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Malpractice insurance: Don’t be caught without full-scope coverage

August 12, 2013

By Chad Fleming, O.D., AOAExcel Business and Career coach

It’s Friday at 11 a.m. and our office receives a call from a new patient who was trimming weeds for his employer. The patient explains he hit some gravel with the weed trimmer and a rock shot up and hit him in the eye. He cannot open the eye and would like to come in right away. Our astute receptionist tells him to come in right away and we will take care of him.

Fortunately for him, I was there and my schedule was packed until noon when the office closes for the weekend, but we could not turn a patient in this circumstance away. He arrives and proceeds through preliminary testing. As I reviewed the chart prior to entering the room, I noticed his visual acuity in the left eye was no light perception, NLP as we all know it. Also, his frequency-doubling technology (FDT) perimeter showed complete black out visual field.

This guy was either blind in the eye or he had a penetrating ocular injury. Wow, I thought, this raises the stakes, and it is Friday, why me? Thinking of the optometric oath I took my first day in optometry school, I walked into the room and introduced myself.

Instead of walking you through every step of the exam, I will save you the time and say the patient’s overall eye health was normal. He had some mild bruising of the upper eyelid and mild-to-moderate superficial punctate keratitis but nothing of the magnitude of what he was supposedly seeing. I retook the case history to make sure I had everything documented, as I had a gut feeling this would not be the last time I faced this guy. A full 30-2 visual field was performed, and a glaucoma diagnosis (GDx) was also run at the time.

After communicating my findings, I wisely referred him on for consultation with retinology.

A couple weeks later, I received a letter back stating there were no obvious findings that would indicate the level of visual loss the patient reported and tested.

My intuition early on was not wrong as this patient ended up back in my chair complaining of the same concerns. We visited and I stated the story was not matching up, but we could do further neurological testing as the retinologist and myself had suggested if the patient continued to have concerns.

The patient was sent to neuro-ophthalmology. A report and the patient were sent back to me with no obvious pathology explaining his significant vision loss. I communicated with the patient that all testing demonstrated that he was ok and that the injury from the weed trimmer had resolved.

A couple weeks later, I received a letter from his lawyer stating the patient was pursuing his employer for his loss of vision. Fortunately, this case for me ended with a three-page letter to the attorney explaining the circumstances of the case and that there was no evidence of correlation between what the patient was claiming and the injury.

This did however peak my interest in our malpractice coverage and the details of my policy.

Here are three things to consider when reviewing your policy.

1. Full scope of practice – I found the company my current policy was under would not specify which surgical codes it would cover. My first thought was would I be covered for a foreign body removal? If the insurance company would not state I was covered to the fullest scope of my license, I could be caught in the grey zone. Make sure your malpractice insurance carrier has “full scope of practice” in writing so you are not without coverage for “surgical” procedures.

2. Consent to settle – Understanding where your carrier stands in regards to your responsibility if you should choose to fight a claim and they want to settle is one important aspect that can differentiate malpractice carriers.

3. Supplemental Payments – What is the limit for which you are covered for depositions or lost wages due to handling a claim against you? If you have a policy that covers $2 million per incident, will that include lawsuits regarding billing errors or omissions?

The reality is that many of us have not read our malpractice insurance policy. We have assumed, just like we do with car insurance or home insurance, that it should cover me if something happens. You do not want to learn tomorrow that your malpractice insurance did not cover you for punctal plugs you inserted today.

Finding a great malpractice insurance is part of having a successful career.

The views expressed are those of the author and do not necessarily reflect the views of the AOA.

One comment

  1. I would think that the responsibility for the rock hitting his eye would have been on him as he should have been the one to wear whatever protective clothing or gear it would take to prevent injury. Yes sometimes even the littlest of situations have us wondering who, what, when and where people should be covered.
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