Many doctors of chiropractic automatically assume that, if they are accused of malpractice, their professional liability company will jump up and defend them vigorously, just as a defense lawyer will fervently defend a client when accused of a crime.

At least, that's the way it is on television and in movies. Defense attorneys are always doing their best to prove their clients innocent, even if they're not. That's the American judicial system.

But malpractice isn't treated as a criminal act and insurance companies aren't motivated by a need to clear a policy holder's name or uphold justice. Their goal is to minimize losses to the company while assuming the financial burden of any lawsuits that are filed.

If you're sued, your main concern is protecting your good name and your assets. Your insurance company, on the other hand, is far more pragmatic about the matter. In exchange for your premiums, it has agreed to assume the bulk of the financial burden if you're sued, but it will take whatever means it can to minimize the amount of money it has to spend.

To do this, it may refuse to defend you at all, settling out of court with the patient even if the case is obviously a frivolous one. After all, it's much cheaper to settle out of court than to go to trial. According to the Physician Insurers Association of America, in 1995, the average defense cost in trials that resulted in plaintiffs' verdicts came to nearly $95,000. For claims that were dropped or dismissed, those defense costs averaged only $10,900. (You can read more about this situation, and how to protect yourself in the CBS Report, "Should you Settle?" (http://www.cbsmalpractice.com/report/articles/jul2501.htm)

Or, it may provide minimal legal support, hoping that the mere pretense of a defense will scare off patients.

Lawyers' fees account for a large portion of defense costs, so the first cost-cutting step for many insurance companies is there. "Some have frozen the hourly rates they pay lawyers, and forced defense attorneys to accept more control over expenses. For instance, some insurers are now limiting or requiring prior approval for payments to medical experts, travel expenses, and even copying costs for medical records and depositions," explained author Berkeley Rice in a Medical Economics article.

The real problem arises because the attorneys are supposed to be working for the doctor, but are being paid by the insurance company. The Medical Economics article contained a statement from Matthew Biscan, a Denver malpractice attorney that provides a great insight into the situation.

"There's no question about a lawyer's traditional obligation to the defendant, but there's also a financial obligation to the company that's paying the bills," Biscan noted. "When a doctor buys a malpractice policy, he gives the insurance company the right to direct his defense if he's sued. As long as their interests don't clash, everything works out fine. But sometimes there's a conflict between the company's financial risk and the doctor's professional risk."

The best way to avoid this situation is to choose a malpractice company whose interests don't "clash" -- one that's owned and operated by chiropractors with the purpose of protecting and promoting chiropractic.

In the 1970s, numerous "doctor-owned" insurance companies sprang up in the medical field, strengthened by the knowledge that M.D.s would work harder to protect "their own." These companies were formed by M.D.s in order to provide an alternative to insurance companies that might have a conflict of interest when it came to defending malpractice cases.

This same attitude of "solidarity" reached the chiropractic profession somewhat later, but was even more important.

An M.D. accused of malpractice does not necessarily reflect on the entire medical profession. However, a D.C. accused of causing an injury or defrauding a patient may make the nightly news. It was thought that an insurance company owned and run by D.C.s would have more incentive to fight for its clients than one with no connection to -- or understanding of -- the chiropractic profession.

This has, indeed, been the case. Non-chiropractic related insurance companies offering policies to D.C.s clearly indicate their lack of understanding by various provisions or exclusions in their policies. Some, for instance, will not cover a doctor for any care provided to pregnant women after their first trimester, or infants under a certain age. In addition, few of these companies retain attorneys or other experts who are knowledgeable about chiropractic or can assist in the defense of a D.C.

A clear indication of their limitations is that their representatives often know nothing about chiropractic and fail even to afford to D.C.s the professional courtesy of addressing them as doctors.

Call a non-D.C.-owned company and ask the person who answers the phone if he or she knows what a subluxation is, or if the company provides chiropractic care for employees. "Many doctors are amazed to find their insurance company is completely ignorant of even the most basic facts about chiropractic," says Timothy Feuling, vice-president of Chiropractic Benefit Services (CBS). "Worse yet, I've even had reports that the representatives from these companies have displayed outright antagonism toward chiropractic. That's not surprising since they more commonly work with medical doctors and often have an anti-chiropractic attitude. Yet, these are the people who are supposed to defend the D.C."

Of course, even among chiropractic-owned insurance companies, there is evidence of the same differences in philosophy characterizing the profession itself.