Should we place/present this provider?

This is probably one of the more common questions I receive. A provider comes to you with a board action, open or closed malpractice claim, may or may not fit in your internal verification process, and you want to know if you should continue on with the process.

The locums industry is extremely unique in this regard.  In most malpractice insurance scenarios, the carrier determines the fitness of the provider.  However, due to the unique business model of the locum tenen industry, this is usually not practical.  In your case, a tremendous amount of responsibility is left to you as you may be acting in place of the carrier and underwriter to approve or decline a provider.   Add to that, underwriters in the malpractice environment usually have experience in one state or territory and very few have expertise in most, or all, territories.  That being the case (forewarning, shameless plug) your broker can be a tremendous amount of help in this arena.  While credentials of a particular provider are relatively consistent across the nation and specialties, claims history is not.  A physician with a $1,000,000 claim in Texas means something completely different to me than a physician with a $1,000,000 claim in New York.  

For starters, when asked about a provider, here is what I look at:

  • Education 
  • Years in Practice 
  • Work History
  • Claims History 
  • Facts of claims 
  • Tone of narrative of the claim description.
  • Board Actions 
  • Tone of narrative of the board actions
  • Hospital privileges
  • Tone of narrative of the reason for the hospital privilege issue
  • Experience in specialty placed
  • References
  • Drug/Alcohol abuse 
  • Is the provider currently insured with an Excess & Surplus carrier or Risk Retention Group or have a deductible on their policy.

Once all of this information is obtained, I review everything in the totality of the circumstances to make a determination on my recommendation.  My usual recommendation will depend on whether I feel an "admitted" carrier in that territory would approve the provider.