The neglect of a professional duty of care by a professional. It is a negligent act, error or omission that, if it causes a loss, will make the professional liable in law to a client or third party to whom duty is owed. (See Hedley Byrne v. Heller & Partners (1964)). See PROFESSIONAL INDEMNITY INSURANCE; VOLUNTARY ASSUMPTION OF THE RISK.
Tag: RAW
Professional partnership
Two or more people who work together to provide a public service, such as health care.
Professional reinsurer
Insurance company that specializes in selling and servicing proportional reinsurance and nonproportional reinsurance with the objective of making a profit.
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A term used to designate a company whose business is confined solely to reinsurance and the peripheral services offered by a reinsurer to its customers as opposed to primary insurers who exchange reinsurance or operate reinsurance departments as adjuncts to their basic business of primary insurance. The majority of professional reinsurers provide complete reinsurance and service at one source directly to the ceding company.
professional review organizations (PROs)
1. Groups of licensed physicians and osteopaths engaged in the practice of medicine or surgery in a particular area, formed to ensure adequate review of the services provided by the various medical specialties and subspecialties in the area, as well as providing DRG validation. 2. A group of physicians working with the government to review cases for hospital admission and discharge under government guidelines. Under the Medicare program, PROs are known as Quality Improvement Organization (QIO) programs. See also peer review and Quality Improvement Organization (QIO) program.
Professional sports teams exclusion
Cover in respect of professional sports teams is a standard exclusion in a personal accident catastrophe excess of loss reinsurance cover. The sums insured are high and there is an accumulation risk.
Professional Standards Review Organization (PSRO)
Replaced by Utilization and Quality Control Peer Review Organization (PRO) in 1982 and in 2003 called Quality Improvement Organization (QIO) program.
Profile
1. Compilation of financial data maintained by an insurance carrier for reimbursement purposes. Also see physician’s fee profile. 2. Data segregated by specific time period (e.g., quarterly, annually) and target area (e.g., facility or state) for the purpose of identifying patterns. This may include diagnoses, procedures, diagnosis-related groups, and so on.
Profile analysis
Examination and assessment of activities of patients and physicians to show trends and patterns of health care services.
Profile year
Twelve-month period that traditional indemnity insurance companies maintain to determine allowable charges.
Profiling
Evaluation of a physician’s practice that includes demographics of patients, morbidity data, mortality rates, and treatment patterns. Also called physician profiling.