​What Is the Role of Insurance Coverage in Medical Malpractice Claims?

Insurance can serve a highly important role in many types of personal injury claims, including medical malpractice claims. Medical malpractice insurance serves to take on the financial burden of a medical malpractice claim so that the physician who commits an act of medical malpractice, including medical negligence or a dangerous event caused by human error, will not face personal financial liability for all the damages associated with that incident. Learn more about insurance coverages and medical malpractice below from our experienced medical malpractice lawyers.

Medical Malpractice & Insurance Coverage Guide

• Types of Medical Malpractice Insurance
  • Individual Policies
  • Group Policies
  • Employer Policies
  • Medical Risk Retention Group Insurance
• What Does Medical Malpractice Insurance Cover?
  • The Cost of Legal Services for the Medical Care Provider
  • Damages Suffered by the Plaintiff
  • Punitive Damages Awarded by the Court
• Does Medical Malpractice Insurance Decide If the Plaintiff Gets Compensation?
  • Investigation
  • Negotiation
  • Court
  • Any Increased Medical Costs
  • Income Challenges and Losses
  • Patient Suffering
• Having a Lawyer on Your Side Can Provide Critical Assistance

Types of Medical Malpractice Insurance

Different medical care providers may carry different types of medical malpractice insurance. The level of coverage and compensation offered by the policy may also vary somewhat depending on the type of policy.

Individual Policies

Individual physicians, including those who work in private practices, often carry individual medical malpractice insurance policies. Those policies cover the specific physician and his practice and may help ensure a higher level of protection for any patient injured by the negligent actions of that provider.

Group Policies

Group policies help protect a group of physicians, usually those working in practice together. For example, a practice that consists of three physicians might have a group policy that covers every member of the practice rather than having individual policies to cover each one.

Employer Policies

In some cases, large medical care providers, including hospitals and urgent care centers, may have employment policies that cover all the medical care workers at the practice. To receive coverage under an employer policy, the physician who committed the act of medical malpractice would need to work for the hospital directly rather than simply having permission to practice at that hospital.

Medical Risk Retention Group Insurance

RRGs, or risk retention groups, help provide group policies for medical malpractice insurance for physicians across the country.

What Does Medical Malpractice Insurance Cover?

Medical malpractice insurance offers coverage for many of the damages associated with a medical malpractice claim. A medical malpractice insurance policy can help physicians with the protection needed to avoid having a medical malpractice claim hit their finances. To that end, depending on the policy, medical malpractice insurance may cover several key elements of the claim process.

The Cost of Legal Services for the Medical Care Provider

In many cases, a medical malpractice insurance policy will cover the cost of legal services for the medical care provider. Legal costs can rise exponentially following a medical malpractice claim, including false claims or claims that ultimately resolve in the care provider’s favor. A medical malpractice insurance policy may cover the cost of those much-needed legal services, making it easier for the care provider to afford the legal representation needed to navigate that claim effectively.

Damages Suffered by the Plaintiff

The plaintiff in a medical malpractice claim may have substantial damages from the medical malpractice act. Medical malpractice substantially increases the patient’s overall need for medical treatment and the time the patient has to spend out of work.

In many cases, recovering from medical malpractice will mean substantial expenses. In addition, the patient may suffer ongoing complications that heavily impact multiple areas of the patient’s life. Medical malpractice insurance will typically pay out compensation awarded to the plaintiff.

Punitive Damages Awarded by the Court

Physicians and other medical care providers may commit errors like anyone else. Sometimes, those medical errors arise from gross negligence or a lack of attention to detail. In other cases, they may arise from poor decision-making or intrinsic bias on the care provider’s part.

Sometimes, the court will award punitive damages to the injured party. Punitive damages generally come up in cases of gross neglect. Depending on the policy, medical malpractice insurance may cover many of those damages.

Does Medical Malpractice Insurance Decide If the Plaintiff Gets Compensation?

In many cases, medical malpractice insurance may determine whether the plaintiff gets compensation for damages from medical malpractice. The medical malpractice insurance provider may also determine how much compensation the plaintiff receives, particularly if the two parties resolve the claim through negotiation rather than going to court.

Medical malpractice insurance providers may participate in many of the steps of the medical malpractice claim.

Investigation

As the victim of medical malpractice, you might have strong hopes that the investigation process will go in your favor. You might hope that the medical malpractice insurance provider will look at the damages caused by the medical care provider’s actions and the fact that you received treatment directly from that medical care provider, then award compensation accordingly.

However, in many cases, the insurance provider will look for evidence that may help establish that the medical care provider did not commit an act of negligence in your care or that the damages you suffered did not result from the medical provider’s actions.

A medical malpractice claim relies on several key details.

1. A doctor/patient relationship between the patient and the provider that committed the act of medical negligence. You cannot file a medical malpractice claim against a doctor who had no responsibility for treating you.
2. A deviation from the standard of treatment. To establish medical malpractice, you will need to show that the medical care provider who treated you did not adhere to the standards expected of that care provider, based on how other providers, under the same circumstances, would have diagnosed and treated a patient.
3. Damages related to the care provider’s negligent actions. To file a medical malpractice claim, you must have suffered some damages due to the care provider’s negligence. If the care provider committed negligence in your case, but you ended up recovering with no further damages anyway, you may not have the right to file a medical malpractice claim.

The insurance company, to help avoid paying out compensation for medical malpractice, will look for any evidence that will disprove your right to file a claim or that may decrease your right to compensation. You may regularly interact with the insurance company as the adjuster pursues more information about your claim, including access to your medical records and any statements you might need to make about your recovery and the damages you suffered due to medical malpractice.

A lawyer can help guide you through your interaction with the medical malpractice insurance company, letting you know what information you have to provide and how to handle any questions that may come your way as you deal with the claim.

Negotiation

Often, the medical malpractice insurance company will launch the negotiation regarding the damages you will ultimately recover for your medical malpractice claim. You may, for example, receive a settlement offer from the insurance company soon after the medical malpractice event. That settlement offer will often include a meager amount: just enough to entice you to accept but not enough to fully cover the damages you may have sustained due to the doctor’s negligent actions.

You may go through several negotiation rounds before you reach a reasonable settlement agreement regarding your injuries. The medical malpractice insurance provider may only slowly increase that settlement offer or try to make it as difficult as possible to get the full compensation you may feel you deserve for those injuries.

By working with a lawyer, you can get a better idea of how much compensation to expect, what the medical malpractice insurance provider should cover, and how you should deal with a settlement offer that does not reflect your financial needs following medical malpractice.

Court

Common medical malpractice claims end up in court. Medical malpractice insurance companies often have substantial legal teams to defend the insurance company and the care provider. In court, the insurance company may fight to establish that the care provider did not commit an act of negligence based on the standard of treatment or that you did not sustain the damages you claim due to medical negligence.

The company’s lawyers and representatives will work to minimize the compensation the company has to pay out as much as possible or even to have your claim thrown out altogether. Unfortunately, that might leave you without the compensation you need to cover the additional cost of medical treatment.

Any Increased Medical Costs

Medical malpractice claims frequently include several key elements. Your lawyer can help you take a comprehensive look at the damages you sustained due to medical malpractice, including what compensation you should expect in each area.

Any Increased Medical Costs

Medical malpractice can lead to increased medical costs in several ways. Take the case of misdiagnosis, for example. You might end up paying for treatments you do not need since they have nothing to do with your injuries. You may receive steady medical bills for unneeded and unwanted treatment.

In addition, you may have increased medical costs because your condition worsens without treatment. Many medical conditions get worse quickly when they remain unmanaged. If you suffered an increase in your symptoms, you might have needed more or longer treatment because of medical malpractice.

Having a medical expert testify about the difference in treatment because of the time you had to wait for the treatment you needed can help break down the difference in costs and what you should expect in compensation for those damages.

Finally, medical malpractice could cause increased medical needs in some cases. Never events, which often occur in surgery, could leave a patient with devastating symptoms and a long road to recovery. The patient might even have lifelong limitations related directly to the never event and the challenges that went along with it. A medical expert can help lay out exactly what damages the patient may have sustained due to medical malpractice.

Income Challenges and Losses

Medical malpractice can, in many cases, interfere with a patient’s income. Some patients cannot work through their symptoms or treatment, especially if symptoms continue to worsen due to a lack of treatment due to misdiagnosis or failure to treat. In other cases, when a patient sustains severe injuries due to medical malpractice, they may find themselves out of work for a very long time as they struggle to recover from those injuries.

A lawyer can help you look at your income losses and how to best include them as part of your claim.

Patient Suffering

Medical malpractice can lead to immense patient suffering, and patients deserve compensation for the non-financial losses that may accompany medical malpractice and the more tangible financial losses. Patients may suffer considerable physical pain, PTSD, and anxiety or struggle with losing their independence following medical malpractice.

The ongoing medical needs and pain related to those injuries can wear a patient down and make it increasingly difficult for them to function normally. Working with a lawyer can help patients identify those elements of suffering and pursue the compensation they may deserve.

Having a Lawyer on Your Side Can Provide Critical Assistance

Can you handle a medical malpractice lawyer without a lawyer? NO, If you suffer medical malpractice due to a care provider’s negligence, you may find yourself fighting against the hard-hitting legal team associated with medical malpractice insurance. Having a lawyer on your side can help you fight for the compensation you deserve. Contact a medical malpractice attorney as soon as possible to learn more about your rights.

Gabriel Levin - Owner/Founder

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Gabriel Levin is a highly experienced and award-winning attorney with over 10 years of practice in Pennsylvania. Known for his tenacity, he has represented clients in a wide range of civil matters and tried hundreds of cases. He prepares each case as if it will go to trial, ensuring meticulous attention to detail.

Unlike many firms that delegate tasks, Attorney Levin personally handles every aspect of each case and maintains open communication with his clients throughout. He has secured millions in compensation, making him a smart choice for those seeking legal representation.

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