1. Forms
2. PR
3. PR-00-12

What the Form Is

The PR 00 12 is an Insurance Services Office (ISO) professional liability coverage form specifically designed for optometrists and is written on an occurrence basis. This means the policy responds to claims for bodily injury to a patient arising from a "medical incident" (i.e., professional optometric services rendered or that should have been rendered) that occurred during the policy period. Crucially, under an occurrence form, the claim can be reported at any time in the future (subject to statutes of limitations/repose), as long as the incident itself took place while the policy was in effect. This provides a significant layer of security for long-tail exposures common in professional liability.

Classes of Business It Applies To

This form is intended for:

• Licensed optometrists in individual practice.
• Optometric partnerships or groups.
• Professional corporations or other entities providing optometric services.

Real-world examples:

• An optometrist is sued because a patient alleges an incorrect prescription led to persistent headaches and an accident. If the incorrect prescription was provided during the policy period of the PR 00 12, the form would respond even if the lawsuit is filed a year after the policy expired.
• A patient claims an optometrist failed to diagnose a progressive eye disease during an examination, leading to significant vision loss. The PR 00 12 in effect at the time of the alleged diagnostic failure would be triggered.

Special Considerations

• Occurrence Trigger: The key feature is the occurrence trigger. This generally lessens the need for "tail coverage" (Extended Reporting Period Endorsement) for unknown incidents when the policy ends, which is a primary concern with claims-made policies.
• Policy Period and Territory: Coverage is strictly limited to medical incidents that occur within the specified policy period and within the covered geographical territory (e.g., United States, its territories and possessions, and Canada).
• Definition of "Medical Incident": The form will contain a precise definition of what constitutes a "medical incident" and what professional services are covered. This typically includes acts, errors, or omissions in the provision of optometric care.
• Consent to Settle Clause: Many professional liability policies, including those for healthcare providers, incorporate a "consent to settle" clause. This means the insurance company may need the insured optometrist's permission before settling a claim with a third party. The specifics of this clause are important for the insured to understand.
• Conflicting Information on Form Features: Some industry analyses have grouped PR 00 12 with claims-made forms and mentioned features like a retroactive date requirement and that claims must be made during the policy period or an extended reporting period. This is atypical for a standard occurrence form, where the focus is solely on when the incident occurred. The official title from regulatory filings indicates "Occurrence". Policyholders and professionals should carefully review the actual PR 00 12 form language to clarify if any such non-standard provisions exist, as they could significantly alter coverage expectations.

Key Information for Agents and Underwriters

• Risk Assessment: Underwriters should evaluate the optometrist's (or practice's) scope of practice (e.g., routine eye exams, contact lens fitting, co-management of surgical patients, diagnostic responsibilities), patient volume, years of experience, continuing education, risk management protocols (e.g., informed consent, record keeping), and prior claims history.
• Limits of Liability: Adequate per-incident and aggregate limits of liability are crucial. These should be determined based on the practice's exposure, state-specific requirements or common liability awards, and the potential severity of optometric malpractice claims.
• Exclusions: Be thoroughly familiar with the form's exclusions. Common exclusions in professional liability policies include illegal acts, intentional wrongdoing, services rendered while impaired, and contractual liability beyond that which would exist in the absence of the contract.
• Comparison with Claims-Made: When replacing a claims-made policy with an occurrence form like PR 00 12, ensure there are no coverage gaps. The new occurrence policy effectively provides its own "prior acts" coverage for incidents occurring from its inception date forward. The insured may still need tail coverage from their prior claims-made carrier for incidents that occurred before the PR 00 12 inception but have not yet been reported.
• State-Specific Endorsements: While PR 00 12 is an ISO form, state-specific endorsements may apply, altering its terms or adding mandatory coverages/provisions.