Pennsylvania Medical Professional Liability Insurance Market Summary
Doctors in Pennsylvania have the following options for purchasing medical liability coverage from these major insurers:
- The Doctors Company
- Aspen American Insurance Company
- Medical Protective
- ProAssurance/Norcal (merged in 2020)
- Coverys Group
These companies are considered the best insurers in Pennsylvania because of their A-rating from A.M. Best and their track record providing robust legal and financial support for physicians. These carriers use proprietary methodologies to set rates and there is no set standard rate across insurers for each specialty, so using a broker like MEDPLI helps surgeons, OB/Gyns, and other physicians secure coverage at the most competitive price.
Historically, providers in Pennsylvania witnessed the same malpractice crisis of the 1970s that affected many states across the country. Because of high premiums, insurance carriers considered fleeing the state, threatening to make reasonably priced options even more difficult to find. Lawmakers came together to pass major legislation in 1975 and again in 1996, but by the 2000s, three major insurers had stopped offering policies. In response, the Medical Care Availability & Reduction of Error Act (MCARE) was passed in 2002, “addressing both medical errors in the healthcare system and reforms to the legal system and the medical malpractice industry”. However, medical malpractice insurance premiums continue to be high for practicing Pennsylvania doctors.
Medical Malpractice Insurance Requirements for Pennsylvania in 2020
Pennsylvania has the MCARE Act, which requires all practicing doctors to carry medical malpractice insurance. The MCARE Fund mandates proof of coverage, and if evidence of insurance is not received, it has the obligation to report the health care provider to the appropriate licensing board for license suspension or revocation. MCARE requires liability limits of $1,000,000 per claim and $3,000,000 as an annual aggregate. Private policies insure the first $500,000 of any claim, and the MCARE fund will cover excess losses of up to another $500,000.
Medical Malpractice Insurance and COVID-19 in Pennsylvania
The first two cases of COVID-19 in the state of Pennsylvania were confirmed on March 6, 2020. One day after the first confirmed death in the state, Governor Tom Wolf issued a statewide order that closed all “non-life sustaining businesses operations and services,” to take effect on March 21. Additional orders, including a statewide stay at home order and a mandate that masks must be worn in all public spaces, were issued throughout April of 2020.
Since that time, the state government has developed a three-phase system that provides guidance to individuals and businesses on how and when they can re-open. The red phase includes a stay at home order and only allows essential businesses to be open. The yellow phase allows some businesses to be open under certain restrictions, and the green phase allows for most businesses to be open while still following the social distancing, public masking, and business capacity guidelines. The state, individual counties, or even metropolitan areas can move between the phases based on state and local government recommendations.
Guidance on COVID-19 for healthcare professionals is provided by the PA Department of Health, and includes the following suggestions:
- Non-urgent and elective care can be provided when personal protective equipment is available and telehealth is “not clinically sufficient”
- Providers should use their own professional judgment on whether to provide care based on the needs of the community, the rates of infection, and their access to adequate supplies
- All patients should be screened for symptoms before coming to the facility
- All health measures, including social distancing and mandatory masking, should be enforced within the facility
Despite the transparency of the colored phase system used in the state, the unpredictability of the rate of COVID-19 makes it imperative that Pennsylvania physicians move swiftly to protect themselves with medical malpractice insurance.
Telemedicine in Pennsylvania
COVID-19 has fueled the adoption of telehealth services in the state. In March 2020, to reduce the risk of patients contracting COVID-19, Penn State Health urgently expanded telemedicine access from its pilot phase for COVID-19 testing, urgent care, and dermatology patients. Chris LaCoe, the health system’s VP of Operations, anticipates that the services will only increase, “adding that he believes anywhere from 20-25 percent of visits might become virtual visits in the near future, including postoperative follow-ups”.
The state government, however, is trying to play catch-up with the rise in demand for telehealth. Governor Tom Wolf vetoed a bill in April 2020 that would have required insurers to pay for remote doctor’s visits and currently, guidance is not provided on payment parity in telemedicine in the state. In addition, Pennsylvania does not yet belong to the Interstate Medical Licensure Compact, a program that expedites the licensing process for out-of-state providers.
However, in March 2020, as a response to COVID-19, an emergency declaration expanded access for Medicare patients, allowing for Medicare reimbursements for specialty consultations and telepsychiatry. Additionally, many other health insurers in the state have updated their telemedicine policies in response to the crisis, but providers need to check with each insurer to make sure they are adhering to the plan’s details for maximum reimbursement.
Although the state will temporarily “waive penalties for HIPAA violations against health care providers that serve patients in good faith through everyday communications technologies”, since doctors have the same liability with telemedicine visits as they do with face to face visits, it is recommended that doctors carry insurance that specifically covers telemedicine.
Malpractice Insurance Rates for Pennsylvania Doctors
Medical malpractice insurance rates in Pennsylvania tend to be high – so working with an independent broker, like MEDPLI, allows you to easily shop for the most competitive option among carriers. A provider’s specific rate will be based on factors like exact location, specialty and claims history.
State filed rates from 2016
Tort Reform in Pennsylvania
PA has a long history of tort reform in the state, including the establishment of the first patient compensation fund in the country in 1975. From the early 1970s to 2019, Pennsylvania has ushered in major tort reform in the state, including the MCARE Act in 2002. Other notable reforms include:
- lowered limits of liability coverage for primary care physicians and specialists
- caps on punitive damages and certain other recoveries after a personal injury
- plaintiffs are required to obtain a certificate of merit before proceeding with a claim
- individuals must file claims in the county where the malpractice occurred
- all hospitals are required to incorporate detailed patient safety plans under the Patient Safety Authority
The Administrative Office of Pennsylvania Courts reported in 2015 that medical malpractice filings in Pennsylvania were on a steady decline and attributed this in part to the MCARE Act.
Pennsylvania’s Damage Caps on Medical Malpractice Lawsuits
Many states have legislated a cap on the amount of compensation an individual can receive in a medical malpractice case, but Pennsylvania is not one of them. There is currently no cap on economic or non-economic medical malpractice damages in the state. Punitive damages are capped but are not often awarded in medical liability cases.
Statute of Limitations for Medical Malpractice Claims
The following guidelines outline Pennsylvania’s statute of limitations for medical malpractice claims:
- Generally, the amount of time a person has to file a medical malpractice lawsuit in the state is two years
- The Discovery Rule states that if an injury is not immediately known, the statute of limitations does not begin until the date when the individual knew or should have known about their injury
- Regardless of the Discovery Rule, a medical malpractice lawsuit may not be filed more than seven years from the date on which the medical error occurred (recently struck down by the state Supreme Court in 2019)
- Exceptions to the seven-year deadline can be made in cases where a foreign object was left in the patient
- The PA Minors Tolling Statute states if a child is injured by medical malpractice before the age of 18, the two-year statute of limitations does not begin until they reach 18
Tail Insurance in Pennsylvania
If you are a physician with a claims-made policy practicing in Pennsylvania and you DON’T have Prior Acts insurance (also known as Nose Coverage), having a tail insurance policy will make sure you’re protected from malpractice claims if you change jobs. Tail insurance covers the time between your retroactive date with your former employer, and the last day you are covered by that policy. The dates typically line up with your first day on the job and your last day seeing patients at that job. Before you start with your new employer, the new employer will often want to confirm you have tail coverage from your prior job. To get the best rates on tail insurance in Pennsylvania, contact a broker before you notify your employer of your resignation.
When and why is tail insurance necessary?
When a doctor leaves an employer, their insurance coverage with that employer ends on the last day of employment. Since most malpractice insurance policies are underwritten on a claims-made basis, you will be exposed to a lawsuit if someone files a claim against you after you leave your employer, without tail coverage. Tail insurance covers you from your retroactive date up to the last day the policy is in effect – with the ability to report claims years after the last day. Read more about tail malpractice insurance.
Medical Malpractice Insurance Outcomes in Pennsylvania for 2019
The total medical malpractice payout in Pennsylvania for 2019 was $289,968,000.
Despite high medical malpractice insurance premiums, physicians report that they enjoy practicing in the Keystone state. The state boasts close to 250 institutes of higher learning and is home to much-respected hospital systems; Hospitals of the University of Pennsylvania – Penn Presbyterian, UPMC Presbyterian & Shadyside, Jefferson Health-Thomas Jefferson University, and Penn State Health Milton S. Hershey Medical Center all ranked highly in Newsweek’s “World’s Best Hospitals 2019” list. In addition, a recent Wallet Hub study ranked Pennsylvania as the “eighth-best state for health care access”.
MEDPLI helps physicians from all specialties. Whether you are a surgeon in Scranton, an ObGyn in Philadelphia, or an anesthesiologist in Pittsburgh, we can help you find the best medical malpractice insurance in Pennsylvania. To get coverage from an A-rated carrier,contact us by requesting a quote.