What are the common exclusions in medical malpractice insurance policies?

Common exclusions in medical malpractice insurance policies are specific scenarios or types of claims that the policy does not cover. While exclusions can vary depending on the insurer and policy, some of the typical exclusions in medical malpractice insurance policies include:

Intentional Acts:

Claims arising from intentional harm, such as assault or fraud, are generally not covered.

Criminal Activities:

Any illegal activities by the insured healthcare professional are typically excluded from coverage.

Claims Outside the Policy Period:

Claims made for incidents that occurred before the policy's retroactive date (in claims-made policies) or after the policy's expiration are not covered.

Non-Medical Activities:

Acts or services that fall outside the scope of the healthcare provider's professional duties may be excluded.

Claims by Family Members:

Claims brought by the healthcare provider's family members may be excluded to prevent potential conflicts of interest.

Claims Made After Reporting Period:

Claims not reported to the insurer within the policy's reporting period may not be covered.

Claims for Punitive Damages:

Some policies do not cover punitive damages, which are intended to punish the healthcare provider for gross negligence or willful misconduct.

Claims Beyond Coverage Limits:

Any claims exceeding the policy's coverage limits may not be fully covered.

Prior Acts:

Some policies do not cover claims related to incidents that occurred before the start of the policy (in claims-made policies) unless "tail coverage" or "prior acts" coverage is purchased.

Claims Resulting from Non-Compliance:

Claims arising from failure to adhere to professional standards, regulations, or guidelines may be excluded.

Claims from Unlicensed Practice:

Services provided while the healthcare provider is not properly licensed or credentialed may be excluded.

Understand the exclusions and consider any optional endorsements or additional coverage options that may be needed to fill potential gaps. Additionally, consulting with an insurance expert can provide clarity on the specifics of a particular policy and how it applies to individual circumstances. We at Insurance Unlimited can help you navigate the options that are best for you.