'Slapped' doctor wins dispute over coverage limits

A doctor who says he was the victim of workplace bullying has won a dispute with his insurer over the applicable subclause for his medical indemnity claim.

The policyholder filed a claim after taking Fair Work Commission action after reporting that he was subjected to workplace harassment, bullying, and assault by his co-workers on several occasions.

Medical Insurance Australia accepted the man’s claim and covered associated costs under subclause 1.4 (b) of the policy that protects doctors against bullying and harassment associated with their practices.

The claimant argued that subclause 1.4 (d) of the policy, which covers doctors concerning threats to their safety stemming from their practice, should also be applied in this case.

Subclause 1.4 (b) carried a maximum sublimit of $20,000 whereas subclause 1.4 (d) held a cap of $200,000.

The complainant alleged he had been the victim of three separate incidents involving senior doctors and colleagues.

The man said on September 1 last year, he was slapped across the neck and shoulders by his direct senior doctor after being accused of incorrectly charting the medication of one of her patients. The complainant said later in the day, the same doctor pushed him from behind while he was treating a patient, causing a back injury, and later threatened him.

The claimant also alleged he was hit across the neck by a different co-worker a few weeks later.

The complainant brought proceedings to the Fair Work Commission regarding the allegations and acknowledged the insurer had covered costs. The Australian Financial Complaints Authority (AFCA) panel said the finalisation of the proceedings did not incur any further costs beyond those that had already been paid.

The panel said the dispute focuses on whether section 1.4 (d) applies in instances beyond doctor harassment from patients.

The insurer said the subsection was not triggered because the threat did not come from a person the doctor was providing “practice” to.

The panel acknowledged Medical Insurance Australia’s position but said the subclause was open to broader interpretation.

“The panel accepts a reasonable person could interpret subclause 1.4 (d) as threats that arise out of giving care to a patient, not just threats from a person to whom care is provided,” AFCA said.

“A reasonable person could fairly interpret the perceived threat to personal safety arose out of the complainant’s health care provided to a patient.”

It said in the alleged instances, the complainant had been providing “practice” – defined as healthcare treatment, advice or service – and was threatened because of his efforts.

“The perceived threat to the complainant’s personal safety arose because the senior doctor allegedly accused the complainant of incorrectly charting medication of one of the patients and physically assaulted the complainant,” AFCA said.

The panel determined that subclause 1.4 (d) did apply in this matter, saying it should be read to cover “any threat to personal safety” arising from the complainant providing health care “regardless of who makes that threat”.

But AFCA did not require the insurer to pay further amount, saying there was no continuous threat to the complainant’s safety as he was no longer working at the hospital.

Click here for the full ruling.