The EP should consider an insurance company’s guiding philosophy. That philosophy is reflected in the company’s underwriting, claims management, and loss prevention or risk management. Those activities affect the company’s pricing policies as well as the service it provides to its insureds.

Well-managed insurers are staffed by experienced underwriters who have a thorough knowledge of the insureds' particular type of medical practice. Also, a risk management and claims prevention program should be an integral part of the coverage provided by a medical liability insurer. Risk management information may be supplied in newsletters and educational forums on specific topics or specialties. The risk management program should also provide a regular claims review that examines current claims trends to provide current information on loss prevention.

The quality of claims management is critical. Claims should be reviewed promptly by skilled claims investigators. Policyholders should be vigorously defended against non-meritorious claims. In cases where negligence is apparent, the company should attempt to settle quickly and fairly. The company should provide the policyholders with an explanation of how to proceed in the event of a claim, or a threat of claim and provide support and guidance to physician’s who experience a claim.

The EP should also be aware of the “trigger” an insurance company uses to determine when a claim has been made. Some companies recognize a claim only after a demand letter is received from a patient or an attorney, or a “Summons and Complaint”. That definition pushes claims into the future, making it difficult for physicians leaving such companies to obtain retroactive (prior acts) coverage from their new insurance carriers. In those cases, physicians may have to purchase costly tail coverage from their former carriers.

The more desirable definition is a broad one that considers that a claim is made when an insured alerts the carrier in writing that a potentially compensable adverse incident has occurred. Under that definition, even though a claim arising from an incident may not be made for several years, even after the policy is no longer in effect, the claim is already considered to have been reported, and therefore it is covered.

Making a well-informed choice of a professional liability insurance carrier is vital for emergency physicians and emergency practice groups. The choice should be made on the basis of the factors reviewed in this section. Additional considerations include the availability of lower premiums based on deductibles, discounts, and other features tailored to individuals or the group structure. By thoroughly investigating all alternatives, prospective policyholders can make a prudent choice in selecting a professional liability insurance carrier.