Understanding the Professional Liability Claim Process: Part 1, License/Certification Scrutiny

/ / General, Management, Professional Liability Insurance
Professional Liability Claim Process

The legal process is complex and can be difficult to understand. This series of articles is intended to give you a basic knowledge of the Professional Liability Claim process so that if you’re ever faced with a malpractice claim, you will be better equipped to handle the situation.

Part 1: License/Certification Scrutiny

Being named in a lawsuit is not something that any of us hope to experience in our lifetime. Fortunately, most of us won’t face this situation, but there are some professions and industries where the risk is greater—and health care is one such industry.

As a health care professional, it’s important to know that you are liable for the care and services you provide and are held accountable to the credentials of your license. Most health care education programs provide appropriate training on the risks associated with delivering health care, so you’re likely well aware of the fact that a violation of the standard of care or a damaging outcome in patient treatment could lead to a misconduct accusation and a potential attack on your professional license.

Anyone has the right to make a complaint to your state’s Department of Regulation (DPR), the body that has the power to revoke or censure your license/certification. An attack on your license can come from any one of the following sources:

  • A Dissatisfied Patient. Often, if a discontented patient chooses to sue you, their counsel will file a complaint with the DPR asking it to investigate your license or certification. Sometimes the purpose of this action against you is a way to gain information so that a lawsuit can be filed against you at a later time.
  • State Agencies. In the event that you default on a student loan or fail to pay your taxes, the taxing body (income, state or federal) will report you to the DPR. They will then take action against your license/certification for failing to pay your obligations.
  • Criminal Activity. If you are found to have misappropriated drugs, your employer is obligated to report the activity to the DPR. You do not have to be convicted of a crime for your license/certification to be revoked or restricted for drug misappropriation.
  • Substance Abuse. In the event you have a problem with substance abuse, such alleged abuse can be reported to the DPR, who will investigate the activity. The abuse doesn’t have to have affected your work for an investigation to ensue and your license/certification to be restricted.

If you are notified that your license/certification is under scrutiny by the DPR, you should immediately hire an attorney experienced with regulatory body statutes to help protect your license/certification. If you have a Professional Liability Insurance policy with Lockton Affinity, your insurance works on your behalf to select an attorney to represent you. (We’ll discuss attorney representation in the next article in this series).

Your Lockton policy also automatically provides coverage for regulatory investigation defense. This means you will receive reimbursement (up to $5,000 per incident and no more than $10,000 per annual policy period) for fees and expenses that are related to any investigation or disciplinary action by the regulatory body (the DPR) associated with your professional license or certification. This coverage limit is provided as supplementary coverage and does not reduce the limit of liability of your policy.

Your license can be affected by more than just patient interactions. Buying your own Professional Liability Insurance gives you protection for your license if it is ever questioned.


Our article series on understanding the Professional Liability claim process will include these informative topics:

Part 1: License/Certification Scrutiny

Part 2: Summons, complaints & subpoenas and attorney representation

Part 3: What is the discovery process?

Part 4: What to expect when giving a deposition

Part 5: What to expect in trial preparation and testimony