Does the medical director need separate liability coverage?

A medical director in a skilled nursing facility wears two hats. As a treating physician for residents on their panel, exposure is ordinary medical malpractice and their own policy responds. As medical director, the role is administrative: implementing resident care policies, coordinating medical care, participating in quality assurance, and reviewing the competency of clinical staff.

The second hat is the one that shows up in facility litigation. When a complaint alleges systemic care failures, the medical director is named for the oversight function rather than for treating anyone, and the allegation is that the policies were inadequate or that quality assurance did not catch a pattern.

Physician malpractice policies are written to cover the rendering of professional medical services to a patient. An allegation that a policy manual was inadequate is not obviously the rendering of services to a patient, and some forms have an express administrative or committee activities exclusion. Others cover it by endorsement, sometimes at no charge, if asked.

On the facility side, the professional liability policy covers insureds, and a contracted physician is not automatically an insured. Some forms include the medical director as an insured solely with respect to the medical director duties; many do not.

The failure mode is that both policies point at the other. That argument is resolved eventually, but it is resolved on the operator timeline, with defense being funded by nobody in the meantime.

First, add the medical director as an additional insured on the facility professional liability policy solely with respect to the performance of medical director duties, with a stated carve-out for their own treatment of patients so the two policies do not overlap unproductively.

Second, require in the medical director agreement that the physician carry malpractice coverage that expressly includes administrative and medical director activities, with a certificate confirming it and a stated limit. Then require notice of cancellation and confirm the coverage annually rather than once at signing.

Doing both is cheap and removes the coverage argument entirely, which is the point.

Indemnity running in the direction that matches the facts: the physician indemnifies for their own treatment, the facility indemnifies for the facility operations. Insurance requirements with a stated limit and a tail obligation if the agreement ends, because the exposure is claims-made on both sides. And a document retention obligation, since the quality assurance record is the evidence in a systemic care case.