Indemnity Opt-Out

Medical Malpractice Opt-Out Form

A confirmation statement for Radiologists working with Teleconsult in the UK to Opt-Out of the Company Medical Malpractice Policy.

Personal Details

Name(Required)

First Last

GMC Number(Required)

Email(Required)

Date(Required)

Why this confirmation is required

Teleconsult must maintain a clear record of individuals who are not covered under the company’s group policy.

Formal confirmation helps us:

Avoid insurance overlaps or claim disputes (double insurance)
Comply with our insurer’s audit and risk management requirements
Ensure every contractor is appropriately indemnified

If you have any questions, please contact matthew.maple@teleconsult.net.

Opt-Out Declaration

I confirm that I wish to opt out of the Medical Malpractice Insurance policy held by TXM Teleconsult Ltd. (Policy Ref: B1389PO4074994125) for the period 1 April 2025 – 31 March 2026. I understand that this opt-out applies solely to my work performed under contract with TXM Teleconsult Ltd.

Opt-Out Confirmation(Required)

I confirm that I am opting out of the corporate insurance policy.

Independent Insurance Confirmation(Required)

I confirm that I hold my own professional indemnity/medical malpractice insurance covering the scope of my teleradiology work with TXM Teleconsult Ltd.

Upload Proof of Insurance

Upload a copy of your current insurance certificate or schedule(Required)

Accepted file types: pdf, jpg, doc, docx, Max. file size: 256 MB.

Consent & Submission(Required)

I confirm that the information provided is true and complete, and I understand that I am solely responsible for maintaining professional indemnity cover for work undertaken for TXM Teleconsult Ltd.

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