Tenn. Comp. R. & Regs. 0780-01-84-.05

Current through December 10, 2024

Section 0780-01-84-.05 - ANNUAL CLAIMS DATA SUBMISSION REQUIREMENT

(1) All reporting entities, with the exception of those enumerated in Rule 0780-1-84-.04(15)(d) shall individually submit to the commissioner by March 1 of every year, a claims data file containing all information required by this Chapter for medical or professional malpractice claims and expenses 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. Additionally, all reporting entities shall separately list the total from the inception date of any filed claim those damages and defense expenses found in subparagraph (l) of Paragraph (3) this Rule.

(2) The claims data file shall be comprised of two (2) data sheets--the Closed Claims Sheet and the Pending Claims Sheet, as set forth and explained in more detail in Appendix A. To the greatest extent possible, the format and coding protocol shall be consistent with the format and coding protocol for data reported to the National Practitioner Data Bank.

(3) Each claims data file sheet shall contain the following data as set forth and explained in more detail in Appendix A listed by medical specialty of provider, if any:

(a) The name of the reporting insuring entity, self-insurer, facility or provider;

(b) The address of the reporting insuring entity, self-insurer, facility or provider;

(c) The name, telephone number and electronic mail address of a contact person for the reporting insuring entity, self-insurer, facility or provider;

(d) Claim and incident identifiers, including:

1. A claim identifier assigned to the claim by the insuring entity, self-insurer, facility or provider; and

2. An incident identifier if companion claims have been made by a claimant;

(e) The policy limits of the medical professional liability insurance policy covering the claim;

(f) License number of health care institution or professional;

(g) Information about the health care facility where the

1. The type of health care facility where the medical malpractice incident occurred;

2. The primary location within a facility where the medical malpractice incident occurred; and

3. The geographic location, by city and county, where the medical malpractice incident occurred;

(h) Information about the claimant, including:

1. The injured person's sex and age on the incident

2. Claimant's social security number, to the extent that the claimant's social security number is available to the reporting entity; and

3. The severity of malpractice injury using the National Practitioner Data Bank severity scale;

(i) The following significant dates:

1. The date of the incident that was the proximate

2. The date notice was given to the insuring entity, self-insurer, facility or provider;

3. The date a suit was filed, if any was filed;

4. The date of the final indemnity payment, if any; and

5. The date of the final action by the insuring entity, self-insurer, facility or provider to close the action if the action has been closed;

(j) Information about the damages asserted by the

1. Damages asserted by the claimant other than amounts asserted by a lawsuit; and

2. Damages asserted by the claimant through a lawsuit; if damages are asserted by the claimant through a lawsuit, the date of the filing of the lawsuit;

(k) Settlement information that identifies the timing and final method of claim disposition, including:

1. Claims settled by the parties;

2. Claims disposed of by a court, including the date disposed;

3. Claims disposed of by alternative dispute resolution, such as arbitration, mediation, private trial, and other common dispute resolution methods; and

4. Whether the settlement occurred before or after trial, if a trial occurred;

(l) Specific information about indemnity payments and defense and cost containment expenses, including:

1. For claims disposed of by a court that result in a verdict or judgment that itemizes damages:

(i) The total verdict or judgment;

(ii) If there is more than one (1) defendant, the total indemnity paid by or on behalf of this facility or provider;

(iii) Economic damages;

(iv) Noneconomic damages;

(v) Punitive damages, if applicable; and

(vi) Defense and cost containment expenses, including court costs, attorneys' fees, and costs of expert witnesses; and

2. For claims that do not result in a verdict or judgment that itemizes damages:

(i) The total amount of settlement;

(ii) If there is more than one (1) defendant, the total indemnity paid by or on behalf of this facility or provider;

(iii) The insuring entity's or self-insurer's best estimate of economic damages included in the settlement;

(iv) The insuring entity's or self-insurer's best estimate of noneconomic damages included in the settlement;

(v) Defense and cost containment expenses, including court costs, attorneys' fees, and costs of expert witnesses; and

(vi) Amounts paid in connection with other legal expenses not previously identified;

(m) The reason for the medical malpractice 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;

(n) The name of the attorney(s) representing the claimant for those claims on which amounts are paid to the claimant and reported under subparagraph (l).

(4) Reports shall also contain information identifying those open or pending claims which were contained in a prior report.

(5) Reporting entities should report all claims arising from acts or omissions occurring in this state, even where the claimant is not a Tennessee resident. In the event that a judgment reported by a reporting entity is from a court outside of this state, the reporting entity should notify the Department of such so that it can be properly noted on its report.

(6) Any column left blank by the reporting entity will be assumed to be "not applicable" if any information other than that requiring currency data, and if currency data is required, will be assumed to be zero (0).

Tenn. Comp. R. & Regs. 0780-01-84-.05

Original rule filed January 16, 2007; effective April 1, 2007. Amendment filed February 3, 2009; effective April 19, 1009.

Authority: 2008 Tenn. Pub. Act Ch. 1009, T.C.A. §§ 56-2-301, 56-54-101, et seq., and 56-54-110.