Resuscitating Insurance Coverage for Medical Transport Risks

Ambulance operations can be simply defined as air, water or ground patient transport, but the healthcare professional liability risks of this class are far more diverse and complex than that description conveys.

Along with the siren-blazing ambulances of city streets, insurance is needed to cover boat-borne medical personnel ferrying injured workers from offshore oil rigs, EMTs standing by at nuclear power plants, medevac helicopters airlifting U.S. military personnel from war zones, a university's private EMT unit or the air ambulance retrieving a broken-legged skier from an icy slope.

Spanning for-profit, non-profit and governmental entities, this insurance class includes:

• Local, town and municipal ambulance corps;
• Hospitals and medical centers providing medical transport independently or in joint ventures;
• Corporations making medical transport available as part of occupational health services;
• Water ambulances serving remote islands;
• Temporary "MASH" units providing on-the-go care to military personnel, private security forces, or government contractors and humanitarian relief workers around the globe;
• Commercial enterprises specializing in air, water and/or roadway patient transit;
• Staffing operations that provide EMTs and paramedics to various entities.

These are far from cookie cutter exposures. They are distinct and potentially severe. With patients already sick or in critical condition, a misstep can have catastrophic results. Family members distraught after a loved one's illness or injury can be more prone to blame and sue paramedics who tried to help.

Medical transport by air unfurls another layer of complexity. Patients and caregivers are in a confined space. They cannot stop suddenly to address unexpected contingencies or get needed supplies. Medevac helicopters and fixed-wing transports typically embark on longer journeys, cross international borders and attempt to access patients in remote and difficult locations. They are also more likely than other transports to have physicians onboard to assist EMTs or paramedics.

Policy or Placebo?

When risks are this intricate, coverage design must be too. Prospective insurance buyers and their brokers should be actively involved in the underwriting process, asking the right questions to ensure that a policy will respond as it should to their particular risk.

Following are some key questions we recommend asking when weighing a potential policy:

1. Does it articulate coverage for patient loading/unloading?

One of the highest frequency areas of professional liability claims for this class stems from the loading and unloading of patients. A patient slips from the gurney during unloading and suffers a broken arm. A patient with a spinal injury is jostled off the stretcher as he is hefted into an ambulance. Should the ambulance's auto liability insurer or the professional liability carrier pick up the tab on the subsequent claim? Finger pointing between carriers can go on and on, with legal fees mounting and no remedy for the insured in sight.

To avoid this, a policy should expressly cover negligence claims arising from patient loading and unloading. If the operation's auto insurance covers this, that can be considered in pricing the risk. The goal should be to eliminate finger pointing and ensure clear-cut coverage.

2. Should the Insured versus Insured exclusion be carved back?

In this class of business, the Insured versus Insured exclusion can be particularly ominous. Consider the true story of a steel mill worker who injured his arm and was rushed to the occupational health clinic set up onsite by his employer. The clinic's medical staff assured him it was just a sprain and sent him on his way. Later, barely able to move his arm, the employee consulted a physician who informed him that his arm was broken and that the bones were not properly set.