Incompetency: Reporting and Coverage

By Kimberly Wynkoop

OMIC Legal Counsel

Digest, Spring 2010

Insureds may have to deal with incompetency issues from either the side of the impaired physician or as an evaluator of one of their peers. There are policy issues to consider from either perspective.

When an insured is the physician with potential competency issues, he or she has affirmative reporting duties under the OMIC professional and limited office premises liability insurance policy. Under Section VIII. General Conditions, Rules, and Duties, of the policy, Subsection 2, insureds agree to update OMIC immediately, in writing, about any changes to the statements they made in their application. If the insured fails to notify OMIC within thirty days of the change, OMIC has the right to deny coverage of a claim related to that change, or to cancel the policy. More specifically, Subsection 3 requires insureds to give OMIC written notice within thirty days of certain specific situations, including the insured being advised to or undergoing treatment for substance abuse or psychiatric illness and the insured suffering from an illness or physical injury that could impair his or her ability to practice ophthalmology for thirty days or longer. Regarding group policies, the policyholder has the duty to act on behalf of all insureds under the policy. To the extent the policyholder or its representative is aware of an insured’s incompetency, it has the duty to inform OMIC (Section VIII.1).

What occurs after the insured notifies his or her underwriter depends upon the specific facts and circumstances of the insured’s situation. The underwriter will require complete details of the impairment or incompetency, including its nature, date of origin, whether treatment has been sought, prognosis, and whether the insured has been cleared by his or her treating physician to continue practice (if applicable).  Underwriting will require a letter from the treating physician or treatment program coordinator confirming this information. Underwriting also will want to know if the impairment or condition has affected the insured’s licensure or hospital privileges.

Underwriting will evaluate all of these factors, either by staff or through the physician review process, and will determine whether and under what conditions OMIC can continue providing coverage to the insured. If the insured is cleared for a reduced scope of practice, reduction in the coverage classification may be warranted. If the insured is temporarily unable to practice, he or she may be eligible for a suspension of coverage. If serious action has been taken against the insured’s privileges or licensure, such as suspension or revocation, OMIC may determine that it is no longer in a position to insure the doctor. OMIC generally takes the least restrictive action that is prudent for the company and its members.

For patient safety reasons, and because such claims can be extremely difficult to defend, OMIC does not cover claims arising from insureds’ performance of direct patient treatment while under certain impairments. For instance, Section III.B.4. of the policy provides that “OMIC will defend an insured because of a claim otherwise covered by this policy that arises out of, but is not solely limited to, the following; however, under no circumstances will OMIC pay any damages or supplementary payments except Claim expenses resulting from either settlement or judgment attributed to…an act, error, or omission (a) committed while the insured is under the influence of alcohol, drugs, or other substances that adversely affect the Insured’s professional ability or judgment or (b) that results from substance abuse.” If the insured’s condition leads to restrictions on or the loss of his or her licensure (including DEA license), be aware that the policy (Sections III.A.2. and III.A.3.) provides that OMIC will neither defend an insured nor pay damages or supplementary payments because of a Claim that arises out of direct patient treatment or dispensing of controlled substances that occurred in violation of a restricted or revoked license.

In order to financially assist insureds who leave practice due to incompetency and disability, if the insured is judicially determined to be incompetent or is permanently and totally disabled, OMIC provides the insured with free tail coverage upon termination of the policy. In order to receive this benefit, OMIC must receive written notice of the insured’s condition and the policy premium must be paid through the date of termination.

Conversely, an insured may be called on to evaluate another physician’s competency. OMIC’s policy offers protection for this evaluation in certain situations. Coverage D provides defense and payment of damages and supplementary payments for the insured’s professional committee activities performed for (a) a state licensed health care facility or clinic that is not the professional entity with which the Insured is affiliated as a member, officer, director, partner, or shareholder or (b) a professional association or society. Professional committee activities are defined as service of an insured while acting within the scope of his or her duties as a member of, participant in, or person charged with the duty of executing the directives of, a formal accreditation, utilization review, credentialing, quality assurance, peer review, or similar professional board or committee. A conditional defense is provided to insureds performing professional committee activities in good faith who are sued for such wrongful acts as slander and defamation of character and alleged anticompetitive activities.

If you have questions about your policy coverage, please call your underwriter for assistance. For help determining what steps to take with a suspected incompetent peer, please call OMIC’s risk management hotline.

Entity Coverage

By Betsy Kelley OMIC VP, Product Management

Digest, Spring 2011

As the lead article illustrates, professional entities face a number of liability exposures. They have direct liability arising from administrative services the entity provides to the practice to facilitate the delivery of health care services. Such functions may include credentialing or supervisory activities, development of practice protocols, and maintenance of the premises. Under the doctrine of vicarious liability, liability for an injury may be assigned to a party who did not cause the injury but who has a legal relationship to the person who did act negligently. For entities, vicarious liability arises from the acts, errors, and omissions (“actions”) of the owners, employees, and other health care providers who render services to the practice’s patients. Ophthalmologist– owners of the professional entity may be held vicariously liable for direct patient treatment provided by others as well. To protect insureds from these exposures, OMIC extends coverage under two separate insuring agreements.

Coverage C—Professional Entities

Under Coverage Agreement C: Professional Liability Coverage for Professional Entities, coverage is extended to the professional entity for its direct liability arising from direct patient treatment provided by the entity and for its vicarious liability arising from direct patient treatment provided by any person for whose actions it is legally responsible, so long as that person was acting within the scope of his or her licensure, training, and professional liability coverage, if applicable. Coverage also applies under Coverage Agreement C to any person or entity affiliated with the insured professional entity in his, her, or its capacity as a member, officer, director, partner, or shareholder of the entity (“member”). This includes not only vicarious liability coverage for claims arising from direct patient treatment provided by others for whose actions they are legally responsible, but also coverage for claims resulting from professional committee activities the member performs for the insured entity. Professional committee activities include formal accreditation, utilization review, credentialing, quality assurance, peer review, and similar board or committee services. Coverage Agreement C does not cover members for direct liability arising from their own direct patient treatment or vicarious liability for the actions of others arising outside of that member’s role as an entity owner. (Ophthalmologists named in the declarations are covered under Coverage Agreement A for these liabilities.)

Vicarious liability coverage provided under Coverage C is conditional. If the claim results from a professional services incident involving direct patient treatment provided by a health care provider not insured under the entity’s policy, the provider must maintain professional liability insurance with a carrier acceptable to OMIC during the term of his or her employment, contractual relationship with, or utilization of the facility of, the insured entity. In the event the provider failed to maintain insurance as required, OMIC will not defend the entity or its members or pay damages or other payments resulting from their vicarious liability for the actions of the uninsured provider. This is why we ask you to provide certificates of insurance for all non- OMIC associates at each renewal. OMIC will defend an insured against allegations of vicarious liability for the actions of others based on an apparent partnership between the insured and another health care provider or professional entity, but supplementary payments and damages are excluded from coverage. If you share office space with health care providers who are not owners, employees, or formal independent contractors of your practice, please contact an underwriting representative to request a “Guide to Apparent Partnership.”

Coverage E—Premises

Limited office premises liability is insured under Coverage Agreement E. The entity and its members are insured for claims resulting from injury to a patient or property damage to a patient’s personal, tangible property caused by a professional services incident resulting solely from premises maintenance performed by the insured or anyone for whom the insured is legally responsible. Premises maintenance refers to the insured’s ownership, maintenance, or use of the office premises in which the insured provides direct patient treatment. Premises liability coverage is subject to a maximum limit of $50,000 per claim/$150,000 annual aggregate. Office misadventures that result from negligent supervision or are otherwise related to direct patient treatment are considered professional liability cases and are not subject to this sublimit. Coverage Agreement E does not constitute and is not meant to replace commercial general liability coverage or other fire and property coverage for the insured’s office premises.

Please note that no coverage will extend to an entity, its non-physician employees, or its members in their capacity as members unless the entity is named as an insured on the policy declarations. If your entity is not listed on your declarations and you would like to obtain entity coverage, contact your underwriter at (800) 562-6642, ext. 639, for an application. Similarly, if you form or acquire a new entity, change the name of your entity, or make any other change in your entity affiliation, please notify OMIC as soon as possible to minimize the risk of uninsured liability.

Malpractice Coverage Extended to Eye Banks

By Betsy Kelley, OMIC Underwriting Manager

[Digest, Spring 1999]

Qualified eye banks may now purchase professional liability coverage from OMIC for direct and vicarious liability arising out of services they render. There are close to 100 eye banks in the U.S. to which OMIC might offer coverage and which might benefit from OMIC’s extensive expertise in ophthalmic underwriting, claims handling and risk management.

OMIC began exploring the feasibility of insuring eye banks last year at the request of a large insured network and its affiliated eye bank. A major factor in being able to sign on networks and other large ophthalmic groups is an insurer’s ability to provide coverage for eye banks, surgery centers and other related provider organizations affiliated with the network or group. After assessing the coverage needs and potential liability exposures of eye banks, the Underwriting Committee and Board of Directors determined that eye bank coverage would be a reasonable expansion of OMIC’s services to the eye care profession.

Who Qualifies?

Unlike other carriers that treat eye banks like any other “medical entity,” OMIC has carefully tailored an application form and underwriting guidelines specific to the activities and exposures of eye banks. To qualify for coverage, an eye bank must be a member of the Eye Bank Association of America or the American Association of Tissue Banks. As members of these organizations, eye banks must adhere to the medical standards developed by these organizations. OMIC has adopted these and other guidelines intended to reduce the likelihood of potential claims and to aid in the defense of any resulting claims. Additionally, the medical director or at least one board member must be a member of the American Academy of Ophthalmology for the eye bank to be eligible for coverage.

What is Covered?

OMIC also has crafted an Eye Bank Amendatory Endorsement to modify the standard policy terms and address the special liability issues of eye banks. For example, the definition of “professional services” has been modified to specifically include activities that eye banks perform: procuring, processing, testing, storing and distributing donor ocular tissue. In addition, the definition of “injury” has been broadened to include the possible allegations of disfigurement or mutilation of a cadaver and wrongful removal of tissue. Claims against eye banks are not common, but when they occur, most generally revolve around allegations that the donor tissue was obtained without the permission of authorized next of kin.

Coverage applies to the eye bank and its non-physician staff for their direct liability arising out of services they render. In addition, the eye bank is insured for its vicarious liability arising from services rendered on its behalf. Vicarious liability coverage arising from services rendered by employed or volunteer physicians applies provided these physicians maintain professional liability coverage themselves.

Policy Limits

Premiums for eye banks are based on a per-donation rate and vary based on the limits of liability selected and the eye bank’s retroactive date. OMIC offers a variety of limits ranging from $500,000 per claim/$1,500,000 aggregate to $5,000,000 per claim/$10,000,000 aggregate. (Lower limits of liability are available for eye banks that participate in their state’s patient compensation fund.) Limits apply on an indemnity-only basis. Defense costs are paid in addition to the limits, and unlike the coverages offered by other carriers that write eye bank coverage, OMIC’s coverage is “first dollar.” No deductible applies.

In addition to professional liability coverage, qualified eye banks also are eligible to purchase other insurance products available through OMIC, including coverage for directors and officers, errors and omissions, employment practices, Medicare/Medicaid fraud and abuse, workers’ compensation and business owners liability.

For more information on OMIC’s professional liability coverage for eye banks or other OMIC insurance products, please contact Betsy Kelley at (800) 562-6642, extension 630 or bkelley@omic.com.

Hold Harmless Clauses

By Betsy Kelley
OMIC Underwriting Manager

[Digest, Spring 2000]

Contracts are a fact of life in most ophthalmic practices today. Providers sign contracts with health care plans, laser centers, finance companies, and other entities. Contracts outline each party’s responsibilities, compensation, and other terms. In many instances, contracts may include provisions that affect a provider’s professional liability exposure.

One provision frequently found in contracts is a hold harmless or indemnification clause whereby one party (usually the physician) agrees to contractually assume the liability exposure of the other party. Some indemnification clauses are quite broad, requiring that the physician hold the other party harmless for “any and all claims, suits, losses, or damages” arising from services rendered, without regard to which party was responsible for such activities or whether negligence was involved.

Other clauses are sufficiently narrow and require that the physician hold the other party harmless only for “claims, suits, losses, or damages arising solely from the physician’s negligence and not otherwise covered by insurance.” Indemnification clauses may be unilateral, meaning that only one party holds the other harmless, or they may be mutual, meaning that both parties agree to hold the other harmless for its own negligent actions.

OMIC provides limited contractual liability coverage within policy limits for indemnity and reasonable defense costs that insureds become legally obligated to pay pursuant to a hold harmless or indemnification agreement in a written contract between the insured and a hospital, health maintenance organization, preferred provider organization, or other managed care entity. This coverage is limited to indemnity and defense costs incurred solely from the performance of professional services provided by the insured and is solely for medical incidents otherwise covered under the policy. In certain circumstances, OMIC may, for an additional premium, extend contractual liability coverage by endorsement to other entities that are not engaged in the practice of medicine but may incur liability exposure as a result of their relationship with the insured.

OMIC’s policy excludes coverage for liability assumed under contract with other types of organizations if such liability would not exist in the absence of the contract. Therefore, OMIC generally recommends that indemnification clauses be removed from the contract, if possible. If the clause cannot be removed, OMIC recommends that it be replaced with a narrow, mutual hold harmless clause in which each party agrees to indemnify the other for losses arising solely from the party’s negligence.

Additional Insureds

A new trend is emerging in which organizations are no longer satisfied merely having the physician contractually agree to hold them harmless in the event of a claim. Instead, they are now adding clauses to their contracts requiring that the physician name them as an additional insured under the physician’s policy.

OMIC is generally able to name a third party as an additional insured only in situations where the entity is a management services organization (MSO) involved in administrative activities such as the purchase of equipment, billing, and other matters. Because they do not render medical services themselves, such organizations are frequently unable to purchase medical malpractice policies of their own.

With the exception of MSOs, OMIC will not name third parties, such as medical professional corporations or laser refractive centers, as additional insureds. Because these organizations render professional services themselves and are likely to be responsible to some extent for supervision and control of the physician’s activities, they are equipped to insure themselves or to purchase separate coverage for their liabilities. It is generally in the best interests of both parties to purchase their own insurance policy so separate limits apply. Otherwise, each party’s limits are reduced by any indemnity paid on behalf of the other party.

Other Provisions

Other contract provisions may specify the limits of liability that the physician must carry or may require that the physician provide evidence of insurance. Upon request, OMIC can issue a certificate of insurance to the organization, specifying the insured’s policy number, effective and expiration dates of coverage, and limits of liability. In addition, OMIC also will attempt to notify the certificate holder of any material changes in coverage, such as a change in limits or cancellation of coverage. Some contracts may require that the organization be provided with advance notice prior to cancellation or coverage changes. Although OMIC will do its best to provide ample notice to certificate holders, OMIC itself may not receive sufficient advance notice of requested changes to comply with such contract provisions. For this reason, such requirements should be removed from any contract.

As a service to its insureds, OMIC will review contract language*** as it relates to professional liability issues and provide advice regarding uninsured risks. To have OMIC review these contract provisions, contact the Risk Management Department at (800) 562-6642, ext. 603 or fax the specific clauses to (415) 771-7087.

*** NOTE: OMIC no longer reviews contract language. However, as a service available only to its insureds, OMIC will provide an analysis of indemnification agreements prepared by our Legal Counsel. Policyholders may share this analysis with their own attorney. To obtain this analysis, contact the Underwriting Department at (800) 562-6642, option  1 or via email at underwriting@omic.com, or the Risk Management Department at (800) 562-6642, option 4 or via email at riskmanagement@omic.com. 10/8/14.

Hard Times Ahead for Doctors and Carriers

By James F. Holzer, JD
Mr. Holzer is OMIC’s President & CEO.

[Digest, Winter 2001]

The U.S. economy and stock market may be showing signs of renewed vibrancy this quarter, but malpractice insurance carriers are bracing for the worst. Physicians in all specialties are seeing professional liability rates skyrocket for the first time in many years. It’s a grim reminder of when so-called malpractice crises erupted in the past, driving doctors to pay higher premiums, find replacement, and seek shelter behind defensive practice patterns.

Although ophthalmologists are not immune from current adverse developments, their loss experience is better than most other specialties and, in some cases, significantly better on average than all specialties combined. OMIC’s loss experience and financial performance continues to be more favorable than the industry as a whole. Yet claims costs and related expenses require even the most conservative carrier to periodically adjust its price. A few physician-sponsored carriers have been able to keep rate increases well under the 10% this year. OMIC, for example, will adjust its premium by 7.5% for policies issued or renewed after July 1, 2001.

The news unfortunately isn’t as good for other physicians. Double-digit rate hikes are back. Many medical malpractice carriers anticipate or have already instituted premium increases that may well exceed the expected national average of 15%. Commercial (non-provider-owned) carriers seem the hardest hit with planned increases of 50% to 100% in some states. Although the relative rate for an ophthalmologist is less than say for an OB-GYN specialist, some of these large increases may apply across the board to ophthalmologists insured by these companies. One large national carrier, which has slipped from first to fifth place as the leading provider of malpractice insurance, reportedly doubled its premiums for some ophthalmologists in Arizona, Missouri, and Texas and selectively levied a 60% increase for risks in Vermont and 75% in California. Another large national provider of physician professional liability insurance isn’t writing or renewing business at any price in Georgia, sending many of its longtime policyholders and insurance brokers scrambling to find replacement coverage.

Physician-owned or sponsored insurers seem to be faring better. Rate announcements from doctor-owned carries range from no increase to 30% with some 40% to 50% increases in so-called problems states such as West Virginia. Insurance companies there were created by medical societies and governed by physicians mushroomed in the 1970s and 80s in response to capacity and affordability problems during prior hard markets. Collectively, these companies now provide professional liability coverage to nearly two-thirds of the physicians in the U.S. Based on year-end 2000 financial statements, this physician-controlled segment of the insurance industry has generally done better than the medical malpractice industry as a whole., which includes the large commercial stock companies.

Rapidly Deteriorating Market
In a recent study, a leading research analyst for the insurance industry, Conning & Company, warned that the financial condition of the medical malpractice insurance business is rapidly deteriorating with “no margin for negative surprises.” Looking at the industry as a whole, it estimates a huge deficiency in malpractice claims reserves to the tune of a staggering $1.7 billion. This degree of adverse development clearly doesn’t happen overnight. Conning suggests the problem began as early as 1993 when the severity of incidents, accelerating claims payments, and increasing defense costs started to climb. Of particular concern as the rising incidence of claims alleging failure to diagnose and medication-related errors. Ophthalmologists should not be quick to assume that such problems don’t apply to them. A number of OMIC’s largest settlements have related less to the science and practice of ophthalmology and more to general medical problems such as failing to diagnose cancer or failing to adequately track and follow up on urgent care. Clearly, failure to follow some of the most basic risk management principles of general medical practice could have a more crippling effect on overall ophthalmic loss experience nationwide than some of the newer refractive procedures such as LASIK, which to date show only low to moderate claims severity.

What’s causing this deterioration and why does it seem to be occurring so suddenly after years of declining malpractice rates and aggressive competition? For at least the past five years, many medical malpractice carriers have had a voracious appetite for market share. This has had the effect of driving prices down even though combined and operating ratios for the industry as a whole were locked in a steady upward creep. Fortunately, physician-owned/sponsored carriers such as OMIC have been able to maintain more stable and consistent ratios during this period.

Nevertheless, during these “soft market” conditions, the financial results of carriers were propped up by good investment returns, favorable reinsurance deals, and better-than-expected loss results from prior policy years, which allowed companies to reduce their reserves and increase surplus. In the background, however, malpractice claims severity continued to grow. Defense costs kept rising, reserve takedowns on older policy years began to dry up, investment returns started to shrink, but premiums on the most part remained the same. Malpractice carriers were still locked in a battle to gain a shrinking market share. Artificially depressed rates prevailed until the damn burst at year-end 2000.

Loss Ratios Worsen
Every spring, insurance carriers file detailed financial statements showing the results of their operations through December 31 of the previous year. As analyst look at these year-end 2000 statements, a collective picture of the industry began to emerge. Their suspicions during the past 24 months are being confirmed. The approaching “hard market” has finally arrived. Loss ratios, which measure a company’s loss experience in relation to its total book of business, jumped nearly 10 points in one year to approximately 100% for all doctor-owned carriers combined. Analysts expect the numbers to be worse when large independent carriers are included in the mix. (OMIC’s loss ratio in comparison increased only 2.5% to 79.9% at year-end 2000.)

Other ratios that analyst use to measure an insurer’s operating performance also worsened during the past year. The combined ratio, which measures a company’s overall underwriting profitability before investment returns, climbed to 125% for the provider-sponsored carriers and 134% for the entire industry. However, after factoring gains on investments, carriers still showed relatively acceptable (albeit increasing) operating ratios. An operating ratio of less than 100 indicates acceptable financial health for a carrier because it is still able to show a profit from its core business. The average operating ratio for all doctor-owned carriers combined was 95.6% at year-end 2000. (OMIC reported a combined ratio of 119.3% and a favorable operating ratio of 91%.)

More Ominous Signs for Some Carriers
Unfortunately, we are now starting to see a number of long-standing carriers having difficulty even measuring up to the average. Data from financial filings for year-end 2000 indicate that between one-quarter and one-third of provider-sponsored medical malpractice carriers may show an operating ratio of greater than 100% and could report negative operating cash flow. A handful of companies may even show operating ratios in excess of 120%. A number of large independent commercial carriers also are facing significant challenges. The health care unit of one of the leading national medical liability carriers reported a year-end 2000 combined ratio of almost 130% and a fourth quarter combined ratio of nearly 160%. A large hospital association carrier reported a combined ratio last year of 200% as well as receiving two rating downgrades by A.M. Best Company in as many years.

Even if an improving U.S. economy turns Wall Street bullish again, it’s clear that it will take more than higher returns on investments to reverse the deterioration of some segments of the medical malpractice insurance industry. Insurance carriers will have to invoke a number of tough and unpopular remedies to exorcise the demons of the hard market of 2001. Here’s what ophthalmologists and doctors in all specialties can expect:

• Higher malpractice premiums for the near future. The size of increases will vary by carrier and depend on an individual company’s financial performance and overall profitability. OMIC anticipates a more modest fluctuation in its rates compared to the industry because it has historically kept rates a level sufficient to support its ability to pay claims over the long term.
• Tougher underwriting and cancellations of policies that carriers deem unprofitable. Some carriers appear to be engaged in wholesale cancellation of policies based primarily on geography, claims history, and scope of practice. Some uninsured ophthalmologists have called OMIC with stories of physicians being dropped because they were doing refractive surgery or had just one claim. OMIC plans to continue underwriting physicians in the same prudent manner it has in the past, relying on its historical success of selecting insureds who ultimately contribute to loss results that are consistently better than the industry.
• Fewer discounts and lower dividends. Cash-strapped carriers may become less generous with premium discounts to raise much needed revenue. Last year, the surplus of all companies combined fell for the first time in recent history. Shrinking surplus and smaller or nonexistent reserve takedowns could mean lower dividend payouts in the future. OMIC’s surplus did not decrease last year and was maintained as the same conservative level as the previous year. OMIC also is continuing its cooperative ventures with a dozen state and subspecialty societies and provides a special 10% premium discount for participating in cosponsored risk management programs. As in the past, dividends will be determined each year based on annual performance results.
• Claims costs will continue to increase unless controls are employed. Despite the cyclical nature of insurance markets and litigation, claims severity will continue to grow unabated unless doctors and carriers employ proven measures to stem the tide.
  • Tort Reform — First and foremost, efforts to bolster state tort reform initiatives are critical to keeping claims indemnity under control. According to Jury Verdict Research, jury awards in malpractice cases jumped 7% in 1999, raising the median award to $800,000. During previous, “medical malpractice crises,” the most common factor associated with markedly improved loss experience was the existence of strong tort reform measures with an effective cap on noneconomic damages (pain and suffering).
  • Risk Management — Despite the temptation to reduce costs by cutting back on operational expenses, such as risk management, carriers instead need to provide more resources for these activities. OMIC will continue to make its ophthalmic-specific risk management activities available to policyholders and members of the American Academy of Ophthalmology and anticipates extending these activities through the Internet and other means.

Why Some Carriers Can Withstand a Hard Market
Perhaps the silver lining in this hard market is that physicians and their professional liability carriers have been down this road before. What we’ve learned from previous hard markets is that such a condition is not so much a malpractice crisis as it is a cycle. Fortunately, cycles turn, but their duration can clearly be impacted by how quickly and how well we respond. Physicians who didn’t chase some of those irresistibly cheap rates in the past and stayed with a strong and reasonably priced insurer are now in a better position to ride out the hard market with their current carrier. Companies that previously engaged in predatory pricing tactics to gain market share may now have to play “catch-up” by significantly boosting rates to meet the future demands of rising claims. Others, such as OMIC and those physician-sponsored carriers that remained focused on their original mission and purpose, are likely to successfully ride out the current storm as well as provide opportunities to those doctors now forced to search for a new carrier that can better support their long-term insurance needs.

In the future, adverse market cycles might be broken if some carriers choose to learn from the past and resist the temptation to feed their egos and corporate appetite for market domination and growth at any cost.