Definitions of Insurance Terms

To help you have a better understanding of malpractice insurance terms, this glossary contains policy definitions of Medical Protective terms.

Medical Protective Terms

Additional Insured
means any person or entity listed on Item 1(b) on the Declarations page.

Administrative expenses
mean any reasonable expenses incurred pursuant to an administrative hearing for attorney’s fees for legal services rendered, including but not limited to, pre-hearing discovery and investigation costs, and charges for attorney’s general services.

Administrative hearing(s)
means a disciplinary proceeding against an Insured arising solely out of the performance of your professional services as a Healthcare Professional, and shall be limited to the following:

1. Any proceeding initiated by a licensing authority of an Insured’s jurisdiction against the Insured for unprofessional conduct;
2. Any proceeding initiated by a State Department of Health Services or the Federal Department of Health and Human Services alleging that an Insured has performed professional services as a Healthcare Professional in excess of, or in violation of, guidelines for appropriate utilization of these services; or
3. Any proceeding initiated by a licensed or certified hospital.

Anti-trust law
means those laws listed in:

1. Title 15, Section 12 of the United States Code;
2. The Federal Trade Commission Act; or
3. Any similar state law.

Automobile means
a land vehicle, self-propelled or not, a trailer or a semi-trailer. This includes any machinery or apparatus attached, whether or not subject to motor vehicle registration or designed for use principally on public roads.

Biomedical waste
means a biological agent or condition that includes, but is not limited to, an infectious organism or unsafe laboratory condition that may cause or result in bodily injury or property damage.

Bodily injury
means bodily harm, sickness or disease, including death resulting therefrom.

Claim means
an express, written demand upon an Insured for money or services as compensation for civil damages.

Claims expense
means all costs and expenses incurred in connection with the investigation, adjustment, and defense of any claim. Such costs and expenses shall only include:

1. Attorney fees paid to the law firm selected by the Company to defend an Insured;
2. Court costs;
3. Expert fees;
4. Reporter fees;
5. The cost of any alternative dispute resolution ordered by a court, otherwise required by law, or pre-approved by the Company;
6. Post-judgment interest on that portion of the judgment that does not exceed the applicable limit of liability available under the policy; and
7. Such other costs and expenses that the Company has determined are reasonably related to the defense of a claim.

However, claims expense does not include:

1. Loss;
2. Attorney fees awarded to a claimant;
3. The salary of any employee of an Insured; and/or
4. The forgiveness of any amounts owed for the cost of care or services rendered by an Insured.

Criminal prosecution
means any governmental enforcement of criminal laws, including offenses or convictions, which could result in imprisonment.

Discrimination means
any violation of any law, whether statutory or common law, which prohibits disparate treatment, based upon, but not limited to, race, color, religion, national origin, age, handicap or disability, sex, or sexual orientation.

Event
means an accident, including continuous or repeated exposure to substantially the same conditions, resulting in bodily injury or property damage unexpected and unintended from the standpoint of the Insured. Event does not include the rendering of, or failure to render, any professional services, nor does it include defamation.

First made
means the date on which an Insured first received a claim. All claims arising from loss suffered by the same claimant(s) shall be considered as having been first made when the first such claim is received by an Insured.

HIPAA Proceeding
means any federal proceeding alleging any breach of the responsibilities, obligations or duties imposed upon you under the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) and any rules or regulations promulgated thereunder.

Initiated
means the commencement of an administrative hearing at the time written notice is received by an Insured.

Loss

1. means civil damages, including prejudgment interest, that an Insured becomes legally obligated to pay through adjudication or settlement.
2. Loss does not include:
   • any damages that are greater than any limit of liability;
   • any injunctive or other equitable relief;
   • claims expense;
   • attorney fees awarded to a claimant as a fine, penalty, or sanction based on an Insured’s misconduct. However, attorney fees awarded as a part of the claimant’s damages in a covered claim for any other purpose will be included as loss;
   • the salary of any employee of an Insured; or,
   • the forgiveness of any amounts owed for the cost of care or services rendered by an Insured.

Patient
means an individual who is undergoing medical treatment and care that is directed by a licensed practitioner of the healing arts toward maintenance, improvement or protection of health or lessening of illness, disability or pain.

Peer review
means the evaluation of a healthcare professional’s fitness and qualification to provide treatment by a professional review board or committee through formally adopted, written procedures.

Personal injury
means injury, other than bodily injury, arising out of one or more of the following offenses:

1. False arrest, detention or imprisonment;
2. Malicious prosecution;
3. Wrongful eviction from, wrongful entry into, or invasion of the right of private occupancy of a room, dwelling or premises that a person occupies, by or on behalf of its owner, landlord or lessor;
4. Oral or written publication of material that slanders or libels a person or organization or disparages a person’s or organization’s goods, products or services; or
5. Oral or written publication of material that violates a person’s right of privacy.

Policy period
means the period commencing on the effective date shown on the Declarations. This period ends on the earlier of the expiration date or the effective date of cancellation of this  Policy. If an Insured becomes an Insured under this Policy after the effective date, the policy period begins on the date they became an Insured.

Pollutants
means any solid, liquid, gaseous, or thermal irritant or contaminant including, but not  limited to, smoke, vapor, soot, fumes, acids, alkalis, chemicals, asbestos, asbestos-containing materials, lead, lead-containing materials and waste. Waste includes, but is not limited to, biomedical waste, nuclear waste, and materials to be recycled, reconditioned, or reclaimed.

Potential Claim 
means an incident which an Insured knows or reasonably should know is likely to result in a claim.

Professional services 
means peer review and medical treatment for those services listed on the Declarations or any other services listed, by endorsement, for which an Insured is licensed as  required by law, trained, and qualified to perform in the Insured’s capacity as a Healthcare Professional. Professional services include services as an educator or as a member of a formal  accreditation, standards review, or similar professional board or committee, including as a  director or officer of such board or committee.

Property damage 
means:

1. Physical injury to, or destruction of, tangible property; or
2. Loss of use of tangible property, which has not been physically injured or destroyed. All such property damage shall be deemed to occur at the time of the event causing said property damage.

Suit 
means a civil proceeding in a court, and includes an arbitration proceeding.

Treatment
means:

1. The rendering of medical, surgical, dental, or nursing services to a patient;
2. The provision of medical examinations, opinions, or consultations regarding a person’s medical condition within an Insured’s practice as a licensed health care provider; or,
3. The furnishing of any of the following, but only as it relates to the rendering of medical, surgical, dental, or nursing services to a patient:
   • Counseling and social service,
   • Food and beverages, or
   • Medical, surgical, or dental supplies, appliances, or drugs

Utilization review
means the review of the necessity, appropriateness, cost, type or utilization of healthcare services made without patient contact.

We, us, and our, 
refer to the Company providing this insurance.

Wrongful act 
means any actual or alleged negligent act, error or omission in the performance of professional services as a Healthcare Professional. All injuries arising from:

1. The same or related acts, errors, or omissions; or
2. The continuous or repeated exposure to substantially the same harmful conditions, will be considered one wrongful act. For the purposes of this definition, all injuries to a mother and fetus (or fetuses) from conception through delivery shall constitute one wrongful act.