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Test person insurance

How to properly insure clinical trials to protect subjects and satisfy the ethics committee.  

When is it mandatory to take out volunteer insurance?

Clinical trials are required to test non-approved drugs or new medical devices. The trial subject insurance discussed on this page is mandatory and serves to protect the trial participants, regardless of any contractual or tortious basis for liability. The insurance is taken out in favor of the trial participant with a special insurer approved within the scope of the AMG or MPG - usually with the help of a special insurance broker such as us as your risk partner.

When is it not mandatory to take out volunteer insurance?

In contrast, it is not mandatory to take out test person insurance if it is not a clinical trial to test a medical device or a medicinal product. Therefore, scientific studies or clinical trials of food supplements, for example, which are often carried out for marketing purposes, are not subject to compulsory insurance. However, voluntary insurance to protect the test subjects should be considered.

Why is Helsinki often mentioned in the context of clinical trial insurance?

This is due to the Declaration of Helsinki. In 1964, the World Medical Association committed itself for the first time to strict compliance with ethical standards in medical research in a self-declaration. Principles:

  • Duty to inform subjects about the risks of participating in clinical trials.
  • Yes, to appropriate compensation in the event of unforeseen damage to health.
  • No, to financial incentives to take risks.

A challenge for governments around the world

In Germany, insurance for test persons has been mandatory since 1978. Across Europe, corresponding laws were only introduced after 1985(introduction of the EU directive on product liability).

What is volunteer insurance?

Subject insurance must cover damage caused by the conduct of a study or other clinical trials in which a person is killed or physically injured or their health is impaired in any way. The insurance must also provide benefits in cases where no one else is responsible for the damage. The main promise of trial subject insurance to trial subjects applies, for example, in the event of permanent disability or death.

Who needs test person insurance?

Sponsors of clinical trials for medicinal products or medical devices are required by law to provide evidence of subject insurance in order to obtain official approval to conduct the trial. Ethics commissions therefore also prescribe a corresponding insurance policy for trial subjects. For other types of clinical trials for which there is no statutory insurance requirement (such as new examination and treatment methods), many sponsors also take out appropriate insurance to protect the test subjects. We are also increasingly seeing that a corresponding promise of insurance can be helpful in recruiting trial subjects and that voluntary benefits such as accident insurance for trial subjects on the way to and from the study center are now commonplace.

Possible additional cover

  • Travel accident insurance for study participants who are on their way to or from the study location (usually a hospital or a research institution or study center). This insurance serves the study sponsor's extended duty of care.
  • For studies in which radioactive substances or ionizing radiation are used on humans for medical research purposes, in some cases the inclusion of radiation liability insurance or additional radiation liability insurance is required in order to obtain approval (proof of nuclear coverage) from the Federal Office for Radiation Protection (BfS).

Premium drivers from the perspective of the test person insurance

Parameters in the evaluation of a test person's insurance (image)

From a risk management perspective, it is essential to create a common risk awareness in the first step, which is largely supported by the risk strategy. Convince your investors in the due diligence process of your next financing round with a risk report and a deep understanding of your risks, thereby safeguarding against risks that could threaten your company's existence.

On the basis of sound risk and insurance management, we develop a decision-making basis for your company. You decide what to insure and what not to insure. Because not every risk is worth insuring. Here is our basic approach:

  • Risk identification in joint risk workshops, coupled with our experience in industry-typical risks for life sciences, FinTech, tech companies and venture capital firms
  • Risk analysis and assessment (software supported on request)
  • Development of a joint risk management strategy (Which risks can be accepted, avoided, reduced or transferred?)
  • Determination of your company's risk-bearing capacity and risk acceptance and impact analysis on KPIs in your balance sheet (how much risk can you afford or do you want to take?)
  • Creation of an insurance strategy (what risk should be borne by the company, what should be insured? Goal: Minimization of risk premiums)
  • Implementation and placement of risk and insurance strategies on the insurance market

 

Your added value through active risk and insurance management:

  • Sustainably increase the security level for your company
  • Value-oriented risk management will boost your valuation in the next financing round
  • Significantly reduce your insurance costs
  • Manage and process claims more efficiently
  • CONSCIOUSLY take risks and promote growth!

 

The importance of this for young growth companies was demonstrated not least by the Silicon Valley Bank case, which was identified as part of a risk management process and - if necessary - would have led to an adjustment of the banking/treasury strategy.

If a clinical trial falls under the German Medicinal Products Act (AMG), according to § 40a General requirements for the clinical trial.

Beyond the requirements of Regulation (EU) No. 536/2014, a clinical trial may only be conducted as long as:

in the event that a human being is killed or the body or health of a human being is injured during the conduct of the clinical trial, insurance exists which also provides benefits if no one else is liable for the damage, in accordance with the following provisions:

  • the insurance must be taken out for the benefit of the person concerned by the clinical trial with an insurer authorized to do business in a Member State of the European Union or another state party to the Agreement on the European Economic Area,
  • the scope of the insurance must be proportionate to the risks associated with a clinical trial and must be determined on the basis of the risk assessment in such a way that at least EUR 500 000 is available for each case of death or continuing disability of a person affected by the clinical trial,

What many companies only become aware of in discussions with the notified bodies is the obligation to provide insurance in accordance with MDR Article 10, Paragraph 16 (2), which is worded as follows:

"Manufacturers shall take precautions appropriate to the class of risk, the nature of the product and the size of the undertaking to ensure adequate financial coverage of their potential liability under Directive 85/374/EEC, without prejudice to more stringent protective measures under national law."

"Thanks to the partnership with our subsidiary "Atrialis GmbH: experts in clinical trial insurance", we are one of the leading specialists in the market. Thanks to our many years of experience, we offer you competent support in the risk structuring and risk transfer of complex international trials as well as in the event of claims under clinical trial insurance."

What does probationer insurance cost? What does excess liability insurance for probands cost?

The insurance premium for volunteer insurance cannot be quantified as a lump sum, but is usually between 30 and 400 euros per volunteer. The insurance premium for test person insurance cannot be quantified in a lump sum. The following criteria are taken into account:

  • Which test medication/procedure etc. is involved?
  • What phase is the clinical trial in? (I-IV, CE approval or not subject to insurance)
  • How many test subjects/patients are taking part in the study?
  • How much sum insured is required and how should this capacity be structured?
 

The last point can become very important, for example, if you have to cover the very high sums insured required by the German Ethics Commission for a particularly risky study project (see also the following section on the special features of international studies). This is where a national provider can reach its limits - in case of doubt, even if it continues to purchase capacity from its (expensive) reinsurers. We discuss this problem, which is particularly common in the insurance of multinational clinical trials, with you at an early stage after we have studied the trial project, as experience has shown that, in addition to the fulfillment of requirements, an insufficient sum insured can become a problem at the end of the trial. In order to avoid uneconomical emergency solutions, we structure this for you at the outset, e.g. by adding 2-3 insurers (keyword: co-insurance & excess liability insurance).

What are the other special features of insuring international clinical trials?

Studies in several countries must comply with local laws and regulations, required sums insured and the issuing of policies in the local language, which is why country-specific policies are necessary. This starts with different legal standards and lower or higher prescribed sums insured per test subject. Local policies can also be used to meet the requirements of statutory subsequent liability periods and the special feature that all participants in the study must be able to read the insurance policy in their local language.

It is also advisable to provide a no-fault indemnity for volunteers to ensure the required insurance coverage according to local laws. This no-fault insurance is required by law in many countries where you may be conducting your study.

Or would you have thought that the maximum compensation per test person within the EU states is subject to an extreme range? The test subject in the Baltic states has to settle for a maximum of EUR 29,000, while in France he can claim up to EUR 1 million(!). However, in the case of large, international studies, it is also important to bear in mind that the sum insured should cover the entire risk. Here it can be very advisable to purchase a higher sum insured in a risk-oriented manner than the maximum legally required in one country of the study. Following a risk dialog with our specialists, this should be structured accordingly with an excess liability for the trial subject insurance or in a "co-insurance". With a view to any local insurance that may be required for regulatory purposes, e.g. for the study center in Brazil, it is important to agree on a so-called DIC / DIL component. This harmonizes the insurance cover not only in terms of amount, but also in terms of content, taking into account the insurance law requirements of the respective countries, as the local possibilities of the respective insurance markets differ greatly. We can also advise you on this if it is relevant to your project.  

We are familiar with these challenges and, thanks to our many years of intensive contact with leading insurance companies from international projects in almost every country in the world, we can offer you a solution for test person insurance. Even with the most important insurance market in the world Lloyd's of London in order to organize special studies and higher levels of cover if required. Last but not least, we recently joined forces with our experienced colleagues at Atrialis GmbH - experts in clinical trial insurance (formerly aric Advances Risk & Insurance Consulting, known for its "aric trial insurance approach", among other things) and pool our experience. In future, this will also be reflected in the addition of a medical doctor to the team, who we will involve accordingly in the event of a claim.

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1

Your question to us

We are highly specialized, so we can tell you immediately whether this is our area of expertise (e.g. fire insurance for a sawmill is not), but international proband insurance is.

2

Advice & proposed solution

As an independent insurance broker, we work with all insurers relevant to our specializations in the continental European and UK markets to ensure that the study center in Brazil is also covered locally and compliantly. As part of our consultation, we will discuss with you the optimal marketing strategy for your risk for our tender.

Franziska Merz

Senior Risk Advisor Financial Lines

3

Market comparison & recommendation

Depending on the specific requirements, we offer various insurance solutions, whether it is a trial subject insurance for Europe through a single insurer or a structured, worldwide program with excess insurance, which enables sufficient capacity to be secured. Our aim is to present you with a range of options so that you can make the best decision regarding your choice of provider.

It is then ultimately up to you to decide whether we should implement the proposal

4

Promise of care

Your risk changes (e.g. new study center in Belarus insurable at all?), we discuss with you possible adjustment options or urgent need for changes to the insurance. Claim? You call us first and we will handle the claim for you on an equal footing with the insurers. Risk Partners & Atrialis - experts in clinical trials, your insurance experts!

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