Managed Care Errors & Omissions

Managed Care Errors & Omissions vs. Medical Malpractice

There have been confusions about medical malpractice and managed care errors & omissions coverage. We have often heard from medical organizations that they do not need managed care errors & omissions coverage because they have medical malpractice coverage. A medical malpractice policy that is not specifically for managed care does not give full coverage for errors & omissions which occur in healthcare. Medical malpractice provides coverage for the delivery of medical care only.

Managed Care Errors & Omissions Liability provides coverage for actions brought against the organization, its officers, directors, medical directors, employees and volunteer staff for errors or omissions committed in the daily operation of the organization. It provides for many liabilities usually not covered by clinic or physician Malpractice Policies.

A medical malpractice suit can name the physician, hospital and as well the managed care organization the physician is associated with. This is called “vicarious” liability and is one very good reason the organization would need to have Managed Care Errors & Omissions.

Insurable Costs Include:

  • Legal Fee
  • Damages (may include punitive damages)
  • Settlements

Insurable Events Include:

  • Credentialing
  • Peer Review
  • Claims Processing
  • Marketing/Advertising
  • Wrongful denial of benefits
  • Management/Administration of services
  • Failure to properly credential providers
  • Unlawful restraint of trade
  • Exclusive dealing (brought by provider denied access to a panel)
  • Improper Utilization Review (rationing of care)
  • Failure to process negligent processing of claim bills or claim information
  • Misleading advertising or marketing
  • Improper conduct of Peer Review Panel
  • Discrimination against an enrollee or panel provider
  • Improper staffing

Contact me with any questions.

E&O Policy Application

Susan Kattoo
(818) 541-7900