Medical Liability Insurance

Coverage for disciplinary or regulatory actions

Every TMLT policy includes Medefense. Medefense covers legal expenses, fines, and penalties associated with disciplinary actions, such as actions by the Texas Medical Board, a hospital review committee, or a federal regulatory agency.

Covered disciplinary proceedings include:

• actions by a state medical licensing authority;
• a professional review action regarding clinical privileges;
• a proceeding instituted by a state department of insurance, state workers’ compensation commission, state department of health and human services, the U.S. Department of Health and Human Services, or Centers for Medicare and Medicaid Services alleging medical services were performed in violation of guidelines;
• Medicare billing audits conducted by Recovery Audit Contractors (RAC) or other private contractors as well as allegations of non-compli­ance with Medicare/Medicaid regulations or procedures;
• proceedings alleging violations of EMTALA, HIPAA, Stark law; and
• a tax practitioner's fees to assist a policyholder in an IRS audit of a federal tax return.

Available limits

$50,000 per claim/$100,000 per policy period.

An aggregate of $250,000 for all members of your group per policy period. This includes a maximum tax expense of $5,000 per policy period that provides for tax audit expenses, fines, or other penalties.

• There is a $1,000 deductible per insured event.
• This coverage also include a 60-day reporting period.
• Policyholders have free choice of counsel. However, we will waive the deductible and pay legal expenses directly if the policyholder hires an attorney from a panel provided by TMLT.
• Higher limits require approval by the TMLT Underwriting Department.

Higher limits are available

• $100,000/$100,000 per risk — $250
• $200,000/$200,000 per risk — $350
• $500,000/$500,000 per risk  — $550

Tail coverage

Policyholders also have the option to purchase tail coverage for Medefense. This coverage allows for continuous reporting of Medefense claims that arise during the time a physician was insured with TMLT. This coverage is available only at time of cancellation.

Help for cyber incidents when you need it most

A cyber-attack can be financially devastating to medical practices — large or small.

Cyber insurance is included with all TMLT policies. It includes coverage for network security and privacy incidents.

Coverage includes

• Ransom payments incurred directly resulting from a ransom threat.
• Data and system recovery costs incurred directly resulting from a cyber event.
• Business interruption loss, including extra expense, incurred because of a business interruption directly resulting from a business interruption event.
• Reputation harm — Reputation loss incurred because of a reputation event directly resulting from a cyber event or extortion threat.
• Cyber event costs directly resulting from a cyber event.
• Proof of loss — Any reasonable and necessary costs for an expert to determine the amount and the extent of any covered business interruption loss, data and system recovery costs, extra expense, and reputation loss.
• Privacy and network security — Any damages and defense costs arising from a liability claim against an insured for any cyber event.
• Regulatory fines and penalties — Any fines, penalties, and defense costs arising from a regulatory claim against an insured for any cyber event.
• Cyber deception — Losses from fraudulent instruction, funds transfer fraud, and telephone fraud.
• Payment card — Any PCI payments, PCI investigation costs, and defense costs arising from a PCI claim against the insured for a PCI wrongful act resulting from a cyber event.
• Media — Any damages and defense costs arising from a liability claim against the insured for a media wrongful act.

Limits

Physician: $100,000 per claim / $100,000 per policy period
Entities: $100,000 per claim / $500,000 per policy period

Important information about your cyber policy

• There is a $2,500 deductible per insured event
• 60-day reporting period
• Please note: Legal defense costs are included in a policy’s aggregate limit of liability. In the case of a cyber claim, the aggregate limit of liability available to pay loss and the retentions shall be reduced and may be exhausted by the payment of defense costs. The insurer (AmTrust) shall not be liable for defense costs or the amount of any loss after the aggregate limit of liability has been exhausted.

Higher Limits

Enhanced Cyber Liability coverage is available through Barton Oaks Insurance Services, Inc., a TMLT affiliate, and is underwritten by AmTrust.  The enhanced coverage provides greater protection against claims that may exceed your standard cyber liability policy limits.

Higher limits — up to $2 million (or higher) — are available for purchase. For more information on higher limits, please email cyber@tmlt.org and a representative of Barton Oaks Insurance Services will respond to discuss your options.

Coverage for employment-related claims

EPLI is included with all TMLT policies and provides coverage for alleged wrongful employment acts, such as :

• violation of any federal, state, local, or common law prohibiting any kind of employment-related discrimination;
• harassment, abusive or hostile work environment;
• wrongful discharge or termination of employment;
• decisions that violate public policy or the Family Medical Leave Act (FMLA) or similar state or local law;
• discrimination (including harassment) or civil rights violation against any non-employee, such as a patient or nurse employed by the hospital;
• misuse of social media, workplace bullying, and improper use of background checks;
• violation of any immigration practices law;
• theft of an employee’s personally identifiable information; and
• expense reimbursement for an employment advisor related to an acquisition; layoff/termination of 20% or more of the workforce; public announcement of harassment by an executive office; or notification that a public interest group is investigating the practice for violations of state or federal employment law. Coverage amount is $5,000.

EPLI coverage is limited to claims brought against you by or on behalf of an employee, a former employee, or by an applicant for employment. EPLI includes EEOC complaint hearings.

Available limits

• $75,000 per claim (including both defense and indemnity payments)
• The yearly aggregate limit is also $75,000.
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Higher limits are available upon request.
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• There is a $5,000 deductible per insured event.
• 75-day reporting period

Additional resources — EPLI Pro

TMLT policyholders also have access information on employment and HR issues with the online EPLI Pro resource. EPLI Pro includes webinars, training materials, step-by-step procedures for HR tasks, including how to create staff handbooks and policies and procedures.

Coverage for a substitute physician

Locum tenens provides indemnity and defense coverage to a substitute physician who assumes responsibility for your patients during a scheduled absence.

All TMLT policyholders can request locum tenens coverage for up to 30 days per policy year without an additional premium charge. Coverage for more than 30 days will incur a fee of $500 per day.

Requests for locum tenens coverage require written notice before the scheduled absence, and the substitute physician must submit a locum tenens application.

Coverage for premises injury

All TMLT policies include limited professional premises liability coverage with limits of $200,000 per claim/$200,000 per policy period. Coverage includes compensatory damages for claims arising out of premises injury or damages to any patient that:

• occur during the policy period and within the policy territory;
• are caused by a premises occurrence; and
• arise out of your ownership or leasehold interest in the insured premises.

The coverage only applies to claims by patients, and it does not eliminate the need for a general liability policy for your practice.

Protects physicians serving as head of an organized medical staff.

Claims can often arise from administrative decisions or processes that lead to a negative outcome for patients. Medical Director coverage is provided to physicians who also serve in an administrative capacity as head of an organized medical staff.

This coverage is available at a cost of $250 per policy period. Policyholders can opt out of medical director coverage when they renew their policies. Medical director duties may include the following:

• Training and supervising medical staff (both physician and non-physician).
• Drafting and using appropriate policies and procedures.
• Assuring an organization is complying with federal, state, and local laws.
• Medical director services do not include employment-related practices.

Available limits

$100,000, inclusive of the existing limits provided on the declarations page.

Higher limits of $200,000, $500,000, and $1 million are available for purchase