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ASHRM CPHRM Exam - Topic 2 Question 10 Discussion

An organization has recently changed insurance. The risk manager receives a claim from a former patient on July 3, 2004, claiming injury and alleging negligence by the surgery staff on September 5, 2003. Which of the following would apply to this claim?a claims-made policy for the period 1/1/03 to 1/1/04 with a retro date of 1/1/02an occurrence policy for the period 1/1/03 to 1/1/04a claims-made policy for the period 1/1/03 to 1/1/04 with a 1-year tail coveragean occurrence policy for the period 1/1/04 to 1/1/05
C) 2 and 3 only
A) 1 and 2 only
B) 1 and 4 only
D) 3 and 4 only

ASHRM CPHRM Exam - Topic 2 Question 10 Discussion

Actual exam question for ASHRM's CPHRM exam
Question #: 10
Topic #: 2
[All CPHRM Questions]

An organization has recently changed insurance. The risk manager receives a claim from a former patient on July 3, 2004, claiming injury and alleging negligence by the surgery staff on September 5, 2003. Which of the following would apply to this claim?

a claims-made policy for the period 1/1/03 to 1/1/04 with a retro date of 1/1/02

an occurrence policy for the period 1/1/03 to 1/1/04

a claims-made policy for the period 1/1/03 to 1/1/04 with a 1-year tail coverage

an occurrence policy for the period 1/1/04 to 1/1/05

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Suggested Answer: C

According to Health Care Risk Management standards supported by ASHRM and the American Hospital Association Certification Center, coverage determination depends on both the policy trigger and relevant dates. The alleged negligence occurred on September 5, 2003. Under an occurrence policy in effect from 1/1/03 to 1/1/04, coverage applies because the event occurred during that policy period, regardless of when the claim was filed. Therefore, option 2 applies.

For a claims-made policy covering 1/1/03 to 1/1/04, coverage would require that the claim be made and reported during the policy period unless tail coverage is in place. Because the claim was received on July 3, 2004, after expiration of the 1/1/03 to 1/1/04 claims-made policy, coverage would apply only if a 1-year tail was purchased. Thus, option 3 applies.

Option 1 would not apply because the claim was made after the claims-made policy period ended, and no tail is specified. Option 4 would not apply because occurrence coverage from 1/1/04 to 1/1/05 would not cover an event that occurred in 2003.

Risk financing objectives emphasize understanding policy triggers, reporting requirements, and tail coverage. Therefore, the applicable coverage scenarios are the occurrence policy for 2003 and the claims-made policy with tail coverage.


Contribute your Thoughts:

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Dianne
5 hours ago
This claim is from 2003, so it falls under the occurrence policy.
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Leanora
5 days ago
I feel like I need to double-check the tail coverage concept. If the claim was made after the policy ended, does that mean option 3 is definitely out?
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Shantay
11 days ago
I practiced a similar question where the timing of the claim was crucial. I think the occurrence policy might apply here since the injury happened before the policy period.
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Eric
16 days ago
I'm a bit confused about the retroactive date. Does that mean the claim could still be covered under the claims-made policy?
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Jess
2 months ago
I remember that claims-made policies only cover claims made during the policy period, so I think options 1 and 3 might be relevant.
upvoted 0 times
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