56-54-105 - Claims Report. - Tennessee Statutes

56-54-105. Claims Report.

(a)  For claims closed or open and pending on or after January 1, 2008:

     (1)  Every insuring entity or self-insurer that provides medical malpractice insurance to any facility or provider in this state must report each medical malpractice claim to the commissioner;

     (2)  A claim that is covered under a primary policy and one (1) or more excess policies shall be reported only by the insuring entity that issued the primary policy. The insuring entity that issued the primary policy shall report the total amount, if any, paid with respect to the claim, including any amount paid under an excess policy, any amount paid by the facility or provider, and any amount paid by any other person on behalf of the facility or provider;

     (3)  If a claim is not covered by an insuring entity or self-insurer, the facility or provider named in the claim must report it to the commissioner after a final claim disposition has occurred due to a court proceeding or a settlement by the parties. Instances in which a claim may not be covered by an insuring entity or self-insurer include situations in which:

          (A)  The facility or provider did not buy insurance or maintained a self-insured retention that was larger than the final judgment or settlement;

          (B)  The claim was denied by an insuring entity or self-insurer because it did not fall within the scope of the insurance coverage agreement; or

          (C)  The annual aggregate coverage limits had been exhausted by other claim payments.

(b)  (1)  Any self-insurer, risk retention group, or unauthorized insurer that may be exempt from this chapter due to a federal preemption or other cause, may report all data required under this section.

     (2)  The self-insurer, risk retention group, or unauthorized insurer must notify covered providers and facilities that they may have reporting responsibilities under this chapter if the self-insurer, risk retention group or unauthorized insurer does not report due to a federal exemption or other jurisdictional preemption.

     (3)  If any self-insurer, risk retention group or unauthorized insurer does not report information required by this chapter due to the assertion of a federal exemption or other jurisdictional preemption, the facility or provider named in a medical malpractice claim shall report all data required by this chapter once notified by the self-insurer, risk retention group or unauthorized insurer that such entity is not reporting under this section.

(c)  Counsel for claimants asserting claims covered by this section shall provide information about fee arrangements to the commissioner. The information shall include the portion of any settlement or judgment received by claimant's counsel. For the purposes of the levying of civil penalties under § 56-54-109, counsel for claimants who are required to submit the information outlined in this subsection (c) shall be considered reporting entities under this section.

(d)  Beginning in 2009, reports required under subsections (a) and (c) must be filed by March 1. These reports must include data for all claims open and pending as of the last day of the preceding calendar year, and those claims closed in the preceding calendar year and any adjustments to data reported in prior years.

(e)  The commissioner may adopt rules that require insuring entities, self-insurers, facilities, providers and claimant's counsel to submit all required claim data electronically.

[Acts 2008, ch. 1009, § 6.]