Saudi Arabia’s standard insurance policy for medical malpractice

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The Central Bank of Saudi Arabia (the central bank) announced the issuance of a model medical malpractice insurance policy (the Medical malpractice policy), which takes effect on January 1, 2022.

The medical malpractice policy imposes the minimum conditions regarding medical malpractice errors, coverage, exclusions and limits of compensation. The decision to introduce the medical malpractice policy was influenced by a growing number of malpractice claims brought against practitioners within the Kingdom of Saudi Arabia (Saudi Arabia). A total of 3,684 medical malpractice cases were filed between 2016 and 2018 in Saudi Arabia, recording a 73% increase in cases over a five-year period (Saudi Journal of Anesthesia 2021 Apr-Jun; 15 (2): 97–100).

Malpractice Coverage

The policy covers professional misconduct resulting from “Any bodily, physical or mental injury, illness, disease, illness or death of any patient” resulting from an act, error, omission or negligence of a physician. This includes (i) routine treatment (ii) emergency treatment (iii) medical home visits and (iv) telehealth care, as part of the physician’s role that occurs in the Kingdom of Saudi Arabia.

Limits

The medical malpractice policy provides for compensation for malpractice (as defined above) and for defense costs. This includes all costs, fees and expenses related to the settlement of a claim or the defense of the insured against the claim.

The policy sets maximum limits based on a health professional’s level of technical expertise and historical claims made against certain groups of physicians. For example, 25% of the total malpractice claims filed between 1992 and 2003 in Riyadh concerned obstetrics services (Ann Saudi Med. 2006 Mar-Apr; 26 (2)). The maximum compensation limit set in the policy has been calculated based on the anticipated risk incurred. The annual coverage limit for a given event is set as follows:

  • 100,000 SAR for medical technicians, assistants, nurses, pharmacists;
  • 300,000 SAR for dentists and non-surgical physicians; and
  • 500,000 SAR for specialists including surgeons, anesthesiologists, pediatricians and gynecologists is 500,000 SAR.

The insurer or insured cannot agree to lower limits than prescribed in the medical malpractice policy, however, they can agree to higher limits.

Blanket

In the case of policies issued without interruption of coverage, the insurer must provide compulsory retroactive insurance from the date of coverage of the first policy issued. However, if a policy is issued by a new insurer or renewed by an existing insurer with less than fourteen (14) calendar days of interruption, the insurer must provide mandatory retroactive insurance from the date of issue of the first. policy either by the insurer or by the previous insurer of the insured.

Exclusions

Coverage is subject to a number of specific exclusions and does not include (i) policyholders who do not hold an appropriate medical license (ii) treatments provided outside of Saudi Arabia or (iii) specific responsibilities assumed by an insured under a contract that goes beyond the duty of care required in the ordinary course of these activities.

Specific acts, namely performing general anesthesia by a non-anesthetist, cosmetic surgery, blood banks, genetics and abortions are excluded from malpractice coverage.

Claims arising from defective medical products, products that do not fulfill the performance of a specific warranty and any professional misconduct that arose in the performance of research, experiments or clinical trials to test the effectiveness of drugs are excluded from the Policy. In addition, coverage excludes claims related to asbestos maintenance, disposal of nuclear, radioactive or hazardous waste, war, invasion or hostilities.

Cancelation

The Policy distinguishes between the termination of compulsory and non-compulsory insurance coverage. In the event of compulsory cover, the insurance cannot be terminated by the insured or the insurer, unless an alternative policy (which covers the remaining term of the existing policy) has been taken out, or if the license of the professional of the health has expired and / or terminated.

If the cover obtained is not compulsory, the insured may terminate the unused contract at any time. In the event of cancellation, the insurer must reimburse the amount due for the period not recovered within three (3) working days from the date on which the insurer becomes aware of the occurrence of such an event. The reimbursement must be made to the insured by depositing the remaining amount in his bank account. The reimbursement amount is calculated in accordance with the formula prescribed in the Medical Malpractice Policy.

Conclusion

The medical malpractice policy aims to improve the protection of policyholders and promote an insurance industry capable of supporting continued economic growth in Saudi Arabia’s healthcare sector. The policy will support compliance with Saudi medical malpractice law and provide enhanced protection for practitioners operating in Saudi Arabia.


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