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Whose Insurance Covers Doctors’ Mistakes or Accidents?

Oregonians, like most Americans, are blessed to live in communities offering excellent medical care. Doctors, nurses, and other medical care providers are highly educated and well-trained. Most providers perform their services skillfully and to the best of their abilities.

However, medical care providers also make mistakes. Thankfully, many times these mistakes can be corrected. Unfortunately, medical malpractice can also produce catastrophic harm from which patients never fully recover, and, in some cases, they can even cause death. In many instances, a victim of medical malpractice requires significant medical treatment aimed at repairing the harm caused by the initial malpractice.

As we all know, the cost of medical care has soared through the years. This leads many people to ask us how a medical malpractice victim is compensated and how medical malpractice insurance works.

Medical Professional Liability Insurance

Some patients injured by medical malpractice have the misconception that the health care provider will have to pay all of the victim’s damages out of pocket. However, in truth, most medical care providers carry insurance that will cover them for damages resulting from their medical malpractice. This insurance has a variety of names, such as “medical professional liability insurance,” “medical malpractice insurance,” and “medical errors and omissions (E & O) coverage.”

Of course, as with all insurance, deductibles, coverage limits, and other policy terms vary, depending on the insurance policy purchased. Here, we’ll discuss a few common policy terms in medical malpractice insurance policies.

Common Types of Policies

There are two common types of policies: “occurrence” and “claims-made.” An occurrence policy covers incidences of malpractice that occur during the policy coverage period, regardless of when the claim is raised. A claims-made policy covers claims raised during the policy period, regardless of when the negligence occurred.

Legal Defense Costs

Medical malpractice policies generally provide the medical care provider with a lawyer to defend the case in the event of a lawsuit. Insurance companies hire highly competent legal specialists to defend their insureds, hoping to limit any payment ultimately made by the insurance company to the victim. In some instances, the insurance company will pay for multiple lawyers to help defend a single lawsuit.

Settlement Consent

Many medical malpractice policies provide that the insurance company cannot settle a case without the insured’s (i.e., the medical care provider’s) consent. This is different from many other types of insurance. For instance, if a driver has an automobile accident and injures someone, the automobile liability insurance carrier can settle the lawsuit without its insured’s consent.

These consent provisions can make it harder to settle a medical malpractice lawsuit because sometimes, even when settlement seems appropriate, the medical care provider may not want to admit liability, fearing that such an admission will harm his or her professional reputation.

Common Forms of Medical Malpractice Covered by Malpractice Insurance

Some malpractice occurs at the very beginning of treatment, such as cases involving a failure to diagnose, or misdiagnosis. Other forms of medical malpractice occur during treatment and can involve issues such as making an error during an operation.

We have seen many instances of medical malpractice that result from simple miscommunications, either between doctors, or between a doctor and other staff members. For example, a doctor may misunderstand a nurse’s handwriting in a medical record, which results in a treatment or surgical mistake. Other common forms of medical malpractice include the following:

  • Childbirth errors – this can include negligence during prenatal care, as well as negligence during and after the delivery process
  • Prescribing an incorrect medicine
  • Following an incorrect treatment protocol
  • Misinterpreting a test
  • Surgical errors
  • Anesthesia errors

Who Pays a Medical Malpractice Victim’s Ongoing Medical Bills?

If you can prove medical malpractice, the medical care provider’s malpractice insurance generally makes one lump sum payment at the end of the case if the victim prevails on the claim at trial, or if a settlement is reached. In the interim, the injured person often must turn to his or her own health insurance company.

However, in some instances, a medical care provider might offer to attempt to correct a mistake, without further charge. We’ve had success in helping our clients find new medical care providers who will provide treatment while waiting until the end of the case to be paid.

Consult with a Lawyer

At Nelson MacNeil Rayfield, we’re thankful for all the great doctors that serve our community. But just as with any other profession, we expect those who are negligent to be held accountable for their actions. We have investigated thousands of medical malpractice cases and we understand complicated medical malpractice insurance policies. Please call us with questions or for a free consultation.