Policyholder Services

A patient filed a complaint with my state medical board. Is this covered under my policy?

As additional benefits under your policy, coverage is provided for disciplinary and regulatory proceedings.

OMIC will defend insured ophthalmologists and pay associated claim expenses against investigations, disciplinary proceedings, or other actions for review by federal, state, or local regulatory agencies arising from complaints or reports by patients of injury resulting from direct patient treatment provided by the insured. Coverage is limited to $25,000 for each disciplinary proceeding , with a maximum of $75,000 for all proceedings reported within a policy year. Disciplinary proceeding coverage is also subject to the terms and conditions of the professional liability policy. If the disciplinary proceeding arises from professional services incidents not covered under – or that are specifically excluded by – the professional liability policy, coverage for the disciplinary proceeding likewise will not be covered.

OMIC will also reimburse insured ophthalmologists and entities for legal expenses, audit expenses relating to billing errors proceedings, and fines and penalties relating to billing errors, EMTALA, HIPPA, and STARK proceedings. The insured maintains freedom of choice of legal representation. Although we do not assume a duty to defend insureds in such proceedings, OMIC will provide insureds with the names of panel attorneys experienced in defending these types of actions. If an attorney from the panel is selected, OMIC will reimburse 100% of covered expenses (subject to the coverage limit). If non-panel counsel is selected, OMIC will reimburse 75% of such expenses, and attorney fees will be limited to a maximum of $300 per hour. Regulatory proceeding coverage is limited to $100,000 per policy term.

Please see Section VII. Additional Benefits of your policy for more information regarding these and other valuable benefits.

Updated 8/13/2015

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Six reasons OMIC is the best choice for ophthalmologists in America.

#3. Best at defending claims.

An ophthalmologist pays nearly half a million dollars in premiums over the course of a career. Premium paid is directly related to your carrier’s claims experience. OMIC has a higher win rate taking tough cases to trial, full consent to settle (no hammer) clause, and access to the best experts. OMIC pays 25% less per claim than other carriers. As a result, OMIC’s base rates have consistently averaged approximately 15% lower than multispecialty carriers in the U.S.