Assessment of the adequacy of minimum guarantee sums in mandatory medical malpractice insurance in Poland in relation to claims for annuities by injured patients

Abstract

This article examines the adequacy of minimum guarantee sums in compulsory insurance for entities providing medical services in Poland, within the framework of risk management principles and objectives. The authors refer to the principles and functions of the risk management process and the perspectives of various stakeholders. Value of risk is analysed in relation to annuities claimed for bodily injury, using the maximum probable loss approach in cases of serious injury resulting in the loss of the ability to work and lead an independent life at a young age—key components of annuity claims. To determine the value of the damage, the authors conduct example annuity calculations using the scenario method. The calculations were conducted in relation to two medical malpractice cases involving Polish medical entities: one concerning an injured Polish patient, and the other a German patient (illustrating medical tourism from a neighbouring country). In both cases, Polish substantial law applies, as determined by the location of the tort. That is why, the claim assessment is based on life expectancy tables and macroeconomic data from both the Polish and German markets.

The key findings lead to the conclusion that the insurance sums stipulated by the legislator are grossly inadequate in relation to the level of injury sustained. Limited empirical examples and scenario analyses of potential claims for serious bodily injury (without even considering the worst-case scenarios) suggest that the legislator’s minimum insurance sums are exceeded by 4 to over 100 times (for foreign patients), solely for annuities. This has negative consequences—albeit varying across different stakeholders. The findings also show that the value of annuities is indeed spread over time, but it significantly surpasses compensation claims, underscoring the importance of annuities in risk assessment

The results concerning the potential claim values should form the basis for the legislative decisions regarding minimum guarantee sums, especially if we assume the primacy of the proper protection of potentially injured parties. Furthermore, these findings are also important in shaping the scope of protection under voluntary insurance instruments.

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