Professional indemnity insurance

How protected are you?

PII webpage crowd pic

How protected are you really in today’s increasingly litigious world? With many of us facing increasing time pressure, complex patients or new technology, knowing that we are covered by effective professional indemnity insurance (PII) should be a top priority.

Several choices in PII are now available on the market through Optometry Victoria membership, corporate employers or as a stand-alone product eg Aon. Who do you choose? What should you look for and what should you be aware of?

What's covered?

Let's start by looking at features of your existing Avant policy, which is Optometry Australia’s PII provider. Some features that you may not be aware of are:

  • no excess/deductible needs to be paid on a claim;
  • 24/7, 365 days a year medico-legal advice line;
  • support from Optometry Victoria’s CEO alongside Optometry Australia’s Professional Services Manager Luke Arundel and his team;
  • largest medico-legal insurer in Australia with the most experience in optometry claims;
  • criminal[1] as well as civil cover, plus AHPRA investigations, defamation, privacy breaches and telehealth covered;
  • PII policy focused on protecting the individual – claims are kept confidential and not disclosed to employers;
  • other staff in your practice (eg dispensers) are covered if they are acting under your instruction when dealing with patients;
  • temporary cessation of membership[2] and unlimited retroactivity[3]
  • coverage for overseas volunteering aid/charity trips[4] (except USA) and,
  • in a co-management situation with another registered and indemnified healthcare practitioner, your part of the liability is covered.

What's not covered?

However it is just as important to understand what PII does not cover. For Avant, this includes:

  • working without AHPRA registration;
  • claims by an OA member against you;
  • recovery of money or refund of patient fees;
  • disputes between business partners and/or employees;
  • transmission of contagious disease;
  • intellectual property;
  • dishonest, criminal, fraudulent, discriminatory acts, sexual misconduct or intoxication;
  • property damage and,
  • workers compensation.

You may also be the holder of multiple PII policies, such as through your corporate employer and by being an Optometry Victoria member. You may not be in the mood to read through the entire product disclosure statement for each policy, although this would be the best way to get the full picture!

Unfortunately without an Australian Financial Services Licence, simplified comparisons (eg in the form of a table) between different policies is illegal. However it is important to answer questions frequently asked by members.

What is your coverage as a locum?

Avant covers you as a locum regardless of where you practice.

If you have a corporate group/store PII (ie the insurance is purchased by the store you're working at), check with your support office, as locums may be classified as contractors rather than employees, which means you may be uninsured when working outside your normal store location (even within the same corporate).

What steps should you take if a claim is lodged against you?

A common theme of concern amongst optometrists is mismanagement, misdiagnoses or missed pathology. In general, a patient may file a claim against you directly or lodge a complaint through AHPRA.

If you are concerned following a complaint or incident with a patient, notify your PII company immediately, otherwise they may significantly reduce or refuse coverage.

If a claim or complaint is lodged against you, your first port of call should be Optometry Australia's professional services (03) 9668 8560 or AVANT’s 24/7 advice line 1800 128 268.

If you are not an Optometry Victoria member, call the number listed in your PII policy during business hours. They will instruct you on what to do next and you may be asked to fill out an incident form, where you can list additional PII policies that you hold. In many cases how the issue is handled at this stage can affect whether a complaint actually progresses to a claim or regulatory investigation, along with the long term outcome.

It is important not to be fixed on the headline figure of the PII cover (usually $10 million), as certain sub-limits apply for different categories or in the pursuit of legal advice. Also check your level of excess as, like with any insurance, this will differ between companies.

One should also keep in mind that PII does not always serve to protect just you, but also the insurance company, whether financially or its reputation. If legal advice is required, legal professional privilege or confidentiality (ie. attorney-client privilege) between you and the lawyer is waived for the insurance company.

Likewise, if the PII is purchased on your behalf by a corporate entity, you should consider whether a case will be defended or settled in your best interests, or the corporate's and/or employer's best interests.

Finally, as with any insurance policy, the fine print is important so make sure you understand (at least!) the basics. Having limited retroactivity in your contract will not help you if it takes over 5 years for a failure to diagnose a tumour case to mature. Fighting a claim or being under investigation can be an incredibly stressful period so remember your association is there to support you.

[1] Potentially more important in the wake of the first successful prosecution of an optometrist for gross negligent manslaughter in the UK in 2016.

[2] In cases where OA membership is suspended or temporarily ceased, such as during maternity leave or long service leave, the clinician is still covered for this period upon resuming their membership on the condition that they did not practice during this period.

[3] Retroactivity determines how far back an insurer will cover an incident – particularly important with malignancy cases which can take many years to be lodged.

[4] For a period less than 120 days.

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