Professional Liability/Errors and Omissions

This is one of the most important managed care exposures that is often bought by HMOs but MSOs may not be aware of the importance of this coverage. Claims arise from normal operations of delivering service to the entity’s members. E&O liability coverage protects firms from allegations of management negligence, including the exposure area of vicarious liability, credentialing, peer review, provider selections, utilization review and claims processing. It is important that all managed care organizations, from small to large, that provide credentialing or utilization review for managed care plans should purchase E&O coverage.

Activities - Provider Selection, Utilization Review, Claim Services, establishing provider networks, sales/marketing or enrollment of HC plans, wellness programs, development of clinical guidelines, etc. plus a “catch all” for services or activities performed in the administration or management of healthcare or workers’ compensation plans.

Our ability to apply the facts and narrow the issues has benefited clients in controlling their cost and receiving valuable insurance protection. Thus, clients have benefited and appreciate our ability to broaden coverage without any extra premium such as the following to mention just a few: employment practices coverage, EMTALA coverage, Bilateral discovery, regulatory carve back for defense costs associated with Fraud and Abuse issues, government funding, health care benefit administration and sales endorsement (TPA), defense for Medical Director related to Medical Board of Examiners, etc.

• Credentialing, Utilization Review, Peer Review and Health Care Management
• Vicarious Liability - liability imposed upon an insured under theories of agency, ostensible agency, apparent agency or respondent superior as a result of the performance or non-performance of medical services by a contracted health care provider.
• Coverage for claims staff in the processing of claims, case management, provider credentialing, medical director, enrollment and processing, and marketing/contracting
• Employment Practices Liability (ERISA)
• Failure, Denial or Delay in Treatment
• TPA claims risk
• Medical Directorship Liability
• Medical Malpractice complaints or suits arising from Managed Care
• Telephone Triage Services and Call Centers
• UR, Claims Administration, Case Management, Advertising, Marketing & Selling Activities

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