ETHIQAL FAQ

1What is Occurrence-based vs Claims-made professional indemnity cover?

With Occurrence-Based cover, you are protected for claims that result from any incident that occurs whilst being a policyholder, irrespective of when the claim is made and includes the time after a policy has been cancelled. This contrasts with Claimsmade cover where protection is only offered for incidents reported to the insurer whilst premiums are being paid (i.e. it provides protection for incidents that both occur and are reported during the policy period, regardless of when a claim is received). Depending on the retroactive date of the policy in force, it may also include claims that relate to adverse incidents that occurred prior to the Claims-made policy being issued and of which the doctor was unaware at the time of taking out the policy.

2What happens to past incidents and claims when I switch to EthiQal?

If you currently have Occurrence-based cover, your previous insurer or protection society will continue to indemnify you for claims resulting from adverse incidents that occurred during the period of your insurance or membership, in line with the benefits associated with your cover.

If you currently have Claims-made cover, all matters notified to your previous insurer or protection society during the period of your insurance or membership will still be covered by them irrespective of when a claim is made, in line with the benefits associated with your cover.

It is important that you consult your broker to ensure that there is no gap in protection when you switch your indemnity cover.

3How will EthiQal support me when I am confronted with a legal threat?

As a first line of defence, EthiQal, through its own in-house team of medical and legal professionals, will work closely with you to assess your situation and provide you with appropriate assistance and support . In addition, EthiQal will employ the services of specialist lawyers who are best equipped to deal with your claim or circumstance.

EthiQal has contracts with several legal firms that have specialist medical law practices devoted to the defence of medical cases. In the category of dispute resolution, all are recognised leaders. Each has its own established track record of excellence in the field of medical litigation, having successfully defended healthcare professionals, hospitals and other medical services providers in civil actions for damages.

4Does VAT apply to my premium?

EthiQal’s premiums are inclusive of VAT. If you are a registered VAT vendor, the input VAT can be claimed from SARS. Your certificate of insurance serves as a tax certificate in this regard. It is important that your financial advisor includes details relating to VAT implications in any professional indemnity product comparisons that are presented to you.

5How do we know that EthiQal will be around in the future?

EthiQal is a Division of Constantia Insurance Company Limited, part of Constantia Risk & Insurance Holdings (Pty) Ltd, which is more than 65-year-old insurer licensed as a Financial Services Provider. Constantia is a company that is proud of its heritage and the contribution it has made to the South African insurance market over the past six decades. Our 100% shareholder is Conduit Capital, who is listed on the JSE and has significant financial backing to ensure our sustainability.

As a Division of Constantia, EthiQal operates in a highly regulated market under the jurisdiction of the Financial Sector Conduct Authority. Prescribed amounts of premium are allocated towards building substantial insurance reserves for defending future claims and a mandatory solvency report is submitted for review by the Regulator on a monthly basis. This is similar to the medical aid industry where the Council for Medical Schemes monitors the reserves of medical aid schemes and implements corrective actions in the event of a scheme’s solvency being threatened. All these measures are in place to ensure the financial sustainability of EthiQal so that you, as a policyholder, are protected, now and in the future.

6What is the difference between a short-term insurer and a mutual organisation that provides professional indemnity cover?

Short-term insurers and mutual organisation are not mutually exclusive.

A Short-Term insurer is a company licensed to do business in terms of the Company’s Act 2008 and registered as a financial services provider (FSP) in terms of the FAIS Act, 37 of 2002, its Codes of Conduct and Board Notices. The Short-Term insurer underwrites policies in a manner that is compliant with the Short -Term Insurance Act, 53 of 1998. In doing so, the Short -Term insurer complies with market conduct and policyholder protection requirements implemented to protect the rights of you, the policyholder. Should you, for any reason, be unhappy with the service we have provided, you have recourse via the Ombudsman for Short-Term Insurance (OSTI). The OSTI provides the insuring public and the Short-Term industry with a free, efficient and fair dispute resolution mechanism through an alternative dispute resolution process, applying the law and principles of fairness and equity.

A Mutual is an organisation that is owned collectively by its members who are also its customers. For policyholders to enjoy the same legal protection as above, the Mutual must be registered as a FSP

It is thus important that policyholders obtain proof of FSP registration when purchasing professional indemnity cover.