The Silent Policy: How One OD Discovered a Major Flaw in Their Malpractice Insurance Policy

May 8, 2023
Read the story of an OD left vulnerable by their insurance carrier and learn how you can protect yourself from unclear coverage
Man signs insurance policy document

An AOA member recently reached out to AOAExcel endorsed business partner Lockton Affinity for a complimentary review of their malpractice insurance policy. The OD held an existing policy with a nationally-recognized, Fortune 1000 insurance provider for years. The OD wasn’t exactly sure what procedures were covered, so they took advantage of an AOA member benefit and submitted their policy for a complimentary review to be safe. It’s a good thing they did—when the team at Lockton combed through the doctor’s 36-page policy, Lockton discovered that the policy didn’t define scope of coverage and didn’t make note of any exclusions. In other words, it was what some in the industry call a silent policy.

A silent policy is a policy that does not explicitly refer to or specify one or more aspects of coverage, such as a particular procedure or exclusion. It’s up to insurance adjustors to determine claim coverage—and you should confirm the adjustors working on your claims have experience with optometry related claims. Under a silent policy, the adjustor works to determine if the intent of the policy is to provide coverage for the reported claim.

In this case, the AOA member determined that it was too risky to rely on malpractice insurance that didn’t specify scope of coverage. After the complimentary review, the OD received a quote for a comprehensive policy from Lockton Affinity that covered all of the procedures they performed on daily basis. The OD received quick and detailed answers to their questions from a Lockton representative, who had extensive knowledge of the optometric industry and its particular requirements. After comparing costs and benefits, the AOA member decided to make the switch.

3 steps to determine whether you have a silent policy:

  1. Locate your full policy document—not just the two-page certificate of insurance.
  2. Contact your malpractice insurance broker and ask them to show you where in your policy the procedures you’re covered for are clearly outlined.
  3. If you aren’t 100% sure after speaking with your insurance broker, click here to submit your policy to Lockton for a complimentary policy review.
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