Professional Liability Errors and Omissions (E/O)

You and your organization can be sued for the actions you take or fail to take that are considered to affect someone or the organization negatively. Professional Liability (also known as Errors & Omissions). E&O policies provide coverage for actions brought against the Organization, its Officers, Directors, Management, employees and volunteer staff for errors or omissions committed in the daily activities of the organization.

Summary of Product

Insurable Costs:

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

Activities and Exposure to Loss:

  • Vicarious Liability – ostensible agency or apparent agency (*)
  • Claims Processing
  • Marketing/Advertising
  • Management/Administration of services
  • HIPAA Privacy Issues

*Organization is named in a suit because of an affiliation with the person or organization sued

Insurable Events:

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

To learn more about HMO Reinsurance brokerage and consultant services at McPhee & Associates—contact us or call (818) 541-7900.