Coverage & Discounts

Medical Professional Liability Insurance coverage is typically offered on a claims made or occurrence basis. Excess coverage is also available to those who qualify.

Occurrence Form:
In accordance with the terms and conditions of the MLMIC policy, coverage is provided for claims arising from your professional services rendered during the policy period regardless of when the claim is reported.

Claims Made Form:
In accordance with the terms and conditions of the MLMIC policy, coverage is provided for 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.

Excess Coverage
The New York State Excess Liability Program provides an additional layer of insurance protection, over and above the standard primary limits of $1.3 million each person/$3.9 million total.

 

Additional Claims Made Information

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%
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 autho- rized insurer on a claims made basis for 10 or more consecutive years; or (c) regardless of age, if the insured permanently and totally 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 ex- pense 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 profes- sional 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.”

Optional Coverages

Defense Costs Coverage
For an additional premium charge, physician policyholders who qualify 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, that involves allegations which could form the basis of a claim of legal liability under the policy and (2) a governmental proceeding alleging Medicare/Medicaid fraud or abuse related to violation of Medicare or Medicaid guidelines involving allegations that you presented an erroneous claim seeking payment for reimbursement. 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. A Professional Entity is “the professional service corporation, professional limited liability company, partnership or limited liability partnership” of an insured physician.

To be eligible to qualify 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 mid-level practitioners in the practice must be acceptable based on MLMIC’s underwriting standards; and,
  • All members, employed physicians and/or mid-level practitioners must carry individual limits of insurance of at least $1,000,000 Each Person/$3,000,000 Total limit.

Optional Endorsements

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).

Employee Coverage

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 in accordance with the terms and conditions of the MLMIC policy 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 of 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.

Payment Options

Quarterly Installment Payments – Four equal payments
Quick Payment – A 2% premium credit is applied to physicians and surgeons for prompt payment of the full annual premium upon receipt of the invoice.

Discounts

MLMIC provides a number of discount opportunities to help lower your premiums:

With the exception of the Claim Free Discount, none of the
following discounts are available to physicians and surgeons who are 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.

New Doctor Discount will not be applied concurrently with the Claims Free or Part-Time discounts.

Part-Time Discount
Physicians and surgeons who limit their medical practice to 20 hours a week or less of medical practice – Classes 1-8 and 11 – 35%; Classes 9, 10 and 12-23 – 50%.

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

Claims Free Discount
7.5% to qualified physicians and surgeons who (1) have been continuously in practice for a minimum of five years and (2) have no open claims (or suits) and no closed claims (or suits) with indemnity or expense within the past 5 years (regardless of the accident date or report date).

12% to qualified physicians and surgeons who (1) have been continuously in practice for a minimum of 10 years and (2) have no open claims (or suits) and no closed claims (or suits) with indemnity or expense within the past 10 years (regardless of the accident date or report date).

Voluntary Attending Physician (VAP) Discount 12%
Eligibility requirements for physician policyholders include:

  • Principal affiliation with a MLMIC insured hospital
  • Agreement to participate in a combined legal defense
  • Participation in mandatory risk management and loss control programs.

MLMIC Excellus Credentialed Physician Insurance Program (ECPIP) Discount 12%
Eligibility requirements for physician policyholders include:

  • Credentialed provider for Excellus Health Plan, Inc. in the upstate area
  • Agreement to voluntary non-binding arbitration
  • Agreement to participate in a combined legal defense
  • Participation in mandatory risk management and loss control programs.

New York State Excess Liability Program

The Excess Liability Program was established by New York State legislation and later extended under Section 18 of the Medical Malpractice Reform Act. As a result, this program is often referred to as Section 18 Excess Professional Liability Coverage. This coverage provides an additional layer of insurance protection, over and above the standard primary limits of $1.3 million each person/$3.9 million total. This additional coverage is made available to physicians, surgeons, and dentists in New York State who meet the eligibility requirements and is offered at no additional cost to those who qualify, as outlined in the State regulation.

How to Qualify
In order to be considered for Section 18 Excess Professional Liability Coverage, a physician, surgeon, or dentist must meet the following eligibility requirements:

  • Maintain a primary affiliation with a New York state general hospital.
  • Render emergency medical services at the primary affiliated general hospital from time-to-time.
  • Maintain primary medical professional liability coverage with limits of $1,300,000/$3,900,000 with a carrier authorized to do business in New York.
  • Complete a qualified risk management course within the two years prior the excess policy effective date.

It should also be noted that each hospital is allotted a specific number of slots for physicians, surgeons and dentists who have met the requirements outlined above. Enrollment in the program is open to new applicants from July 1 through December 31. Applicants new to Section 18 are placed on a wait list until the hospital’s additional eligible slots are released by New York State, and the hospital has reviewed and approved its new applicants. Not all new applicants will have an available slot, as determined by their affiliated hospital.

For more information about excess, please call (888) 672-1844. Or download an application.