NP Malpractice Insurance

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How to Shop for NP Insurance Coverage

Np Insurance is essential. Learn how to avoid malpractice claims, learn how to protect yourself as an APRN,  learn why you should have Nurse Practitioner Professional Liability Insurance and learn how to compare Nurse Practitioner Insurance quotes.

Advanced Practice Registered Nurses have gained more autonomy in the last decade in the USA. With increased autonomy comes increased accountability and thus a steady rise in malpractice claims.

Who collects all the data surrounding Malpractice claims?  The National Practitioner Data Bank was established in 1986 and helps protect the public. The NPBD prevents medical professionals from evading disclosure of previous malpractice claims by moving across state lines. The Mission statement of the NPDB is to “improve health care quality, protect the public, and reduce health care fraud and abuse in the USA. The site has impressive infographics for health care professionals.

What we are taught as nurses. We are taught that full transparency and honesty with the patient and family will reduce suits and claims. We are taught to stay within our scope of practice within our state practice act.  Not so difficult right? So where exactly are all of these claims coming from? What specialty is driving up these numbers? What is the distribution of allegations?

According to the CNA Health PRO Nurse Practitioner claims data from 1998 – 2008 the following findings has been observed:

  • Wrongful death is the most frequently associated factor.
  • The Pediatric Neonatal specialty has the highest average severity.
  • Scope of practice allegations are rare. Hmm…So where exactly are these incidents occurring? The medical care office is the location with the highest number of claims. As an aside, payments overall are increasing.

What about us PMHNP’s in the field of mental health?  Psychiatric claims make up 5.2% of the claims by specialty (Adult/Geriatric at 52.2%). Keeping this in mind, it makes sense that we should have the most affordable insurance rates, correct? Yes, and maybe.  The premium varies depending on the state in which you are insured and the history of other claims against you and your specialty.  Breaking the data down a little further, we learn that most allegations are related to diagnosis (39%), treatment (28%) and medication (17%).

The diagnosis issues are related to the failure to correctly diagnose.  The medications issues are related to the prescribing of the wrong medication (33%).  The second most common medication issue is related to prescribing the wrong dose (16%).

Prevention. So how do you protect yourself as a PMHNP? You must purchase Nurse Practitioner Liability insurance. (It is tax deductible). You should know the boundaries of your scope of practice within your respective state.

Other potential pitfalls include practicing with an expired license.  Documentation errors and documentation shortcomings are a big problem. Make sure you document all pertinent patient discussions that occurred in person or on the phone. Document refusals, missed appointments and efforts to contact the client. Screen for depression and suicidality.

Utilize a sound resource like Eopcrates or up to date when fact checking your prescribing decisions and dosing. Finally, review the top 10 things every PMHNP should know about writing a prescription here.

Before you start NP insurance shopping…. learn the basic lingo.  There are a few key terms that you need to know to have a meaningful conversation with an insurance sales agent. This will ensure you understand what you get with the specific Nurse Practitioner Liability Insurance you purchased.

First up, you need to understand the basic NP Insurance coverage options. You have occurrence based policies vs. claims made policies. The difference here is crucial because you don’t want to mistakenly think you got a better deal than your colleague, only to realize you are comparing apples to oranges.

Occurrence Based Policies are what most clinicians desire. However, it is not always available in each state and it is the more expensive option. So why does it cost more money?  Occurrence based policies cover you for any claim during the period the incident occurred even after you cancel the policy. The dates within the time you were insured remain covered despite you moving on. In other words, its lifetime policy.  Let’s say a patient files a claim in 2018 for an issue in 2017 and you retired in 2017. The policy covers you for that claim even though you have not paid for that insurance into 2018.

Claims made policies. These policies only cover you if you continue to pay the premium for your NP Insurance policy.  The coverage is valid during the policy period unless you purchased an extension called a policy tail. The extended reporting endorsement or tail is not often cheap.

Policy lingo translated

Limits. The first number is the max per claim and the second is the aggregate or total amount the insurance company will pay for all claims during the policy period. For Example; $1,000,000/$3,000,000 means the company will pay $1,000,000 for each claim, up to 3 claims in that year.

Deductible. Just like auto insurance. This is the amount you are responsible to pay before the insurance company picks up the remainder of the charges or settlement.

Exclusions. A list of situations that your insurance company refuses to pay for because you were way out of your scope or engaged in criminal activity.

Policy settlement provisions. The need to understand if the insurer will settle a claim without your consent. This is critical because you want to minimize what goes on your professional record whenever possible.

Contractual obligation. The need to notify your insurance company immediately of any concerning issues, so they can help prepare for defense. Stalling here may void your coverage. Additionally, don’t talk about the suit with others who may ultimately provide the plaintiff with information

Learn who pays for the defense costs.  Does the policy cover nursing board defense costs or licensure protection coverage? Additionally, you want to ensure costs such as legal fees and court fees are covered.

Indemnity claims.  An indemnity is an obligation by the party to compensate another for loss. For example, your employer goes after you for losses paid out in a settlement to an injured patient.

A.M. Best rating.  The insurance company has a benchmark rating scale, so we can compare across the industry to determine if the insurer can meet their financial obligation to you (the policy holder).  A++ Superior. A, A- Excellent, B++, B+ are very good. D is poor, and E is under supervision. The take home here is make sure the insurer is rated at a minimum of A-.


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