Frequently Asked Questions

Policy Coverage: (top)

Q: What is the distinction between “Claims-Made” policies and “Occurrence” policies?

A:“Claims-Made” policy covers claims that are made during the policy period provided that the incident giving rise to the claim occurred on or after the retroactive date and on or before the termination date of the policy.  A “Claims-Made” policy focuses on the date the claim was made relative to the policy.   

An “Occurrence” policy covers claims which arise from incidents which occur during the policy period regardless of when the claim is made.  An “Occurrence” policy focuses on the date of the incident relative to the policy.

Q: What is Prior Acts Coverage?

A: Prior Acts (“Nose”) coverage refers to coverage for acts that took place prior to the inception or effective date of the first Claims-Made policy written by one insurer that replaces the Claims-Made policy written by the prior insurer.

In order for a policyholder to avoid gaps in coverage it is important to remember when moving from one insurer to another that either a “Tail” or Prior Acts coverage is required.

Q: What is a “Tail” endorsement and what does it cover?

A: The correct name for the “Tail” endorsement is the Extended Reporting Period Endorsement because it extends the time to report claims beyond the termination date of coverage.

For coverage to apply under a “Tail” the alleged act or omission giving rise to the claim must have taken place on or after the retroactive date of the coverage and on or before the coverage termination date. The “Tail” endorsement covers claims arising from incidents occurring during the period of time between the retroactive date and the termination date.

There are several ways for a qualified Insured to receive a “Tail” at no cost: permanent and total retirement from your professional practice after having been insured with GALEN for at least three full years and at age 55; permanently disabled from the practice of medicine; and on death, it is free to the estate.

Accounting: (top)

Q: Are there premium billing options?

A: Galen Insurance Company offers a variety of options for Policyholders.  Payments can be made in full, quarterly, or monthly through ACH payments. The installment options are “interest free”.  Galen Insurance Company also provides a one-time set-up for payments to be made automatically to your credit card account.  This can be completed on the Company’s web site or by contacting Policy Administration.

Q: Can I access my policy billing records?

A: Yes.  Contact Galen Insurance Company and request a copy of your billing statement.

Risk Management: (top)

Q: How long should I keep medical records?

A: The safest approach is to keep medical records indefinitely.  However, if it is not possible to keep records indefinitely, the minimum time that records should be retained is:

  • 10 years from an adult patient’s last medical service
  • For minor patients, the later of 10 years from last medical service or age 25*
  • 10 years from the date of a patient’s death

Keep in mind that the Federal False Claims Act has a 10 year statute of limitations.  It could be possible that destroying records prior to 10 years could leave a practitioner vulnerable to citations under the Act.

* Each state has its own statute of limitations concerning the length of time a minor has to bring a claim after reaching the age of majority, and some states have their own regulations or statutes regarding records retention.  Check with your state’s regulatory agency or licensing board, or your personal attorney, to determine whether your state has enacted specific laws and regulations.

Q: How do I handle a non-compliant patient?

A:

  • Document everything the patient has or has not done which shows his/her non-compliance.

  • Send the patient a letter (via regular and certified mail) explaining the treatment recommended and the importance of compliance. You may indicate that continued non-compliance could result in termination of the physician-patient relationship.

     

Q: How do I terminate the physician-patient relationship?

A: Do not terminate the relationship during an acute situation which could lead to allegations of abandonment. Send the patient a letter (via regular and certified mail) indicating your desire to terminate the relationship; your willingness to handle any emergency situations for the next 30 days; and suggestions on where to procure alternate treatment.  Clearly document the patient’s current medical posture, and let the patient know that you will be happy to furnish their new physician with a copy of the patient’s medical record.

  • If the patient belongs to a managed care organization, you must first check with them to determine termination protocol, if any.

Q: What should I do when a managed care organization does not approve recommended treatment?

A:

  • You need to go through the appeals process with the managed care entity.

  • Advise the patient your recommended treatment was not approved and give the patient their options (including paying for the recommended treatment themselves).

  • Document the above.

Claims FAQ: (top)

Q: I just received a subpoena for medical records and/or deposition.  What should I do?

A: As a busy healthcare professional, it is likely you may be subpoenaed at some time during your career to provide medical records or to give a deposition concerning your care of a patient.  Often times, this is an everyday occurrence and is unrelated to your medical care and treatment of a patient.  For example, a patient may be involved in some other type of litigation, such as a personal injury claim or workers’ compensation claim where the physician’s records and/or testimony as a treating physician are necessary relative thereto.  Be aware that state laws vary, but in many jurisdictions the attorneys defending personal injury or workers’ compensation claims are not permitted to discuss the patient’s medical treatment without written authorization from the patient to do so.  Accordingly, in such a situation the only means of getting information concerning the physician’s care and treatment of a patient may be a formal deposition.  Accordingly, and if you have determined that the subpoena or requirement to give deposition testimony is not related to your performance as a physician in the rendering of medical care, then there is no need to contact Galen Insurance Company.

If, however, you are not certain about the purpose for the records or deposition subpoena, or have concern that either the patient or other parties already named in the lawsuit could be attempting to claim some wrongdoing on your part, you should contact Galen immediately so that such a determination can be made.  Contact the Galen Claims Hotline, at 314-721-2366, to discuss the current matter.  Do not attempt to contact the patient and/or the patient’s attorney to discuss the subpoena or any other paperwork you may receive.

Q: What is a claim?

A: A claim is a demand to be compensated for an alleged injury.  You may encounter a situation where a patient is unhappy with an outcome.  This is not a claim until there is a demand for compensation or formal legal proceedings based on alleged medical negligence are initiated.  Galen encourages you to contact our Galen Claims Hotline at 314-721-2366 so that the situation may be discussed and analyzed.

Q: Will reporting an incident affect my premium or policy?

A: Simply reporting an incident has no impact on your premium.

Q: How do I report a claim?

A: Complete a Galen Insurance Company Claims Form which may be found on our website (here), by calling your Agent/Broker or the Galen Insurance Company, at 314-721-2366. Additionally, a completed Galen Claim Form may be faxed to Galen at along with all supporting documentation.

Q: After I have reported a claim and/or incident, what should I do?

A: After reporting a claim and/or incident, you will be given a list of precautions to follow. It is important that you adhere to these instructions, as they will serve to preserve the integrity of your case and the defense thereof.

  • Do not discuss the circumstances surrounding the incident with anyone other than the attorney representing you.
  • Do not make any additions or deletions to the patient’s records.
  • Do not respond to any inquiries regarding the patient before contacting Galen.
  • Do not respond to any legal papers before contacting Galen.
  • Do not review any medical literature specific to the alleged or potential claim. Defense counsel advises such actions are potentially discoverable and should be undertaken only upon specific direction of counsel.

Q: Can I choose the attorney I want to defend me?

A: Galen Insurance Company strictly partners with lawyers and law firms who are Martindale Hubbell (AV rated) and specialized in the defense of professional medical negligence claims.  Galen will make every effort to work with the Insured to provide counsel with whom he or she feels most comfortable.

Q: Once an attorney has been assigned to my case, what can I expect?

A: Initially you will be contacted by a Galen attorney for an initial phone interview.  During this conference, you will be advised of the litigation process and a discussion of the specific facts of the insured’s matter will be entertained.  It is helpful if you have available the original medical chart of the patient at issue, along with copy of your CV.

Q: Who determines whether a claim is settled?

A: Galen offers a true consent to settle policy and accordingly, Galen will not settle or resolve a claim without the specific written consent and authorization of the insured.  Some insurance companies say they will not settle a case without your consent—however, if you don’t provide your consent, their policy may allow for arbitration to determine if you are withholding consent unreasonably.  An arbiter’s finding that consent is being unreasonably withheld could authorize the company to settle the claim without your approval. 

Q: When does information get reported to the National Practitioners Data Bank (NPDB)?

A: The information is reported to the NPDB only when the insurance carrier makes a payment on behalf of an insured.  A situation could exist where there is a judgement against an insured and the insured chooses to pay the judgment himself or herself. In that case, no report is made to the NPDB. The same would apply if the insured pays a settlement himself or herself.

Q: How can I obtain my Claims History for a hospital, HMO, etc.?

A: Requests for claims histories must be in writing and signed by the insured. The request should include the insured’s name, license number, policy number (if not insured under your own name), and the specific years for which the claims history is sought.  The claims history will be mailed to the current address on your policy, unless otherwise requested by the insured.  The claims history will also be mailed directly to the requesting institution.