Medical Malpractice News

The High Risk Associated with Orthopedic Surgery

Tags: | Comments: 0 | June 20th, 2011

Orthopedic surgery comes with a much higher risk to medical professional liability insurance companies than most medical specialties. All types of surgery carries a much higher risk of malpractice claims than do non-surgical specialties, however orthopedic surgery is at the high end of the risk range. The liability insurance companies classify orthopedic surgeons into three separate risk categories for orthopedic surgery. They are:

  • Orthopedic Surgery – With Spine
  • Orthopedic Surgery – No Spine
  • Orthopedics – No Surgery

Declarations Page – Orthopedic Surgery Specialty Classification

Medical malpractice insurance for orthopedic surgery with spine carries the highest risk of the three areas of expertise and comes with the highest premium charge. It is extremely important that orthopedic surgeons understand how their medical malpractice insurance policy is structured. Each individual physician has their specialty listed on the declarations page of the policy, referencing the specialty that insurance company is covering.

  • If a physician’s declarations page shows orthopedic surgery no spine, that physician will not be covered in the event that physician receives a medical malpractice claim for a spine surgery that he/she had performed.
  • If a physician’s declaration page shows orthopedic surgery with spine, that physician is covered for traditional orthopedic surgery and spine surgery.

Many spine surgeons stop performing spine surgery towards the end of their career and focus on traditional non-spine orthopedic surgery. Physicians can switch to the lower risk specialty of orthopedic surgery no spine, and continue to be covered by their medical malpractice insurance carrier, as long as the carrier is aware of the spine surgery in that physician’s prior acts or “retro active” period.

If a physician makes the switch to orthopedic surgery no spine and continues coverage with the same insurance carrier, that carrier will continue to cover the spine surgery in the physician’s prior acts. It is important for orthopedic surgeons to understand that their premium will not be reduced to the orthopedic surgery no spine rate immediately. Many of the liability insurance companies will blend the lower orthopedic surgery no spine with the higher spine rate and that premium will blend down to the lower rate over a three year period. The insurance companies do this as they are still carrying the risk of the spine surgeries in the physician’s prior acts.

What if the orthopedic surgeon switches medical malpractice insurance companies?

Physicians with claims-made policies are able to switch orthopedic surgery medical malpractice insurance companies and have their prior acts or retro active period covered with their new carrier. The new carrier will cover the orthopedic surgeon back to the retroactive date listed on the physician’s current declarations page or certificate of insurance. If orthopedic surgeon is no longer performing spine surgery, but has spine surgeries in his/her prior acts period, it is imperative that physician informs the new company in writing and on the application that they previously performed spine surgery.

The new carrier will require the date of the last spine surgery and the orthopedic surgeon will not be covered for any spine surgeries performed after that date. If a physician switches liability insurance companies without informing the new company that they previously performed spine surgery, and the new policy declarations page shows orthopedic surgery no spine, there will be NO coverage if a claim comes in for spine surgery.

The cost of medical malpractice defense alone is tens of thousands of dollars per claim, not including any indemnity payments should the physician need to settle or lose a case at trial. Making sure prior acts coverage is properly in place when switching from spine to no spine specialty classification is not difficult but very important that the process is done properly. The same situation is true for orthopedic surgeons who stop performing surgery completely and continue to practice as an orthopedics no surgery physician. The date the orthopedic surgeon stopped performing surgery is the date the medical malpractice insurance company will need to know and will be documented. Claims received for surgery done after this date will not be covered. As discussed above, the rate will be blended down over a three year period (with most carriers).

Conclusion

An important factor that orthopedic surgeons can include to help lower annual premiums is to provide good records of how many spine surgeries were performed each year as a spine surgeon over the previous three years. Underwriters will see a physician as a lower risk if the number of spine procedures performed were low or lower than average. By far the most important factor that underwriters look at is a physician’s claim history. The better an orthopedic surgeon can document past claims with well written and thorough claim narratives, the better chance the physician will have of convincing the medical malpractice insurance company the physician is a low risk.