Practitioner Indemnity Policy wording

1. About this policy

This document is the policy wording— the legal contract that, together with the Product Disclosure Statement and the Schedule, would set out the terms of cover between an insurer and an insured practitioner. It is written in the claims-made form that is standard for medical indemnity in Australia, meaning the policy that responds to a claim is the one in force when the claim is first made against you or notified to the insurer, not the policy in force when the incident occurred. Continuous cover and an appropriate retroactive date are therefore essential.

In this wording, “we”, “us”, “our” means the insurer named in the Schedule; “you”, “your”, the “insured” means the practitioner named as the insured in the Schedule. The contract is governed by the Insurance Contracts Act 1984 (Cth) and the law of the State or Territory shown in the Schedule.

2. Insuring clauses

Subject to the Schedule, the definitions, conditions and exclusions of this policy, and to the limit of indemnity, we agree to provide the following cover for claims first made against you and notified to us during the period of cover, arising from healthcare you provided on or after the retroactive date.

2.1 Part A — Civil liability

We will indemnify you for compensation and claimant’s costs you become legally liable to pay, and the reasonable legal costs of defending a civil claim, arising from a breach of your professional duty in the provision of healthcare. This includes claims relating to telehealth, breaches of patient privacy or confidentiality, defamation arising from your practice, and Good Samaritan acts.

2.2 Part B — Inquiries, investigations and disciplinary matters

We will pay the reasonable legal costs of representing you at a disciplinary inquiry, a registration-board or AHPRA investigation, a coronial inquest, a Medicare or professional-services review, or a criminal proceeding arising from your practice, subject to the sub-limit shown in the Schedule.

2.3 Part C — Loss of documents and tax-audit costs

We will pay the reasonable costs of restoring or replacing patient records lost or damaged, and the accounting costs of responding to an audit of your practice by a taxation authority, subject to the sub-limits in the Schedule.

Where the relevant Commonwealth thresholds are met, the High Cost Claim Scheme and Exceptional Claims Scheme may reduce the insurer’s exposure on large or catastrophic claims. Those schemes are described in the third person for context.

3. The Schedule

The Schedule individualises the policy for you. Your own schedule sets out the values that apply to your cover. The example below shows the form a schedule takes for a non-procedural general practitioner.

Premium figures shown in this example are confirmed on application, once scope of practice and history are assessed.

4. Definitions

Words in bold have the meaning given below wherever they appear in this policy.

• Claim— a demand for, or an assertion of a right to, compensation or damages; or the service of proceedings against you, arising from the provision of healthcare.
• Healthcare— the medical care, treatment, advice, diagnosis or services you provide in the practice of your profession within your declared category of practice.
• Period of cover— the period shown in the Schedule, unless cancelled earlier in accordance with this policy.
• Retroactive date— the date shown in the Schedule, before which healthcare you provided is not covered.
• Limit of indemnity— the maximum amount we will pay, as shown in the Schedule, inclusive of claimant’s costs and your defence costs.
• Excess— the amount shown in the Schedule that you must bear for each and every claim before we contribute.

5. Conditions

• Continuous cover. Cover under this claims-made policy depends on the policy being in force when the claim is made or notified. Cover may lapse if the policy is not renewed.
• Retroactive date. We provide no indemnity for any claim arising from healthcare provided before the retroactive date shown in the Schedule.
• Reasonable care. You must take reasonable care not to make a misrepresentation to us before entering into, varying, renewing or reinstating this contract, consistent with section 20B of the Insurance Contracts Act 1984 (Cth) for consumer insurance contracts.
• Maintaining registration. You must hold current, unconditional registration with the Medical Board of Australia for the practice covered, and comply with your conditions of registration.
• Other insurance. Where another policy or scheme also indemnifies you for the same matter, this policy applies only in excess of that other cover.

6. Exclusions

We will not provide indemnity for any claim, liability or loss directly or indirectly arising from:

• Pre-retroactive healthcare— healthcare you provided before the retroactive date shown in the Schedule.
• Known claims and circumstances— any claim, fact or circumstance that you knew about, or ought reasonably to have known about, or that had been notified to any insurer or medical defence organisation, before the start of the period of cover.
• Practice outside your category— procedures or healthcare outside the category of practice you declared and we agreed, or provided while you were unregistered or in breach of your registration conditions.
• USA / US territories jurisdiction— any claim brought, or judgment entered or enforceable, in the United States of America or its territories, or determined under their laws.
• Criminal, dishonest and intentional acts— any wilful, reckless, dishonest, fraudulent, malicious or criminal act or omission (legal costs for defending such allegations may be available under Part B subject to its sub-limit).
• Sexual misconduct. Liability arising from any sexual misconduct, assault or inappropriate relationship with a patient.
• Trade and commerce— liability arising from the manufacture or supply of goods, the ownership of premises, pollution, asbestos, or your conduct as an employer to the extent covered by workers’ compensation.
• Fines and penalties— fines, civil penalties, punitive, exemplary or aggravated damages, except where insurable at law.
• War, terrorism and radioactivity— the usual market exclusions for war, terrorism, nuclear and radioactive causes.

7. Claims conditions

• Notification. You must notify us in writing as soon as practicable, and within the period of cover, of any claim made against you or any fact or circumstance that may give rise to a claim. Late notification may prejudice your indemnity.
• No admissions. You must not admit liability, settle, or incur defence costs without our prior written consent.
• Conduct of the claim. We are entitled to take over and conduct the defence or settlement of any claim in your name, and to appoint lawyers. You must cooperate fully and provide all information and assistance we reasonably require.
• Subrogation. We may pursue, in your name, any right of recovery you have against a third party in respect of a matter we have indemnified.

8. Cancellation

You may cancel this policy at any time by notice to us; we may refund any unearned premium on a pro-rata basis, less reasonable costs. We may cancel only on the grounds permitted by the Insurance Contracts Act 1984 (Cth) — including where you have failed to comply with the duty to take reasonable care not to make a misrepresentation, have failed to pay the premium, or have made a fraudulent claim — by giving written notice.

9. Duties of the parties

Both parties owe each other a duty of utmost good faith under section 13 of the Insurance Contracts Act 1984 (Cth) in all dealings under this policy. You must pay the premium when due, comply with the conditions and claims conditions, and keep your declared category of practice and contact details current. We must handle claims fairly, in a timely way, and consistently with the service and claims-handling standards expected of general insurers in Australia.

10. Dispute resolution

We operate an Internal Dispute Resolution process that aims to resolve complaints promptly and fairly. If your complaint is not resolved to your satisfaction, you may escalate it, free of charge, to an independent external dispute resolution scheme, whose determinations can bind us up to applicable monetary limits. Full details of how to make a complaint are in your Product Disclosure Statement and Financial Services Guide.