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Medical Malpractice Insurance Coverage Basics

Medical malpractice settlements can be as high as hundreds of thousands of dollars, with some awards totaling in the millions. For the average healthcare provider, it can be very difficult to pay for a patient’s damage out of pocket. 

To protect their interests in the event of a lawsuit, many professionals carry medical malpractice insurance. This coverage pays for a patient’s damages following a medical malpractice claim, reducing the at-fault provider’s out-of-pocket liability.

What Does Medical Malpractice Insurance Cover?

If a patient is injured by a medical professional’s negligent actions, he or she has the right to file a medical malpractice lawsuit or insurance claim against the at-fault provider. Through his or her claim, the patient can recover compensation for the losses that he or she experienced, such as medical expenses, lost wages, and pain and suffering. 

While Georgia does not require healthcare professionals to carry this coverage, many providers choose to purchase medical malpractice insurance to pay for a patient’s losses following an alleged act of negligence. This coverage protects the professional’s financial interests by paying for a settlement on his or her behalf.

Most malpractice policies provide up to $1 million in liability coverage per patient, with up to $3 million in total coverage annually. Healthcare providers can choose to purchase more coverage if they choose, but they could be liable for patient damages that exceed their policy limits.

Claims-Made versus Occurrence-Made Policies

Medical malpractice insurance coverage usually falls into one of two categories: claims-made and occurrence-made policies. Most policies follow claims-made rules.

• Claims-Made Policies: If a provider holds a claims-made policy, he or she will be protected as long as the policy was in effect when the alleged medical error occurred and when the patient first filed the medical malpractice claim.
• Occurrence-Made Policies: If a provider holds an occurrence-made policy, he or she will be protected as long as the policy was in effect when the alleged medical error occurred. The policy will cover the provider even if the patient files a claim after the coverage expires.

For example, say that a doctor holds an insurance policy from January 1st, 2020, to January 1st, 2022. If a patient files a claim for alleged malpractice on March 3rd, 2021 on February 2nd, 2022, the doctor will not be covered by a claims-made policy. However, he or she would be covered by an occurrence-made policy. 

Should You File an Insurance Claim or Lawsuit after Medical Malpractice?

If you are injured by a negligent healthcare provider who holds medical malpractice coverage, you may wonder if you should pursue an insurance claim or lawsuit. Your optimal legal pathway will depend on the circumstances surrounding your case.

Many medical malpractice cases that involve insurance companies begin as an insurance claim and escalate to a lawsuit if the claim is unsuccessful. However, there are some cases where you may want to file a lawsuit from the beginning.

For example, you can only recover compensation up to the provider’s policy limits when filing an insurance claim. If you have very high amounts of damages that exceed these limits, you may want to pursue a lawsuit instead. 

In these situations, it is important to discuss your legal options with an attorney. A medical malpractice lawyer in Augusta can evaluate your case and identify your optimal path to maximum compensation. Contact an attorney as soon as possible following the malpractice to discuss your next steps.