Alternative liability insurance: are you ready for a captive?

Liability insurance is a substantial and increasing expense to most physicians. This expense can be reduced at the cost of increased risk management and claims-handling effort. However, if these efforts are not successful, there is the additional risk that actuarially determined future funding requirements will escalate. This article discusses several mechanisms that radiologists should consider when malpractice insurance expenses have increased beyond acceptable levels or when such insurance is not available at any price. The authors discuss using deductibles, self-insured retentions, and the development of one's own insurance company, that is, a captive.