The DoctorShield | Medical Indemnity Insurance

Chubb Elite Medical Malpractice Insurance

Brunei

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I have read, understood and agree to the terms and conditions, privacy policy and I meet all local regulation to practice my profession.

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The benefit(s) payable under eligible certificate/ policy/ product is(are) protected by PIDM up to limits. Please refer to PIDM’s TIPS Brochure or contact Chubb Insurance Malaysia Berhad or PIDM (visit www.pidm.gov.my).

Chubb Elite Medical Malpractice Insurance

33%

QUOTATION

DISCOUNTED INDIVIDUAL PREMIUM

SPECIAL INDIVIDUAL PREMIUM

(i) This premium is pro-rated for the period to

(ii) For your information, the standard premium for a 12 month period will be

This premium is for the period to

Add-on Coverage

Do you want to add clinic indemnity insurance?

Please select clinic limit of liability

YOUR CLINIC INDEMNITY DISCOUNTED PREMIUM

YOUR CLINIC INDEMNITY PREMIUM

This is the free for you

Do you want to add Automatic Reinstatement

Your Insurance comes with complimentary Automatic Reinstatement now

YOUR TOTAL PAYABLE PREMIUM

Individual:

Clinic:

Total:

Buy now

Email me the Indicative Quotation and Policy Wording

Please refer to the Policy Wording for the full details of benefits, exclusions, terms and conditions,. Click here for Policy Wording, Product Disclosure Sheet and FAQ.

Chubb Elite Medical Malpractice Insurance

66%

Personal Particulars

Please enter the Full name

Allowed character set for full name (A-Za-z., @/)

Please enter a valid DOB

Please enter nric number

Please enter the clinic name

Please enter the No of patients served

Please enter the income earned

Enter the primary location where you engage in your Practice/work

+673

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I agree that No claim have ever been made or lawsuits been brought against me

* Required

Please provide details below

* Required

Are you aware of any errors, omissions, offences, circumstances or allegations which might result in a claim being made against you?

* Required

Please provide details below

* Required

Have you ever been the subject of disciplinary action or investigation by any authority or regulator or professional body?

* Required

Please provide details below

* Required

Have you ever been the subject of a criminal investigation or had criminial charges brought against you? For the purposes of this question, please disregard traffic or minor motor vehicle licensing offences

* Required

Please provide details below

* Required

Have any claims ever been made, or lawsuits been brought against you, your predecessors in business, or any current or former Principals, Partners, Directors, employees, or any other person or entity applying to be insured under this proposed contract of insurance?

Are any of the Principals, Partners, Directors or employees aware, after inquiry, and as of the date of signing this application, of any errors, omissions, offences, circumstances or allegations which might result in a claim being made against you or any person or entity applying to be insured under this proposed contract of insurance?

Have you, your predecessors in business, or any current or former Principals, Partners, Directors, or employees ever been the subject of disciplinary action or investigation by any authority or regulator or professional body?

If you had answered Yes to any of the three questions above, please provide full details and the status of each claim, lawsuits, allegations or matter

span>Please provide details below

* Required

Have you ever been the subject of a criminal investigation or had criminal charges brought against you? For the purposes of this question, please disregard traffic or minor motor vehicle licensing offences

Please provide details below

* Required

If you had answered Yes to any of the questions in this section, please provide full details and the status of each claim, lawsuits, allegations or matter, including

Please provide details below

* Required

Please provide details below

* Required

*All the above questions are mandatory.

By proceeding, you agree that you have complied with all local regulations pertaining to your profession and you have further agreed that you have read, understood and accepted to the Declaration and Authorization, Policy Wording, Privacy Policy and Product Disclosure Sheet for this product.

*Required

Chubb Elite Medical Malpractice Insurance

100%

CONTACT SUPPORT

PLEAESE CALL SUPPORT OFFICE

We need more information to process your application, Will you be ok for our manger to call you at

Chubb Elite Medical Malpractice Insurance

100%

SUMMARY


Plan name:


Classification:


Coverage period:	to


Auto Reinstatement:	Complimentary Auto Reinstatement


:


Type of coverage	Coverage ( )


Individual Coverage
Establishment Coverage

Individual Premium
Clinic Premium
Total Premium (inclusive of 25% commission)
Discount
Nett Premium
SST 8%
Stamp Duty
Final Premium

Choose anyone of the payment option below:

Credit/Debit Card/Wallet/Personal Internet Banking

Business Internet Banking

Chubb Elite Medical Malpractice Insurance

66%

Regulatory Based Considerations

1. Have you been fined, sanctioned or warned by authorities for non-compliance with public policy surrounding Covid-19?

* Required

If Yes,please explain

* Required

Does your specimen professional contract contain disclaimers a/o limitation of liability for COVID-19 or any pandemic? For new contracts going forward?

* Required

Virus Management

1. To your knowledge, have any of your employees, contractors or clients/ customers:

a. Been infected by COVID-19?

* Required

b. Died from COVID-19?

* Required

2. Does the Insured have an action plan to deal with COVID-19 outbreak?

* Required

If so, please enclose document summarizing plan.

* Required

3. Detail action plan by the applicant/ insured to prevent the spread of the virus. Including and beyond any government guidelines and directives. [ e.g. This could include closing the doors for large groups of people, shutting down conventions, stadiums,additional cleaning, sterilization, work from home contingency plan etc.]

* Required

4. Is the facility actively screening and restricting employees, visitors and vendors who meet the following criteria:( as per WHO or local health authorities guidance?) :

a. Exhibit signs and symptoms of a respiratory infection, such as fever, cough, or shortness of breath?

* Required

b. Resides in a community where community-based spread of COVID-19 is occurring?

* Required

c. For residents exposed to COVID-19, as well as those under observation, has quarantine been established for the incubation period of 14 days from the last date of exposure, per the WHO or local health authorities guidance/guidlines?

* Required

*All the above questions are mandatory.

Chubb Elite Medical Malpractice Insurance

66%

Business Continuity Planning

1. How is the insured addressing/mitigating new exposures related to the pandemic in terms of:

a. Serving Customers

* Required

b. Business continuity / operational capabilities amid pandemic [e.g. like supply chain risks, closed borders, and how that affects their ability to carry on with existing professional service contracts etc.]

* Required

2. Has the facility’s Emergency Preparedness team in place for a potential spread of COVID-19?

* Required

3. Does the facility have a designated Infection Preventionist?

* Required

4. When was the facility’s Emergency Preparedness Plan last updated?

* Required

4.1. What changes if any have been made since Jan 1st, 2020?

* Required

4.2. What provisions for disruption of personal protective equipment (“PPE”) and disinfectant supplies have been made?

*Required

4.3 Has the facility implemented World Health Organization Guidance of Infection Control and Prevention of COVID-19?

* Required

*All the above questions are mandatory.

Chubb Elite Medical Malpractice Insurance

66%

Employee Training / Awareness

1. Have all employees including housekeeping, Registry and traveling staff received in-service COVID-19 infection control training, including, but not limited to, personal protective equipment, hand hygiene, cleaning and disinfection of environmental surfaces?

* Required

2. Are employees who have signs and symptoms of a respiratory infection told not to report to work as per WHO or local health authorities guidance/ guidelines?

* Required

3. Do you have control measures in place to have necessary PPE available for staff when it’s determined PPE is needed for the resident?

* Required

4. Have employees been educated on what to do in the event they develop signs and symptoms of a respiratory infection while on-the-job?

* Required

5. Is a transfer process in place for residents with severe symptoms that require hospital admission?

* Required

If yes, does this process include contacting the local health department, emergency medical services, and receiving hospital

* Required

Communication Procedures

1. Is a formalized communication plan in place to disseminate up-to-date information about coronavirus surveillance and prevention to residents and their families?

* Required

2. What is your crisis communication mechanism for responding to media reports and resident/family concerns?

* Required

*All the above questions are mandatory.

The Applicant declares that, after enquiry, to the best knowledge of all persons to be insured the statements set forth herein and if any attachments made hereto are true, and no material facts have been suppressed, omitted, or misstated.

*Required

Chubb Elite Medical Malpractice Insurance

100%

CONTACT DETAIL

Please enter the Full name

Allowed character set for full name (A-Za-z., @/)

Please enter the Full name

+673

Please enter a valid contact number

Please enter a valid email address

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SERVICE DETAILS

Specialization	Percentage(%)


Sum of percentage should be 100 The value must be greater than zero.	Total: 0 %

Notes

You have already bought the policy based on this Quote. If you need further assistance, please contact [email protected] or WhatsApp +60 12-536 0700

Notes

Hi, you have already purchased an indemnity policy for same period. For further info, kindly contact us through [email protected] or WhatsApp +60 12-536 0700

Notice

At DoctorShield, we are continuously working towards bringing you a seamless experience. Today, we are pleased to announce that from 1 April 2021, you can renew your insurance for the year 2022.

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Notes

You have already bought the policy based on this Quote. If you need further assistance, please contact [email protected] or WhatsApp +60 12-536 0700

Notes

You have already bought the policy based on this Quote. If you need further assistance, please contact [email protected] or WhatsApp +60 12-536 0700

Kindly review the details provided and confirm to proceed


Classification
Limit Of Liability
Insurance Start Date
Insurance End Date
Email
Promo Code

Notes

This link has expired. If you need further assistance, please contact [email protected] or WhatsApp +60 12-536 0700

Notes

Kindly note that the promo code you have used is ineligible for you as you are an existing client, Nevertheless, we have replaced it with the right promo code that still ensures you enjoy the discounted premium. Kindly acknowledge so that we can proceed with the renewal. Thank you. If you need further assistance, please contact [email protected] or WhatsApp +60 12-536 0700

Important Notices to the Applicants

Your Duty of Disclosure

Before you enter into a contract of general insurance with an Insurer, you have a duty to disclose to the Insurer every matter within your knowledge that is material to the Insurer’s decision whether to accept the risk of the insurance and, if so, on what terms.
You have the same duty to disclose those matters to the Insurer before you renew, extend, vary or reinstate a contract of general insurance.
It is important that all information contained in this application is understood by you and is correct, as you will be bound by your answers and by the information provided by you in this application. You should obtain advice before you sign this applicaton if you do not properly understand any part of it Your duty of disclosure continues after the application has been completed up until the contract of insurance is entered into.

Non-Disclosure:

If you fail to comply with your duty of disclosure, the Insurer may have the option of avoiding the contract of insurance from its beginning.
If your non-disclosure is fraudulent, the Insurer may also have the right to keep the premium that you have paid.

Change of Risk or Circumstances:

You should advise Chubb as soon as practicable of any change to your normal business as disclosed in this application, such as changes in business activities, location, acquisitions and new overseas activities.

Subrogation

Where you have agreed with another person or company ( who would otherwise be liable to compensate you for any loss or damage which is covered by the contract of insurance) that you will not seek to recover such loss or damage from that person, Chubb will not cover you, to the extent permitted by law, for such loss or damage.

Declaration & Signature

I have read and understood the Important Notices contained in this application.

I agree that this proposal, together with any other information or documents supplied,will form the basis of any contract of insurance.

I acknowledge that if this application is accepted, the contract of insurance will be subject to the terms and conditions as set out in the policy wording as issued or as otherwise specifically varied in writing by Chubb.

I declare, after inquiry, that the statements, particulars and information contained in this application and in any documents accompanying this application are true and correct in every detail and that no other material facts have been misstated, suppressed or omitted.

I undertake to inform Chubb of any material alteration to those facts before completion of the contract of insurance.

We understand that Chubb needs to deal with our personal data to administer our Policy and offer us insurance products and services. To achieve these purposes, We allow Chubb to collect, use and disclose our personal data to selected third parties in or outside Malaysia, in accordance with Chubb’s Personal Data Protection Notice, which is found in Chubb website at http://www.chubb.com/my-privacy. We may contact Chubb for access to or correction of our personal data, or for any other queries or complaints. / Kami faham bahawa Chubb perlu berurusan dengan data peribadi kami untuk mentadbir Polisi kami dan menawarkan kami produk dan perkhidmatan insurans. Untuk mencapai tujuan-tujuan ini, kami membenarkan Chubb untuk mengumpul, mengguna dan memberi data peribadi kami kepada pihak ketiga terpilih yang terletak di dalam atau di luar Malaysia, selaras dengan Notis Perlindungan Data Peribadi Chubb, yang terdapat dalam laman web Chubb di http://www.chubb.com/my-privacy. Kami boleh menghubungi Chubb untuk mendapatkan atau membetulkan data peribadi kami, atau untuk sebarang pertanyaan atau aduan

Policy Backdate Agreement

CHUBB ELITE MEDICAL MALPRACTICE INSURANCE FOR PERIOD OF INSURANCE.

NON-CONTINUOUS RETROACTIVE COVERAGE PERIOD.

Pursuant to Clause 6.12 Licensing of Medical Professionals & Maintenance of Records under this Policy, I hereby acknowledge that Chubb shall not be liable for any Loss or any other payment under this Policy directly or indirectly caused by, arising out of or in any way connected with any Medical Incident occurring from 1 January 2025 until 17 October 2025.

Policy End Date

* Policy end date is always 31'st December

VERIFICATION

Please enter one time password which is sent to your registered mobile number

Please enter the valid otp.

Verification

Please enter your registered mobile number

+673

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Policies tagged to your mobile number

Notes

You are policy has been already renewed, if you need further assistance please contact [email protected] or WhatsApp + 60 12-536 0700

Policy End Date

* Policy end date is always 31'st December