The Psychiatrists' Program

Frequently Asked Questions (FAQs)

Insurance Coverage FAQs

· What is the difference between claims-made and occurrence coverage?
· Is there insurance available for disciplinary procedures?
· Are there any premium discounts offered for first year in practice?
· Under a group policy, can I be held liable for the actions of my partners?
· Does The Program offer insurance to cover liability exposures on my premises?

Claims and Risk Management FAQs

How is defense counsel assigned if I am involved in a lawsuit?
What happens if I receive a subpoena duces tecum for a patient's records?
What are some of the leading causes of claims against psychiatrists?
Should I charge patients if they request patient records?

Do you have a question? Submit it to: Frequently Asked Questions or call (800) 245-3333, ext. 389

Q: For the first time, I need to purchase liability coverage and have a question regarding claims-made and occurrence coverage's. My practice is located in California and it is my understanding that the APA-endorsed Professional Liability Insurance Program offers both coverages. Can you explain the differences between these coverages?

A: Yes. The APA-endorsed Professional Liability Insurance Program (The Program) offers both claims-made and occurrence coverage (coverage may vary per state).

In an occurrence policy, a psychiatrist is covered for all care rendered in the policy year, regardless of when the alleged negligence is discovered. Under a claims-made policy, a practitioner is covered only for those claims that are filed in the policy year. In addition, the claim is only covered if the physician had the same policy in force in the year the care was given. When leaving a claims-made policy, it is recommended to purchase extended reporting endorsement (tail coverage).

The Program’s claims-made and occurrence coverage's both provide important benefits and are both designed for psychiatrists by psychiatrists. A few of the many benefits include:

· consent to settle provision
· nationwide network of experienced defense attorneys
· peer and utilization review and quality assurance coverage
· toll-free access to risk management consultation service
· portable coverage (if you move, your coverage moves with you)
· administrative defense coverage
· coverage for forensic work
· supervision

For more information or further assistance, please call 1-800-245-3333, ext. 389.

Q: I am interested in obtaining insurance for disciplinary procedures. Does The Program offer this type of coverage?

A: Malpractice suits aren’t the only reasons why you need good insurance coverage. Administrative actions brought forth by state license boards, managed care organizations, hospitals or healthcare organizations, can financially impact your psychiatric practice. In addition, investigations by federal and state government agencies may also incur high and unexpected costs.

Once these actions have been brought forth, it may be too late to discover that your defense costs are not adequately covered by your current medical malpractice policy. Do you know if you’re ready for such events?

The Psychiatrists’ Program recognizes the severity of these actions by providing enhanced coverage for these needs. The Program’s policy provides both administrative and governmental billing defense coverage with limits of $50,000/$100,000 at no additional premium cost.

Coverage includes legal expenses associated with preparing a legal defense for both administrative and governmental billing and coding error actions. Furthermore, if an action is brought forth, participants have access to a team of experienced defense attorneys who understand the intricacies of mental health practice.

Q: I am in my last year of residency and will soon need to purchase professional liability insurance. I currently have moonlighting coverage with The Psychiatrists' Program and receive a 50% premium discount. Are there any premium discounts offered for first year in practice?

A: Yes. The Program has expanded discounts for early career psychiatrists to better respond to your needs as follows:

- First year of practice: 60% discount immediately following completion of residency, fellowship or active discharge from military (50% discount on claims-made policies only; 50% discount in New York; discount remains 60% with claims-made policies in California, Florida and Washington state)
- Second year of practice: 40% discount (25% discount on claims-made policies only; in New York, discount only available with claims made; discount remains 40% with claims-made policies in California, Florida and Washington state)
- Third year of practice: 35% discount (25% discount on claims-made policies only; in New York, discount only available with claims made; discount remains 35% with claims-made policies in California, Florida and Washington state)

In addition to the early career premium discount, if you are a child and adolescent psychiatrist and meet specific criteria, you are eligible for a 15% rate reduction. Additionally The Program offers the same discounts to psychiatrists following discharge from active military duty.

Q: I am one of four partners in a psychiatric clinic. This past year our administrator has been urging us to convert our individual insurance policies to a group policy in an effort to decrease administrative duties and create a more economical practice. I am a little skeptical of a "group policy". I have always felt that I was only responsible for my own actions with my individual policy. Under a group policy, can I be held liable for the actions of my partners? And would it really be less expensive?

A: A group policy will indeed make administrative duties within your practice easier. The benefits of a group policy include: one renewal (annual) and one source from which to obtain claims histories. It is then cost effective because it allows your administrator to devote his time to other responsibilities.

The increased exposure to claims arising out of your partners’ actions have more to do with affiliation with them than the type of coverage you possess. Thus, coverage under a group policy does not increase your exposure to claims arising from actions of your partners. The group policy provides $1 million/$3 million limits for the corporate entity.

Each group policy is different, but on average, premiums for a group are less expensive than four individual policies due to the purchase power of groups and the additional premium discounts. For more information, please call 1-800-245-3333, ext. 304, or contact Groups@prms.com.

Q: I am opening a private practice where I will have my own office. My insurance agent informed me that I need insurance to cover liability exposures on my premises. Does The Psychiatrists' Program offer this type of coverage?

A: The Program provides premises liability coverage at no charge as part of your professional liability insurance coverage.* The limits of liability are equal to the liability limits of your malpractice coverage. Premises liability insurance is an important coverage to protect your practice.

*may vary by state

Q: I am currently a participant in The Psychiatrists' Program. If I am involved in a lawsuit, how is defense counsel assigned?

A: The Program has established a national network of experienced medical malpractice defense attorneys who have an outstanding record of success. They are assigned to assist participants through the litigation process in their given jurisdiction. In the event of an incident, participants should immediately contact the Claims and Risk Management departments of PRMS, The Program’s manager. Claims staff, highly qualified in behavioral healthcare malpractice issues, will discuss the incident with the insured and determine whether counsel is necessary at that time. If counsel is needed, PRMS will contact the defense attorney and make an assignment. In turn, defense counsel will contact the insured within a 24-hour period. PRMS claims staff monitors the entire litigation process to ensure that any participant that is faced with this trying time, receives a quality defense and the necessary emotional support. To report a claim, please call 1-800-245-3333.

Q: When a psychiatrist receives a subpoena duces tecum for a patient’s records that is signed by a Clerk of the Court, should the records be released?

A: No. This subpoena is in reality an attorney’s subpoena and the records should not be released without the written authorization of the patient to do so. If the patient refuses to consent, the psychiatrist should write to the requesting attorney and advise that without written authorization of the patient, the records cannot be released.

CAVEAT: Each situation is unique. If you are a Psychiatrists' Program Participant, you can call our Risk Management Consultation Service (RMCS) if you are unsure of an appropriate response to a subpoena for records.

Q: I have read several articles over the last few months relating to a significant increase in malpractice claims against psychiatrists. What are some of the leading causes for these claims?

A: There are several reasons for the increase in malpractice claims, including the litigious climate and publicity surrounding allegedly questionable practices by some behavioral healthcare practitioners. Two of the leading causes in psychiatric medical malpractice in The Program claims database are the classifications of incorrect treatment and incorrect diagnosis. Incorrect treatment would include, for example, failure to appropriately treat major depression, bi-polar disorder or alcohol and substance abuse. The classification of incorrect diagnosis, includes for example, a failure to diagnose an underlying tumor or steroid-induced psychosis.

Q: When I receive a request for medical records from my patients, I have my office staff copy them free of charge. I have heard some of my colleague’s say they charge their patients for copying records. Do you recommend charging patients?

A: Access to mental health records is controlled by state law. Before any record is released, you should be familiar with the state statues governing your situation. Many states require that patients have a right to view the information contained in a psychiatric records while other states prohibit such access. Assuming the law in your state allows patient access, each record belongs to the practitioner. When or if you receive a valid, written request for this information from your patient, you may provide the copies.

Depending upon the volume of records, providing a copy of medical records free of charge to your patient is a good business practice and considered a professional courtesy for the first request. For multiple requests, or for a large volume of information, charging your patients copying fees and costs for administrative time is acceptable if your state law permits you to do so. Many states have statues that set a maximum allowable per-page charge. Obtaining a copy of any such statue for use by you or your staff to justify the charges may help avoid angering a patient.

If you are going to charge, it makes sense to obtain payment up front, if you can give an accurate page count in your reply to the request. Most directors of medical records in hospitals are knowledgeable regarding these laws and are willing to provide the information to you upon request. You may also obtain this information from your District Branch and/or your attorney.

The Psychiatrists' Program’s Risk Management Consultation Service is a benefit to its participants at no additional cost. Staffed by nurse attorneys that will provide answers to questions such as this one and others relating to documentation, the provider/patient relationship, and the relationship among and between providers.