The newsletter for members of the Emergency Physicians Insurance Company Risk Retention Group
Winter 2005 - In this Issue
- Reinsurance: EPIC’s License to Operate
- The Birth and Life of a Claim
- EPIC Pricing Innovations Benefit Expanding ER Groups
- EPIC’s Investment Philosophy
- EPIC Management Team Expands
- News Briefs
- EPIC 2006 Conference Schedule
- EPIC Governance
MESSAGE FROM THE CHAIRMAN
Reinsurance: EPIC’s License to Operate
by Bartholomew G. Nyhan, MBA, CLU
In the spring of 2003, EPIC, a new company under development, began a search for professional liability support in the U.S. and London marketplace. The timing of this initiative could not have been much worse. The worldwide property and liability insurance industry was struggling financially as a result of premium inadequacies of the late 1990s and the early years of the new millennium. EPIC representatives were told that the likelihood of finding support was highly speculative and, at best, if a market could be found, would be very costly.
Why was such reinsurance so difficult to arrange and why is it so important? First of all, new insurance companies, particularly those writing medical professional liability insurance, are looked upon as highly speculative ventures. Over the past 25 – 30 years, there have been numerous new medical professional liability insurance start-ups, a number of which have failed, most commonly due to inexperienced managers, inadequate capitalization, or questionable business plans. Consequently, reinsurers are extremely cautious about supporting such new ventures. Second, medical professional liability is a complicated and difficult business due to the increasing complexity of modern healthcare, the often unreasonable expectations of consumers as to physician performance and capabilities, and the highly litigious nature of business in the U.S. today.
The importance of reinsurance, particularly for a new insurer is underscored by the fact that insurance regulators rarely license such companies without reinsurance coverage. What then is the nature and role of reinsurance coverage? First, it provides protection against severe or potentially catastrophic losses. Fledgling medical liability insurers commonly enter into reinsurance treaties that provide coverage excess of an underlying limit called the insurer’s retention (typically $200,000 - $300,000) depending upon the insurer’s level of capitalization. The higher the capital and surplus, often the greater its retention or retained limit. Second, such excess of loss reinsurance smooths out the financial impact of severe claims and precludes one or two such claims causing serious financial damage to the company. Finally, as mentioned earlier, it is usually a condition for licensure by insurance regulators.
So, then, what became of EPIC’s efforts to procure reinsurance during its formation stage? After intensive efforts and discussions with domestic and London reinsurance underwriters, EPIC was successful in developing a solid reinsurance program supported by six Lloyd’s of London syndicates and two of Europe’s largest professional reinsurers. Under the terms of the treaty, EPIC retains the first $300,000 of each claim while the eight reinsurers share the loss exposure excess of EPIC’s retention. One very important aspect of EPIC’s program is the lack of dependence on a single reinsurer, or, for that matter a small number of underwriters. If, for some reason, one or two reinsurers should opt out of EPIC’s reinsurance plan, the company would only have to replace a small percentage of the total program due to the spread among so many other players. The net result of the negotiations with reinsurers conducted by EPIC’s senior management is a very competitive and cost effective arrangement.
Why was EPIC one of the very few new professional liability insurers to successfully place reinsurance for emergency physician business in 2003? There are three fundamental reasons:
- The track record of EPIC’s management team in developing financially sound medical professional liability insurance over the past 30 years that have proven to be true, long-term, stable enterprises;
- EPIC’s absolute focus on patient safety and risk management and the requirement that all insured groups adopt an aggressive approach to protecting the safety of their patients; and
- The active participation of EPIC’s physician-insurers in the underwriting, claims management, and patient safety aspects of the company’s operation.
In the past 60 days EPIC successfully completed its second annual rate renewal with its reinsurers, all of whom expressed strong continuing support for EPIC’s innovative program. What does this mean to the company’s policyholder-owners? It means ongoing stability of the company’s operations and insurance offering!
Bartholomew G. Nyhan is the President and CEO of Emergency Physicians Insurance Company RRG (EPIC) and its parent company, NCG Enterprises, LLC. In a career that has spanned more than 30 years in the insurance industry, Mr. Nyhan has personally led the formation and development of 10 physician-owned professional liability insurers. Throughout his career, Mr. Nyhan has focused on creating innovative and timely solutions for his healthcare industry clients, with particular emphasis on liability issues faced by physicians.
The Birth and Life of a Claim: How it Begins and How it Progresses
by Tamara LeFevre, JD
Western Litigation Specialists, Inc.
This is the second in a series of articles that provide an overview of the litigation process from the psychological impact of litigation to the technical aspects of defending a claim or lawsuit.
What motivates a patient to assert a medical malpractice claim against the emergency room physician who treated him or her? The following are some of the most common reasons:
- Bad Outcome – The patient had a poor result due to the injury or illness itself, due to one of the known risk factors of a procedure, or due to less than optimal care in the emergency department.
- Service – The patient does not like the way the physician spoke to her or perceived that the physician was dismissive in some way. Behavior that is perceived by the patient to be arrogant or patronizing is a magnet for claims. Likewise, a long wait in the emergency department before being seen can cause a patient to have a negative and critical view of her treatment from the outset.
- Family Involvement – An angry or guilt-ridden family member may convince the patient that the patient was wronged or, if the patient has died, the family member may assert a claim to assuage his own feelings of anger, guilt, sadness, and helplessness. The claim becomes a vehicle for the grieving process of the family.
Initiation of a Claim
What constitutes a claim? A common definition of a claim is a written demand from a patient to a physician or hospital seeking compensation for damages the patient has allegedly incurred due to the physician’s negligence.
Some claims are foreseeable and start as “incidents.” An incident is any situation related to medical treatment provided by a physician which the physician or hospital believes may lead to a claim (because of a bad outcome or an angry patient, for example). Sometimes a patient will complain to the hospital risk manager by phone or in writing before actually asserting a claim. Other times a patient will send a “notice letter” directly to the physician and/or hospital, setting forth his alleged injury and damages.
Patients also sometimes file a complaint with the appropriate state board or department which oversees the professional regulation of physicians (commonly referred to as a board investigation). When that occurs, the board notifies the physician of the claim, and the physician should then report the situation immediately to his professional liability insurance carrier and the head of his group.
What Happens After a Claim is Made
Once a patient has asserted a claim against a physician and the physician reports it to his professional liability carrier, the following occurs:
- The claim is investigated by the physician’s carrier and/or third party administrator (such as Western Litigation Specialists, Inc.), and then the claim is either denied or a settlement offer is made, depending upon the results of the investigation. The investigation typically involves, at a minimum, a review of the medical records by the carrier and third party administrator as well as by a non-treating physician in the role of a consulting expert, and discussion with the treating physician against whom the claim was asserted. If settlement is deemed necessary, negotiations may be done informally or by way of mediation.
- Occasionally, depending on the type of claim made or in what state it is made (e.g. a 180 day notice claim in Ohio), the carrier and third party administrator will simply wait to see if the claimant proceeds to suit within the time frame allowed. If the claimant does not, the claim is barred from being pursued.
- In all states, claims must be filed as a lawsuit within a specified time period (the statute of limitations), or else the claim cannot be pursued at all. Some states have mandatory pre-suit periods, where informal discovery is conducted and/or the matter must be presented to a panel of attorneys for a preliminary opinion to be issued before the claimant can file a lawsuit.
- The physician’s carrier and/or third party administrator monitor all deadlines related to a claim and keep the physician apprised of any developments.
When a Claim Goes into Suit
Once a lawsuit is filed, the physician is served by the Court with a Summons and the Complaint (also referred to as Petition in some states). When a physician is served with a Complaint, he should immediately advise the head of his group and his professional liability insurance carrier and send them a copy of the Complaint. If the carrier utilizes a third party administrator, the carrier will refer the matter to the third party administrator, who will immediately retain local counsel in the venue where the suit has been filed to represent the physician named in the suit.
The physician can expect to be contacted by the carrier, third party administrator and/or counsel retained for the physician within a short period of time after the physician has forwarded a copy of the Complaint to the carrier.
All states have a procedural rule which sets forth the number of days after service upon the physician by which an Answer must be filed on behalf of the physician. The physician’s counsel prepares and files the Answer. At or around the same time, the physician’s counsel will meet with the physician to discuss the medical records and the physician’s recollection of the patient and treatment provided. Written discovery (i.e. written questions and requests for documents) will be exchanged between the parties for responses to be prepared. This may happen at the same time the suit is filed or several months later. Later, usually a number of months after the filing of the suit, the physician will be asked to give her deposition, and it is usually after the plaintiff has already given his deposition. In general, lawsuits take anywhere from one year to five years or more to reach resolution, either by settlement or verdict. The average life span of a lawsuit is two to three years.
Prior to trial, most states require some type of alternative dispute resolution (referred to as “ADR”) in the form of a settlement conference with the judge or panel review or mediation. The physician is typically required or at least invited to attend personally, and the ADR process may last anywhere from two hours to ten hours.
The actual trial may last anywhere from four days to six weeks, depending on the complexity of the case and the number of defendants. The average length of trial for a medical malpractice case is probably two weeks. The physician is expected to personally attend the trial.
Once a verdict is rendered by the judge or the jury, either the plaintiff or the defendant may appeal the decision if they wish. They must do so within a certain period of time (typically around thirty days), which varies depending on the state. An appeal can be ruled upon within several months, but it can also drag on for years.
Conclusion
The life of a claim varies widely, depending on the type of claim, whether the claimant is represented by counsel, what state the claim has been brought in, and how many health care providers have been put on notice of the claim. Sometimes physicians’ attorneys, who have been handling medical malpractice claims for years, forget that the “basics” of how a claim proceeds may be completely foreign to the physician, particularly if the physician is going through it for the first time. A physician who is facing a claim should not hesitate to ask his carrier, third party administrator, or counsel about the process.
Our series on the fundamentals of litigation continues in the next issue with “Evaluation of Medical Malpractice Claims.”
Tamara LeFevre is an attorney of 17 years in Houston, Texas. She represented physicians in medical malpractice suits until eight years ago, when she joined Western Litigation Specialists, Inc. (WLSI), a third party administrator that provides claims management services to EPIC and other insurers as well as self- insured health care providers. For additional information, go to www.wlsi.com.
EPIC Pricing Innovations Benefit Expanding ER Groups
by David R. Bickerstaff
Bickerstaff, Whatley, Ryan, & Burkhalter, Inc.
When EPIC RRG was in its embryonic stage a couple of years ago, EPIC Insurance Managers seized upon the opportunity to initiate many innovations which would have been difficult if not impossible to pull off in the traditional commercial market. One of these innovations deals with the mechanism to determine premiums, and it proves to be a significant benefit to ER groups which are expanding in size.
Before describing this innovative feature, a few definitions are in order:
In insurance parlance, an exposure is the unit which is used to rate a policy. For example, for automobile insurance, the exposure unit is one car for one year (a “car-year”). For worker’s compensation, the unit is dollars of payroll. To illustrate, a particular business may pay a premium rate of $4.00 per $100 of annual payroll.
Typically, for hospital professional liability, there are dual exposure units: average occupied beds (bed-years) and annual outpatient visits. For physician and surgeon liability, historically the exposure unit has been one doctor for one year (a “doctor-year”). However, for Emergency Physicians, emergency visits has been adopted as the exposure unit by most insurance carriers, including EPIC. The rate per visit is sometimes subdivided into three subcategories: acute care, urgent care, and other. The actual visits per year is recorded (and audited) and the rate per visit is simply multiplied by this number to arrive at the applicable premium.
For a claims-made policy – which EPIC writes exclusively – the annual policy premium is predicated on claims which are expected to be reported during the year, even if they arose from patient encounters of previous years (i.e., the accident year), as long as the insured had maintained continuous claims-made coverage starting back at that accident date or earlier (the retroactive date). If the retroactive date precedes the current policy year by five or more years, the claims-made policy is said to be mature.
To illustrate how this works, let’s say that an insured has a mature premium rate of $10 per visit. This $10 rate is actually the sum of six pieces, one to cover claims arising from this year’s visits, another to cover claims from last year’s visits, another for the preceding year, and so on. For policy year 2005, for example, these six components would look like this:
| Accident year | Rate | As you can see, these components add up to the “mature” rate of $10. To illustrate, $1.20 of this total covers claims arising from 2002 encounters expected to become reported claims in 2005. The procedure that is used customarily in the industry is that the premium for a mature policyholder in 2005 would be determined by multiplying the full $10 rate times the 2005 visits. It is at this point that EPIC deviates from the normal procedure, much to the benefit of the expanding group. Let’s say that the group has exposures of 50,000 visits for each year from 2000 through 2004, but in 2005 a major expansion takes place and the expected visits doubles to 100,000. |
| 2000 | 0.40 | |
| 2001 | 0.70 | |
| 2002 | 1.20 | |
| 2003 | 1.70 | |
| 2004 | 2.00 | |
| 2005 | 4.00 |
Under customary industry procedures, the group’s 2005 premium would be $1,000,000 (100,000 times the $10 mature rate). EPIC’s rating structure, in contrast, rates each of the accident year components separately. In this example, the sum of the 2000-2004 rate components would be $6.00 per visit and the rate for the 2005 accident year component is $4.00. Thus, with EPIC, the group’s premium would only be $700,000 (6.00 times 50,000 visits plus 4.00 times 100,000 visits).
In other words, EPIC’s rate structure is set up so that the premium correctly matches the true exposure to claims – the actual visits by year. Maybe this is why we use the term “exposure” as a rating unit in the first place.
It is important to point out that, as you might expect, the converse of the above described example is also true: If a group which had been averaging 100,000 visits a year suddenly contracts down to only 50,000, a mature premium based only on the 50,000 visits would be $500,000 (10.00 times 50,000), clearly inadequate to cover the past years’ exposure. The correct premium would be $800,000 (6.00 times 100,000 plus 4.00 times 50,000). So by using this “accident year component” rate structure, EPIC has protected itself in order to collect an adequate premium for all exposures.
All of the premiums referred to above are the “manual” premiums, which can be adjusted up or down based on the individual group’s own loss experience. These adjustments will be discussed in a future piece.
David R. Bickerstaff is chairman of the consulting actuarial firm Bickerstaff, Whatley, Ryan & Burkhalter. A Fellow of the Casualty Actuarial Society and a Member of the American Academy of Actuaries, he began his actuarial career in 1963. Mr. Bickerstaff specializes in a wide range of property-liability concerns and now concentrates his practice on medical professional liability. With clients including insurance companies, general agents, captives, self-insurance trusts, and regulatory bodies, Mr. Biockerstaff also has broad experience in personal lines pricing, loss reserves, and developing risk models and actuarial information systems. For additional information, go to www.epicrrg.com and www.bickwhat.com.
EPIC’s Investment Philosophy
by Scott Shubert
Blue Granite Capital
Blue Granite Capital, EPIC’s investment management partner, is a registered investment advisor headquartered in Charleston, South Carolina. The firm is operated by its founders, who collectively have more than 60 years of institutional investment management experience. The firm provides its advisory services for individuals, trusts, and foundations, as well as insurance and captive insurance companies. The basic tenet of Blue Granite’s conservative investment philosophy is borne in asset allocation whereby we blend a portfolio with equities and fixed income securities. The rationale for this balanced approach is to provide better returns while protecting capital and minimizing market risk. It is our belief that “total return” strategies – those generating income and growth – tend to smooth market volatility and perform better in varying market conditions that may favor one asset class over another.
Blue Granite Capital is sharply focused on designing and implementing customized investment strategies that meet the needs of each client and adhere to the objectives outlined in their investment policy statement. Our core strategy focuses on large-capitalization value equities and investment grade fixed income securities. The comprehensive equity and fixed income analysis we perform allows us to construct an efficient portfolio with the proper diversification and optimal asset allocation. Securities offering attractive fundamentals and compelling valuations are considered for additions to our portfolios. Furthermore, we are patient investors seeking the opportune time to deploy capital to enhance performance, seeking to avoid asset classes not meeting our research requirements. Within our equity allocation we seek companies paying attractive dividends because it demonstrates financial stability and augments corporate competitiveness.
As an active money manager within the captive insurance industry, we design fixed income portfolios to meet the individual requirements of each firm. Paramount in our methodology is to clearly understand our client’s financial picture, such as the timing of their claims payments and liabilities. Creating the optimal portfolio to maximize yield yet maintain liquidity is critical to the captive or risk retention group. Our fixed income research utilizes a laddering technique and a duration-based approach to identify the optimal fixed income asset classes with the most attractive maturities. This process creates a well-diversified, lower-risk bond portfolio that will meet the ongoing needs of the captive and provide the capital to more effectively manage their insurance operations.
One of the cornerstones to our risk management is asset allocation modeling. The optimal blend of equity and fixed income will enhance performance and reduce risk. Empirical studies have shown that balanced portfolios will deliver comparable returns, over the long term, in comparison to an all equity portfolio but carry lower levels of risk as measured by beta, standard deviation and volatility. Because we focus on companies that pay dividends, we are drawn to successful, market dominant, and innovative companies. For more than 75 years, dividends have played a major role in the long-term return of the S&P 500 Index. Dividend return has approximated 45% of the total S&P 500 return, reducing the need to invest in stocks that merely provide growth potential. Within the fixed income component we reduce exposure to interest rate risk by varying asset classes, duration, and maturities to deliver an optimal portfolio that generates attractive cash flow and provides liquidity.
We at Blue Granite Capital hope you enjoy the launch of this investment column and will find future installments useful and informative. We are proud of our relationship with EPIC and look forward to continuing our advisory role for many years. Thank you for the opportunity to contribute to this newsletter and for your confidence in our organization as an advisor to your firm.
Scott Shubert has 24 years’ investment experience developing conservative fixed income and equity asset allocation strategies for individuals, corporations, and institutional investors. He spent 10 years on Wall Street, responsible for Institutional Sales and Trading while with major global investment banks, ING and Nomura. Through his career, Scott has further developed an equity valuation strategy designed to enhance market performance while minimizing risk.
Douglas D. Wisman, CPA, CPCU
Douglas D. Wisman is chief financial officer and senior vice president of NCG Enterprises, LLC and EPIC Insurance Managers. Mr. Wisman has more than 20 years of experience as a financial executive in the insurance industry, specializing in professional liability and related healthcare industries. Before joining NCG Enterprises, Mr. Wisman held senior executive positions with Reliance Insurance Companies, Washington Casualty Company, and Cascade National Insurance Company. He also performed insurance consulting services for Safeco Insurance Company, Symetra Financial, and the Montana State Fund. Mr. Wisman earned his MBA in Finance and is a certified public accountant as well as a certified property casualty underwriter.
Dennis J. McCann
Dennis J. McCann, senior vice president of Business Development for NCG Enterprises, LLC and EPIC Insurance Managers, has 25 years of experience in the professional liability insurance industry, specializing in sales, marketing, business development, and operations management. Prior to joining NCG Enterprises, Mr. McCann held senior executive positions with several large regional brokerage houses and insurance carriers, including W. A. Lang Company, COPIC Companies, Liberty Mutual, and Intercare Insurance, where he was president of insurance operations.
Rally at the Capitol
EPIC staff joined the estimated 4,000 Emergency Physicians who rallied at the U.S. Capitol on September 27, 2005 to urge Congress to pass HR3875, the Access to Emergency Medical Services Act of 2005. If you want to send a letter to your representative, you can go to the ACEP website to fill out a form letter: http://advocacy.acep.org/acep/issues/alert/?alertid=8012886&type=CO.
The Act proposes to extend liability protection to emergency physicians who provide EMTALA- mandated care; provide additional payments for services provided by emergency departments; and give incentives to hospitals to end the practice of boarding admitted patients in emergency departments. The bipartisan legislation was introduced on September 22, 2005 by Representatives Bart Gordon (D-TN) and Pete Sessions (R-TX) and was referred to two committees: Energy and Commerce and Ways and Means. On October 7, 2005, it was referred to the Subcommittee on Health for review.
EPIC Presents at Nevada Captive Insurance Association
Emergency Physicians Insurance Company Risk Retention Group (EPIC RRG) was honored by an invitation to present at the Nevada Captive Insurance Association’s Annual Conference on September 23, 2005. Bartholomew G. Nyhan, President and CEO of EPIC, spoke on developing physician-owned professional liability RRGs in the progressive business environment that exists in Nevada. It was also noteworthy that Nevada’s Governor referenced EPIC in his introductory remarks as one of the recent captive RRG success stories in Nevada.
EPIC RRG is domiciled in Nevada and is registered in 49 states and the District of Columbia.
January 29 – February 1
Oregon ACEP
Sun River, OR
February 16 – 18
American Academy of Emergency Medicine
San Antonio, TX
February 27 – March 1
Virginia ACEP
Richmond, VA
March 9
Illinois ACEP
Chicago, IL
April 20 – 23
Texas ACEP
Galveston, TX
May 9
New Jersey ACEP
East Windsor, NJ
May 10 – 12
National Patient Safety Foundation Patient Safety Congress
San Francisco, CA
June 9 – 11
North Carolina College of Emergency Physicians
Myrtle Beach, SC
July 9 – 12
Michigan ACEP
Acme, MI
July 17 – 19
Ohio ACEP
Huron, OH
October 15 – 18
ACEP Scientific Assembly
New Orleans
October 29 – November 1
American Society for Healthcare Risk Management
San Diego, CA
EPIC RRG Board of Governors and Committee Members
EPIC RRG Board of Governors
James S. Leftwich, Chairman*
Bartholomew G. Nyhan, MBA, CLU, Vice President & Secretary
Graham T. Billingham, MD, FACEP, Vice President
Robert A. Bitterman, MD, JD, FACEP, Vice President
Victor Miranda, MD, FACEP, Vice President & Treasurer
Claims Management Committee
Graham T. Billingham, MD, FACEP, Chairman
Robert A. Bitterman, MD, JD, FACEP
Dennis Block, DO, FACEP
George Dengler, DO, FACEP
Thomas Gutwein, MD, FACEP
James Foster, MD, FACEP
Richard Garrison, MD, MS, FACEP
Jeff Wright, MD, FACEP
Robert G. Ripley, MD, FACEP, FAAEM
Robert Broida, MD, FACEP, Ex Officio
Finance and Investment Committee
Victor Miranda, MD, FACEP, Chairman
Bartholomew G. Nyhan, MBA, CLU
Robert Jasper, MD, FACEP
Michael Choo, MD, FACEP, FAAEM
Paul Fleming, MD, FAAEM
Mark Jacoby, CPA
Karen Massey, MHA
Jay Taylor, M.D, FACEP
Patient Safety and Risk Management Committee
Robert A. Bitterman, MD, JD, FACEP, Chairman
Graham T. Billingham, MD, FACEP
Brian Robb, DO, FACEP, FACOEP
Mag Greig
Robert Orosz, DO, FACEP
John M. Strayer, MD, FACEP
Patrick Johannes, MD, FACEP
Scott Welden, MD, FACEP, FAAEM
Russell Rudy, MD, FACEP
Christopher Goliver, M.D, FACEP
Randal D. Bensen, MD, FACEP
Robert Broida, MD, FACEP, Ex Officio
Underwriting and Marketing Committee
Bartholomew G. Nyhan, MBA, CLU,
Acting Chairman
Christian Burke, MD, FACEP
Sean Fulton, MD, FACEP
Frank Kaeberlein, MD, FACEP
Ameet Deshmukh, MD, FACEP
Mark Menadue, DO, FACEP, FACOEP
Christopher Pund, MD, FACEP
Jon Vargas, MD, FACEP
Robert Broida, MD, FACEP, Ex Officio
* As Chairman of the EPIC Board of Governors, Mr. Leftwich serves as an ex officio member of all EPIC committees.
EPIC Insurance Managers
Senior Management Team
Bartholomew G. Nyhan, President & Chief Executive Officer
James T. McMahon, Senior Vice President & Chief Operating Officer
Douglas D. Wisman, Senior Vice President & Chief Financial Officer
Dennis J. McCann, Senior Vice President, Business Development
Janice L. Lester, Senior Vice President, Operations
Mick Parmentier, Assistant Vice President, Claims
Grace Crisostomo, Director of Underwriting
Shawn Mountcastle, Director of Operations
Emergency Medicine Patient Safety Foundation Management Team
Graham T. Billingham, MD, FACEP, President & Chief Executive Officer
Dianne Vass, Executive Vice President & Chief Operating Officer
Vanessa Smith, Director of Operations
The EPIC Report is published quarterly by EPIC Insurance Managers for members of the physician-owned Emergency Physicians Insurance Company Risk Retention Group (EPIC). Letters to the editor and articles, to be edited and published at the editor’s discretion, are welcome. Views expressed in letters to the editor are those of the writer and do not necessarily reflect the opinion or official policy of the EPIC RRG or EPIC Insurance Managers. Please sign letters and address them to the editor or send them via email to editor@ncg-usa.com.
Publisher EPIC Insurance Managers, Inc.
Art Director: Shawn Mountcastle
Web Master: Jason Fontaine
EPIC Insurance Managers publishes The EPIC Report quarterly to inform emergency medicine member groups insured by the Emergency Physicians Insurance Company Risk Retention Group (EPIC) on issues pertinent to emergency medicine and professional liability insurance. Any recommendations found in the newsletter are intended as guidelines, not standards of care, and do not ensure successful outcomes. Any guidelines address principles of the practice of emergency medicine, and are not inclusive of all proper methods of care nor exclusive of other appropriate methods. Treatment decisions must be made by individual healthcare providers within the context of specific situations and in accordance with the laws of the jurisdiction in which the care is provided.
EPIC Insurance Managers, Inc.
11760 Atwood Road, Suite 5
Auburn, CA 95603
Phone 866.374.2457
www.epicrrg.com
Copyright © 2005, EPIC Insurance Managers.
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