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In Medical Malpractice Cases, Insurers Pay — Doctors Don’t

For people who have been injured or who have lost a loved one due to medical malpractice, an important question that arises is how to recover the monetary damages that are due. In Pennsylvania, compensation for a medical malpractice injury comes principally from a professional liability insurance company. 

Under the MCARE (Medical Care Availability and Reduction of Error) Act, all physicians in the state must maintain minimum liability coverage of $1,000,000 per claim and $3,000,000 in total annual coverage. Failure to carry such insurance can expose the doctor to disciplinary action or loss of license. In addition, doctors engaged in higher-risk specialties, such as obstetricians and neurosurgeons, generally purchase greater insurance amounts.

However, the fact that your care provider has adequate coverage does not mean the insurance company will simply hand over compensation when you make a claim. You will likely need a personal injury lawyer’s help, because insurance companies are notorious for finding ways to deny claims, such as by asserting that a patient’s injuries were pre-existing or caused by something other than the doctor’s negligence.

Your attorney must also analyze the policy to determine whether it applies to your particular injury. Many medical malpractice policies contain exclusions of certain acts or omissions by an insured doctor. Most policies do not cover the following:

  • Sexual harassment or misconduct
  • Theft or alteration of hospital records
  • Other illegal or criminal acts
  • Intentional misconduct
  • Conduct amounting to willful or wanton disregard for the patient’s safety

If your doctor’s conduct is excluded from coverage, or if the policy amount is insufficient to cover your claim, then you would need to seek to hold the doctor personally liable through a lawsuit. Obtaining compensation from an underinsured medical professional can be difficult. They are not always as wealthy as people think. 

Additionally, you must bring your lawsuit within two years of the date you knew or should have known of the injury. For example, if you underwent surgery and did not learn until four years later that the doctor made an error, you have two years from the date of that discovery to file the claim.

If you’ve been injured by a doctor or other medical provider in Pennsylvania, reach out to the office of Matthew R. Zatko, Attorney at Law. I serve clients throughout Bedford, Cambria and Somerset counties. Call 814-483-7075 or contact me online to arrange a free consultation.