by Timothy J. Feuling, President, CBS

Choosing a malpractice insurance policy isn't easy. How do you know which is best for you? To find out, you can, of course, just call representatives of the different companies you are considering. Call me and ask me about the Chiropractic Benefit Services malpractice insurance program and I'll tell you that it's the best policy available and explain why.

Call reps for other companies and you know what? They'll tell you the same thing about their policies. After all, everyone in the business thinks their policy is the best (or at least wants you to think that).

So, who do you turn to for honest, accurate information about different policies?

There's only one insurance "expert" you can really trust ‑‑ yourself. You may not think of yourself as an insurance expert but if you do a little bit of homework, you if you know the right questions to ask, you can compile all the information you need to make an informed decision about malpractice insurance.

First, dig out a copy of your current insurance policy and go through it carefully, making note of what provisions it has relating to coverage, exclusions, etc. Then call two or three other insurance companies specializing in chiropractic malpractice insurance (I personally wouldn't consider any company that isn't geared specifically to chiropractic. They can't truly understand the needs, risks and other unique factors that apply to DCs).

Ask each of them the same questions and make sure they give you a direct answer for each. Don't let them talk in generalities or give you a "well, sort of" response. Either the policy has an exclusion or it doesn't. It either offers X amount of coverage or doesn't. Note, too, whether the representative is profession, knowledgeable and courteous. This will hopefully be a long‑term relationship, so you don't want to be dealing with people who treat you as anything less than a valued client.

Among the most important areas to ask questions about are:

Type of policy. Almost all insurance advisors today recommend claims‑made policies for health care professionals. In fact, occurrence insurance for this type of liability coverage is rarely offered today because of the difficulty of projecting long‑term claims costs. In addition, they have serious disadvantages for doctors. An article in the Los Angeles County Bar Association warned that: "Occurrence policies mislead insureds into believing that they have adequate protection 'forevermore', when in fact the limits of liability they buy today are likely to be inadequate for five or ten years from now."

Underwriter health. A policy is only as strong as its underwriter. Ask about the company's history, assets, and ratings. CBS, for example, is backed by CNA Insurance company, the 7th largest U.S. commercial insurer and the 14th largest U.S. property & casualty insurer. It provides insurance protection to more than 1 million businesses and professionals in the U.S. and internationally, with assets of close to $60 billion. It is "A" rated for financial strength by A.M. Best, and also enjoys strong ratings from the other independent rating agencies. Get similar information for all other companies you are considering.

Coverage. Make a list of the coverage that is (or ever might be) important to you. This includes defense costs for accusations of sexual misconduct, profession board disputes and HIPAA violations as well as coverage for other employees (other than DCs), first aid, vicarious liability, corporate coverage, etc.

Exclusions. Just as important as what the policy covers is what it excludes. Among the most common exclusions are for lawsuit resulting from "not‑for‑fee" care, that is, free care provided for staff or others. Additional exclusions found in chiropractic malpractice insurance policies include:

*** Infants under the age of 14 days

*** Patients sent to collections or involved in disputes over fees

*** Pregnant women beyond their first trimester

*** Employees covered under your policy

Each of these exclusions lessens the value of a malpractice insurance policy and can leave you vulnerable to lawsuits. Any policy containing one or more of these exclusions is probably not going to offer full protection and can end up being a costly mistake if purchased merely on the basis of lowered premiums.

Deductibles. Some policies offer policies with deductibles of $5,000 or more. While there's nothing intrinsically wrong with a policy that has a deductible, it can quickly erase any savings you enjoyed on the premiums, and end up costing you much more in the long run. Find out what deductibles apply to the policy.

Quality of defense. Your insurance company is supposed to provide the best possible defense for you if you end up in court. Yet, that isn't always the case. In order to save themselves money, many insurance companies skimp on the defense they provide. In addition, they may not have access to lawyers experienced in defending chiropractors. It's not always easy, but try to judge whether the company appears to understand the need for a quality defense and if it has a cadre of top lawyers and expert witnesses willing and able to help defend your case.

Consent to Settle clause. Unless a policy specifically contains a consent‑to‑settle clause, the insurance company ‑‑ NOT the doctor ‑‑ makes the decision whether to fight the charges in court. According to some experts, many insurance companies are electing to reduce their costs by refusing to defend doctors even when they're completely innocent. "Rupp's Insurance & Risk Management Glossary" includes the statement: "Since a settlement can affect the reputation and earning ability of the insured, this type of clause is an important consideration in selecting a policy." Make sure your policy DOES have a Consent to Settle clause.

Hammer clause. A hammer clause is a provision included in some consent‑to‑settle clauses that tries to coerce you into accepting a settlement offer. With a hammer clause, if you refuse the settlement offer recommend by the insurer, the insurer's liability is limited to the amount of the recommended settlement offer. Make sure your policy does NOT have a hammer clause.

There are many other considerations, including:

Customer Service ‑‑ Was your call answered or returned promptly? Is the rep knowledgeable about chiropractic as well as insurance?

Dedication to chiropractic ‑‑ Does the company "give back" to the profession? Is it owned and/or run by chiropractors and chiropractic supporters?

Values ‑‑ Does the company share your views and chiropractic values?

Price ‑‑ Can you save money without sacrificing coverage?

I realize this is a long list of considerations and questions, and it may take an entire day to call two or three companies, get the answers you need, and do a careful comparison. But considering that lack of proper coverage could cost you your entire practice and income, it's worth the time. In the end, you'll be the "expert" on your insurance needs.