Medical Malpractice Insurance – Conditions, Coverage and Exclusions

Malpractice Insurance

This type of insurance falls under the branch of insurance errors or risks of the profession. Among these insurable professions are engineering, accounting, law and of course medicine. And in the term insurance, this insurance is called medical malpractice. Medical Malpractice

Under this type of insurance, each doctor can be covered separately or a group of doctors in a health center or whole hospitals, and even professional errors made by the nurses, paramedics and technicians inside these hospitals, in addition to the possibility of covering the visiting doctors who perform operations inside certain hospitals and are not residents Out.

This insurance compensates the insured for the amounts that he becomes liable under the law to pay due to physical or mental damage or death suffered by any patient as a result of a mistake, omission or negligence in the professional services that were provided or that were It is supposed to be presented which is known as medical malpractice at the work site of the insured, whether it is a hospital, medical center or clinic.

What is the  insurance coverage for the medical errors policy?

The program covers the value of the compensation that the courts or Sharia bodies award to the insured who caused health damage to the patient resulting from error, negligence, or omission during the exercise of his profession, and the limits of the insurance policy differ from one country to another, for example in the Kingdom of Saudi Arabia the maximum limits for compensation range from 100,000 riyals and 1000,000 riyals, either for one claim or the annual total of claims according to the terms of the policy.

In any case, the insurance company will not pay more than the compensation amount in the policy, for example, if the judge decides a compensation of 120,000 riyals and the compensation value in the policy for one incident is 100,000 riyals, the insurance company will pay 100,000 riyals.As for the litigation expenses that the insured pays or that the insured judge is obligated to pay, they are part of the amount that the insurance company is obligated to pay in most of the insurance policies against medical errors in most of the higher countries.

Medical specialties in terms of risk

Medical specialties can be classified in terms of risk related to them according to the following categories:

1. Anesthesiologists and gynecologists, and this specialty is considered the most dangerous.
2. Surgeons, orthopedics and diseases, and urology are considered to be of moderate risk in this specialty.
3. Other disciplines: low risk.
4. Working doctors and dentists: low risk.
5. Less dangerous paramedics, technicians and nurses.

Insurance premiums are collected according to the type of specialization. The more serious the specialty, the higher the insurance premium that the doctor is obligated to pay and vice versa.

Exceptions to  medical errors insurance policy

 As for the exceptions to securing medical malpractice, they are:

1. Any act committed that is in contravention of instructions and norms, such as encroachment on professional secrets or professional experiences or services provided under the influence of poisoned or narcotic drugs.

2. The dangers arising from owning, using, maintaining, or renting a work site (hospital, clinic, etc.), especially bodily harm to the persons hosted by the insured, with the exception of damages resulting from medical treatment or its deletion.

3. The dangers resulting from the low degree of success in the medical services provided, for example in the event that there is no conviction to see an improvement in appearance or appearance after performing cosmetic surgery, and any claim or claim in this regard is not covered under this insurance.

4. Dangers arising from general anesthesia by dentists or dental surgeons, or any procedures performed under general anesthesia, unless they are performed in a licensed and approved hospital under the supervision of the anesthesiologist.

5. The risks resulting from the treatment or the services provided to stimulate or avoid genetic generation.

6. The dangers resulting from infection or treatment with AIDS.

7. The dangers arising from the services provided that are not provided by a person who has passed the required examinations and has a license or license to carry out specific services, in accordance with the requirements of the law.

8. Dangers resulting from damage resulting from radiation or radioactivity.

9. Risks arising from material and physical damage to the third party as a result of the insured operating, owning or renting fixed properties other than the location from which he works.

10. Liability resulting from providing services other than the usual services agreed upon with the insurance company.

11. Liability arising from the manufacture, construction, alteration, repair, provision of services, processing of any merchandise or product sold, supplied or distributed by the insured except for the one who works exclusively for its use in the insured operations.

12. Liability arising from or related to any person or institution whose name is not included as an insured in the document’s schedules and which is owned directly or indirectly or under control, management or operation by an insured or a partner of the insured.


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