Significant changes to Risk Category Guide

MDA National has announced that it will limit cover for certain claims arising from the treatment of gender dysphoria in children and adolescents.

The insurer updated their Risk Category Guide for Medical Students and Medical Practitioners to include an exclusion for claims against doctors arising from aspects of gender transitioning treatment for patients under 18 years (exclusion 26.28), which will come into effect on 1 July 2023.

Exclusion 26.28 of the Professional Indemnity Insurance Policy could be applied if a claim made against a practitioner has arisen “in any way out of: their assessment that a patient under the age of 18 years is suitable for gender transition; or by initiating prescribing of gender affirming hormones for any patient under the age of 18 years.”

MDA National said that the move was made in response to the “high risk of claims arising from irreversible treatments provided to those who medically and surgically transition as children and adolescents.”

However, Medical Forum has received feedback that suggests the decision has caused concern among some in the profession.

MDA President, Dr Michael Gannon, said that the underwriting committee and board grappled with the decision for many months and explained that court cases emerging internationally were a compelling factor.

“We think there are so many unknowns…but we cannot ignore emerging claims in Europe and the closure of The Tavistock Centre in the UK in response to negligence claims brought by some former patients,” Dr Gannon said.

“We came to an authentic view that there is likely to be significant claims from individuals through expressed regret, years down the track, about the decisions they made when they were very young…there might be multimillion-dollar claims.”

In a statement issued to Medical Forum, the insurer stressed that the changes were based purely on insurance risk and were in no way a moral judgement on the provision of transgender healthcare.

“It is important to reiterate that we have not excluded cover for practitioners providing care for patients with gender dysphoria. We have deliberately targeted the areas of exclusion to ensure that we are focusing on those areas of practice that we believe are the greatest risk of future claims,” MDA National said.

“This is an insurance risk decision: the exclusions don’t relate to the treatment of gender dysphoria broadly but rather the initial assessment that a patient under 18 is suitable for gender transition or initiating prescribing of cross-sex hormones for any patient under the age of 18 years.”

The insurer has recommended that assessment and initial prescribing for patients transitioning under the age of 18 years should occur “with the support and management of a multi-disciplinary team, in a hospital setting,” noting that physicians undertaking such treatments within a public hospital or public clinic are likely to be covered by that State or Territory’s indemnity.

“If undertaking such treatments within a private hospital or clinic, [doctors] should check that [they] have employer indemnity for any civil claims that are made against [them] from such services,” the insurer said.

MDA National said it was important to note that the exclusion was limited in scope and did not exclude coverage for:

  • any other healthcare services to children or adolescents who have gender dysphoria
  • the treatment of patients over the age of 18
  • legal representation at an investigation or inquiry arising from the provision of such services

For example, a practitioner is still covered for:

  • ongoing repeat prescribing of cross-sex hormones (based on the medication regime initiated by a non-GP Specialist as part of a multi-disciplinary team)
  • prescription of puberty blockers with the expectation that the Australian standards of care and treatment guidelines for trans and gender diverse children and adolescents are complied with at all times when treating children and/or adolescents with gender dysphoria
  • where a practitioner is indemnified by their employer for their work in gender transition, the MDANI policy will continue to provide cover for the legal costs of investigations and inquiries arising from this work.
  • Counselling and general healthcare involving a patient with gender dysphoria

MDA National Members who provide services in this space and who may be impacted by this change are asked to contact the insurer if they have any questions at: