Physician's Protection Plan
I. INTRODUCTION.
Physician's Protective Group, Inc. (hereinafter "PPG") is a Georgia corporation formed by physicians for the purpose of providing physicians and medical doctors practicing medicine in the State of Georgia with protection from, and redress for, frivolous medical malpractice lawsuits. The Physician's Protection Plan (hereinafter "Plan") is offered by PPG to Georgia physicians and medical doctors to provide them with the ability to bring complaints and/or lawsuits against Plaintiffs, their attorneys, and/or their medical expert witnesses for abusive or frivolous claims.
II. PARTIES WHO MAY BECOME PLAN MEMBERS.
Any physician or medical doctor licensed to practice medicine in the State of Georgia is eligible to become a Member of the Plan upon payment of an annual subscription or Membership fee, provided, that he or she is not otherwise disqualified as provided for herein.
III. PERIOD OF COVERAGE.
The period of coverage for the benefits provided hereunder to Members of the Plan shall be one (1) year commencing at 12:01 A.M. Eastern Standard Time on the day following the day the Membership fee is received by PPG. The period of coverage shall end at 12:01 A.M. on the 366th day following the beginning date. A Member may renew his or her membership annually as provided herein.
IV. PARTIES TO WHOM BENEFITS ARE AVAILABLE.
Benefits are available to any Member of the Plan who is named as a Defendant in a civil action in the State of Georgia, which action is in whole or in part for medical malpractice, and which action is based upon acts or omissions in the State of Georgia occurring during the period of coverage, and for whom there has been a Termination in Favor of the Member. A Member must be a Member in good standing at the time of Termination in Favor of Member for the member to be eligible for benefits.
V. BENEFITS.
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Legal Benefits
1. Analysis of Claim
PPG will pay for a medical/legal analysis of the claim for the purpose of determining whether the claim qualifies as frivolous. Such an analysis will serve as a basis to determine whether to proceed with a civil action against the Plaintiff and/or the Plaintiff's attorney. PPG will pay reasonable fees and costs for said analysis, and a decision as to whether or not to proceed with legal action against the Plaintiff and/or the Plaintiff's attorney shall be determined according to the claim criteria.
A Member must be a Member in good standing at the time of the act or omission giving rise to the medical malpractice suit, unless Member has purchased Prior Acts Coverage, in which case Member will be covered for acts or omissions occurring during the period of Prior Acts Coverage purchased.
2. Claim Prosecution¹
If, after reviewing the medical/legal analysis of the claim, it is determined by PPG that a civil action is appropriate against the Plaintiff and/or the Plaintiff's attorney, PPG shall provide an independent attorney experienced in this area of the law to prepare and prosecute the civil action, conduct discovery, and fully prosecute the claim within all legal and ethical boundaries against the Plaintiff and/or the Plaintiff's attorney for such damages as may be available to the Member under the law of the State of Georgia, which may include, without limitation, reasonable attorney's fees and costs.
3. Litigation Cost Benefits
In addition to the benefits provided hereinabove, PPG will also in connection with such civil action pay for the reasonable cost of medical experts and expert witness fees to assist in the prosecution of the claims. Additionally, PPG will pay other costs such as court filing fees, court reporters, and the like.
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Medical Witness Benefits.
1. PPG will pay reasonable fees for the review and analysis of the medical malpractice expert witnesses affidavit and/or testimony to determine whether the witness committed perjury, delivered false testimony, and/or engaged in fraud or deception or other such actions as may be a violation of the rules and regulations of the state medical licensing board and/or the state agencies responsible for physician disciplinary action.
2. If PPG determines that any action against the medical expert witnesses is appropriate, PPG shall file and pursue complaints and/or disciplinary action against such expert witness with one or more of the following:
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national and/or state medical association;
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fellowship of national and/or state specialty societies;
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state agencies for physician disciplinary actions;
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state and medical licensing board;
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notify any hospital or medical facility at which the physician has privileges of--the complaint or disciplinary action;
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the appropriate board of medical specialties.
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Review of Attorney Conduct.
PPG will pay the reasonable fees and cost for review and analysis as to whether Plaintiff's attorney in a medical malpractice case filed against a Member has engaged in unprofessional, improper or unethical attorney conduct. After said review and analysis, if PPG determines that disciplinary action is appropriate, PPG will pay reasonable costs to assist the Member in preparing for filing the appropriate complaint forms with the agency responsible for attorney disciplinary action.
D. Member Website.
PPG will provide at its sole cost a website in which Members of its Plan may be identified as notice to potential claimants and claimants' attorneys of Membership in the Plan. The website shall also provide other information helpful to its Membership.
VI. PHYSICIAN'S PROTECTION PLAN CLAIM CRITERIA.
All decisions as to whether or not to proceed with legal action against the Plaintiff and/or the Plaintiff's attorney or against a medical witness shall be made by the Claim Committee and shall be determined according to the claim criteria. The claim criteria is set forth in Schedule "A" which is attached hereto.
VII. OBLIGATION OF MEMBER.
A. The Member shall notify PPG in writing within thirty (30) days of the "Termination in Favor of the Member" that the Member exercises his or her right to benefits as contained in the Plan. For the purposes of this Plan, the terms "Termination in Favor of the Member" shall be defined as:
(1) Summary judgment in favor of the Member; or
(2) Jury verdict and judgment in favor of Defendant awarding ZERO (0.00) dollars.
B. Cooperation with PPG by the Member is required, and the Member shall furnish legible copies of all documents and records pertaining to the lawsuit, including, without limitation, all pleadings, depositions, relevant notes, medical records and charts, and other such documents and records. Further, the Member shall, when necessary, cooperate in the prosecution of the claims, which cooperation shall include, without limitation, the requirement that he or she attend depositions or trial, meetings with attorneys, and, when necessary, to give testimony by affidavit.
C. As a condition precedent to any claim for abusive litigation under Georgia law, O.C.G.A. §51-7-84 requires notice to a Plaintiff. Accordingly, as a prerequisite to pursuing any claim against the Plaintiff and/or the Plaintiff's attorney, notice must be provided by the Member or the Member's attorney as provided for in O.C.G.A. §51-7-84.
VIII. CONDITIONS PRECEDENT.
A. A Member must be a Member in good standing at the time of the act or omission giving rise to the medical malpractice suit, unless Member has purchased Prior Acts Coverage, in which case Member will be covered for acts or omissions occurring during the period of Prior Acts Coverage purchased; and
B. The Member must be a Member in good standing at the time of Termination in Favor of Member in order to qualify for benefits under this Plan; and
C. The Member shall notify PPG in writing within sixty (60) days of the Termination in Favor of the Member and of the Member's desire to pursue benefits under this Plan; and
D. For benefits to be available related to prosecution of claims against the Plaintiff and/or the Plaintiff's attorney for abusive litigation, the notice required by O.C.G.A. §51-7-84 must have been provided by Member and/or Member's attorney in the malpractice action.
IX. PRIOR ACTS OPTION.
A Member may purchase coverage for Prior Acts for one year or for two years by paying the applicable premium for each year purchased.
Prior Acts Coverage provides Plan Benefits to the Member for any acts or omissions of a Member occurring during the period of Prior Acts Coverage purchased.
"Acts or omissions" as used hereunder mean those acts or omissions of a physician Member which give rise to the medical malpractice lawsuit upon which a claim is made under the Plan.
The Prior Acts Option is only applicable to a Member who purchases Prior Acts Coverage. A Member who declines Prior Acts Coverage will not be provided benefits under the Plan for any acts or omissions occurring prior to the coverage period purchased and any renewal periods.
Prior Acts Coverage does not apply to any acts or omissions of a physician if a lawsuit has already been filed at the time a Member's coverage begins.
X. LIMITS OF LIABILITY.
PPG's limit of liability to a Member per occurrence shall be FIFTY THOUSAND DOLLARS ($50,000.00). PPG's limit of liability to a Member for any and all benefits defined hereinabove for the lifetime of the Member shall be limited to an aggregate of ONE HUNDRED THOUSAND DOLLARS ($100,000.00).
XI. OFFSET PROVISION.
In the event of a recovery on behalf of a Member under the benefits described above, the Member agrees to reimburse PPG out of the collective proceeds of any recovery a sum equal to the amount expended by PPG for the benefits described above. In the event of no recovery the Member is not required to reimburse PPG for any costs or expenses associated with providing benefits under this Plan.
Reimbursement will not exceed PPG's actual cost and fees spent in providing benefits under the policy. All sums above PPG's actual cost will be the property of the Member.
XII. EXCLUSIONS.
A. There are no benefits provided in this Plan unless and until the underlying medical malpractice action has been terminated in favor of the Member.
B. There are no benefits provided with respect to any lawsuit filed against the Member that would not be considered medical malpractice.
C. There are no benefits available to any Member who fails to provide the requisite notice of lawsuit and notice of termination in favor of the Member as provided in Paragraph VI.
D. There are no benefits available to a Member for an abusive litigation claim against the Plaintiff and/or the Plaintiff's attorney unless the notice required by O.C.G.A. §51-7-84 is provided by Member to the Plaintiff or Plaintiff's attorney in the medical malpractice claim.
E. There are no benefits available to a Member with respect to any action required relating to abuse of prescription or controlled substances requiring a Drug Enforcement Agency number.
F. There are no benefits available to a Member with respect to any penalties or judgments against a Member awarded or ordered by any court.
G. There are no benefits available to any Member that is not specifically listed in this Plan as a benefit under the Plan.
H. Specifically excluded are other legal matters that are not medical malpractice, including, without limitation, employment matters, managed care contract matters, real estate matters, taxation matters, sexual harassment matters, and non-medical matters.
I. There are no benefits available with respect to any action arising out of or related to any fraudulent or dishonest acts, malicious acts or omissions, or any acts of moral turpitude on the part of the Member.
J. There shall be no benefits available to a Member for activities of a Member not carried on in his or her professional capacity.
K. There are no benefits available unless a Member is a Member in good standing at the time of Termination in Favor of Member.
L. There are no benefits available if the medical malpractice action arises from an act or omission related to an area of practice which is not included on Member's application.
M. There are no benefits provided under the Plan for any medical malpractice lawsuit against a physician which was filed prior to the physician becoming a Member.
XIII. DISPUTE RESOLUTION.
If a dispute arises between a Member and PPG, the Member and PPG agree to use their best efforts to resolve such dispute amicably. If, however, they cannot reach a mutually satisfactory resolution, this dispute shall be submitted to an arbitration board composed of three (3) attorneys practicing in the same bar circuit in which the Member lives or works. Member will chose one attorney to serve on the arbitration board, PPG will chose a second attorney, and the two attorneys so chosen will select a third attorney to serve on the arbitration board. The decision of the majority of the three attorneys so selected will be binding on Member and PPG.
XIV. CANCELLATION.
PPG has the right to cancel the Membership of any Member who:
Fails to maintain a license to practice medicine in the State of Georgia during the period of coverage under the Plan;
Commits any act of fraud or dishonesty; and/or
Fails to make accurate truthful disclosures to PPG.
Notice of termination or cancellation shall be provided to Member in accordance with O.C.G.A. §33-24-44.
XV. TERMINATION OF BENEFITS FOR MEMBER.
All Members of PPG in good standing are covered for benefits under this Plan. On the day a Member ceases to be a Member in good standing benefits to that Member shall cease. This does not apply to coverage for claims occurring prior to the termination of Membership.
XVI. RENEWAL PROVISIONS.
Membership in the Plan may be renewed on an annual basis by payment of the annual premium to include any noticed increases in premium during the prior coverage period, within fifteen (15) days following the end of the coverage, without lapse in coverage.
XVII. MISCELLANOUS PROVISIONS.
A. Affiliated Attorney.
The attorneys selected by PPG to participate in the prosecution of claims for its Members are attorneys who are admitted to practice law before, and are in good standing with, the State Bar of Georgia, and who have agreed with PPG to provide legal services that are covered by this Plan. Such attorneys are not PPG's agents or employees, and PPG does not guarantee in any way the skill, quality, or capability of any affiliated attorney or the resolution or outcome of any legal matter handled by the attorney.
B. Transfer and Applicability.
The Members of this Plan may not transfer Memberships and this Plan shall not be applicable to family Members or anyone other than the Member.
C. Grace Period.
There shall be a grace period for making renewal premium payments, and such payments shall be accepted when they are received within fifteen (15) days of the date of the renewal period, and there should be no lapse in coverage in such case.
D. Membership Fees.
The Membership fees are paid annually and are more particularly set out as to each medical specialty in Exhibit "B" which is attached hereto and specifically incorporated by reference herein.
E. Use of Statements.
No statement by the Member in any application shall void the contract or be used in any legal proceeding under the contract unless the application or an exact copy of the application is included in or attached to such contract.
SCHEDULE "A" - CLAIM CRITERIA
- I. Claims Against Medical Expert.
PPG will take no action against any medical expert involved in a malpractice action against a Member unless the following criteria are met:
1. There shall have been a termination in favor of the Member as provided for in the Plan.
2. The Member shall notify PPG in writing within sixty (60) days of termination in favor of the Member and of the Member's desires of pursued benefits under this Plan.
3. The Member must be a Member in good standing at time of termination in favor of Member in order to qualify for benefits under this Plan.
4. The review and analysis committee of PPG must determine that in connection with the action against the Member the medical expert violated a regulation of the State Board of Medical Examiners and/or committed any dishonest, fraudulent, or unethical act in connection with such action against the Member.
- II. Claims Against The Plaintiff and/or The Plaintiff's Attorney.
PPG will not pursue a claim against a Plaintiff or Plaintiff's attorney involved in a malpractice action against a Member unless the following criteria are met:
1. The claimant must be a member in good standing at the time of termination in favor of member as defined in the Plan.
2. The Member shall notify PPG in writing within sixty (60) days of termination in favor of the Member and of the Member's desire to pursue benefits under the Plan.
3. The notice required by O.C.G.A. § 51-7-84 must have been provided by Member and/or Member's attorney in the malpractice action subject to the claim.
4. The medical and legal analysis committee must determine that the Plaintiff and/or the attorney in prosecuting the malpractice action acted with ill will or for a wrongful purpose and that the underlying malpractice action was without substantial justification. As defined herein "without substantial justification" means that the Plaintiff and/or his/her attorney could present no rational argument in support of the malpractice action based upon the evidence and the law. The underlying action may also be determined to be without substantial justification if upon review the medical legal analysis committee finds that the claim was groundless in law and fact or Plaintiff and/or his/her attorney lacked any reasonable basis for making the claim.
¹ O.C.G.A. §51-7-80
et. seq. provides a legal remedy for those who are victims of abusive litigation. "Abusive litigation" claims may be brought against any person who takes an active part in the initiation, continuation, or procurement of civil proceedings against another shall be liable for abusive litigation if such person acts:
1. With malice; and
2. Without substantial justification.
"Malice" means acting with ill will, or for a wrongful purpose and may be inferred in an action if the party initiated, continued, or procured civil proceedings or process in a harassing manner or used process for a purpose other than that of securing the proper adjudication of the claim upon which the proceedings are based.
Without "substantial justification" when used with reference to any civil proceeding, claim, defense, motion, appeal, or other position, means that such civil proceeding, claim, defense, motion, appeal, or other position is:
1. Frivolous;
2. Groundless in law or fact; or
3. Vexatious.