Policyholder Services

I review medical records for the DMV and provide advice whether the person presents an increased driving risk. Does my OMIC policy cover me for these activities?

Whether your OMIC policy would respond depends upon the facts of the claim and the allegation. To qualify for coverage, the services rendered must be considered direct patient treatment. While OMIC defines direct patient treatment not only as the provision of medical or surgical treatment but also rendering opinions to a patient, giving advice to a patient, and consulting about a patient with another health care provider, it generally requires that a relationship between the physician and patient exist. Medical reviews you conduct on behalf of the DMV may or may not qualify as direct patient treatment. In addition, the claim must allege that the patient was “injured” as a result of those services. As defined by the policy, injury means physical injury, sickness, disease, or death. Mental and emotional injury are covered only if they arise out of a defined injury.

If a person whose medical record you have reviewed is injured as a result of your review and subsequent medical opinion and files a claim against you and a doctor-patient relationship exists, your OMIC policy would respond. However, if the claimant was alleging only that his or her license was wrongfully denied or revoked, the claim would not be covered because there is no injury as defined in your policy. Similarly, no coverage would apply in the event another party filed claim against you alleging they were injured as a result of a license wrongfully issued to a person whose medical record you reviewed.