Medical Liability Mutual Insurance Company Rating Classifications
IMPORTANT NOTICE: In accordance with state legislation, all physicians and surgeons policies may be written on either an occurrence or a claims
made basis.
Physicians and Surgeons professional liability insurance policies issued by MLMIC bear the most appropriate of the following descriptions:
Premium Class 1
• Neurosurgery
Premium Class 2
• General Surgery, including Bariatric Surgery
Premium Class 3
• Obstetrics and Gynecology
Premium Class 4
Orthopedic Surgery
Premium Class 5
• General Surgery, excluding Bariatric Surgery
Premium Class 6
• Cardiac Surgery
• Vascular Surgery
Premium Class 7
• Gynecology only
Does not provide coverage for pre-natal care; obstetrical deliveries of any kind
(except for assistance at Cesarean Section); induced abortions (except for
those in the first trimester), or treatment of spontaneous abortions (except for
those in the first trimester).
• Otolaryngology, including otolaryngological cosmetic plastic surgery
• Plastic and Reconstructive Surgery
Premium Class 8
• Colon and Rectal Surgery and/or Proctology
• Urology, including major surgery
Premium Class 9
• Computerized Tomography
• Diagnostic Radiology only
• Diagnostic Radiology and Radiation Oncology
Premium Class 10
• Neurology and/or Psychiatry, including the supervision, direction, or
performance of myelography andlor angiography
• Obstetrics and Gynecology, Uncomplicated Obstetrics and Limited Surgery
See description under Family/General Practice and Limited Major Surgery
and/or Anesthesiology.
• Otolaryngology, excluding cosmetic plastic surgery
Premium Class 11
• Emergency Medicine
Premium Class 12
• Obstetrics and Gynecology, Uncomplicated Obstetrics and Minor Surgery.
See description under Family/General Practice and Minor Surgery.
Premium Class 13
• Internal Medicine, including cardiac catheterization
Premium Class 14
Gynecology Only, including minor surgery
Does not provide coverage for pm-natal care; obstetrical deliveries of any kind
(except for assistance at Cesarean Sections); treatment of spontaneous abortions
(except for those in the first trimester); any intraabdominal surgery or any
orthopedic procedures and any major surgery, including but not limited to T&A
vasectomies, herniorrhaphies, hemorrhoidectomies, pilonidal cystectomies,
elective abortions the administration of general or spinal anesthesia.
• Otolaryngology, with surgery limited to minor procedures
Does not include tonsillectomy and adenoidectomy.
• Occupational Medicine and Minor Surgery
See description under Family/General Practice and Minor Surgery.
Premium Class 15
• Neurology, excluding the supervision, direction, or performance of myelography
and/or angiography.
Premium Class 16
• Anesthesiology
Premium Class 17
• Dermatology, including dermabrasion, hair transplants, mice-lipo injections, lipo
suction, face peels using Phenol, Mohs microsurgery, and all procedures listed
Class 21, Dermatology
• Internal Medicine, excluding cardiac catheterization
But including cardiology, gastroenterology, rheumatology, pulmonary disease,
endocrinology and medical oncology.
• Radiation Oncology only
• Urology, including minor surgery
Premium Class 18
• Ophthalmology including major surgery
Premium Class 19
• Occupational Medicine, excluding surgery
See description under Family/General Practice. Exclusive of Surgery
• Pediatrics, not to include tonsillectomy and adenoidectomy, other major surgery,
or general or spinal anesthesia.
Premium Class 20
• Ophthalmology, with surgery limited to minor procedures
• Pathology and/or Hematology
Premium Class 21
• Allergy, including pediatric allergy
• Dermatology, including the use of laser, face peels with agents other than Phenol,
collagen injections, and sclero-therapy, but excluding all procedures listed in Class
17, Dermatology
• Ophthalmology, excluding surgery
• Physical Medicine, Rehabilitation, Preventive Medicine, Public Health
• Psychiatry, excluding the supervision, direction or performance of myelography
,
and/or angiography.
Family/General Practice Classifications
Premium Class 19
Family/General Practice Exclusive of Surgery
General medicine, medical diagnostic procedures and excisional and punch biopsy; minor surgery limited to incision of boils and superficial abscesses and suturing of skin
and superficial fascia; splinting or casting of non-displaced fractures; fulguration of growths; and circumcision of the newborn.
Premium Class 14
Family/General Practice and Minor Surgery
Family/General Practice as described under Premium Class 19; closed reductions of fractures, excision of superficial growths, treatment of spontaneous abortions, diagnostic
D&Cs, circumcision of other than the newborn, assistance at major surgery, prenatal care for uncomplicated pregnancies ad normal deliveries. Prenatal care for
uncomplicated pregnancies will not include the care of patients with high risk conditions such as hypertension and diabetes, or pregnancies with known breech presentations
or multiple gestations unless there is antepartum consultation with a qualified obstetrician and a qualified obstetrician is readily available for consultation and treatment of the
patient. Normal deliveries are defined as follows: (a) normal spontaneous deliveries; (b) the use of outlet forceps, or vacuum delivery; (c) episiotomy; (d) repair of cervical tear
in emergency situations; (e) the pharmacological or surgical induction or augmentation of labor; provided the physician examines the patient and consults with a qualified
obstetrician prior to its use and the physician is physically present until the patient has been stabilized for a minimum of 30 minutes after the induction or augmentation is
administered and thereafter is readily available to attend to the patient and if a Cesarean Section is indicated then the physician must contact a qualified obstetrician who
must be available within 30 minutes of the determination of the need to perform a Cesarean delivery; and (f) performance of vaginal delivery following a Cesarean Section
(VBA C) provided there is antepartum consultation with a qualified obstetrician and a qualified obstetrician is 7mmediately available” for consultation and treatment of the
patient. lmmediately available” means physically present at the location of the delivery and the qualified obstetrician with cesarean privileges with whom you consulted
cannot be perfonning a surgical procedure or delivering another patient during this time. NORMAL DELIVERY DOES NOT INCLUDE THE DELIVERY OF KNOWN BREECH
PRESENTATIONS OR MULTIPLE GESTATIONS.
Premium Class ID
Family/General Practice and Limited Major Surgery and/or Anesthesiology
Family/General Practice as described under Premium Class 19 and 14; referred or non-referred major surgery limited to tonsillectomy and adenoidectomy, vasectomy,
hemiorrhaphy, hemorrhoidectoy; and pionidal cystectomy; abortions, through the 12th week of pregnancy done only by suction curettage; anesthesiology on a part-time basis,
not to exceed an average of 12 hours per week.
A physician will not qualify for a Family/General Practice classification if he/she (1) performs open orthopedic procedures or elective intraabdominal surgery including
hysterectomies or (2) in the opinion of the Physician Underwriting Committee, represents a risk similar to that of a specialist.
NOTE: FOR CLASSIFICATION PURPOSES, TONSILLECTOMY AND ADENDIDECTOMY AND ABORTIONS (OTHER THAN TREATMENT OF SPONTANEOUS ABORTIONS)
ARE CONSIDERED MAJOR SURGERY.
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Medical liability Mutual Insurance Company
About The Company
Medical Liability Mutual lnsLlrance Company (hereinafter referred to as
‘MLMIC’) is a mutual insurance company organized in 1975 under the
Insurance Law of the State ot New York in response to the crisis of availability of
physicians professional liability coverage in New York. MLMIC is one of the
largest writers of medical professional liability insurance in the nation. MLMIC is
the only insurer endorsed by the Medical Society of the State of New York
(MSSNY) for professional liabfliiy insurance for physicians and surgeons.
The cost for “Tail” coverage related to ‘termination of coverage” due to
cancellation or non-renewal is based on a percentage of the occurrence rate(s)
in effect at the time ot cancellation, taking into consideration adjustments for
changes in classification, territory, and limits during the coverage period.
First Year- 74.8%
Second Year- 122.1 %
Third Year- 1 46.4%
Fourth Year 1 52.4%
-
Policyholder Dividends
Policyholders, as owners of Medical Liability Mutual Insurance Company, are
entitled to participate in the distribution of dividends, if SI/Cl? dividends are
actually distributed by the Companv The Board of Directors decides whether
dividends will be paid, and their amount.
The following cs an overview of policy forms and additional coverages aL-al/able.
A more detailed descrij (iOn of c/aims made coverage can be found in the
Conipanyc ‘A Closer took At Coverage Forms” at p vww mini/c corn. Any
questions concernihg coverage or rates may be cifrected to the Company
Underwriting Departments th New York at (212) 576-9670; in Syracuse at (315)
428-1188; ñì the Albany Area at (518) 786-2700 and in long Is/and at (516)
794-720U
Occurrence and Claims Made Information
Occurrence Policy
Covers claims arising from professional services rendered during the policy
period regardless of when the claim is reported.
claims Made Policy
Covers claims arising from professional services rendered while the policy is in
effect which are first reported while the policy is in effect or during an extended
reporting endorsement period.
Additional Claims Made Coverage Information
Optional Reporting Endorsement (Tail Coverage) For Claims Made Policies
This coverage is available to claims made policyholders to provide protection for
covered claims which are first reported after ‘termination of coverage’. This
includes cancellation/non-renewal of the policy, a decrease n limits, a reduction
in coverage, an increase in deductible or self-insured retention, a new exclusion
or any change in coverage less favorable to the insured whether made by the
insurer or the insured at any time.
Fifth Year’ 173.3%
Sixth Year 181.0%
Seventh Year- 186.7%
Eighth Year and Thereafter
-
-
190.6%
The cost of ‘Tail’ coverage related to termination of coverage’ other than
cancellation or non-renewal will he calculated in accordance with the rating
method established by New York Regulation.
Waiver of Premium for Tail Coverage
The costs related to “Tail’ coverage will be waived for a natural person named
insured when termination of coverage is due to (1) death, (2) permanent and
total disability, or (3) permanent and total retirement from the practice of
medicine a) after atlaining the age of 65 or older and being insured by an
authorized insurer on a claims made basis 5 or more consecutive years; (b) after
attaining the age of 55 or older and being insured by an authorized insurer on a
claims made basis 10 or more consecutive years; or (c) regardless of age, if the
insured retires and has maintained claims made coverage with an authorized
insurer for at least 10 consecutive years, provided the last five consecutive years
were through MLMIC.
Prior Acts (Nose) Coverage
Claims made applicants who are presently covered on a claims made basis by
certain acceptable insurers may avoid the expense of purchasing “Tail’ coverage
with their prior insurer by securing prior acts (nose) coverage through MLMIC.
Nose Coverage provides protection, in accordance with the terms and
conditions of the MLMIC policy, for covered claims arising from professional
services rendered during the coverage period with the prior insurer which are
first reported after the inception of the MLMIC policy.
The premium for nose coverage is included in the claims made rate level that
reflects the total number ot years for continuous claims made coverage. For
example. if you had 3 years of claims made coverage with another insurer, you
would be rated at the 4th year claims made rate with MFMIC.
Your prior years of coverage with a New York State licensed insurer will be
credited toward the requirements for prepaid retirement “Tail’ coverage
described in the previous section entitled 1
Waiver of Premium for Tail
Coverage’.
Available limits of Liability
Optional Endorsements
The rates listed in this schedule are based on limits of liability of $1000000
Each Person/$3,000,000 Total and $1,300,000 Each Person/$3,900,000 Total.
Either one, not both may be selected:
Waiver of Consent to Settle a Claim
This endorsement is available to
individual named insureds for a premium reduction of 5%.
-
The maximum limits of liability available to Professional Entities is $1,000,000
Each Person/$3,000,000 Total.
Deductible An indemnity deductible of $5,000 each claim is available to
named
insureds
for
a
premium
reduction
of
1.4%.
of
the
S1.000,000/S3,000,000 rate regardless of individual limits of liability).
-
Limits
of
liability
of
$i00,000!S300,000;
S200,000’5600,000;
S300.000/$900,000; and $500,000/Si .500,000 are available at lower rates of
p rem u m.
Premium Discounts
Optional Coverages
Defense Costs Coverage
For an additional premium charge, qualified physician policyholders, may
purchase coverage for the costs of defending (U an administrative action
brought against a physician by a governmental body such as the Office of
Professional Medical Conduct, arising out of allegations which could form the
basis of a claim for legal liability under the policy and (2) a governmental
proceeding alleging tvedicare/Medicaid fraud or abuse related to violation of
Medicare or Medicaid guidelines arising out of filing an erroneous claim. Limits
of liability of either $25,000 or $100,000 are available.
Professional Entity Coverage
Separate limits of coverage up to $1,000,000 Each Person /$3,000,000 Total
may be available to a Professional Entity bra premium c/large. A Professional
Entity is ‘the professional service corporation, professional limited liability
company, partnership or limited liability partnership” of a named insured
physician.
To be eligible for coverage a Professional Entity must meet the following
eligibility requirements:
•
MLMIC must insure at least 75% of the members and/or employed
physicians of the entity;
•
The Professional Entity must be incorporated in New York State;
Members and employed physicians, surgeons or physician extenders in
the practice must be acceptable based on MLMIC’s underwriting
standards; and
•
With the exception of the Claim Free Discount none of the following discounts
are available to physicians and surgeons who are participants in the MLMIC
Voluntary Attending Physician Program.
New Doctor Discount applicable to physicians and surgeons who enter private
practice solo or group) immediately following the completion of training:
-
Claims Made Policies 50% first year; 25% 2nd year; 25% 3rd year;
-
Occurrence Policies 50% for one year.
-
NEW DocroR DISCOUNT WILL NOT BE APPLIED CONCURRENTLY WITH THE CLAIMS
FREE, VOLUNTEER OR PART TIME DISCOUNTS.
-
Part Time Discount physicians and surgeons who require coverage for 20
hours a week or less of medical practice Classes 1-8 and 10- 35%; Classes 9
and 11-21 50%.
-
-
-
-
Risk Management Discount 5% to physicians and surgeons who satisfactorily
complete a qualified Risk Management Program.
-
Claims Free Discount 7.5°A, to qualified physicians and surgeons who (1) have
been continuously in practice for a minimum of five years and (2) have no open
claims (or suits) and no closed claims (or suits) with indemnity or expense within
the past 5 years (regardless of the accident date or report date).
-
Payment Options
Quarterly Installment Payments
Prompt Payment A 2% premium credit is applied for prompt payment of the
full annual premium upon receipt of the invoice.
-
•
All members, employed physicians and/or physician extenders must
carry individual limits of insurance of at least $1000000 Each
Person/S3.000,000 Total limit.
This material is provided for general information about our physicians and surgeons professional liability program and is not a contract. No coverage is provided by
this brochure nor can it be construed to replace any provisions of the policy. If there is a conflict between this brochure and the policy, the provisions of the policy
will prevail