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Consumer Protection Act and Medical Profession

Doctors and Medical Practitioners (Guidelines)

The policy will indemnify any act committed by the insured, who shall be a Registered Medical Practitioner, giving rise to any legal liability to Third Parties. The Insured includes the policy holder and his qualified assistants or employees named in the proposal.

The act has to be committed during the period of insurance commencing from the retroactive date.
In the normal course all claims for compensation have to be legally established in a court of law. However, insurers may arrive at compromised settlement if prima-facie liability exists under the policy.
Jurisdiction applicable will be Indian Courts.

The limit of indemnity granted under the policy for any one accident or any one year (per accident per policy year ) will be identical.

No short period policies are permitted. However, in case of cancellation of the policy by the Insured short period scale rates as provided for will be applicable.

Registered Medical Practitioners shall be classified as :-

(1) Physicians (2) Pathologists (3) Oncologists (4) Cardiologists (5) Psychiatrists (6) Radiologists or Roentgenologists (7) General Surgeons (8) Plastic Surgeons (8) Orthopaedic Surgeons (10) Urologists (11) Abdominal Surgeons (12) Thoracic Surgeons (13) Neuro-Surgeons (14) Cardio-Vascular Surgeons (15) Otorhinolaryngologists (16) Protologists (17) Ophthalmologic Surgeon (18) Ophthalmologic Physician (19) Obstetrician & Gynaecologist (Excluding Surgery) (20) Physician & non-specialist (21) Other Practitioner-describe Surgeon. fully.

Insurance Rating for Doctors and Medical Practitioners
[To be charged on Any One Year (AOY) limit]

1. (a) Physicians without dispensing and other facilities General Pathologist/Radiologist

(b) General Physicians with facilities like dispensing /pathological/ radiological etc

Rs. 0.5 per 1000 on AOY limit.

7.5% additional premium for each facility subject to maximum of 20%.

2. (a) Specialists/Consulting Physician (Non-surgical)

(b) For other facilities (Specify) such as E.C.G.,X-ray,Scanning, Sonography etc.

Rs. 1.0 per 1000 on AOY limit

7.5% extra for each facility subject to facility subject to maximum of 20%.

3. (a) Surgeons excluding specialists in Plastic Surgery,Lithotripsy Dentists & similar extra corporeal methods of treatment would fall within this category.

(b) For other facilities (specify) such as E.C.G.,X-Ray,Scanning,Sonography etc.

Rs. 2.0 per 1000 on AOY limit

7.5% extra for each facility subject to a maximum of 20%.

4. (a) Diagnostic Centres

(b) For other facilities (specify) such as E.C.G.,X-Ray,Scanning,Sonography etc

Rs. 1.0 per 1000 on AOY limit.

7.5% extra for each facility subject to a maximum of 20%.

5. (a) Surgeons (Plastic Surgery) Anesthetics.

(b) For other facilities (specify) such as E.C.G.,X-Ray,Scanning,Sonography etc.

Rs. 3 per 1000 on AOY limit

7.5% extra for each facility subject to a maximum of 20%.

Minimum Premium Rs. 100. - No Compulsory or Voluntary Deductibles are applicable.

Insurance Rating for Medical Establishments -

Rs. 3 per 1000 on AOY limits plus
Rs. 5 per each in patient plus
Rs. 1 per out-patient.
(Number of patients to be as per previous yearís record or the anticipated number of patients during the year whichever is higher.)

Radioactive treatment Additional premium of 1 (other than X-ray) on total premium.

The indemnity in respect of any one person would be limited to 25% of the Any One Year (AOY) limit under the policy.

Minimum Premium under one policy : Rs. 1000.

Compulsory Excess and Voluntary Excess are applicable.

Exclusions:

1. No liability shall attach to the Company in respect of -

i. Any criminal act or any act committed in violation of any law or ordinance :
ii. Services rendered while under the influence of intoxicants or narcotics ;
iii. The performance by dentists and dental surgeons of :(1) general anaesthesia; or (2) any procedure carried out under general anaesthesia unless performed in a Hospital :
iv. The use of drugs for weight reduction ;
v. Cosmetic surgery ;
vi. Third party public liability ;
vii. Claims arising from any condition directly or indirectly caused by or associated with Human T-Cell Lymphotropic Virus Type III (HTLV III) or Lymphadenopathy Associated Virus (LAV) of the mutants derivaties or variations thereof or in any way related to Acquired Immune Deficiency Syndrome (AIDS) or any Syndrome or condition of a similiar kind howsoever it may be named.

2. The Policy does not cover liability -

1. assumed by the Insured by agreement and which would not have attached in the absence of such agreement ;


2. arising out of deliberate, wilful or intentional non-compliance of any Statutory provision ;


3. arising out of loss of pure financial nature such as loss of goodwill, loss of market, etc ;


4. arising out of all personal injuries such as libel, slander,false arrest, wrongful eviction, wrongful detention.,defamation, etc. and mental injury, anguish or shock;


5. arising out of fines,penalties, punitive or exemplary damages ;


6. directly or indirectly occasioned by happening through or in consequence of war, invasion, act of foreign enemy, hostilities (whether war be declared or not),civil war, rebellion, revolution, insurrection or military or usurped power ;


7. directly or indirectly caused by or contributed by :-

i. ionising radiations or contamination by radioactivity from any nuclear fuel or from any nuclear waste from the combustion of nuclear fuel;
ii. the radioactive, toxic , explosive or other hazardous properties of any explosive nuclear assembly or nuclear component thereof;

8. arising out of genetic injuries caused by X-ray treatment/diagnosis or treatment /diagnosis with radioactive substances, in respect of professional services rendered by the Insured prior to the Retroactive Date in the Schedule.

9. the deliberate conscious or intentional disregard of the insuredís technical or administrative management of the need to take all reasonable steps to prevent claims ;

10. injury / death to any person under a contract of employment or apprenticeship with the Insured when such injury / death arises out of the execution of such contract.

It may be noted that the amount paid as premium for obtaining a Professional Indemnity Insurance Policy qualifies as deductible expense under Sec. 36 of the Income Tax Act.


The doctors /hospitals may contact the Insurance Companies or their Agents for obtaining more information on the subject.

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