Professional Liability Insurance

Transcription

1 Professional Liability Insurance Underwritten by Liberty Insurance Underwriters Inc., a member company of Liberty Mutual Insurance Benefits Guide for CPhA Members Why should employed pharmacists purchase this coverage? Questions? CPhA CPhA.Insurance.service@mercer.com You can t rely solely on the liability protection provided by your employer. Without your own personal liability protection, you could end up paying all attorney fees, court costs and loss of wages out of your own pocket because... There may be gaps in your employer s policy. A suit may be filed after you have terminated employment. Most employer-provided coverage does not cover you for actions that take place outside the workplace. With employer-provided coverage, you have to share your coverage with your coworkers, your employer and the entity. This protection is yours alone it is not shared among your coworkers or with your employer. A qualified consent-to-settle clause enables you to make the final decision in settling your claims. Coverage up to $2 million per occurrence, $4 million annual aggregate, may be needed when... You ve been named in a covered professional liability lawsuit. Your covered case is settled for a large sum of money. You re required to cover multiple covered claims in one year. You ve been subpoenaed to appear at a deposition. You ve missed work due to court appearances, on a covered claim. New to Practice Immediately following graduation, you are eligible for a 50% premium discount on your first year of practice. Protection You Can Count On, Now and in the Future As a pharmacist, this policy protects you in the event of an error or omission in the practice of pharmacy for all procedures approved by the California Board of Pharmacy as long as you have received the proper training and/or certification required and you are acting within the scope of practice. 1

2 The Bottom Line: Whether justified or not, a malpractice suit could cost you thousands or ruin the career you ve worked so hard to build. Your best defense? Coverage up to $2 million per incident, $4 million annual aggregate, with the CPhA-sponsored Professional Liability Program. This program is administered by Mercer ealth & Benefits Insurance Services LLC and underwritten by Liberty Insurance Underwriters Inc., member of Liberty Mutual Insurance. aving your own policy could mean you re covered for pharmacy services you perform even outside of your employment. Plus, this program uses an occurrence form that covers any designated professional service you perform while the Insurance Policy is in force. So, your coverage is active even if a suit or claim is made years later. As a pharmacist, you ve devoted years to study and training. Your skills and experience are constantly being tested. ow you respond can determine your professional reputation and your future. Under such circumstances, it s too easy for something to go wrong. A malpractice suit or a charge of negligence justified or not could mean the end of your career without the right kind of Professional Liability protection. Your Coverage Includes: A Qualified Consent-To-Settle Clause that requires your consent to settle. Reimbursement of Defense Costs up to $5,000 per incident/$10,000 per policy period for the investigation or defense of proceedings before most entities responsible for regulating your professional conduct (i.e., licensing boards). Deposition Assistance up to $5,000 per policy period for legal representation for depositions related to your professional duties. This coverage applies when you re not named in a claim but are required to be deposed, for instance, as a witness. Lost Wages pays up to $10,000 per incident/occurrence for attendance at a trial, hearing or arbitration proceeding for a covered claim. Reasonable expenses are included in this limit. Reimbursement for First-Aid Expenses up to $2,500 for medical supplies when you respond to an emergency. Assault Coverage up to $5,000 per incident/$10,000 per policy period. Coverage includes travel to and from the workplace. Legal Fees and Court Costs Are Paid in addition to your limits of liability. Damage to the Property of Others up to $500 is provided for damage you unintentionally inflict on the property of others during any nonbusiness pursuit, yet related to your personal duties. Supplemental Liability for Nonbusiness Pursuits provides bodily injury and property damage coverage for occurrences not related to your professional duties. Medical Payment(s) Coverage up to $2,000 per person for all persons for nonbusiness pursuits if someone is injured in or around your home, for example. 2

3 If you own a pharmacy, you may be eligible for coverage for your firm, which would include many of the benefits mentioned above, and may also include: For qualified group practices, a premium credit applies. Depending on the number of professionals in the group, credits may be available from 4% to 12%. Volunteers are automatically covered. Aggregate limits apply separately to each insured. Additional Insured Coverage available protects the additional insured against claims arising out of the sole negligence of the named insured. Locum Tenens Coverage for when another professional temporarily assumes your duties and provides services on your behalf for a specific period of time. The locum tenens shares in your limits of coverage. 3

4 Questions? Call Toll-Free CPhA 8:00 AM - 5:00 PM Monday-Friday About This Program This brochure contains a summary of the Insurance Policy provisions. If there is a conflict between this brochure and the actual Insurance Policy, the Insurance Policy language will control. About Our Role and Compensation The California Pharmacists Association has selected Liberty Insurance Underwriters Inc., a member company of Liberty Mutual Insurance for this insurance program. Alternative insurance products may be available in the insurance marketplace. Mercer ealth & Benefits Insurance Services LLC is providing this single insurer option on behalf of the California Pharmacists Association. In accordance with industry custom, we are compensated through commissions that are calculated as a percentage of the insurance premiums charged by insurers. We may also receive additional monetary and nonmonetary compensation from insurers, or from other insurance intermediaries, which may be contingent upon such factors as volume, growth or retention of business. This compensation may include payment from insurers for marketing-related expenses or investments in technology. Our compensation may vary depending on the type of insurance purchased and the insurer selected. We will provide you additional information about our compensation and information about alternative quotes, upon your request. You may obtain this information by referring to and entering the security code o or call us at for specific details. CA Ins. Lic. #0G39709 Mercer ealth & Benefits Insurance Services LLC CPhA CPhA.Insurance.service@mercer.com Sponsored by: Underwritten by: Liberty Insurance Underwriters Inc., Member of Liberty Mutual Insurance. 55 Water Street, New York, New York S. Figueroa Street Los Angeles, CA All coverages are subject to the terms and conditions of the policy. #4-460 (1/14) Copyright 2014 Mercer LLC. All rights reserved. 4

5 CPhA Professional Liability Plan FOR MEMBERS OF TE CALIFORNIA PARMACISTS ASSOCIATION ow to apply: Simply complete the application, enclose your premium check made payable to Mercer and mail to the address provided. All coverages elected must be under the same plan limits. All premiums are annual. Coverage is effective the date your application is approved and payment is received. Please allow three to four weeks for delivery of your Policy. Please print neatly or type all information. PART 1 Applicant (all applicants must complete) Last Name First Name Initial Business/Corporate Name/DBA (if applicable) (Complete only if you own this business.) Names of Owners, Partners and Corporate Officers who are active in the business and their professional occupations Address Date of Birth Daytime Phone City state Zip Fax Number Address Students Only Full Name of School scheduled Graduation Date Students Only Address of School City state Zip PART 2 Employed Individuals Annual limits and premiums $2 million per incident/occurrence $1 million per incident/occurrence $4 million annual aggregate $3 million annual aggregate Professional Liability Named Insured No products liability coverage is provided. premium premium Employed Pharmacists $ 130 $ 111 First-Year Graduate Rate $ 65 $ 56 Date of Graduation Pharmacy Technician $ 104 $ 89 Individual Employed Coverage is not available if you have employees or independent contractors working on your behalf. ALL APPLICANTS MUST COMPLETE & SIGN PAGE 4 OF TIS APPLICATION CONTINUE

6 PART 3 Self-Employed Pharmacist or Consultant Pharmacist If you own the business, or have employees or independent contractors, please complete this section. Annual limits and premiums $2 million per incident/occurrence $1 million per incident/occurrence $4 million annual aggregate $3 million annual aggregate Professional Liability Named Insured A premium must be paid for each owner active in the business. No products liability coverage is provided. A premium must be paid for each owner active in the business. Premium Premium Self-Employed (more than 20 hours per week) ( ) x $364 = $ ( ) x $311 = $ Self-Employed (20 hours or less per week) ( ) x $183 = $ ( ) x $156 = $ Self-Employed First-Year Graduate Rate ( ) x $182 = $ ( ) x $156 = $ Other ( ) x $ = $ ( ) x $ = $ (Please specify & contact administrator for premium.) A premium must be paid for each professional employee active in the business. Pharmacist employee ( ) x $130 = $ ( ) x $111 = $ Pharmacist Technician employee ( ) x $104 = $ ( ) x $ 89 = $ Other ( ) x $ = $ ( ) x $ = $ (Please specify & contact administrator for premium.) SUBTOTAL Section 3 $ $ Indicate which of the following describes your practice and answer the questions which follow the description. Self-Employed Pharmacist or Consulting Pharmacist (Must Answer) 1. Do you employ other professionals?... Yes No (If YES, a premium must be paid for all employees.) 2. Do you have partners, shareholders or other owners working with you in your business?... Yes No (If YES, a premium must be paid for all owners, partners or corporate members active in the business.) 3. Do you own a pharmacy... Yes No (If YES, include a copy of your General Liability Declarations Page) PART 4 Optional Coverages (Self-Employed Individuals and Business Applicants Only) Professional Liability Additional Insured (This optional coverage protects each facility under contract with the insured against claims arising out of the sole negligence of the insured. It should only be purchased if required by contract.) Premium is for each facility under contract. ( ) x $193 = $ ( ) x $165 = $ (List name and address of each facility on a sheet of letterhead.) General Liability (Locations must be owned or rented by the named insured) Do you currently carry General Liability Insurance?... Yes No If not, and you would like to purchase the optional coverage, please provide the following information: Type of pharmacy *Please note large retail chains or mail order pharmacies are not eligible to purchase General Liability coverage. Coverage for 1st location $140 $120 Each additional location ( ) x $ 59 = $ ( ) x $ 50 = $ List name and physical street address of each facility on a separate sheet of your letterhead. ALL APPLICANTS MUST COMPLETE & SIGN PAGE 4 OF TIS APPLICATION CONTINUE

7 PART 5 Premium Credits (Calculate Your Premium) Multiple Insureds Premium Credit: This credit is based upon the size of the group at the time coverage is purchased. Credits apply as follows: groups of 2 9 professionals = 4%, groups of professionals = 8%, groups of 15 or more professionals = 12%. Subtotal Premium (Section 2 or 3) Plus Optional Coverages (Section 4, if applicable) Total Premium Less Size-of-Group Premium Credit (if applicable) Total Premium Due (rounded to the nearest whole dollar) $ + $ - $ PART 6 All Applicants Must Answer Underwriting Questions 1. ave you or any of your employees ever had the following: professional license and/or your malpractice insurance revoked, suspended, refused, denied renewal, placed on probation, canceled, or voluntarily surrendered by you or any of your employees or is such an action pending? (If Yes, explain on a separate sheet of letterhead including dates and allegations.) State License or Certification... Yes No.Malpractice Insurance**... Yes No **Notice to Missouri Residents: This question does not apply. 2. as any claim or suit ever been brought against you or any of your employees, or are you or any of your employees aware of any incident that might reasonably lead to a claim or suit? (If Yes, explain on a separate sheet of letterhead including dates, allegations and amounts.)... Yes No I understand that I am not covered by this insurance for rendering or failure to render any professional services as the following: physician, surgeon, dentist, nurse midwife, nurse anesthetist, perfusionist, cytotechnologist, chiropractor, podiatrist, osteopath or psychiatrist. I understand that these professional occupations are excluded from coverage. I understand that this insurance will not apply to any partner, principal or owner of a residential/overnight facility. In order to enhance the stability of this professional liability insurance program, coverage has been organized through a purchasing group, pursuant to legislation, known as the Federal Liability Risk Retention Act of 1986, enacted by Congress. Coverage is provided to the purchasing group by Liberty Insurance Underwriters Inc. Once the completed application has been approved and the premium has been received, you will automatically become a member of the ACPGA Purchasing Group Association, located and domiciled in Illinois and obtain the insurance coverage afforded through the Group Policy on an annual term. This application is subject to the underwriter s approval. Your completion of this application and premium payment does not bind coverage or obligate the insurance company to issue you insurance coverage. Coverage will become effective following the receipt of your acceptable application and premium payment. Your application cannot be processed unless it is completed in its entirety. The application is subject to the company s underwriting rules. The undersigned, on behalf of all prospective insureds, after a reasonable inquiry, declares to the best of his/her knowledge and belief that the statements contained herein are true and are the basis of the acceptance of the risk or the hazard assumed by the Company under this Policy. It is further agreed by the undersigned, its Subsidiaries and their directors, officers and trustees, that the Policy, if issued, is in reliance upon the truth of such representations. It is agreed that, although the signing of the application does not commit the undersigned to purchase the insurance being applied for, the statements made in this Application shall become the basis of the Policy should one be purchased. The Company is hereby authorized to make any investigation and inquiry in connection with this Application deemed necessary. (ALL STATES EXCEPT AR, CO, DC, FL, I, KS, KY, LA, ME, MD, NJ, NM, NY, O, OK, PA, TN, VA, WA, WV): ANY PERSON WO KNOWINGLY AND WIT INTENT TO DEFRAUD ANY lnsurance COMPANY OR OTER PERSON, FILES AN APPLICATION FOR INSURANCE OR STATEMENT OF CLAIM CONTAINING ANY MATERIALLY FALSE INFORMATION OR CONCEALS, FOR TE PURPOSE OF MISLEADING, INFORMATION CONCERNING ANY FACT MATERIAL TERETO, COMMITS A FRAUDULENT INSURANCE ACT, WIC IS A CRIME. ALL APPLICANTS MUST COMPLETE & SIGN PAGE 4 OF TIS APPLICATION CONTINUE

8 Signature (required) you must sign and date this application Signature of Authorized Partner/Officer/Owner X Date X Title Printed Name Enclosed is my check for: $ Effective Date Desired* *May not be earlier than the date the administrator receives and approves this application. Make check payable to Mercer and return with this application to: Mercer, attn: Association Department, 777 S. Figueroa St., Los Angeles, CA I authorize Mercer ealth & Benefits Insurance Services LLC to charge my: VISA MasterCard Amount $ Credit Card Number Print name exactly how it appears on card Expiration Date Mercer ealth & Benefits Insurance Services LLC 777 S. Figueroa St., Suite 2200 Los Angeles, CA CPhA CA Ins. Lic. #0G39709 Underwritten by: Liberty Insurance Underwriters Inc., Member of Liberty Mutual Insurance. 55 Water Street, New York, New York ACAPP2037B-1000A (Ed. 12/2010) #4-460 (1/14) Copyright 2014 Mercer LLC. All rights reserved.

9 Pharmacists Professional Liability Supplemental Questionnaire California FOR MEMBERS OF TE CALIFORNIA pharmacists ASSOCIATION ow to apply: Simply complete the application AND TIS SUPPLEMENTAL QUESTIONNAIRE, enclose your premium check made payable to Mercer and mail to the address provided. All coverages elected must be under the same plan limits. All premiums are annual. Coverage is effective the date your application is approved and payment is received. Please allow three to four weeks for delivery of your Policy. Please print neatly or type all information. Applicant (All applicants must complete and sign the questionnaire.) Member Non-Member Name Business Type: Individual Corporation Partnership Joint Venture Other: For Students Only: Annual Limits and Premiums If you are a student, please complete this information: $2 million per incident/occurence $1 million per incident/occurrence $4 million annual aggregate $3 million annual aggregate Pharmacy Student Rate $53 $45 Enclosed is my check for: $ Effective Date Desired* *May not be earlier than the date the administrator receives and approves this application. I authorize Mercer ealth & Benefits Insurance Services LLC to charge my: VISA MasterCard Amount $ Credit Card Number Expiration Date Print name exactly how it appears on card Make check payable to Mercer and return with completed application and this supplemental questionnaire to: Mercer, attn: Association Department, 777 S. Figueroa St., Los Angeles, CA Signature (required) you must sign and date Signature X Date X Title Print Name Over, please

10 For more information, or answers to your questions, please call a Client Advisor at CPhA. Or us at CPhA.Insurance.service@mercer.com About Our Role and Compensation The California Pharmacists Association has selected Liberty Insurance Underwriters Inc., a member company of Liberty Mutual Insurance ( Insurer ) for this insurance program. Comparable insurance products may be available in the insurance marketplace. Mercer ealth & Benefits Insurance Services LLC is only offering CPhA s selected insurer quote proposal. In accordance with industry custom, we are compensated through commissions that are calculated as a percentage of the insurance premiums charged by insurers. We may also receive additional monetary and nonmonetary compensation from insurers, or from other insurance intermediaries, which may be contingent upon such factors as volume, growth or retention of business. This compensation may include payment from insurers for marketing-related expenses or investments in technology. Our compensation may vary depending on the type of insurance purchased and the insurer selected. We will provide you additional information about our compensation and information about alternative quotes, upon your request. You may obtain this information by referring to and entering the security code o or call us at for specific details. CA Ins. Lic. #0G39709 Mercer ealth & Benefits Insurance Services LLC Mercer ealth & Benefits Insurance Services LLC 777 S. Figueroa St., Suite 2200 Los Angeles, CA CPhA CA Ins. Lic. #0G39709 Underwritten by: Liberty Insurance Underwriters Inc., Member of Liberty Mutual Insurance 55 Water Street, New York, New York #4-460 (1/14) Copyright 2014 Mercer LLC. All rights reserved.