Chapter 10. Medical Professional Insurers Online Claim Survey Reporting Requirements

In this chapter, the following terms have the meanings indicated.

Terms Defined.

Scope. An insurer that issues professional liability insurance to health care providers in the State shall submit to the Commissioner a financial information report.

Confidential Information.

Filing Requirements.

Scope. Each insurer that issues professional liability insurance in the State shall complete and submit to the Commissioner a closed claim survey form, as described in Regulation .04 of this chapter, for each closed claim.

Within 90 days after the end of each calendar quarter, an insurer shall complete and submit to the Commissioner the closed claim survey forms for claims closed by the insurer in that quarter.

The closed claim survey forms shall be submitted to the Commissioner using an online survey tool made available by the Maryland Insurance Administration.

A closed claim that is covered under a primary policy and one or more excess policies shall be reported only by the insurer that issued the primary policy. The insurer that issued the primary policy shall report the total amount, if any, paid with respect to the closed claim, including any amount paid under an excess policy and any amount paid by the health care provider subject to the claim or by a person other than an insurer on behalf of that health care provider.

A closed claim survey form shall be completed and submitted only for a closed claim that arises out of an act or omission alleged to have occurred in the State or that was covered under a policy of professional liability insurance issued in the State. If the act, omission, or injury alleged in the closed claim allegedly occurred outside the State but was subject to resolution under the substantive laws of the State, a closed claim survey form is not to be submitted on that closed claim, unless the closed claim was covered under a policy of professional liability insurance issued in the State.

A single closed claim survey form shall be filed for any closed claim that arises out of the same alleged acts or omissions of a health care provider and asserts the same injury, regardless of the number of claimants seeking damages on account of that injury. Any amounts identified on the closed claim survey form in connection with such a closed claim shall reflect all amounts paid to all claimants in that closed claim.

If the insurer did not close any claims during a calendar quarter, the insurer need not submit a closed claim survey form but shall so notify the Commissioner in writing within 90 days after the end of the calendar quarter.

Name of insurer;

Name of insurer group;

Claim file identification (ID);

Name of person completing the form;

Telephone number, including area code, of person completing the form;

Date form completed;

Date of injury;

Date injury reported to insurer;

Date claim closed;

Whether the claim was previously reported;

Age of injured person at time of injury;

Gender of injured person at time of injury;

Type of injury, such as wrongful death, permanent disability, or other bodily injury;

Description of injury;

Name of health facility where injury occurred;

Type of medical professional liability policy, such as occurrence, claims made—basic, or claims made—tail;

Type of patient, such as inpatient, emergency room outpatient, or other outpatient;

Physician Insurance Services Office Incorporated (ISO) classification or equivalent classification;

Type of health care provider, such as physician-no surgery, surgeon, psychiatrist and related specialties, nurse, nurse midwife, optometrist, pharmacist, chiropractor, podiatrist, psychologist, dentist, hospital, other health care facility, or nurse anesthetist;

Physician and surgeon classification, including name of specialty;

Health care provider name;

Health care provider license number;

Policy limits for each claim or medical incident;

Policy limits for annual aggregate;

If known, the facility, office, or county where the injury occurred;

Whether the claim is a zero payment claim file;

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

Case or docket number;

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 of the final disposition;

If there was no final judgment or settlement, the reason for the final disposition;

If case did go to trial, whether the case was tried by a jury or tried by a judge;

Total amount paid to the claimant;

Amount paid by the insurer;

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, not including deductible or retention amounts;

If known, the amount paid by the insurer due to settlement or award in excess of policy limits, not including deductible or retention amounts;

If known, the amount paid by other defendants or contributors;

A summary of the occurrence from which the claim or action arose;

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;

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

The amount of past medical expenses claimed by the plaintiff;

The amount of future medical expenses claimed by the plaintiff;

The amount of past lost wages claimed by the plaintiff;

The amount of future lost wages claimed by the plaintiff;

The amount of noneconomic damages claimed by the plaintiff;

The amount of other damages claimed by the plaintiff;

Whether a structured settlement or periodic payment was used, and if so:

If a neutral expert was used, the findings of a neutral expert witness regarding future medical expenses;

If a neutral expert was used, the findings of a neutral expert witness regarding future loss of earning;

If case was tried to verdict:

The total allocated loss adjustment expense;

Of the total allocated loss adjustment expense, the amount representing fees paid to defense counsel;

Of the total allocated loss adjustment expense, the amount of expenses not included in the defense counsel fees;

Whether there was a claim made for extra contractual damages;

The amount claimed for extra contractual damages;

Whether a suit was filed or claim was made for extra contractual damages; and

Where the suit for the extra contractual damages claim was filed, including: