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Having a liability insurance policy can make all the difference for you and your practice. In addition to being saved from a potentially tremendous expense, you have experts handling any claims for you.

Below are brief stories of claims a few of our members faced. The claims have been presented and resolved by Tokio Marine, a subsidiary of Philadelphia Insurance Company, the company which underwrites the professional liability insurance program for Energy Medicine Professional Association members.


Case Study #1

General Liability – Importance of Informed Consent

Background

As a practitioner, you should be in the habit of requiring all your clients to complete certain forms prior to treating them. Three of the most important forms to complete are: 1) Patient Background; 2) Scope of Practice; and 3) Informed Consent. Combined, these forms both safeguard your liability and ensure the client has agree to and understands the type of services they are to receive. As well as being informative documents for both you and the patient, these documents serve to protect you and mitigate liability issues if they arise. This case study serves as an excellent example of the protection an insurance policy offers to you.
 CUSTOMER CHALLENGE 

An EMPA Member received a notice from the Texas Medical Board of a complaint from a family member of a client.  This was followed with a summons from a medical board subpoenaing information claiming the practitioner was a medical doctor.  This was extremely upsetting for the practitioner.  This claim was submitted to the insurance company.


 SOLUTION

The insurance company provided an attorney to handle the complaint. When the adjuster talked to the practitioner about the complaint the practitioner was concerned about losing her practice which she had invested much time and energy to build. The insurance company hired an attorney to assist the practitioner in her reply to the complaint. The attorney helped rewrite the required answers to the Medical Board and it cleared the practitioner’s name.  Cost to the insurance company was $916.66.  Cost to Practitioner was nothing.


 OUTCOME

The attorney fees were covered by the insurance company. This was a great relief to the practitioner to get the professional support she needed with out any out of pocket expense on her part. This practitioner resumed her regular practice.



Case Study #2

General Liability – Bodily Injury

Background

Liability insurance prepares you for the unexpected and provides piece of mind. Sometimes claims against a practitioner can be small, and others extensive. This means your scope of financial responsibility can range from a small amount to a large sum which could even include attorney fees. Since you can never predict the scope of a claim made against you, you cannot be sufficiently prepared to handle the expense. You might think you could handle a small claim, but why guess and why put yourself at risk. That’s why a comprehensive insurance policy is important. It prepares you both for the small as well as the larger cases. Why apply any of your savings when a policy can take on the financial obligation. The following case addresses an issue that could happen at any time.

 CUSTOMER CHALLENGE 

This case involves a situation that could happen to any energy practitioner who uses lotion or oil as part of treatment therapy. While medical information can be provided on a client profile, you might not be informed about a medical condition that could affect a client’s reaction to treatment. Sometimes a client might not even know they have an allergy or sensitivity until a certain product is used on them. In these cases, a practitioner has done their part to know their client, buts it is impossible to assess all variables when collecting health and medical information about a client. Such is the case with one of our insured practitioners who used a product that had almond oil in it.  The client had an allergic reaction and had to go to the emergency room for treatment. The practitioner had taken all the appropriate steps in risk prevention with this client (as with all the clients), but the unforeseen can happen any day. An insurance policy is made for this type of circumstance.

 SOLUTION

This was a no-fault situation. The practitioner was unaware of the client’s allergy and did not willfully cause harm. This is a products liability issue and is the type of coverage included in an insurance policy from EMPA. With this type of coverage, the practitioner is protected should a claim arise having to do with the use of a lotion, aromatherapy or massage oil, etc.


 OUTCOME

The insurance company paid the emergency room bill, totaling over $1600 which was the only expense incurred by the claimant. The practitioner was only held liable because it was an oil used (not manufactured or sold) by the practitioner which caused the allergic reaction. No further damages arose from this case.



Case Study #3

General Liability – Slip and Fall

Background

Each year, more than eight (8) million people receive emergency room treatment for injuries sustained from slip-and-fall accidents. Common injuries sustained from slip-and-fall injuries include traumatic brain injuries, broken bones, spinal cord injuries, and torn muscles. Cases can involve medical treatment, lost wages and pain and suffering. As a practitioner, be aware of possible hazards on your property and be proactive about corrective actions. The financial impact of a slip and fall accident can range from minor inconvenience to massive liability, depending on the circumstances. Make sure you have adequate business liability insurance (General Liability) coverage for slip and fall accidents to cover any claims and legal cost.

 CUSTOMER CHALLENGE 

A claim was filed against an EMPA Member for injuries from a slip and fall claim; however, there were special circumstances about this claim as there were three defendants. After a workshop one of the attendees left the classroom and exited the building by way of an outside stairwell.  There was snow or ice on the steps and the person slipped and fell.  The story behind this claim is very interesting as the circumstances about the claim resulted in there being three defendants: our insured, the instructor of the workshop and the property owner where the workshop was held.

 SOLUTION

Each of the defendants had to pay a share of the claim which also meant that each had legal expenses in addition to expenses from the injuries sustained from the fall. The insurance company paid our insured’s portion of the claim as well as the legal expenses.


 OUTCOME

The circumstances of the incident resulted in a claim and legal fees that were more than two times the amount of the claim since there were three defendants. Each of the defendants had to pay a share of the claim which also meant that each had legal expenses.  Our insurance company paid our insured’s portion, of the claim as well as one-third of the legal expenses totaling over $20,000.



Case Study #4

Breach of Contract and Copyright

Background

Copyright claims in a holistic practice is uncommon. As a general matter, copyright infringement occurs when a copyrighted work is reproduced, distributed, performed, publicly displayed, or made into a derivative work without the permission of the copyright owner.
 OUTCOME
The court decided in favor of the plaintiff in this case. However, the insured did not have to pay any costs – neither the attorney nor the settlement.  The policy covered all expenses and fees totaling over $67,000. If the policyholder had not been insured, they would have had to pay a substantial sum out of their own pockets.
 CUSTOMER CHALLENGE 
A claim was made for copyright infringement of and instructor teaching a modality/ or modified modality that they learned form another trainer. This claim included written material that was being used and a breach of contract to teach this material.
 SOLUTION
The insurance company provided an attorney who defended the client against the claim. Unfortunately, there wasn’t sufficient documentation to support the defendant, however, since the defendant had an insurance policy, they did not have to pay attorney costs.


Concluding thoughts. There have been a couple incidents which never turned into formal claims.

However, they offer insight into the types of claims the insurance company handles on your behalf.

Professional Liability

A professional liability claim occurs when a plaintiff believes the insured committed malpractice, negligence, or misrepresentation and files a lawsuit. One professional liability claim  occurred when a plaintiff claimed slander, libel and other counts against a policyholder. There were expenses on this claim, so the insurance company was involved. However, a payment was never issued, and the claim ended up being closed.


General Liability – Complaint by a family member

In another case, a family member issued a complaint with the Attorney General in Washington State.  This was reported to the insurance company and a general liability claim was filed against the policyholder. The insurance company was prepared to provide the defense for this practitioner, but the family never followed through with the complaint. As a result, the claim was closed.  However, it is important to note that the insurance company would have represented the insured if the case had been pursued.

 


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