Physician Services / Underwriting
- Q. What is a "claims-made" policy?
- A. A Claims-Made policy provides coverage only for claims made against "professional services rendered" on or after the retroactive date of the policy. In addition, the policy only covers claims that are reported while the policy is in force. Once coverage is terminated, reporting rights cease unless extended reporting rights, commonly referred to as "tail," are purchased.
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- Q. What is an "occurrence policy"?
- A. An Occurrence policy covers you for claims that occurred during the effective policy period regardless of the date reported. Thus, the "tail" is built in to the premium.
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- Q. What type of policy does API offer?
- A. Claims-made policy.
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- Q. What is prior acts coverage?
- A. Coverage for incidents occurring prior to the effective date, but subsequent to the retroactive date, and reported within the policy period.
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- Q. What is Extended Reporting Period Coverage (tail)?
- A. Coverage that extends the time for reporting claims after a policy has been terminated or canceled; extended reporting period coverage. Many companies, such as API, provide free tail in the event of death, total disability and, with certain restrictions, retirement.
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- Q. What is the cost of tail coverage?
- A. Approximately 200% of the annual premium for each physician.
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- Q. What is aggregate limit?
- A. The "aggregate" limit is the most we will pay for all claims made and reported during the policy period or during the entire period of any indefinite reporting endorsement. Coverage will cease upon exhaustion of the "aggregate" limit.
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- Q. What is an endorsement?
- A. A document which changes the named insured or coverage provisions in the policy. The terms of any endorsement supersede the policy terms.
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- Q. What is a declarations page?
- A. The document which validates coverage provided under the policy. No coverage is in effect unless a declarations sheet has been issued.
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- Q. What does the legal expense endorsement cover?
- A. We will reimburse you for Legal Expenses incurred as a result of any one of the following Disciplinary Proceedings:
- A professional review action instituted against you by the professional review body of a health care entity with which you have clinical privileges or membership.
- Proceedings threatened or instituted against you by a state licensing authority for unprofessional conduct.
- Proceedings instituted by a Professional Review Organization pursuant to parts 1004 and 1005 of title 42, Chapter V, Code of Federal Regulations.
- Proceedings instituted by a state Department of Health Services or the Federal Department of Health and Human Services alleging Medicare/Medicaid fraud and abuse.
- Proceedings instituted by a governmental agency alleging violation of HIPAA privacy regulations.
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- Q. What is an exclusion?
- A. The condition or circumstance that is not covered by the insurance and is so stated in the policy. A clause in an insurance policy which specifies what is excluded from the policy's coverage.
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- Q. What is a deductible?
- A. The amount of loss paid by the policyholder. Our standard normally includes Indemnity and Expense.
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- Q. Am I covered for the acts and/or omissions of my physician extenders (physical therapists, physician assistants, certified registered nurse anesthetists, nurse practitioners, and nurse midwives) under my API medical liability policy?
- A. In order for vicarious coverage to be present, these individuals must be endorsed onto the policy. In most cases they do not have individual coverage under your policy and should carry their own policy with limits equal to or greater than the limits of the physician. Please contact your Account Manager if you have additional questions.
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- Q. Am I covered for the acts and/or omissions of my ancillary personnel (personnel other than physicians and/or physician extenders) covered under my API medical liability policy?
- A. Yes. Please contact your Account Manager if you have additional questions.
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- Q. Does my API policy cover me for my activities as a medical director?
- A. No.
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- Q. How long does it take to process an application?
- A. Forty-eight hours from the time the application is completed and all supplemental information is received.
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- Q. I need a copy of my policy or proof of coverage. Who do I call?
- A. Your Account Manager at 1-800-252-3628.
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- Q. What is vicarious liability?
- A. Liability on your part with respect to any professional services rendered by someone else for whose conduct you are legally responsible.
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- Q. What are my duties to notify API of changes in my practice?
- A. You must notify us in writing within 14 days of:
- Any change in the nature or scope of your practice;
- Any change in your specialty (classification stated in the declarations sheet or endorsement(s));
- Any change in the location of practice;
- Any change regarding the physicians, dentists, or physician extenders in your practice; or
- Any change in the full-time or part-time nature of your practice.
If you do not notify us in writing of changes, you may not receive a full refund if the changes result in an overpayment of your premium. Also, changes may result in conditions which would not be covered by this policy. Therefore, it is important that you let us know of changes so we can advise you of any such conditions. The authorized representative of the first named insured is authorized to make changes in this policy. Such written notice must be received by us, at our home office, within the time required.
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- Q. Why didn't my premium go down as much as I expected (now that I changed my specialty from a higher class to a lower class)?
- A. The premium will "step" down over a five-year period. As the higher exposure gets further and further away, the premium will reduce until the fifth year at which time the premium will stabilize.
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- Q. I have added a professional association or other entity to my practice what do I need to do?
- A. In order for a professional association or other entity to be covered on your policy, it needs to be listed on the policy via declarations page or endorsement. This request needs to be submitted through the underwriting process for approval. Please contact your Account Manager.
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- Q. How can I contact Underwriting?
- A. uw@api-c.com
