In general, telehealth services can be covered under your policy. Our policy mandates appropriate state licensure and adherence to scope of practice, state and federal laws for your specialty, as well as any telemedicine laws or regulation. 

Additionally, we recommend the following:

• Consider your practice and patient mix to decide what services can be provided via telemedicine technology
  
  • Please call us if you are performing any wound care via telemedicine, or are planning to provide telemedicine services exclusively and not as a part of an expansion of delivery of services
• Any interaction using telemedicine technology be appropriately documented in the patient’s record
• Use of appropriate informed consent for telemedicine services

• There is no need to notify us if you are unable to make a payment with a due date prior to June 30, 2020
• There is no penalty for paying the entire premium amount due on June 30, 2020
• Late fees will be waived through June 30, 2020
• Depending on your payment plan, regular finance charges will apply, but no additional finance charges will be accrued (this does not apply to premium finance by third parties)
• All scheduled automated payments will continue to auto-draft; to remove automated payments, log into our website portal and select manage payments or see Instructions for Changing or Removing Auto-Pay

Additionally, we will remain in compliance with the Departments of Insurance (DOI) for individual states which have guidance beginning before or ending after our own grace period. NOTE: Invoice mailing/automated payment plan debits already established will proceed as normal unless there is specific direction from your state’s DOI; this is simply a notice your policy will not be canceled due to non-payment during the grace period.

For all state DOI bulletins, please click here.

General routine chiropractic service is not an essential service, but treatment of acute situations may fall under essential services. The CDC is not providing a specific definition to essential services. The practice needs to consider if the employees, including the DC, are in a healthcare class who should not be providing services or not. Many younger, healthy providers have determined they will stay open and screen all patients (and those accompanying the patient) before their appointment and upon arrival by checking for signs/symptoms of COVID-19, and asking if they have traveled out of the country or been exposed to an individual with the virus.

Ultimately, it is the practice's responsibility to determine what patients may fall into an acute healthcare situation and those who would not. The practice can close the office if they feel their patients are not in need of immediate ongoing treatment that might be detrimental to the patient’s recovery. If they determine that they are closing, they need to contact the patients on the schedule and reschedule the appointments. Nevertheless, the patients under acute treatment, who could suffer from not being seen, either can be evaluated on a one-on-one basis and be seen, or instructed to go to urgent care or a hospital if the condition needs immediate evaluation and treatment.

The decision to treat or NOT treat a patient based upon concerns of COVID-19 spread is one of balancing the harm to the individual patient versus that of others in the office and the community at large. If a patient appointment is cancelled due to circumstances out of the control of the office, like staffing issues due to the virus, it is unlikely to create an issue – even if it is alleged that the condition worsened due to the cancellation. This most likely would not be considered abandonment.

If the office is concerned after questioning and examining a patient (taking their temperature) that the patient is showing signs of the virus or has been exposed, it is perfectly acceptable to cancel or reschedule them unless it is a true acute emergency – in that case, the physician should utilize universal precautions and limit the patient’s exposure to other patients and unnecessary staff.

During this time of the COVID-19 pandemic, we have been asked about medical professional liability coverage related to federal and state laws and executive orders that may expand the scope of practice for our policyholders. As our policy is a scope of practice policy, policyholders’ coverage is expanded accordingly by these individual state and federal laws or executive orders and will remain in effect until these laws or executive orders are rescinded.

We recommend that you follow state mandated guidelines. If in your professional judgement you feel that a patient or patients fall into the criteria provided, then providing care to them would be valid.

It is our commitment to remain in compliance with Departments of Insurance (DOI) for individual states which may provide specific guidance on deferring non-renewal underwriting actions.

During this time, we are renewing policies unless specifically requested by the policyholder not to. We understand many of our policyholders may not be in their office and not working, so our intent is to make the renewal processes one less headache to figure out. If you do not want to renew your policy, please contact us.

Here are several ways you can prepare your office for COVID-19, including (but not limited to):

• Hold a staff meeting to educate employees on COVID-19 and what they can do to prepare.
• Prepare to contact patients who may have been exposed in your office. Should it be later disclosed/discovered that a patient infected with COVID-19 was in your office, all patients and others who were in the office the same day should be notified.
• During appointment confirmation calls, ask if the patient, close family members, co-workers, or the person(s) accompanying them to their appointment have any symptoms of acute respiratory illness (e.g., fever, cough, sore throat, recent difficulty breathing), or have recently traveled internationally, especially to currently identified hot zones for the infection.
  • If so, cancel the appointment, unless the patient is experiencing an acute emergency. Depending on the patient’s reported flu-like symptoms, it may be advisable to refer them to an emergency room. Strongly advise them to report their symptoms to their healthcare provider, and the local health department.
  • If not, instruct the patient that if their respiratory health changes prior to their appointment, please call to cancel and request that they contact their primary care physician for further evaluation.

          NOTE: if you handle appointment confirmations via pre-recorded messages, you should also consider updating those recordings to include                        information regarding COVID-19.

Take extra steps to thoroughly disinfect all areas of the office the patient contacted. Notify all patients, employees, and others, if you subsequently learn that an infected patient or employee was in the office.

• Patient exposure at your practice: Your professional liability policy may defend and indemnify you against claims by patients who allege they contracted COVID-19 at your office depending on the nature of the allegations. Negligent acts and omissions are generally covered, while liability for intentional conduct is excluded. For example, if a patient contracts COVID-19 at an insured’s office despite an insured’s best efforts to follow current guidelines, such a claim could fall within the coverage of the policy. Alternatively, if an insured continues to treat patients after the insured knows he or a staff member is contagious with the virus, this could lead to a claim of intentional conduct, which is excluded by the policy.
  
  Download and use our Sample Patient Acknowledgement to Receive Treatment During COVID-19 Form.
  
  Note: We cannot provide a coverage opinion or confirm coverage as to hypothetical claims. Coverage opinions are provided only after analyzing the specific allegations of an actual claim together with the applicable policy. The information here is general in nature and should not be interpreted to mean any given claim or actions by an insured will be covered by our policy. Rather, we will adhere strictly to the provisions of our policy, which is the only statement of our coverage obligations.

• Office staff exposure at your practice: In general, our policies exclude coverage for any claim made by an employee, unless the claim arises from the employee’s status as a patient of the practice.

In regard to patients:

Physicians ALWAYS have a duty to utilize "universal precautions" notwithstanding the current crisis. Universal precautions, standard precautions, and contact precautions should ALWAYS be utilized with all patients – those are the standards to prevent cross contamination. To the extent a physician is not following current generally accepted guidelines, they may be held liable to a patient or staff member.

Office should already have policies in place to aid in prevention of all respiratory diseases, but if not, the office should immediately put into effect strict respiratory hygiene/cough etiquette guidelines.

More on the CDC website:

• Infection Control Basics
• Isolation Precautions
• Respiratory Hygiene/Cough Etiquette

In regard to staff:

OSHA’s General Duty Clause, Section 5(a)(1) of the Act, requires an employer to protect its employees against “recognized hazards” to safety or health which may cause serious injury or death. While there is no specific regulation dealing with COVID-19, it is the General Duty Clause which mandates that you must act to protect your employees.

You are obligated under OSHA to develop a written plan to protect your employees from this risk. The plan assessing the “hazard” should include, but is not limited to:

• Training employees with regard to the hazard
• Revisiting the procedures utilized with personal protective equipment (PPE)
• Recording (logging) any illness which are occupationally related
• Documenting all efforts and training on this hazard

More information from OSHA:

• Guidance on Preparing Workplaces for COVID-19