First time, home-grown medical indemnity option for SA doctors

Volker von Widdern, CEO at Constantia Insurance Company.

In the face of rocketing medical indemnity risk premiums, a crisis that is driving some practitioners out of the profession, local insurer Constantia Insurance Company Ltd has developed South Africa’s first home grown medical indemnity insurance product, EthiQal.

Until now, SA doctors effectively have been tied to offshore insuring entities, and with premiums in some specialisations rapidly approaching levels of R1-million annually, billions of rands in revenue are being taken out of the local market. A further concern has been that the non-domiciled medical risk insurers are not subject to SA’s strict financial service regulations in terms of solvency and financial transparency, says Constantia’s Chief Executive Officer, Volker von Widdern.

Research, said Von Widdern, had identified a strong demand from SA practitioners for “stable and sustainable” premiums based on the local risk assessment of SA’s private sector settlements only, backed by on-the-ground professional support for doctors facing litigation or disciplinary proceedings.

He said that Constantia is particularly proud of being rooted in South Africa, with insurance contracts that are fully enforceable in terms of SA law and regulations. “We have not only developed EthiQal according to the SA risk protocol, cutting out the unfair skewing of premiums to some practice categories – something that occurs all the time when working with international risk profiles – but premium revenue does not leave SA to subsidise practitioners elsewhere in the world.”

Constantia, a subsidiary of JSE-listed Conduit Capital Ltd, has solvency capital in excess of the Financial Service Board’s requirements, Von Widdern said. "All premiums, claims reserves and investment income are invested locally. Additional capital is maintained for the EthiQal portfolio, amounting to 40%-50% of the premium, as per the regulatory requirements of the Short Term Insurance Act.”

EthiQal is reinsured by the third-largest international reinsurer, which has a very strong AA- credit rating, while Constantia’s claims payment rating is a stable outlook A-. Constantia and its reinsurers share more than 20 years of successful partnerships in SA, said Von Widdern.

The policy limitations are “fair, transparent and stabilise exposures,” said Von Widdern. In broad categories these are medical (the direct participation in trials and blood transfusion services); legal (patents, fines and penalties, directors’ and officers’ liability; contractual; behavioural (occurrences influenced by narcotics, fraud or insolvency); and geographic (United States and Canada, as well as war, insurrection and nuclear radiation).

He said Constantia used a well-proven IT insurance administration system that would be deployed to practitioner associations via web access, or for individual practitioners via mobile applications. “Further, Constantia has strong data analytic capabilities. Our analysis will support practitioner groups to both improve practices based on established Guidelines, and to seek insights on risk exposures.”

At the EthiQal launch, Von Widdern said that at present, SA practitioners have to rely on faceless staff based at overseas call centres. These actually have little understanding of the unique pressures that health professionals in SA face.

In contrast, EthiQal is backed by a team of more than 20 professional staff and medico-legal experts, based in the main centres of the country, to ensure a vigorous defence against litigation, especially in the light of the unprecedented boom in contingency-based litigation that is making some specialisations unviable. The failure of existing medical risk products are reflected, he noted, in the announcement that the Life Midmed Hospital in Middelburg, Mpumalanga, is to shut down its neonatal Intensive Care Unit and its obstetrics ward, because of specialists quitting in the face of soaring medical malpractice insurance.

Similarly, in Worcester, in the Western Cape, all four obstetricians in private practice recently announced their refusal to do future deliveries, due to sky-rocketing insurance premiums. According to the statistics of the SA Society of Obstetricians and Gynaecologists, the cost for medical risk insurance for an obstetrician has soared from R180,000 in 2013 and is expected to pass R800,000 next year.

In comparison, the EthiQal premium for Gynaecologists is around R526,000 (excluding VAT), with premiums for good risks capped until at least 2019, said Von Widdern. Indemnity is provided up to R50-million per incident, with retroactive cover and run-off options. General liability extension is available at sublimit.

EthiQal offers 24/7 medico-legal support, as well as counselling to help cope with the psychological challenges following complaints, claims or Health Professions Council of SA investigations. “It is the only product to offer alternative dispute resolution mechanisms, in order to avoid costly and emotionally sapping litigation.”

“It’s also about prevention. We are committed to proactive risk management and will work with practitioners and their associations to identify, evaluate and address practice and clinical risks. That means providing information, training and consulting services for our policyholders," concluded Von Widdern.