Medical Malpractice Insurance Coverage

January 5, 2008 1:00 PM

Does medical malpractice insurance typically cover all damages of injured patients? I'd like a citable source on this if at all possible, but searches so far haven't turned up anything worthwhile.
posted by chriswarren to health & fitness (11 comments total)

Medical Malpractice Insurance is a special case of "liability insurance". It doesn't cover damages of injured patients, it covers awards lost in civil suits. (Either due to trial or due to negotiations to avoid trial.)
posted by Steven C. Den Beste at 1:18 PM on January 5, 2008

SCDB, I don't understand the distinction you seem to be trying to make. "Damages" as I understand it is the word used to refer to the negative consequences of committed malpractice, and this can be wrongful death, bodily injury or harm, lost wages from disability temporary or permanent, other money lost ("pecuniary damages"), and pain and suffering. Damages have to be proven in order to establish a judgment of malpractice. Liability insurance only pays out money - it doesn't restore the patient's lost eye, of course, nor resurrect the dead. But as I understand it the amount of money is usually related to the damages. Is that your point?

The original poster's question isn't clear. Are you asking about what the insurance covers if the case goes to court and the doctor is found to be wholly at fault?
posted by ikkyu2 at 4:14 PM on January 5, 2008

Maybe I am asking a question that doesn't have a good answer. I am writing a brief arguing that a ship owner should be not be held vicariously liable for the negligence of their on-board doctors (which is what the vast majority of court's hold). I want to be able to say that the doctor is the appropriate person to sue and that such suit will be sufficient for most plaintiffs. I want to be able to say that the vast majority of doctors carry medical malpractice insurance that will cover the damages given at trial, but I understand that insurance has limits. So, I was wondering if the limits of medical malpractice insurance typically cover the liability damages.
posted by chriswarren at 4:34 PM on January 5, 2008

Metamailed an answer on this, and explained why.
posted by dilettante at 5:04 PM on January 5, 2008

"Damages" are whatever a court awards, or whatever negotiators agree to. Maybe it covers the full losses of the patient, maybe it doesn't. There's no guarantee.

It isn't insurance for the patient, it's insurance for the doctor. It protects the doctor against expenses of malpractice suits. It doesn't specifically protect patients who are victims of malpractice. (For instance, if they don't sue, they get nothing. If they do sue and lose, they get nothing.)

The OP's question implied that malpractice insurance was a sort of backup health insurance. That's not the case.
posted by Steven C. Den Beste at 5:19 PM on January 5, 2008

So, I was wondering if the limits of medical malpractice insurance typically cover the liability damages.

It depends entirely on how that particular doctor's policy was written. And like car insurance, and all other liability insurance, there's a predetermined payout ceiling, a maximum amount that the policy will pay. Any liability damages in excess of that come out of the doctor's pocket -- or don't get paid at all, if the doctor files for bankrupcy.

It isn't insurance intended to compensate malpractice victims. It is insurance intended to protect doctors from going bankrupt in case they lose malpractice cases. Trying to talk about what it will and will not do for victims is to miss the point: it does what the court tells it to do, no more and no less. (Up to the liability limit.)

If the court awards damages which are less than the total patient losses, then that's all the patient gets. The contractual requirement for the insurance company is to prevent the doctor from having to pay, not to do good to/for the patient.

It isn't health insurance, it is liability insurance. It doesn't automatically cover anything for the patient.
posted by Steven C. Den Beste at 5:28 PM on January 5, 2008

"I want to be able to say that the vast majority of doctors carry medical malpractice insurance that will cover the damages given at trial, but I understand that insurance has limits. So, I was wondering if the limits of medical malpractice insurance typically cover the liability damages."

This is much less true than it used to be, and the real issue you'll face is that the doctors often choose to reduce the amounts of their coverage to:

a. lower their premiums, and
b. reduce their attractiveness as lawsuit targets.

This is especially true in Florida, where many cruises are based from and also where many of these cruise-ship lawsuits take place.

So, the answer to your question is not so much the TYPE of damages that would be covered (which generally does include pain & suffering, etc.) but the coverage limits - in other words, the total amount.

As I understand it, $250,000 is currently a popular coverage choice due to factors a. and b. above.

Frankly, I think that the point you're trying to make about the doctors' insurance covering malpractice-related damages on cruise ships is probably not going to work for your argument. You might find it a stronger argument to say that it is more economically efficient for passengers to buy their own insurance against such injuries taking place during the cruise. At least, the passengers would be able to decide for themselves what level of coverage is appropriate, etc.
posted by mikewas at 5:34 PM on January 5, 2008

Also note that the coverage limit (e.g. $250,000) is per policy. In other words, it's per doctor, not per patient. If 50 patients sue and win, then the first one or two get the money and the rest get jack.
posted by Steven C. Den Beste at 9:29 PM on January 5, 2008

What you need to do is read what the contract says for medical malpractice insurance, which you can find by googling "medical malpractice" insurance policy wording. Drafting a policy contract that spells out exactly what you intend to cover but that won't be interpreted in a courtroom to cover far more than you intended is a very specialist skill. Because of this, the insurance industry has developed a lot of standardized wordings, which most underwriters use with small variations. If you read a handful of malpractice policy documents, you should come away with a fair idea of what most policies cover.
posted by happyturtle at 8:21 AM on January 6, 2008

Steven was right, as usual, up to his last contribution. Policies covering medical malpractice liability are typically issued with a per-claim and aggregate limit. Some of them are Combined Single Limit policies (which is what he was describing) but very often the aggregate is some multiple of the per-claim limit (usually 3x), so that a policy might have a limit of $500,000 per claim, and an aggregate limit of $1.5 million per year.

The other thing that the OP may need to know is that there are two kinds of damages claims that med mal insurance often does not cover - punitive damages and damages arising from intentional acts. A claim arising from improper sexual contact, for example, will usually not be covered.
posted by yclipse at 9:43 AM on January 6, 2008

There are a lot of nuances that none of the posters here have considered. A lot - perhaps all - depends on what sort of relationship the physician maintains with the cruise line and how he is paid for his services. Still more depends on jurisdiction. A sample malpractice insurance policy can be downloaded off the internet pretty easily, but it's not going to suffice to answer the O.P.'s question because of these issues.
posted by ikkyu2 at 8:53 PM on January 6, 2008