7 Essential Questions Every Optometrist Should Ask Their Employer About Their Group Malpractice Insurance Policy

Some employers offer a group malpractice insurance policy for the doctors of optometry practicing within their group. These malpractice insurance policies may offer opportunities for discounted premiums, but, depending on the policy type, may have gaps in coverage. Lockton Affinity, AOAExcel’s endorsed malpractice insurance provider, suggests asking your employer these seven questions about your group malpractice insurance policy.

• Can I have a copy of the policy documents? The best place to start is by asking your employer if you can have a copy of the policy documents so you can assess whether you’ll need to purchase additional coverage. If your employer agrees to provide you with a copy of the policy documents, AOA members can submit them for a complimentary review by Lockton Affinity, who can help you identify gaps in the coverage.

• Who pays the premium? If your employer provides a group policy, they may cover the premium as part of your compensation package, or you may be responsible for paying your portion of the premium. If you are not satisfied with the coverage in the group policy and you are responsible for paying your portion of the premium, you may want to ask your employer if you can obtain your own separate malpractice insurance policy.

• What type of policy is it? There are two common malpractice insurance policy types: claims-made and occurrence. Occurrence policies provide coverage for incidents that occur during the policy period, even if the claim is not filed until after the policy period has ended. Claims-made policies, however, provide coverage only for claims that occur and are reported while the policy is in effect. With a claims-made policy, additional coverage called tail coverage is necessary to protect you in the case a claim is made after the policy is terminated. If your employer provides a claims-made policy, you will need to discuss with your employer who is responsible for purchasing tail coverage if the policy ends.

• What are the limits? Knowing the limits of your employer-provided coverage will give you an idea of how much coverage is available to you in the event that you are named in a claim. Some insurance companies and vision plans have minimum coverage requirements for participation as a provider and knowing the limits of your policy can help you ensure you meet those requirements.

• Are the limits shared or individual? If your group malpractice insurance policy has shared limits, you and all other named individuals on the policy will share the same policy limit. This could potentially reduce the amount of coverage that is available to you if a claim is filed against another named individual on the policy, as the associated expenses for the claim will be pulled from the shared limit amount. Some group policies, however, have individual limits for each named individual. With this type of policy, your limits will not be impacted if a claim is filed against another named individual on the policy.

• What are the exclusions in the policy? Most malpractice insurance policies contain exclusions which outline instances in which a patient might file a claim that the malpractice insurance provider would not provide coverage for. Common exclusions include intentional violation of a law, libel or slander, or services provided under the name of an organization that is not named in the policy as a covered insured. Some policies, however, may contain exclusions that can be left open to interpretation and some policies may contain surgical exclusions, which may leave you unprotected for common procedures. Procedures associated with the following ICD-10 codes can often fall within a surgical exclusion:
  • 65205 – Removal of a foreign body, Conjunctiva
  • 65222 – Removal of corneal foreign body, Cornea
  • 65435 – Adjust tissue, Corneal debridement
  • 66984 – Ophthalmology co-management
  • 68761 – Punctal plugs, Closure of puncta

• Will the policy cover me for work done outside the employer’s facility or for work not included in my official job description? Some malpractice insurance policies are written to limit the scope of coverage to work that you do for the employer who owns the policy and to tasks that fall within your official job description. If you work in more than one practice or volunteer at a clinic, for example, you may need to purchase additional coverage to protect you for work done outside the scope of your employer-provided coverage.

If you think you may need to obtain your own malpractice insurance policy in addition to your employer-provided coverage, as an AOA member you can receive a malpractice insurance quote in less than thirty seconds from Lockton Affinity.

This content was provided by Lockton Affinity, AOAExcel's strategic partner. Available insurance products include professional liability, cyber liability, business owners' insurance, employment practices liability insurance, and much more. To learn more, visit AOAInsuranceAlliance.com or contact Lockton Affinity at Info@AOAInsuranceAlliance.com.