# Do you carry your own liability insurance???  Well, you should.



## NUEMT (May 20, 2016)

Do you know the difference between criminal, civil and administrative liability?

Critmedic did a great podcast covering this issue and I think it is something medics and EMTs need to be aware of.  Medicine can be litigious and there are not always the guarantees you think there might be in terms of your service protecting you.


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## MrJones (May 20, 2016)

If it's a choice between saving their *** or yours, virtually every service known to man will throw you under the bus. That's why it's important that you carry your own errors and omissions (malpractice) insurance. Healthcare Providers Service Organization (HPSO) is a good place to start if you're looking for a policy.

Pro Tip: If you're an EMS educator or speaker, add the consulting services liability endorsement.


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## NUEMT (May 20, 2016)

HPSO holds my policy and I am very happy with their service.
Disclosure: I have no interest in this company.


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## MrJones (May 20, 2016)

NUEMT said:


> HPSO holds my policy and I am very happy with their service.
> Disclosure: I have no interest in this company.


Now that you mention it, I have no financial interest in HPSO, either.


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## NomadicMedic (May 20, 2016)

HPSO for me as well.


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## DesertMedic66 (May 20, 2016)

HPSO again


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## MrJones (May 20, 2016)

Come to think of it - what other company even offers E&O insurance for EMTs and Paramedics?


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## TransportJockey (May 20, 2016)

None that I'm aware of. HPSO for me too


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## NUEMT (May 20, 2016)

Good to see some folks on here with individual policies.


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## Chris07 (May 20, 2016)

I've got one from HSPO as well. $100 a year is more than reasonable in my opinion.


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## akflightmedic (May 20, 2016)

I am waiting on actual case studies where paramedics have been successfully sued and endured wage garnishments. When the majority of government public services are self-insured or have very large carriers, any accusations of wrongdoing that are proven to have actual merit are typically settled before an actual trial takes place. I personally have not seen, heard or read of an individual being sued unless they actually deserved it (gross negligence in the cases I have read). 

I have been named in suits and was subsequently dropped from the suit. I had no money at the time and the claim was BS anyways (one was a vehicle crash while responding to a call, the second was a frivolous claim which I have written about before as a warning) the county settled on both between vehicle insurance and their own self insured policy. There is the argument that if you carry policy then you now have a pocket to dip in versus being dropped from the suit while they pursue the bigger prize.

Just a flip side of the discussion...


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## Carlos Danger (May 20, 2016)

akflightmedic said:


> I am waiting on actual case studies where paramedics have been successfully sued and endured wage garnishments. When the majority of government public services are self-insured or have very large carriers, any accusations of wrongdoing that are proven to have actual merit are typically settled before an actual trial takes place. I personally have not seen, heard or read of an individual being sued unless they actually deserved it (gross negligence in the cases I have read).
> 
> I have been named in suits and was subsequently dropped from the suit. I had no money at the time and the claim was BS anyways (one was a vehicle crash while responding to a call, the second was a frivolous claim which I have written about before as a warning) the county settled on both between vehicle insurance and their own self insured policy. There is the argument that if you carry policy then you now have a pocket to dip in versus being dropped from the suit while they pursue the bigger prize.
> 
> Just a flip side of the discussion...



Excellent points.

Suits go where the money is. Paramedics typically don't have much money. Their employers and medical directors and insurers do, however, or at least that's the perception.


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## Bullets (May 22, 2016)

akflightmedic said:


> I am waiting on actual case studies where paramedics have been successfully sued and endured wage garnishments. When the majority of government public services are self-insured or have very large carriers, any accusations of wrongdoing that are proven to have actual merit are typically settled before an actual trial takes place. I personally have not seen, heard or read of an individual being sued unless they actually deserved it (gross negligence in the cases I have read).
> 
> I have been named in suits and was subsequently dropped from the suit. I had no money at the time and the claim was BS anyways (one was a vehicle crash while responding to a call, the second was a frivolous claim which I have written about before as a warning) the county settled on both between vehicle insurance and their own self insured policy. There is the argument that if you carry policy then you now have a pocket to dip in versus being dropped from the suit while they pursue the bigger prize.
> 
> Just a flip side of the discussion...


i Have HPSO as well, started when i was an EMT and began using it after i started working for a lot of private event medical companies. While the money for these "adventure races" was fun and easy, since were werent technically acting as EMTs and i dont trust the companies if something were to happen, i thought it prudent to get personal coverage. 

It was also very easy to transition to paramedic coverage and for like $100 a year its a bah-gin


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## medicsb (May 23, 2016)

Got sued for an MVC that I got into while driving an ambulance.  I was an EMT at the time.  No one I spoke to really thought that I was really at fault, but by the letter of the law, I was.  The suit was frivolous in my opinion and in the opinion of others, but that didn't matter.  I did not have my own insurance and did not need it as I was covered by my former employer.  Ultimately, I was dropped from the suit and the judgement was against the employer.  I don't think personal insurance is needed, but I think everyone should make sure that they'd be covered if they were sued after employment ceased (for any reason).


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## akflightmedic (May 23, 2016)

Not sure why you quote my post Bullets...you said nothing to address any of it. Just curious if there was a missed thought?


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## Bullets (May 23, 2016)

Sorry i guess i didnt complete my thought. If i am working for my employer, i trust that any suit with me named in it will give me a decent representation and coverage. 

However when i am working for these contracted small event medical companies, set and construction medic gigs,  i dont feel that way. After that guy drowned in the Virginia Tough Mudder, i dont trust these types of companies to back up their workers, so having personal insurance makes me feel better about picking up this kind of temp work


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## zzyzx (May 24, 2016)

Over the years, I've spoken to a couple of lawyers that work in medical malpractice, and none of them felt very strongly about paramedics (or nurses) having their own liability insurance.


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## SpecialK (May 24, 2016)

I am curious, how does having to have insurance against being sued and such an environment affect you?

Ambulance personnel in this part of the world are protected from suit for treatment injury by universal accident compensation legislation and from personal proceedings by both the insurance (and legal services) of the ambulance service and the union.  As far as claiming a civil judgement for negligence not related to treatment injury (for example for lack of treatment or referral) against the individual personnel, not only will the ambulance service and union defend you but the applicable tribunal would likely never agree to arbitrate such a case.  In fact, the District Court (disputes tribunal) recently ruled in favour of the ambulance service regarding a part-charge dispute.

The Health and Disability Commissioner can find against the ambulance service, and against individual ambulance personnel, as has happened recently, however they can only recommend changes and actions but cannot award any form of punishment, civil or otherwise. 

I have personally been the subject of an HDC complaint, it's not a _nice _experience, but by all means it was quite painless and unremarkable.  I am quite happy we have such a mechanism, we carry stocks of those patients' rights brochures and I have told people, both verbally and in writing, they can make a complaint against me, or the service I work for, and how to do so!  I would never, ever discourage anybody from doing so, in fact, I legally cannot, it's their legal right under the HDC Act!

I will go my entire career and not have to worry about being named in a legal case (the Coroners Court excluded) from a professional standpoint.  It's simply never even entered my mind, ever, nor do I ever imagine it would in any way, shape or form.


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## mgr22 (May 24, 2016)

Bullets said:


> Sorry i guess i didnt complete my thought. If i am working for my employer, i trust that any suit with me named in it will give me a decent representation and coverage.



Sounds naïve to me, which doesn't make you a bad person; just a poor one, perhaps. I definitely wouldn't assume your employer is going to have enough concern about your welfare to represent you. I've been there.

Why all this uncertainty about carrying personal liability insurance? It's cheap enough to be a no-brainer, isn't it?


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## Summit (May 24, 2016)

In a way, having liability insurance provides deep pockets.... your insurers. You might be kept in the case where you might have been dropped (SOP to name everyone then drop those who are poor targets (no deep pockets or no real liability).


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## Gurby (May 24, 2016)

Does this change as you get closer to retirement and have a higher net worth?  I know people who work constantly and have been pulling down 100k+/year.  Should those people be more worried since they have more to lose?


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## Summit (May 24, 2016)

Gurby said:


> Does this change as you get closer to retirement and have a higher net worth?  I know people who work constantly and have been pulling down 100k+/year.  Should those people be more worried since they have more to lose?


absolutely

The more your net and the more you make the more insurance you should carry in general.

If you are 60 year old MD/PA/CRNA/NP and have 3Mil net between real property, retirement accounts, etc yea you should max out your auto insurance and homeowner liability coverage and have a supplimental umbrella policy and good mal practice coverage.

If you are 23 with a net worth of -20K because of school and auto loans and you make 35K per year as a paramedic, you probably don't need malpractice coverage.

If you are somewhere inbetween, use your judgement or get some professional advice. I am not a financial adviser.

I don't think most EMS providers need coverage.


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## akflightmedic (May 24, 2016)

Like I said....still waiting on the actual cases where a paramedic has been sued and had to pay damages.


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## akflightmedic (May 24, 2016)

Here is the deal....aside from my request twice of show me a case study challenge.

You have been compelled into feeling like you need the insurance by stories not based in fact from our litigious society. Feelings are worthless when contemplating a business transaction. Use facts and data.

So...on the HPSO site, there is a link to view actual cases and claims. Do you know what it shows under BOTH EMT and Paramedic?
NO RESULTS FOUND. That simple. HPSO has no historical cases to reference or use as an example for the EMT or Paramedic. I laughed because they now have student liability insurance. WTF? I mean if your program and the organization hosting you cannot cover you, you need to rethink your plan of action.

They are a business. They will imply, they will scare and do what is necessary to sell. At the end of the day, while they have actual claims involving other professions, they do not have any for EMS workers. How many years now have they been hawking their goods in back of JEMS magazine (for us old timers)?

Between your employer, your vehicle insurance policies, and Special Event Insurance and Good Samaritan Act (if off duty) you are damn near immune to paying out ever. You might be named, but payout has yet to be proven to me.

Sure the cost is low which is why they keep it there. They know your wages are low AND they know your actual risk is VERY low. They will never pay out for our field so this is all icing on the cake. Now multiply all the10s of thousands who say "its so cheap, why not"...and it is a gold mine for them! Well done to their business model. Fear Sells! Always!

From a business perspective, they are solid and the majority of us are the typical uninformed consumer too lazy to research and just reach for whats on the low shelf for a feel good sensation.

One final comment....imagine if NONE of us ever bought the plan. What do you think would happen?


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## mgr22 (May 24, 2016)

Akflightmedic, I know of such a case on a very detailed level. I'm talking about a medic who actually had the same kind of liability insurance we're debating here, but it turned out to be short, so he lost a lot anyway. You can PM me if you want more information.

I understand your concern about insurance companies using fear tactics to stimulate sales. Maybe HPSO engages in some of that -- I don't know.

No one knows what legal precedents will be set in the future and how they will affect us as individuals. It makes my brain hurt to agonize over paying $200 a year in an inherently risky profession, even if the only thing I ever get out of it is peace of mind.


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## akflightmedic (May 24, 2016)

I rather not know of what seems to be a close/private situation. I want actual publicized cases, and HPSO should proudly be advertising them (redacted of course). If you have a valuable product, show me something tangible, support the claim with evidence. Saying it is because you say it is, is too similar to another system I have strong disdain for. 

And in the guy's case you know, it seems it did not help anyways. You may say well it reduced the cost some...but once in the hole for X thousand...whats another few thousand, right? For most paycheck to paycheck workers, either scenario is disaster.


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## mgr22 (May 24, 2016)

Fine, here's the link to my 7/12 Life Support column for EMS World. I didn't want to make a big deal about it:

http://www.emsworld.com/article/10711901/ambulance-crash-outcome

If you're saying this article shows we shouldn't carry any liability insurance because it wasn't enough this time...well, I'm just not getting that. Let me also point out that the $200 annual premium I quoted is on the high side because it includes an extra amount I pay for teaching, writing and consulting. Yes, you could question whether I'm really capable of doing any damage in those areas 

This has gotten way more detailed than I intended, but I can understand your preference for facts.


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## meatanchor (May 24, 2016)

For most of us, whatever agency we work or volunteer for should be the "deep pockets" for purposes of lawsuits.  For personal encounters, we should be covered by our state's "Good Samaritan" law.  If you're teaching, consulting, etc for money then this seems like a case for insurance.  It's just like any other business you could be involved in - regular EMS rules don't really apply.


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## Summit (May 24, 2016)

mgr22 said:


> Fine, here's the link to my 7/12 Life Support column for EMS World. I didn't want to make a big deal about it:
> 
> http://www.emsworld.com/article/10711901/ambulance-crash-outcome
> 
> ...


First didn't realize that HSPO would cover traffic accidents.

Second IANAL...

The details you presented are nonsensical. He could have appealed on many grounds, order of proceedings, new evidence, etc. Yet he lost his house instead of doing so? Further, he was covered at the time of the incident by his employer, so their refusal to protect him because they later fired him because of his on-duty injuries would be ridiculed by the judge. Then there is the claim that they terminated him for injuries sustained in the line of duty.... wait what? He was a worker's comp case so they couldn't possibly do that until he was at the point of MMR + FMLA expiration.

Basically, the story does not add up at all or your acquaintance took zero effort to right any of the grievous wrongs against him.


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## mgr22 (May 24, 2016)

Summit said:


> First IANAL.
> 
> The details you presented are nonsensical. He could have appealed on many grounds, order of proceedings, new evidence, etc. Further, he was covered at the time of the incident by his employer, so their refusal to cover him because they fired him because of his on duty injuries would be ridiculed by the judge. Then there is the claim that they terminated him for injuries sustained in the line of duty.... wait what? They couldn't possibly do that until he was at the point of MMR + FMLA expiration.
> 
> Basically, the story does not add up at all or your acquaintance took zero effort to right any of the grievous wrongs against him.



Yeah, pretty crazy, right? Guess he really messed all that stuff up. Good thing none of the rest of us should have to worry about such nonsensical things happening.

May I suggest you consider the possibility that some issues were not as simple as you're saying? 'Course I'm not a lawyer either, so even with the transcript and notes I have on this case, I'm reluctant to debate things like legal claims of wrongdoing and the judge's state of mind. In fact, after going back and forth so many times on the strategic use of $200, I'd much rather talk about the Red Sox


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## Summit (May 24, 2016)

Insurance won't help you much if you get walked all over repeatedly and don't fight back.
... or rather...
I'll grant that the issues might not be as simple as I'm saying as soon as you grant that there is a lot more to the story than your simple writeup tells...


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## akflightmedic (May 24, 2016)

Statistical outlier amongst all the other inconsistencies noted above. Not a good example as HPSO does NOT cover vehicle crashes. If they did, the premiums would be much higher.

Still waiting on the proof of a medical malpractice claim where a paramedic was sued and had to pay. This is what HPSO "covers".


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## mgr22 (May 24, 2016)

Summit said:


> Insurance won't help you much if you get walked all over repeatedly and don't fight back.
> ... or rather...
> I'll grant that the issues might not be as simple as I'm saying as soon as you grant that there is a lot more to the story than your simple writeup tells...



Well, I only had 800 words  Yes, there's more to the story. Mostly, it gets scarier.


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## mgr22 (May 24, 2016)

akflightmedic said:


> Statistical outlier amongst all the other inconsistencies noted above. Not a good example as HPSO does NOT cover vehicle crashes. If they did, the premiums would be much higher.
> 
> Still waiting on the proof of a medical malpractice claim where a paramedic was sued and had to pay. This is what HPSO "covers".



The guy's insurance did cover him. He just didn't have enough of it. I don't remember what brand he had.

"Statistical outlier"? Yes, but not for him.


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## akflightmedic (May 24, 2016)

It sounds like he was dipping into his own vehicle insurance coverage. A whole 'nother discussion....this thread was about HPSO or medical liability coverage and whether it is good deal or not. In short...it isn't.

I do not care to discuss all the variables in his case because he could have been at fault or not depending on which report emerged and other factors in the case. This case highlights caution with speeds and red lights but not much to do with personal medical liability insurance. But the criminal court determining him not guilty certainly reinforces that the majority of juries would not seek to penalize a "hero" especially when walking on backward legs and fractured pelvis and not realizing it. Dramatics will get one far in the court system, right or wrong.


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## Carlos Danger (May 24, 2016)

Bullets said:


> If i am working for my employer, i trust that any suit with me named in it will give me a decent representation and coverage.



Well, I wouldn't necessarily be so confident about that. Your employers insurance does cover you......but only indirectly.

The thing to understand is that this policy is _your employers_ policy. If something big and bad happens that involves you and serious lawsuits start flying, one of the first things that will happen is that you will be called into a meeting with HR and your boss and an attorney (paid for by your employers insurer) and they will ask you very nicely to sign forms and releases that will "allow the lawyers to work on on your behalf". What those releases really do is give your employers the right to negotiate _and settle_ without any further input from you. And of course you'll sign those forms willingly because you think those lawyers are working for you, and because you can't afford to hire your own even if you wanted to.

Once you sign those forms - and again, you probably don't have much choice - your employer's lawyers will defend you only insofar as defending you defends the employer. Maybe arguing that you did the right thing is in your employer's best interest, and maybe arguing that you clearly violated your training and policy and therefore your employer shouldn't be held responsible for your actions is the best way to protect the policyholder (your employer). It will depend and the circumstances and the lawyers strategy. If the latter happens, they'll agree to a settlement that leaves the employer looking as good as possible and having to pay as little as possible, regardless of what happens to you personally.

I don't know whether this argues for it being worth a paramedic carrying their own policy or not. On one hand I think it is really cheap insurance. On the other hand, the likelihood of you needing it is very small, and you having it could potentially even make it more likely that you are personally sued.


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## akflightmedic (May 25, 2016)

Beautiful Remi...excellent point. So many people fail to understand who the attorney works for exactly...


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## meatanchor (May 25, 2016)

akflightmedic said:


> Beautiful Remi...excellent point. So many people fail to understand who the attorney works for exactly...



To be fair, this is exactly what your own insurance company does when they defend you.  Their goal is to minimize their losses, not protect your reputation.


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## Summit (May 25, 2016)

meatanchor said:


> To be fair, this is exactly what your own insurance company does when they defend you.  Their goal is to minimize their losses, not protect your reputation.


Yep HSPO isn't in it to win the case, but to come out of it for the least cost.

What is better is to find a prepaid legal insurance that covers cases related to professional actions... nothing makes frivolous or even vindictive cases go away like having effectively free counsel and shallow pockets.


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## NUEMT (May 25, 2016)

Summit said:


> In a way, having liability insurance provides deep pockets.... your insurers. You might be kept in the case where you might have been dropped (SOP to name everyone then drop those who are poor targets (no deep pockets or no real liability).




Liability insurance...as a liability.  Hmm.  

I do get the logic.  But I would re-iterate the ability for insurance providers in our field to also provide representation during administrative hearings as well.  Now, AK and STX may live in places where it is unlikely to be successful in individually suing a medic.  State laws vary and some states have enacted protections against such actions.  It has also been mentioned that the "deep pocket" are what attract suits.  This is anecdotally true but a bit of a generalization.  Plenty of patient attorneys have sued and followed through on suits against medical providers simply because of how mad they are.  A greedy suit happy plaintiff is one thing.  An angry family member is another story.  I would also say that the person more likely to sue you is the person who generally has the means and the method which to sue you with if they so choose.

In talking with my colleagues who actually practice EMS law specifically, they note that not having enough money to be worth suing is not a recommended defense.  

A judgement against you may result in an "execution" of that judgement.  Have a car?  A house? An expensive guitar? Guns?  All fair game should the plaintiff "levy on the execution."  Let's not forget either, just flat out filing for a "supplemental process" to have your wages garnished.  You may not see yourself as a good target but the motivated party can ruin whatever happens to be there.  How does that 100 dollars look now?  

In mentioning the administrative actions, I am referring to the EMS licensing process at the state level.  Yours may vary.  Many times an administrative judge will preside over hearings regarding the violation of supposed rules and regulations, protocols, and the like.  In this case, without proper representation (not by your company since this part involves your personal license) you may find yourself at the mercy of a system a few episodes of "Law and Order" won't help you to fake your way through.

_Disclaimer: Not legal advice. Purely opinion. Seek your own legal advice from experts in your area and familiar with the laws, rules, and regulations where you practice. _


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## NUEMT (May 25, 2016)

http://www.ems1.com/ems-advocacy/articles/733288-Provider-Insurance-Convenience-or-Necessity/

Specifically the last paragraph.  David Givot is both paramedic and an EMS attorney.


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## Summit (May 25, 2016)

NUEMT said:


> A judgement against you may result in an "execution" of that judgement.  Have a car?  A house? An expensive guitar? Guns?  All fair game should the plaintiff "levy on the execution."  Let's not forget either, just flat out filing for a "supplemental process" to have your wages garnished.  You may not see yourself as a good target but the motivated party can ruin whatever happens to be there.  How does that 100 dollars look now?


It looks like you better look up bankruptcy protection instead of insurance company scare tactics. I've seen a innocent poor girl sued by a vindictive rich person. She declared bankrupty. Her liability insurance wouldn't have covered the amount pursued and it was a justification to reduce costs. She declared bankrupty based on other debts before the civil case even ended. She listed the pending litigation as a debt to be discharged if completed. They wouldn't have been able to take her car or garnish her wages had they pursued further. They dropped the case. Problem solved.

You can purchase prepaid legal cost insurance with that $100. Again, make yourself a hard target with poor rewards.

Or if you have assets to protect, you can purchase an Umbrella Policy with a professional rider that would shield you in most personal liability instead of only the most unlikely type (EMS malpractice).

Look, if you have your personal liability coverage rates maxed out on your auto and home policies, or in accordance with the coverage requirements of your sufficiently large umbrella policy, THEN you could start looking at malpractice insurance.

*IF YOU DO NOT HAVE THOSE THINGS, YOUR PRIORITIES ARE SCREWED UP IF YOU ARE LOOKING AT MALPRACTICE INSURANCE!*

IANAL IANAFA

HPSO is not going to save you from a car wreck you caused. You are many times more likely to need prepaid legal, auto, home, or umbrella coverage than malpractice in EMS.


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## Summit (May 25, 2016)

> In mentioning the administrative actions, I am referring to the EMS licensing process at the state level.  Yours may vary.  Many times an administrative judge will preside over hearings regarding the violation of supposed rules and regulations, protocols, and the like.  In this case, without proper representation (not by your company since this part involves your personal license) you may find yourself at the mercy of a system a few episodes of "Law and Order" won't help you to fake your way through.



Most state board investigations don't involve charges being filed. When they do, most of the investigation take place prior.

Your policy *will not provide you a lawyer for license defense... until after the formal charges* are filed.

Read your policy again. You already read it once... right?


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## Summit (May 25, 2016)

NUEMT said:


> http://www.ems1.com/ems-advocacy/articles/733288-Provider-Insurance-Convenience-or-Necessity/
> 
> Specifically the last paragraph.  David Givot is both paramedic and an EMS attorney.


I'll counter this simplistic scare tactic "YOU'LL LOSE YOUR JOB AND YOUR DOG IF YOU DON'T HAVE INSURANCE!"

With a much better article about how HPSO et al work. Yes it is nsg orienteid but most of it carries over to EMS:

http://allnurses.com/general-nursing-discussion/one-healthcare-risk-999441.html

For starters, *your malpractice coverage is likely going to be a secondary policy to your employers coverage*.

There is a reason this insurance is *SO CHEAP yet the insurance company is making money. It is because the chances of you being able to use it are beyond remote.*


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## mgr22 (May 25, 2016)

Summit said:


> I'll counter this simplistic scare tactic "YOU'LL LOSE YOUR JOB AND YOUR DOG IF YOU DON'T HAVE INSURANCE!"
> 
> With a much better article about how HPSO et al work. Yes it is nsg orienteid but most of it carries over to EMS:
> 
> ...



I'm not sure about this, Summit. I get your argument about probably never being sued, but do you think the best way for me, as a medic, to make a decision about whether to carry liability insurance is to base it on what nurses do?


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## Summit (May 25, 2016)

mgr22 said:


> I'm not sure about this, Summit. I get your argument about probably never being sued, but do you think the best way for me, as a medic, to make a decision about whether to carry liability insurance is to base it on what nurses do?


Not on what nurses do, but on how the insurance works, because it is the SAME companies and SAME underwriters for their policies and Paramedic policies. It is one industry and you can learn how it works and the pitfalls from that indepth article that is quite informative if you read it. It is written by a healthcare risk manager who worked in the field. Most of the content is *NOT nursing specific.*


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## akflightmedic (May 25, 2016)

And I still come back to my first question without all the pomp and circumstance....SHOW ME a documented case where a paramedic was sued for medical liability and had to pay or have wage garnishment. When the seller of the insurance cannot even do it, I certainly challenge you to do so.

That simple. 

I can have my mind changed...with evidence.


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## mgr22 (May 25, 2016)

Summit said:


> Not on what nurses do, but on how the insurance works, because it is the SAME companies and SAME underwriters for their policies and Paramedic policies. It is one industry and you can learn how it works and the pitfalls from that indepth article that is quite informative if you read it. It is written by a healthcare risk manager who worked in the field. Most of the content is *NOT nursing specific.*



I did read it. Here's what I'm wondering:

When the author says he's writing the article to answer the question, "As a nurse, should I buy my own malpractice insurance?", how much of that applies to medics like me?

When the author qualifies his advice as being "for a nurse employed by a hospital or healthcare facility," does it also apply to medics who work in neither environment?

When the author advises me, the reader, to buy a "nursing malpractice liability policy," how much weight should I give that as a medic?

While this article may have some advice relevant to paramedics, what makes it the best source of information for us? Conversely, would an article about risk management for paramedics be the best source of advice for nurses?


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## mgr22 (May 25, 2016)

akflightmedic said:


> And I still come back to my first question without all the pomp and circumstance....SHOW ME a documented case where a paramedic was sued for medical liability and had to pay or have wage garnishment. When the seller of the insurance cannot even do it, I certainly challenge you to do so.
> 
> That simple.
> 
> I can have my mind changed...with evidence.



Didn't we already do this?


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## akflightmedic (May 25, 2016)

No, we did not. You brought a case completely irrelevant. And I discussed it.

A vehicle crash is not relevant and is not covered by HPSO. As I requested, bring me a medical liability claim against a paramedic...also note that HPSO, the one who sells this insurance cannot even highlight a claim.


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## mgr22 (May 25, 2016)

Wasn't it maybe only partly irrelevant?


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## akflightmedic (May 25, 2016)

No, it was wholly irrelevant.

Crashing a vehicle into another vehicle and possibly breaking laws and having all kinds of stuff go wrong through you or your employer's inactions is not relevant. This was a vehicle insurance claim (should have been). Which HPSO does not cover.

As said earlier, if they did the premiums would be significantly higher and you would not get coverage by a few clicks and $100 transfer.

Find a case where a medic has been sued for medical malpractice and the insurance saved his/her butt. Again, the very insurance company which sells these policies cannot demonstrate an instance, so go for it!


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## mgr22 (May 25, 2016)

It's an attractive offer, researching medical malpractice and the insurance industry, but I think I'm gonna go watch some hockey instead.

Did you see NUEMT's link to the David Givot piece?


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## Summit (May 25, 2016)

mgr22 said:


> Did you see NUEMT's link to the David Givot piece?


You mean the brilliant piece with lines like


"EMS is the only profession I can think of where the provider places his or her license to practice and livelihood on the line and dares the world to take it away — every shift."

What a crock!

"if something happens and you are not insured, you could find yourself living a country song when you lose your job, your truck, your house...and maybe your dog."

Oh COME ON!


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## akflightmedic (May 25, 2016)

See, I did my research and supported my position. I am seeking the same...reasonable request in my opinion.

I do not watch sports so enjoy.


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## mgr22 (May 25, 2016)

Summit said:


> You mean the brilliant piece with lines like
> 
> 
> "EMS is the only profession I can think of where the provider places his or her license to practice and livelihood on the line and dares the world to take it away — every shift."
> ...



Ok, so much for David Givot. You guys are a tough crowd. Do you buy any insurance?


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## Summit (May 25, 2016)

mgr22 said:


> Ok, so much for David Givot. You guys are a tough crowd. Do you buy any insurance?


Probably more than you...


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## akflightmedic (May 26, 2016)

^^^  This above...fact.

I carry a LOT of insurance, however this is one which is not needed.


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## akflightmedic (May 26, 2016)

Whew...just added up everything. I spend in excess of 50K annually on various personal insurance plans. My businesses far exceed that.

But I do know HPSO will not be one of them ever and keeping it all relative, they are ripping off hard working, lower paid EMS workers with fear tactics. And you sir help them in that endeavor by being an educated person with reach (through your publications).

Yes, it is just $100. There are many, many things in life that is just X or just Y. And if it is supported with fact/evidence, I absolutely would support it. My mind can be changed.

How many times do I have to say, the very company who sells the insurance cannot provide an example of it working?

Paramedic sued for Medical Liability Claim and HPSO saved the day or the Paramedic had no insurance and is now garnished every payday.

With all of the fear mongering this should be very easy to prove. (Or is there some broken old man behind the curtain?)


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## mgr22 (May 26, 2016)

akflightmedic said:


> Whew...just added up everything. I spend in excess of 50K annually on various personal insurance plans. My businesses far exceed that.
> 
> But I do know HPSO will not be one of them ever and keeping it all relative, they are ripping off hard working, lower paid EMS workers with fear tactics. And you sir help them in that endeavor by being an educated person with reach (through your publications).
> 
> ...



Ok, two questions:

1. How do you decide which insurance to buy?
2. In general -- and I know it's a very broad question -- how do you decide what to spend $100 on?


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## akflightmedic (May 26, 2016)

1. Life Insurance, car insurance, house insurance, flood insurance, health insurance, dental insurance, vision insurance.
    Those are no brainers as they all have evidence supporting the need for the claim. I do not insure products, appliances, etc. Upsale based on fear.
2. I base my purchases on value. There is no value in me throwing away $100 on a plan that to date, in all the decades of its existence can present a case which does exactly what I requested above in prior comments. Even less value for the "average" paramedic who counts on overtime to make his rent or other bills. Might as well throw the $100 in the slot machine and pull the handle, better return potential.


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## mgr22 (May 26, 2016)

akflightmedic said:


> 1. Life Insurance, car insurance, house insurance, flood insurance, health insurance, dental insurance, vision insurance.
> Those are no brainers as they all have evidence supporting the need for the claim. I do not insure products, appliances, etc. Upsale based on fear.
> 2. I base my purchases on value. There is no value in me throwing away $100 on a plan that to date, in all the decades of its existence a case which does exactly what I requested above in prior comments. Even less value for the "average" paramedic who counts on overtime to make his rent or other bills. Might as well throw the $100 in the slot machine and pull the handle, better return potential.



Ok, thanks. So, about the flood insurance: Do you live in an area that floods a lot? And about the $100: Can you see yourself ever spending $100 on something without assured value, but with the remote possibility of great value, sort of like your slot-machine example? I'm not criticizing -- just asking.


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## Summit (May 26, 2016)

Health insurance - DUH

Life Insurance... MAYBE only if you have a need and then in appropriate amounts. A single 23 year old medic doesn't need it. A married medic with kids arguably needs it. A very well off family may not need it if they have sufficient assets. There are a ton of plan types and a lot of them are poor value, so choose carefully.

On your Home Insurance or Renters Insurance (yes it is a thing and you should have it) make sure you have sufficient coverage and I mean that for replacing the house and for liability. For car insurance, make sure your liability coverage is sufficient.

If you have significant assets or a family, such that declaring bankruptcy could be denied or doing so would disrupt your life, then buy an Umbrella liability policy. An umbrella policy is a backup coverage if your home/auto doesn't cover you or doesn't have enough coverage. Usually, you can back your home/auto liability coverage off some (the umbrella will stipulate how much you need). You can usually get an Umbrella for a similar amount to what you'd pay HPSO, except it will cover you in vastly more circumstances and maybe even the same depending on the policy (never personally looked into professional riders).

Most dental policies are losers for regular services, but they can save you if major services are needed (crowns, maxillofacial surgery).

If your employer offers a prepaid legal service policy, TAKE IT. Seriously... one of the best things I ever have had access to!

Short term disability insurance % buy up through your employer - debatable... depends largely on what kind of cushion you have and what their terms are. Big cushion? Don't take. Live month to month? Buy up!

Full buy in disability plans outside your employer? Through your employer usually the prices are good. Through a third party (union, professional organization, etc) the prices are often onerous and not worth it.

Travel insurance? Depends... read the policy EXTREMELY carefully because the exclusion can make it completely useless. I have bought it once for a long trip to rural China but I had to choose one that would cover mountaineering. Be sure to look at what it covers medically vs your health insurance policy coverage for out of country. I do have a DAN policy that I ensure is active if I am diving because SCUBA is excluded by virtually all other policies, this covers evac too.

Rescue Insurance: When I go to Europe to ski, I buy Carte Niege but most of the policies out there like GEOS are questionable...

IANAFA

ABOVE ALL, READ AND UNDERSTAND YOUR POLICIES, WHAT THEY COVER, AND WHAT THEY EXCLUDE


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## mgr22 (May 26, 2016)

Thanks, Summit. Lots of good advice.


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## akflightmedic (May 26, 2016)

Yes, I live in FL, my property and surrounding property is low level marsh/flood zones, we get lots of rain and hurricanes. 

Yes, I can spend $100 bucks carelessly, but I am not paycheck to paycheck kind of guy. For someone who is (I spent many years there), this policy is a rip off and is sold based on fear. My whole point (AGAIN) is not whether or not you have $100 to blow, the point is does this policy TRULY do anything for you? And if so, where is the proof? And when the seller of the goods cannot answer this, then why should I listen to fear mongering? Why should a hard working, overtime dependent paramedic throw $100 away on this each and every year? It would be better value sitting in a savings account at .02% interest than throwing it away to "successful" marketing campaign.


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## mgr22 (May 26, 2016)

Ok, and my point is, even in the absence of proof, a minor expenditure -- $100 in this case -- can still have a favorable cost/benefit ratio. Just because I can't prove it's a good idea doesn't make it a bad idea, especially when the cost is so low.

You're correct the money might be wasted, but taking the time to vet lots of opinions and advice in favor of spending the money -- even if all of that input turns out to be nonsense -- costs more in time than the fee itself. Lots of times we make cost/benefit decisions that way: How much risk do we perceive, how big is the penalty associated with that risk, and how much does it cost to eliminate, or drastically reduce that risk? Sometimes the people we give our money to make out like bandits. Sometimes we come out ahead because they're not charging enough. Sometimes it's a fair exchange.

I just bought a water filter for my kitchen sink. I did it because a family friend who works in a nearby hospital commented that she's seen more kidney stones in this part of the country than other places she's worked, and believes it's related to impurities in our drinking water. She has no proof of that, and I'm not assuming she's right. But I've had kidney stones, there are impurities in almost everyone's tap water, and I'm willing to spend $30 a few times a year in case she's right about the connection. I don't have a better use for that $60 or $90 a year. If the cost were, say, over $200, I probably wouldn't be buying those filters.

So, you and I have two different points of view on this, and I think they're both valid.


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## Summit (May 26, 2016)

Your friend made an anecdotal observation and then concluded that it has to do with tap water and further concluded that a water filter could prevent the problem. Is their anecdote backed by data? Did you check the publicly available information on your tap water mineralization? Do you know what type of stones you have had in the past? Did you check if your filtering solution actually reduces calcium?

Wait... that is unnecessary... Did you bother to see if there is actually evidence to support the idea that filtering water reduces kidney stones? I checked... this is unsupported.

So when you ask how you should spend $100 or $200...

Do you have any debt you are paying interest on?
Are you maxing out your 401K and IRA?
Do you have all the other more valuable insurance products?

If not, then you do have a better use for that $60, $90, or $100 for a water filter or HPSO policy.

Or... I give up... send me $150 and I'll cast a magical spell that will reduce your chance of being sued and your chance of kidney stones. It is cheaper than a water filter and HPSO policy combined and just as effective!


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## mgr22 (May 26, 2016)

Your first-paragraph questions: No, Yes, Yes, Yes.

Then the stuff about it being unsupported -- yeah, I get that. Unsupported; not necessarily untrue. But I digress.

Based on your criteria, we agree it's ok for me to spend $60, $90 or $100 for a water filter or HPSO policy. I'll have to put a little of the water-filter money towards the HPSO policy. That's ok, maybe I'll only get really tiny kidney stones.

So that means I don't need the magic spell, right? But here's the thing: If you were standing right next to me, and gave me a convincing story, without proof, about your ability to cast magic spells, and asked for, say, a quarter to do that, I'd give it to you. That would be my cost/benefit assessment. Before you make me an offer from wherever you are, you'd have to factor in the postage.


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## Summit (May 26, 2016)

mgr22 said:


> Your first-paragraph questions: No, Yes, Yes, Yes.
> 
> Then the stuff about it being unsupported -- yeah, I get that. Unsupported; not necessarily untrue. But I digress.
> 
> ...



Hey if you are putting in $18K to your Roth 401K (or equivalent) and $5.5K to your Roth IRA and you have all that insurance, you are doing better than 90% of the people out there, statistically speaking. Nice work!

That being said, your outlook of "I don't care if it doesn't work or if it has been proven ineffective...  worst case I'm out some money!" is the very mindset that underpins many scams and profitable snakeoil ventures (like homeopathy, healing crystals, magnetic bracelets, HPSO policies, and more than a few of the ACLS intrarrest drugs).

Maybe I'm in the wrong line of work...


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## akflightmedic (May 26, 2016)

Agree Summit.

I do not think mgr22 likes my request for ONE single piece of evidence. He has yet to directly address that and the fact that the very company who sells it cannot produce what I am asking.

Guess it is time for me to start company #4. Insurance for EMS Workers.

And I love being educated on cost/benefit or risk benefit scenarios...first time I ever heard of or experienced any of this. The irony is if you actually employed this model, you would find there is no benefit for the cost.


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## mgr22 (May 26, 2016)

Summit said:


> Hey if you are putting in $18K to your Roth 401K (or equivalent) and $5.5K to your Roth IRA and you have all that insurance, you are doing better than 90% of the people out there, statistically speaking. Nice work!
> 
> That being said, your outlook of "I don't care if it doesn't work or if it has been proven ineffective...  worst case I'm out some money!" is the very mindset that underpins many scams and profitable snakeoil ventures (like homeopathy, healing crystals, magnetic bracelets, HPSO policies, and more than a few of the ACLS intrarrest drugs).
> 
> Maybe I'm in the wrong line of work...



Did I really say that stuff about "I don't care if it doesn't work..."? That sounds so unlike me. "Worst case I'm out some (small amount of) money" definitely sounds like me, though.

I just realized the only down-side to this discussion is I'm probably going to be inundated with offers to sell me all kinds of stuff. Hmmm...healing crystals...haven't tried them. Do they prevent kidney stones?


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## Summit (May 26, 2016)

mgr22 said:


> Did I really say that stuff about "I don't care if it doesn't work..."? That sounds so unlike me. "Worst case I'm out some (small amount of) money" definitely sounds like me, though.



You are looking at cost benefit like this: 

(potential benefit) / (cost)

You need to look at things like this instead:

(potential benefit) * (chance of encountering need) * (chance of receiving benefit if needed) / (cost) 

Look at HPSO the first way:

(high)/(low)=win

The second way:

(high) * (near zero) * (low) / low = near zero

That is step 1. Step 2 is compare it to the cost benefit of other uses (the opportunity cost).



> I just realized the only down-side to this discussion is I'm probably going to be inundated with offers to sell me all kinds of stuff. Hmmm...healing crystals...haven't tried them. Do they prevent kidney stones?


THEY MIGHT!!! But only if you buy from me... $99.95!


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## mgr22 (May 26, 2016)

Summit said:


> You are looking at cost benefit like this:
> 
> (potential benefit) / (cost)
> 
> ...



Actually, I'm considering the expected value. I know you know what that is, so I'll just add that my perception of probabilities is such that I come out ahead buying the insurance. Also with filtering my water.

Your price quote is compelling


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## akflightmedic (May 26, 2016)

Isn't an EV the sum of all values multiplied by the possible occurrence?

If so, then an occurrence which has yet to be proven is 0

My kids common core math tells me anything X 0 is still ZERO. Right?


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## mgr22 (May 26, 2016)

Yes, the expected value is the probability multiplied by the cost of each occurrence. You believe the probability of needing the insurance we're discussing is zero. I believe it's fractionally higher than that. Only a fraction of a percentage point of likelihood is needed when multiplied by, say, $2,000,000 to make spending $100 worthwhile.

You keep coming back to the thing about lack of proof = zero probability. Am I paraphrasing you correctly? I feel differently -- i.e., I don't think you have to prove something is true for there to be a possibility it's true.


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## akflightmedic (May 26, 2016)

All I ask for is a single case. So until then it is zero.

You can play this game on most things I suppose but this particular situation is seemingly an absolute and easy to prove or disprove. Unless you want to go all advanced and say there are no absolutes. Either way this horse is dead pretty much. I would say the burden of proof resides with the one making the claim. But even the creator or protector of the potential claims cannot prove it, so oh well.


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## Summit (May 26, 2016)

lack of proof doesn't = zero probability, but YOU CAN CONSTRAIN THE PROBABILITY:

Look at it from the reverse: if you want to be simple about it, if you pay $100, the agent gets $15, and lets say $15 in overhead for the insurer and that they aren't making anything off of investing the premiums. If they are going to break even they need your chance of needing 2 million in coverage have to be less likely than 1:28,500 per annum. Screw it. Let's let them have a reasonable profit and make it 1:50,000.

Let's say everything works out for you, that's 5:1 against you if you looks at (risk * benefit) / cost for what would likely be their minimum benefit.

Except if it were 1:50,000, shouldn't there be a massive number of examples of the benefit from the last few decades?

There aren't.

Is it because nobody buys their product? No...

It is because their product is nothing but premium and overhead with essentially zero payout in claims.

That is why they can offer a price so low it is hard to find many insurance policies of any level of coverage for any type of risk with a lower annual premium. HPSO is priced to overcome consumer resistance for an unneeded SUPPLEMENTAL policy with 1:20,000+ premium:coverage while an OBGYN is paying 1:10 (and there is competition in that market) or you pay 1:400-1:100 on for your auto policy.

The only policies that approach that level of premium:coverage are umbrella policies, another type of supplemental liability policy but one that covers a much broader set of risks with a lower supplementation threshold.

*If they sold EMS liablity policies for what they were worth, they wouldn't get enough money to pay their operating overheads even if they didn't pay the agents a dime.*


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## akflightmedic (May 26, 2016)

I know that no proof does not equal no chance however we are not discussing beliefs systems. 

It would seem that an insurance company could produce one single case after numerous decades to support its claim. Every other insurance policy  I have can do so...and gladly. To do so would garner more sales. 

My intensity on this thread is three fold. One, it is a company which preys on lower wage workers and fear mongers to do so. This is unethical. 

Two. Regardless of the cost it is a useless product. I don't like useless products. Ever since my Flowbee refused to suck while cutting and left me with a bowl cut...

Three. Intelligent educated people suspending facts to support feelings.


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## Summit (May 26, 2016)

> YOU CAN CONSTRAIN THE PROBABILITY:
> 
> Look at it from the reverse: if you want to be simple about it, if you pay $100, the agent gets $15, and lets say $15 in overhead for the insurer and that they aren't making anything off of investing the premiums. If they are going to break even they need your chance of needing 2 million in coverage have to be less likely than 1:28,500 per annum. Screw it. Let's let them have a reasonable profit and make it 1:50,000.
> 
> ...



Further constraining, this was the only data I could find on insurance rates for EMS providers... 25% of paramedics (of the 37% of NJ EMT-Ps that responded) had coverage... just assume it is a representative sample. http://www.monoc.org/research/Malpractice Abstract 0304.pdf

So there are 345K medics... that means that roughly 86K have personal malpractice policies. If it was 1:50,000 of needing the policy, then 1-2 medics would have their butts saved every year (actually much higher if you do a more complex analysis) and HPSO would have stories to tell. If it was 1:2,000,000 then we should at least have one story from the last few couple decades! Except we don't... if we had one success story we could constrain your (risk * benefit) / cost to 1:200 against you or worse.

So do the math... *the insurance industry has been paid 100s of MILLIONS of dollars in premiums over the last several decades by EMS providers, and we can't produce a single case study of where it has saved the provider. *


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## akflightmedic (May 26, 2016)

But, but.....I *FEEEEEL* better. I am leaving now to head down to the 7-11 to play the poor man's retirement game...cause probabilities and all...SOMEONE always wins.


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## mgr22 (May 26, 2016)

What's the poor man's retirement game at 7-11?


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## luke_31 (May 26, 2016)

mgr22 said:


> What's the poor man's retirement game at 7-11?


Lottery


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## Kevinf (May 26, 2016)

The lottery is 50/50... You win or you don't!


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## mgr22 (May 26, 2016)

Got it, thanks.


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## NUEMT (May 27, 2016)

I feel you AK. I like evidence too.  

For me, 100 dollars is worth it either way.  Illinois is literally one of the worst states for malpractice medically related lawsuits in the country so  my view is colored by that admittedly. If you are still in ALaska(?) that might not be the case as stated above.

The thing is, these cases can drag on for a while.  Just the mere ability to have someone represent you in proceedings can be a bit of a lifesaver.  

I am not sure about the ability to dig up civil cases but I am trying to find some examples of cases that, if nothing else, illustrate how convoluted the cases can become and how an individual provider might be pitted against his company's lawyers if a judgement is finally imposed.

http://jacksonandwilson.com/negligent-ambulance-wrongful-death/

These folks lost their son.  Tesoro H.S is in RSM which is rich people area to say the least.  Rich+Pissed=bad for you.

http://www.lubinandmeyer.com/cases/emt-malpractice.html

Unknown who paid this.

http://www.robertshumanlaw.com/Verd...ical-Malpractice-EMT-Negligence-825-000.shtml

Same.  Unknown payer.

Here is an example of the amounts paid.
http://www.hpso.com/Lists/CommonFormStateList/Attachments/6/G-141230-B.pdf

I note that the insurance also will pay out to you if you yourself are assaulted and your personal items are damaged.  Which may or may not be difficult to get your agency/company to do.

To all:
We are in EMS.  We know the situation varies from corner to corner. It may be more suitable for people in different areas.  Truth is, it depends. At the very least, research your area and decide for yourself based on your situation.


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