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Professional Indemnity Proposal for Doctors

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0% found this document useful (0 votes)
34 views2 pages

Professional Indemnity Proposal for Doctors

Uploaded by

raxitjha56
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

ICICI Lombard General Insurance Company Limited

Registered Office : ICICI Lombard House, 414, Veer Savarkar Marg, Near Siddhi Vinayak Temple, Prabhadevi, Mumbai 400 025.
PROPOSAL FORM OF PROFESSIONAL INDEMNITY POLICY FOR DOCTORS AND MEDICAL PRACTITIONERS

Leena Shashikant Mhashal


Name of Proposer
9930597353
1 Mobile No.
docleenamhashal@[Link] / 24-Nov-
Email Id / Date of Birth
1985

M7, D -402, Mauli CHS, Pratiksha Nagar,


2 Residential Address
Sion, Mumbai- 400022

A) Professional Qualification and year of such qualification


DMRE - 2013
3 B) In which brand of medicine viz. Allopathy, Homeopathy, Ayurveda
Allopathy
or any other?

A) Medical Registration Number 2009/03/1402


4 B) Year of Registration 2009
C) How long have you been practicing? 5+ Years

Are you a member of any Medical Association / Council? If yes, please MMC
5
state name and address of such Association / Council membership no. 2009/03/1402

A) Are you’re a General Physician, MBBS, General practitioner, Family


Radiologist/Pathologist
Physician, radiologist, Pathologist or MD, Plastics Surgeon, Anaesthetist,
6
Surgeon?
Radiologist/Pathologist
B) If any, please specify your line of specialization

7 State the average number of patients you are attending per day? 25+

Please specify facilities such as dispensing facility, X-ray, radiation


X-ray, Sonography, ECG, MRI, Radiation
8 therapy, scanning ECG, Sonography, MRI, etc., available/operated by
Therapy, Other
you or under your control.

Are you attached to/or attending as a visiting physician/surgeon in any


9 Tanishka sonography and diagnostic
Hospital/Nursing Home/Clinic etc. If yes please give details. clinic
Does the proposer currently hold any Professional Indemnity insurance?
If yes, please give details: No
10 A) Renewal date
B) Limit of Indemnity
C) Retro-active date

Have any claims been made upon you or legal proceeding instituted or
11 likely to be instituted against you by patients in respect of your treatment No
etc.? If so, please give details.

Limit of indemnity required


12
A) Any One Accident (AOA):Any One Year (AOY) 1:1

13 Period of Insurance

Declaration by Proposer

I/We do hereby declare that the above statements and answers are true and what I/We have not withheld any information
whatsoever regarding the proposal. I/We hereby declare that all statutory provisions relating to my/our business proposed for
insurance are complied with. I/We agree that this proposal and declarations shall be the basis of the contract between me/usn and ,
whose policy for the insurance proposed is acceptable to me/us. I/We undertake to exercise all ordinary and reasonable precautions
for safely of the property as if it were uninsured. I/We here by state that the above-mentioned address shall be taken as address on
record for the purpose of GST. I/We hereby confirm that the contents of the proposal form and connected documents have been
fully explained to me/us and I/We have fully understood the significance of the proposed contract.

Date: 21-11-2024

Place: Signature of Proposer


SECTION 41 OF THE INSURANCE ACT 1938

PROHIBITION OF REBATES

No person shall allow or offer to allow either directly or indirectly as an inducement to any person to take out or renew or continue
an insurance in receipt of any kind or risk relating to lives or property in India any rebate of the whole or part of the commission
payable or any rebate of the premium shown on the policy nor shall any person taking out or continuing a policy accept any rebate
except such rebate as may be allowed in accordance with the prospectus or tables of the Insurer

Any person making default in complying with the provisions of this Section shall be punishable with fine, which may extend to ten
lac's Rupees

Common questions

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In the proposal form, the 'Limit of Indemnity' required by the proposer is specified in terms of Any One Accident (AOA) to Any One Year (AOY) as 1:1, indicating that the maximum payout for any single claim will equal the total limit available for the policy year .

Section 41 of the Insurance Act 1938 prohibits offering or accepting any rebate as an inducement to take out, renew, or continue an insurance policy. Any violation of this can lead to a fine extending up to ten lakhs of rupees .

Precise identification of place and date, like the proposal being signed at Tanishka Sonography and Diagnostic Clinic on 21-11-2024, provides a legal timestamp that affirms the proposer's intent and awareness at a specific time and location, potentially crucial for legal verifications and claims processing .

The proposer, Leena Shashikant Mhashal, holds a qualification in DMRE obtained in 2013 and practices in the field of allopathy as a Radiologist/Pathologist .

The practitioner has over 5 years of experience, which contributes to a risk analysis that balances professional expertise against potential claims. More experience might reduce perceived risk due to honed skills leading to fewer errors, impacting premium calculations favorably .

The proposer provides or operates facilities like X-ray, Sonography, ECG, MRI, and Radiation Therapy. These technologies indicate a wide range of diagnostic capabilities, suggesting a higher professional engagement which can increase the risk exposure and necessitate detailed risk assessment due to potential equipment-related claims .

The declaration of statutory compliance ensures that all business activities related to the insurance proposal adhere to legal regulations. This reduces risk for the insurer by affirming that the proposer follows all relevant legal protocols, crucial for the validity and enforceability of the policy .

The lack of current Professional Indemnity insurance increases the financial risk exposure for the practitioner, as any claim made against them would need to be covered out-of-pocket. This might necessitate immediate coverage uptake to mitigate ongoing liability risks .

Despite no prior claims or legal proceedings being noted, should future claims arise, the proposer could face significant financial and reputational risks. This underscores the importance of continuous coverage and accurate disclosure in indemnity insurance, as the insurer will examine past declarations if claims are made .

Being a member of a Medical Association or Council, such as MMC with membership number 2009/03/1402, provides professional oversight and validation, which can enhance credibility and trustworthiness, potentially lowering the assessed risk and premiums in professional indemnity insurance .

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