* *

Similar documents
Professional Liability Insurance

3. SELF-EMPLOYED INDIVIDUALS Self-Employed is a professional who functions full or part-time as an independent agent with private patients, or as the

Academy of Nutrition and Dietetics ACDEMY-S 2. DEFINITIONS

RESIDENTS OF FLORIDA ONLY 1. APPLICANT INFORMATION (All applicants must complete. Please print all information.)

Your application must be in our office at least 30 days prior to your desired effective date

SPECIMEN HEALTHCARE PROVIDERS PROFESSIONAL LIABILITY COVERAGE PART OCCURRENCE

Professional Liability- Student Coverage through HPSO "Protects Your Academic Career and Your Future"

INDIVIDUAL PROFESSIONAL LIABILITY INSURANCE APPLICATION FOR MISCELLANEOUS ALLIED HEALTH PROFESSIONALS

MEDICAL MALPRACTICE 100% REINSURED BY CERTAIN UNDERWRITERS AT LLOYDS OF LONDON

THE MISSING PIECE IN COMPLETE BUSINESS PROTECTION PROFESSIONAL LIABILITY INSURANCE PROGRAM

PROFESSIONAL LIABILITY FITNESS TRAINERS

UNITED EDUCATORS ASSOCIATION, INC. EDUCATORS PROFESSIONAL LIABILITY INSURANCE SUMMARY

CHAPTER Senate Bill No. 1792

A GUIDE TO PURCHASING MEDICAL PROFESSIONAL LIABILITY INSURANCE

HEALTHCARE PROVIDERS PROFESSIONAL LIABILITY COVERAGE PART CLAIMS-MADE

* *

OCF 18 - TREATMENT PLAN USER MANUAL

UNIVERSITY OF ILLINOIS LIABILITY SELF-INSURANCE PLAN

Medicare Supplement. CI-AML-MSPBrochG-CO [R 814]

Thank you for inquiring about the AFA Short Term Recovery Insurance Plan (RecoveryCare).

HOME HEALTH CARE / TEMPORARY STAFFING APPLICATION

What Solo and Small Firms Need to Know about Malpractice Insurance

I understand that the insurance applied for will take effect on the date specified by The United States Life Insurance Company in the City of New York

CLUB GUIDE RISK MANAGEMENT

Helping provide financial security Medicare Supplement Insurance

Physicians, Surgeons, Dentists and Podiatrists Professional Liability Insurance Policy

COMMERCIAL INSURANCE PROGRAM HANDBOOK

Helping provide financial security. Medicare Supplement Insurance. Plans A, B, F, High Deductible F, G, N. California

LAND SURVEYORS PROFESSIONAL LIABILITY INSURANCE POLICY

Our Defense Never Rests

MEDICAL TESTING LABORATORY APPLICATION PLEASE CONTACT YOUR AGENT WITH ANY QUESTIONS AND TO RETURN COMPLETED APPLICATION

HOME HEALTHCARE/TEMPORARY STAFFING APPLICATION

MSP-NE. Medicare Supplement

LIQUOR LIABILITY COVERAGE FORM

CIVIL PRACTICE AND REMEDIES CODE TITLE 4. LIABILITY IN TORT CHAPTER 84. CHARITABLE IMMUNITY AND LIABILITY

ABUSE OR MOLESTATION LIABILITY COVERAGE PART

A guide for injured workers. Introducing WorkSafe. April 2014

Travel Assistance. Worldwide support for travellers in emergency medical situations

A guide for injured workers. Introducing WorkSafe. September 2011

Medical Practitioners Professional Liability And Legal Defense Reimbursement Policy

INDIVIDUAL PROFESSIONAL LIABILITY INSURANCE APPLICATION FOR ADVANCED PRACTICE NURSING PROFESSIONALS

COA Professional Liability Plan

MISCELLANEOUS MEDICAL PROFESSIONAL LIABILITY INSURANCE Claims-Made

A Worker's Guide to Workers Compensation From The Law Office of Robert M. Keefe

COLORADO SPECIAL DISTRICTS PROPERTY AND LIABILITY POOL WORKERS COMPENSATION COVERAGE DOCUMENT GENERAL SECTION

Insurance for Professionals

APPLICATION FOR MEMBERSHIP

Community Clinic Application for Claims-Made Professional Liability Insurance

Voluntary Student Accident Medical Insurance Program

What Solo and Small Firms Need to Know about Malpractice Insurance

LIQUOR LIABILITY COVERAGE FORM

PERSONAL INJURY CLAIM FORM

American Professional Agency, Inc.

Corporation and Partnership Professional Liability Application

VALUE ADDED SERVICES FROM A COMPANY YOU CAN TRUST

Victims Guide to the Defense Base Act: Your Next Steps

Amendment for Employer Indemnity Coverage ("Indemnity Amendment")

Professional Liability Application for Social Services With No Residential Exposure

NOTICE OF CLAIMS OR POTENTIAL CLAIMS

LIQUOR LIABILITY COVERAGE FORM

ACI MEDICARE SUPPLEMENT INSURANCE. Underwritten by American Continental Insurance Company. Pennsylvania. PLANS A, B, F, High Deductible F, G, N

AAA BENEFIT ENROLLMENT FORM AAA Group Accidental Death & Dismemberment Insurance Plan Name: Add 1: Add 2: City, St., Zip: Last First MI After the firs

Healthcare Professional Liability Insurance Mark Albi, Assistant Vice President Risk Management. Transition to Practice Workshop September 7, 2016

PUBLIC ENTITY PAK EMPLOYMENT PRACTICES LIABILITY COVERAGE

BCA Members: Insurance Information Pack

THIS PAGE IS INTENTIONALLY LEFT BLANK. * *

Volunteers Insurance Service Association, Inc.

GROUP HOSPITAL INCOME INSURANCE PLAN ENROLLMENT FORM

All about workers compensation. A guide for injured employees

Helping provide financial security Medicare Supplement Insurance

Supplement-65 District of Columbia. Find out why Medicare Supplement Coverage is so important

AREAS OF PRACTICE. Administrative Law. Alternative Dispute Resolution. Appellate Litigation. Asset Protection & Business Planning

Law and Order: Lawyers Professional Liability Policies (LPL) Beth Whitney Head of Small & Mid-sized Lawyers Swiss Re Corporate Solutions

Hospital and. Medical Services Insurance. Benefits. Eligibility. Out-of-Province Coverage

I request and authorize the AAA Group Insurance Program, G * * GMA-GI

Professional Liability Insurance for Chemical Consultants. Member ACS. Insurance. Insurance. Program. Plans

Insuring The Nurse s Liability: Comparing Corporate And Individual Policies

Chubb Elite Medical Malpractice Insurance

Helping provide financial security Medicare Supplement Insurance

Aon Malaysian Medical Indemnity

Income Protection+ Special arrangements for NHS doctors, surgeons, nurses and midwives

THE EXECUTIVE BENEFITS PLAN

Glossary of Malpractice Insurance Terms

PROVIDER MANUAL. Revised January Page 1

Continuum affordable insurance Plan for students who are completing their studies.

Will my RF-provided disability cover me while I am out of the U.S.? What if I am disabled by an accident, an act of terrorism or by an act of war?

CARE EXPERTISE THAT WORKS FOR YOU

SIXTY-FOURTH LEGISLATURE OF THE STATE OF WYOMING 2018 BUDGET SESSION

Nothing is more important than your health. With Pallas GlobalHealth, you get the best possible care in case of illness or injury.

To the best of your knowledge and belief, have you or your dependents (if applying for dependent coverage) ever received treatment or been medically a

CANCELLATION AND NON RENEWAL ENDORSEMENT MISSOURI

Guide. to Recovery Under The Illinois Workers Compensation Act. The Injured Employee s

To the best of your knowledge and belief, have you or your dependents (if applying for dependent coverage) ever received treatment or been medically a

FLORIDA EXTENDED PERSONAL INJURY PROTECTION

PERSONAL INJURY CASES

PAs. Insurance Primer. A Quick Guide For The Insurance You Need, In Language You Can Understand. FOR

THIS PAGE IS INTENTIONALLY LEFT BLANK. * *

COMCAST NBCUNIVERSAL WELCOME KIT FOR MEDICARE- ELIGIBLE INDIVIDUALS

Partnership / Corporation / Association Application for Claims-Made Professional Liability Insurance

Simple, smart solutions to supplement your Medicare coverage

Transcription:

marmoore_ahplfl-ahp Medical and Allied Health Professionals AHP S.C. WWW 0000481-0000001-0000052

*02390001000* 0000482-0000002-0000052

Administrator: Joan F. O'Sullivan, Licensed Agent 75 Remittance Drive, Suite 1788 Chicago, IL 60675-1788 1-800-503-9230 www.proliability.com S.C. WWW! 0000483-0000003-0000052

THIS PAGE IS INTENTIONALLY LEFT BLANK. *02400002000* 0000484-0000004-0000052

0000485-0000005-0000052

THIS PAGE IS INTENTIONALLY LEFT BLANK. *02410003000* 0000486-0000006-0000052

Professional Liability Insurance Program Allied Health Professionals Safeguard Your Financial Future With Your Own Professional Liability Coverage l l l More Opportunities, More Responsibilities, More Risk Do you supervise others? Follow doctors' orders? Monitor patients' reactions to treatment? Render counseling or advice? Provide professional services? If so, you are at risk of being sued for malpractice. As a healthcare professional, you've devoted years to study and training. Your skills and experience are constantly being tested...with emergency decisions, stressful conditions, and difficult patients or clients. How you respond can determine not only your professional reputation, but 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. That's why we strongly urge you to have your own Professional Liability Insurance. Protection You Can Count On, Now and in the Future Because our plan uses an "occurrence form," you are covered for designated professional services performed during the term of the insurance certificate...no matter when the suit or claim is made. You have this protection now and in the future for any claims resulting from covered services performed while the insurance certificate was in force. Employer Provided Coverage is Limited You can't rely solely on the liability protection provided by your employer. Without your own professional liability protection, you could end up paying all attorney fees, court costs and loss of wages out of your own pocket because... l There may be gaps in your employer's policy. l A suit may be filed after you have terminated employment. l Most employer-provided coverage does not cover you for actions that take place outside the workplace or for actions performed outside of your job description or when established procedure was not followed. l With employer-provided coverage, you have to share your coverage with your co-workers, your employer and the entity. l A consolidated defense for an employer usually represents the interest of the employer, not you. This protection is yours aloneindividual coverage is not shared among you, your co-workers and your institution. A qualified "consent to settle" clause enables you to make the final decision in settling your claims. And, it protects you if someone you supervise, and for whom you are legally liable, is named in a suit. Now You Know How You Can Protect Yourself The Marsh Affinity Group Services Professional Liability program written by Chicago Insurance Company, one of the Fireman's Fund Insurance Group is specifically tailored to fit the diverse needs of healthcare professionals. To apply for coverage, simply complete the enclosed application and send it in with your premium payment. Once your payment is received and your application is accepted your coverage will begin. Don't wait another day! Come Grow With Us... Marsh Affinity Group Services and Chicago Insurance Company have grown with the healthcare industry and are in a position to help you grow, as well. We will be with you each step of your career. As your Insurance Administrator, Marsh is equipped to insure all of your professional risks as your healthcare role evolves from student to practicing professional to self-employment, even retirement. Our solid experience in teaming with healthcare professionals like you guarantees insurance tailored to your needs. Our long relationship with Chicago Insurance Company (our insurance carriers), our expertise in your industry and our current product line will benefit you throughout your career. Consider us your home for insurance. We invite you to call us for more information; our friendly service representatives will be happy to answer your questions. A Company You Can Trust Marsh Affinity Group Services administers professional liability insurance programs for more than 200 professional associations, representing 15 million members worldwide. Our staff of trained professionals understands your needs. 0000487-0000007-0000052

Marsh Affinity Group Services and the Chicago Insurance Company have worked closely together to develop one of the most competitive professional liability insurance programs available for healthcare professionals. As the administrator of this program, Marsh Affinity Group Services, a service of Seabury & Smith, is dedicated to providing you with the customer service you deserve. Optional Coverages Self-employed Individuals & Group Practices may also purchase the following: l Entity Coverage Separate Limits of coverage equal to those selected for the professional members are available for the entity, up to 1 million/3 million, for an additional premium. This feature protects the entity with a separate set of limits for its liability. l General Liability Provides coverage for non-professional liability claims resulting from business operations, either on or off your business property. l Additional Insured Protects a healthcare facility you provide services for against claims arising out of the sole negligence of the persons insured. You should only purchase this coverage if the facility requires you to. For Individuals: l a qualified "consent to settle" clause which requires your consent to settle claims. l loss of earnings 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. l reimbursement of defense costs up to $5,000 per incident / $10,000 annual aggregate for the investigation or defense of all proceedings before any entity responsible for regulating your professional conduct (i.e., licensing board). l expense reimbursement up to $5,000 for legal representation for depositions related to your professional duties. This coverage applies when you are not named in a claim but are required to be deposed, for instance, as a witness to the event. l locum tenens coverage provides coverage when another professional temporarily assumes your duties and provides services on your behalf for a specific period of time. The locum tenens shares in the limits of the professional being replaced. For self-employed only. l managed care contracts are specifically addressed; if you assume liability in a contract, you will be covered for negligent acts, for which you are solely responsible. l reimbursement for first aid expenses, providing up to $2,500 for medical supplies when you respond to an emergency. l $500 coverage is provided for damage to the property of others if unrelated to your professional duties. l assault coverage is provided up to $5,000 per assault/ $10,000 annual aggregate and includes travel to and from the workplace. l supplemental liability for non-business pursuits provides bodily injury and property damage coverage for occurrences not related to professional duties. l medical payments coverage pays up to $1,500 per person (maximum $75,000 for all persons) for non-business pursuits if someone is injured in or around your home, for example. l legal fees and court costs are paid in addition to your limits of liability. l covers you anywhere in the world provided the claim is made or suit is brought within the United States, its territories or possessions, or Canada. For Group Practices: l for qualified group practices, a premium credit is available. Depending on the number of professionals in the group, credits range from 4% to 12%. l each professional member of an insured group will have a separate annual aggregate limit. l volunteers are automatically covered. l a qualified "consent to settle" clause which requires your consent to settle claims. l "Products Hazard" coverage for equipment specifically designed, made or altered for a patient or client. l loss of earnings 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. l reimbursement of defense costs up to $5,000 per incident/$10,000 annual aggregate for the investigation or defense of all proceedings before any entity responsible for regulating your professional conduct (i.e. licensing board). l expense reimbursement up to $5,000 for legal representation for depositions related to your professional duties. This coverage applies when you are not named in a claim but are required to be deposed, for instance, as a witness to the event. l locum tenens coverage provides coverage when another professional temporarily assumes your duties and provides services on your behalf for a specific period of time. The locum tenens shares in the limits of the professional being replaced. l managed care contracts are specifically addressed; if you assume liability in a contract, you will be covered for negligent acts, for which you are solely responsible. l reimbursement for first aid expenses providing up to $2,500 for medical supplies when you respond to an emergency. l assault coverage is provided up to $5,000 per assault/ $10,000 annual aggregate and includes travel to and from the workplace. l moonlighting coverage for business owners' professional activities. l legal fees and court costs are paid in addition to your limits of liability. *02420004000* 0000488-0000008-0000052

l covers you anywhere in the world provided the claim is made or suit is brought within the United States, its territories or possessions, or Canada. Our professional staff will answer your questions. If you have any questions about your coverage, please call Marsh Affinity Group Services toll-free at 1-800-503-9230. One of our knowledgeable service representatives will be happy to assist you. About This Program This brochure contains a summary of the insurance certificate provisions. If there is a conflict between this brochure and the actual insurance certificate, the insurance certificate language will control. Administrator: Affinity Group Services a service of Seabury & Smith Joan F O'Sullivan, Licensed Agent 75 Remittance Drive, Suite 1788 Chicago, IL 60675-1788 1-800-503-9230 www.proliability.com CA-0633005 Underwritten by: Chicago Insurance Company, one of the Fireman's Fund Insurance Companies. Restrictions This program is designed to provide professional liability insurance protection. All rates and coverages are subject to the terms and conditions of the policy and may vary by state. You are not covered while operating a motor-driven vehicle, when engaged in any other business outside your professional duties, when engaged in an unlawful action, or when acting as a proprietor, owner, partner, manager, superintendent, or officer of any hospital, sanitarium, medical clinic, health maintenance organization, managed care facility, foster care agency, adoption agency or any other facility not specified in the declarations. You are not covered when acting as a colon therapist, chiropractor, cytotechnologist, dentist, nurse midwife, osteopath, perfusionist, physician, podiatrist, psychiatrist, sonographer, surgeon, or any other medical specialist not named in the declarations. See insurance certificate for complete list of exclusions. œ Seabury & Smith, Inc. June 2006 PLPA 0000489-0000009-0000052

THIS PAGE IS INTENTIONALLY LEFT BLANK. *02430005000* 0000490-0000010-0000052