OLR Bill Analysis
AN ACT CONCERNING MEDICAL MALPRACTICE DATA REGARDING MEDICAL PROFESSIONALS.
This bill requires insurers of any “medical professional,” instead of just insurers of physicians, surgeons, advanced practice registered nurses, or physician assistants, to provide to the insurance commissioner a closed claim report, on such form as the commissioner prescribes. A “closed claim” is a claim that has been settled, or otherwise disposed of, and the insurer has paid all claims. By law, the insurer must submit the report within 10 days after the last day of the calendar quarter in which a claim is closed. The report includes information only about claims settled under Connecticut law.
The bill defines “medical professional” as any person licensed or certified to provide health care services to individuals, including chiropractors, clinical dietitians, clinical psychologists, dentists, nurses, occupational therapists, optometrists, pharmacists, physical therapists, physicians, podiatrists, psychiatric social workers, and speech therapists. By law, a closed claim report contains details about the insured and the insurer, the injury or loss, the claims process, and the amount paid on each claim.
EFFECTIVE DATE: October 1, 2007
Closed Claim Reports
By law, the insurance commissioner must aggregate the individual closed claim report data into a summary and annual report. The summary must include an analysis of the trend of direct losses, incurred losses, earned premiums, and investment income as compared to prior years. The report must also include base premiums medical malpractice insurers charge for each specialty and the number of providers insured by specialty for each insurer. By law, the commissioner must annually submit the report to the Insurance and Real Estate Committee. She must also (1) make the report available to the public, (2) post it on the department's Internet site, and (3) provide public access to the contents of the electronic database after establishing that the names and other individually identifiable information about claimants and practitioners have been removed.
Details about the Insured and Insurer
The report must include the (1) insurer's name; (2) policy limits; (3) insured's name, address, license number, and specialty coverage; and (4) insured's policy number and unique claim number. It must also indicate whether the policy was an occurrence policy or was issued on a claims-made basis. An “occurrence policy” provides protection for malpractice that occurred during the time the policy was in effect. A “claims-made” policy provides protection for claims made during the period the policy is in effect.
Details About the Injury or Loss
The report must specify the:
1. date of the injury or loss that was the basis of the claim;
2. date the injury or loss was reported to the insurer;
3. name of the institution or location where the injury or loss occurred;
4. type of injury or loss, including an injury severity rating that corresponds with the injury scale that the commissioner must establish based on the severity scale developed by the National Association of Insurance Commissioners; and
5. name, age, and gender of any injured person covered by the claim.
Any individually identifiable health information (as defined by federal HIPAA regulation) is confidential. The act specifies that the law requires reporting of this information. It requires that if necessary to comply with federal privacy laws, the insured must arrange with the insurer to release the required information.
Details About the Claims Process
The report must contain details about the claims process including:
1. whether a lawsuit was filed and, if so, in which court;
2. its outcome;
3. the number of other defendants, if any;
4. the stage in the process when the claim was closed;
5. the trial dates;
6. the date of any judgment or settlement;
7. whether an appeal was filed and, if so, the date filed;
8. the resolution of the appeal and the date it was decided;
9. the date the claim was closed; and
10. the initial and final indemnity and expense reserve for the claim.
Details About the Amount Paid on the Claim
The report must include:
1. the total amount of the initial judgment rendered by a jury or awarded by the court;
2. the total amount of the settlement if no judgment was rendered or awarded or the claim was settled after judgment was rendered or awarded;
3. the amount of economic and noneconomic damages, or the insurer's estimate of these amounts in a settlement;
4. the amount of any interest awarded due to failure to accept an offer of compromise;
5. the amount of any reduction or addition and the amount of final judgment after such reductions or additions;
6. the amount the insurer paid;
7. the amount the defendant paid due to a deductible or a judgment or settlement in excess of policy limits;
8. the amount other insurers or defendants paid;
9. whether a structured settlement was used;
10. the expense assigned to and recorded with the claim, including defense and investigation costs but not including the actual claim payment; and
11. any other information the commissioner determines necessary to regulate the medical malpractice insurance industry, ensure its solvency, and ensure that such liability insurance is available and affordable.
Annual Data Summary
The report must analyze the closed claim information, including:
1. a minimum of five years of comparative data, when available;
2. trends in frequency and severity of claims;
3. itemization of damages;
4. timeliness of the claims process; and
5. any other descriptive or analytical information that would help interpret the trends in closed claims.
The annual report must summarize rate filings for medical malpractice insurance for medical professionals and entities that the department approved for the prior calendar year.
Beginning March 15, 2007, the insurance commissioner must provide the DPH commissioner with electronic access to all the closed case information she receives. The bill also requires the DPH commissioner to keep such information as confidential as the law requires the insurance commissioner to do.
Insurance and Real Estate Committee
Joint Favorable Substitute