1. Forms
2. PR
3. PR-00-04

What the form is

The PR 00 04 Hospital Professional Liability Coverage Form (Claims-Made) is an insurance policy form developed by ISO (Insurance Services Office) that provides professional liability coverage specifically for hospitals on a claims-made basis. This means the policy covers claims for damages arising from professional services that are first made against the insured hospital during the policy period or, if applicable, an extended reporting period (tail coverage). A key feature of claims-made policies is the retroactive date; the policy will typically only cover incidents that occur on or after this specified date.

Classes of business it applies to

This form is specifically designed for:

• Hospitals (both public and private)
• Other healthcare facilities that may have similar professional liability exposures as hospitals, if deemed appropriate by the underwriter.

Real-world example: A patient sues a hospital alleging negligence by a staff surgeon during an operation that took place after the policy's retroactive date. If the claim is first made against the hospital during the policy period, the PR 00 04 form would be the basis for determining coverage, subject to its terms and conditions.

Special considerations

• Claims-Made Basis: Understanding the claims-made trigger is crucial. Coverage is for claims first made during the policy term (or extended reporting period) for incidents occurring after the retroactive date. This differs from occurrence policies that cover incidents happening during the policy term, regardless of when the claim is made.
• Retroactive Date: This date is critical. No coverage is provided for incidents occurring before this date. Maintaining continuity of the retroactive date is vital when switching insurers or renewing policies to avoid coverage gaps.
• Extended Reporting Periods (Tail Coverage): If the policy is cancelled, non-renewed, or if the insured switches to an occurrence form, an Extended Reporting Period (ERP) or "tail coverage" must be purchased to cover claims that may arise after the policy period for incidents that occurred after the retroactive date and before the policy termination.
• Consent to Settle: Professional liability policies often contain a "consent to settle" clause, which may require the insurer to obtain the insured hospital's consent before settling a claim. The specifics would be detailed in the policy.
• Defense Costs: Policies vary on whether defense costs are within the limits of liability or in addition to them. This is a critical aspect to review in the PR 00 04 and its accompanying declarations.

Key information for agents and underwriters

• Risk Assessment: Underwriters must thoroughly assess the hospital's specific services (e.g., types of surgery performed, emergency room services, obstetrics), patient volume, staff qualifications, claims history, and risk management protocols.
• Retroactive Date Management: Agents must ensure clients understand the implications of the retroactive date and the importance of maintaining it. When moving a hospital from another claims-made policy, securing prior acts coverage back to the existing retroactive date is essential.
• Limits and Deductibles: Appropriate limits of liability and deductible levels must be determined based on the hospital's size, exposure, and financial capacity. State-specific requirements for medical malpractice coverage may also apply.
• Endorsements: The base PR 00 04 form may need to be tailored with various endorsements to address specific risks, such as coverage for employed physicians, specific high-risk procedures, or to comply with state regulations.
• Cancellation Provisions: While one source suggests that medical professional liability policies like PR 00 04 may have no cancellation provisions , this is a strong claim and typically standard ISO forms do contain cancellation clauses, albeit potentially restrictive ones. Agents and underwriters should refer to the specific policy language and any state-specific variations.