By Tom Murphy
Behavioral healthcare, and specifically addiction treatment, is rapidly growing and changing as the United States tries to move away from the failed “war on drugs” to the “demand reduction” model. Additionally, the Affordable Care Act has not only increased the number of insured patients seeking care, it has managed to bring behavioral healthcare front and center in the debate on the demand for behavioral health and recovery treatment.
Along with the increase in the patient base and various methods of available treatment, there is an upward trend in the frequency and indemnity payments for professional liability claims in behavioral healthcare and addiction treatment. Typical allegations involve mismanagement or misapplication of suicide-risk information, improper prescribing or management of medications, as well as other errors and omissions involving care. Sexual misconduct is another area of concern that can lead to large settlements by either the provider or the professional liability carrier. Carriers are also starting to see an increase in general liability claims related to facility amenities such as swimming pools. General agents who are not familiar or experienced with recovery clients are not properly insuring many of these exposures. You should always review your professional and general liability coverage with an experienced behavioral healthcare and recovery insurance specialist.
One of the most prevalent liability concerns involves “level of care” decisions, in which the provider recommends a certain level of care that is denied by the insurer. This can often leave the provider in a bad position, with limited options that will usually cause them to take a financial loss if the patient cannot pay for the recommended treatment. It can also lead to a “can’t win” situation if the provider takes the loss and the insurer starts to take advantage of the provider’s good-faith effort to do what is best for the patient by expecting the additional care without having to pay the bill. With the ever-changing regulations and available treatment in the behavioral health and recovery segment, it is imperative to navigate these challenges with legal and insurance specialists who can help to reduce these liability trends and anticipate others that can have an impact on your revenue and growth.
Tom Murphy is a medical malpractice insurance and workers’ compensation specialist with Danna-Gracey. He can be reached at or (800) 966-2120 or Murphy@dannagracey.com.