Consultants work hard to deliver good quality healthcare but sometimes, even with the best experience and training in the world, things can go wrong. Often, these mistakes can have serious financial consequences for a patient, and therefore, the consultant.

If a patient has suffered harm as a result of a consultant’s negligence, it’s very important that the consultants have adequate and appropriate insurance (or indemnity) to compensate the patient.

Medical indemnity insurance responds to an accusation of medical malpractice, where the medical professional service provided was allegedly substandard, and caused physical or mental harm, injury or death to a patient.

Medical indemnity insurance is designed to protect the consultants during the claims process, including any costs and defence fees arising from the claim. In cases where malpractice is proven, compensation is paid to the patient.

Sadly, our society is becoming more and more litigious and the risk of legal action against a consultant for medical malpractice is increasing every day.

Membership of Incision includes Medical Indemnity insurance with a “claims made” insurance policy.

Our “claims made”Medical Indemnity insurance policy will cover you for “circumstances reported” or “claims made” during the period of insurance or extended reporting period (this is run off cover in respect of death, permanent disablement or retirement from independent practice).

So, as long as you are a member at the time the circumstance is reported, or the claim is made the claim will be accepted. This is also dependent on the incident occurring on, or after, your retroactive date and is subject to the policy’s terms and conditions.

You must notify Incision when you first become aware that a circumstance, a claim or an investigation is made against you. This must be done as soon as reasonably practicable and in accordance with the terms and conditions of the policy.

Please note that you will not be covered for claims, or circumstance arising from incidents, that occurred prior to your retroactive date. Matters that are previously known by, or have been notified to, you, your prior insurer(s) or Medical Defence Organisation (MDO) will also be excluded.

Consultants working for the NHS (or for the HSC in Northern Ireland) will receive indemnity for medical malpractice claims through one of the following clinical negligence schemes:

• the Clinical Negligence Scheme for Trusts in England (which is administrated by the NHS Resolution)
• the Welsh Risk Pool Services in Wales
• the Clinical Negligence and Other Risks Indemnity Scheme in Scotland
• each HSC Trust (funded by the Department of Health, Social Security and Public Safety) in Northern Ireland

Consultants should be aware that these schemes do not cover personal regulatory and medico-legal support and advice for work performed in the NHS or for HSC unless this is unindemnified work that you have declared to us in your application. 

Currently, there is no statutory requirement for consultants solely working for a trust or board in the NHS or HSC to purchase medical indemnity insurance.

However, in order to practice in the UK, the General Medical Council (GMC) stipulates that consultants with an independent practice (including any medico legal work) must have “adequate and appropriate insurance or indemnity in place”, even if the independent practice is performed at NHS or HSC premises.

As a minimum requirement to be registered to practice in the UK, the GMC recommends that consultants purchase Medical and Professional Liability for claims arising from (i) any independent practice, whether this work takes place on NHS or HSC premises or not or (ii) medico legal work, if this work requires a licence to practise.

The GMC also suggests that consultants should:

• consider commercial legal protection for costs arising from fitness to practice procedures, GMC inquiries, coronial inquests or hearings etc.
• take out adequate and appropriate insurance or indemnity for the provision of medical care in emergencies outside work (Good Samaritan acts) and voluntary medical care (good neighbour acts).
• organise appropriate cover for liabilities that arise from independent practice after retirement.
• arrange medico legal support for advice and assistance.

In theory, the legal response regarding the required appropriate cover is:

“Cover against liabilities that may be incurred in practising as a doctor having regard to the nature and extent of the risks of practising as such.”

In practice, in order to comply with the GMC guidelines, consultants will need Medical Indemnity that covers the full scope of their independent practice.

Membership of Incision provides con with a comprehensive and competitive contract of insurance (not discretionary) tailored to individual practice profiles. The cover has limits up to £20m from any one claim and £40m in the annual aggregate, access to 24/7 medico-legal advice and risk management videos and articles.

Available coverage for Medical Professionals is up to £10m from any one claim and £10m in the annual aggregate.

There are a number of potential pitfalls if a consultant doesn’t purchase adequate or appropriate medical indemnity insurance; such as:

• Removal of a consultant’s licence by the GMC. The GMC has regulatory powers to check whether consultants have adequate insurance or indemnity and penalise consultants if they deem it necessary.
• Losing practicing privileges at independent hospitals. It is unlikely that a consultants will be granted practicing privileges, or be allowed to continue working, at any of the independent hospitals, if they don’t purchase medical indemnity insurance.
• Consultants may be personally liable to pay compensation to a patient if their medical indemnity cover is insufficient.

According to the GMC, it is the responsibility of the consultant to ensure that they have adequate insurance in place. Then their patients will not be disadvantaged if they need to make a claim for compensation.

It is therefore very important for consultants to understand the policy details and to clarify the exact meaning of any clauses that they do not fully understand.Then, in the event that a claim is received, they know what they are covered for and what action is required.

Here are a few things to look out for:

Fair Presentation

It is the consultants responsibility to make a “Fair Presentation” of their independent practice to underwriters. This allows the underwriters to decide whether to provide insurance or not and, if so, the terms and conditions of such insurance.

Insuring Clauses

The Insuring Clauses describes the breadth of cover that underwriters are insuring.

Exclusions

It is also important to be aware of exclusions contained in the Policy. Exclusions limit the scope any, or all, of the Insuring Clauses by excluding something that would otherwise be covered. For example, most policies will not cover any fraudulent, dishonest or malicious acts even if they arise within a consultants medical professional services.

Notifying a Claim or Circumstances

It is vitally important that doctors ensure that they are familiar with the claim reporting procedures contained within the policy so that any notification of a claim or circumstances is in accordance with the policy terms.

As a member of Incision, you will be provided with an insurance policy designed to protect you from claims made against you arising from your Medical Professional Services and Professional Services.

The bespoke insurance policy consists for 3 sections; Medical and Professional Services Liability, Commercial Legal Protection and Cyber Liability.

Medical and Professional Services Liability

Medical and Professional Liability

• Medical MalpracticeLiability for physical or mental injury, disease or death to any patient caused by any actual or alleged negligent act, error or omission by you in the course of delivery of non-NHS medical professional services.

Professional Indemnity

Liability to your client arising from any actual or alleged negligent act, error or omission by you in the course of rendering professional services, such as expert witness work.

• Liability for any actual or alleged libel or slander (that was not deliberate or reckless) committed by you in the course of rendering professional services.
• Breach of professional confidentiality
• Unintentional destruction of or damage to documents
• Patient’s claim for bodily injury arising from a Cyber event
• Good Samaritan acts
• Public Liability
• Reputational Harm

Cyber Liability – change to Business Combined Liability

• Cyber Liability
• Security and Privacy Liability
• Network Interruption Expenses
• Event Support Expenses
• Privacy Regulatory Defence and Penalties
• Network Extortion
• Liability Arising from Website Media
• Payment Card Industry Fines or Penalties
• Patient’s claim for bodily injury arising from a Cyber event

If you are working within the NHS, your NHS Trust will provide you with indemnity under the Clinical Negligence Scheme for Trusts (CNST), also known as NHS Resolution. The CNST will respond to and handle clinical negligence claims against NHS Trusts. Your Incision policy provides you with coverage for any professional matters relating to your NHS practice but are not covered by the CNST, such as GMC investigations, disciplinary hearings and coronial inquiries.

We provide our members with unlimited, 24/7, medico-legal advice from a unique team of medically and legally qualified staff, at no additional cost and with no call on your excess.

Incision utilise a complex rating model, which takes into account all aspects of your practice, providing you with a bespoke and highly competitive rate.

Backed by A rated (A.M. Best) insurers and Lloyd’s of London syndicates, Incision underwriters are regulated and accountable to the FCA.

If you treat professional sports people, a SEMPRIS policy would be more suited to your needs than Incision indemnity cover. It’s designed for medical professionals who regularly treat professional sports people. SEMPRIS understand first-hand the unique risks medical professionals face, and the extent to which their current indemnity may or may not be suitable. See www.sempris.co.uk

Your Incision policy contractually provides a 21 year Extended Reporting Period (ERP), sometimes called Run Off, which is triggered on the expiry of your policy in the event of death, permanent disablement and permanent retirement and this is included within your subscription with no minimum membership requirement.

Your Incision policy is a contract underwritten on a “Claims Made” basis. This means that the policy will provide cover for any claims or circumstances that are reported to, and accepted by, underwriters during the policy period. It is for this reason all of our surgeons are encouraged to notify any adverse incidents as soon as possible, because if a claim or circumstance is reported within the policy period, it is deemed notified by Underwriters and therefore covered (subject to the terms and conditions of the policy).

Yes, you are covered for Good Samaritan Acts worldwide.

Incision is designed specifically for consultants with a UK practice, therefore you need to inform us if you are planning to work overseas. However, it may be included subject to formal agreement depending on an individual’s circumstances.

We will not adjust your premium mid-term. At renewal, we will ask you to re-confirm your proprietary information and any increase or decrease in your practice will be taken into account and reflected in your renewal quote. However, you need to tell us if your practice profile changes significantly as this would be a material fact.

You will be liable to pay the excess at the point solicitors are instructed and defence costs are incurred.

An excess is the amount you must pay for each and every claim under your policy.

Limit of Indemnity means the total amount of underwriters’ liability for any claims arising from your liabilities, losses and defence costs for any single claim or circumstance covered by, and subject to, the terms and conditions of the policy.

If you were to leave Incision to go to another provider you will need to ensure your next insurer provides you with the correct retroactive date. As long as your new insurer implements the correct retroactive date there should be no gap in cover.

The retroactive date forms part of the policy and is the date from which any unknown circumstance or claims arising from your work will be covered by your Incision policy.

A material fact shall be deemed to be one that would be likely to influence an underwriter’s judgement and acceptance of your application form. Failure to disclose, or misrepresentation of, a material fact may invalidate your cover in part or in whole.

A letter of good standing is a claims summary which details any previous complaints and claims, if applicable. This can be requested by contacting your medical defence organisation (MDO) or current insurer who will provide you with the relevant information

You are responsible for making, after reasonable search, a Fair Presentation, in a clear and accessible manner, of all important and relevant information, at least sufficient to put a prudent insurer on notice to make enquiries and not to make any misrepresentations as required by the Insurance Act 2015.

A Fair Presentation is required in order for a reasonable insurer to decide whether to provide insurance or not and, if so, the terms and conditions of such insurance. The use of an application or proposal form supplied by insurers or Paragon does not relieve or reduce your responsibility to make a Fair Presentation of important and relevant information in a clear and accurate manner. If you do not make a Fair Presentation, then insurers may be able to:

• void the policy and provide no coverage with no return of premium.
• amend the terms of the insurance placement to exclude coverage under the policy.
• reduce the value of claims to be paid.
• charge you additional premium.

Your obligation to keep information up to date is on-going and therefore we ask that you advise us as soon as possible of any changes in respect of any of the information you have provided, so that we can pass such changes onto insurers for their acceptance or otherwise.

As your Incision policy is contractual, the cover afforded is legally binding. The MDOs, however, usually offer discretionary cover. As the name implies, this means the acceptance of any claims made by a member are subject to the discretion of their MDO. The MDOs are not regulated and have no legal obligation to provide assistance to a member.

Incision insurers are specialist medical malpractice Lloyd’s Syndicates and Insurance Companies who are all rated A (Excellent) by A.M., indicating they are best for financial security.

The main reason for your subscription to change would be a result of changes to your practice profile (for example, you start undertaking more procedures). Factors outside of our control, for instance the recent increase in Insurance Premium Tax, will also have an affect.

With our new online portal, provided that you have your information to hand and we have no further questions, you will receive a quote instantly. Your policy wording and certificate will be issued immediately after purchase via email.

Through our online customer portal, you can pay for your subscription in one lump sum by credit or debit card, BACS, cheque or by ten instalments via Premium Credit Limited.

If you choose to move to us, we will handle everything going forward. The only things you need to do are:

• Accept the terms and conditions of our quote
• Provide us with a Certificate of your previous indemnifier
• Notify your previous indemnifier that you’re leaving

If you are a surgeon you will need your estimated and actual income from your independent practice (excluding medical legal report writing), and also from your medico-legal report writing; the number of sessions you perform, split between consultations and surgical work; and an approximate split of your surgical work between minor, intermediate, major, major+ and complex major procedures.

If you are a Medical Professional, in order to successfully apply, you will need the following information:

Personal details, including contact information and GMC number
Your estimated and actual income from your independent practice (excluding medico-legal report writing).

An application form enables underwriters to accurately assess the risk and contains all the information that is needed to provide you with the most competitive price. Any information that you do provide will constitute a material fact.

No. Formerly known as ISISIS group, we changed our name to Incision in 2018. We have been insuring surgeons since 2010.

Switching from an insurance company

At Incision, we understand that you may have been with your previous indemnifier for a long time and switching to a new insurance company can be daunting. That’s why we’ve made the process as simple and straightforward as possible. All we need from you is your acceptance of our terms and a copy of expiring certificate and we will take care of the rest.

You can rest assured that subject to your current coverage being on a ‘claims-made’ basis, your new Incision policy will pick up your retroactive cover from your previous insurer, so you won’t have any gaps in coverage. Plus, there is no additional cost for this service. So if you’re ready to make the switch to Incision, we’re ready to help. We look forward to insuring you and giving you the peace of mind that comes with knowing you are properly protected.

Switching from a mutual

When switching from a Medical Defence Organisation (MDO), there are two main differences in the cover offered.
Firstly, you will be moving from a “claims occurrence” to a “claims made” policy. If you are moving from a mutual, your Incision policy will cover you for incidents that occur after the start date of your new policy. Claims made against you prior to your start date, that happened at the time you were a member of the MDO, should continue to be reported to the mutual. The MDO’s Memorandum and Articles of Association promise to provide cover for these claims but only if your membership was active at the time that the incident occurred.

Secondly, non-regulated cover to regulated. This change means that your policy will now be subject to the Financial Services and Markets Act 2000, which provides peace of mind and greater protection for you.

You can change your personal details by contacting one of the Incision team. Please send an email to info@incisionindemnity.com or visit the Contact Us page on the website.

You will receive an email from Incision no less than 4 weeks before your renewal date. Within the email, there will be a link that requires you to activate your online account, by entering your email address.

You will receive a registration email with a link to complete the registration. Once you have successfully registered your account, you will be able to log in to your membership area and personal dashboard.

Once you have accessed your account, click “Continue” under the “My Quotes” section and you will be presented with the first page of the renewal form.

Your renewal form is pre-populated with the data from the previous year’s application form. Simply review and update the data and submit the form.

Your renewal quote will be sent to your email address and will be saved in your Members Area. To retrieve your quote, click on the link in your quote email.

In the Members Area you will find copies of your application form, your policy schedule, confirmation of insurance, your demands and needs statement and invoice for you to print and save.You will also have access to the information you provided in your application.

For any medico-legal advice or assistance your first point of contact will be Dr. Michael Kyriagis who is the lead medico-legal advisor for Incision. Dr. Kyriagis’ service is available 24 hours a day. All costs for this service are included within your subscription payment.

Call our dedicated medico-legal advisory service on 0333 010 2826 or send us an email to medicolegal@incisionindemnity.com.

Please either contact our dedicated medico-legal advisory service on 0333 010 2826, send us an email to medicolegal@incisionindemnity.com or submit your claim online.

We hope to meet and exceed your expectations, but if you are dissatisfied with any aspect of our service, or if you consider that you might be entitled to compensation from us, we want you to tell us. If you do wish to make a complaint regarding this policy, or us, please follow the procedure outlined below. This procedure is not compulsory and does not affect your statutory rights. However, if you do not follow the procedure, it may affect your ability to recover any legal costs you may incur relating to your complaint.

If you have engaged an insurance broker to help you obtain this policy, please contact that insurance broker in the first instance for assistance and advice regarding your complaint.

If you did not engage an insurance broker, or if your insurance broker cannot assist, then please contact our Head of Compliance at the following address:

• The Complaints Department
  Allied World
  20 Fenchurch Street
  Floor 19
  London
  EC3M 3BY

We will acknowledge receipt of your complaint within five (5) working days and, at that stage, we will endeavour to indicate what steps we will take to investigate it and when we anticipate that we will provide our response.

For all specialties:

In the event that you remain dissatisfied and wish to make a complaint, it may be possible in certain circumstances for you to refer the matter to the Policyholder and Market Assistance team at Lloyd’s. Their address is:

• Complaints at Lloyd’s
  Fidentia House
  Walter Burke Way
  Chatham Maritime
  Chatham
  Kent, ME4 4RN.
• Tel: +44 (0)20 7327 5693
• Fax: +44 (0)20 7327 5225
• E-mail: complaints@lloyds.com

Details of Lloyd’s complaints procedures are set out in a leaflet entitled ‘How we can help to resolve your complaint’ available at www.lloyds.com/complaints and are also available from the above address.

For all specialties:

If you are not satisfied with our response, you may be entitled to have your complaint decided by the Financial Ombudsman Service. Information about the Financial Ombudsman Service, including the timescales within which you must submit your complaint, can be found at www.financial-ombudsman.org.uk. you can also obtain advice by calling 0800 023 4 567 or by emailing complaint.info@financial-ombudsman.org.uk. The postal address of the Financial Ombudsman Service is Exchange Tower, Harbour Exchange Square, London E14 9SR.

If you are based in an EU member state, you may be eligible to lodge a complaint using the EU’s Online Dispute Resolution Platform to resolve the dispute. This service can be found at http://ec.europa.eu/odr.