Policyholder Services

I am thinking about employing a plastic surgeon. Will OMIC cover me if I am named in a claim for services he rendered?

Through their respective coverage agreements (A and C), insured ophthalmologists and professional entities are insured for their vicarious liability arising from the acts or omissions of their employees. Ophthalmologists are covered for employees when they are acting within the scope of their training, licensure, and employment; they are also covered for the vicarious liability of others who are acting under the ophthalmologist’s supervision, direction, or control. Entities are covered for anyone whose acts, errors, or omissions the entity is legally responsible for, so long as that person was acting within the scope of his or her licensure and training. It is assumed, however, that such health care providers are engaged in ophthalmic practice. Employment of or a contractual relationship with a non-ophthalmologist physician, particularly one in a higher-risk specialty such as ENT or plastic surgery, presents an increased risk from that intended under the standard policy. That risk may be even greater if the employer does not possess the expertise required to appropriately supervise the non-ophthalmic activities being performed. The actual increase in risk is difficult to judge but could be significant. For these reasons, OMIC prefers not to insure the vicarious liability exposure arising from services rendered by physicians other than ophthalmologists, but is willing to consider such requests subject to careful underwriting review.

Insureds who wish to pursue vicarious liability coverage for services arising from physician employees or contractors are asked to provide the non-ophthalmologist’s curriculum vitae, insurance history, current proof of coverage, complete claim history, and scope of services to be provided. The claim history should include a detailed listing of all claims the physician has ever been involved in, including open cases and cases that closed with or without indemnity. In addition, the insured should explain the rationale for hiring the specialist as opposed to establishing a referral relationship. If approved, an additional premium commensurate with the estimated increase in exposure will be charged. If the increase in risk is considered too significant, however, OMIC may endorse the policy to exclude coverage for claims arising from the vicarious liability exposure of non-ophthalmologist physicians employed directly by or independently contracting with the insured.