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Case Example: Missed Breast Cancer

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Okay, so I just wanna have a few case examples

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on this is the quiz time.

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So get prepared. You missed the breast cancer in 2002.

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You are made aware of the miss in 2004

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and notify your insurer.

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A suit is filed in 2008.

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It's not unusual for there to be some delay.

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Would the claim be covered by an occurrence policy

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for the year 2002?

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Pause for your answer. And the correct answer is yes

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because it's when the reading occurred.

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Not necessarily when the claim for a medical-legal,

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um, case was made in 2008.

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So what you did in 2002 is covered at infinitum

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for forever by the occurrence policy.

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So yes, in two, 2000.

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And so if you have an occurrence policy

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that is only for 2002

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and you made a miss in 2004, it would not cover it.

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So that's the no answers. Okay?

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You missed the breast cancer in 2002.

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You are made aware of the miss in 2004

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and notify the insurer a PSS filed in 2008.

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Would the claim be covered by a claims

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made policy in 2004?

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So it depends if you have a retroactive date

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that covered the 2002 events,

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because the policy is for claims made

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in 2004,

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or claims made in 2008 rather than

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when the actual incident occurred.

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So you retire in 2 20 26, you had an occurrence policy

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coverage from 2016 to 2026.

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Would you be covered for an error made in 2025

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that is discovered in follow-up in 2028

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with your occurrence policy?

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The answer is yes.

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If you had a claims made policy from 2016 to 2026,

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would you be covered for an error made in 2025

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that is discovered in follow-up in 2028?

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No, because you are not covered in 2028 for a claim

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that's made in that year.

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So what do you do with insurance? B?

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Well, that's where you have the ability to have additional,

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um, policy terms

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after the time that the policy is expires.

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So basic difference claims made policy period, knee surgery,

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submit claims it's covered.

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But if your policy period ends here

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and the claim is made afterwards, you're not covered

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as opposed to the occurrence policy that covers

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what happened during the occurrence policy forever and ever.

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Faculty

David M Yousem, MD, MBA

Professor of Radiology, Vice Chairman and Associate Dean

Johns Hopkins University

Michael A. Bruno, MD, FACR, MS

Professor of Radiology & Medicine, Vice Chair for Quality and Chief of Emergency Radiology

Penn State University

Tags

Non-Clinical