For physiotherapists, professional liability insurance (PLI) is more than just a mandatory requirement of HCPC registration—it’s a vital safeguard for both you and patients. We know the topic of insurance can be complex and difficult to understand. Here we explain why it is important to understand the basics, what certain terms mean and how they interact.
Why do I need to understand my CSP PLI scheme?
- Insurance is not just another expense—it’s an investment in safeguarding your patients. We can all make mistakes and the PLI scheme is there to compensate patients for your negligent acts and omissions in your work that cause them avoidable harm. The CSP PLI scheme provides you essential insurance in order to practise. The CSP PLI scheme offers medical malpractice and public liability insurance for your work activities within the scope of physiotherapy practice, subject to policy terms and conditions.
- We provide a Group Indemnity PLI scheme as benefit of your CSP membership and we provide eligible members access to the CSP scheme, for which the CSP is the policyholder, not you as an individual member. It doesn't cover everything. Like all insurance policies it is up to you to read the terms and conditions and make sure it meets your needs.
- Many of the terms used in insurance have specific meaning but are often misused and misunderstood. Knowing what the terms mean and what the CSP scheme covers helps you make informed decisions, get advice if needed, and make sure you're fully insured for the risks that arise in your work.
What is 'indemnity'?
- Indemnity means 'securing against loss'. It is the arrangements you must have in place to ensure a patient will be financially compensated should they be harmed by you either by your proven clinical negligence or by a non-treatment related public liability events such as slip, trip or fall in your clinic. One way to provide this cover is to have an insurance policy in place that covers risks that can arise from treating patients.
What is 'insurance'?
- A legal contract between two, or more, parties that is one way of providing indemnity for losses. 'Risk pooling' and 'discretionary covers' are other ways of providing indemnity for losses.
Is physiotherapy a risky profession?
- Compared with other professions, overall the physiotherapy profession has a good risk profile. Our scheme has the advantage of decades of risk analysis and claims experience data. This is reflected in the fact that physiotherapists benefit from lower indemnity premiums than, say, doctors. However, any patient who believes they have not received a 'reasonable standard of care' from you may seek to bring a claim for clinical negligence. All individual physiotherapists, including students, who have contact with patients can therefore be at risk of a claim against them.
What about the 'net worth' of an individual – does that matter?
- The net worth' of an individual patient in itself does not drive the risk of that person sustaining an injury, but will be a subsequent consideration where 'loss of actual and/or future earnings' are considered as part of any damages payments in a successful claim.
Does the complexity of what a physiotherapist does make any difference?
- With the growing number of contexts where a physiotherapist has the first and/or only contact with a patient, there is a growing risk of a physiotherapist failing to either make an appropriate diagnosis, or failing to identify in a timely manner that a medical referral is required. The complexity of the intervention delivered by a physiotherapist does not alone indicate the likelihood of a claim.
- Some areas of practice, even though they are within the overall scope of physiotherapy practice are excluded from the CSP PLI scheme, in order to keep the scheme sustainable for the majority of CSP members. For example, our scheme no longer covers some male professional footballers, some spinal injection therapy modalities, thoracic acupuncture or PRP administration.
What is 'dual insurance' and 'gap insurance'?
- Dual insurance is having two insurance policies which cover the same risks at the same time. Having two policies covering the same risks is generally not advisable. However, some members may need additional insurance to cover any risks that are not covered by the CSP PLI scheme, for example, any of our excluded clinical activities.
- Gap insurance is additional insurance to cover the things excluded by our scheme. It can help protect professionals against uncovered liabilities or exclusions in their main indemnity policy.
- Having two policies covering the same risks is generally not advisable, However, this is easily avoided by the additional 'gap' insurer applying an endorsement to the additional policy to exclude overlapping coverage with the CSP PLI scheme.
What should I consider when seeking regulated insurance advice?
- Type of Cover offered: You should understand the type of risk that the policy is covering. Is it ‘contingent’ only cover? Is it medical malpractice? Is it Public Liability? Does it offer run-off cover and retroactive cover? Providing insurance advice is a regulated activity, so make sure you take advice from a FCA qualified professional and always read the small print of any policy you are considering.
- Policy Exclusions and Limitations: You should be able to describe the type of activities you are undertaking, what specifically you need insurance for, and how you are working, and ensure that policy you are looking at covers your needs. Check for policy limitations and exclusions.
- Support and Advice: A good insurance policy isn’t just about the payout if you need it—it’s about the support provided to you not only when things go wrong, but also as your practice evolves and your insurance needs may change. Access to reliable, expert advice and supportive claims handling may make a significant difference in navigating claims and mitigating risks.
Can the CSP give me bespoke insurance advice?
- No. This because providing insurance advice is a regulated activity and may only be provided by Financial Conduct Authority (FCA) regulated individuals and/or organisations. The CSP is not FCA regulated. The FCA-regulated insurance market is open and competitive, and members are free to approach any insurance broker of their choice.
- The CSP's insurance brokers, James Hallam Ltd, are FCA regulated and are happy to advise individual CSP members.
Glossary of commonly used terms
| Insurance Broker | An intermediary who negotiates a policy of insurance between the policy holder ('insured') and the underwriters ('insurers') |
| Claim | To demand or assert as a right. Facts that combine to give rise to a legally enforceable right. A formal request for compensation made by a patient who believes they’ve been harmed due to a healthcare provider’s failure in care. It typically involves legal action seeking damages for injury, loss, or suffering caused by that negligence |
| Claimant | The person(s) making a claim |
| Contingent Insurance | Contingent insurance provides backup coverage for risks that may not be covered by a primary policy, often stepping in if the main insurance is unavailable or insufficient. Contingent insurance typically relies on the existence of a primary policy—it only activates if that primary policy doesn’t respond, is insufficient, or has lapsed. It’s designed as secondary or fallback coverage, not a standalone solution. |
| Concurrent Insurance | Two or more insurance policies running at the same time and insuring the same risks |
| Costs | The fees involved in bringing a litigation claim. Costs include fees for the lawyers, expert witnesses if used, charges, disbursements, expenses and damages awarded |
| Damages | The financial compensation paid to a claimant to reimburse them for losses and/or injuries sustained as a result of a proven legal wrong-doing eg clinical negligence. The type of damages awarded in clinical negligence claims are classified into 'general' and 'special' damages. |
| Defence | The defendant's opposing view of the claimant's case. The legal principle which a person relies on to justify their actions e.g. Bolam defence of reasonable practice. |
| Defendant | The person(s) and/or organisation against whom a claim is made |
| Discretionary cover | Indemnity offered to an individual, within given limits and principles, but provided entirely based on the decisions and judgments of the cover provider |
| Indemnity | This means 'securing against loss’ and refers to arrangements that are put in place to provide compensation for any losses incurred |
| Insurance policy | A legal contract between two parties to provide indemnity against specified risks materialising. The 'insurer’ takes on liability for the risks after a 'premium’ has been paid by the 'insured’, so that any claims made will be covered by the policy, subject to its terms and conditions and only up to the financial limits insured |
| Insurers | The underwriters to an insurance policy |
| Liabilities | Legal obligations and duties |
| Litigation | An action brought in court to enforce a particular legal right. |
| Medical malpractice | Improper, unskilled, or negligent treatment of a patient by a doctor, dentist, nurse, pharmacist, or other registered health care professional in the course of their work |
| Professional indemnity | In this context means the arrangements in place to cover civil liabilities from claims arising from medical malpractice and professional risk |
| Public liability | In this context it means the arrangements in place to cover civil liabilities from claims arising from your work that are not associated with personal injury to your patient |
| Retroactive Cover | This is the term used to describe cover provided for your previous work when you take out an alternative insurance policy to cover work that is no longer covered under a previous insurance |
| Risk | Potential dangers that, if they occurred, could harm a person, object or event. |
| Risk pooling | One method of risk management used in insurance, in this context most commonly used by NHS organisations. All organisations eligible to join the pool, pay a sum of money that is used to pay for clinical negligence claims against any of the member organisations within the pool |
| Run-off cover | This is the term used to describe the ongoing cover for your previous work. Run-off cover is necessary when you retire or stop doing the type of work in question or the existing insurance policy is cancelled or the terms of the existing policy remove cover for certain activities. There must always be some form of ongoing insurance to deal with claims that arise from previous work |
| Top-up insurance | A second, linked, insurance policy that kicks in once the limits of the primary underpinning insurance policy have been reached |
| Insurance underwriter | The 'insurer' which assumes the liability for the risks insured according to the policy terms and conditions, up to the financial limits specified. Underwriters evaluate the risk and exposures of their clients. Underwriting involves measuring risk exposure and determining the premium that needs to be charged to insure that risk. |
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