With millions of newly insured patients expected to fill up thewaiting rooms of doctors' offices as healthcare reform isimplemented, medical malpractice insurers may have reason forconcern about the law's impact on liability trends.

The catalyst for increased utilization is the controversialmandate included in the Patient Protection and Affordable Care Act(PPACA)—better known as “Obamacare”—requiring all individuals tohave health insurance starting in 2014, or pay a penalty via theirfederal income tax form. Subsidies will be made available to helpthose with affordability issues, and Medicaid is being expanded inmost states as well.

In my blog of Oct. 2, I examined the possible spillover effectof the law on workers' compensation, due to concerns about possibledelays in delivery of medical care. But there are potentiallygame-changing implications for professional liability carriers aswell, both positive and negative.

Optimists will point out that, thanks to Obamacare, there willbe a greater emphasis on preventative care, which should meanbetter outcomes and fewer dissatisfied patients tempted to blamethe doctor for their ailments and sue for damages.

Indeed, helping those currently without insurance to getcoverage should prompt more people to set up regular checkups,address minor ailments before they become major ones, and seektreatment for chronic medical conditions when in the past theymight not have been able to afford to do so. To drive home thepoint of being more proactive, the law offers incentives foremployers to form wellness programs and for employees toparticipate in them.

In addition, PPACA provides research funds to study thecomparative effectiveness of various treatment options. Medicalmalpractice insurers could benefit if the insights gained from suchstudies actually improve patient care, resulting in lower claimsfrequency and severity. Therefore, they should consider providingdata to help those studying treatment options establish bestpractices.

PPACA also includes incentives for providers to computerizemedical records. Having an automated system in place might improvepatient care—for example, by more reliably red-flagging aprescription for a drug that would induce an allergic reaction in aparticular patient. Keeping records online might also lead tomore effective coordination of care among providers, againproducing better outcomes and thus avoiding malpractice claims.(There is also a potential cross-selling opportunity to offercyber-liability coverage to practitioners who are computerizingtheir paper records for the first time.)

That's all for the good, but pessimists have reasons forconcern.

For one, if a horde of new patients end up storming medicaloffices waving freshly-minted insurance cards, overwhelming analready shrinking primary care community, doctors might spend lesstime on each case and rush through exams. Many currently insuredpatients might have to wait longer to see a doctor or get adiagnostic test. The result could be more frequent mistakes, delaysin care, and worse outcomes, possibly prompting additional medicalmalpractice suits.

Another element to consider is the likelihood that increaseddemand for medical care will accelerate the use of physicianassistants, nurse practitioners and telemedicine to cope with theoverflow. In my Oct. 2 blog, I credited this as a positive factor fortime-sensitive workers' comp carriers, in that the additionalmanpower might help alleviate delays in seeing patients.

But the flip side of this coin is the possibly negative impacton medical malpractice claims frequency if critical symptoms areoverlooked or misread by less-qualified providers or by doctorsexamining patients virtually.

Computerization of records and studies into more effectivestandards of care may also create problems. Mistakes in datainput—perhaps inevitable given the large influx of new patients tobe processed and old records to be converted—could increasetreatment errors, while providing plaintiff lawyers with a richsource of malpractice evidence. And doctors who stray from anynewly established best practice, no matter what the justification,could find themselves more vulnerable legally.

These risks may still be theoretical. But med mal insurers wouldstill be wise to run worst-case scenarios through their predictivemodels to project how the stress put on the healthcare system as aresult of the new law might be factored into underwriting, pricingand claims systems. They also need to pay close attention tofrequency and severity trends as Obamacare is fully implementedover the next couple of years.

A new healthcare world is emerging, and malpractice insurers aregoing to have to figure out a way to profitably live in it.