Title 4. General Requirements for Insurers — Subtitle 4. Disclosure Requirements for Insurers

a physician, nurse, dentist, podiatrist, optometrist, or chiropractor licensed under the Health Occupations Article; or

a hospital licensed under the Health – General Article; and

a final judgment in any amount;

a settlement in any amount; or

a final disposition that does not result in payment on behalf of the insured.

the insured;

the insured’s agent or representative; or

on request of the insured, a physician of the insured’s choice.

the policyholder does not further disclose the specific medical information; and

the information is required for an audit of the billing made by the insurer to the policyholder; or

a disclosure under this item is subject to the additional limitations in § 4–307 of the Health – General Article on disclosure of a medical record developed primarily in connection with the provision of mental health services;

medical information or medical data contained in an insured’s medical or claims records may be disclosed only in accordance with the federal Health Insurance Portability and Accountability Act of 1996, any regulations adopted under the Act, and any other applicable federal privacy laws, and disclosures under this item may not be made in violation of the prohibited uses or disclosures under the federal Health Insurance Portability and Accountability Act of 1996;

an insurer or an insurance service organization that discloses medical information or medical data contained in an insured’s medical or claims records in accordance with this item shall provide a notice consistent with the requirements of 45 C.F.R. § 164.520 specifying the information to be shared, with whom it will be shared, and the specific types of uses and disclosures that the insurer or insurance service organization may make in accordance with this item;

the notice required by item (iii) of this item shall include an opportunity for the insured to opt–out of the sharing of the insured’s medical information or medical data contained in the insured’s medical or claims records with the insured’s treating providers for the purposes identified in this item; and

if an insurer or an insurance service organization discloses medical information or medical data through an infrastructure that provides organizational and technical capabilities for the exchange of protected health information, as defined in § 4–301 of the Health – General Article, among entities not under common ownership, the insurer is subject to the requirements of §§ 4–302.2 and 4–302.3 of the Health – General Article.

the nature and cost of reinsurance;

the claims experience, by category, of health care providers;

the amount of claim settlements and claim awards;

the amount of reserves for claims incurred and incurred but unreported claims;

the number of structured settlements used in payment of claims; and

any other information relating to health care malpractice claims prescribed by the Commissioner in regulation.

An insurer subject to the reporting requirement under paragraph (1) of this subsection shall notify the Commissioner of any information that the insurer considers proprietary.

In accordance with § 4–335 of the General Provisions Article, the Commissioner shall deny inspection of any part of a report submitted under paragraph (1) of this subsection that the Commissioner determines contains confidential commercial information or confidential financial information.

name of insurer;

name of insurer group;

claim file identification;

name of person completing form;

telephone number (area code); and

date form completed;

date of injury;

date injury reported to insurer; and

date claim closed;

type of injury;

description of injury; and

if the claim is against a health care provider covered under a policy issued or delivered by the insurer completing this form, the name of the health facility where the injury occurred;

type of medical professional liability policy;

if known, whether the patient was:

physician ISO classification, or equivalent classification;

health care provider name and license number; and

policy limits for:

if known, the facility, office, or county where injury occurred; and

the case number and the name and location of the court where the suit was filed and the case was tried;

whether settlement was reached or award was made at one of the following stages:

if settlement was reached or award was made by court verdict, whether the result was:

if there was no final judgment or settlement, the date and reason for the final disposition; and

if the case did go to trial, whether the case was tried by a jury;

the amount paid by the insurer;

the amount paid by the insured due to retention or deductible;

if known, the amount paid by an excess carrier;

if known, the amount paid by the insured due to settlement or award in excess of policy limits;

if known, the amount paid by other defendants or contributors; and

the total amount of settlement or award;

a description of the misdiagnosis or alleged misdiagnosis made, if any, of the patient’s actual condition;

a description of the procedure giving rise to the claim; and

a description of the principal injury giving rise to the claim;

whether a structured settlement or periodic payment was used in closing this claim; and

if a structured settlement or periodic payment was used:

the total allocated loss adjustment expense by fees and expenses paid to defense counsel; and

the total allocated loss adjustment expense.