Q. How do you get a medical leave of absence?

A. If you work for a company with fifty or more employees you may qualify for the Family Medical Leave Act, which typically allows up to twelve weeks for unpaid leave, or more if you are in the military. Also, your state may have its own laws that complement FMLA or add to this leave. Check with the Department of Labor in your state.

Q. What are the basic maternity leave laws?

A. This depends on the state, but the Family Medical Leave Act typically allows up to twelve weeks for unpaid leave. Also, your state may have its own laws that complement FMLA or add to this leave. Check with the Department of Labor in your state.

Q. What is the difference between claims-made & occurrence malpractice?

A. Claims-made covers you for claims submitted while the policy is in force, and also for a tort that occurred from the retro date through the date of the current policy. Occurrence policy covers claims that occurred during the policy period, and the policy does not have to be in force.

Q. Do IPA’s need medical malpractice insurance?

A. No, but they do need industry specific errors and omissions, and directors and omissions insurance that include vicarious malpractice, which cover the IPA’s risk for malpractice.

Q. What’s the difference between medical malpractice and errors and omissions?

A. They both cover errors; but, Medical Malpractice covers physicians for direct medical care and Errors and Omissions cover a business if it makes an error.

Q. What do statutory limits mean on a worker’s comp policy?

A. In many states you cannot sue an employer for more than $1 million by law, excepting gross negligence; therefore, it is a law, so the insurance policy models the statute’s limits.

Q. What is an excess worker’s comp policy?

A. It is for employers who self insure their worker’s comp. They buy excess or stop loss insurance. This insurance limits the employer’s exposure to unexpected total claims, or the specific claims of one person.

Q. What is excess of limit losses in workers compensation?

A. This can refer to an excess policy, which you can buy over a fully insured policy. Normally, workers compensation is limited to the statute, but if gross negligence can be proven then a claimant can sue for more than the limits of statute. If this happens, and the employer has an Umbrella policy, it may respond to the claim that exceeds the limit of the workers compensation policy.

Q. What is worker’s compensation aggregate retention?

A. This is the total amount of claims that you, the employer, pays until the insurer starts paying.

Q. How do you account for workers compensation aggregate stop loss deductible?

A. When you purchase aggregate stop loss for your self-insured workers compensation, the insurer will define upfront what the aggregate is. Your TPA, or third party administrator, should give you periodic aggregate reports showing the total amount of claims paid as they accumulate toward meeting the aggregate stop loss deductible.

Q. What are reinsurance triggers in healthcare?

A. It depends. Health insurers can have a defined dollar amount where they are laying risk off to a reinsurer. For example, a health insurer may buy a $100K of specific reinsurance coverage; thus, if one patient hits a $100K, then every dollar above that amount will be reimbursed by the insurer.
Q. What are the two types of stop loss in hospitals?

A. 1.Specific stop loss covers the hospital for claims that exceed a defined dollar amount for a patient. For example, the hospital for its self insured health plan, or its capitated members, can buy a $100K of specific stop loss deductible, which means the insurer will pay all claims that exceed $100K.

2. The other is aggregate stop loss which covers the hospital for all the claims it pays out in its self insured plan. For example, the insurer will cover you if your total claims paid in the year exceed $5 million. The insurer will reimburse the amounts that exceed that amount.

Q. Does a third party FMLA administrator have the right to contact your healthcare provider?

A. Yes, they have the right to ask for a second opinion, and/or have your doctor complete a form. But contacting them directly, I doubt, would be effective because the MD cannot talk with them due to HIPAA.

Q. What does it mean if your HMO sent a letter saying you have reached the catastrophic portion of your policy?

A. This can possibly mean that you have reached the maximum out of pocket limit.

Q. Can my employer stop my health care when on workers compensation?

A. Yes, they need to put you on COBRA. Health insurance requires that you are to actively working full time. When you are out on a worker’s compensation claim, you cannot meet this requirement.

Q. How can a company process employees’ medical claims?

A. The employer, if it is big enough, can take their claims in house and act as a TPA. Most companies do not do this anymore due to HIPAA concerns; most outsource this to an independent TPA.

NOTE: THE ABOVE IS A GENERAL DISCUSSION ABOUT HOW COVERAGES MAY WORK. YOUR INSURANCE POLICY AND ALL ADDENDA ARE THE ONLY AUTHORITY OF HOW YOUR COVERAGE WORKS. DO NOT RELY ON THIS ARTICLE AS AN EXPLANATION OF YOUR COVERAGE. HAVE YOUR ATTORNEY REVIEW YOUR ENTIRE POLICY WITH YOU TO DETERMINE WHAT IS AND IS NOT COVERED.

By William D. Dyer

Q: What the meaning of equal employment opportunity?
A: This typically applies to a business with fifteen or more employees that prohibits discrimination in any aspect of employment and harassment in the workplace based on race, color, age (40 and over), sex, pregnancy, gender, religion, disability, national origin, ethnic background, military service, and/ or citizenship.

Q. What is the ballpark estimate for directors and officer liability insurance?

A. It can be as low as $1,200 for a small business, to millions for a public company

Q. What is the typical annual premium for D&O in small business?

A. Typically it is $1,200 to $5,000.

Q. What is the cost for errors and omissions coverage?

A. This depends on the limits, industry, geographic location, and past claims experience. Some of the most expensive professions would be MD’s, Real Estate Brokerages, and Appraisal Firms, Insurance Brokerages, Engineering Firms and Law Firms.

Q. How do you apply for errors and omissions insurance?

A. You contact an insurance broker with expertise in E&O (it is an insurance specialty). The broker will have you complete an application; if you have coverage currently they will obtain your loss runs for the past five or ten years. The broker will shop your coverage to multiple insurers.

Q. How much is a $100,000 of general liability?

A. Assuming you are not in something risky, an estimate would be $100 to $500 a year. Most companies buy this coverage with limits in the millions.

Q. What is product professional liability?
A. As it implies in its name, it protects you from suits relating to the products that you produce, or a private label.

Q. Can an employer stop group health benefits during workers compensation claims?

A. Yes; and the employer should. You have to check with your health insurer to see what the contract dictates, but most have a limitation that coverage is for full time employees working twenty-five or thirty hours a week. If an employee is on Workers Compensation, he/she is not working, so therefore, he/she is no longer eligible for group health insurance. You should offer him/her COBRA. If you do not do this, the health insurer can deny the claims of the employee. We know of an employer, which is not our client, who kept an employee on his/her group health insurance while the employee was on Workers Compensation. The employee had a massive heart attack while he/she was disabled. The employee mentioned it to the doctor, and it was entered into his medical record that he was out on a Workers Compensation claim. The employee was given open heart surgery that yielded a big bill, which the insurer denied since the employee was not eligible for health insurance at the time of the claim. The employer was sued for the bill and lost in court.

Q. Can you run a CA Family Rights Act with the Federal Family and Medical Leave Act?
A. Yes, CFRA and FMLA can run concurrently.

Q. Is excess workers compensation a liability policy?

A. Not excess, which usually refers to reinsurance – a self insured Workers Comp. However, if the question is, can you buy excess coverage or umbrella insurance to supplement the liability portion of Workers Compensation, the answer is yes. This is one of the reasons why one buys an umbrella for one’s company. If the Workers Comp limits are breached or used up, then the umbrella may respond. Please note that most states limit the liability for the employer to the limits of the Workers Comp policy unless there is gross negligence.

Q. What is worker’s comp aggregate retention?

A. If you self insure your Workers Comp and say if the past five years show your average claims with an inflation of $3,000,000 then a reinsurer may sell you an aggregate reinsurance policy that will pay all claims that exceed the expected claims of $3,000,000. The $3,000,000 is the aggregate retention or deductible.

Q. Where can you buy medical malpractice coverage while on the US rotation?

A. If you are a resident of the US, you can buy it from a typical malpractice insurer. The problem is the policy will be for one year, so if you are here for less than one year, you will want to pay the premium and request a refund for any unused premium and buy tail insurance. Tail insurance is to cover you for any claims that occurred during the time you were covered. If you are returning to your home country and never plan to live in the US, you will want to consult an attorney to see what your exposure is versus buying tail insurance. When in doubt, buy tail insurance.

NOTE: THE ABOVE IS A GENERAL DISCUSSION ABOUT HOW COVERAGES MAY WORK. YOUR INSURANCE POLICY AND ALL ADDENDA ARE THE ONLY AUTHORITY OF HOW YOUR COVERAGE WORKS. DO NOT RELY ON THIS ARTICLE AS AN EXPLANATION OF YOUR COVERAGE. HAVE YOUR ATTORNEY REVIEW YOUR ENTIRE POLICY WITH YOU TO DETERMINE WHAT IS AND IS NOT COVERED.

By William D. Dyer

The work force is ever changing especially during these tough economic times that have resulted in a rise in employment claims and litigation. Big and small business owners need to protect themselves with EPLI or Employment Practices Liability Insurance that covers them for exposures relating to employment (i.e. discrimination, wrongful termination et al). Business owners don’t have the resources to battle these cases on their own, nor are they prepared to implement risk management practices to avoid them. Obtaining business employment practices liability insurance will cover litigation expenses alleged by anybody from the employee to the third party. EPLI premiums are affordable, with minimum premiums that can be less than $1,000. Here are some facts worth noting that should influence small business owners in the right direction, taken from June 2010′s issue of Best Review.

• Hartford Steam Boiler found two out of three [small business owners] were concerned that their employees will file an employment-related charge against them with only a fraction, who have some type of insurance protection for workplace claims.

• U.S. Equal Employment Opportunity Commission reports that employment claims reached the second highest level ever in 2009, with more than $376 million awarded to employees.

• EEOC statistics also show 81% of claims settle for an amount ranging from $22,400 to $40,500 (excluding defense costs).

The time is now to protect your company from employment claims. Don’t wait, because if you get sued then it is too late to buy coverage to cover that claim. A significant employment or workplace claim can be the tipping that can be the ruin of your business.

HCP National is an Employment Practices Liability, EPL, or ELPI provider or broker for over 16 years. As an EPLI broker we know the risk exposures of employment, and we know how to insure it. This blog does not alter or change coverage, nor is meant as legal advice.

By William D. Dyer

Basic 101 of Errors and Omissions
Basic 101 of Professional Liability
Basic 101 of Malpractice Insurance

Let’s begin with the basic 101, all of the above insurance coverage are for the most part the same. All are terms that refer to liability coverage that covers a person or a business if it makes an error, or mistake, as it provides its service to its customers (patients in the case of medical malpractice insurance). Anyone with a business, who provides a service, needs this insurance.

Why you need Errors and Omissions Insurance, or Professional Liability Insurance, or Medical Malpractice Insurance

We find there are lots of businesses, who think they do not need Errors and Omissions or Professional Liability Coverage. They wrongly assume that their General Liability will cover them. General Liability normally excludes professional services.

Some people think their corporate shield will protect them. Good luck with that one! It is true that the corporate entity may shield you from personal exposure, but how long will your business or practice last while there is a Keeper appointed by the court sending notices to all your customers to pay him, not you?

In general, Errors and Omissions Insurance AKA E and O Insurance (or any of the other names in the title of this blog) is affordable and well worth it.

How to pick the right coverage

You will be given an application when you apply for professional liability insurance. Make sure you take lots of time to complete it fully and accurately. If the application does not allow you to describe what you do, add an addendum describing what you do. Be very accurate. You want to be fully covered by an insurer, so they need to know what you are doing. Never lie or understate what you are doing, just the whole truth and nothing but that. Then, after you submit your application, you will get some price quotes. Now it’s time to do your homework.

Do not look at price alone. You do not want to save $5K or even $50K now, and find out in the future that you did not buy the best coverage. You could possibly face an uncovered multi-million dollar lawsuit. If you are a pure price shopper you will get what you pay for in E and O Insurance, and you will not obtain the coverage that you need.

Doing your homework

First, go to Ambest.com and look up all the insurers from whom you received quotes. You want an insurer with billions in assets and an A, or A+, or A++ rating. You can also consider A- insurers, but A+ or A++ is ideal. This grading is AM Best’s way of designating what the insurers’ financial strength is; thus A++ is the highest grade it can assign. Never buy insurance from an insurer with a grade below A- , unless you have no choice. Once an insurer is in the B grade area, or lower, or worse no grade at all, the chances of it not being in business when you have a claim are higher. Like in school, you want the highest grade you can achieve.

Ask questions

Then, ask for a copy of the specimen policy with all the endorsements that apply to you. Quotes are not the coverage, the policy is. Look at the policy pages that show what is excluded first. If you see anything that may affect you having coverage, start asking questions. The same goes for what is covered, but we find that what is not covered most is telling.

Furthermore, ask specific questions in writing, and ask for a written response from the insurer via the broker. Save that response in your file. Also, it is a good idea to pay for an hour of your attorney’s time to review the policy. An insurance policy is a contract, and unless you or your broker has a JDL, you are not qualified to review a legal document fully.

Remember, this insurance policy can save you and your business millions of dollars, so choose wisely and do your homework before you purchase the insurance coverage.

HCP National Insurance is a provider of Errors and Omissions, Professional Liability, and General Liability Insurance for small businesses. We are experts in small business insurance, health care insurance, D and O and E and O insurance, medical malpractice insurance, and all other insurance coverage. Our home office is located in Aliso Viejo, CA.

NOTE THE ABOVE IS A GENERAL DISCUSSION ABOUT HOW COVERAGES MAY WORK. YOUR INSURANCE POLICY AND ALL ADDENDA ARE THE ONLY AUTHORITY OF HOW YOUR COVERAGE WORKS. DO NOT RELY ON THIS ARTICLE AS AN EXPLANATION OF YOUR COVERAGE. HAVE YOUR ATTORNEY REVIEW YOUR ENTIRE POLICY WITH YOU TO DETERMINE WHAT IS AND ISN’T COVERED.

We’re on the social networks! Now what? Well, we just joined this new realm a few months ago and are eager to engage with you. Our clients and prospects are very important to us, which is why we decided to be a part of social media. We understand that the age of web 2.0 requires a level of conversing, Q&A, dialogue in order to build and improve relationships, as well as spur innovation and the sharing of ideas. So write, message, or talk to us about your concerns, questions, comments, etc. in the various social networks we are participating in which includes Twitter, Facebook, Friendfeed, and Linkedin.

Our expertise is in the healthcare industry and we offer excellent coverage at affordable rates for doctor’s who need medical malpractice insurance and hospitals and businesses that need group health coverage. We also specialize in business liability insurance such as Errors and Omissions and Directors and Officers insurance. You can check out our other offerings here.

Looking forward to chatting with you!

Based on the above title, you are probably scratching your head and asking, “What does this mean?” Tech Errors and Omissions was created as a response to General Liability that did not extend liability to web pages and other electronic risks. Everyone, Tech and non- 0Tech companies, who has a website, or has gone paperless on private employee and/or client information, should have Tech E and O insurance.

Some firms who have a broker who is not knowledgeable, may assume that Tech E and O is errors and omissions insurance (AKA Professional Liability) for the tech company. It is not. How can that be? It is called Tech E and O so the uniformed broker assumes this is a policy especially to cover Tech companies, but this is wrong.

When it comes to E and O insurance, whether you’re a Tech Firm or an Insurance Brokerage, it responds to claims for professional liability, not your Technology, but what you do. Thus if you are a Tech company and are sued under E and O (AKA Professional Liability), then it will be for things like you wrote the code badly which caused a tort, or if you warranted something about your Technology or your service and it was not true/accurate (excluding fraud).

If you are a Tech Company, you want to have Errors and Omissions insurance also known as Professional Liability. On top of this you also want Tech E and O to cover your website and other electronic risks and breaches. Do not confuse the two. Also worth noting, E and O will be more expensive than Tech E and O, since the likelihood of a claim is much higher.

HCP National Insurance is not a law firm, but an Employment Practices Liability Insurance, Directors and Officers, and Errors and Omissions insurance brokerage whose home office is in Costa Mesa, CA.

NOTE THE ABOVE IS A GENERAL DISCUSSION ABOUT HOW COVERAGES MAY WORK. YOUR INSURANCE POLICY AND ALL ADDENDUMS ARE THE ONLY AUTHORITY OF HOW YOUR COVERAGE WORKS. DO NOT RELY ON THIS ARTICLE AS AN EXPLANATION OF YOUR COVERAGE. HAVE YOUR ATTORNEY REVIEW YOUR ENTIRE POLICY WITH YOU TO DETERMINE WHAT IS AND ISN’T COVERED.

Changes to EPLI Employment Practices Liability Insurance California LA Labor & Wage Violations Report

Employment Practice Liability Insurance (EPL) provides protection for an employer against employee claims, former employee claims, or claims made by potential employees based on discrimination, wrongful termination, harassment, and other allegations. If you are a California employer, you should know that labor and wage violations are higher in Los Angeles, CA than in any other major cities nationally. You should also know that getting insurance to protect your company or firm may soon be much more difficult.

Today’s EPL policy may no longer be available in Southern California, as well as other regions. This news follows the disturbing report issued by UCLA’s Institute for Research on Labor and Employment that found a shocking “9 out of 10 workers in Los Angeles County experienced wage theft and 80 percent did not receive legally mandated overtime”. The same report showed that “Los Angeles workers were more likely to suffer wage and labor violations than those in New York or Chicago”.

In light of this report, it is expected that many insurers will take aggressive steps to reduce their exposure in Southern California or risk an avalanche of losses. Failure to protect themselves would force insurers to face complete withdrawal from this essential venue.

• The first signs of restriction will be the elimination of Wage and Hourly coverage; a key coverage enhancement available in most policies that provides coverage for the very violations noted above.

• Expect the “Full Prior Acts” coverage term to be replaced by a strict Retro Date Inception (RDI) for first time policyholders, as insurers will look to favor their current policyholders over the “late comers”.

• New applicants for coverage will be forced to deal with stringent underwriting standards and may not be able to secure coverage at any cost (much like homeowners trying to re-finance their mortgage).

• Immediately following a series of coverage/underwriting restrictions, increases in retentions and premiums are sure to follow.

The bottom line is this: the signals for an extremely difficult EPL market are out there and firms that do not secure coverage IMMEDIATELY may be left out in the cold when they need the coverage the most. Since EPL is tied closely with Directors and Officers Liability, the impact on the EPL coverage line will undoubtedly affect D and O as well. So if you do not secure these coverages in the next 60 days, your options will not resemble what they could have today.

HCP National Insurance is an EPLI (Employment practices brokerage) company, who works with Rubicon Insurance Services – our affiliate and author of this blog. HCP National Insurance is not a law firm, but an Employment Practices Liability Insurance, Directors and Omissions, and Errors and Omissions insurance brokerage whose home office is in Aliso Viejo, CA.

NOTE THE ABOVE IS A GENERAL DISCUSSION ABOUT HOW COVERAGES MAY WORK. YOUR INSURANCE POLICY AND ALL ADDENDUM ARE THE ONLY AUTHORITY OF HOW YOUR COVERAGE WORKS. DO NOT RELY ON THIS ARTICLE AS AN EXPLANATION OF YOUR COVERAGE. HAVE YOUR ATTORNEY REVIEW YOUR ENTIRE POLICY WITH YOU TO DETERMINE WHAT IS AND ISN’T COVERED.

If you are a private, public, or even a public entity, and you have a website, then you need E and O and D and O, and Tech and Privacy Breach E and O insurance. E and O insurance (Errors and Omissions Insurance) covers the service that you provide and the representations that your employees make to your customers. D and O ( Directors and Officers Insurance) protects the officers and directors as they conduct the affairs of the business. Tech and Privacy E and O covers the things you say and do on your website, and also if you have a computer security breach and clients or employee’s confidential information is stolen. Also, if you are a technology company and your technology harms another (viruses, lack of data breach protection, your system malfunctions and the client is harmed financially), Tech and Privacy E and O insurance will cover your company.

D and O (Directors and Officers Insurance) coverage protects your board members, who make decisions about the direction of the company. It also protects the manager, employees, and officers, who make decisions regarding the operation or direction of the company. Lastly, the company, the entity itself, as it is named in a suit for these types of actions is also covered.

Here are some example claims:
1. A director has a friend in the carpet business and the director recommends that the company buy carpet from his friend. The company spends three times more for what the carpet would normally cost, and the director also received a kick back from his friend. The stockholders sued for wasting company assets, self dealing et al.

2. A sales manager recruits two sales reps from a competitor, and he tells them to take the competitors client lists. The competitor sues for business interference et al.

3. A privately held business is sold, and before the sale, the owner signed a 10 year lease at an above market rental rate. The new buyer comes back and sues for non-disclosure and wasting corporate assets (the seller is only covered if he/she bought prior acts for the D and O insurance).

E and O (Errors and Omissions) – This covers your employees and other representatives for the actions they take as they deliver your product or service. It covers misrepresentations and errors, or lack of disclosure. It excludes fraud or other criminal activities.

Here are some example claims:
1. A sales representative of a technology company sells a $2 million contract and assures the client that it will work with his/her systems. The representative was wrong and the software destroys the client’s legacy systems. The customer sues for the error.

2. A medical supply company sells a new device to a hospital and forgets to let the customer know that the machine will malfunction if it is not grounded. The machine malfunctions and kills a patient. The hospital and the patient sue for wrongful death.

3. An insurance agent tells a client he/she is covered for wind damage in his/her homeowner policy. A big wind storm destroys the client’s home, and his policy clearly excludes wind damage. The agent is sued for the error.

Tech and Privacy Breach E and O insurance is a new area of insurance if you have one or all of the following: a website, client personal information, and/or employees. Anyone with a website accused of harming another’s reputation or posting copyrighted information, needs this coverage in order to be protected from lawsuits. General Liability has coverage for advertising, but it is debatable and therefore it is unlikely that you will find coverage since a website is not considered advertising. If you have Tech and Privacy Breach E and O insurance, you are covered. Also if your computer system is breached and confidential information is breached, Tech and Privacy Breach E and O insurance will cover you. The coverage will also reimburse the cost to inform all those that were breached and defend any suits.

Here are some example claims:
1. A medical group has a laptop stolen with 10,000 patient records on it. The thief sells the patients’ information to others who steal their identities and apply for credit cards in their names. The patients sue the medical group in a class action suit for the damage.

2. A technology company that makes software for airplanes has a virus and it destroys the computer systems of 50 planes. The airline sues for $20 million.

3. A flooring company uses an Elmer Thud cartoon on its website and its web designer assured them that he paid the license fee for its use. The flooring company gets lots of hits and business from its use of the image. The licensor of Elmer finds the site and sues for $1 million for multiple infringements of the copyright.
Every company should have E and O and D and O, and Tech and Privacy Breach E and O insurance. The cost of the insurance is not significant when compared to the risk.

HCP National is an E and O and D and O, and Tech and Privacy Breach E and O insurance brokerage whose home office is in California. This article is not an insurance policy. All questions of insurance coverage are determined by your insurance policy. We are also not a law firm and we do not offer any legal advice.

NOTE THE ABOVE IS A GENERAL DISCUSSION ABOUT HOW COVERAGES MAY WORK. YOUR INSURANCE POLICY AND ALL ADDENDUM ARE THE ONLY AUTHORITY OF HOW YOUR COVERAGE WORKS. DO NOT RELY ON THIS ARTICLE AS AN EXPLANATION OF YOUR COVERAGE. HAVE YOUR ATTORNEY REVIEW YOUR ENTIRE POLICY WITH YOU TO DETERMINE WHAT IS AND ISN’T COVERED.

There are distinct differences between Medical Malpractice insurance for Medical Providers and Managed Care Errors and Omissions (Professional Liability) and Directors and Officers insurance.

Malpractice Insurance applies to the actual physician’s treatment of patients, whereas Managed Care E&O and D&O Insurance provide a distinct and separate layer of insurance for exposures that may occur in association with the business activities related to managed care operations.

At times there may be cases where a medical malpractice suit not only names a physician or hospital, but goes on to name a managed care organization such as an IPA or HMO. This spread of risk is often referred to as “Vicarious” liability and is one of the main reasons why such organizations must carry Managed Care Professional Liability insurance or Errors and Omissions.

• Vicarious Liability is defined as: When one person is liable for the negligent actions of another person, even though the first person was not directly responsible for the injury. For instance, a parent sometimes can be vicariously liable for the harmful acts of a child, an employer sometimes can be vicariously liable for the acts of a worker, and a managed care organization can sometimes be vicariously liable for the acts of a contracted provider. In all of these cases the party causing the tort is seen as under the third parties control.

In the above scenario, a Medical Malpractice policy would respond for the physician or medical facility named in the suit and the Managed Care Insurance policy would respond for the managed care organization.

Note: HCP is not a law firm and we are not giving legal advice, or defining coverage; your insurance policy is the final authority. HCP National is a Medical Malpractice Insurance and Managed Care E&O and D&O Insurance Company or broker.