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Coverage and Policy Management FAQs

For any questions not addressed here, please contact Policyholder Services at (877) 443-7232.

 

Policy and Coverages

Contracts and the NORCAL Policy

 

Billing and Premium Collection

 

Miscellaneous

 

Policy and Coverages


What is claims-made coverage?
Claims-made coverage is the most common type of professional liability coverage available. NORCAL’s coverages (with the exception of the optional Health Care General Liability Coverage available to qualified policyholders) are written on a claims-made basis. Claims-made coverage affords coverage to a policyholder for claims that are first reported to NORCAL while the policy is in effect, and that are otherwise covered under the policy, as long as the incident or occurrence giving rise to the claim occurred on or after the policyholder’s retroactive date.

 

What is a retroactive date?
The retroactive date is the earliest date on which a medical incident or occurrence may occur and for which coverage may be afforded under a claims-made policy. The retroactive date is shown on the policy’s declarations page or applicable endorsement. The retroactive date will be the same as the effective date of the policyholder’s coverage if Prior Acts Coverage is not purchased. However, if Prior Acts Coverage is purchased, the retroactive date will be before the effective date of the policyholder’s coverage.

 

What is prior acts coverage?
Prior acts coverage (also known as retroactive or nose coverage) is an optional coverage available to qualified applicants. Prior Acts Coverage provides protection for claims that may be first reported after joining NORCAL for health care services rendered while previously insured by another insurer. If purchased, Prior Acts Coverage eliminates the need to purchase Tail Coverage from the previous insurer.

 

How does a physician request prior acts coverage?
The physician must submit a completed NORCAL application in which the prior acts section of the application is completed and all supporting documentation requested in the application (e.g., the declarations page from the most recent insurance policy and current loss runs for the previous ten years) is provided.


What is tail coverage?
Extended Reporting Period Coverage (also known as tail coverage) is generally available for an additional premium upon the cancellation or non-renewal of a policy. If purchased, it covers claims resulting from medical incidents or occurrences that occurred on or after the policyholder’s retroactive date and before the policy termination date and that are first reported to NORCAL after the policy is terminated.

 

Are there any circumstances under which NORCAL will waive the Tail Coverage premium?
Yes. Provided all policy premiums have been paid, NORCAL will generally waive the tail premium for a physician if he or she retires completely from the practice of medicine at age 55 or older and was insured with NORCAL 60 months; becomes totally and permanently disabled (and is unable to continue practicing as a physician or surgeon); or dies during the policy period.

 

Additional benefits may apply for those physicians who were insured with NORCAL before October 1, 2005. Please contact NORCAL’s Policyholder Services Unit at (877) 443-7232 for additional information.

 

What is Physicians Administrative Defense Reimbursement (PAD) Coverage and who gets it?
NORCAL provides exclusive PAD Coverage at no additional charge. Under this coverage NORCAL will reimburse a qualified insured for attorney’s fees and costs incurred in the defense of an administrative proceeding such as those related to medical licensure, clinical privileges, medical staff membership, and employment-related civil actions. In addition, NORCAL will reimburse a qualified insured for reasonable expenses and earnings lost if they are required to attend any hearings related to such an administrative proceeding or employment-related civil activities.

 

The coverage is automatically provided to the Named Insured, endorsed physicians and employed licensed health care professionals insured under the policy.

 

Will NORCAL settle a claim without my consent?
NORCAL will not settle any professional liability claim against a physician without his or her written consent.

 

Does NORCAL offer entity coverage for a physician’s solo corporation or for a medical group’s partnership or corporation?

Yes. NORCAL offers shared limits coverage for a physician’s solo corporation at no additional charge. In addition, a medical group formed as a partnership or corporation that has two or more physician partners or shareholders may purchase separate limits of liability for the entity. The premium charged for this coverage is a percentage of the premium charged to the underlying physicians and health care extenders and is subject to a minimum premium.

 

If I will be away from my practice, can NORCAL suspend—rather than cancel—my coverage?
Subject to certain conditions, NORCAL can suspend a physician’s policy when he or she ceases practicing as it relates to that policy for situations such as a sabbatical for additional training, maternity or family leave, or when the physician is between practices. The minimum and maximum periods of time that a policy may be suspended are sixty days and one year, respectively. The physician is required to pay a reduced premium in order to keep the policy active during the period of suspension.

 

In addition, NORCAL can suspend the policy of a physician who is called to active duty in the United States Armed Forces. In addition to some other conditions, the physician is not permitted to provide professional health care services unrelated to his or her military duties. In contrast to a suspension of coverage for other reasons, a physician approved for military leave will not be subject to the minimum and maximum time periods mentioned above and the premium will be waived during the period of suspension.

 

Regardless of the reason for the suspension, no coverage is provided to the physician for claims that arise from incidents or occurrences that happened while the policy was on suspension.

 

 

Contracts and the NORCAL Policy

 

Will NORCAL provide legal advice regarding contracts/potential contracts?
No. NORCAL is not in a position to provide you with legal advice regarding your business or personal contracts, including advice concerning which contracts you should or should not enter into. Since so many legal and business-related issues are raised by contracts, we strongly encourage you to have your personal attorney review the contracts. If you are licensed in California, the California Medical Association (CMA) offers a contract analysis service. For information regarding this service, please contact the CMA at (916) 444-5532 or visit its website at www.cmanet.org.

 

What is a hold harmless/indemnification clause?
A hold harmless/indemnification clause is a contractual agreement whereby one party assumes the liability of another. For instance, if a contract that contains a hold harmless agreement is signed and a case goes to trial or is settled, the party who agreed to indemnify another may be personally responsible for the other party’s defense costs, as well as the entire settlement or judgment against that other party.

 

My contract includes a hold harmless/indemnification clause. Will NORCAL defend and/or indemnify the other party if the clause is invoked?
Generally, no. NORCAL will defend and/or indemnify you, subject to the terms, conditions and limitations of your NORCAL policy. However, your NORCAL policy contains a contractual liability exclusion (as do most professional liability insurance policies). Should you sign a contract that includes such a clause and, in the event of a claim, the clause is invoked, in most instances NORCAL will neither defend nor indemnify the other party, and you could be personally responsible for defending and indemnifying the party. Please refer to the contractual liability exclusion and definition of an “insured contract” in your policy.

 

My contract requires that my insurance carrier notify the other party if the policy is canceled or terminated, and/or if the terms and conditions of the policy are changed. Will NORCAL notify the other party of such changes?
No. The policy is a contract between NORCAL and the Named Insured, and NORCAL will only notify the Named Insured of policy changes in accordance with the terms of the policy. If the contract requires that you provide the other party with such notice, it is your responsibility to do so. NORCAL will not modify the policy to comply with the contract.

 

My contract requires mandatory coverage terms (e.g., minimum limits of liability). Does my
NORCAL policy satisfy the contractual requirements?
NORCAL will not review a contract to compare the contractual requirements with the coverage terms of your NORCAL policy. However, if you have specific questions regarding your coverage terms, you may contact NORCAL’s Policyholder Services Unit at (877) 443-7232.

 

If my NORCAL policy is terminated, and I choose to not purchase an Extended Reporting Period
Endorsement (tail coverage), my contract requires my insurance carrier to provide the other party with the option of purchasing the tail coverage. Will NORCAL provide this option to the other party?

No. NORCAL will provide only the Named Insured and, if applicable, the Named Insured’s NORCAL-insured employer, with a tail coverage invoice in accordance with the terms of the policy. You may forward the invoice to others for payment if you so choose.


My contract requires that my insurance carrier provide the other party with evidence of insurance. Will NORCAL do this?

Yes. As long as your NORCAL policy is active, NORCAL will provide a certificate of insurance (COI) to those persons, facilities, etc. whom you have identified as a COI holder. However, the COI reflects only the status of the policy when the COI is issued and is not a guarantee that the policy will remain active throughout the policy period specified.

 

If you would like to add a COI holder, you may do so online by accessing My NORCAL Log-In.

 

 

Billing and Premium Collection

 

How often will I be billed for my premium?
While the majority of NORCAL's solo physicians and groups are on a quarterly billing cycle, the option to pay on an annual basis is available as well.


How may I pay my premium?
Policyholders may pay by check or credit card, and individual physicians may use My NORCAL Log-In to pay on-line via credit card. Those paying by check may mail in their premium payments.


Policyholders who would like to pay their premium using their corporate or personal MasterCard or VISA may also contact NORCAL’s Policyholder Services Unit at (877) 443-7232 to make their payment.

Both My NORCAL Log-In and credit card payment services are free.


Should I include my premium payment when I submit my application?
Premium payments should not be mailed with an application for coverage. Premiums should be mailed only after the physician has received a letter of acceptance from NORCAL's Insurance Operations Department. A billing statement will be mailed at the same time as the letter of acceptance.



Miscellaneous

 

How long does it take NORCAL’s Underwriting Department to review and make a decision regarding my application for coverage?
An application can generally be reviewed and a decision made within two weeks of NORCAL’s receipt of it. However, the actual amount of time varies with the complexity of the practice and the completeness of the submission. Therefore, NORCAL encourages potential applicants to submit their applications approximately 30 days before the desired effective date to allow sufficient time to perform a thorough review and obtain additional information if needed.


How does NORCAL determine the premium it charges to physicians?
The primary characteristics impacting a physician’s premium include the physician’s medical specialty and geographical territory, whether or not the physician is requesting prior acts coverage, the desired limits of liability, the discounts for which the physician qualifies and the physician’s previous claims experience.


What discounts are available?
NORCAL offers the new doctor, risk management, part-time practice, group size, and voluntary deductible discounts for physicians. However, not all discounts are available to all policyholders. In addition, NORCAL reviews large accounts based upon their specific loss history.

 

Is there an additional charge to cover salaried employees such as health care professionals and front office staff?
It varies with the type of employee. NORCAL does not charge additional premium for nonmedical staff or for certain health care professionals such as registered nurses, licensed vocational nurses and medical assistants. However, NORCAL does charge additional premium for health care extenders (HCEs). HCEs are certified registered nurse anesthetists, nurse midwives, nurse perfusionists, nurse practitioners, physician assistants, preceptees and podiatrists. HCEs must complete a NORCAL application, undergo an Underwriting review and be approved for coverage.


Is NORCAL endorsed by any medical professional associations?
Yes. NORCAL is endorsed by 28 local county medical societies in California, the Rhode Island Medical Society and the Osteopathic Physicians & Surgeons of California (OPSC).

 

Does NORCAL cover physicians who are not members of a medical society?
Yes.

 


NOTE: All policy provisions are subject to underwriting approval and may vary from state to state. This published language should not be construed as a coverage interpretation of the policy in whole or in part. Any actual coverage determination would be subject to all the terms and conditions of the actual policy, endorsements.

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