A doctor has failed to convince the ombudsman his insurer was wrong to refuse indemnity in a civil case involving alleged sexual assault during a gynaecological procedure.

The medic had medical indemnity cover with MIPS Insurance, and in February 2022 he flagged that he was being investigated by the Australian Health Practitioner Regulation Agency (AHPRA) over accusations made by a patient.

MIPS accepted the notification under the 2021-22 policy and the doctor engaged a law firm to assist him with the AHPRA investigation.

He was charged in May 2024 with three counts of unlawful and indecent assault.

MIPS told the doctor it would not indemnify him over the charges because its policy did not “cover liability or defence costs arising out of or in connection with criminal offences”.

The medic took his case to the Australian Financial Complaints Authority, which ruled in favour of the insurer.

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Now, AFCA has made a separate ruling relating to civil proceedings brought by the patient in April last year.

When notified of this case, the insurer told the doctor it “reserved its rights in relation to extending indemnity for the civil proceedings pending receipt of further information, including the allegations made against him”.

Until the issue of indemnity was decided, it would cover reasonable legal costs.

On June 3 last year, the doctor was served with a statement of claim from the patient who alleged she was “sexually assaulted ... in the course of the gynaecological surgical procedure”.

The following month, MIPS told the doctor it would not cover him for the civil proceedings based on a sexual assault exclusion in his policy.

The medic argued that because the criminal charges had been downgraded to unlawful and indecent assault, the civil case allegations should also be regarded as downgraded. He said unlawful and indecent assault was not sexual assault.

But AFCA says the insurer correctly applied the policy terms.

“The policy excludes cover for liability or defence costs arising out of or in connection with actual or alleged sexual assault or sexual misconduct,” the authority said. “The civil proceedings unequivocally allege the complainant sexually assaulted [the patient]. Further, even if the civil proceedings alleged unlawful and indecent assault, that would still be sexual misconduct.”

See the full ruling here.