Occurrence Screening

As it relates to medical liability insurance, occurrence screening involves the evaluation of the physician seeking liability insurance coverage in the light of his or her risk to the insurer for possible claims-related losses. Some insurers use “experience rating,” charging those doctors with “clean” claims records lower premiums (see entry for Premium); those with poor claims histories (numerous claims against them) are charged higher amounts (if at all covered). Other factors taken into consideration during the evaluation process are medical specialty, types of medical procedures performed, length of time in active practice, history of poor outcomes (so-called “potential negligence” cases against which a claim has not been formally launched), formal notifications by patient's attorney of intent to file a claim (“180-day letter”), geographic location of insured, and participation in risk management programs.

Participation in risk management programs has been increasing over the past few years, in an attempt by both physicians and insurers to limit their exposure. Some insurers offer a discounted premium with proof of attendance [Page 397]at these programs, whereas others make their policy renewal contingent on their completion. Some insurers have also begun considering discounts for those physicians and practices that employ an electronic medical record, recognizing the improved data capture these systems can achieve, resulting in improved documentation. An example of screening would be an insurer who assesses, based on a questionnaire describing actual claims history and potential claims, the risk of loss to come from insured; if coverage is granted (and it may be denied), the premium will reflect the level of such risk.