MTInsurance for Independent Contractors

Health Insurance 1997

Review of Article in PERSPECTIVES
By Mary Morken
(This journal can be ordered from Health Professions Institute)
"Preventing DPS (Deep Pocket Syndrome)"
by Donna Avila-Weil and Mary Glaccum

The authors of THE INDEPENDENT MEDICAL TRANSCRIPTIONIST address the issue of professional liability insurance (errors and omissions) for MTs. They believe that IMTs can protect themselves adequately with excellence, ongoing improvement and a waiver of liability stated in their contracts. Physicians are responsible for the documents they sign, and there is an extremely small chance (if any) of a malpractice suit involving an IMT who does not have this insurance. They report the results of a survey done in January 1996 with 66% of hospitals contracting out their transcription. Accredited, licensed and credentialed healthcare providers must have liability insurance; medical transcription is not in this category. They feel that MTs should work for recognition as allied health professionals, but not make themselves a target for a lawsuit with inappropriate liability insurance. For more information on the book by these authors, call 800, 852-4890, Rayve Productions.

Health Insurance for Self-Employed MTs

Pioneer Insurance Co., Design Benefit Plans, 1750 East Golf Road, Schaumberg, IL 60173.
DBP is Pioneer's marketing company for their products specifically designed for the self-employed. Call 1-800-395-9875 and ask for Susan Hahn for information.

10/10/95, Cathie Duzyk, CDoozle@aol.com
Health Insurance for Independents
Until recently I had a Blue Cross plan called Complete Care that was roughly $92 per month (just for me as a single). It was designed for people who don't use the insurance often, and my deductibles were pretty high. However, I recently found through an insurance agent that I could get better protection at group rates by joining The Pennsylvania Small Business Alliance (http://www.industry.net/smc) and purchasing the insurance through them. My premium is now $140 per month, in addition to $240 annual dues for the Business Alliance, costing almost an additional $900 per year, but my coverage is so much better (NO deductibles, $10 copay on office visits, $15 Rx on brand names and $5 for generics, etc.). That additional peace of mind is well worth it!! I have a friend who has to purchase her insurance through her rather large employer (she's only part-time); she has the same coverage and pays the same rate I do.

Obviously this will vary between the different states, but it's worth checking into. I'm waiting for this same agent to get me pricing and information on long-term disability insurance as well. I checked several years back, and I believe at the time the cost was even GREATER than medical coverage! I'd be interested in hearing if anyone has this coverage at a reasonable cost.

Of additional interest, I had checked when I bought my home about loss of wages if something was to happen to my house since I work here, but nothing was available at the time. Hopefully this will change in the future, with more and more people coming home to work. Plus, don't forget loss of wages on the car insurance! Most plans supply only a flat monthly income, and it only costs a few extra dollars a year to ensure that your income will continue at the present level in the event you're injured while in the car.

10/15/95, from: jodi@accessnv.com (Jodi Lambert)
Health insurance has always been my biggest problem, also, since neither my husband or I have health insurance, so I depend on it from a job of some sort. Thus I maintained a hospital job of 20 hrs/wk beside my work at home to get insurance. Then I discovered Gem Insurance, P.O. Box 449, Salt Lake City, Utah 84110-0449. They insure small businesses and will take them as small as one person. My insurance costs me $79 per month.. That is zero deductible, I pay a co-pay of $10 to doctor, can go to any hospital in my area, and have a list of over 700 doctors to choose from. My prescriptions cost me 10% (I just had a couple filled yesterday, one cost me $0.41 and the other $0.53!). With the insurance I had at the hospital, I paid a flat $10 per prescription. A lot of prescriptions don't cost $10 and that would mean that a Rx would have to be $100 for me to have to pay $10. Also, I can have dental for $15 more and eye glasses for $5/mo more. I live in Nevada and have a local agent who handles this insurance. I don't know if it is available in other states or not, but it finally made it possible for me to quit the hospital and just do it at home.

10/17/95, from Jodi Lambert, jodi@accessnv.com
Those were 700 doctors in Las Vegas which is where I live! That's a lot of choices! I guess they give you a list wherever you get the insurance, but I don't know if it is available outside of Utah and Nevada. Will try to find out.

10/17/95, from: FAPG57A@prodigy.com (Julie Veronick)
The hospital I used to work at was a self-insured hospital. They had facilities in California, Oregon, Washington, and Alaska. With that many employees, they were able to self-insure and provide a wonderful medical/dental/vision package with reasonable deductibles and fees. When I left, I was paying $160 per month for coverage for four people, $250 deductible for medical/vision, $25 deductible for dental, and 80% reimbursement up to $5,000 and then it was 100%.

The office where I work now is an eight-doctor clinic and the docs in the state have just formed their own insurance plan with a risk-benefit management company handling the claims. The plan is very similar to the one stated above and in fact is better in some areas.

I was just curious as to why no one has thought about the independent medical transcriptionists getting together and forming a pool that could be insured as a group. Surely there are enough of us out there that we would have a sizable group with reasonable rates and deductibles? Is anyone familiar enough with the insurance industry that they know who to ask about this? I just think it would be so neat if we could all do something like that. Then we wouldn't be dependent on working at a hospital or some similar place just because we need insurance. If I could be independent and be insured, I wouldn't even care if I didn't get paid vacations. It would be one less headache to worry about!

From Sue McKean: SKMckn@aol.com
The Lutheran Brotherhood had health insurance if you are a Lutheran. Some Business Chamber of Commerces have insurance for business in their areas. How much and what it would cover would vary from area to area, but at least it would be health insurance. Dental insurance can be gotten though CIGNA if you are a member of AHIMA. It was reasonable at only $7.50/month BUT I don't think that there are that may dentists who participate due to CIGNAs low reimbursement rate. At any rate, you can get a list of dentists by state who participate by contacting AHIMA.
Liability Insurance for Errors and Omissions

9/18/95, Doris A. Anderson
73323.1422@compuserve.com
Information on new E&O Insurance from AAMT

Agent: Albert H. Wohlers & Co. Insurance, (800) 323-2106.
Carrier: Chicago Insurance
For: Professional liability insurance (also referred to as E&O) for AAMT and BIS members. No exclusions, which means that it is "accepted in CA" and other states.
Self-employed MT coverage: $1-3 million, $289 year.
Employee MT coverage: $1-3 million, $81 year.
Coverage: Full protection for any claims incurred while policy is in effect. If I understand it correctly, if you retire or quit as an MT, you cancel the policy. However, if any claims were filed while the policy was in effect, then you are covered.
Questions asked of MT: Has subscriber's state medical license, certification or malpractive ever been revoked? Has any claim for an alleged malpractice ever been brought against you?

9/16/95, Doris A. Anderson
73323.1422@compuserve.com
The Sept-Oct '95 issue of JAAMT, p. 49, states that professional liability insurance is now available to members. It offers up to $1 million in liability protection for each claim, and a limit of $3 million in claims per year. The article states MTs can be "at risk of possible lawsuits."

In my opinion, since AAMT endorses and promotes this, it sets a new precedent. This gives attorneys a whole new field to target when it comes to litigation and "deep pockets" when they know we have insurance. Even if you have IMT contracts with various doctors and facilities to "indemnify and hold the contractor harmless against any claims," they can still try to sue you. You would be protected by your contract, but you would still need the coverage to pay for your legal representation costs, which one broker informed me could run as much as $10,000 to $12,000.

9/17/95, Marianne Wolfman
marianne@ccnet.com
1) Who defines errors and omissions? What is the proof that the transcriptionist rather than the dictator made the error or omission? This could be a hornet's nest. Anybody who has done transcription for even a short period of time knows that dictator errors and omissions are common.

2) Who is responsible for a report dictated to another person? In the business world, the person who dictates and signs the report is responsible. I am responsible for anything that goes out under my name, no matter how it was created. Is errors & omissions insurance an effort to shift responsibility? What is going on here?

3) Should E&O insurance become a standard, who pays? Clearly, people in the transcribing business would have to charge hospitals and doctors more to cover the cost of insurance. In a cost-cutting era, how does this fit in?

9/17/95, Cynthia Lewis
CYNROSES@aol.com
Even though I am new to this profession and my opinion shouldn't carry a lot of weight without experience behind it, I am worried that the door will indeed open to incredible abuse if this becomes the norm. We all know how the threat of malpractice suits have negatively impacted the whole of health care--and that is in a situation where there is genuine responsibility and liability. It is my understanding that we are only preparing documents for review and acceptance by the originator whose real responsibility are the contents. Heaven help us all if we truly become legally responsible for content. Malpractice suits are generally filed because someone has suffered bodily harm or the loss of another person--and would have to be surrounded by intense emotionalism where retribution at any cost is demanded, and including anyone who drew a breath during the case--us, for instance.

As I posted before, I was forced to obtain a certificate of insurance for a "one million/two million" policy before I signed a contract with a County hospital. As it happens, this was very inexpensive through our homeowners insurance (State Farm), costing only about $100 annually. Realistically, it seemed totally useless to me, given the limits of liability currently. By offering this policy, it seems to me that AAMT is legitimizing this nonsense, and raising the ante in the game. While it might be viewed as a service to members, I would think a stronger position of "no MT liability" would serve us much better. Liability insurance can appear more "professional." The more baggage we have to carry, the more "important" we appear and the more respect we can demand, but with it goes greater liability.

9/17/95, Mary Morken
MMorken@ix.netcom.com
Court reporters, scopists and legal transcriptionists do have this kind of insurance. Nurses and medical technicians have it as well.

A case could be made that since AAMT is one company, a 501(c)6, and the American Medical Association does not recognize them as the official representative or standard in our field, they only represent their 10,000 members which is 4% of the MTs in the U.S., and cannot set precedents for the rest of us. There are about 4000 CMTs. I think independent MTs need health insurance more than this kind of insurance.

9/18/95, Bill Bentsen
Bbentsen@ix.netcom.com
I'm not an authority on this subject; plus, my work is always from a county or state government (Medical Examiner's office), so they don't even worry about E&O for themselves, and certainly not from me. I have never heard about a transcriptionist being pulled in for E&O.

Logic says that the physician is the author of the document, and he has signed it, therefore signifying that the information contained is his and is accurate. He accepts responsibility for it. I really can't fathom an MT ever getting hauled into court about a document written by and signed by a doctor.

Toni Mercadante, 9/18/95
tmerc@ix.netcom.com
For what it's worth, I've been doing medicolegal transcription specifically related to the defense of malpractice suits since 1989--hundreds and hundreds of cases. There hasn't been one in which a medical transcriptionist was a named codefendant, brought in later as a third-party defendant, or even mentioned in any of the material I've transcribed thus far. This issue was the topic of discussion on the sci.med.transcription newsgroup when I joined last December or January. Out of curiosity, I spoke with my client--the owner of a firm that conducts investigations on behalf of malpractice insurance carriers and defense attorneys. She could not recall one instance of a transcriptionist being named in a lawsuit; further, she could not recall a case in which a transcriptionist was even interviewed regarding the content of medical records subpoenaed and reviewed in the course of an investigation.

When I received the AAMT/Albert H. Wohlers Insurance Co. information in the mail today, I called Wohlers and spoke with a claims representative. The company has been providing malpractice/professional liability insurance coverage for eight years, and the claims representative could find no record of the company ever defending a claim involving a medical transcriptionist.

I then called Med-Pro, a malpractice insurance provider in New York, and spoke with one of their claims representatives. She stated she had never heard of an MT being impleaded in a case in the five years she has worked for the firm and referred me to one of their risk managers: "He's out there in the front lines every day and can tell you more than I can."

The gentleman I spoke with (I have his name) has been a risk manager at Med-Pro for seven years. In essence, here's what he had to say:

1. He has never had a case and, indeed, has never heard of a case involving a medical transcriptionist as either a codefendant or a third-party defendant.

2. The doctor is responsible for his/her notes in the medical record, whether they be handwritten or transcribed. Admittedly, there is a problem with physicians failing to read transcribed notes; however, this failure in no way shifts responsibility for the contents of those notes to the transcriptionist.

3. A medical transcriptionist would not be a primary target in a professional liability/malpractice suit in the first place. A more likely scenario would be for the transcriptionist to be brought in as a third-party defendant. It would work this way: You transcribe for Dr. Jones. Dr. Jones is sued for malpractice and the plaintiff wins. In an effort to limit her liability and recover some of her losses, Dr. Jones sues you for inaccurately transcribing her dictation.

4. He just doesn't see this happening. He reiterated that the doctors are ultimately responsibile for content of their notes and for correcting any errors they may contain after it has been transcribed; therefore, it is his opinion that the chances of an MT being sued because of an error in the record are "slim to none, and slim is out of town."

He then asked me about the yearly premium for coverage. When I told him $294 a year for a single owner/operator, he chuckled and suggested I check with a nursing association and see what nurses generally pay per year for their coverage. They render direct care to patients and are responsible for administering proper medications and dosages, documentation in the medical record, etc., and therefore are much more a target for a professional liability/malpractice claim than are transcriptionists. He said I'd probably find that nurses pay somewhat less than $294/year for coverage. At the end of our conversation he added, "You know, I hate to be such a skeptic, but it seems to me your professional association probably stands to gain something if it can convince its members that they need this coverage and then encourage them to buy it from this particular company."

Toni Mercadante, 09/22/95
I spoke with a representative of the Georgia Nurses Association. She said nurses here generally pay a yearly premium of $99 for coverage. The exception would be specialty nurses, nurse-midwives, for example, who would pay more. To her knowledge, however, even specialty nurses don't pay as much as $289 per year. Responses to a request for information posted to a nursing newsgroup on usenet confirmed this information. The nurses who responded indicated a premium range of $77 to $99 per year depending on location.

The gentleman I spoke with at the second New York malpractice insurance carrier contacted, MLMIC, happened to be one of their defense attorneys. In the 20 years he's been defending malpractice claims, not one MT has been involved as a primary or third-party defendant. In his words, "The doctor is responsible for the information contained in the record and for ensuring accuracy and content." When asked if he had ever considered impleading a medical transcriptionist, he replied, "No, there's no authority there."

Well, that's it. There are valid reasons to have professional liability insurance, of course. As business owners, we could be sued for breach of contract or be involved in a personal injury claim--you know, the client slips on the driveway and breaks a leg while delivering and/or picking up work (right?). However, based on my personal experience and what I've learned and reported here recently, the possibility of being named in a malpractice action seems extremely remote at best.

10/3/95: Toni sent this note from a lawyer, Mr. DeWitt:

If the doctor does everything right, and the hospital screws up, I go after the hospital only. If the hospital does everything right, and the doctor issues the wrong orders, and the hospital employees knew it but took no action, then I go after everyone.

Question from Toni: "To your knowledge, has a medical transcriptionist, either hospital employee or independent contractor, ever been included in the 'everyone'?"

To the best of my knowledge, no, I have never heard of anyone going after a transcriptionist, and I can't imagine why anyone would. In my experience transcriptionists have the unenviable job of having to listen to doctors all day. If that weren't bad enough, they then have to try to make sense out of what the doctors say. Haven't they been punished enough?

In order to make out a prima facie case of negligence, a plaintiff must show negligence, causation and damages. Negligence is defined as a breach of the duty of care one person owes to another. Stated in more normal terms, that means that someone has to act in other than a reasonable and prudent manner. For example, if a doctor is dictating and you can't tell whether he's saying aminophylline or amitriptyline, then you usually type in a ______ and let the doctor fill it in, right? If you guess and type in one of the two, you may have made an error, and you may have breached the standard of care for medical transcriptionists (or maybe not, I'm just giving an example).

But you probably still would not be liable because the physician has to read and sign the document before it has any legal effect, and if the doctor hasn't written out his progress notes in the chart, that isn't your fault. Now, lets carry this a step or two further. Lets say Dr. Rookie comes in, sees the word Aminophylline, and makes a bad clinical decision which he then tries to blame on the transcription error. In most cases, that will not work as a defense for him, because he had a duty to gather additional information, and if he didn't, then the error by the transcriptionist is probably not the "cause in fact" of the injury.

Now, I suppose it is possible that the hospital could be liable in contribution (where the doctor tries to lay off some of his fault on someone else). I have not researched that. But, to the best of my knowledge, there haven't been any cases involving transcriptionists. This is not legal advice. Consult an attorney in your jurisdiction to answer legal questions.

You can certainly use anything from my note. I don't know of any suits against transcriptionists. I suppose that could have happened, but it didn't make news in the legal community.

A. L. DeWitt, Esq.
Shamberg, Johnson & Bergman
4551 W. 107th St.
Suite 355
Overland Park, KS 66207

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