy or risk retention pool or something similar. I don't sell medical malpractice so just trying to give my client enough information that she understands what she is looking to recover from and can make sure she doesn't have to take extra steps or meet different deadlines than if this was just a standard insurance policy like she has for her own malpractice.

 

[somarco]

I haven't worked with Med Mal in years but wrote a lot of self funded medical for a dozen years or so. Most were single employer plans but I also handled a few MEWA's and Taft-Hartley trust plans.All of those plans were self funded with stop loss.

The loss fund was seeded with employer contributions up to $X and excess cover picked up if a claim exceeded $X.

I had limited involvement in Med Mal coverage for a state medical association. At that time traditional carriers didn't want anything to do with Med Mal (and that may be the case now as well). Members were issued certificates of coverage indicating their quota share portion with a notation that excess cover was reinsured.

Because the reinsurer could change from time to time it was never named in the certificate.

On the medical side of a self funded trust the state DOI is not involved . . . they don't have regulatory authority over a trust that may not even be domiciled in their state. I suspect any Med Mal coverage is the same and the participants get a certificate of coverage, not a policy.

Med Mal is a specialty item and most agents don't get involved in it unless they work for a managing general underwriter or TPA that handles the claims.

That being said, maybe one of the P&C agents will chime in an offer something definitive.

One other thing . . .

Med Mal cases are vigorously defended. Litigation is lengthy including appeals. Out of court settlements are more common than civil trials.

Settlements come from the loss fund and reinsurance is rarely touched.

 

[TomsDiner982]

I haven't worked with Med Mal in years but wrote a lot of self funded medical for a dozen years or so. Most were single employer plans but I also handled a few MEWA's and Taft-Hartley trust plans.All of those plans were self funded with stop loss.

The loss fund was seeded with employer contributions up to $X and excess cover picked up if a claim exceeded $X.

I had limited involvement in Med Mal coverage for a state medical association. At that time traditional carriers didn't want anything to do with Med Mal (and that may be the case now as well). Members were issued certificates of coverage indicating their quota share portion with a notation that excess cover was reinsured.

Because the reinsurer could change from time to time it was never named in the certificate.

On the medical side of a self funded trust the state DOI is not involved . . . they don't have regulatory authority over a trust that may not even be domiciled in their state. I suspect any Med Mal coverage is the same and the participants get a certificate of coverage, not a policy.

Med Mal is a specialty item and most agents don't get involved in it unless they work for a managing general underwriter or TPA that handles the claims.

That being said, maybe one of the P&C agents will chime in an offer something definitive.

One other thing . . .

Med Mal cases are vigorously defended. Litigation is lengthy including appeals. Out of court settlements are more common than civil trials.

Settlements come from the loss fund and reinsurance is rarely touched.

Very interesting. Thanks for sharing this.