PHYSICIANS AND SURGEONS – NEW YORK STATE

Medical Professional Liability Insurance coverage is offered on either a claims made or occurrence basis.

Occurrence Form:

Covers claims arising from your professional services rendered during the policy period regardless of when the claim is reported.

Claims made Form:

Covers claims arising from your professional services rendered on or after the retroactive date specified in your policy and before the end of the policy period which are first reported while your policy is in effect or during an extended reporting period.

Click here for further information on Claims made and Occurrence coverage.

Optional Reporting Endorsement (Tail) Coverage for Claims Made Policies

This coverage is available to claims made policyholders to provide protection for covered claims which are first reported after "termination of coverage." “Termination of coverage” includes cancellation/non-renewal of the policy, a decrease in limits, a reduction in coverage, an increase in deductible or self-insured retention, a new exclusion or any change in coverage less favorable to the insured whether made by the insurer or the insured at any time.

The cost for Tail coverage related to "termination of coverage" due to cancellation or non-renewal is based on a percentage of the occurrence rate(s) in effect at the time of cancellation, taking into consideration adjustments for changes in classification, territory, and limits during the coverage period. Those percentages are:

First Year	74.8%
Second Year	122.1%
Third Year	146.4%
Fourth Year	162.4%
Fifth Year	173.3%
Sixth Year	181.0%
Seventh Year	186.7%
Eighth Year and thereafter	190.6%

The cost of Tail coverage related to "termination of coverage" other than cancellation or non-renewal will be calculated in accordance with the rating method established by New York Regulation.

Waiver of Premium for Tail Coverage

The costs related to Tail coverage will be waived for a natural person named insured when termination of coverage is due to (1) death, (2) permanent and total disability, or (3) permanent and total retirement from the practice of medicine (a) after attaining the age of 65 or older and being insured by an authorized insurer on a claims made basis for 5 or more consecutive years; (b) after attaining the age of 55 or older and being insured by an authorized insurer on a claims made basis for 10 or more consecutive years; or (c) regardless of age, if the insured retires and has maintained claims made coverage with an authorized insurer for at least 10 consecutive years, provided the last five consecutive years were through MLMIC.

Prior Acts (Nose) Coverage

Claims made applicants, who are presently covered on a claims made basis by certain acceptable insurers, may avoid the expense of purchasing Tail coverage with their prior insurer by securing the Prior Acts (Nose) coverage through MLMIC. Nose coverage provides protection, in accordance with the terms and conditions of the MLMIC policy, for claims arising from professional services rendered during the coverage period with the prior insurer which are first reported after the inception of the MLMIC policy.

The premium for Nose coverage is included in the claims made rate level that reflects the total number of years for continuous claims made coverage. For example, if you had 3 years of claims made coverage with another insurer, you would be rated at the 4th year claims made rate with MLMIC.

Your prior years of coverage with a New York State licensed insurer will be credited toward the requirements for prepaid retirement Tail coverage described in the previous section entitled "Waiver of Premium for Tail Coverage."

Defense Costs Coverage

For an additional premium charge, qualified physician policyholders may purchase coverage for the costs of defending (1) an administrative action brought against a physician by a governmental body, such as the Office of Professional Medical Conduct, arising out of allegations which could form the basis of a claim for legal liability under the policy and (2) a governmental proceeding alleging Medicare/Medicaid fraud or abuse related to violation of Medicare or Medicaid guidelines arising out of filing an erroneous claim. Limits of liability of either $25,000 or $100,000 are available to qualified physician policyholders.

Professional Entity Coverage

Separate limits of coverage up to $1,000,000 Each Person /$3,000,000 Total may be available to a Professional Entity for a premium charge. Professional Entity is "the professional service corporation, professional limited liability company, partnership or limited liability partnership of an insured physician." This coverage also affords protection to certain qualified employees of the Professional Entity that share its limits of liability.

To be eligible for coverage, the Professional Entity must meet the following eligibility requirements:

• MLMIC must insure at least 75% of the members and/or employed physicians of the entity;
• The Professional Entity must be incorporated in New York State;
• Members and employed physicians, surgeons, or physician extenders in the practice must be acceptable based on MLMIC's underwriting standards; and,
• All members, employed physicians and/or physician extenders must carry individual limits of insurance of at least $1,000,000 Each Person/$3,000,000 Total limit.

You may select either one, not both:

Waiver of Consent to Settle a Claim

This endorsement is available to individual named insureds for a premium reduction of 5%.

Deductible

An indemnity deductible of $5,000 each claim is available to named insureds for a premium reduction of 1.4% of the $1,000,000/$3,000,000 rate (regardless of individual limits of liability).

Professional liability coverage is available to certain employees of a physician practice. Employees of a MLMIC insured physician or surgeon may apply for a separate policy with individual limits of liability that provides coverage within the scope of employment for the physician practice.

If a physician practice purchases Professional Entity Coverage, then certain qualified employees of the entity are afforded coverage and share the entity’s limits liability.

Disclaimer:

All provisions contained in the policy are subject to prior underwriting approval and may vary. Nothing contained in this website shall be construed as an offer of coverage or as an interpretation of the coverage contained in the policy, either in whole or in part. Actual coverage would be determined by, and is subject to, all the terms and conditions of the policy, endorsements, application, and any legitimate claim.

The following discounts are available to physicians and surgeons who are not participants in the MLMIC Voluntary Attending Physician Program or Upstate Professional Liability Association.

New Doctor Discount - applicable to physicians and surgeons who enter private practice (solo or group) immediately following the completion of training:

Claims Made Policies - 50% first year; 25% second year; 25% third year;
Occurrence Policies - 50% for one year.

Part-Time Discount - physicians and surgeons who require coverage for 20 hours a week or less of medical practice - Classes 1-7 - 35%; Classes 8-18 - 50%.

Risk Management Discount - 5% to physicians and surgeons who satisfactorily complete a qualified Risk Management Program.

New Doctor and Part - Time discounts will not be applied concurrently.

Quarterly Installment Payments – Four equal payments

Prompt Payment - A 2% premium credit is applied to physicians and surgeons for prompt payment of the full annual premium upon receipt of the invoice.

MLMIC’s Merit Rating Plan, our peer review for physicians and surgeons, is based on the system of peer review employed by MSSNY for over 45 years and is unique among medical professional liability carriers.

MLMIC's Merit Rating Plan, the only plan of its kind approved by the New York State Insurance Department, permits a true peer review process regarding loss experience rather than automatic surcharges and cancellations. MLMIC never automatically non-renews or surcharges a policy on the basis of claims history without first submitting it for review by your peers. The success and strength of our peer review system makes us the only medical liability insurer not required to use the State's mandated automatic surcharge schedule.