Medical Malpractice Instructions
Definition of a health care provider and medical malpractice insurance per Section 383.100:
- Subsection (2) "Health care provider" includes physicians, dentists, clinical psychologists, pharmacists, optometrists, podiatrists, registered nurses, physicians' assistants, chiropractors, physical therapists, nurse anesthetists, anesthetists, emergency medical technicians, hospitals, nursing homes and extended care facilities; but shall not include any nursing service or nursing facility conducted by and for those who rely upon treatment by spiritual means alone in accordance with the creed or tenets of any well-recognized church or religious denomination.
- Subsection (3) "Medical malpractice insurance" means insurance coverage against the legal liability of the insured and against loss, damage, or expense incident to a claim arising out of the death or injury of any person as a result of the negligence or malpractice in rendering professional service by any health care provider.
Definition of who is to file medical malpractice claim data per Section 383.105:
- Subsection (1) Every insurer providing medical malpractice insurance to a Missouri health care provider and every health care provider who maintains professional liability coverage through a plan of self-insurance shall submit to the director of the department of insurance a report of all claims, both open claims filed during the reporting period and closed claims filed during the reporting period, for medical malpractice made against any of its Missouri insureds during the preceding three-month period.
- Subsection (3) As used in this section, "insurer" includes every insurance company authorized to transact insurance business in this state, every unauthorized insurance company transacting business pursuant to chapter 384, RSMo, every risk retention group, every insurance company issuing insurance to or through a purchasing group, and any other person providing insurance coverage in this state. With respect to any insurer transacting business pursuant to chapter 384, RSMo, filing the report required by this section shall be the obligation of the surplus lines broker or licensee originating or accepting the insurance.
Definition of what is a claim, companion claim and date of this payment or closure per Section 383.105:
- A claim/demand for payment of damages is received in writing from claimant, a lien letter was received or a lawsuit has been filed
- A companion claim, each named defendant that is covered whether or not they are the named insured on the policy or covered employees or agents of a corporation, association or the trust, then any claims made against such employees/agents should be reported as such to our office. For example, if a covered physician and nurse were named as defendants in a medical malpractice claim, (in addition to the hospital) three separate reports would be submitted to our office. Each such defendant is considered a named insured for reporting purposes and should be identified in Item 3a. All indemnity and expenses should be tracked and reported separately for each defendant. Claim identification numbers should be unique for each claim file.
- Date of this payment or closure is defined when the insurer closed the claim.
Open claims: No lawsuit filed, Items 1 through 16 must be completed, if a lawsuit has been filed, Items 1 through 20f must be completed (excluding 17, 18, 19 and 20).
Closed reports:The total form must be completed. All claims closed without payment and claims with payment must be reported. Report all dollar mount in whole dollars, all dates as MM/YYYY.
The following addresses additional clarification when reporting Missouri medical malpractice claim data per Section 383.105.
- Item 1b Claim File Identification - assign a unique code to each claim.
- Item 1c NAIC Group & Company Code - use the NAIC assigned nine-digit code beginning with the group four-digit code followed by the company five-digit code. Excess/surplus lines companies that do not have an assigned NAIC nine-digit code use the assigned NAIC alien number. DIFP will assign a unique nine-digit code to each self-insured.
- Item 2d Original Claim ID Number - if a claim is reported as a reopened claim, indicate the original claim identification number used when the claim was previously filed with the DIFP.
- Item 3 License Number - provide the Missouri license number assigned by the appropriate licensing board http://pr.mo.gov. In those instances where an entity does not possess a license, enter the federal identification number.
- Item 3a Insured's Name - the named insured or any named defendants that are covered under a corporation policy or self-insured trust policy. For example, in some instances, a corporation is the designated policyholder, and the health practitioner employees or agents of the corporation are also considered to be covered policyholders. Separate forms must be completed for each name defendant with the defendant named as the insured, and all costs tracked separately for each where applicable.
- Item 6a Profession Code must correspond to Item 6b Specialty Code. Both fields are required and must be completed.
- Item 10a-d Person Instituting Claim if Injured Party is Deceased or a Minor - the name and address must be completed when Item 9a is either deceased or a minor.
- Item 14a Allegation Categories and Codes - this is a required field that corresponds to the code used by the National Practitioner's Data Bank.
If suit has been filed, Item 20b Name of Court (enter full name of court including county) and Item 20c Docket Number and Item 20d Date suit was filed must be completed. When applicable, these fields apply to both open and closed claims.
- Item 21a Economic Damages and/or Item 21b Non-Economic Damages - the damages must be separated by the portion that is economic and/or non-economic if an indemnity payment is reported in Item 21. These fields apply to closed claims only. The reporting entity should ensure that the allocation of total indemnity into its constituent economic and non-economic portions corresponds as closely as possible to any documentary evidence provided as part of the claim resolution process. Simply allocating the total indemnity on a fixed formula (say, 50% to economic and non-economic portions) is not acceptable.
- Item 21a Economic Damages - if an amount is reported for economic damages, Items 26-30, detailing incurred and expected wage and medical loss, and other expenses must be completed. These amounts may or may not equal the exact amount reported in Item 21a. These fields are required for closed claims only
- Item 24 Loss Adjustment Expense paid to Defense Counsel and/or Item 25 All other Allocated Loss Adjustment Expense Paid by you - especially when a lawsuit is filed, one or both are required fields, and apply to closed claims only.
- Item 16 Companion Claims - the unique claim number assigned to any companion. All cost and indemnity awards for multiple defendants in a single case must be reported separately for each defendant. Allocation of amounts between defendants should be based on an assessment of comparative fault for each defendant.
- Item 18 Claim Disposition Code - appropriate code needs to be identified even if claim was closed without payment or abandoned. This field is required to be completed.
- Item 19 Settlement Code - appropriate code needs to be identified even if claim was closed without payment or abandoned. This field is required to be completed.
- Item 20 Court Code - appropriate code needs to be identified even if no court proceedings were initiated and claim was closed without payment or abandoned. This field is required to be completed.
- Item 20b Name of Court - complete name of court for example, St Louis City Circuit Court.
- Item 20c Docket Number - docket or case number given by court identifying lawsuit filed.
- Item 20d Date Suit was Filed - date lawsuit was filed in court.
- Item 20e County FIPS Code - appropriate county FIPS code which identifies county of court location.
- Item 20f District Court Code - appropriate district court code which identifies county court district.
Please make sure the forms are typed or printed clearly, forms that are not legible will be returned.