3 Benefits of Healthcare Tweet Chats

Healthcare Tweet Chats - Symplur
Do you have a diagnostic or treatment question and wish there were a place you could visit to find answers outside of your practice? Do you ever wonder what your diagnosis and treatment is like from your typical patient’s perspective?   How about reaching into the minds of other healthcare leaders on communication, patient safety, insurance issues? Imagine if you had a place where you could visit regularly that could help provide answers to all of these questions.

Welcome to Healthcare Tweet Chats

So what are Healthcare Tweet Chats?  According to our friends at Symplur:

A tweet chat affords Twitter users the opportunity to engage in conversation with each other. A tweet chat can either emerge from a new community that coalesces around a particular subject or keyword, or serve to focus the conversation of an existing community.

At Perron Insurance Services, we have been participating in the weekly #hcldr tweet chat for about a year now.  We find ourselves increasingly involved in reaching out to others, like yourself, to spread the word about the #hcldr community and other healthcare tweet chats. So, why do we believe in this medium and, how can it benefit you?

Benefits of Healthcare Tweet Chats

    1. Education – Participants gather with common interests and, since participants may be from different interest groups, such as patients, consultants, and other healthcare professionals, there are a variety of opinions, sharing and learning from one another.Healthcare Tweet Chats can be specific to a medical specialty, diseases and conditions, leadership and many others. I am especially excited when I participate in a tweet chat that provides valuable information that I can bring back to my clients.Here are some examples of some current weekly scheduled tweet chats:


      • #bioethx    bioethics, healthcare, medical ethics, medical humanities, nursing ethic
      • #AlzChat   Alzheimer’s Disease, alzheimer, caregiving, dementia
      • #bccww     Breast Cancer
      • #solvePT   Physical Therapist Issues. physical therapy
      • #MedEx     doctor, Medical Education physician
      • #CPHC      crowdsourcing, empowerment, healthcare information, transparency


    1. No Geographic Location Boundaries – Communicate with participants in your field, who could be in the same state as you or found internationally.  The #hcldr tweet chat has participants in the United States, Canada, Philippines, and Australia.


  1. Participate in International Healthcare Conferences – Without being there!  Our veteran #hcldr participant, Bernadette Keefe, MD @nxtstop1 was not physically present at the Doctors 2.0 (#doctors20)conference held in Paris earlier this year, but she was able to take in information and tweet it out to her followers. Why is this a benefit of healthcare tweet chats? Well, without #hcldr, we wouldn’t have gotten to know Doctor Keefe who willingly shared this information.

Need more convincing? Here are some comments from our #hcldr community when we asked them why they participate in healthcare tweet chats.

Resources for Healthcare Tweet Chats

Take a look at Symplur’s web page on Healthcare Tweet Chats. Within it you will see a schedule of healthcare tweet chats, including related hashtags.

When you select a tweet chat from the list, you will be able to see details of the chat, including the description, top influencers, transcripts and analytics. Check out our #hcldr tweet chat page. This is serious stuff here! Go ahead. Try it.

Find a tweet chat that interests you and search Twitter for that hashtag and participate. Or, check out our favorite tool for tweet chats, which is tweetchat.com. Just go there at your scheduled time, sign in, enter the healthcare tweet chat hashtag and voila. See the stream of chats. If you are nervous in the beginning, feel free to observe, and check it out. We won’t tell.

Most chats have a dedicated topic of the session and some, like #hcldr, maintain a blog where participants to visit, read about the topic of the session, and see the questions we will be discussing.

We also recommend Symplur’s Healthcare Hashtag Project, which tracks hashtags for healthcare tweet chats, conferences and diseases.We’d love to hear from you. Share your comments below. If you like what you see, please consider sharing this post by clicking the share buttons above. Thank you.

Risks and Rewards in a Risk Retention Group

Let’s just admit it, insurance is not fun. We know it’s especially difficult if you are a physician struggling to make ends meet in your practice. You may be faced with an unaffordable renewal premium or even a non-renewal notice from your current carrier. You may be wondering what your options are and hope that your insurance broker is honest in laying out all the facts.

Our experience over the years has taught us a lot about Risk Retention Groups and our goal is to share this information with you. This is why we created our 22 page ebook entitled, Risks and Rewards in a Risk Retention Group.

Risk Retention Groups

Here is a sample of what you’ll discover:

  • Advantages and Disadvantages
  • Evaluation Tools
  • What You Need to Know to Make an Informed Decision

You can get my new ebook free just by registering for my email list. This way you don’t have to visit my blog to stay up-to-date. Instead, you can get updates via email.  Whenever I post fresh content, I will send you an email message. It’s that simple.

Just click to the right, enter your email address and first name, and I will immediately send you the link to download your ebook Risks and Rewards in a Risk Retention Group.  Be assured, you can unsubscribe at any time.  Privacy Guarantee: I will never share your e-mail address with anyone else.

Question: What are your concerns as you face your medical malpractice insurance renewal? You can leave a comment by clicking here.

Policy Conditions – Knowing These Will Keep You Covered

Policy Conditions


Importance of Knowing Your Policy Conditions

Did you know that your medical malpractice insurance coverage contains policy conditions that must be met in order to keep the policy in compliance?  Not knowing and not following through on these conditions can be detrimental to your coverage, including cancellation.   We are telling you this because it happened to one of our clients, even though we strongly recommended he read the medical malpractice insurance coverage, including its policy conditions.

We do not want to see this happen to you.  Let’s take a close look at the Conditions Clause from one of our medical malpractice insurance policies:

Policy Conditions – Obligation to Report Material Changes

The FIRST NAMED INSURED shall notify the COMPANY of any changes that might affect the terms of this insurance, including but not limited to any of the following:

1. a change in the location of the practice of any INSURED.

2. if any INSURED or LOCUM TENENS is denied medical staff privileges or has had such privileges restricted, revoked, suspended or reduced by a licensed health care facility.

3. if any INSURED or LOCUM TENENS voluntarily restricts, revokes, suspends or reduces medical staff privileges by a licensed health care facility.

4. if any medical licensing or other governmental agency investigates, restricts, revokes, suspends, places on probation, reduces or otherwise takes any other action with regard to the medical license or DEA authorization of any INSURED or LOCUM TENENS.

5. if any INSURED or LOCUM TENENS voluntarily restricts, revokes, suspends, reduces or otherwise takes any other action with regard to his or her medical license or DEA authorization.

6. if any criminal proceedings are instituted against an INSURED or LOCUM TENENS that are based upon, attributable to or directly or indirectly related to his or her status or conduct as a health care provider.

7. if any INSURED or LOCUM TENENS is ordered or instructed to enter or voluntarily enters a diversionary or rehabilitation program for alcohol, drugs or other substance abuse. Notice must also be provided upon the individual’s departure from such program.

8. if any INSURED intends or seeks to practice in an additional (1) location, (2) health care facility, or (3) area of medicine not designated in the PROFESSIONAL SERVICES endorsement attached to this policy.

9. a change in partners, officers, members or any changes in the structure of operations, ownership or control.


Policy Conditions Not Met – Real Example

One month ago, we received a Cancellation letter on behalf of our client. The insurance company chose to cancel the policy because the insured had not given notice of one of the items that was listed and required to report.  Further, the Cancellation provided only 15 days in which to find replacement coverage.  Here is the Cancellation Clause taken from this same policy:

Policy Conditions – Cancellation Clause

The COMPANY may cancel this policy more than sixty (60) days after its effective date by mailing or delivering such notice to the FIRST NAMED INSURED at least fifteen (15) days before the effective date of cancellation, provided such cancellation is based upon the following reason:

* An act or omission by any INSURED that substantially increases the hazards insured against, including but not limited to one or more of the material changes identified in Article IX.H.2.-7 (Referring to Obligation to Report Material Changes).

Subsequently, we needed to find replacement coverage in a hurry. In addition to losing the policy, the insured also lost time that he invested in earning a free tail upon his retirement.  Now, he will now have to start investing time with his new carrier, which will make him eligible for a free Extended Reporting Period, also known as Tail Coverage, in another five years (v.s. three with the prior carrier).

In conclusion, we recommend you read your policy carefully so that you do not run into issues like the one explained here. We are happy to take the time to review your current policy with you upon request. We welcome you to add your comments. If this article has provided value to you, we ask that you share it.

Consent to Settle Clause

Consent to Settle

Consent to Settle language within a malpractice insurance policy is important for insureds to understand prior to purchasing coverage.  This is because the language within the clause details the extent to which an insured is responsible for claims payment, and how the claims will be paid. It can provide the insured with superior coverage or coverage left with unexpected holes in it.  Let us look at the following Consent to Settle Clauses from two actual policies:


Consent to Settle – Example 1

The COMPANY shall not settle any CLAIM without the written consent of the INSURED against whom the CLAIM has been made. If the INSURED refuses to consent to any whole or partial SETTLEMENT of a CLAIM recommended by the COMPANY within the applicable Limits of Liability, the COMPANY’S obligation to make any further payments for amounts in connection with the CLAIM incurred after the recommended SETTLEMENT was proposed shall not exceed the amount for which the CLAIM could have been settled by the COMPANY had the INSURED consented to the SETTLEMENT. The INSURED is not entitled to, and the COMPANY will not be obligated to pay, any DAMAGES or CLAIMS EXPENSE beyond that amount. To the extent the COMPANY pays any DAMAGES or CLAIMS EXPENSE beyond that amount, you agree that, after the CLAIM ends, such amounts shall be repaid to us by the INSUREDS , each according to his or her respective interest.

Does this first example scare you?  Well, we hope it does.  This clause means that that if you do not agree to the proposed settlement, you may be left hanging with a large out-of-pocket bill, including final damages beyond the original settlement amount and defense expense costs, including expensive attorney fees.

Consent to Settle – The Hammer Clause

This first example contains what is commonly called the Hammer Clause, which is defined as: *A provision (also known as the “hammer clause” and “blackmail settlement clause”) found in professional liability insurance policies that requires an insurer to seek an insured’s approval prior to settling a claim for a specific amount. However, if the insured does not approve the recommended figure, the consent to settlement clause states that the insurer will not be liable for any additional monies required to settle the claim or for the defense costs that accrue from the point after the insurer makes the settlement recommendation.

Okay, let us look at – Example 2:

Consent to Settle Example 2

We will obtain written consent from you before we settle a claim against you arising from a medical incident. You agree to waive such right to consent under the following circumstances:

  • The settlement amount is within any deductible amount applicable to the claim
  • You are deceased or adjudicated incompetent
  • Judgment is entered
  • Your license to practice medicine is suspended or revoked
  • The claim was reported under an Extended Reporting Period Endorsement to this policy
  • You, after reasonable efforts by us, cannot be located

Aside from the understandable exceptions, this clause provides full consent, meaning should you decide not to settle, the carrier would keep defending on your behalf at no additional cost to you. The only caveat is if the final judgment goes beyond your purchased policy limits.

Making the Decision That’s Right For You

Understanding the Consent to Settle clause will help you in deciding which coverage is right for you. Should you choose coverage with full consent, such as the second example, you will be able to enjoy peace of mind in knowing that your carrier is really fighting for you.  If you have any questions regarding your policy, we would be pleased to provide a no cost / no obligation consultation.

What are the concerns you have about your coverage?  We welcome your comments below.  If you find this post helpful, we simply ask that you share it.

*Reference provided by: International Risk Management Institute

The content is for informational purposes only. All matters must be analyzed on a case by case basis.

Malpractice Insurance Change Can Be Profitable!

Understanding Malpractice Insurance Clauses

Malpractice Insurance Strategy

We love talking to physicians about lowering their malpractice insurance premium and improving their coverage. In many instances, we find additional savings with better coverage through another carrier. The problem is that most clients assume they need to wait until their current policy expires to change carriers, which could be a year if they just renewed.

Physicians can move their malpractice insurance coverage mid-term, but looking into the current policy’s cancellation clause will help them in the following ways:

  • It will clarify their coverage needs.
  • It will show the real costs and savings.
  • It will enable them to make a better decision.

Let us show you how by looking at malpractice insurance cancellation clauses from two different carriers. For our illustrations, assume you currently have a policy that runs January 1, 2013 to January 1, 2014. The annual premium is $60,000. You decide to cancel on March 15, 2013.

Malpractice Insurance Cancellation Clauses


Here is the policy Cancellation Clause for Insurer 1
(Calculated Pro-Rata)

If the policy or a SCHEDULED NAMED INSURED is canceled by the FIRST NAMED INSURED : The FIRST NAMED INSURED will receive a refund of the pro-rata unearned premium amount.

Here is the calculation of your $48,000 refund:






Here is the policy Cancellation Clause for Insurer 2
(Calculated Short-Rate)

This policy may be canceled at any time by the policyholder by sending advance written notice to us stating when thereafter such cancellation shall be effective. We will return any unearned premium, less the customary short rate fee. However, the policy cancellation will still be effective even if you have not yet received any such return premium due you.

Here is calculation of your $43,200 refund:




The industry customary short-rate penalty is 10%.  Note that you would have lost $4,800 if the second carrier provided your coverage.

Malpractice Insurance Strategy

There is one caveat here. We have found that when an insured pays the current policy in quarterly installments and then cancels coverage on the next quarterly installment due date, the carrier does not usually balance bill the client for the penalty amount.  In addition, similar giving up players in sports, if an insurance carrier wants to let go of an insured, they are most likely going to allow a pro-rata cancellation.

Knowing how your insurer calculates the return premium if you cancel coverage mid-tem will help you make a better decision in whether to move coverage.

In many cases, we have found that the premium savings we have provided with a new carrier outweigh the short-rate penalty amount.  For additional information on specific insurance coverages, check out our Education Page.

We are Here to Help!

What specific questions do you have about your coverage? We would love to hear from you.  Leave your comment below:

As always, we are always here to provide a complimentary coverage review.

Clinical Guidelines Help Decrease Risk

When we first read the article on Clinical Guidelines below, we were excited to share it with you. This information is invaluable  in reducing your risk, especially as you set up your practices to fit new government requirements.

Susan Martin, Esq., for Clinical Guidelines: Improving Quality to Decrease Risks

We are delighted to have Susan O. Martin, RN, JD,  Executive Vice President, Litigation Management / Loss Control of Best Practices Insurance Services, LLC, as our special guest blogger. In the following article, she discusses the importance of Clinical Guidelines and Performance Standards and how they are Improving Quality to Decrease Risks.


Improving Outcomes

There is no doubt that the ultimate goal of all health care practitioners is to improve patient outcomes.  Attorneys want better outcomes as well, because happy, satisfied patients correlate to fewer lawsuits filed against health care providers. While performance standards, professional clinical guidelines or protocols of care are often employed in an attempt to improve outcomes, as an attorney, it is problematic to review or give advice regarding them because plaintiff attorneys will try to use these documents as “standards of care,” even if that is clearly not the intent. For example, if a protocol states that a patient is to have antibiotics on board within a specific time of the diagnosis of pneumonia, and the antibiotic is given twenty minutes after the time period required, is that considered a violation of the standard of care?


The Rise of Clinical Guidelines & Performance Standards

Emergency physicians and emergency medicine groups execute agreements with their hospital partners which place clinical guidelines and performance standards and core measures directly on the physicians in the practice. Most medical specialty organizations and institutions require some form of clinical performance measurement as well.

For example, the American College of Cardiology and the American Heart Association have recommended core measures for treating patients with ST segment MI and non ST segment MI. Those cases used to represent the majority of cases filed against emergency room physicians, but in the past five years, the “missed MI” cases out of the emergency department are very few. Now, with the institution of the “code STEMI” in the pre-hospital care environment, and the hospital cath labs responding immediately, patients are having better outcomes and heart muscle salvage.

Many of these core measurements are used by the Centers for Medicare & Medicaid Services (CMS) for post review of the quality of care delivered to Medicare patients. While many practitioners would argue that CMS is merely looking for an avenue to deny payment to those facilities and physicians who do not follow the criteria, CMS would argue it is only seeking better outcomes for its beneficiaries, including decreased hospital admissions. Unfortunately, many times these performance criteria are promulgated by committees or hospitals as “standards of care,” which further expose medical staff members.


Clinical Guidelines & Performance Standards vs. Standards of Care

The term “standard of care” is a legal term used in courts of law to determine a practitioner’s duty to a patient. Standards of care are determined by jury, judge and/or expert testimony. In contrast, clinical guidelines – performance standards are recommendations by hospitals, medical staff committees and professional review organizations to provide a “road map” for practitioners to consider. As recommendations that change over time, these guidelines should not set policy. They should never be considered as hard evidence in a medical malpractice lawsuit. It is recommended that any clinical guidelines or protocols set up for mid-level practitioners, physicians, or other health care providers have language that allows the practitioner the flexibility to use his or her own independent medical judgment.


Tips for Writing Clinical Guidelines & Performance Standards

In writing such guidelines, we suggest the following:

• Clinical guidelines – performance standards should have the following language at the beginning of the page:

“These guidelines are tools and considerations for the practitioner’s use and are not intended to suggest or dictate medical standards of care. Each patient has individualized needs and each practitioner must use his or her own professional independent judgment in medical decision making for each patient’s treatment plan of care. “

With this language at the beginning of each clinical recommendation, you can respond accordingly. If asked in deposition testimony, you can state that you know of the guidelines, but you determined that your patient, Jane Doe, needed different treatment modalities, and you were acting in the best interest of the patient at the time of care.

• Use caution in using words such as “practitioners shall always”or “practitioner shall ensure that.”
Again, the wording must give flexibility for the practitioner and should not denote absolute terms.

• Nursing policies can be somewhat more problematic, yet required by the Joint Commission on Accreditation of Health care Organizations (JCAHO) and nursing boards. Nurses are accustomed to policies and procedures, which they strictly construe. For example, instead of a policy that states, “Vital signs shall be repeated every two (2) hours,” a departure from which would be considered a violation of hospital policy, if possible, allow patient acuity to better define the guidelines. It would be better to state, “Vital signs shall be repeated according to the acuity of the patient or as ordered by the physician.” In this manner, nurses are not charged with taking repeat vital signs on non-acute patients or patients who do not require it.


Get Involved – Develop Clinical Guidelines & Performance Standards

Whatever term is used core measurements, performance standards or clinical guidelines – these policies are here to stay.  It is in the practitioner’s best interest to assist in the development of these measurements in their hospitals and/or their specialty organizations to draft reasonable and medically sound criteria that gives flexibility and allows practitioners to continue to determine individual patient needs.


About Susan O. Martin, RN, JD

Susan has a unique background that compliments the integrity of AMS Best Practices. Prior to joining Best Practices, she was Chief Legal Counsel for a physician management group consisting of primary care, multi-specialists and ED physicians. Prior to her role as Chief Legal Counsel, Susan managed the litigation and risk management for a large, national physician practice management company (EmCare). She has also been in private practice defending physicians in lawsuits, as well as handling regulatory matters and insurance coverage issues.


About Best Practices Insurance Services, LLC

Best Practices Insurance Services, LLC (BPIS) is the exclusive agent for Applied Medico-legal Solutions Risk Retention Group (AMS RRG) providing underwriting, brokering, clinical risk management, claims management oversight and distribution services.

For questions regarding Clinical Guidelines & Performance Standards: Improving Quality to Decrease Risks, please contact Steve Shapiro, MD, Chief Medical Officer, at (800) 367-1 337 or Susan Martin, Esq. at (866) 520-6896.


If you’ve liked what you have read here, please share the information with your colleagues. Our agency’s goal is to provide you with information that will enable you to reduce risk and malpractice claims, so that you can enjoy a successful practice.  We welcome any thoughts or suggestions on how we can help you achieve these goals.

If you have questions about reducing insurance premiums, risk reduction and improving overall coverage, feel free to contact me, Michelle Perron, personally at (603) 926-1318.


Malpractice Insurance Costs Over Time

malpractice insurance costs comparison

Physicians often choose malpractice insurance coverage based on attractive up front pricing without understanding the implications of their malpractice insurance costs over time.  In this post, we illustrate and compare current and future costs over time between two competitive markets for the same physician.


Let’s look at malpractice insurance costs from Carrier 1:

Carrier 1 Example

Here we are providing malpractice insurance costs from two types of  coverage, Occurrence vs. Claims Made Coverage, for the current (Year 1) and seven consecutive years afterward with rates and physician claim experience remaining constant. Note that with Occurrence coverage, the premium remains consistent. With Claims Made, the premium increases due to the Claims Made Step Factor. Remember, since the Claims Made trigger date is the date claims are filed, there is a lower chance of a claim being filed for the first few years. This is the reason for the step-up factors. Risk exposure increases as time passes. Claims Made Step Factors differ between carriers, so it is important to carefully review each of them. As you can see, we have included Cumulative Costs in this coverage example, including the purchase of a Tail in the Claims Made example should one be needed. Note that the increase of purchasing Occurrence vs. Claims Made is minimal in this example.


Now, let’s look at malpractice insurance costs from Carrier 2:

Carrier 2 ExampleNotice that with this carrier, the Occurrence rate and Claims Made Mature rate are equal and the Claims Made Step Factors and Tail Factors differ. More importantly, look at the Cumulative Cost Difference. See how the Claims Made Coverage will cost approximately $24,000 more than if you had purchased Occurrence in Year 8, should you need to purchase a tail?


Extended Reporting Period Waivers

When comparing these coverages, it is also important to review the Extended Reporting Period (Tail) Waiver, which provides a Free Tail. For the carriers listed above, these waivers are as follows:

Carrier 1

The carrier will provide a waiver for the Extended Reporting Period upon the following:

1. Death

2. Disability

3. Retirement at the age of at least 60 and having been insured with the carrier for at least five consecutive years or retirement at any age and having been insured with the carrier for at least seven consecutive years.

Carrier 2

The carrier will provide a waiver for the Extended Reporting Period upon the following:

1. Death

2. Permanent and Total Disability

3. Permanent and total retirement from the practice of medicine after he/she attains the age of 65 or older and has been insured on a claims made basis by an authorized insurer for five or more consecutive years

4. Permanent and total retirement after an insured attains the age of 55 or older and has been insured on a claims made basis by an authorized insurer for ten or more consecutive years

5. Permanent or total retirement and has maintained claims made coverage with an authorized insurer for at least 10 consecutive years, provided the last five consecutive years were with the carrier.



We believe that physicians need a full understanding of their malpractice insurance costs before making their purchasing decision. There is healthy competition between carriers which makes some stronger in certain areas than others. Understanding long-term costs and contingencies goes a long way in mitigating or preventing heavy financial impacts when carriers provide unexpected premium quotes in future years.

A comprehensive assessment of malpractice insurance costs and coverage types can improve the financial health of your practice and should be part of your business strategy. Most of today’s focus in healthcare tends to be on the Income side of the balance sheet, when in reality, both Income and Expenses are equally important.

We continually research the market to find the best resources to help you. The Fox Group is an experienced management consulting firm that specializes in assisting physicians and other healthcare providers throughout the U.S. and abroad to achieve their strategic and operational goals. While they are clearly in the business of consulting to healthcare providers, they do provide some free valuable resources. As part of your malpractice insurance costs assessment, you may be interested in considering their Medical Practice Assessment, which may reveal insights into the real financial health of your practice. This is just one of many valuable sites we’ll link to our blog to continually keep you informed. Please visit here often for business tips and important updates in risk management.


Paid-Claims Policies . . . Pitfalls and Perils

Paid-Claims - Watch Out For PerilsPhysicians may be attracted to a Paid-Claims medical professional liability policy type because of its lower initial price compared to Claims-Made or Occurrence policies. While they all have their differences, the Paid-Claims policy type is one that needs the most understanding before purchasing. Here is why:

First, you need to examine the coverage trigger definitions of each policy type. The coverage trigger is the “event that must occur before a particular liability policy applies to a given loss.” Let us look at the triggers for three coverage types.


Paid-Claims vs. Claims-Made vs. Occurrence:

Comparing Insurance Policy Triggers

Occurrence – The trigger is the occurrence of the injury or damage. Liability will be covered under that policy if the injury or damage occurred during the policy period. With an Occurrence policy, once you pay for the policy, no matter when a claim is filed in the future, the insurance carrier that was in place at the time of the injury or damage will respond to the claim. The buyer needs to feel confident that the carrier will still be around for many years to respond to any future claims.

Claims-Made – The trigger is the date the claim is made, which can be long after the date of the actual injury or damage. Should the insured or carrier cancel the policy, the insured may need to purchase an Extended Reporting Period (known as a Tail) which would allow claims to be reported in the future for professional services rendered during the policy period(s). If the insured is moving to another carrier, the new carrier may be able to pick up “Prior Acts”, meaning the new carrier may be willing to pick up coverage from the first date of the current Claims-Made policy. In this case, the insured does not need to purchase a tail.

Paid-Claims – The trigger is the time a claim is paid. Therefore, if a claim is filed, the insured must remain on the policy until it is closed. This approach can offer significant benefits in terms of pricing accuracy for the insurance carrier offering the coverage, since premiums are based on overall expected costs for the next twelve months rather than estimates of future claim payouts. However, since claims will be paid only while the policy remains active, the insured facing a claim cannot cancel the policy while the claim is pending, often for years, unless he or she is willing to pay the claim out of personal assets, or purchases an Extended Reporting Period (Tail).


Bottom Line Advice:  “Avoid Paid-Claims Policies”

In summary, Perron Insurance Services advises professional service providers to avoid the Paid-Claims policy type due the inability of an insured to move coverage while a claim is pending without purchasing a Tail. We believe that carriers will often non-renew coverage or increase rates when they receive notifications of claims they expect to payout, even if not for several years.



IRMI – International Risk Management Institute, Inc. (IRMI) http://www.irmi.com

The Risk Retention Reporter, January 2004


Morton’s Fork – Modern Medical Malpractice Thriller

Book Review by Michelle Perron and Chuck Sink –

Morton’s Fork is a modern medical drama set in 2012 revolving around the life of Doctor Roger Hartley, an extremely hard-working and dedicated 46 year-old physician. Here is a man who sacrifices most of his waking hours, at the expense of his dear and precious family life, to care for his patients within a healthcare system that seems only to punish an individual’s professional dedication and care.  Morton’s Fork stages a cast of characters who represent most of the major healthcare constituencies of today. They include two physician co-workers of Doctor Hartley’s hired by an insurance conglomerate to control costs, members of insurance companies who have the right to deny care, a plaintiff patient, a big name malpractice lawyer and political activists from both parties. Dr Hartley’s wife Celeste and his four children are also critical to the story’s plot.

Early in the book, the family and professional life of Dr. Hartley are each painted vividly and then skillfully interwoven as the professional side of his life begins to supersede and overwhelm the family life.  Emotionally and spiritually, Dr. Hartley’s actions begin to spiral out of control after he is presented with a lawsuit from an uninsured non-compliant patient.  A series of subsequent events cause him to commit a rash and irresponsible act born of arguably justifiable passion. A national high visibility trial ensues as a result, publically exposing systemic problems in the U.S. Legal, Political and Medical communities.

During Doctor Hartley’s trial and the events leading up to it, the reader gains an understanding of our current healthcare issues, including Tort Reform, Defensive Medicine, and the Patient Protection and Affordable Care Act, aka “Obama Care.” All sides are presented with thoughtful arguments. Villains and heroes evolve as the story unfolds.

The book is a page-turner in league with some of the best thriller novels.  The undercurrents go much deeper than exploring legal-medical-political issues in the country. The author skillfully plants moral and spiritual challenges throughout the book that each reader can ponder for himself.  The shocking ending will literally stun the reader into deep contemplation. It begs the author for a sequel in 2013.

As an insurance broker specializing in helping physicians with malpractice insurance, I can see Doctor Hartley in many of my clients; overly dedicated physicians who care for their patients with increasing expenses and reduction in payments from insurance carriers. I have seen physicians struggle with many frivolous malpractice cases and often wonder how they still practice.


The author, Doctor Coy is a Board Certified gastroenterologist practicing medicine in group practice in Illinois.  He graduated from Ohio State University School of Medicine and completed his training in Internal Medicine and Gastroenterology at Northwestern University.  Most notable is his philosophy of care in an accurate and expedient diagnosis of the patient’s illness and adherence to the highest quality of medical care. His bedside manner is professional and friendly while treating patient problems.

What to Consider When Choosing Your Insurance Advisor

With insurance rates continually on the rise and increasingly complicated regulations, it can be one of a business’s biggest cost outlay and headache. Therefore it is critical to make sure you pick the right insurance professional to help guide you through this process and to be your ally and champion.

Let’s say you are a physician with a medical practice. Your patients trust and depend on you to provide them with the best care for their particular symptoms and diagnoses.  You provide a physical examination, send them for additional tests if necessary, and assess their needs in order to develop a treatment plan.

Time-and-MoneyWhen you work with your insurance agent they should do a preliminary analysis of your needs much in the same way that you do with a patient. The insurance should be designed to cater to your specific business and your particular specialty needs and provide you the best coverage at the lowest possible premium.

An insurance agent that you trust can be a huge asset. Not only can they do the legwork for you to find a well-suited insurance company, they help shop for the best rates, and most importantly, explain the ins and outs of your plan. How do you find a reputable agent? Check credentials with your state’s licensing board.  Make sure they have proven experience in your industry. Chances are if they do, they will have a good handle on any special insurance needs and watch outs that are particular to your business or medical practice.

Once you identified the possible agents, here are some questions to consider:

  1. What is the motive of your insurance agent? Especially consider how your insurance agent is being compensated for their work. Is he/she being paid by the amount of commission dollars brought into the agency?
  2. Does your insurance agent understand your practice and uncover potential ways to reduce your premium? An insurance agent who is knowledgeable in your specific industry will know many of the ins and outs that pertain to your line of work and should be able to efficiently help you navigate to get to what is pertinent for your business.
  3. Does your insurance agent obtain all eligible credits to reduce your premium? With the constantly changing regulations, you need someone up to-date to make sure you are getting everything your business is entitled to keep your premiums low.
  4. Does your insurance agent keep you up-to-date in offering ways to reduce your risk exposure? This is particularly key if you work in a high-risk industry such as physicians who must carry malpractice insurance or contractors who need to carry workers compensation.
  5. Does your insurance agent handle multiple insurance lines or does he/she specialize in the coverage you need and keep up with training in that specific area? Someone current, knowledgeable and an advocate for you is a true asset to your business.
  6. Is your insurance agent on your team? Does your insurance agent represent your best interests or the insurance carriers? Are they independent of the insurance carriers and therefore free to shop multiple carriers for the best rates? Does your insurance agent advocate for you?

Advocating for clients and meeting their needs is a great quality to look for in an insurance agent. Recently, a physician was being added to a practice and required malpractice insurance to be able to start right after a holiday weekend. The agent he contacted not only worked after hours and was willing to communicate back and forth with the client during the holiday weekend in order to obtain the right information so that the underwriter would have a full submission waiting for him on Monday morning.   Because the submission was thorough, the underwriter was able to quickly review the information and provide approval enabling the new physician to start with the practice right away. This is an example of having an insurance agent who is on your team, willing to go above and beyond to get you the right coverage at the right price when you need it.  In today’s increasingly complicated world of insurance, having an ally can make all the difference.

Michelle Marie Perron is principal of Perron Insurance Services, a Hampton-based insurance firm specializing in physician insurance needs and passionate about protecting your practice’s health. For information visit www.perronservices.com, e-mail mperron@perronservices.com or call 603.926.1318. You can also follow her on Twitter @perronservices or Facebook at Perron Insurance Services or LinkedIn www.linkedin.com/in/michellemarieperron.