In 2020, CapeTalk interviewed SA Society of Obstetricians and Gynaecologists council member Dr Johannes van Waart on how many highly trained and experienced obstetricians and gynaecologists were emigrating as a result of the astronomical rise in insurance premiums.

To put things into context, an anonymous obstetrician from Tamboerskloof, Cape Town, called in to say: “A few years ago, our insurance premiums were a few thousand rands per month. Now, they are at least R1.3 million per annum. This means your first 10 deliveries of the month are just paying towards medmal insurance.”

Topical, controversial, real… But the first thing a medical specialist in a high-risk category seeking professional indemnity needs to understand is the difference between an occurrence-based and a claims-made insurance policy, what gaps may transpire when changing from one to the other, and whether the indemnity cover they have in place matches their risk profile.

Occurrence-based versus claims-made – how not to be caught out

Both policy types, if structured correctly, will cover a medical specialist for their medical malpractice needs. However, there are slight differences. With an ocurrence-based policy, your medical insurer will cover your medmal claim at the time the procedure or occurrence took place.

With a claims-made policy, on the other hand, your insurer is liable for the claim regardless of when it is made. This is particularly important when changing from one insurer to another –  i.e. when identifying who received the premium in the year when the occurrence took place or the claim was made against you.

The claims-made approach is considered more modern and cost-effective, so it tends to be the more popular of the two options. Taking out this sort of policy also means that you can move across from an occurrence-based policy, without any significant coverage gaps being created.

However, it is worth noting that on retirement, an occurrence-based policy will continue to cover the procedures you performed during the policy period. On the other hand, a medical practitioner on a claims-made policy will require some kind of run-off cover once their policy has been cancelled or they retire.

Be sure to ask your broker about the possibility of an extended reporting period (ERP), which will set you up to continue covering negligence claims, even after you have ceased to practise.

On the money – fees should be risk-dependent

Sure, a medical practitioner can check whether they are being over- or under-insured by using the online “quote” offerings of a number of different providers. But what they’ll essentially want to have in their corner when a medical malpractice claim is laid against them is an insurer who offers the best possible legal assistance and has assessed their unique risk profile astutely at the outset, so that the cover in place is completely adequate.

It is therefore worth seeking out and choosing a product, and indeed a brokerage, that has years of experience behind them, so that affordability and risk are always perfectly balanced.

Medmal insurance is a complicated game. You’ll need to go with your gut, but also use your savvy in terms of ensuring sufficient cover is in place, without it seeming astronomical for the type of medicine you practise – or the skills you are confident in providing on the surgical table.