Apart from being an important requirement of the Health and Care Professions Council (HCPC) registration, medical negligence cover is probably the most important policy in the career of a paramedic, or any health professional involved in the treatment of patients.
Medical negligence insurance
The cover is generally described as Medical Malpractice insurance—but can often be referred to as Medical Liability insurance, Medical Indemnity, Clinical Negligence cover or Professional Indemnity. Its overriding objective is to insure the health professional against claims arising from wrongful advice or negligent treatment.
Who should purchase this cover?
Any health professional delivering medical services should establish how their work will be insured before engaging in practice. There are two basic areas, each with a different perspective; the first applies to engagement as an employee, and the second, as an independent/voluntary paramedic.
Where the paramedic is employed under a contract of employment, the employer is legally liable for the negligence of their employees (whether that negligence is medically related or otherwise). The employer therefore should maintain an appropriate policy in their name, covering all business liabilities including claims arising from the medical negligence of its employees. To satisfy HCPC regulations, employees should check with their employer they have the necessary insurance before commencing employment.
Independent/voluntary paramedics are usually accountable for their own advice and treatments, for example, if they are self-employed or while acting as an independent contractor. It is often overlooked that insurance will also be required when paramedics offer advice or provide treatments on a voluntary basis (such as to local amateur sports clubs, charities, or simply to family or friends), or when acting as a Good Samaritan.
Insurance options for paramedics
There are three main forms of indemnity cover available to paramedics:
Insurance that is arranged by their employer for work undertaken within the employee's scope of employment. The policies held by employers should include Medical Malpractice, Professional Indemnity, Public and Employers Liability in their name, and it is important the employer informs employees of any specific exclusions within the policy that may affect the scope of work undertaken
Insurance arranged by individual paramedics (or their trading entity) in respect of medical services for which they or their organisation are legally accountable. This will normally include Medical Malpractice, Professional Indemnity and Public Liability—all of which can usually be included within one policy
The College of Paramedics provides a block insurance scheme for all eligible members as a benefit of membership providing cover for voluntary and unpaid work, Good Samaritan acts, and a limited amount of paid work (up to £5000 per annum) outside of the member's main employment, but excluding any NHS work.
Cover for paramedics is only available from specialist commercial insurers (i.e. insurance companies or at Lloyds), or from discretionary mutuals such as the Medical Protection Society (MPS) or Medical Defence Union (MDU).
There are several distinguishing features between this type of cover and other insurance policies, which are important for applicants to understand. Some of these key features include:
In almost every case, there is a maximum limit per claim, followed by a maximum limit for all claims payable in any year of insurance (referred to as the policy aggregate)
The limit includes the maximum payable for compensation claimed by patients for alleged damage they have sustained as a result of medical negligence, together with the cost of legal fees and defence costs including associated expenses in obtaining evidence to defend claims
Paramedics should consider a minimum limit per claim of £5 million, but higher limits are recommended where affordable, owing to the escalating and continued rise in settlement costs
Only claims first notified during the currency of the policy are covered. When ceasing to practice, it is important that run-off options are considered to deal with the possibility of future claims arising from previous work after the policy has lapsed
Normally policies will only cover claims for work undertaken after the start date of the policy. However, if previous insurance has been in place, the start date of that policy can be carried forward as the retroactive date.
Policies of this type can also include an ‘excess’ for which the policyholder is responsible. This exclusion (if applicable) applies to each and every claim and should be considered as part of the potential costs
It is important the policy clearly and correctly identifies all the work intended to be covered and the name of the person or organisation to be insured. Changes must be notified to insurers immediately.
Main conditions and exclusions
As with any insurance policy, this type of cover is also subject to exclusions and conditions. As an example for qualified paramedics, there will be an HCPC registration requirement, and exclusions may involve work with elite athletes, or certain areas of practice. Sometimes policies can include specific governance requirements (e.g. when dealing with suspected meningitis conditions); but in all cases, paramedics are expected to work only within their individual scope of practice. Failure to comply with the terms and conditions may invalidate cover.
In the majority of cases, cover applies to policyholders that are UK-domiciled but can often extend to temporary work overseas. It is important to check where in the world cover applies, and the territories in which claims can be brought. It may also be necessary to comply with any local regulatory obligations that may exist.
The overall cost of insurance is influenced by the following:
Nature and amount of work to be insured
Qualification and experience of the applicant
History of claims and rising settlement values
Disclosure of ‘adverse’ underwriting features.