Filling a Gap in the Pennsylvania Medical Malpractice Insurance Market

Don’t Get Stuck Between the Proverbial Rock & An Expensive Place

Legislation mandates that a doctor must have continuous Pennsylvania medical malpractice insurance coverage in order to maintain an active license in the state of Pennsylvania.  One of the main reasons for this is the state’s Mcare fund.  The Mcare fund provides a portion of a physician’s total medical practice insurance coverage.  In Pennsylvania, $500,000/$1,500,000 limits are obtained by a private insurance company and the additional $500,000/$1,500,000 are supplied by the state’s Mcare fund.

In order to ensure the Mcare fund is actually funded, the state requires doctors practicing within its boarders to contribute to it every year.  If the doctor fails to do this, the state reserves the right (and will eventually exercise this right) to suspend their Pennsylvania state license.

Since each doctor is therefore required to purchase essentially two separate medical malpractice insurance policies ever year, it would stand to reason that every once in a while a mistake is made and a gap in the Mcare coverage is created.  This can be attributed to several things such as a unreliable ex-practice manager to non-payment to simply not understanding the complexities of the Pennsylvania medical malpractice insurance market.

How Do Gaps Form in Coverage?

Most prevalently, the gap is formed when a doctor purchases coverage from an insurance company that does not role the private coverage and the Mcare coverage into one package.  While this coverage combination is certainly not necessary, when it is lacking, assumptions can happen and mistakes can be made.

Putting the doctor’s lawsuit liability exposure on the back burner for a minute, if a gap forms and is not fixed, the doctor’s PA license is in jeopardy.

Unfortunately, most doctors and practice managers only realize there is a gap and the full gravity of the situation when they receive a letter from the state explaining the potential action against their medical license.

How Can I Fix This Problem?

The solution, while potentially expensive, is quite simple.  After reviewing the time periods that form the gap, a physician will need to re-pay the Mcare fund for that time, as well as fill any private insurance gaps. While Mcare must accept payment for gaps in the past, private insurers can be more selective.  If there are private insurance gaps, it is important to note that not all carriers in Pennsylvania will offer coverage for gaps in the past.

Talk To A Professional

An experienced professional liability consultant will have an intimate knowledge of the ins and outs of the Mcare system and Pennsylvania’s rules.  If you have a gap in your Pennsylvania medical malpractice insurance coverage, the first step to filling it is connecting with someone who knows the system and who will work to fix it on your behalf.

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