This section applies to:
each insurer that provides professional liability insurance to:
a physician, nurse, dentist, podiatrist, optometrist, or chiropractor licensed under the Health Occupations Article; or
a hospital licensed under the Health – General Article; and
each self–insured hospital.
An entity subject to this section shall report quarterly any claim or action for damages for personal injury if the claim or action:
is claimed to have been caused by an error, omission, or negligence in the performance of the insured’s professional services or is based on a claimed performance of the insured’s professional services without consent; and
resulted in:
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.
A report required under this section shall contain the information required under § 4–405(b) of this subtitle.
A report required under this section shall be filed within 90 days after the end of the quarter during which an event described in subsection (b)(2)(i), (ii), or (iii) of this section occurred.
A report that relates to a physician shall be filed with the State Board of Physicians.
A report that relates to a hospital shall be filed with the Secretary of Health.
A report that relates to a nurse, dentist, podiatrist, optometrist, or chiropractor shall be filed with the appropriate licensing board for these health care providers.
Subject to paragraph (2) of this subsection, a report filed in accordance with this section shall be treated as a personal record under § 4–501(e) of the General Provisions Article.
Each report shall be released to the Maryland Health Care Commission.
An insurer that reports under this section or its agents or employees, the State Board of Physicians or its representatives, and any appropriate licensing authority that receives a report under this section shall have the immunity from liability described in § 5–701 of the Courts Article for any action taken by them under this section.
Failure to report to a person specified in subsection (e)(1), (2), or (3) of this section may result in the imposition by a circuit court of a civil penalty of up to $5,000.
Medical files on applicants and claimants that are compiled by insurers under policies of health insurance or life insurance shall be made available for inspection:
on request of the applicant or claimant;
on request of the agent of the applicant or claimant; or
on request of the applicant, to a physician of the applicant’s choice.
Information that is provided by a physician shall be made available on request:
after a period of 5 years after the date of the medical examination; or
at any time on written authorization of the physician.
An agent that requests to review the medical file of an applicant or claimant must have an authorization to review medical records signed by the applicant or claimant.
Except as provided in subsection (b), (c), or (d) of this section, an insurer, or an insurance service organization whose functions include the collection of medical data, may not disclose the contents of an insured’s medical or claims records.
An insurer may disclose specific medical information or medical data contained in an insured’s medical or claims records to:
the insured;
the insured’s agent or representative; or
on request of the insured, a physician of the insured’s choice.
An insurer, or an insurance service organization whose functions include the collection of medical data, may disclose specific medical information or medical data contained in an insured’s medical or claims records if the insured authorizes the disclosure.
An insurer, or an insurance service organization whose functions include the collection of medical data, may disclose specific medical information or medical data contained in an insured’s medical or claims records without the authorization of the insured:
to a medical review committee, accreditation board, or commission, if the information is requested by or is in furtherance of the purpose of the committee, board, or commission;
in response to legal process;
to a nonprofit health service plan or Blue Cross or Blue Shield plan to coordinate benefit payments under multiple sickness and accident, dental, or hospital medical contracts;
to investigate possible insurance fraud;
for reinsurance purposes;
in the normal course of underwriting, to an insurer information exchange that may not redisclose the information unless expressly authorized by the person to whom the information pertains;
to evaluate an application for or renewal of insurance;
to evaluate and adjust a claim for benefits under a policy or to evaluate and calculate provider fiscal incentives or other types of provider payments;
to evaluate, settle, or defend a claim or suit for personal injury;
in accordance with a cost containment contractual obligation to verify that benefits paid by the insurer were proper contractually;
to a policyholder if:
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
to the insured’s treating providers for the sole purposes of enhancing or coordinating patient care or assisting the treating providers’ clinical decision making, provided that:
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.
This section does not prohibit the use of medical records, data, or statistics if the use does not disclose the identity of a particular insured or covered person.
An insurer that knowingly violates this section is liable to a plaintiff for any damages recoverable in a civil action, including reasonable attorney’s fees.
If a life insurer denies a policy of life insurance to an applicant, the life insurer shall disclose the results of any medical examination administered to determine the applicant’s insurability to a physician of the applicant’s choice if the applicant so requests.
Each insurer providing professional liability insurance to a health care provider in the State shall submit to the Commissioner information on:
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.
In addition to the information required under subsection (a) of this section, for each claim filed with the Director of the Health Care Alternative Dispute Resolution Office under § 3–2A–04 of the Courts Article, each insurer providing professional liability insurance to a health care provider in the State shall submit to the Commissioner the following 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;
age and gender of insured person at time of injury;
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:
an inpatient;
an emergency room outpatient; or
other outpatient;
physician ISO classification, or equivalent classification;
health care provider name and license number; and
policy limits for:
each claim or medical incident; and
annual aggregate;
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:
arbitration;
mediation;
before suit was filed;
after suit was filed, but before trial;
during trial, but before court verdict;
court verdict;
after verdict; or
after appeal was filed;
if settlement was reached or award was made by court verdict, whether the result was:
directed verdict for plaintiff;
directed verdict for defendant;
judgment notwithstanding the verdict for the plaintiff;
judgment notwithstanding the verdict for the defendant;
judgment for the plaintiff;
judgment for the defendant;
for plaintiff, after appeal;
for defendant, after appeal; or
any other;
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;
with respect to the total amount paid to the claimant:
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 summary of the occurrence from which the claim or action arose, including:
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 amount of immediate payment;
the present value of the projected total future payout (price of annuity if purchased); and
the projected total future payout;
if a neutral expert witness is employed under § 3–2A–09(d)(2) of the Courts Article, the findings of a neutral expert witness as to a plaintiff’s future medical expenses or future loss of earnings;
if the case was tried to verdict, the amount of noneconomic damages; and
the total allocated loss adjustment expense by fees and expenses paid to defense counsel; and
the total allocated loss adjustment expense.
The Commissioner:
shall adopt regulations on the submission of information described in this section; and
may adopt regulations that require insurers of other lines of liability insurance to submit reports containing information that is substantially similar to the information described in subsection (a) of this section.
Failure to report in accordance with this section may result in the imposition by the Commissioner of a civil penalty of up to $5,000.
The Commissioner shall report, in accordance with § 2-1257 of the State Government Article, the Commissioner’s findings as to the impact of Chapter 5 of the Acts of the 2004 Special Session of the General Assembly and Chapter 477 of the Acts of the General Assembly of 1994 on the availability of health care malpractice and other liability insurance in the State to the Legislative Policy Committee on or before September 1 of each year.