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Indemnity Update I have decided to provide a brief update on this issue for each edition of the national newsletter, as even though progress in this issue is painfully slow, the College remains mindful of the ongoing and immediate impact the lack of professional indemnity insurance is having on midwives and the women for whom they could and/or do provide care. Following a meeting with the Insurance Council of Australia in October 2003, some contact names were provided for 2 international insurance broker firms that are in daily contact with the big 4 professional indemnity insurers. In January I met with some brokers from these firms with expertise in medical and professional indemnity to discuss the continuing situation facing midwives and any possible ways forward. I presented them with the research now available on why and how midwifery care presents a lower risk option for insurers than the comparatively hi-tech and higher risk end of maternity care through insuring only medical specialists. In a nutshell, the advice given was that the picture remains bleak re insurance for midwives and is likely to remain so in the near to medium term despite legislative reform in most States. The main reason given was that from the point of view of international insurers the market in Australia is still very small and insurers are largely unresponsive to scientific evidence of risk. Instead they rely upon their own assessment of risk, and childbirth in general continues to be seen as a hight risk area because of the ratio of premiums to the size of potential claims and the length of time for which a policy holder is liable. The brokers also advised that the most likely source of insurance in Australia for midwives would be the medical defence organisations, who buy reinsurance from big international insuers. Recent Commonwealth legislation on medical indemnity defines a �health practitioner� in very broad terms that could be argued to include midwives and the MDO�s are able under the Act to issue �complying policies�. However the battle remains to persuade these organisations to consider insuring midwives, and to do so at an affordable premium. It is likely that the relatively small number of midwives seeking PI policies (since the majority of midwives receive vicarious liability through their employer) will continue to be an impediment to successful negotiation of insurance from a reliable source. Advocating for governments to provide midwifery services that provide continuity of carer seems like the only sure way to enable this type of care to be insured in the near and medium term. Snippets of information about indemnity come across my desk from time to time. I�m aware of one anecdote about a nursing agency in Australia that has evidently secured indemnity for midwives on its books by paying around $15,000 per midwife per year with an excess of $50,000 on any claim lodged. If any sustainable solution can be found in negotiations with insurers, premiums will need to be much more affordable than that. Another anecdote is of an offer of PI insurance for midwives in Australia at a rate of around $2,000 per year from an insurer based in South-East Asia. Advice provided to the College indicates that such offers should be treated with caution as a policy holder who lodges a claim against such a policy may find that payment is not forthcoming. Off-shore insurers are not subject to the same legal responsibilities as insurers in Australia and other OECD countries, and a midwife could be left out of pocket for premiums paid, and/or out of pocket for any claim without legal recourse to address any failure by an insurer to meet the terms of its policy. It seems likely that broader problems with the market for indemnity insurance will continue to impact on the insurance for all professionals involved in maternity care, and particularly for midwives. If you�re interested in regular (monthly) updates on indemnity, subscribe to our new electronic bulletin list via the website. Just go to www.acmi.org.au and click on �What�s New�. Barb Vernon, EO. |
