Surgeries

In this section, we want to look at :

The issue of running a clinic where others are involved either as employees renting space or making another type of contribution to the income and resources of the practice.
Issues around running a clinic and whether you need clinic malpractice policy in addition to any personal policy you may have
A list which will explain the different types of cover you could or indeed in some cases, should be considering.

1. Are You a “Corporate” Risk?

Do you need extra malpractice cover?

When a Health Professional forms a Limited Company or other Corporate Entity, it is usually the Tax or Legal Implications which exercise the mind. If your Practice consists of just you or is augmented by a receptionist, other clerical person or/wife/partner, this is normally covered by your existing block scheme cover. You need to change the name on your policy to reflect the Ltd Company or other change,and of course show your corporate new name,registered office and company registration number on all notepaper,invoices etc. You will of course need Employers Liability for any Employees as required by Law, but our Supplementary policy for contents etc will include this for upwards of £50 per year.

It is apparent however that more and more Health Professionals are setting up multi- person, multi therapy practices, with a core person or persons organising and running the clinic or centre. A range of Corporate activities are undertaken such as: advertising all the therapists, hiring out rooms, checking they have valid insurance, that Osteopaths or Chiropractors are properly registered, booking appointments or giving health advice, referring possible clients to other Associates and therapists, or even taking money on behalf of other practitioners, and thus possibly unwittingly acting as their agent. We have also seen that Therapists have been employing other practitioners, or sub contracting work for which they retain overall responsibility as proprietor of the Clinic or Centre. Even though your receptionist and staff are covered for their actions under your policy as an individual, they are not covered if the patient of another associate or therapist complains about their behaviour or communication style. As a principal with a clinic complaints procedure, you may get involved in a case that on the surface does not seem to implicate or involve you in any way, but as the case progresses, you may be named as a 3rd party in an action. There are too many grey areas for a sensible osteopath clinic proprietor to ignore the potential losses which they could incur through no fault of their own. You could also face a regulatory/disciplinary complaint for failing to monitor or supervise your staff or even consultants or keep proper data protection or have a complaints procedure

It seems also that a recent trend has developed, where solicitors letters have gone to the principal, rather than the practitioner concerned. A legal firm will go for the organisation rather than the individual especially if the practice advertises the therapist concerned, or is otherwise possibly linked. The argument can be made that the Principal chose or allowed that practitioner to work there. Even if the claim ultimately gets redirected to the practitioner, there could be costs before it can get to that point. In the perceived increase in this sort of claim, a corporate practice owner is being seen as easier to go for than individuals, in a clinic set up.

We have encountered situations where an Osteopath or other Practitioner who was an associate or employee has left the country or disappeared without trace leaving the owner of the clinic, or fellow associate who hired out the room where treatment took place, to receive the blame when a solicitors letter surfaced later on. Insurers can’t normally process or deal with a claim without adequate information or the involvement of the Practitioner concerned, and it could fall back on you!

It can be said therefore, that there is a “corporate” risk requiring a separate clinic policy covering both “front line” or “contingent” treatment risks. A front line risk I would describe as where you or your employees could be held directly responsible as a result of giving advice, treatment, or causing upset, harm, embarrassment. A contingent risk is one that arises from being implicated in some way with the chain of events or association with the person causing the injury or loss. The degree of vulnerability ranges from the remote (and raises the question “is it really worth taking out extra insurance for?”) to the extreme, where there is inadequate Insurance protection in place to protect the owner of the business. Remember Your usual Scheme Affinity Group Policy is largely for the protection of individuals and their receptionists involving their own clients, and not for “corporate” operations described above.

Hiring locums would fall into a different category, as these are usually employed in temporary situations and their respective insurances would normally deal with that situation. It is essential that you do check the Insurance of any Locum, even if they are GOsC registered and be prepared to be extra vigilant if you see anything with which you are concerned.

Up to now, specially designed corporate policies for “ front line” cover has not always been easy to get and has been especially expensive to include osteopathy or chiropractic because of the restricted number of insurers offering cover for such therapists running clinics.

We are pleased to advise that we have arranged a number of special schemes catering for the treatment and advice aspect of these risks. Cover will be very similar to the sorts of Risk you have under your individual policy- Professional Indemnity, Medical Malpractice, Breach of Confidentiality Libel and Slander, Loss of Documents etc.

For Contents, Money, Buildings, Employers and Public Liabilities, you should consider Balens’ Bridge Surgery Package cover, which delivers all of this and more at a competitive premium. You may also want to consider a locum cover to pay for one if you are off work due to illness or accident. In a larger set up, you may also want to consider Commercial Legal Expenses Insurance to cover Criminal Defence, Employment Awards and disputes, contract disputes etc.

You can ask for a form now to get the ball rolling and receive a customised quote. Premiums will reflect the fee income, types of therapies offered and the number of qualified practitioners to be covered. .

In the meantime here is a table to help you decide if your business is vulnerable. We cannot cover every situation, so please contact David or Josh Balen and their Commercial Insurance team on 01684 581875 01684 581880 or on db@balen.co.uk for in depth technical advice. Although this information above has been checked by a solicitor, we are not qualified to advise on Legal Matters, but such queries can be referred on for you.

2. Insurance issues around running a clinic - Do I Need a Policy?

QUESTION	ANSWER	SOLUTION
Are you a Health Centre/Clinic/Individual making Appointments for other therapists?	Yes	Clinic Policy may be advisable
	No	Individual Policy OK for most situations
Are you running a Clinic with Associates?	Yes	Clinic Policy may be Advisable/maybe essential depending on how Clinic is set up
If “yes”, do you have a standard contract that is signed with them?	Yes	Legal Advice may be needed to clarify extent of possible liability- this still may not prevent someone trying to sue you
Do you take money on behalf of other therapists’ work? Are cheques made out to you/your company?	Yes	Clinic Policy essential. Perception of contract is that it is with you as money has been taken.
Do you Simply rent the space to other practitioners with no other involvement?	Yes	Individual Policy OK for most situations- check you have Public Liability and maybe Loss of Rent/Profits insurance in case your income is curtailed by a fire etc.
	No	Clinic Policy may be Advisable
Do you advertise other therapists/therapies as part of your overall operation?	Yes	Clinic Policy essential – Lawyers will argue that the Public Perception will be of a corporate entity not an individual
As proprietor, do you regularly check that their Insurance is in force, correctly describes what they do, and require sight of insurance at renewal of their policy?	Yes	Clinic Policy essential – if you fail to do this and practitioner turns out to be uninsured you may be implicated
Do you have any Therapist Employees?	Yes	Clinic Policy essential – your policy covers you and your practice not necessarily a number other qualified therapists for whom you are responsible
Does your receptionist carry out any treatment on your behalf or under supervision?	Yes	Highly likely that this is not insured anyway if this employee is not qualified, but if they are, then Clinic Policy is essential
Are you renting Rooms?	Yes	Check you have a Public Liability to cover this – your standard cover will be OK for this.
Are you renting Rooms out to others? Do you have a mortgage on the Building?	Yes	Consider some form of protection for this income or cover to pay for additional cost of hiring somewhere else- e.g. Loss of Rent or Profits or increased cost of working cover (ICOW) if the rooms become seriously damaged by Fire, Flood, Storm and you can’t use them.
Do you have a mortgage on the Building? Do you use a locum if you are ill?	Yes	Consider some form of Illness and accident Income Protection, for lump sum disablement benefits as well as weekly income replacement cover
Are you taking on work experience people?	Yes	You must have an Employers Liability cover for this. Even though they are not technically employees, allegations of negligence against you if they are injured will be covered under such a policy.

3. Different Types of Cover

Surgery

Most surgeries need a contents package and in some cases need extra malpractice to cover the corporate risk as explained above. We have a variety of packages available for all types of Health Professionals Businesses, but the most popular of these is our "Bridge" Policy which has been in existence for over 17 years. The premiums have changed very little over the years, and the minimum premiums are very low compared to the standard marketplace.

Buildings and Contents, Money and other Covers usually on an All Risks basis. As well as Shop Front and Glass, Money, Employers, Public/Products liabilities - see "Bridge" Supplementary Scheme information
Can consider Commercial Legal Expenses Cover, particularly if you employ people
Financial Advice and /or Business funding may be required
Employee Benefits packages including Stakeholder Pensions where there are more than 5 employees should be considered

Directors and Officers (D & O)

Where a charity or a Business have directors/trustees, they can be held legally liable personally for their actions by law. These policies will defend them against an allegation
Typical allegations would be failure to adequately look after the finances (breach of fiduciary duty) taking negligent decisions which adversely affect the organisation.
Allegations of fraud or misconduct.

Commercial Legal Expenses

Rated on wages and Turnover. Law is complex and ever changing, so these policies are more and more sought after by businesses

A business can incur expenses and be vulnerable under the law of the land, and contract law.
Criminal allegations Defence
Discrimination
Health and Safety
Inland Revenue Investigations, VAT issues
Contract Disputes
Employment tribunals and Advicelines
These also cover help and advice lines on legal or tax issues

Employment Practices Liability - EPL

Examples of typical claims situations, and good explanation leaflet available - see section of the website dedicated to claims

A very recent addition, this replaces the need for Employment tribunal cover such as you would get in A commercial Legal Expenses Policy.
EPL covers Employment Practices, so if there is a dispute or industrial tribunal the Insurer will pay for the legal help and awards.
Commercial Legal Policies also do this but require Client to follow strict ACAS guidelines and procedures, and this is not always possible for a client

Public / Products Liability

Trip and slip cover. Products Liability Insurance is covered in depth elsewhere, but in these types of policy are limited and only injury due to a defect in the product itself innocently supplied. is covred. We have separate covers for product design etc- please contact us for this information.

Legal liability for injury or damage to other people or their property
Legal Liability for products sold supplied tested, repaired, demonstrated, manufactured etc
Often included as part of package, but certain types of surgery need more specialised cover