Code of Maryland Regulations
Title 31 - MARYLAND INSURANCE ADMINISTRATION
Subtitle 08 - PROPERTY AND CASUALTY INSURANCE
Chapter 31.08.10 - Medical Professional Insurers Online Claim Survey Reporting Requirements
Section 31.08.10.04 - Required Information
Current through Register Vol. 51, No. 6, March 22, 2024
The following information shall be reported on a closed claim survey form:
A. Name of insurer;
B. Name of insurer group;
C. Claim file identification (ID);
D. Name of person completing the form;
E. Telephone number, including area code, of person completing the form;
F. Date form completed;
G. Date of injury;
H. Date injury reported to insurer;
I. Date claim closed;
J. Whether the claim was previously reported;
K. Age of injured person at time of injury;
L. Gender of injured person at time of injury;
M. Type of injury, such as wrongful death, permanent disability, or other bodily injury;
N. Description of injury;
O. Name of health facility where injury occurred;
P. Type of medical professional liability policy, such as occurrence, claims made-basic, or claims made-tail;
Q. Type of patient, such as inpatient, emergency room outpatient, or other outpatient;
R. Physician Insurance Services Office Incorporated (ISO) classification or equivalent classification;
S. Type of health care provider, such as physician-no surgery, surgeon, psychiatrist and related specialties, nurse, nurse midwife, optometrist, pharmacist, chiropractor, podiatrist, psychologist, dentist, hospital, other health care facility, or nurse anesthetist;
T. Physician and surgeon classification, including name of specialty;
U. Health care provider name;
V. Health care provider license number;
W. Policy limits for each claim or medical incident;
X. Policy limits for annual aggregate;
Y. If known, the facility, office, or county where the injury occurred;
Z. Whether the claim is a zero payment claim file;
AA. Full name and location of the court where the suit was filed and the case was tried;
BB. Case or docket number;
CC. Whether settlement was reached or award was made at one of the following stages:
DD. If settlement was reached or award was made by court verdict, whether the result was:
EE. If there was no final judgment or settlement, the date of the final disposition;
FF. If there was no final judgment or settlement, the reason for the final disposition;
GG. If case did go to trial, whether the case was tried by a jury or tried by a judge;
HH. Total amount paid to the claimant;
II. Amount paid by the insurer;
JJ. Amount paid by the insured due to retention or deductible;
KK. If known, the amount paid by an excess carrier;
LL. If known, the amount paid by the insured due to settlement or award in excess of policy limits, not including deductible or retention amounts;
MM. If known, the amount paid by the insurer due to settlement or award in excess of policy limits, not including deductible or retention amounts;
NN. If known, the amount paid by other defendants or contributors;
OO. A summary of the occurrence from which the claim or action arose;
PP. A description of the misdiagnosis or alleged misdiagnosis made, if any, of the patient's actual condition;
QQ. A description of the procedure giving rise to the claim;
RR. A description of the principal injury giving rise to the claim;
SS. The amount of past medical expenses claimed by the plaintiff;
TT. The amount of future medical expenses claimed by the plaintiff;
UU. The amount of past lost wages claimed by the plaintiff;
VV. The amount of future lost wages claimed by the plaintiff;
WW. The amount of noneconomic damages claimed by the plaintiff;
XX. The amount of other damages claimed by the plaintiff;
YY. Whether a structured settlement or periodic payment was used, and if so:
ZZ. If a neutral expert was used, the findings of a neutral expert witness regarding future medical expenses;
AAA. If a neutral expert was used, the findings of a neutral expert witness regarding future loss of earning;
BBB. If case was tried to verdict:
CCC. The total allocated loss adjustment expense;
DDD. Of the total allocated loss adjustment expense, the amount representing fees paid to defense counsel;
EEE. Of the total allocated loss adjustment expense, the amount of expenses not included in the defense counsel fees;
FFF. Whether there was a claim made for extra contractual damages;
GGG. The amount claimed for extra contractual damages;
HHH. Whether a suit was filed or claim was made for extra contractual damages; and
III. Where the suit for the extra contractual damages claim was filed, including: