Statutory Authority:
RSA 400-A;15,
Ins 3801.01
Purpose. The
purpose of this chapter is to identify the rules and guidelines to be used to
report detailed claim information applicable to medical professional liability
insurance.
Source. #8754, eff
12-1-06
Ins 3801.02
Scope. This chapter
shall apply to all insurers writing medical professional liability insurance in
this state.
Source. #8754, eff
12-1-06
Ins 3801.03
Definitions.
(a) “Act or omission code” means the 3-digit code
provided by the insurance carrier, that identifies the type of loss category
related to:
(1) Diagnosis;
(2) Anesthesia;
(3) Surgery;
(4) Medication;
(5) Intravenous
and blood products;
(6) Obstetrics;
(7) Monitoring;
(8) Biomedical;
(9)
Equipment/Product; and
(10)
Miscellaneous.
(b) “Claim” means a request for indemnification submitted by a health care provider
pursuant to a medical professional liability insurance policy for which an
insurer has established a loss or loss adjustment expense reserve amount at any
point in time.
(c) “Claim number” means a unique identifying
code assigned to each claim by the insurer.
(d) “Closed claim” means a claim that has been settled,
or otherwise disposed of, where the insurer has made all indemnity and expense
payments on behalf of the insured.
(e) “Commissioner” means the insurance
commissioner of the state of
(f) “Common statistical base classification code”
means the Insurance Services Office's 5-digit code used to identify
professional liability risk classifications.
(g) “Companion claim” means a separate claim for
each named defendant that is covered under the policy, whether or not they are the
named insured on the policy or covered employees or agents of a corporation,
association or trust.
(h) “Court code” means the 2-digit code
identifying the result of court proceedings.
(i) “Date of payment or closure” means the date
on which the insurer closed the claim.
(j) “Health
care provider” means:
(1) In the case
of a natural person, a person, licensed or approved by the state to provide
health care or professional services, including, but not limited to:
a.
Acupuncturists;
b. Allied
health professionals;
c.
Chiropractors;
d. Dentists and
dental hygienists;
e. Emergency
medical care provider;
f. Licensed
dietitians;
g. Mental
health practitioners;
h. Midwives;
i. Naturopaths;
j. Nurses;
k. Occupational
therapists;
l.
Optometrists;
m. Pharmacists;
n. Physical
therapists;
o. Physician
assistants;
p. Physicians
and surgeons; and
q. Podiatrists.
(2) In the case
of an institution:
a. Ambulance or
other corporation;
b. Ambulatory
care clinic;
c. Health maintenance
organization;
d. Hospital;
e. Long-term
care facility;
f. Pharmacy;
g. Residential
care facility;
h. Facility or
entity licensed by the state to provide health care services; or
i. An officer, employee
or agent of any such person or institution acting in the course and scope of
his employment; and
(3) Where the
context so permits, both persons and institutions as listed in (1) and (2)
above.
(k) “Insurance Services Office (ISO)” means the property
and casualty, for-profit insurance advisory entity that assists insurers in the
collection of statistical information and ratemaking-related activities.
(l) “Insured” means the policyholder and any
named defendants covered under a medical professional liability insurance
policy.
(m) “Insurer” means every:
(1) Insurance
company authorized to transact insurance business in this state;
(2)
Unauthorized insurance company transacting business pursuant to RSA
406-B;
(3) Risk
retention group;
(4) Insurance
company issuing insurance to or through a purchasing group;
(5) Captive
insurance company;
(6)
Self-insured person or entity; and
(7) Other
person providing insurance in this state.
(n) “License
number” means the number assigned by the state professional licensing board
associated with the applicable health care provider, or the federal identification number.
(o) “Loss
adjustment expense” means the dollars expended to defend, manage, or otherwise process
a claim on behalf of the insured health care provider.
(p) “Medical
professional liability 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.
(q) “NAIC group
and company code” means the NAIC - assigned 9-digit code beginning with the
group 4-digit code followed by the company 5-digit code or the assigned NAIC
alien number.
(r) “National
Practitioner's Data Bank” means the data maintained by the U.S. Department of
Health and Human Services and established by the Health Care Quality
Improvement Act of 1986, Title IV of Public Law 99-660 as amended.
(s) “Open
claim” means a claim that has yet to be settled, or otherwise disposed of,
where the insurer expects to make future indemnity and expense payments on
behalf of the insured.
(t) “Open claim
ID number” means the original identification number used when the claim was
previously filed with the department.
(u) “Practice
code” means the 2-digit code identifying the kind of practice for an insured
when it is a physician or other medical professional.
(v) “Profession
code” means the 2-digit code identifying the medical specialty practiced by the
health care provider.
(w) “Reserve”
means the dollar value established by the insurer as their best estimate of the
dollar amount needed to cover future loss and loss adjustment expense payments.
(x) “Screening
panel code” means the numeric code used to identify the status or outcome of
the screening panel process.
(y) “Settlement
code” means the 2-digit code used to identify when in the legal process the
claim has been settled.
(z) “Severity
of injury code” means the 2-digit code that identifies the relative degree or
severity of injury, covering a range from "emotional only" to
"death."
(aa) “Specialty
code” means the 5-digit code established by the ISO to define a common
statistical base classification code used for underwriting.
Source. #8754, eff
12-1-06
Ins 3801.04 Detailed
Reporting Requirements.
(a) As a condition of doing business in this state,
each insurer providing medical professional liability insurance coverage to a
New Hampshire health care provider, and every health care provider who
maintains professional liability coverage through a plan of self insurance,
shall submit to the commissioner a report of all open and/or closed claims and
companion claims made against any New Hampshire insureds during the preceding 3
month period.
(b) Every
report shall contain the following detailed information:
(1) A summary, listing the individual claim reports
included with the particular submission;
(2) A separate
form titled "Medical Professional Liability Insurance Claim Report"
filed for each individual claim newly opened, modified or closed during the
previous 3 month period, and for which the following mandatory fields shall be
completed:
a. When
reporting an open claim items 1 through 9b;
b. When
reporting a closed claim items 1 through 23.
Source. #8754, eff
12-1-06
Ins 3801.05
Report Dates. The
report shall be sent to the department no later than 10 days following the
close of each quarter or on or before January 10th, April 10th, July 10th, and
October 10th.
Source. #8754, eff
12-1-06
Ins 3801.06
Penalty. Failure to
file a completed report in accordance with the provisions outlined in this rule
shall result in the application of the penalty provisions of RSA 412:40.
Source. #8754, eff
12-1-06
Ins 3801.07
Confidentiality. All information collected under Ins 3801.04
regarding individual claims, loss adjustment and other expenses, reserves,
indemnity payments, or other financial information that is not otherwise
reported to the commissioner or available to the public, shall be treated as
examination material under RSA 400-A:37, kept confidential, and not subject to
RSA 91-A.
Source. #8754, eff
12-1-06
MEDICAL
PROFESSIONAL LIABILITY INSURANCE CLAIM REPORT FORMS
(EXCEL DOCUMENTS)
APPENDIX
RULE
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STATUTE
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3801.01 |
519-B:12, II.; 412:13; 412:14; 412:16 |
|
3801.02 |
519-B:12, II.; 412:13; 412:14; 412:16 |
|
3801.03 |
519-B:12, II.; 412:13; 412:14; 412:16 |
|
3801.04 |
519-B:12, II.; 412:13; 412:14; 412:16 |
|
3801.05 |
519-B:12, II.; 412:13; 412:14; 412:16 |
|
3801.06 |
519-B:12, II.; 412:40 |
|
3801.07 |
400-A;15, |
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