Consumer Protection Act and Medical Profession - Protection against Outcome of Litigation

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Protection against Outcome of Litigation

A tertiary level of protection against outcome of litigation would be to go for Insurance cover. PROFESSIONAL INDEMNITY INSURANCE cover became available for Doctors and Medical establishments only recently, i.e. from December, 1991.

The term " indemnity " means reimbursement, to compensate.The principle of indemnity is strictly observed in liability insurances. These insurances ( e.g., Professional Indemnity Insurance ) are designed to provide the insured person protection against the financial consequences of legal liability.If the insured is legally liable to pay damages to others, the policy will indemnify him subject to the terms, conditions and limitations of the contract. Indemnity is also available in respect of legal costs awarded against the insured as well as legal costs and expenses incurred by the insured with the written consent of the insurers in the defence of settlement of claims.

Professional Indemnity Insurance

Salient features and terms and conditions of Professional Indemnity Insurance Policy as provided by the General Insurance Corporation of India are given hereunder :-

General Rules and Regulations:

1. Applicability - The policy provides insurance cover in respect of ERRORS and OMISSIONS on the part of the professionals whilst rendering their services. This applies to Doctors and Medical Establishments, Engineers, Financial Consultants, Management Consultants, Lawyers, Advocates, Solicitors and Counsels. The agreeable limits within India and including Nepal / Bhutan, for any one year/during the policy period, shall not exceed Rs. 2 crores.

2. Standard Proposal Form - Insurers shall obtain duly completed Standard Proposal Form from the prosecutors at inception and subsequent renewals. No cover shall be granted unless a declaration as provided for in the proposal form is obtained from the proposer to the effect that all statutory requirements relating to the business activities are complied with.

3. Standard Policy Form - All policies fresh and renewals issued shall be in the Standard Policy Form prescribed by the insurance company / corporation.

4. Liabilities covered - Policies issued under this scheme shall cover all sums which the Insured becomes legally liable to pay as damages to third party in respect of ERRORS and/or OMISSIONS on the part of the Insured whilst rendering professional services, arising out of claims first made in writing against the insured during the policy period, including legal costs and expenses incurred with the prior consent of insurer, subject always to the limits of indemnity and other terms, conditions and exceptions of the policy. It shall notbe permissible to issue any Professional Indemnity Insurance Policy with unlimited liability.

5. Premium - The rates of premium under the Agreement are annual rates. Full premium under the policy shall be paid at inception. It is not permissble to accept premium in installments.Turnover figure whenever required shall be as far as possible accurately assessed and declared by the proposer at inception of the policy. In case the insured anticipates any increase /decrease in turnover during the policy period such fluctuations should be immediately notified to the Insurer and necessary adjustments made. Under no circumstances it shall be permissible to adjust the premium for the turnover after expiry of the policy.

6. Retroactive Date - Retroactive Date is the date when the risk is first incepted under a claims made policy and thereafter renewed without break in the period of cover.

7. Revision in Limits of Indemnity - No revisions ( increase / decrease ) shall be allowed in the limits of Indemnity during the currency of the policy.For any upward revision in indemnity limits at renewals, the retroactive date shall be the inception date of the Policy renewal, so far as the increased limits are applicable.

8. Compulsory Excess - All policies issued under the Agreement shall be subject to compulsory excess of certain fixed percentage of the limit of indemnity per any one accident or any one year subject to a minimum of Rs. 1,000 and maximum of Rs. 1,00,000 ( Rupees One Lakh Only) . The Insured shall bear this Compulsory Excess which is applicable to both property damage claims and death /bodily injury claims inclusive of defence costs arising out of any one accident. This excess is not applicable for Doctors and Medical Practitioners.

9. Voluntary Excess - The following discounts on the premium may be allowed for Voluntary Excess opted by the Insured except for policy for Doctors and Medical Practitioners. But these are applicable in case of insurance policies obtained by Hospitals and Medical Establishments.

Voluntary Excess (percentage) of
limit of Indemnity per any one Accident Discount (%)

1 2.5

2 5.0

4 7.5

6 10.0

8 12.5

10 15.0

10. Short Period Premium - It shall not be permissible to issue Policies for periods more than 12 months. The following short period scale of premium shall apply to (i) policies issued for periods less than 12 months and (ii) policies cancelled during the currency at the request of the insured subject to no claims :

Period Rate

Not exceeding one month 1/4th of the annual premium

Not exceeding two months 3/8th of the annual premium

Not exceeding three months 1/2th of the annual premium

Not exceeding four months 5/8th of the annual premium

Not exceeding six months 3/4th of the annual premium

Exceeding six months Full annual premium

For annual policies cancelled during the currency at the request of the insured,premium should be adjusted at the Short Period Scales for the actual period of cover subject to no claims.No refund is permissible in case of any claim under the policy.

The short period premium is subject to the minimum premium in the Rating Schedule.

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Kapil999 

I was appointed to run a clinic from a hospital facility. The management one day suddenly closed the premises, with all my belongings trapped inside, without giving me any notice. The treatment of many patients was under way and they feel lost. I have complained to police for cognizable offences and also written to the state medical bodies highlighting the manner in which the premises was shut down in my absence. Are any clauses of medical act violated in this sudden and unannounced closure of a medical facility? Dr K G

Rajeev2009 

I have booked two tickets under PNR no. 4408538575, for travelling from bangalore to delhi by 12213 duranto express on 27-06-2015. But on 23-06-2015 i have received a message regarding cancellation of train, then i called railway enquiry no. 139 in this regard and they told that train cancellation can only be confirmed on 27-06-2015 morning and also advised that i have not to cancel the ticket now but after departure time of the train i have to file the TDR online through irctc website. But when i open the site next day the ticket cancellation option said that it is too late too be cancelled and TDR option said that TDR can only be filled after charting and departure. So I could not cancel my tickets and contact the irctc helpline 011- 39340000 and they told to send an email in this regard on [email protected] and they issue me a Ticket No. 1686501, But they also refused the return on 12/07/2015 by saying that I have filled the TDR very late on 03/07/2015, which had to be filled within 72 hours of train departure time. As I have said earlier wihen I make cancellation of ticket irctc website refuse it and when I file TDR irctc site told that TDR can only be file after charting done and departure of train, no other method is describe there. The method of sending email is only come to know by me when I contacted irctc helpline. This is duty of Railway and Irctc to let the passenger know about the refund procedure in case of cancellation of train. So I want back all my money which is Rs.5636.17/- as train is cancelled by railway itself.

abhi0786 

I need suggestion regarding the doctors bill. Doctor is giving me bill for 17000 for 3 day for my wife's treatment. She was not admitted to the clinic, just for three days doctor given her 2 bottle of saline everyday. Doctor is having clinic not the hospital. Can you suggest what can i do?

chit123 

I want to complain against shiv medicos in H block ashok vihar for not giving proper bills for medicines purchased and also not verifying or asking for any prescription and seselling medicines without prescriptions...

nagercoil123 

This letter is with reference to the wrong or unwanted medical procedure and hiding the truth regarding my health. Dr. S.Selvamani, Senior Consultant and Interventional cardiologist [ Reg. No: 36009] done procedures like TPI CAG Successful PTCA with BVS (Bio Resorbable Vascular Scaffold) to RCA done on 18-19-2013. I was discharged on 28/09/2013 with the discharge summary as General Condition is GOOD and I thought that I had a single vessel block and that it was cleared by PTCA method and I can continue a normal life. After Discharge,( since the hospital is around 250 Km away from my home town ) I went to another cardiologist in my home town , He took ECHO and stated the extra points like Dialated LA/LV , Grade 3 Diastolic Dysfunction , Moderate PAH , Sclerotic aortic value and minimal effusion behind inferolateral wall , moderate to severe MR, posteriorly directed wall hugging jet ( MR dp/dt 982) and the Global EF is 33 % although Meenakshi Mission Hospital and Research Centre, Madurai took ECHO they didn't reveled the above points in their discharge sheet and the cardiologist Dr.S.Selvamani ,didn't prescribed the medicines which will improve the EF % . Now I am taking T.Planeb, T.Cardarone and T. Cardace to improve the condition of the heart prescribed by an another cardiologist to improve the pumping capacity of the heart, which was failed by Dr. S. Selvamani. So I suspect that Dr. S. Selvamani didn't diagnosed or gave importance to the pumping capacity of my heart and he did wrong or unwanted procedure like PTCA and temporary pace maker installation. Dr. S. Selvamani, procedures makes me to spend around Rs.4,50,000 ( Rupees Four lacs and fifty Thousand ) at Meenakshi Mission Hospital and Research Centre, Madurai and now I am spending more money on review and other lab and ECHO procedures to improve the EF% of my heart. I strongly believe that I have been treated wrong / unwanted procedures at Meenakshi Mission Hospital and Research Centre, Madurai by Dr. S.Selvamani. I am ready to submit any medical documents and willing to go any more procedures to prove that I had been treated at Meenakshi Mission Hospital and Research Centre, Madurai in unwanted or neglected medical procedures.

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