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Insurer drops nine doctors’ coverage

Decision was based on calculation of malpractice risks, company says.
Friday, October 31, 2003 | 12:00 a.m. CST; updated 7:23 a.m. CDT, Thursday, July 17, 2008

Letters arrived Wednesday for nine of the 30 doctors at Boone Clinic, informing them that they would have to find a new provider for medical malpractice insurance next year.

On a second tier of risk

The affected physicians specialize in pulmonary medicine, ophthalmology, rheumatology, oncology and internal medicine. Gloria Logan, Boone Clinic’s personal administrative specialist, said the doctors were “very concerned and upset” about losing their coverage.

GE Medical Protective, the fourth largest medical liability insurance provider in Missouri, stopped underwriting medical liability insurance to the nine Boone Clinic physicians. Some insurance carriers considered the physicians to be on “a second tier of risk,” meaning they do not have primarily surgical specialties. Insurance companies consider these physicians a lower-risk than others who provide more surgical care, such as neurosurgeons and obstetricians.

Possible causes

Randy McConnell, spokesman for the Missouri Department of Insurance, said the Fort Wayne, Ind.-based insurance company may be revising its underwriting policies to equate second-tier-risk physicians with those who practice higher-risk specialties.

John Novaria, spokesman for GE Medical Protective, could neither confirm nor deny that such a change in policy was behind the decision to end the coverage.

“We evaluate each physician based on the merits of his or her application,” Novaria said.

Novaria said physicians are not automatically placed into different categories based on their medical specialty. Terminating the coverage for the nine Boone Clinic doctors was based on a calculation of risk, he said.

The company analyzes the physicians’ history of malpractice claims — a practice known as “experience rating” — and the legal environment. Many physicians blame the high cost of malpractice insurance on what they perceive to be unjustified jury awards for noneconomic damages, or “pain and suffering.”

A possible solution

Novaria suggested that Missouri needs tort reform to stem the loss of both physicians and malpractice insurance providers, many of who are not taking on any new business in the state.

Logan said the Boone Clinic doctors “are frantically looking” to find new insurance providers. But locating new providers may be difficult because many carriers are not able to take on new policyholders.

From 2001 to 2002, 57 percent of Missouri’s medical liability market disappeared for physicians looking for new carriers, according to the state’s Department of Insurance.


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