Reports by Insurers of Professional Liability Claims and Actions Required

DEPARTMENT OF FINANCIAL SERVICES
OIR – Insurance Regulation

RULE NO: RULE TITLE
69O-171.003: Reports by Insurers of Professional Liability Claims and Actions Required

NOTICE OF CHANGE

Notice is hereby given that the following changes have been made to the proposed rule in accordance with subparagraph 120.54(3)(d)1., F.S., published in Vol. 32 No. 8, February 24, 2006 issue of the Florida Administrative Weekly.

69O-171.003 Reports by Insurers of Professional Liability Claims and Actions Required.

(1)(a) Each entity self-insurer identified in Section 627.912(1)(a), or 627.912(5), F.S., authorized under Section 627.357, F.S., and each insurer or joint underwriting association providing professional liability insurance to a practitioner of medicine licensed pursuant to the provisions of Chapter 458, F.S., to a practitioner of osteopathic medicine licensed pursuant to the provisions of Chapter 459, F.S., to a podiatric physician licensed pursuant to the provisions of Chapter 461, F.S., to a dentist licensed pursuant to the provisions of Chapter 466, F.S., to a hospital licensed pursuant to the provisions of Chapter 395, F.S., to crisis stabilization units licensed under Part IV of Chapter 394, F.S., to a health maintenance organization certified under Part I of Chapter 641, F.S., to clinics included in Chapter 390, F.S., to an ambulatory surgical center as defined in Section 395.002, F.S., or to a member of the Florida Bar, shall report to the Office of Insurance Regulation (Office) any claim or action for damages for personal injuries claimed to have been caused by error, omission, or negligence in the performance of such insured’s professional services or based on a claimed performance of professional services without consent. In any calendar year in which no claim or action for damages has been closed, the entity shall file a “No Claim Submission Report”. Each such entity insurer or self insurer required to report under this rule shall submit such information to the Office using the “Professional Liability Claims Reporting (“PLCR”) located at https://apps.fldfs.com/plcr, Form OIR-A1-1672 (1-06). The PLCR is incorporated and adopted by reference electronically by using computer software provided by the Office. A copy of the judgment or settlement must be provided along with any other information required by the Office that is not included in the computer software. The following forms have been converted into the software provided by the Office are hereby incorporated by reference, and shall take effect on the effective date of this rule amendment: Form OIR-303 (5/99) “Florida Medical Professional Liability Insurance Claims Report” and OIR-304 (5/99) “Lawyers Professional Liability Closed Claim Reporting Form.” Professional liability closed claim reports must be filed by the insurer if the claim resulted in:

(a) A final judgment in any amount; or

(b) In addition to the requirements set forth in Section 627.912(2), F.S., and to assist the Office in its analysis and evaluation of the nature, causes, location, cost and damages involved in professional liability cases, reports shall contain: A settlement in any amount.

1. The type of entity insured to include but not limited to hospitals, individuals or other facilities;

2. The field of medicine in which a physician practices;

3. The facility license or registration number, if available;

4. The amount the insurance company has set aside to pay the claim as of the closing date of the claim;

5. The names of all known defendants;

6. Whether or not the claim was closed due to a jury verdict or settlement;

7. The county in which the injury occurred; and

8. The date on which payment was made.

(2) Each authorized insurer, risk retention group, joint underwriting association and surplus lines insurer shall annually report to the Office on or before May 1 of each calendar year a reconciliation of all paid claims and loss adjustment expenses reported pursuant to Section 627.912, F.S., and direct loss and loss adjustment expenses paid in the State of Florida and reported in their National Association of Insurance Commissioners annual statement. Such reconciliation shall be reported using the method as described in paragraph (1)(a) and include but are not limited to the following:

(a) Payments on claims not closed in previous calendar year;

(b) Payments made prior to January 1 on claims closed during the previous calendar year;

(c) Losses paid on claims not settled under Florida law but which are reported in the NAIC annual statement;

(d) Payments on claims reported on policies written in another state;

(e) Reimbursements received;

(f) Rounding and statistical adjustments (explaining documentation must be provided);

(g) Un-reconciled amounts (explaining documentation must be provided);

(h) Closed claim subtractions; and

(i) Closed claim additions.

(3)(2) Any self-insurance program established under Section 1004.24 240.213, F.S., shall report, using such method as described in paragraph (1)(a), in duplicate to the Office of Insurance Regulation any claim or action for damages for personal injuries claimed to have been caused by error, omission, or negligence in the performance of professional services provided by the Board of Regents through an employee or agent of the Board of Regents, including practitioners of medicine licensed under Chapter 458, F.S., practitioners of osteopathic medicine licensed under Chapter 459, F.S., podiatric physicians licensed under Chapter 461, F.S., and dentists licensed under Chapter 466, F.S., or based on a claimed performance of professional services without consent if the claim resulted in a final judgment in any amount, or a settlement in any amount.

(4)(3) Reports are due no later than 30 days after the claim has been closed following the occurrence of one of the events listed in paragraph (a) or (b) above. “No Claim Submission Reports” are due no later than May 1st of each year. Entities not filing a closed claim or a “No Claim Submission Report” will be subject to fines and penalties as listed in Section 627.912, F.S. A closed claim report which is inaccurate, incomplete, or not properly formatted will be returned unprocessed and will be considered late until an accurate, complete and properly formatted report is received.

(4) The Office shall impose a fine of $250 per day per case, but not to exceed a total of $1,000 per case against an insurer or self-insurer that violates the professional liability closed claim reporting requirements. This applies to claims closed on or after October 1, 1997.

(5) Copies of the Professional Liability Closed Claim Software are available from the Office of Insurance Regulation, Bureau of Property and Casualty Forms and Rates, Room 238.14, Larson Building, Tallahassee, Florida 32399-0300, [phone].              

Specific Authority 624.308(1) FS. Law Implemented 624.307(1), 627.912, 627.918 FS. History–New 1-16-83, Amended 6-14-83, 7-1-85, 12-31-85, Formerly 4-59.03, Amended 11-9-86, 6-15-88, Formerly 4-59.003, Amended 4-28-92, 6-13-99, Formerly 4-171.003, Amended ________.