Concept of AOA and AOY in Doctors Professional Indemnity Insurance

A doctor performs several risk-associated tasks. He needs to cure different kinds of diseases affecting patients. loss However, a doctor cannot guarantee that a patient shall survive in case of serious surgeries. Hence, they are prone to different kinds of claims and lawsuits. Therefore, a doctor must subscribe to medical insurance policies in order to mitigate such repercussions. In addition, most of the doctors do not possess any knowledge about the concept of AOA (Any One Accident) and AOY (Any One Year) in doctors Professional indemnity insurance.

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Concept of AOA and AOY in Doctors Professional Indemnity Insurance

Indian laws have become more stringent in order to deal with medical malpractices. The cases of medical malpractice are rising on a daily basis. A doctor might be held liable for medical breach, negligence, etc. 

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This coverage is only for following professionals:

  • Doctor/Medical Practitioner
  • General Physician
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Hence, he must ensure safety via the doctor’s professional policy. However, several insured doctors in India are unaware about the concept of AOA and AOY in doctors professional indemnity insurance.

Let us discuss the concept of AOA and AOY in doctors professional indemnity insurance.

The coverage amount provided by doctors indemnity insurance is referred to as the Limit of Indemnity. This limit is defined for each accident and within each policy period. It is identified as the Any One Accident (AOA) limit and the Any One Year (AOY) limit, respectively. The proportion between the AOA limit and AOY limit is customizable. The AOA limit, indicating the maximum payout for a single accident, is predetermined.

Various ratio options for the AOA limit to AOY limit, along with their implications and relevant examples, are detailed in the following table:

Limit of Indemnity Meaning Example
1:1 Full sum assured for any one claim. If the policyholder chose a sum insured of Rs. 1 Crore and a claim arises within the policy duration, coverage up to Rs. 1 Crore is available for 1 claim.
1:2 Maximum 50% of sum assured for any one claim. With a sum insured of Rs. 1 Crore, a claim during the policy tenure offers coverage up to Rs. 50 Lakh for 1 claim, and the same for an additional claim.
1:3 One-third of sum insured for any one claim. If a sum insured of Rs. 1 Crore is chosen, a claim during the policy period provides coverage up to Rs. 33.33 Lakh for 1 claim, repeated twice.
1:4 25% of sum insured for any one claim. Opting for a sum insured of Rs. 1 Crore means a claim within the policy timeframe gives coverage up to Rs. 25 Lakh for 1 claim, thrice over.

Note 1: The determination of the AOA limit should factor in elements like the nature of the insured's activities, potential impact on individuals, and potential property damage in a worst-case scenario accident.

Note 2: When evaluating coverage, it's vital to assess the adequacy of the sum insured and the chosen extensions to ensure comprehensive protection.

Exclusion

The insured must understand that a sum cannot be claimed in every circumstance. The doctors indemnity insurance is subject to some exclusion.

  1. Deliberate Misconduct

    A doctor cannot claim any sum in case of deliberate misconduct. The insurance contract explicitly excludes willful misconduct in order to file a claim. However, the burden of proof lies on the insurer. The insurer is subject to substantiating if the claim has arisen from deliberate misconduct.

  2. Alcohol

    If surgery is performed under the influence of drugs or alcohol and the patient suffers from the injury, the insurer is not liable to settle such claims under indemnity insurance. In addition, the insurance contract excludes such claims.

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Conclusion

The concept of AOA and AOY in doctors professional indemnity insurance states that the claim is settled on the basis of 1:1, 1:2, 1:3, and so on. The insured must be acquainted with this concept and determine the risk associated with his profession. On the basis of risk, the insured should set the policy limit by subscribing to doctors indemnity insurance.

Written By: PolicyBazaar - Updated: 17 May 2024
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