Professional liability insurance for healthcare workers

Professional liability insurance for healthcare workers protects the property interests of medical staff relating to the obligation to compensate harm to a patient's life and health caused as a result of medical activity.

Since 23 October 2024, Kazakhstan has had a system of imposed liability insurance for healthcare workers. Healthcare entities are required to conclude a co-insurance contract with the members of the unified insurance (reinsurance) pool under the approved standard form.

Key change: the old version of this page described the product as voluntary. Now a compulsory mechanism in the form established by law applies to medical organisations and to individuals engaged in private medical practice.

Who must conclude the contract

The policyholder is the healthcare entity that carries out medical activity on the basis of a licence and its annexes:

  • a medical organisation concludes a collective contract for its medical staff;
  • an individual engaged in private medical practice concludes an individual contract;
  • other entities do so in the cases and in the manner established by current legislation.

The insurance is paid for by the healthcare entity. Passing the compulsory contribution on to the patient as a condition of receiving care is not permitted without a separate lawful basis.

How the unified insurance pool works

The contract is concluded with the members of the unified insurance (reinsurance) pool. The work is organised through the pool administrator and an online platform used for data exchange, contract conclusion and claims settlement.

The rules provide that a pool member may not refuse to conclude a contract with a healthcare entity that meets the established requirements. Issuance must follow the standard form, not the arbitrary terms of an individual insurer.

What is the subject of insurance

The subject of insurance is the property interests of healthcare workers relating to compensation for harm to a patient's life and health caused as a result of medical activity.

Liability insurance does not pay for the medical service itself and is not voluntary health insurance for the patient. It comes into play when an obligation to compensate the harm caused is being considered in the manner established by law and the contract.

What this policy is not

Product What it protects
Healthcare worker liability A property interest where there is an obligation to compensate harm to a patient
Voluntary health insurance The patient's medical service costs under a programme
Compulsory employee accident insurance (OSNS) The life and health of the employee himself or herself in an industrial accident
Clinic property insurance Premises, equipment and other assets

Which situations may be considered

The grounds for a claim may be harm connected with medical activity, for example in:

  • diagnosis and interpretation of results;
  • prescribing treatment or medicines;
  • performing a surgery, procedure or manipulation;
  • patient monitoring and postoperative management;
  • the organisation of medical care;
  • any other professional act or omission falling within the terms of the system.

An unfavourable outcome does not in itself always mean a professional error. Causation, the nature of the harm and compliance with standards are assessed under the established procedure.

The role of the independent expert commission

To establish the circumstances and the possibility of an insurance payment, the conclusion of an independent expert commission is used in the cases provided for by legislation. The commission analyses medical records and professional actions.

The insurer must not replace medical expertise with its own assumptions. It is important for the patient and the healthcare worker to provide a complete and reliable set of documents.

What the patient should do

  1. Obtain the necessary medical care and document the condition.
  2. Request the medical records: discharge summaries, test results, prescriptions and consents.
  3. Submit a complaint to the healthcare entity describing the event and your claim.
  4. Find out the details of the co-insurance contract and the procedure for applying through the pool.
  5. Take part in the expert review and provide the necessary materials.
  6. Obtain a written decision and the payment calculation.

Do not alter medical records or publish the personal data of other patients. A complex dispute may require the help of an independent lawyer.

What the healthcare worker should do

  1. Ensure the patient's safety and the necessary care.
  2. Inform your manager and the person responsible for insurance.
  3. Preserve the documentation in its original form and make only lawful entries.
  4. Notify the pool administrator or the insurer in line with the procedure.
  5. Do not admit or conceal liability before the established review has taken place.
  6. Cooperate with the expert review and provide professional explanations.

What a clinic should put in place

  • a valid collective co-insurance contract;
  • a full list of the healthcare workers covered;
  • a responsible employee and an internal notification procedure;
  • safekeeping of medical documentation;
  • informing staff about what to do when a claim is made;
  • monitoring of contract terms and the validity of licences;
  • staff training in handling incidents without concealment or pressure on the patient;
  • protection of personal data and medical confidentiality.

Legal assistance costs

The legislation provides for the possibility of applying to the unified pool for reimbursement of actually incurred lawyer's fees when a pre-trial investigation is opened into certain offences connected with medical activity, within the established conditions.

Such compensation is not automatic: supporting documents are required and the procedure must be followed.

Cost of the contract

The old version of the article listed only claims statistics, doctors' qualifications and the clinic's length of service. A modern calculation is made under the rules of the system and takes into account the profile of medical activity, the number of staff, risk categories and other established parameters.

The exact amount cannot be determined without data on the healthcare entity. Since a standard contract and a unified pool apply, comparing ordinary voluntary offers as before is no longer appropriate.

Which documents are required

  • the licence for medical activity and its annexes;
  • registration details of the healthcare entity;
  • a list of healthcare workers and their specialities;
  • information on the profile and volume of medical care;
  • information on previous claims and payments;
  • the data required by the pool's online platform;
  • additional confirmations on request under the rules.

Payment and settlement

An insurance payment is made where there are grounds provided for by legislation and the standard contract. The amount depends on the nature of the harm and the established limits.

If signs of dishonest conduct are identified, payment may be suspended for the period provided for by the rules. The parties must receive written notices and be able to submit documents.

Why insurance does not replace quality of care

The policy compensates the harm provided for, but does not remove licensing, clinical protocols, informed consent, internal control and professional responsibility. A clinic's main task is to prevent errors, not merely to finance their consequences.

An incident reporting system should encourage analysis of causes and improvement of processes, not the concealment of adverse events.

Archive ideas from the 2013 article

In the original version, the insurance was described as voluntary and recommended for private clinics and organisations operating under the right of economic management. The author proposed to:

  • create a qualified and objective system for assessing complex cases;
  • develop mutual insurance and shared bearing of risk by the medical community;
  • take into account a citizen's responsibility for his or her own health;
  • use insurance to guarantee financial compensation to the patient;
  • reduce a clinic's incentive to conceal a professional error.

Some of these ideas have in practice been developed through independent expert assessment and the unified insurance pool. At the same time, the patient's rights and the medical organisation's obligations are determined by current legislation, not by the opinion of an old publication.

The role of Polis Re

Polis Re can explain general insurance concepts and help prepare documents. However, the compulsory contract is concluded by the healthcare entity with the members of the unified pool through the established system.

The insurance service is provided only by insurers that are pool members and hold the necessary licences. An intermediary does not decide on payments.

Summary: since October 2024 the liability of healthcare workers has been insured under a compulsory co-insurance system. For clinics, it is important to conclude the standard contract, cover all staff and set up notification; for patients, to keep their documents and use the established procedure for expert review and payment.

This material is for information purposes only and does not replace medical or legal advice. Check the current rules and the standard contract.