Risk Management

Notify OMIC of Changes in Your Practice

By Kimberly Wittchow, JD OMIC Staff Attorney

Digest, Spring 2005

It is important to OMIC that our insureds remain adequately protected from liability, especially during times of change and transition. By accepting your OMIC policy, you agree that the statements you made in the application are true. Most insureds supply accurate and thorough information both on the written application and in follow-up correspondence with their underwriter. However, after the underwriting process is complete and the insured is accepted for professional liability coverage, insurance may not be at the forefront of his or her mind. Nevertheless, it is important that insureds continue to communicate with their underwriter about any changes that occur in their practice.

Change in Practice Activities, Arrangements and Locations

The policy requires that insureds promptly inform OMIC, in writing, of any changes to the representations they made in their application. And insureds warrant, when signing the application, that they will update the information supplied on the application as necessary. This ensures that the coverage you have and the premium you pay correspond to your risk exposures.

• For instance, if you begin to perform a new refractive surgery procedure, you must complete and submit a supplemental questionnaire for this procedure. If OMIC grants your coverage request, your policy, which excludes coverage for all refractive surgery procedures, will be endorsed to provide coverage for the particular approved procedure.

• If you hire an optometrist or certified registered nurse anesthetist or bring in a locum tenens, you will want to ensure that he or she has his or her own insurance, or else is accepted for coverage by OMIC under your policy.

• You must alert OMIC when your practice arrangement changes, for example, if you join another practice, form a partnership with others, incorporate your practice, or allow outside utilizers to use your surgery facilities. You and your underwriter can discuss what options you have for deleting, adding, or otherwise changing your entity coverage and what limits are available or required for you to maintain.

• You must notify your underwriter if you significantly reduce your hours, eliminate certain surgical activities, or discontinue surgery altogether, so that your coverage can be amended and premium discounts, if any, can be applied.

• You must notify OMIC if you move or begin to practice in additional counties or states because your premium may need to be adjusted.

Claims, Complaints and Medical Conditions

While you already know to contact OMIC to report claims covered under your OMIC policy, you also must advise us of any claims filed against you that are covered by another carrier. Additionally, you must notify OMIC if a professional conduct complaint is filed against you, and as soon as you become aware of any proceedings or status changes regarding your license to practice medicine; your BNDD (drug) license, privileges at a hospital, HMO, or other medical facility; or your certification by or membership in a medical association, society, or board.

You are required to notify OMIC when certain life changes occur, for instance, if you have been treated for any medical condition that might impair your ability to practice, if you have been diagnosed with any mental illness, or if you have experienced any alcohol or drug dependency problems. If you are taking time off from your practice for maternity or paternity leave, you will want to alert OMIC because you may be eligible for a suspension in coverage.

Policy Endorsements and Coverage Reviews

While OMIC attempts to accommodate its insureds and their practice needs, changes requested by insureds are not always approved due to underwriting considerations. If requests are not made in a timely manner, there is no guarantee that we will retroactively amend your policy. Please remember that only endorsements or revised policy declarations, not simply notice, can waive or change the terms of your policy.

Under certain circumstances, changes that the insured notifies OMIC of may result in the insured being reviewed for continued insurability by OMIC. When certain increases in hazard are apparent or when membership criteria are not met (for example, if an insured loses his or her license or is no longer a member of the American Academy of Ophthalmology), OMIC may discontinue providing coverage to the insured.

The consequences of not notifying OMIC of changes will vary depending on the nature of the omission and the circumstances under which the omission is noted. These range from simply updating the information in your OMIC underwriting file to possible denial of a claim, or, in extreme cases, cancellation of your policy. Our goal is to encourage our insureds to notify us of changes to information we have about them in a complete and timely fashion to avoid any gaps in coverage.