1. License Protection Defense Claims
The American Association of Nurse Attorneys
October 2014 – Las Vegas, NV
Loretta D’Antonio, MBA
Vice President
Nurses Service Organization (NSO)

2. Presentation Objectives
Discuss claim metrics for the Allied program.
Create awareness of allegations, expense payments for paid claims and factors that may contribute to claims.
Provide risk management recommendations to support managing professional liability risks.

3. Who is Aon? Affinity? NSO? HPSO? CNA?
Aon Corporation is the largest insurance broker worldwide.
Affinity is a subsidiary of Aon Corporation specializing in affinity groups such as Nurses, APNs, Allied Health, Dentists, Attorneys, Accountants to name a few.
Nurses Service Organization (NSO) is the brand name for our nursing program and as a broker we provide insurance solutions to 600,000+ Nursing Professionals and Nursing Students.
Healthcare Providers Service Organization (HPSO) is the brand name for our Allied Health program and provides insurance solutions to 350,000+ Allied Health Professionals
CNA is not the California Nurses Association or a Certified Nursing Assistant. CNA is the insurance underwriter for the NSO and HPSO professional liability programs.
Read
The HPSO program includes over 100 healthcare professions.
(slide)

4. Agenda Professional liability program overview
Policy Coverage Highlights
Competitive Difference
License Protection Defense Statistics
LP Case Discussion

5. NSO and HPSO Market Leaders in Professional Liability
Specialty
Nurses
Nurse Practitioners
Physical Therapists
Counselors
Pharmacists
More than 60 state and specialty associations

6. Additional Coverage Solutions
Case Management
Cosmetic Procedures
Schools
Small group practices
Home Health, Staffing, Rehab Facilities, Counseling practices, Community Pharmacies
Extends coverage to Medical Directors
Medical Corporations
Consulting
Expert Witness
Educators

7. Policy Forms
Sample Policy Forms 7 7

8. Certificate of Insurance
Here is a copy of the certificate of insurance. For those of you who handle NSO disciplinary defense claims, it is important to note that the certificate of insurance is sent to every insured with their first billing notice … before they pay their premium. The certificate alone is not proof of coverage.
(Slide) – The effective/expiration dates are important to you and the insured as the incident reported must fall between these two in order for the policy to respond.
(Slide) – At the bottom of the Certificate, each endorsement that applies to the insurance policy is listed. The type of endorsement that this refers to is listed on the back of the Certificate (not shown here) and in a moment I’ll show you where you can find more detail on these endorsements.
(Slide) -- Coverage Part A – Professional Liability. This is the “beef” of the policy, the reason most individuals purchase the policy.
(Slide) -- Coverage Part B – Coverage Extensions. This is the coverage part that responds to a licensing action. This section is commonly referred to as the “sweetener” as it is not typically the reason the individual purchased the policy. In addition to License Protection / Disciplinary Defense coverage, there are several other ways that we cover our insureds. I will review some of these in a few moments. 8

9. Coverage Features Defense Costs
Pays covered legal defense, regardless of win or loss
Even the cost of investigating claims is covered
Defendant Expense Benefit
Reimburses for lost wages and other covered expenses when required to take time away from work to appear in court as a defendant
Deposition Representation
Reimburses attorney fees for representation at a deposition involving testimony regarding the insured’s professional services

10. Coverage Features Information Privacy Coverage
Covers the legal obligation to pay HIPAA fines and penalties
Will also reimburse for notification costs related to the disclosure of confidential personal information when there is a statutory mandate requiring you to comply with notification to patients or clients
This coverage will also pay claim expenses related to the above proceedings
Sexual Misconduct Indemnity sublimit of $25,000
Assault* coverage includes Workplace Violence Counseling
*not available in Texas 10

11. Risk Management Services
Risk management e-newsletter - Monthly
In person presentations of claims findings and risk control recommendations ( )
Continuing Education program re-launched in July 2013.
Three-part series on Licensing
Educator Tool kit
Risk Advisor Newsletter

12. Paid Claims Reports Each contains PL paid claims analysis
Specialty
2005
2009
2011
2012
2013
2014
2015
Plans RN X o
Physical Therapist
Nurse Practitioner
Pharmacists
Counselors
Small Group Practices
Each contains
PL paid claims analysis
LP paid claims analysis
Self-Assessment Checklist
Risk Control Recommendations
Work Survey
Latest versions available at

13. Risk Management Services
Annual Risk Advisor newsletter
Educator Tool Kit
Webinars
Legal case studies
Spotlight legal cases - interactive

14. License Protection Coverage
“We will pay you up to the License Protection limit of liability stated on the certificate of insurance, for attorney fees incurred by you, for your investigation and defense of complaints. Such complaints must:
arise from a license protection incident which occurred on or after the effective date of coverage, and before the expiration date of the policy period stated on the certificate of insurance; and
be filed against you with a state or federal administrative agency, licensing or regulatory authority responsible for regulating your professional conduct.”
‘We’ is CNA Insurance Company

15. License Protection Coverage
Launch
1999
2001
2009
License Protection
$5,000
$10,000 per incident
$25,000 aggregate
$25,000 per incident / aggregate
Reimbursement for
Legal Fees
$150/hr.
$200/hr.
Covered Incidents
Medical
Incidents Only
Expanded to include
non- Medical
Incidents for
Nurses Only
Medical and Non
Medical Incidents
for All Professions
Non Legal Fees
$500 per claim
Not sure we need this, as Loretta has slides on LP 15

16. CLAIM METRICS

17. License Protection Facts – Total Program
First reported LP claim Sept 1997
First LP claim paid – Jan $1,665
Reported incidents ,598
Paid Claims ,025
Paid expense reimbursement $ 18,082,985
Average cost reimbursed $3,599
(slide)

18. Status of total reported incidents
Closed w/o payment
45.3%
Pending
15.1%
Declined
6.7%
Paid - Closed
32.9%
Of these 10,662 claims reported, we have paid out legal expenses for 3,127, or 29%.
2,922 have been closed without payment – what this means is that NSO received notice of an investigation, but nothing ever materialized and there were no attorney fees.
We currently have 1,651 claims which we consider pending. That is, we have received formal notification of an investigation and we are awaiting a final outcome.
21%, or 2,214 claims, are recorded as incident only - meaning that we were notified by the insured that an incident occurred, but there has been no official notification by the state.
Finally, 748 have been declined.
Early on, a number of these declinations were because the license protection coverage we offered was limited *
Now, the most frequent reason for decline is that the incident date does not fall within a covered policy period, typically prior to the original inception date of the policy
* LP used to be limited to medical incidents only …

19. Total Incidents – Closed Claims - Paid Claims
We have seen a steady increase of roughly reported claims over the prior year since We continue to include more license protection information and case studies in our newsletters and marketing materials, hoping to inform our insureds about the benefits and use of this coverage extension.
We had projected total of 1,243 incidents to be reported by the end of 2009, the actual number was 1,395.
(slide) For 2010 we project a total of 1218 reported incidents.

20. Top 10 States by Incident

21. Paid Claims by Nursing Specialty
Incidents
Paid Claims
% of Incidents Paid
Total $ Paid
Average Paid
LPN/LVN
1,878
773
41.2%
2,637,451
$ 3,412 RN
8,254
3,432
41.6%
12,546,695
$ 3,656 NP
925
206
22.3%
781,703
$ 3,795
Total
11,057
4,411
39.9%
15,965,849
$ 3,620

22. Most Common License Allegations
LPN/LVNs $3,412
Medication Errors
Abuse/Patient’s rights
Improper Treatment and care
Nurses $3,656
Substance Abuse
Improper treatment and care
Nurse Practitioners $3,794
Improper Treatment and Care
Unprofessional Conduct

23. Most Common Allegations
Physical Therapists $3,344
Improper Management of Treatment
Improper Behavior
Fraudulent Billing
Pharmacists $3,595
Medication Mismanagement
Drug Diversion
Failure to Supervise

24. Most Common Allegations
Counseling Professionals $3,800
Sexual Misconduct
Breath of Confidentiality
Beyond scope of practice

25. CLAIM SCENARIOS

26. Board Outcomes for Nursing Specialties

27. Our Claims Process
In your annual TAANA membership package there is a question about your interest in being added to the list we provide to our customers
We receive a list updated monthly
If there are several attorneys in a given state, we will provide our customer with 3 to 4 names
We send our customer a claims packet which includes the assignment of benefits form which our customer provides to the attorney that have engaged to defend them

28. Disclaimer
The purpose of this presentation is to provide general information, rather than advice or opinion. It is accurate to the best of the speakers’ knowledge as of the date of the presentation. Accordingly, this presentation should not be viewed as a substitute for the guidance and recommendations of a retained professional and legal counsel. In addition, Aon, Affinity Insurance Services, Inc. (AIS), Nurses Service Organization (NSO) or Healthcare Providers Service Organization (HPSO) do not endorse any coverage, systems, processes or protocols addressed herein unless they are produced or created by AON, AIS, NSO, or HPSO, nor do they assume any liability for how this information is applied in practice or for the accuracy of this information.
Any references to non-Aon, AIS, NSO, HPSO websites are provided solely for convenience, and AON, AIS, NSO and HPSO disclaims any responsibility with respect to such websites. To the extent this presentation contains any descriptions of CNA products, please note that all products and services may not be available in all states and may be subject to change without notice. Actual terms, coverage, amounts, conditions and exclusions are governed and controlled by the terms and conditions of the relevant insurance policies. The CNA Professional Liability insurance policy for Nurses and Allied Healthcare Providers is underwritten by American Casualty Company of Reading, Pennsylvania, a CNA Company. CNA is a registered trademark of CNA Financial Corporation. © CNA Financial Corporation, 2014.
NSO and HPSO are registered trade names of Affinity Insurance Services, Inc., a unit of Aon Corporation. Copyright © 2014, by Affinity Insurance Services, Inc. All rights reserved.