Medical care always carries risk: even a conscientious doctor can make a wrong diagnosis, and complications can arise from a correctly performed procedure. Patients are increasingly going to court, and the amounts claimed are growing. Professional liability insurance helps a clinic and a doctor compensate a patient for harm without putting the organisation's budget at risk.

Who is liable for harm to a patient

Federal Law No. 323-FZ "On the Fundamentals of Health Protection of Citizens in the Russian Federation" (Article 98) establishes that medical organisations and medical workers are liable for violating citizens' rights in health care and for harm caused to life and health in the course of medical care. The harm is compensated by medical organisations.

This is consistent with the Civil Code: under Article 1068 of the Civil Code of the Russian Federation, harm caused by an employee in the performance of their job duties is compensated by the employer. That is why a patient's claim is usually brought against the clinic. The clinic may then seek recourse against the employee at fault, within the limits set by labour law.

If the medical service is paid for, the Consumer Rights Protection Law also applies: in addition to compensation for harm, the patient may claim compensation for non-pecuniary (moral) damage, and the court imposes a penalty of 50% of the amount awarded for failing to satisfy the claim voluntarily.

Is medical liability insurance compulsory?

No. There is no compulsory liability insurance for medical workers or clinics in Russia. Article 72 of Law No. 323-FZ gives medical workers the right to insure the risk of their professional liability. Policies are taken out voluntarily — by the clinic itself, by an individual doctor or by an employer for its staff.

Besides direct financial protection, insurance brings other benefits:

  • the patient knows that a justified claim will be paid;
  • it is easier for the clinic to settle a dispute out of court without fearing for its own budget;
  • having a policy increases the trust of partners and patients.

What the policy covers

A typical liability insurance contract for a medical organisation includes:

  • compensation for harm to a patient's life and health caused by unintentional errors in diagnosis, treatment, procedures and manipulations;
  • legal defence costs, court costs and independent expert examinations;
  • damage to the patient's property, if provided for in the contract;
  • compensation for moral damage — usually for an additional premium or within a separate limit.

Typical exclusions

  • intentional acts and gross violations committed knowingly;
  • working without a licence for the relevant type of medical activity or without the specialist's authorisation to practise;
  • working under the influence of alcohol or drugs;
  • a patient's dissatisfaction with an aesthetic result where there is no harm to health;
  • fines, penalties and other sanctions, as well as the consequences of criminal prosecution.

Key contract parameters

  • Sum insured. An aggregate limit for the whole period and a separate limit per claim.
  • Deductible. The part of the loss the organisation pays itself; it encourages quality control and lowers the premium.
  • Retroactive period. Cover for errors made before the contract started, provided the claim is made while it is in force. This is especially important in medicine: the consequences of treatment may appear months later.
  • Insured activities. The list of specialties, the addresses where care is provided, the list of doctors.

What drives the price

An insurer quotes an exact price only after underwriting — an assessment of the risk. The rate depends on:

  • the clinic's profile: surgery, dentistry, obstetrics and plastic surgery are riskier than general medicine;
  • the number of doctors and the volume of care provided;
  • the history of claims and lawsuits in previous years;
  • staff qualifications and experience, and the internal quality control system;
  • the chosen limits, deductible and additional covers.

How to take out a policy and what to do if a claim is made

To calculate a premium, the insurer will need an application form, a copy of the licence, information about staff and the types of care provided, and details of claims in recent years. After underwriting, the terms are agreed, the contract is signed and the premium is paid.

If a patient makes a claim, it is important to notify the insurance company immediately, not to admit fault or promise payment without the insurer's consent, to keep the medical records and to take part in the expert examination. Breaching these conditions may give grounds for refusal.

Polis Re specialists can help you find a policy for a clinic or private practice: see the professional liability insurance section, voluntary health insurance for employees, or send a request for a quote.