CLAIMS-MADE FAQs

The issue of professional protection for obstetricians is a highly complex one. The nature of birth related injury is a very specific kind of risk because of the length of time that can elapse between the incident occurring and a complaint or claim being made. In some cases this can be over 20 years, compared with an average of five years for non-obstetric claims, and by the very nature of the injuries that can result, they are often the very largest of claims.

As a result of the delay between an incident occurring and complaint or claim being made, many factors can intervene to impact on the final cost of a claim, such as legislative or legal changes, increases in the cost of care and improved life expectancy. This makes the accurate pricing of obstetric risk very difficult.

We recognised that there was a need to price obstetric risk appropriately for the long term, because the cost of settling obstetric claims could escalate in a way which could not have been foreseen and allowed for at the time the subscriptions were set and paid.

The escalation in costs of such claims is a worldwide problem. The only way we could satisfactorily continue to accept these risks was on a basis where we could price year-to-year, so subscriptions are set closer to the emergence of the claim. This is the essence of claims-made arrangements, which is the most common type of professional protection available to obstetricians around the world, including those in the United States.

There are two types of protection: occurrence-based and claims-made.  There are several important differences between the two, largely the timing and certainty of the full cost of your protection.

Occurrence-based protection allows you to access the benefits of membership and request assistance for any claim or complaint that arises from an adverse incident that occurs during the period of your membership with Medical Protection, regardless of when it was reported and the claim or complaint is received.

Occurrence-based protection allows you to request assistance even after you have left Medical Protection membership and your subscription payment has ceased, so long as the incident occurred during the period in which you were a member and you were in appropriate category of membership with Medical Protection.

Claims-made protection also allows you to access the benefits of membership and request assistance for claims or complaints that arise from an adverse incident that occurs during your membership with Medical Protection. However, you must have been a member at the time of the incident, and had continuous membership with us for the period between the incident occurring and the time you report it. You are also required to report the incident to us as soon as is reasonably practicable after you become aware of it.

To be able to report an incident that you only became aware of after your membership with claims-made protection has ended, you would need to either apply to purchase extended reporting benefits (ERBs) from us, or alternatively, if you are to continue to practice after ceasing Medical Protection membership, have arrangements in place with your new provider that would allow you to report the incident to them.

An adverse incident is any event or circumstance that might give rise to you seeking assistance and/or indemnity from us. With claims-made protection you are required to report an adverse incident to us as soon as is reasonably practicable after you become aware of it.

If an incident takes place and you are unsure whether it is likely to give rise to a claim, complaint or allegation against you, please contact our medicolegal team on 800 616 7055 or [email protected] for guidance.

No, you only need to report adverse incidents or events that you genuinely think will lead to you seeking assistance and/or indemnity from us. If you are in doubt, please contact our medicolegal team on 800 616 7055 or [email protected] for guidance.

It is essential that the details of an adverse incident are recorded in writing because if it does result in a claim or complaint being made against you, it could be years before it is actually brought. Please use the adverse incident reporting form to report any adverse incidents to us.

The membership subscription for claims-made protection is calculated on the likelihood of you having to report an adverse incident to us in that year regardless of when the incident occurred during your period of membership.

All subscriptions are calculated by reviewing and assessing the claims environment of your specialty. This will include the frequency of complaints and claims, the cost of litigation and proceedings and the size of payments awarded by the courts - which are impacted by a number of factors such as changes in costs of future care, changes in life expectancy and legal and regulatory changes. 

Subscriptions are set on a year-to-year basis so we are not in a position to provide information about future subscriptions.

Subscriptions for membership with claims-made protection typically rise in steps, until the annual subscription is broadly similar to the annual subscription that would be payable for occurrence-based protection. The reason for these steps is that you are gradually increasing the number of incidents that are likely to be reported in the current year of claims-made protection, as the number of years to which these notifications relate also increases.

Over time, the risk of an adverse incident from previous years needing to be reported decreases, and as a result, the cost of including protection for these years within your subscription also decreases, until eventually, the subscription we collect no longer includes an amount for these previous years.

Please remember that in order to protect yourself from claims and potential claims from adverse incidents which you only become aware of after you cease practising and leave claims-made protection, you will need to apply for and purchase ERBs. If you become aware of the incident prior to retiring, you will need to notify us. ERBs do not protect against the late reporting of incidents of which you were aware and should have reported as soon as reasonably practicable to us.

Where we do provide assistance or indemnity there will be a financial limit for each membership year. When we take on a member’s case we can take care of the legal costs and compensation payments up to a discretionary indemnity limit.

The limit is set in advance for each membership year and applies to all adverse incidents that are reported in that year. The current limit is S$15 million.

The limit applies whether this is for one individual adverse incident, or for the total of all adverse incidents reported in a single membership year. These limits have been set with a view to offering fair and affordable subscriptions, and protecting the interests of the membership as a whole.

No, Medical Protection is not an insurance company. As a member, you do not pay an excess on clinical negligence claims or complaint costs. Although the structure of the indemnity has changed, with claims-made protection you will continue to receive the same high quality service, support and expertise from us.

There isn’t a typical reporting pattern for obstetric claims. In obstetrics we see a reasonable number of smaller claims and a small number of very large birth injury claims and these can be reported many years after the event. As you would expect with a small number of claims the pattern appears very volatile. 

There is far less certainty about the reporting patterns and frequency of obstetric claims than for any other specialty because significant time can elapse between an incident occurring, being reported, and a claim arising and being settled.

ERBs enable you to request our assistance and report adverse incidents that occurred during your membership, but that you only become aware of after your membership with claims-made protection has ended.

This is important because it is not always obvious that an adverse incident has taken place, and you may only become aware of an issue when the complaint or claim is received, which could be years later or even after you have retired.

If you do not purchase ERBs and later learn that there were adverse incidents that you were unaware of during your membership (or in the 30-day post membership notification period), and therefore had not reported to Medical Protection, you would not have the right to request assistance with any subsequent claims that related to these adverse incidents.

With claims-made protection you can request assistance for a claim or complaint that arises from an adverse incident that occurs, and is reported to us, during the period of your continuous membership, and no later than 30 days after your membership with claims-made protection ends.

In order to be able to continue to report any adverse incidents which occurred during your membership, but which you were unaware had occurred and therefore had not reported to us, once you have retired or ceased practice, you will need to apply to purchase ERBs from us.

Please note that you do not need ERBs to continue to receive assistance from us with regards to a claim arising from an incident already reported during your membership with claims-made protection.

ERBs also help you to safeguard your future and help you to manage your risk. They can be used by your estate to report incidents which occurred during your membership, but only come to light after you die, meaning that assistance can still be requested from us if a claim is made.

Costs for ERBs are determined on an individual basis. Predicting the price of ERBs is difficult because of the rapidly changing claims environment and because it will also depend upon the length of your career and practice history.

We do understand the desire to know what the likely cost will be. So for illustrative purposes, we would say that if you are considering retiring, provided the litigation environment remains as it is now, and the basis upon which we are able to offer ERBs remains unchanged, we do not anticipate that the cost will be more than double your final year’s membership subscription with claims-made protection.

If you have claims-made protection, and are considering retiring, please contact us at [email protected] for information on the cost of ERBs for your circumstances.

Yes – our ERBs cover lifetime post retirement. We understand that members want greater clarity over options for protection once they retire and so we offer you the opportunity to make a single payment for ERBs at the time you retire.

You can apply to purchase ERBs if you meet one of the qualifying criteria:

Single payment ERBs

• Permanent retirement from medical practice
• Personal representatives acting on behalf of your estate if you have died

Annual ERBs

• Permanent change to your scope of practice if it involves ceasing obstetrics
• Extended break from medical practice over 12 months
• Permanently stop medical practice in your country of practice (i.e. moving overseas)
• Personal representatives acting on behalf of your estate if you have died

Granting ERBs is at the discretion of Medical Protection, in accordance with the Memorandum & Articles of Association.

In order to make an application, please contact [email protected]

To be considered, your application must be received within 30 days before or after the end of your Medical Protection membership with claims-made protection. In the event of your death, your personal representatives must submit an application to purchase ERBs within 90 days after your death.

If you purchase annual ERBs and want to purchase further ERBs, this must be done within 30 days before or after the end date of your current ERB period.

Granting ERBs is at the discretion of Medical Protection, in accordance with the Memorandum & Articles of Association.

In order to make an application, please contact [email protected]

You should consider having protection in place for as long you are at risk from a potential claim relating to your clinical practice, which could be 20 years or more.

If you permanently change your practice, for example by ending obstetric practice and moving to gynaecology, then ERBs will allow you to report adverse incidents that relate to your obstetric practice, but that you only become aware of after your membership with claims-made protection has ended.

ERBs in this circumstance are currently available to purchase on an annual basis.

If you do not continue your membership with Medical Protection, but do continue to practise, you will need to make sure that you purchase protection or insurance from a new provider that covers you for adverse incidents that occurred during your membership, but which were not reported to us while you were a member (or within the 30-day notification period). This is sometimes referred to by insurers as ‘nose cover’.

Previously unreported adverse incidents which occurred while you were practising with claims-made protection may still give rise to complaints or claims even after your retirement.  To be able to report such incidents and to seek assistance with any complaint or claim which results from it, you will need to apply purchase ERBs.

Claims are rarely made immediately after an adverse incident occurs, and a patient can potentially make a complaint or claim against a doctor long after he or she has retired or ceased practising.

Death while in membership

In the event of your death while in Medical Protection membership, your personal representatives can act on behalf of your estate to report complaints or claims which you would have been entitled to report. Your personal representatives can also apply, within 90 days of your death, to purchase ERBs.

ERBs in this circumstance are available to purchase annually or in a single payment to cover an unlimited period.

Death after your membership has ended

If you are no longer a Medical Protection member at the time of your death but have previously purchased ERBs, your personal representatives can continue to report any complaints or claims.

If you leave membership, but die within 30 days of leaving, then your personal representatives will have 90 days from your last day of membership to apply to purchase ERBs.

If at the time of your death you had left membership and had not purchased ERBs in the 30 days following the end of your membership, your personal representatives will not be able to apply to purchase ERBs or report any adverse incidents.

If you choose not to accept ERBs you will be exposed to any claim in the future arising from adverse incidents that occurred during your claims-made protection with us, but that were not reported.

We are not in a position to comment on the variety or availability of other types of protection. We would however encourage you to apply for ERBs when you cease practice, so as to guard against incidents that occurred but were not reported during your membership.

The nature of medical negligence claims means that a significant amount of time can elapse between an adverse incident occurring and a claim arising. If a claim is made against you and you have not appropriately notified us of the adverse incident to which it relates, you will not be able to request assistance from us.

This is why you must report any adverse incidents which you think could lead to you seeking indemnity and assistance from us as soon as is reasonably practicable after the incident occurs, or when you become aware that it has occurred. This must be during your membership of Medical Protection with claims-made protection, or within a period where you hold extended reporting benefits.   

Please use the adverse incident reporting form to report any adverse incidents to us.