retroactive protection application

Transcription

1 retroactive protection application All physicians should have adequate protection against medical-legal difficulties that may arise from their professional work. CMPA retroactive protection is a one-time cost that keeps you protected. What is retroactive protection? Retroactive protection is offered to physicians who are joining the CMPA to assist with potential medical-legal difficulties resulting from their past medical professional work. It is available to most physicians who have held either commercial claims-made insurance or occurrence-based protection (other than CMPA). If you are joining the CMPA and previously carried professional liability insurance or the equivalent (not CMPA protection) please note: Commercial claims-made insurers will usually only insure for claims reported to them before the termination date of the policy. A gap in protection may exist for claims arising from professional work done while holding a commercial claims-made insurance policy, but reported after the termination date of the policy. In other words, it is likely the insurer will not accept the claim nor will you be eligible for CMPA assistance. The CMPA provides occurrence-based protection, which means a member is eligible for assistance in the face of a claim arising from professional work done while the physician was a member, regardless of when the claim is made. A physician has two choices to correct this gap in protection: 1. If it is available, purchase from the commercial claims-made insurer a special policy extension called tail coverage (extended reporting period). 2. Purchase retroactive protection from the CMPA. If you held occurrence-based protection (other than CMPA), you continue to be protected by your former insurer for past professional work. However you may prefer to benefit from CMPA retroactive protection. In which case, if you are faced with a claim you will need to choose at the onset which organization you will look to for assistance. Are you eligible for retroactive protection? To be eligible, you must meet all of the following conditions: Have held either claims-made insurance or occurrence-based protection. Be in the process of joining or have joined the CMPA or have reactivated membership within the last 6 months. Remain a member for a minimum of 3 years after joining the CMPA. Should you not maintain membership for a minimum of 3 years after joining, the CMPA may, at its discretion, cancel retroactive protection and return the applicable payment. The retroactive protection period must be for professional work performed in Canada while duly licensed or registered by a provincial or territorial medical regulatory authority (College). Important: You will not be eligible for assistance by CMPA for any work done before you joined the CMPA until your retroactive protection application is accepted and you have made payment arrangements. Page one of seven

2 retroactive protection application form Page two What are the restrictions? Retroactive protection is not available for any period when a physician did not have any type of professional liability insurance or occurrence-based protection. Physicians will NOT be eligible for assistance from the CMPA for medicoal-legal difficulties arising from professional work done during the retroactive protection period if one or more of the following apply: A threat, legal action, or other proceeding was brought prior to purchasing CMPA retroactive protection. The physician could have concluded, based on known circumstances at the time of making this application, that a threat, legal action, or other proceeding might be brought against him or her. The professional work in question was done while the physician was not duly licensed. The professional work in question was done outside of Canada. A legal action is brought outside Canada. What are the fees? The CMPA Council sets retroactive protection fees annually. Your fee will be based on the period of protection required, the type of professional work done, and the province or territory of work. You may choose to purchase partial retroactive protection: If the period for which you are eligible for protection is 10 years or less, you must purchase retroactive protection for the complete period. If the period for which you are eligible for protection is more than 10 years, you can purchase retroactive protection for a partial period, the minimum of which is 10 consecutive eligible years. Example: A physician who is eligible for 20 years of protection can apply for a minimum of 10 consecutive eligible years of retroactive protection or up to the complete 20-year period. How to apply for retroactive protection Important: To be eligible for retroactive protection, your application must be received in our office within 6 months after becoming a CMPA member. Retroactive protection is available only for threats, legal actions, or other proceedings starting after your retroactive application is accepted by the CMPA and you have made acceptable payment arrangements. 1. Establish your eligibility for retroactive protection (see Are you eligible for retroactive protection?). 2. Complete all 4 pages of this Retroactive protection application. 3. Sign and return the completed application. 4. Make acceptable payment arrangements. Note: Your retroactive protection fee must be paid in full within 6 months of applying. Based on the information provided in the Professional work history section of this Retroactive protection application, the CMPA will calculate the applicable retroactive fee and be in contact with you. What is mutuality and how does it affect your CMPA membership? As a mutual defence organization, the CMPA enjoys a relationship with its members defined by the principles of mutuality. The CMPA provides liability protection for its members who, in turn, are expected to practise in a manner that aligns with the ethics and expectations of the profession and the values of the Association (the mutual) as described in its Bylaw. Page two of seven

3 retroactive protection application form Please complete all four pages Before you begin: Ensure you meet the terms in Are you eligible for retroactive protection? Familiarize yourself with the type of work code descriptors on the enclosed fee schedule. Then: Complete this application, answering all questions and reporting all periods of activity and inactivity from the date you were first licensed/registered. Your payment by pre-authorized debit (PAD) will be added to your next debit. Note: If you currently do not pay your fee by PAD, you must change your method of payment to pre-authorized debit (PAD). (1) Complete the Pre-Authorized Debit (PAD) Agreement and (2) send it to the CMPA with a void cheque from a Canadian bank account (cannot be a line of credit or credit card account) without delay. If you prefer, you can complete the PAD agreement directly online. More information is available on our website at > My Membership > Fees and payment > Payment methods. Please print Name: (first name) (Middle name) (last name) Your CMPA Member number: Mailing address: (APT/SUITE, street NUMBER AND STREET name) (CITY) (PROVINCE/TERRITORY) (POSTAL CODE) (COUNTRY) Telephone: (HOME) (BUSINESS) (EXT) (CELL) Fax: address: Date of birth: Page three of seven

4 retroactive protection application form Page four Professional work history All periods (of activity and inactivity) from the date you were first licensed/registered must be reported. 1. Period from: Period to: 2. Period from: Period to: 3. Period from: Period to: 4. Period from: Period to: 5. Period from: Period to: Page four of seven * Type of work Reference the fee schedule online to select the type of work code(s) that most accurately describe(s) the professional work you were doing.

5 retroactive protection application form Page five Medical-legal history Answer all questions. If you answer YES to any question, you must indicate all details and outcomes, including clinical situation, date of incident, and any recognized threats, if applicable. List all matters excluding only those already reported to the CMPA. If you require additional space, attach a separate note to this form. 1. Have you ever had threats, or legal actions, or other proceedings against yourself or your employees arising from your or your employees medical work? Yes No If yes, to which protective organization or insurer were they reported? 2. Has any insurer or other type of organization providing the equivalent of medical professional liability protection declined, refused to renew, or only accepted on special terms, your professional liability protection? Yes No 3. Have you ever had hospital privileges reduced, restricted, or suspended, or has probation ever been invoked? Yes No 4. Have you ever been charged with professional misconduct or the like by a medical regulatory authority (College)? Yes No 5. Has your fitness to practise or medical competence ever been inquired into or investigated by a medical regulatory authority (College)? Yes No 6. Have you ever been suspended or erased from the register of a medical regulatory authority (College)? Yes No 7. Has there ever been any interruption in your licensure or registration? Yes No 8. Are you aware of any circumstances which could result in a threat, legal action, or other proceeding for malpractice, error, or mistake being brought against you or one of your employees? Yes No 9. If you are reactivating, have there been any new threats or legal actions, or other proceedings against you or your employees since you last had CMPA membership? Yes No If yes, to which protective organization or insurer did you report? Page five of seven

6 retroactive protection application form Page six Limitations to cmpa assistance If your application for retroactive protection is accepted, it is understood that: 1. Subject to #2 below, you shall be deemed to have been a member for the purposes of Article 6 of the CMPA By-law from the start date of your retroactive membership period. 2. You will not be eligible for assistance in respect of any matter occurring during this retroactive protection period: a. which resulted in a threat, legal action or other proceeding starting before the CMPA accepted this application for retroactive protection b. about which you could have concluded, based on the known circumstances at the time of making this application, that a threat, legal action or other proceeding might be brought against you c. which arises from professional services rendered at a time when you were not duly licensed or registered with a provincial or territorial medical regulatory authority (College) anywhere in Canada d. about which you are or have previously been assisted by your existing or prior insurance policies or protection arrangements e. which arises from professional services rendered at a time when you did not have malpractice insurance or other professional liability protection f. which arises from professional services done outside of Canada I HEREBY APPLY for retroactive protection with the Canadian Medical Protective Association (CMPA). I understand that assistance as outlined in Article 6 of the Association s by-law is provided at the discretion of council. I also certify that all the information provided on the Professional work history section is correct and that all of the foregoing answers are correct. The CMPA may verify any of the information provided in this application and my signature both acknowledges and authorizes this validation activity. In accordance with Section 2.04 of the CMPA By-law, the Association reserves the right to void membership and retain any money received from any applicant who is deemed by council to have given false or incomplete information on this application. Note: The CMPA may, at its discretion, cancel retroactive protection and return the applicable payment should the member not maintain membership for a minimum of 3 years after joining the CMPA. Signature: Date: Please return the completed form to the CMPA by fax, mail or member portal (requires member number and password). Page six of seven CMPA /17

7 retroactive protection application Page seven Excerpt from Article 6, CMPA By-law Association Assistance 6.01 Assistance Available in Matters Affecting Professional Character or Interests of Members. The Council may undertake the conduct of or assist in the conduct or defence of any matter or proceedings, by action or complaint, whether of a strictly legal nature or otherwise concerning or affecting, whether directly or indirectly, the professional character or interests of: (a) any Member; (b) any former Member; (c) any deceased Member; provided that: (i) the Council shall be satisfied that the matter or proceedings arises out of the practice of the Member, former Member or deceased Member and at a time when the Member, former Member or deceased Member was a Member of the Association; (ii) the person making the request shall abide absolutely by every decision of the Council on the conduct or defence or settlement of the matter or proceedings and shall not, without the prior authority of the Council or its duly appointed representatives, unless otherwise allowed by the Council, take any steps with reference to such matter or proceedings; and (iii) the person making the request shall not then be a former Member who shall, at the time of the commencement of such matter or proceedings, by action or complaint, or at the time of threat thereof, have in force a policy of insurance whereby the person may be indemnified with respect to the occurrence complained of Application for Assistance. It shall be the duty of any person desiring the assistance of the Association in respect of any claim or complaint being threatened or brought against any person or the legal personal representatives of a person specified in Section 6.01, or upon there occurring to the knowledge of any such person any circumstance, error, mistake, omission or act which might give rise to an application for assistance from the Association, to forthwith communicate the facts to the Executive Director Authority of Council to Grant Assistance. Upon the receipt by the Association of a request for assistance, and upon the receipt from the person requesting assistance of a statement in writing giving full particulars of the circumstances of and surrounding the matter, and upon the receipt of such other material and information as Council may require, and after such investigation as the Council may direct, the Council shall decide whether a matter or proceedings is such that the Association shall assist and the extent of such assistance Nature and Extent of Assistance Subject to the like conditions as are specified in the provisions of Section 6.01 and to the other provisions of this By-law, the Council may grant from the funds of the Association to any person specified in Sections 6.01(a) and 6.01(b) and to the legal personal representatives of the persons specified in Sections 6.01(a), 6.01(b) and 6.01(c) assistance, wholly or in part, with regard to any matter, action, proceedings, claim or demand or complaint concerning or affecting, whether directly or indirectly, the professional character or interests of such Member or former Member or deceased Member, and the assistance may extend to all incidental or consequential losses, damages, costs, charges and expenses (exclusive of fines or penalties) and to fees and disbursements of legal counsel authorized by the Council Unless otherwise determined by the Council it shall not grant the assistance of the Association, where it is alleged, or established by evidence, in any action or other proceedings or by other evidence accepted by the Council in its discretion, that the matter complained of arose out of the act, default, negligence, error or mistake: (a) of any person, other than a Member or former Member or deceased Member, when that person though eligible to apply for membership was not a Member; (b) by the Member or former Member or deceased Member while that Member s ability to perform as a medical practitioner was impaired by the misuse of alcohol or drug; (c) by the Member or former Member or deceased Member at a time when such Member was acting in violation of any statute, law or ordinance or in the commission of any criminal act or act with criminal intent Assistance by the Association shall be granted, and its extent shall be determined, by resolution of the Council. The grant of assistance and its continuance shall be made only upon such terms and conditions as determined by the Council. The Council shall have full discretion in every case to limit or restrict the grant of assistance or altogether to decline to grant the same or to terminate any assistance granted. Any Member may request reconsideration of any decision to limit, restrict, decline or terminate a grant of assistance and reconsideration shall occur in a manner specified by Council Subrogation of the Association. When any person is assisted by the Association, then, by accepting such assistance, the person receiving such assistance shall be deemed to have agreed that the Association is subrogated, to the extent of the assistance rendered, to all such person s rights of recovery therefore against any person or organization and the Member, the former Member and the legal personal representatives of a deceased Member shall execute and deliver such instruments and papers and do whatever is necessary in the opinion of the Council to secure such rights. The Member, former Member and the legal personal representatives of a deceased Member shall do nothing to prejudice such rights Assistance by Members. It shall be the duty of every Member, former Member and the legal personal representatives of every deceased Member, being assisted by the Association, to aid and co-operate fully with the Association and counsel appointed by the Association and the Association s representatives, at the Association s request, in respect of any matter or proceedings concerning such person, in particular, without limiting the scope of such aid and co-operation, in providing statements, oral and written, in meeting with counsel appointed by the Association and the Association s representatives, in securing and giving evidence, all without charge to the Association unless such charges are specifically agreed upon by the Association. end