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The authors outline the current position of psychiatrists in the United States regarding their vulnerability to lawsuits for malpractice. They review the various activities of the American Psychiatric Association on behalf of its members, especially its endorsement and supervision of a professional liability program for review and control of losses.
At a time when D & O insurance is becoming increasingly difficult to obtain, hospital governing boards are making decisions on issues of growing complexity--decisions that could make trustees the target of lawsuits. This article looks at several alternatives to commercial D & O liability coverage.
When a health plan denies payment for a procedure on grounds that it is not medically necessary or when it refuses a physician-ordered referral to a specialist, has it crossed the line from making an insurance judgment to practicing medicine? If the patient suffers harm as a result of the decision, is the plan liable for medical malpractice? Those were questions 35 states considered in 1999, and at least 32 states are grappling with this year as they seek to respond to physician and patient pressure to curb the power of the managed care industry. Traditionally, health insurers have been protected by state laws banning "the corporate practice of medicine," which means the patient's only recourse is to sue under a "vicarious liability" theory. Now, however, lawmakers are debating legislation to extend the scope of malpractice liability beyond individual practitioners to insurance carriers and plans themselves.
When a health plan denies payment for a procedure on grounds that it is not medically necessary or when it refuses a physician-ordered referral to a specialist, has it crossed the line from making an insurance judgment to practicing medicine? If the patient suffers harm as a result of the decision, is the plan liable for medical malpractice? Those are questions 29 states considered in 1998, and at least 35 states are grappling with this year as they seek to respond to physician and patient pressure to curb the power of the managed care industry. Traditionally, health insurers have been protected by state laws banning "the corporate practice of medicine," which means the patient's only recourse is to sue under a "vicarious liability" theory. Now, however, lawmakers are debating legislation to extend the scope of malpractice liability beyond individual practitioners to insurance carriers and plans themselves.
When a health plan denies payment for a procedure on grounds that it is not medically necessary or when it refuses a physician-ordered referral to a specialist, has it crossed the line from making an insurance judgment to practicing medicine? If the patient suffers harm as a result of the decision, is the plan liable for medical malpractice? Those were questions 35 states considered in 1999, and at least 32 states are grappling with this year as they seek to respond to physician and patient pressure to curb the power of the managed care industry. Traditionally, health insurers have been protected by state laws banning "the corporate practice of medicine," which means the patient's only recourse is to sue under a "vicarious liability" theory. Now, however, lawmakers are debating legislation to extend the scope of malpractice liability beyond individual practitioners to insurance carriers and plans themselves.
When a health plan denies payment for a procedure on grounds that it is not medically necessary or when it refuses a physician-ordered referral to a specialist, has it crossed the line from making an insurance judgment to practicing medicine? If the patient suffers harm as a result of the decision, is the plan liable for medical malpractice? Those were questions 35 states considered in 1999, and at least 32 states are grappling with this year as they seek to respond to physician and patient pressure to curb the power of the managed care industry. Traditionally, health insurers have been protected by state laws banning "the corporate practice of medicine," which means the patient's only recourse is to sue under a "vicarious liability" theory. Now, however, lawmakers are debating legislation to extend the scope of malpractice liability beyond individual practitioners to insurance carriers and plans themselves.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
The plaintiff sought reimbursement for the costs of an in vitro fertilization procedure which resulted in her conceiving a child. When her insurance company refused reimbursement, she brought suit claiming that the procedure was covered by her insurance policy. The Court ruled in favor of the insurance company, holding that an vitro fertilization procedure was not "medically necessary" within the meaning of the insurance policy because the plaintiff's infertile medical condition was in no way reversed or cured. It reached this decision despite the fact that the insurance company had previously paid for out-patient and in-patient surgical treatment designed to repair the plaintiff's fallopian tubes.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
This article provides information on containing liability protection costs. The authors, experienced corporate and institutional liability protection specialists who provide risk management services to the medical and business community, describe the causes of the high cost of liability insurance and cost-saving alternatives to traditional insurance. Quality assurance's role in working with risk management to prevent losses and reduce costs in a self-insured program is covered. Insurance costs rise and fall in inevitable cycles, but the medical community can protect itself from these cycles. Quality assurance and risk management can work together to reduce costs and prevent losses. The principal conclusion is that through policies, procedures, and information exchange, quality assurance can expand its risk management role to help maintain high quality health care and financial stability. Within a self-insured liability program, direct savings to the institution will result.
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Professional liability insurance costs have increased rapidly in the last 10 years in the United States, while availability of companies offering professional liability insurance has decreased. The result is that ob-gyn physicians are changing their practice patterns. Many are no longer performing difficult or complex surgical procedures while others have stopped caring for obstetrical patients. Some physicians are retiring early or moving to other localities where there are less liability concerns. These changes all impact on the availability of health care for women. In addition, these problems have become a concern of medical students, and this is reducing the numbers considering a career in ob-gyn. Even where ob-gyns are available, hospitals and insurance carriers are limiting their ability to practice the wide range of procedures for which they were trained. Although legislative efforts to correct the problems are proposed, very few have been enacted. The end result is that women's health care has been threatened and will continue to face shortages and restrictions.
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Explore the source record for details and available documents.