MALPRACTICE INSURANCE AND BECOMING A PA EXPERT : Jeffrey G. Nicholson, Ph.D., PA-C, M.Ed., MPAS, DFAAPA APALM MEETING NEW ORLEANS 5/22/2018

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1 MALPRACTICE INSURANCE AND BECOMING A PA EXPERT : Jeffrey G. Nicholson, Ph.D., PA-C, M.Ed., MPAS, DFAAPA APALM MEETING NEW ORLEANS 5/22/2018

2 GENERAL OBJECTIVES What kind and how much Liability Insurance do PAs need? What are the elements/general workings of malpractice litigation? What is the role of experts How do I become a PA Expert?

3 DISCLAIMER All information presented is not intended to be legal advice. There is no intention to give legal advice, and information presented should not be misconstrued as legal advice. Information presented is based on actual malpractice cases, real life experience, attorney interaction and research.

4 I. INSURANCE

5 Ins and Outs of Liability Insurance PAs are responsible for their own negligent acts PAs are sued Insurance companies provide a defense attorney Insurance covers claims, legal fees, and court costs up to the policy limit

6 What is at Risk? Your good name Your license Your career Your income potential Your personal assets home included in many states asset protection important for PAs AAPALM

7 Malpractice Awards Compensatory Financial compensation to restore patient to prior injury state Punitive Deter future wrongful conduct

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9 Imputed Liability Def: Non-negligent party held liable for the actions of another based on their relationship. Vicarious Liability Employers held responsible (MD/PA) Apparent Agency Agency held responsible for employees Physician Liability Liability for supervisors (respondeat superior)

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11 Malpractice Insurance What do PAs need? Employer provided Umbrella Coverage Cost less than your own policy Patient Compensation Fund (Some States) Cost (varies $300 WI annually physicians pay Individual (own) policy Cost ($ annually- MMIC, CM&F)

12 Complexities of Malpractice Insurance Shopping for insurance AAPA, MMIC, HPSO, MG&E, CM&F Group Do shop! Cost and who pays premiums What affects Premiums Scope/type of practice Hospital privileges History of lawsuit or claim Deductible not common

13 Types of Coverage Occurrence Claims Made Tail Nose /Prior Acts Umbrella Separate Limits

14 Insurance Policy Elements DICE Declarations (Limits, Costs in Excess) Insuring Agreement Conditions (Duty to Report-Timely Manner) Exclusions

15 Occurrence (forever) Covers claims made during and after the policy period. Broadest protection available More $ Nose /prior acts coverage

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17 Claims Made Coverage Only covers claims made and reported during the policy period Less costly Tail coverage needed Or Prior acts coverage needed on new policy.

18 Employment Agreements Employer will provide liability insurance Continuous Coverage Certificate of Insurance Know the type of insurance before you sign a contract be sure you have tail coverage its not if you leave but when you leave

19 INSURANCE SUMMARY Get an Occurrence Policy or add a Tail to a Claims Made Policy Be sure of your dates of coverage. Be sure your limits are correct for your state Ask your employer for a copy at least of the endorsement page or certificate of ins. The controversial Should PAs get their own separate policy?

20 AAPA Insurance Services AAPA benefits financially Information may be slanted/facts wrong One size does not fit all GET YOUR OWN REPRESENTATION NOT YOUR OWN PAYMENT LIMITS (Check out PrePaid Legal) DO NOT DUPLICATE COVERAGE OR MAKE YOURSELF A TARGET

21 II I WANT TO SUE YOU!! THE LITIGATION PROCESS

22 THE LITIGATION PROCESS Time Limits on Filing see summary Initial Review Expert Review Depositions Mediation Settlement versus Jury Trial?

23 THE LITIGATION PROCESS Caps on Non-economic Damages Caps on Attorney Fees Expert s Fees Expert s Qualifications Do you want to be an expert? FAQs

24 I WANNA BE AN EXPERT YOU DO NOT NEED SPECIAL TRAINING IT IS AVAIABLE SEAK A.T. STILL YOU ARE QUALIFIED BY VIRTURE OF ACTIVE CLINICAL PRACTICE AND DEGREE

25 CASH IN MY RETIREMENT? I WANT TO DO THIS IN MY RETIREMENT - NO CAN DO!!! RETIREMENT OPTION IS.LEGAL SUPPORT, INITIAL IN HOUSE REVIEW FOR MERIT, LNC PARALEGAL TYPE WORK

26 HOW DO I GET MY FIRST CASE? LIST YOURSELF AND SPECIALITY ON EXPERT WITNESS WEB DIRECTORIES BECOME AN APALM MEMBER LIST YOURSELF WITH REFERRAL SERVICES (Consolidated Consultants, PA Experts Network)

27 HOW MUCH SHOULD I CHARGE? $175 - $350/HR for records review, depo reading, research, consults with attorney Add $100/Hr to the above for deposition time (usually paid by opposing counsel) Flat fee of $2000-$3000 for trial appearance

28 YOUR INTRODUCTORY LETTER List your qualifications Thank them for retaining you Request your retainer Include your fee schedule separate sheet Include a W-9 separate sheet Specify document type hard copy, CD, flash drive, or web file (dropbox etc.)

29 TIPS ON CHARGING Get a 3 hour retainer up front especially if plaintiff firm, mail with records Let them know if you prefer hard copy Have your travel for trial arranged and paid for by the firm List these request details in your fee schedule

30 TIPS ON INITIAL CALL They need to see if you are qualified and meet their needs. Do not charge for the screening call. Do not reveal too much sometimes they are fishing for a free answer on merit. You could loose the possibility of a 3 hour minimum!

31 WRITING A REPORT Affidavit versus Report Report Format: Qualifications, Materials Reviewed, Short course of Pertinent Care in Question, Deviations or defense points, Summary Statement End each report with a caveat right to modify opinions if further discovery docs are made available to me Sample Reports on APALM website

32 DEPOSITION DO S AND Be well prepared DON T S Bring your requested production documents Pre-meet with your hiring attorney Speak slowly Listen carefully to the question Keep answers brief Answer the question only

33 DEPOSITION DO S AND DON T S Watch out for tricks, loaded questions, questions with implications If you can t answer yes or no, say so!! Ask for frequent breaks, rest Don t get emotional Don t appear to be biased or too much of an advocate

34 DEPOSITION DO S AND DON T S Expect to feel beat up If opposing attorney gets angry/frustrated. it means you are doing a good job Ask for prepayment before the depo if you charge a minimum (4 hour minimum can be justified).

35 VIII. RESOURCES

36 MORE INFORMATION PA Malpractice, Expert Witnessing Websites: ReachMD XM Radio Summary of State Laws:

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