Ohio Administrative Code
Title 3364 - University of Toledo
Chapter 3364-10 - Reporting and processing job injuries; legal counsel
Section 3364-10-05 - Underwriting committee

(1) The committee establishes an underwriting process for the insurance program and all items necessary for insurance underwriting purposes including underwriting guidelines (appendix a) and a risk rating schedule (appendix b) based on specialty class and other risk elements.

(2) The administrator for risk management gathers and assesses each applicant in accordance with the underwriting guidelines and determines a risk rating. Applicants with a risk rating of "a" and with no risk issues per the underwriting guidelines are approved for participation in the insurance program. Action regarding the "a" rated applicants will be reported to the committee at their next meeting.

(3) Any applicant assessed by the administrator for risk management who has a risk rating of "b" or lower, or has risk issues identified by the underwriting guidelines is presented to the committee for review and action.

(4) The administrator for risk management reports underwriting action to the credentials committee when applicants are presented for medical staff appointments.

(1) UT physicians president or vice president;

(2) UT physicians executive director;

(3) UT administrator for risk management.

The Chair will be the UT physicians executive director. In the absence of the chair, the UT physician president will act as chair.

(A) Purpose of guidelines

These underwriting guidelines establish the procedures used to conduct underwriting activities for the physicians and certain clinical associates of the University of Toledo Physicians, LLC ("UTP") and The University of Toledo ("UT") (collectively "Applicants") wishing to participate in The University of Toledo Professional Liability Insurance Program ("Program")

(B) Frequency of review

The initial underwriting review occurs when the Applicant is applying for Medical Staff credentialing. Bi-annual reviews for policy renewal will be conducted on covered individuals concurrently with their reappointment action by the Credentials Committee.

The Underwriting Committee may review any previously approved insured for continued participation in the Program at any time during the policy period.

(C) False or fraudulent application

If the Underwriting Committee is presented with information that suggests a false or fraudulent application was submitted, they may immediately suspend coverage temporarily. Written notification to the Applicant by the Administrator for Risk Management of coverage suspension will take place within 48 hours of the decision. Final coverage determinations will be made following investigation and notice of policy status will be provided in writing.

(D) Application, forms and verification

The application and supplemental information forms used by the Credentials Committee of the UT Medical Center are also used for underwriting purposes. When the Central Verification Office receives an application from the Applicant and posts it to the credentialing database, they will advise the Administrator for Risk Management who will review the application for completeness. If the application is deemed incomplete for underwriting purposes, the Administrator for Risk Management will notify the Applicant of the need to complete the information prior to underwriting consideration.

At a minimum, the following application information and addendums must be provided so underwriting consideration can be made:

* Current and prior hospital affiliations;

* Relevant training history;

* Board certification information;

* Professional liability insurance history - minimum 5 years;

* Loss run/claims history report - minimum 5 years;

* Ohio State Medical Board or other applicable Ohio State board licensure verification.

* Application attestation and supplemental questions; and

* Signed Insurance Attestation and Agreement.

Additional information requested but not needed prior to consideration:

* Practice location fact sheets;

(E) Underwriting review process

The Administrator for Risk Management will review applications for each Applicant. The underwriting review requirements include the following:

(F) Underwriting actions

Following the underwriting review, the Administrator for Risk Management will assign the Applicant an insurance classification code and determine an underwriting risk rating based on Appendix B.

The determination of whether the applicant should be granted coverage by the Program will be in the form of one of the following three options:

(1) Remain an employee of UT or UTP during the coverage period;

(2) Remain in compliance with the terms and conditions of the applicable professional liability insurance policy issued by the Program; and

(3) Comply with required risk intervention and management processes, if any.

ATTACHMENT B UNDERWRITING GUIDELINES

RISK RATING SCHEDULE

This Risk Rating Schedule is a guideline only and is to be used by the Committee to assist in consistency, but is not meant to direct all decisions. The Committee has the ability, using its discretion, to deviate as circumstances dictate. Suggested underwriting guidelines for risk rating and declinations are as follows:

* Indemnity Payments mean: indemnity payments greater than $5,000 made during the last three years for alleged occurrences that happened within the last ten years; defense costs are not included; and

* Claims mean: lawsuits that were open at any time during the last three years for alleged occurrences that happened within the last ten years; does not include 180-day letters or lawsuits involving instances of mistaken identity, blanket defendant listings, improper inclusion or non-meritorious or frivolous claims,