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Policy Coverage:

What is the distinction between "Claims-Made" policies and "Occurrence" policies?
What is Prior Acts Coverage?
What is a "Tail" endorsement and what does it cover?

Accounting:

How can I pay my billed premium?
Why did I not receive a premium subsidy?
When will I receive my premium subsidy?
Why did I not receive an election form for my premium subsidy?

Can I access my policy billing records?

Risk Management:

How long must I keep medical records?
How long must I keep billing records/schedule books, etc.?
How do I handle a non-compliant patient?
How do I terminate the physician-patient relationship?
What should I do when a managed care organization does not approve recommended treatment?

Claims:

I've received a request for release of my records. Can I release them?
What should I report to MEDICAL MUTUAL?
Will reporting an incident affect my premium or policy?
How do I report a claim?
After I have reported a claim, what should I do?
Can I choose the attorney I want to defend me?
Once an attorney has been assigned to my case, what can I expect?
Who determines whether a claim is settled?
When does information get reported to the National Practitioners Data Bank (NPDB)?
How can I obtain my Claims History for a hospital, HMO, etc.?
What must a claimant do to prove a claim of medical negligence?

 

Policy Coverage:

Q: What is the distinction between "Claims-Made" policies and "Occurrence" policies?

A "Claims-Made" policy covers claims that are made during the policy period provided that the incident giving rise to the claim occurred on or after the retroactive date and on or before the termination date of the policy.

An "Occurrence" policy covers claims which arise from incidents which occur during the policy period regardless of when the claim is made.

In other words, in the event of a claim, coverage will be provided by:

  • The policy in force when the claim is made, as long as the incident which resulted in the claim occurred on or after the Retroactive Date and on or before the Termination Date, if the Insured is on a "Claims-Made" program; or
  • The policy which was in force when the incident occurred which resulted in the claim, if the policyholder is on an "Occurrence" program.
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Q: What is Prior Acts Coverage?

Prior Acts ("Nose") coverage refers to coverage for acts that took place prior to the inception or effective date of the first Claims-Made policy written by one insurer that replaces the Claims-Made policy written by the prior insurer.

In order for a policyholder to avoid gaps in coverage it is important to remember when moving from one insurer to another that either a "Tail" or Prior Acts coverage is required.
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Q: What is a "Tail" endorsement and what does it cover?

The correct name for the "Tail" endorsement is the Extended Reporting Period Endorsement because it extends the time to report claims beyond the termination date of coverage.

For coverage to apply under a "Tail" the alleged act or omission giving rise to the claim must have taken place on or after the retroactive date of the coverage and on or before the coverage termination date. The "Tail" endorsement covers claims arising from incidents occurring during the period of time between the retroactive date and the termination date.

There are several ways for a qualified Insured to receive a "Tail" at no cost: permanent and total retirement from your professional practice after having been insured with MEDICAL MUTUAL for at least one full year; permanent relocation of your professional practice to a state where neither we nor any of our subsidiaries offer professional liability insurance after having been insured with MEDICAL MUTUAL for at least one full year; permanent and complete disability; and on death it is free to the estate.
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Accounting:

Q: How can I pay my billed premium?

The Company offers a quarterly installment plan to Policyholders.  Payments can be made in full or for the minimum installment amount by check or credit card.  Payments can also be made by credit card directly on the Company's web site through the use of a special identification and password obtained from Customer Service at 800-492-0193.  The Company also provides a one-time set-up for payments to be made automatically to your credit card account.  This can be completed on the Company's web site or by contacting Customer Service for more information.
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Q: Why did I not receive a premium subsidy?

Maryland enacted the premium rate stabilization subsidy law to benefit those doctors and nurse midwives subject to a "rate" increase of more than 5%.  Professional corporations were not considered under the law.  In addition, a small group of doctors did not meet the strict requirements of the 5% "rate" increase.  Certain rating components such as the "claims made step increases" and the loss of claims free discounts were not considered subject to subsidy by law.  If you believe you were entitled to a subsidy and did not receive one, please contact Customer Service at 1-800-492-0193.
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Q: When will I receive my premium subsidy?

MEDICAL MUTUAL submits a subsidy-funding request each calendar quarter to the Maryland Insurance Administration.  Your subsidy will be credited to your account once we receive payment from the State.  You should continue to pay any invoices you may receive to assure that your policy coverage will continue uninterrupted.  If your policy balance us paid in full, you will receive an election form to decide if you want to have your credit balance refunded to you or have it applied to your next year's renewal policy. If you elect to have your subsidy refunded to you, it will take approximately 5-10 business days after you complete and return the election form.
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Q: Why did I not receive an election form for my premium subsidy?

If you are entitled to a subsidy, but did not receive an election form it is because you still have a balance due on your policy.  By law your premium subsidy is designed to reduce any outstanding balance that remains on your policy.  Once your policy is paid in full, you will receive an election form to instruct MEDICAL MUTUAL to either refund the excess or apply it to a renewal policy that may be offered to you.
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Q: Can I access my policy billing records?

Yes.  MEDICAL MUTUAL offers password secured access to your policy records through the secure login located on the left sidebar of every page of the site.  If you have not obtained a user identification and password, or need a new one, please contact Customer Service at
800-492-0193.
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Risk Management:

Q: How long must I keep medical records?

Maryland law requires that …

§ 4-403. Destruction of medical records.

  1. Except for a minor patient, unless a patient is notified, a health care provider may not destroy a medical record or laboratory or X-ray report about a patient for five years after the record or report is made.
  2. In the case of a minor patient, a medical record or laboratory or X-ray report about a minor patient may not be destroyed until the patient attains the age of majority plus three years or for five years after the record or report is made, whichever is later.

MEDICAL MUTUAL recommends that you keep them indefinitely.
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Q: How long must I keep billing records/schedule books, etc.?

These records can prove to be very important in the defense of a claim. If possible, keep them indefinitely.
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Q: How do I handle a non-compliant patient?

  • Document everything the patient has or has not done which shows his/her non-compliance.
  • Send the patient a letter (send both regular and certified mail) explaining the treatment recommended and the importance of compliance. You may indicate that continued non-compliance could result in termination of the physician-patient relationship.
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Q: How do I terminate the physician-patient relationship?

Do not terminate the relationship during an acute situation which could lead to allegations of abandonment. Send the patient a letter (both regular and certified mail) indicating your desire to terminate the relationship; your willingness to handle any emergency situations for the next 30 days; and suggestions on where to find another physician (i.e., County Medical Society). Clearly state what the patient's medical situation and needs are at this point, and let the patient know that you will be happy to furnish their new physician with a copy of the patient's medical record.

  • If the patient belongs to a managed care organization, you must first check with them to determine termination protocol, if any.
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Q: What should I do when a managed care organization does not approve recommended treatment?

  • You need to go through the appeals process with the managed care entity.
  • Advise the patient your recommended treatment was not approved and give the patient their options (including paying for the recommended treatment themselves).
  • Document #1 and 2.
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Claims:

Q: I've received a request for release of my records. Can I release them?

As a general rule you must release a copy of the records upon receipt of an authorization signed by the patient. You should not prepare new or additional chronologies or reports, even if requested. Some states have specific statutes governing this. If you have any questions about releasing your records, call the Claims Department at 800-492-0193. Should you have any suspicion that your treatment could lead to a claim or suit for medical negligence, you should request MEDICAL MUTUAL's assistance prior to further action.
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Q: What should I report to MEDICAL MUTUAL?

An Insured should immediately notify MEDICAL MUTUAL of any incident that may lead to or trigger a medical negligence claim. In the event the Insured receives a claim letter from an attorney or a lawsuit, swift reporting is crucial to allow MEDICAL MUTUAL adequate time to respond within the allotted time frame. Insureds are encouraged to contact MEDICAL MUTUAL with any questions or concerns regarding an incident.
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Q: Will reporting an incident affect my premium or policy?

Simply reporting an incident has no impact on your premium.
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Q: How do I report a claim?

Contact the MEDICAL MUTUAL Claims Department and provide the needed preliminary information. Contact can be via telephone (800-492-0193), fax (410-785-1670), or mail (Claims Department, MEDICAL MUTUAL, 225 International Circle, Box 8016, Hunt Valley, MD 21030). Please include:

  • Patient’s name, gender, age, marital status, address and employment status.
  • Names of any other physicians involved in care.
  • Names of any involved hospitals, clinics, etc.
  • Chronology of medical treatment including dates of treatment.
  • Any information available regarding the nature of the claim.
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Q: After I have reported a claim, what should I do?

After reporting an incident, you will be given a list of precautions to follow. It is important that you adhere to these admonitions, as they will help to preserve the integrity of your case.

  • Do not discuss the circumstances surrounding the incident with anyone other than the attorney representing you or a MEDICAL MUTUAL Claims Representative.
  • Do not make any additions or deletions to the patient’s records.
  • Do not respond to any inquiries regarding the patient before contacting MEDICAL MUTUAL.
  • Do not respond to any legal papers before contacting MEDICAL MUTUAL.
  • Do not review any medical literature specific to the alleged or potential claim. Defense counsel advises such actions are potentially discoverable and should be undertaken only upon specific direction of counsel representing you.
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Q: Can I choose the attorney I want to defend me?

MEDICAL MUTUAL has a listing of law firms throughout the region that have been approved by our Claims Department. These firms specialize in the advocacy of Physicians and their performance is monitored to ensure that they follow our guidelines and defense philosophy. We will make every effort to work with the Insured to provide counsel with whom he or she feels comfortable.
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Q: Once an attorney has been assigned to my case, what can I expect?

Initially you will be contacted to schedule an Initial Interview with your attorney and/or the MEDICAL MUTUAL Claims Representative. During this meeting you will be advised what to expect from the litigation process as well as discussing your case specifically. It is helpful if you have available the original medical chart and a copy of your CV.
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Q: Who determines whether a claim is settled?

MEDICAL MUTUAL will not settle a case without your knowledge. After a thorough examination of a large number of factors, including all applicable laws and relevant medical standard of care issues, our claims team will make the decision as to the best legal response to a claim. Maryland law does not allow MEDICAL MUTUAL or any insurance company to include a Policyholder “consent to settle” clause in medical professional liability insurance policies. However, you are an active participant in the claim process and your opinions and preferences will be fully considered.
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Q: When does information get reported to the National Practitioners Data Bank (NPDB)?

The information is reported to the NPDB only when the Company makes a payment on behalf of an Insured. A situation could exist where there is a judgement against an insured and the insured chooses to pay that himself/herself. In that case, it is not reportable. The same would apply if the Insured pays a settlement himself/herself.
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Q: How can I obtain my Claims History for a hospital, HMO, etc.?

Requests for Claims Histories must be in writing and signed by the Insured. The request should include the Insured’s name, license number, policy number (if not insured under your own name), and the specific years which the history should address.  The Claims History will be mailed or faxed to the current address on your policy, as requested.  The Claims History will also be mailed directly to the requesting institution. In the event further information is required regarding a closed claim, please write to the Claims Department, MEDICAL MUTUAL, 225 International Circle, Box 8016, Hunt Valley, MD 21030 and specify what further information is required. In the event you need additional information regarding a pending claim, contact the attorney retained to represent you in that case.
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Q: What must a claimant do to prove a claim of medical negligence?

In general, to prove a claim of medical malpractice three basic elements must be present. These are:

  1. Negligence - defined as a departure from the accepted standard of care.
  2. Causation - there must be a causal link between the negligence of the defendant and the damages suffered by the claimant.
  3. Damages - which must be verifiable and suffered by the claimant(s).
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