Policyholder Services

COVID-19 Coverage

OMIC policyholders providing care during the current COVID-19 outbreak should contact their OMIC representative if we may be of any assistance regarding coverage questions. Common questions you may have are answered below.

Updated 1.18.2021

The responses below apply to circumstances arising from the COVID-19 pandemic and are subject to revision as circumstances evolve. Please note that coverage is subject to your policy terms, conditions, exclusions, and endorsements. OMIC cannot make an official coverage determination until the allegations and facts of a specific claim are known.

Am I covered for patient claims involving COVID-19?

Yes, in the same way OMIC covers other medical professional liability (MPL) claims subject to the terms, conditions, and exclusions of your policy.

Am I covered if I perform elective or routine procedures during the COVID-19 outbreak?

Yes, your OMIC MPL policy covers you for your direct patient treatment, which includes your professional judgment about when to perform treatment, including during the COVID-19 outbreak. Note, however, that many professional organizations strongly recommend that elective and routine procedures be postponed during this crisis. In the interests of patient safety, provider safety, and of the community at large, OMIC encourages you to strongly consider the AAO’s recommendation that all ophthalmologists provide only urgent or emergent care.

Some states have ordered the suspension of all non-essential surgeries and medical procedures. OMIC will defend an MPL claim that arises out of, but is not solely limited to, a violation of a law that imposes criminal penalties, but won’t pay damages attributed to the violation. At this time, OMIC is not aware of any criminal penalties for violating these suspension laws.

NEW >> Am I covered for administering COVID vaccinations?

Yes, OMIC is extending coverage to its insureds for the administration of COVID vaccinations.

We have been carefully monitoring this situation since the first vaccine was approved. Although the PREP Act provides broad immunity from suit and liability, it is not unlimited. Vaccination services may still result in lawsuits or claims. We have weighed our fiduciary responsibilities in protecting the company and its owners, our policyholders, and our commitment to public health and safety. In these unprecedented times, we recognize that we must absorb some unknown risks in supporting our insureds in their contribution to the nationwide vaccination effort.

As our insureds know, the vaccines present many challenges, including appropriate storage and handling, adequate informed consent, post-vaccination monitoring, promptly and properly responding to adverse reactions, supply management, and tracking/follow-up measures to ensure patients receive their second doses in a timely manner. In recognition of these challenges, we have published important COVID-19 vaccination risk management materials for our insureds and the broader ophthalmic community.

We strongly recommend that our insureds implement these comprehensive protocols. In addition to protecting patients, these protocols, combined with the protections afforded under the PREP Act, will allow OMIC to limit exposure to our company and better defend claims should they arise.

Does my policy cover the unintentional transmission of the novel coronavirus (SARS-CoV-2) to patients?

Yes, if the claim is alleging medical malpractice in the transmission. Note that OMIC’s policy contains a communicable disease exclusion. If you are aware – or should be aware based on your symptoms – that you are infected with the virus, coverage will apply only if you have complied with the CDC prevention guidelines for infection control.

For claims involving transmission of the virus to members of the general public, your general liability (GL) policy may respond. We suggest you check with your GL insurer for more details. For claims involving transmission of the virus to employees, review your workers compensation policy for potential coverage.

Am I covered if I provide non-ophthalmic care for COVID-19 patients?

Yes. Your policy covers volunteer emergency services you render as a “Good Samaritan.” It also covers non-ophthalmic treatment you provide in a bona fide emergency, including disease outbreaks.

You also may be immune from liability under your state’s general Good Samaritan laws or under new state measures granting immunity for providers responding to the COVID-19 outbreak. Additionally, the federal stimulus package (CARES Act) signed into law March 27th includes a modest limitation of liability for volunteer healthcare professionals during COVID-19 emergency response. OMIC will defend your claim regardless of whether immunity applies.

Do I need to notify you if I temporarily suspend some or all of my practice based on state orders or CDC or professional organization recommendations?

No, you do not need to notify us about such temporary changes.

Does OMIC’s policy cover telemedicine? Will my coverage remain in force if I temporarily convert some or all of my existing practice during the COVID-19 pandemic to telemedicine or virtual office visits?

Yes, OMIC covers ophthalmic telemedicine services. (Remote ROP screening requires a completed questionnaire and underwriting review)

Patients must be located in a state where you are authorized or licensed to practice, or you are doing so under an applicable federal or state waiver. You do not need to notify us about such temporary changes.

Does my policy cover business interruption losses resulting from the COVID-19 pandemic?

No, we suggest you check your business owners or property insurance policy for potential coverage.

I would like to administer COVID testing on my pre-surgical patients. Is this covered under my OMIC policy?

OMIC understands that, although testing may be readily available in the community, many ophthalmologists may be interested in offering COVID testing within their practices. Some may want to test patients prior to surgery as a precautionary measure. Others may want to test employees on a routine basis for the protection of their patients and other employees. Practices may elect to test employees on a more limited basis, such as to those presenting symptoms or those who have been in close contact with an employee or patient who has tested positive. Or, they may simply want to be prepared should testing through nearby sources no longer be readily available.

How the OMIC policy responds to any resulting claim would depend upon the facts and circumstances of the case, the allegations in the claim, and the population tested:

Testing Patients – Whether offering tests to patients who may have been exposed from close contact with a COVID-positive staff member or another patient, performing tests on each surgical patient as part of the pre-surgery clearance, or more widely testing patients upon request, OMIC-insured ophthalmologists can rest assured that OMIC will cover them. OMIC views this activity to be somewhat similar to other tests insureds perform on their patients. Subject to the standard terms and conditions of the policy, OMIC defends its insureds and pays damages arising from direct patient treatment provided by the insured that results in alleged injury to the patient.

Testing Employees – Whether a claim by an employee arising from COVID testing is covered by OMIC would depend on whether the testing was conducted in the course of the employee’s work and may be subject to state law. Typically, injuries employees sustain during job-related activities are covered under their state-mandated workers’ compensation or other workers’ benefits insurance. If COVID testing occurs in the course of employment, any resulting injury would likely be covered under such insurance. OMIC’s policy excludes coverage for claims arising from injury to employees arising in the course of their work for the insured and from allegations that are covered by workers’ compensation policies or for which the insured may be held liable under workers’ benefits laws.

In their Technical Assistance Questions and Answers document, “What You Should Know About COVID-19 and the ADA, the Rehabilitation Act, and Other EEO Laws,” updated Sep. 8, 2020,* the EEOC notes that “The ADA requires that any mandatory medical test of employees be ‘job related and consistent with business necessity.’ Applying this standard to the current circumstances of the COVID-19 pandemic …an employer may choose to administer COVID-19 testing to employees before initially permitting them to enter the workplace and/or periodically to determine if their presence in the workplace poses a direct threat to others.” Based on this guidance, OMIC believes that COVID-testing of employees would be subject to workers’ benefits laws and most likely would be covered under Workers’ Compensation coverage.

Testing Others Outside the Practice – Testing provided to the general public would not be covered under the OMIC policy due to OMIC’s scope of practice exclusion, which limits coverage to services rendered within the “ordinary and customary scope of practice of an ophthalmologist.”

OMIC developed sample consent forms and other risk management resources to assist insureds who elect to administer COVID testing to the practice’s patients and/or employees.

Other resources you may find helpful:

Providing Care When Disaster Strikes

Protect Your Practice From Catastrophic Events

GO TO >> OMIC COVID-19 Page.

Insureds please contact the Risk Management Hotline with questions involving HIPAA requirements, documentation, etc. Please contact your Underwriting Representative with any coverage questions.