Read the case study presented at the end of Chapter 11, You Be the Judge, which begins, “During an unexpected heat wave,…” (Guido, p. 195): What provisions of an insurance policy would you consult to determine if an insurance company should pay such a claim, and what would the limits of the liability be? Is the nursing home insurance company correct in saying that this is a professional judgment issue? Which insurance company (the nursing home’s or that of the administrator of the nursing home, assuming she has coverage) should pay the court-ordered judgment? How would you decide the case? Please combine all of these responses into a single Microsoft Word document for submission. Submit only completed assignments (not partial or “draft” assignments). Be thorough in your responses to adequately address all aspects of each question.

Part Two:

Limits of liability

Based on the provided provisions of professional liability insurance policy, some of the categories can be identified from the case. However, there are others that are not easily identifiable. Be that as it may, several of the components can be identified with ease and their examples easily perceived. Based on the case, the individual professional liability is restricted to $3,000,000 in aggregate or $1,000,000 per claim. The following categories were identifiable from the case.

Declaration

The policyholder’s name is stated in the declarations as Judy Doe, who was a registered nurse working in an acute care hospital, community health center between 2018 and 2019. As per the contract, the insured party committed to informing the insurer about the details of every beneficiary that would be compensated in case of anything. Additionally, she agreed to work with an insurance claim agent and offered her complete cooperation.

Deductibles

The insurance policy doesn’t specify the amount the policyholder needs to pay out of pocket in the event of a claim, but it does state that the insurer will reimburse any reasonable expenses incurred by the insured if requested by the company. The policy also has certain exclusions, such as any hospital, sanitarium, clinic, laboratory, or company that is not listed in the declarations, and it does not cover the duties of the insurer as a nurse anesthetist or nurse-midwife.

However, there is an exception to this when the insured serves as a member of a partnership that is formally accredited or on a board or committee of a hospital or professional organization, as mentioned in the declarations (Brous, 2017). Injuries as a result of the insured or anyone for whom the insured is legally responsible during the policy period are covered under the policy.

Defense Costs

Based on the case, in the event a claim is made against an insured business, the insurance company will be required to cover all expenses incurred, any interest on the final judgment amount, and any legal or operational fees charged to the insured (Brous, 2017)

Coverage Conditions and Supplementary Payments

The terms of coverage outline the responsibilities of the insured based on an incident, claim, or legal action, and the insured must inform the company in writing. The insured is expected to promptly provide any legal documents, such as requests, notices, or summonses if they are sued. The company will also cover all legal fees and expenses incurred in the company’s defense and any reasonable expenses incurred by the company in investigating or defending the case.

Challenges and Personal Beliefs

The disorganization made it hard to locate certain sections, leading to multiple issues for me. I would not consider obtaining this coverage for my personal or professional liability because it is difficult to comprehend and has several gaps.

Case 3: Insurance Policy

Provisions to Consult

Based on the case, different areas of concern can be consulted in determining the insurance policy. Some of the policies include declarations, deductibles, covered injuries, rights reserves, supplementary payments, and coverage requirements (Lee et al., 2019).

Professional Judgment Issue

The assertions of the insurance company representing the nursing home that the problem in the case study is a result of the administrator’s professional judgment is correct. The administrator’s decision not to turn on the air conditioner, which ultimately led to the deaths of four residents, was based on their knowledge and expertise and is therefore considered an issue of professional judgment. Rather than being sued by the insurer representing the nursing home, the professional liability insurance of the administrator ought to cover any claims that might arise.

Insurance Companies to Pay the Court-Ordered Judgment

The nursing home insurance company is justified in stating that the decision was professional. The decision comes from the event leading to the deaths of nursing home residents (Paté, 2016). If the administrator has professional liability insurance, the insurance company must pay for any court-ordered judgment.

Deciding on the Case

The case focuses on the circumstances leading to the deaths of the patients within the nursing home. Based on the understanding of the case, the administrator made a professional choice which led to unforeseen negative outcomes. As a result, the professional liability insurance that the administrator is subscribed ought to be responsible for paying any fines or restitutions ordered by the court.

Conclusion

This paper focused on analyzing the impact of documentation and lack thereof in the he