Page 1
30/08/2011
THIS IS A SUMMARY AND EXPLANATION OF COVERAGE FOR DISCUSSION ONLY. IT DOES NOT REPLACE THE POLICY OR ANY CERTIFICATES, OR ENDORSEMENTS. IT IS NOT A COMPLETE EXPLANATION OF POLICY TERMS, CONDITIONS, LIMITS OR EXCLUSIONS.
DSM - 2011
“I am on the board – how am I protected?”
Background
Who We Are
Founded in 1987, the Healthcare Insurance Reciprocal of Canada has grown to become the largest healthcare liability insurer in Canada. With subscribers representing over 500 healthcare facilities such as hospitals, nursing homes, health authorities and community health centers, HIROC provides a stable, financially sound and practical alternative to meet the healthcare industry's liability insurance needs.
HIROC comprises the Healthcare Insurance Reciprocal of Canada, and our brokerage, HIROC Insurance Services Limited. However, HIROC is much more than an insurer. We promote efficiency and innovation in healthcare insurance-related areas by delivering:
Cost-effective insurance protection
A variety of innovative insurance products Comprehensive risk management programs
Our Philosophy
Our Vision -- Partnering to create the safest healthcare system.
Our Mission -- Committed to providing insurance, risk management, and innovative solutions supporting safety and collaboration in healthcare.
As Canadian healthcare continues to face many challenges, including advancements in technology, funding limitations and structural change, we at HIROC recognize that we have to do more than meet the needs of today; we must understand and prepare for the long-term issues affecting the healthcare community. Our philosophy is one of foresight and proactive initiatives that will enable us to meet the needs of our members both today, and tomorrow.
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30/08/2011
THIS IS A SUMMARY AND EXPLANATION OF COVERAGE FOR DISCUSSION ONLY. IT DOES NOT REPLACE THE POLICY OR ANY CERTIFICATES, OR ENDORSEMENTS. IT IS NOT A COMPLETE EXPLANATION OF POLICY TERMS, CONDITIONS, LIMITS OR EXCLUSIONS.
Claims management expertise
Critical resources and research information
Our services are complemented by our co-operative approach that identifies and addresses the needs of our subscribers while promoting their mutual interests.
Coverage’s and Services
At HIROC, we are dedicated to providing the Canadian healthcare community with value-driven insurance services. The Reciprocal offers subscribers complete protection, with high limits and comprehensive insurance. Payment of all legal costs is in addition to limits of insurance chosen.
Reciprocal Coverage
The following Reciprocal coverage’s are part of the minimum protection we provide in one seamless policy:
Professional Liability (Medical Malpractice)
Errors and Omissions (Directors and Officers) Liability Bodily Injury & Property Damage
Blood Transfusion Legal Liability Contingent Employers Liability Employee Benefits Liability
Environmental Impairment Liability Non-Owned Automobile Insurance Crime Insurance
Insuring Extensions
Retroactive Coverage HIV/AIDS Supplementary Host Liquor Liability Medical Payments
Blanket Tenants' Legal Liability
Website www.hiroc.com
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30/08/2011
THIS IS A SUMMARY AND EXPLANATION OF COVERAGE FOR DISCUSSION ONLY. IT DOES NOT REPLACE THE POLICY OR ANY CERTIFICATES, OR ENDORSEMENTS. IT IS NOT A COMPLETE EXPLANATION OF POLICY TERMS, CONDITIONS, LIMITS OR EXCLUSIONS.
Reference Documents:
Composite Healthcare Insurance Policy – Master Policy 2006/1
Healthcare insurance Reciprocal of Canada (HIROC)
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30/08/2011
THIS IS A SUMMARY AND EXPLANATION OF COVERAGE FOR DISCUSSION ONLY. IT DOES NOT REPLACE THE POLICY OR ANY CERTIFICATES, OR ENDORSEMENTS. IT IS NOT A COMPLETE EXPLANATION OF POLICY TERMS, CONDITIONS, LIMITS OR EXCLUSIONS.
Who is covered?
Coverage F – Errors and Omissions Liability: the coverage description starts on page 21 of the Master policy. This coverage is similar to a Non-profit Directors and Officers stand alone policy.
Please refer to Page 21 – Definition of the Insured “…shall include as Additional insured’s any trustee, officer, director, members of boards or committees or employees while acting within the scope of their duties as such. ….”
What is the limit of liability?
The limit of liability for Coverage F -is subject to a maximum limit of $20 million. The policy limit is on a per occurrence basis and is a single limit
Does the policy limit apply to each coverage section separately?
Your HIROC liability policy is a single-limit policy. The limit of liability in your insurance certificate is the maximum limit applicable to any one occurrence, whether or not the occurrence straddles two or more coverage sections.
What risks are covered?
Losses, including damages, settlements and defence costs, for wrongful acts which give rise to a claim for which the Insured person is legally obligated to pay: any actual alleged error, any misstatement, misleading statement or act, any omission or neglect or breach of duties in the discharge of duties, individually or collectively, or liability imposed by statute upon the Insured.
There is a list of exclusions on page 22 that are specific to this section of coverage. Some of the exclusions listed in this section are covered elsewhere in other coverage sections of the policy: .
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30/08/2011
THIS IS A SUMMARY AND EXPLANATION OF COVERAGE FOR DISCUSSION ONLY. IT DOES NOT REPLACE THE POLICY OR ANY CERTIFICATES, OR ENDORSEMENTS. IT IS NOT A COMPLETE EXPLANATION OF POLICY TERMS, CONDITIONS, LIMITS OR EXCLUSIONS.
Why could a director, officer or trustee be held liable?
Directors and Officers could be held personally and individually liable for their actions as well as their lack of action, in managing the organization.
Directors and officers of a non-profit entity are vulnerable to lawsuits on any number of grounds. These are just few possibilities:, mismanagement of funds, conflicts of interest, unwarranted salaries, misrepresentation, and misstatement of financial condition, misleading statements, discriminatory practices, self-dealing, and actions beyond granted authority..
Who could initiate these lawsuits?
Lawsuits against non-profit boards can be initiated by a variety of individuals who have contact with the entity. Here are some examples:
(a) a donor or funding sponsor who feels their contribution has not been used the further the aims of the organization;
(b) a disgruntled employee can charge the Board with discrimination in its Employment practices;
(c) An entity’s clients can bring a suit charging they are not getting the services to which they are entitled.
(D) a group of claimants can bring a suit if they believe that the board was not responsible in its response to identified safety issues or that the board did not anticipate and put strategy in place to respond to common safety issues, and as a result a number of people were injured
What risks are excluded?
See the specific exclusions to this section on page 22 of the master policy Common Exclusions are listed on pages 52 – 57 22 of the master policy
IS MEMBERSHIP IN ANOTHER NON-PROFIT BOARD COVERED?
There are some risks that simply can’t be covered by Insurance, i.e., criminal acts is an obvious exclusion but not always anticipated is harm to reputation of the organization, the board and its members or the morale of the organization. This can have a long term effect, in terms of community confidence, hiring and retaining staff, volunteers and board members.
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30/08/2011
THIS IS A SUMMARY AND EXPLANATION OF COVERAGE FOR DISCUSSION ONLY. IT DOES NOT REPLACE THE POLICY OR ANY CERTIFICATES, OR ENDORSEMENTS. IT IS NOT A COMPLETE EXPLANATION OF POLICY TERMS, CONDITIONS, LIMITS OR EXCLUSIONS.
What if I am asked to sit on another board by DSM?
The Errors and Omissions Liability Section has been extended to include participation in the board of another non-profit entity, if membership has been requested by the Named Insured. Insurance is excess Please refer to the policy (page 23) for further details.
What is the deductible?
There is no deductible applicable to Errors and Omissions Claims
Are defence costs included in the limit?
Unlike many commercial D&O policies, defence costs are in addition to the limit of Liability
Are there aggregate limits?
As a rule, our policy does not have an annual aggregate. However, as a result of recent events, our reinsurers have insisted on a $ 15-million combined aggregate for losses over $ 5 million for terrorism. We are glad that we have been able to retain full coverage for losses up to $5 million for both terrorism and cyber-risks, as we understand other insurers are not providing any coverage at all for these exposures.
Aside from the terrorism and cyber-risks exclusions above, our reinsurers have also required us to include the Absolute Fungi Exclusion and the Absolute Asbestos Exclusion-Liability.
Our revised Territorial Limitations Clause retains the worldwide coverage that we provide, however, other than for two exceptions, any liability must be determined and any damages assessed in a Canadian court of competent jurisdiction.
A note on claims-made and occurrence
HIROC provides liability protection on a combined claims-made and occurrence basis. The claims-made form of protection applies to Coverage where there tends to be a lengthy manifestation of injury and determination of the extent of disability. These Coverage is Professional Liability (Malpractice, including Blood Transfusion), Errors and Omissions’ Liability and Environmental Impairment Liability.
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30/08/2011
THIS IS A SUMMARY AND EXPLANATION OF COVERAGE FOR DISCUSSION ONLY. IT DOES NOT REPLACE THE POLICY OR ANY CERTIFICATES, OR ENDORSEMENTS. IT IS NOT A COMPLETE EXPLANATION OF POLICY TERMS, CONDITIONS, LIMITS OR EXCLUSIONS.
Claims-made protection pays for losses which are first reported during the current policy period, regardless of when the loss occurred, whereas occurrence protection pays for losses which occurred during the year coverage was in place, regardless of when the loss was reported. Therefore, the claims-made form allows us greater accuracy in determining premiums and makes it possible for us to return surplus premiums and investment income to subscribers promptly and on a regular basis.
What happens if DSM leaves HIROC?
If DSM decides to leave HIROC after the minimum commitment of four years, the new Insurer would need to provide Prior Acts ("tail") coverage for claims not reported when you were insured with HIROC and possibly previous Insurers. The cost and availability for tail coverage would depend largely on the size, claims experience of and services provided by the facility.
Claims that have been reported to HIROC prior to leaving would continue to be defended by HIROC.
HIROC requires 24 months’ notice of cancellation which can be submitted at any time after the first two years with the Reciprocal. Conditions are described in the Subscribers agreement.
