§36-6812.1. Required information, format, and coding protocol in
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reports.
Reports required under Section 6811 of this title must contain the following information in a format and coding protocol prescribed by the Insurance Commissioner. To the greatest extent possible while still fulfilling the purposes of the Medical Professional Liability Insurance Closed Claim Reports Act, the format and coding protocol shall be consistent with the format and coding protocol for data reported to the National Practitioner Data Bank.
1. Claim and incident identifiers, including:
a. a claim identifier assigned to the claim by the
insuring entity, self-insurer, facility, or provider,
and
b.
an incident identifier if companion claims have been
made by a claimant;
2. The policy limits of the medical professional liability insurance policy covering the claim;
3. The medical specialty of the provider who was primarily responsible for the medical malpractice incident that led to the claim;
4. The type of health care facility where the medical malpractice incident occurred;
5. The primary location within a facility where the medical malpractice incident occurred;
6. The geographic location, by city and county, where the medical malpractice incident occurred;
7. The sex and age of the injured person on the incident date;
8. The severity of malpractice injury using the National Practitioner Data Bank severity scale;
9. The dates of:
a. the earliest act or omission by the defendant that was
the proximate cause of the claim,
b. notice to the insuring entity, self-insurer, facility,
or provider,
c. suit, if a suit was filed,
d. final indemnity payment, if any, and
e. final action by the insuring entity, self-insurer,
facility, or provider to close the claim;
10. Settlement information that identifies the timing and final method of claim disposition, including:
a. claims settled by the parties,
b. claims disposed of by a court, including the date
disposed,
c. claims disposed of by alternative dispute resolution,
such as arbitration, mediation, private trial, and
other common dispute resolution methods, and
d. whether the settlement occurred before or after trial,
if a trial occurred;
11. Specific information about the indemnity payments and defense and cost-containment expenses, including:
a. for claims disposed of by a court that result in a
verdict or judgment that itemizes damages:
(1)the indemnity payment made on behalf of the
defendant,
(2)economic damages,
(3)noneconomic damages,
(4)punitive damages, if applicable, and
(5)defense and cost-containment expenses, including
court costs, attorney fees, and costs of expert
witnesses, and
b.
for claims that do not result in a verdict or judgment
that itemizes damages:
(1)the total amount of the settlement on behalf of
the defendant,
(2)the insuring entity’s or self-insurer’s best
estimate of economic damages included in the
settlement,
(3)the insuring entity’s or self-insurer’s best
estimate of noneconomic damages included in the
settlement, and
(4)defense and cost-containment expenses, including
court costs, attorney fees, and costs of expert
witnesses;
12. The reason for the medical professional liability claim. The reporting entity must use the same allegation group and specific allegation codes that are used for mandatory reporting to the National Practitioner Data Bank; and
13. Any other closed claim data the Commissioner determines to be necessary to accomplish the purpose of the Medical Professional Liability Insurance Closed Claim Reports Act and requires by rule. Added by Laws 2009, c. 176, § 56, eff. Nov. 1, 2009.