S.C. Code Regs. § § 19-415.4

Current through Register Vol. 48, No. 11, November 22, 2024

Section 19-415.4 - Medical Employee Professional Liability Insurance

Definitions

When used in reference to this insurance "damages" means all damages, including damages for death, which are payable because of injury to which this insurance applies. "Insured" means any person qualifying as an insured in the "Persons Insured" provision of the applicable insurance coverage. The insurance afforded applies separately to each insured against whom claims are made or suit is brought, except with respect to the limits of the Fund's Liability;

"Named Insured" means the persons named on the face of this policy.

Conditions

A. Premium. All premiums for this policy shall be computed in accordance with the Fund's rules, rates, rating plans, premiums and minimum premiums applicable to the insurance afforded herein.

B. Inspection and Audit. The Fund shall be permitted but not obligated to inspect the named insured's operations at any time. Neither the Fund's right to make inspections nor the making thereof nor any report thereon shall constitute an undertaking on behalf of or for the benefit of the named insured or others, to determine or warrant that such operations are safe. The Fund may examine and audit the named institution's books and records at any time during the policy period and extensions thereof and within three (3) years after the final termination of this policy, as far as they relate to the subject matter of this insurance.

C. Insured's Duties in the Event of Occurrence, Claim or Suit.

(1) In the event of an occurrence, written notice containing particulars sufficient to identify the insured and also reasonably obtainable information with respect to the time, place and circumstances thereof, and the names and addresses of the injured and of available witnesses, shall be given by or for the insured to the Fund or any of its authorized agents as soon as practicable. The named insured shall promptly take at his expense all reasonable steps to prevent other bodily injury or damage from arising out of the same or similar conditions, but such expense shall not be recoverable under this policy.

(2) If claim is made or suit is brought against the insured, the insured shall immediately forward to the Fund every demand, notice, summons or other process received by him or his representative. (3) The insured shall cooperate with the Fund and upon the Fund's request, assist in making settlements, in the conduct of suits and in enforcing any right on contribution or indemnity against any person or organization who may be liable to the insured because of bodily injury with respect to which insurance is afforded under this policy; and the insured shall attend hearings and trials and assist in securing and giving evidence and obtaining the attendance of witnesses. The insured shall not, except at his own cost, voluntarily make any payment, assume any obligation or incur any expense other than for first aid to others at the time of accident.

D. Action Against Fund. No action shall lie against the Fund unless, as a condition precedent thereto, there shall have been full compliance with all of the terms of this policy, nor until the amount of the insured's obligation to pay shall have been finally determined either by judgment against the insured after actual trial or by written agreement of the insured, the claimant and the Fund. Any person or organization or the legal representative thereof who has secured such judgment or written agreement shall thereafter be entitled to recover under this policy to the extent of the insurance afforded by this policy. No person or organization shall have any right under this policy to join the Fund as a party to any action against the insured to determine the insured's liability, nor shall the Fund be impleaded by the insured or his legal representative. Bankruptcy or insolvency of the insured or of the insured's estate shall not relieve the Fund of any of its obligations hereunder.

E. Other Insurance. In consideration of fact that this insurance is written at a reduced premium the insurance afforded by this policy is excess insurance. Should the insured have other insurance applicable to a loss under this policy on an excess contingent or primary basis this policy will come into effect only after other such insurance has been exhausted. When both this insurance and other insurance apply to the loss on the same basis, excess or contingent, the Fund shall not be liable under this policy for a greater proportion of the loss than stated in the applicable contribution provision below.

(1) Contribution by Equal Shares. If all of such other valid and collectible insurance provides for contribution by equal shares, the Fund shall not be liable for a greater proportion of such loss than would be payable if each insurer contributes an equal share until the share of each insurer equals the lowest applicable limit of liability under any one policy or the full amount of the loss is paid, and with respect to any amount of loss not so paid the remaining insurers then continue to contribute equal shares of the remaining amount of the loss until each such insurer has paid its limit in full or the full amount of the loss is paid.

(2) Contribution by Limits. If any of such other insurance does not provide for contribution by equal shares, the Fund shall not be liable for a greater proportion of such loss than the applicable limit of liability under this policy for such loss bears to the total applicable limit of liability of all valid and collectible insurance against such loss.

F. Subrogation. In the event of any payment under this policy, the Fund shall be subrogated to all the insured's rights of recovery therefor against any person or organization and the insured shall execute and deliver instruments and papers and do whatever else is necessary to secure such rights. The insured shall do nothing after loss to prejudice such rights.

G. Changes. Notice to any agent or knowledge possessed by any agent or by any other person shall not effect a waiver or a change in any part of this policy or estop the Fund from asserting any right under the terms of this policy; nor shall the terms of this policy be waived or changed, except by endorsement issued to form a part of this policy, signed by a duly authorized officer of the Fund.

H. Assignment. Assignment of interest under this policy shall not bind the Fund until its consent is endorsed hereon; if, however, the named insured shall die, such insurance as is afforded by this policy shall apply to the named insured's legal representative, as the named insured, but only while acting within the scope of his duties as such.

I. Cancellation. This policy may be cancelled by the institution by surrender thereof to the Fund or any of its authorized agents or by mailing to the Fund written notice stating when thereafter the cancellation shall be effective. This policy may be cancelled by the Fund by mailing to the institution, at the address shown in this policy, written notice stating when not less than ten days thereafter such cancellation shall be effective. The mailing of notice as aforesaid shall be sufficient proof of notice. The time of the surrender or the effective date and hour of cancellation stated in the notice shall become the end of the policy period. Delivery of such written notice either by the institution or by the Fund shall be equivalent to mailing.

J. Declarations. By acceptance of this policy, the named institution agrees that the statements in the declarations are his agreements and representations, that this policy is issued in reliance upon the truth of such representations and that this policy embodies all agreements existing between institution and the Fund or any of its agents relating to this insurance.

I. Coverage

The Fund will pay on behalf of the insured all sums which the insured shall become legally obligated to pay as damages because of injury to any person arising out of the rendering of or failure to render, during the policy period, the following services:

(1) medical, surgical, dental or nursing treatment to such person or the person inflicting the injury including the furnishing of food or beverages in connection therewith,

(2) furnishing or dispensing of drugs or medical, dental or surgical supplies or appliances if the injury occurs after the named insured has relinquished possession thereof to others,

(3) handling of or performing post-mortem examinations on human bodies, or

(4) service by any person as a member of a formal accreditation or similar professional board or committee of the named institution or as a person charged with the duty of executing directives of any such board or committee, and the Fund shall have the right and duty to defend any suit against the insured seeking damages, even if any of the allegations of the suit are groundless, false or fraudulent, and may make such investigation and, with the written consent of the insured, such settlement of any claims or suit as it deems expedient, but the Fund shall not be obligated to pay any claim or judgment or to defend any suit after the applicable limit of the Fund's liability has been exhausted by payment of judgments or settlements.

A. Exclusions--This insurance does not apply:

(1) to bodily injury to the insured arising out of and in the course of his employment by the institution;

(2) to any obligation for which the insured or any carrier as his insurer may be held liable under any workmen's compensation, unemployment compensation or disability benefits law, or under any similar law.

II. Persons Insured

Each of the following is an insured under this insurance to the extent set forth below:

(a) the named insured;

(b) executive officer or member of the board of trustees, directors or governors of the named institution while acting within the scope of his duties as such.

III. Limits of Liability

Regardless of the number of (1) insureds under this policy, the Fund's liability is limited as follows:

The limit of liability stated in the declarations as applicable to "each claim" is the limit of the Fund's liability for all damages because of each claim or suit covered hereby. The limit of liability stated in the declarations as "aggregate" is, subject to the above provision respecting "each claim", the total limit of the Fund's liability hereunder for all damages.

IV. Additional Conditions

First Aid Exclusion. The insurance shall not apply to expenses incurred by the insured for first aid at the time of an accident. The "Insured's Duties in the Event of Occurrence, Claim or Suit" Condition is amended accordingly.

DIVISION OF GENERAL SERVICES By ___ Chief of Insurance

S.C. Code Regs. § 19-415.4