IMPORTANT NOTES RELATING TO YOUR iTOO MEDICAL MALPRACTICE INSURANCE POLICY DOCUMENT AND SCHEDULE
We urge you to please read through the 2019 policy document and familiarise yourself with all its terms, conditions, extensions, endorsements and exclusions, so that you do not unwittingly compromise your cover by breaching any of the terms or conditions of cover. Please note that your policy document is comprised of 2 parts:
- The Medical Malpractice for Medical Professions Policy Schedule and Disclosure Notices to Short-term Insurance Policyholders. The Policy Schedule provides you with a summary of the cover that you enjoy under this policy and also includes important terms and conditions of cover in the policy endorsements which you will fine on pages 6 to 8 of the Policy Schedule. It is very important that you carefully read all the endorsements found on these pages.
- The policy wording (titled, “ Professional Indemnity Medical Malpractice Public and Products’ Liability for Healthcare Practitioners”). It is very important that you read this document in its entirety as it sets out the terms and conditions of the cover provided under the policy.
Please note that your insurers under this policy are Hollard. Your policy document has been branded with IToo’s branding as iToo are Hollard’s Underwriting Agency responsible for underwriting this insurance policy. Details of iToo’s binding authority on behalf of Hollard can be found on page 11 of your policy document in iToo’s statutory disclosure document. Please do not hesitate to contact us (CFP Brokers) if you have any concerns in this regard.
VERY IMPORTANT NOTES WITH REGARD TO THE CLAIMS’ NOTIFICATION PROVISIONS OF YOUR POLICY DOCUMENT
- Please take note of the following which appears in iToo’s Disclosure Notice (see page 9 of the policy schedule):
SHOULD YOU HAVE A CLAIM AGAINST YOUR POLICY, PLEASE NOTE THE FOLLOWING:
- Procedures for the submission of claims are detailed in the policy wording.
- You may contact the insurance broker’s claims department for assistance.
Please note that claims must be reported as soon as possible after the event or incident giving rise to the claim and must be submitted in writing, to CFP Brokers, with documentary proof of your loss.
You will be required to notify the police in the event of theft or where a criminal act is suspected.
- Please pay special attention to the claims/loss notification provisions of your policy document. In this regard please see:
- “General Conditions” (Paragraph 11 – which appears on pages 14 to 17) of your attached policy wording document- more especially condition 11.2 on pages 14 – 16 (extract below):
The Insured (which is you) shall give written notice to the Insurers (you would contact CFP Brokers and send us the written notice or use our mobile APP to notify us of the claim) as soon as practicable of any Claim made against the Insured or of any Circumstance which may give rise to a Claim being made against the Insured and which forms the subject of indemnity under this Policy and shall give all such additional information as the Insurers require. Every claim, writ, summons or process and all documents relating to the Claim, event or Circumstance shall be forwarded to the Insurers immediately on being received by the Insured.
Failure to adhere to the above condition of the policy, requiring timeous notification of any incident or circumstance that you become aware of, which could give rise to a potential claim or SANC complaint against you, can result in iTOO rejecting your claim, or refusing to assist you with your defence of a SANC complaint made against you.
- Do not wait for formal legal action to be taken against you or to receive an official notification from the SANC, that a complaint has been lodged against you before you notify your insurers of a claim. Notify us, in writing, as soon as you even remotely suspect that you might possibly face a claim or complaint. You can notify us via e-mail sent to email@example.com or via our mobile App.
- Please see our separate document which provides step-by-step guidelines to download our App on your cellphone and which also provides details of additional functions that you can access using our App.
- We urge you to report all circumstances and incidents to us in writing, rather than waiting for an actual claim to eventuate. You should notify through all circumstances and/or specific events or incidents which could lead to a claim or an HPCSA complaint against you, regardless of:
- whether anyone has formally intimated that they intend to claim against you,
- whether you believe the amount of the claim would fall within your excess,
- your assessment of the merits of any threatened or potential claim/complaint against you,
- The status of any investigations into the matter,
- Whether your employer has told you that their attorneys will deal with the matter,
- Your relationship with the potential plaintiff.
- Even if a patient has specifically told you that they have no intention of making a claim or lodging a complaint against you, if there has been an incident or a circumstance which could give rise to a claim or a complaint against you- you still need to notify us in writing. Patients have been known to change their minds- especially if they are led to believe at a later stage, that they will require further treatment/surgery as the result of your alleged negligence or after speaking with members of their family.
- You should never make any admissions or commit your insurers or yourself to any kind of settlement or payment without your insurers’ prior written consent. See condition 11.4 of your policy wording document (page 15) carefully in this regard.
- It is very important that you do not write off or discount any accounts (where there has been an incident, complaint or circumstance or any allegation of some kind of wrong-doing on your part, e.g. billing for services not rendered) or enter into any kind of arbitration or negotiation without the prior knowledge and written consent of your insurer. It is also important that if a medical aid sends you a communication advising that they believe that there have been irregularities in your accounting and demanding payment from you- that you do not make any payments to a medical aid (where they have alleged any wrongdoing on your part), without first notifying us and obtaining iTOO’s prior authorisation. Writing off or discounting accounts, where there have been unfavourable treatment outcomes, can be seen as an admission of liability- which is a breach of your policy conditions and could result in your not being covered in the event of a claim or complaint against you.
- You should not appoint any attorneys or incur any legal costs on any matter, which could be covered under this policy, without first obtaining your insurer’s prior written consent. Doing so could compromise your cover, or have the result that Insurers decline your requests for the reimbursement of such costs you have incurred, prior to obtaining their consent.
- If you believe that you may be subject to a potential claim, please head your notification to us as being “prepared in contemplation of litigation”. Be aware that although attorneys appointed to assist you will assert that such communications are legally privileged and thus confidential, if this is contested successfully in court, the contents of your notification may become subject to disclosure to the opposing party. It is therefore prudent to exercise discretion with regard to the inclusion of any incriminating admissions in your communications with us, which may not be protected by the legal privilege which would apply to communications between yourself and the legal counsel appointed to assist you if a matter proceeds to litigation.
- Please carefully note exclusion no 10.1.6.(on page 11). Insurers have used this exclusion to repudiate claims where they feel that the insured practitioner has violated the law/the SANC regulations- intentionally. You cannot be covered under this policy for any conduct/omission, which insurers deem was intentional or reckless. In some instances, your failure to ascertain the legal/ethical position where someone has questioned your conduct, to establish whether your conduct is legal/ethical- and your continuing to conduct yourself in a manner which has been questioned- may constitute intentional wrongdoing on your part and as such would not be covered. Also- if you know that what you are doing is wrong- and you do it anyway- it is very likely that any claim or complaint arising out of your conduct will not be covered.
Please do not hesitate to contact Noleen or Kristy at CFP Brokers, if you need any assistance or clarification of anything in your policy schedule or wording documents, if you have any questions at all about your cover under this policy or if you need assistance in notifying a potential claim or complaint against you.
It is very important that the above information together with the policy document is made available to all your members (and if possible that you retain proof that they had access to it). Otherwise we tend to find on our other schemes, that in the event that the insurers reject a claim because a member has breached a policy condition- the member will usually turn around and blame us and their professional association saying that we never made them aware of the policy conditions of their cover.
Please will you let me know if you would like me to meet with you and/or anyone else, to provide a refresher of the more important terms and conditions of the policy; this could be useful given the extensive changes made to the policy endorsements. Please do not hesitate to let me know if you need anything else.
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