Since they directly deal with people’s lives and property, professions related to medicine are one of the most risky jobs that, in addition to work pressure, cause a lot of mental and emotional stress to the activists of this group. In addition, the risks caused by individual mistakes may lead to irreparable damages. Liability insurance can be an important factor in increasing peace of mind and compensating for damages.
Liability insurance for doctors and paramedics is one of the types of civil liability insurance policies. This insurance policy is to compensate the physical or mental damages caused to the patient due to the negligence or negligence of the doctor or paramedic. Cases such as error, mistake, negligence or negligence in treatment, surgery, prescription and wrong medicine are covered by this insurance policy.
Even if the patient’s treatment is done with the full consent of the person or his legal guardian, the doctor’s liability insurance policy will take over the doctor’s responsibility at the time of damage.
Important points about liability insurance:
- In the liability insurance of some insurance companies, the legal fees are also paid.
- If the patient is injured due to the mistake of the assistant or nurse under the supervision of the insured doctor, the insurer is obliged to pay the damages.
Hands of doctor giving health insurance card to senior patient
Damages covered by the liability insurance of doctors and paramedics
Damage compensation: If the patient suffers a disability due to the negligence or negligence of the doctor or paramedic, the liability insurance of the doctors and paramedics will pay the patient’s compensation.
Death compensation: If the patient dies due to the negligence or negligence of the doctor or paramedic, the insurance company will pay the death compensation, which is equivalent to the approved amount, to the heirs of the patient.
Damages outside the liability insurance coverage of doctors and paramedics
Liability insurance coverage for doctors and paramedics has a few exceptions. That is, if in this situation, the error of the doctor or paramedic causes problems for the patient, the insurance does not accept the responsibility of paying the damage and the responsibility is on the insurer. These conditions and cases are:
Actions outside of expertise:
Actions to perform any action such as treatment and prescription outside the scope of occupational and trade duties are not covered by liability insurance. Damages caused by treatment or surgery outside the expertise of doctors and paramedics.
For example, if an internist treats a patient’s teeth, the damages will not be covered by medical liability insurance.
Use of drugs and psychotropic substances:
If the doctor’s or paramedic’s error or negligence occurs during the treatment in a state where he is under the influence of alcohol, psychotropic or sleeping drugs, the insurance will not cover the costs of the damage or the damage caused.
Illegal actions:
Compensation resulting from any action, including treatment, treatment, or surgery that is outside of medical standards or against the current laws and regulations of the country.
for example; Vasectomy surgery or abortion is currently illegal, and if this procedure is performed and the patient is harmed as a result, it is not covered by the liability insurance of doctors and paramedics.
Nuclear radiation:
Damage is caused by ionizing or radioactive radiation and nuclear energy rays if the use of such materials is for the purpose of treating the patient and is part of the treatment process.
Anesthesia outside authorized centers:
Damages caused by any general anesthesia performed outside the clinic or hospital.
First degree relatives:
Loss and damage caused by treatment, treatment, or surgery to first degree relatives (causal and relative)
For example: if the doctor treats his first-degree relatives and as a result of that treatment there is a risk, in this case, he will not be covered by the insurance of doctors and paramedics.
Cosmetic surgeries :
Any treatment, treatment, or surgery that is done for the purpose of beauty, the damage is fully assigned to the person.
Procedures for calculating liability insurance premiums for doctors and paramedics:
The main and most important criterion for calculating the liability insurance premium of doctors and paramedics is divided into 4 categories:
- The amount of insurance is based on the type of specialty and field of activity of the doctor or paramedic
- History of no damage and medical history
- Medical resident and paramedical student
- Covering the increase in the amount of the current installment stated in the insurance policy
Types of specialization and place of activity of doctor or paramedic:
Insurance companies divide the liability insurance premium rates of doctors and paramedics into several groups based on different specializations and trends:
The classification of doctors includes the following categories:
- Gynecology and obstetrics surgeons, general surgeons, anesthesiologists, and orthopedics.
- Cardiac, neurological, eye, reconstructive, and plastic surgeons, and urology.
- Maxillofacial, otolaryngology, teeth and gums, dermatology, pediatrics, and nuclear medicine specialists.
- Specialist non-surgeons and surgeons who do not perform surgery for some reason, such as dentists, general practitioners and endoscopy, radiology, microbiology, and pharmacy specialists, oncology specialists, physiotherapy, physical and rehabilitation specialists, emergency medicine and traditional medicine
The classification of paramedics is as follows:
- Midwives working in hospitals or clinics, experimental dentists, and dental hygienists.
- Senior anesthesia experts and anesthesia technicians, physiotherapy experts, nurses and paramedics working in all departments of CCU and ICU and dialysis, emergency room, clinical supervisor, occupational therapy, emergency medical technician, a nursing expert in orthopedic department, nurse in chemotherapy department.
- Nurses and paramedics from other departments, operating room technicians, operating room nurses and paramedics, educational supervisors, blood transfusion organization technicians, emergency medical center nurses and paramedics.
- CT scan and MRI radiology technicians and laboratory experts and technicians, pharmacy and radiography technicians and CSR, paramedic assistants, midwifery assistants, audiologists and optometrists (optometrists), family health, physicists, Behvarz.
- Midwives who have an independent office.
History of no damage:
For liability insurance for doctors and paramedics, like many insurance policies, a discount is considered for each year of no loss, and the discount rate of no loss is different in different insurance companies.
The work records of doctors and paramedics and their medical history have a direct effect on the insurance premium rate. For example, a doctor or a paramedic who has never made a mistake during his years of activity and has imposed a lower risk on the insurer, therefore, pays a lower premium.
Medical resident and paramedical student
It is a practical and supplementary course in the higher education of doctors. In this course, the resident is engaged in learning and clinical or practical training of the basics and trends of his specialty. During this course, he is not considered a specialist doctor and due to less experience than other specialists, there is a possibility of making mistakes. they have more, that’s why the insurance premium rate is higher for them, and during the 4-year residency period (in some fields it is more than 4 years), this rate decreases every year.
The paramedical student has a direct effect on the insurance premium rate.
Covering the increase in the amount of the current payment stated in the insurance policy:
Some insurance companies provide coverage under the title of increasing the amount of the current payment included in the insurance policy; In this coverage, the doctor and paramedic can increase the limit of insurance coverage and pay compensation based on the annual insurance rate that is announced by the competent authorities.
Documents and the process of payment of liability insurance for doctors and paramedics and the maximum period of filing a case:
The process of civil liability insurance for doctors and paramedics begins with the receipt of a claim notification letter from the insured. The damage should be done within 5 days after the occurrence of the damage, which is different in different companies.
Necessary documents to receive liability insurance for doctors and paramedics:
- Damaged identification documents
- Original hospital file
- Copy of the original interrogation sheet
- A copy of the original of the patient’s complaint
- A copy of the original complaint of the legal heirs and the inheritance monopoly sheet (in case of death)
- A copy of the original theory of the Medical Commission
- The principle of the court decision
Important points of liability insurance for doctors and paramedics:
If the treatment or surgery has been done during the validity period of the insurance policy, the patients and their dependents are able to file a lawsuit against the guilty doctor and paramedic for a maximum period of 4 years from the expiration date of the liability insurance of doctors and paramedics, and all lawsuits during this period are covered by this policy. It is an insurance policy. (If the insurer and the insured agree, this period can be extended up to 6 years)
In the liability insurance of doctors and paramedics, the insurer’s obligation to compensate the insured’s professional civil liability losses is based on the maximum limit specified in the insurance policy.
Due to the direct connection of the liability insurance of doctors and paramedics with the current laws of the country (especially the Diet Law), the insurance coverage limits of the insurance policy must be in accordance with the relevant laws.
In addition to paying compensation to the victim, the insurer is also committed to pay the legal fees up to the limit of the obligation stated in the insurance policy for each patient. If the doctor or paramedic is sentenced to pay a dowry through legal authorities. The insurer’s obligation is limited to paying the Riyal equivalent of the cheapest type of mortgage among the types implemented in the mortgage law.
Physician assistants, nurses, etc., who treat patients under the doctor’s orders, are covered by the liability insurance of doctors and paramedics.
The validity period of liability insurance for doctors and paramedics is one year, and after that, it can be extended if the parties agree.
If a doctor or paramedic intends to use short-term insurance, he can purchase it based on the short-term insurance premium rate provided by insurance companies.