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Understanding how your malpractice insurance covers scope of practice
It is common for doctors of optometry to have questions regarding whether their scope
of practice is covered by their malpractice insurance policy. AOAExcel consulted with
Kevin Johnson, Senior Vice President of AOAExcel’s endorsed business
partner, Lockton Affinity, to shed some light on pertinent questions regarding scope of
practice coverage as well as scope expansion.
What does an OD need to do to ensure that their entire scope of practice is
covered by their malpractice policy?
First look at their insurance policy. The policy should contain language to confirm
whether or not scope of practice is covered. The policy should be specific about what is
and isn’t covered. Second, if they’re not sure how to interpret an insurance policy,
reach out to their current insurance agent and ask them if their policy provides scope of
practice coverage and if so, ask where that is found in their insurance policy packet.
What does an exclusion mean for a policy? What are some common exclusions
an optometrist might find in their policy?
An exclusion means that an action or event is not covered by the policy, so it is
excluded from having any insurance coverage for the policy holder. As far as common
exclusions, the most important one that we try to identify is a surgery exclusion. The
exclusions vary in how they are worded. Some of the more concerning exclusions
include having no coverage if surgery penetrates tissue or any part of the body. If you
have a foreign body in your eye, sometimes it can be in the second or third layer of the
eye, which by the letter of the law could be potentially excluded because it is considered
surgery.
What are the consequences for an optometrist when their policy doesn’t cover a
claim?
In the worst-case scenario, it could be catastrophic. If the coverage doesn’t cover a
claim and the claim is severe (for instance, the patient suffers loss of vision or
something along those lines) or if the personal liability insurance has an exclusion that
doesn’t offer coverage, at that point the optometrist might potentially have to come out
of pocket to cover those damages for their patient based off the incident.
What questions should an OD be asking their insurance broker regarding their
policy?
We’ve received this question quite a lot from optometrists over the years. The first
question we always have an OD ask their insurance broker is “Does your current
coverage provide scope of practice?” As their state scope changes and evolves, if an
OD has scope of practice built into the policy form, they don’t have to call in every time
the state changes. If it’s not set up that way in the policy, then the OD needs to check in
with their insurance agent every time the scope changes.
Other questions include “Is there a surgery exclusion on my malpractice insurance and
if there is, what specifically does it exclude?” and “What is considered surgery based off
the policy document that I have?”
Keep in mind that if you’re unsure if your current insurance has adequate coverage for
scope of practice, AOA members may receive a complimentary policy review to
clarify their policy’s scope of practice coverage and exclusions.
When scope of practice is expanded in a particular state, how is it spelled out in
writing in an OD’s malpractice policy?
On other policies, we’ve seen language that is very specific and outlines the specific
procedures and duties that the optometrist is doing. It lays out clearly what is covered.
The other end of the spectrum is the AOA coverage, where we don’t go that way; we tie
it into the scope of practice in the individual state, so it is a much more broad and
general way to insure optometrists across the country.
What I would encourage anyone to do is contact their current agent to check and see
what their policy language looks like relative to scope of practice and if it doesn’t have
that language in there, then make sure that they are in communication with their current
agent to have something in writing, either added as an amendment or endorsement to
the policy to specifically lay out what part of the scope of practice in their state is
covered or get in it writing from the agent or from their insurance carrier on what is or
isn’t covered by the scope and also keep doing that as the scope changes.
If you’re concerned that your current policy doesn’t have sufficient coverage, AOA
members can receive a complimentary policy review from Lockton Affinity. Your
policy will be reviewed for surgery exclusions and to make sure that you have adequate
limits. You can also get an instant quote on your malpractice insurance policy. For
more information, visit AOAExcel.
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