Ohio Administrative Code
Title 3364 - University of Toledo
Chapter 3364-10 - Reporting and processing job injuries; legal counsel
Section 3364-10-09 - Reporting professional liability claim payments
Universal Citation: OH Admin Code 3364-10-09
Current through all regulations passed and filed through September 16, 2024
(A) Policy statement
It is the policy of the university of Toledo ("university") to follow a consistent and legally compliant procedure when the university makes payment(s) in settlement of a professional liability claim or to satisfy a judgment order pertaining to allegations of professional liability and when such payments are made on behalf of a named defendant ("defendant") who is a participant ("participant") in the university of Toledo's professional liability insurance program ("insurance program").
(B) Purpose of policy
To define the responsibilities of the university in regard to the reporting of payments made as a result of alleged professional liability to assure compliance to all state and federal laws and regulations.
(C) Procedure
(1)
Reporting to the state medical board of Ohio
(a)
The university
will notify the state medical board of Ohio within thirty days after the final
disposition of any written claim for damages, arising from patient care,
when:
(i)
The
physician, physician assistant, or anesthesiology assistant who is a defendant
of the written claim is a participant in the university's insurance program;
and
(ii)
The final disposition of the written claim results in
payment made on behalf of a defendant which exceeds twenty-five thousand
dollars or as such other requirements set forth in Ohio law as they may be
amended from time to time.
(b)
For purposes of
reporting to the state medical board of Ohio, the following will apply:
(i)
The amount of
payment will mean the aggregate gross settlement, not including court costs or
other litigation costs.
(ii)
The present value of future payments will be used in
calculating the aggregate gross settlement in cases of structured
payments.
(iii)
In cases involving multiple insurance program
defendants where payment exceeds twenty-five thousand dollars but no specific
allocation is made in the disposition of the claim by the settlement or
judgment order, a report will be filed with the state medical board for each of
the defendants upon whose behalf the payment is made.
(iv)
Payments made
solely for damages not arising from patient care will not be
reported.
(v)
The waiver of an outstanding debt or charge for
services will not be construed as a payment.
(b)
Each notification
to the state medical board will include the following:
(i)
The name and
address of the person submitting the notification;
(ii)
The name of the
university of Toledo;
(iii)
The name and address of the defendant of the
claim;
(iv)
The name of the person filing the written claim
(plaintiff);
(v)
The date of final disposition;
(vi)
The amount of
payment; and
(vii)
If applicable, the identity of the court in which the
final disposition took place.
(2)
Reporting to the
national practitioner data bank ("NPDB"):
(a)
The university
will notify the NPDB within thirty days of the date that a payment is made in
settlement of, or in satisfaction in whole or in part of a written claim or
judgment, arising from patient care for a participant in the university's
insurance program with regard to the physician, dentist, or other health care
provider who is the subject of the claim.
(b)
For purposes of
reporting to the NPDB, the following will apply:
(i)
Reporting
payment(s) to the NPDB requires that:
(a)
The participant
be named in the caption or body of a written complaint or claim demanding
monetary payment for alleged damages; and
(b)
The participant
is named in a settlement release or final adjudication related to the alleged
incident.
(ii)
Reports will be submitted to the NPDB when professional
liability payments are made for the benefit of licensed residents or fellows
who are participants in the insurance program;
(iii)
Payments made
for the benefit of medical or dental students are not reportable to the NPDB,
but all other health care professionals licensed under Ohio law are
reportable;
(iv)
A payment made to settle a professional liability claim
or action is not reportable to the NPDB if the participant is dismissed from
the lawsuit prior to the settlement or judgment due to lack of involvement in
the alleged incident.
(v)
A payment made at the low end of a high-low agreement
that is in place prior to a verdict will not be reported to the NPDB if the
fact-finder rules in favor of the participant and assigns no liability to the
participant; and
(vi)
A complaint filed in any competent court asserting a
professional liability claim and demanding payment constitutes a written claim
for damages.
(b)
Each notification to the NPDB will include a narrative
description of the acts or omissions and injuries and illnesses upon which the
professional liability action or claim was based, including the
following:
(i)
Age of the claimant at the time of the initial alleged event;
(ii)
Sex of the
claimant;
(iii)
Patient type (inpatient, outpatient, or
both);
(iv)
Initial event or medical condition of the patient
(words that best describe the diagnosis);
(v)
Procedure
performed or treatment rendered by the participant as provider to the patient
for the medical condition described;
(vi)
Claimant's
allegation (the occurrence that precipitated the claim of
damages);
(vii)
Associated legal or other issues which have an impact
on the claim; and
(viii)
The outcome.
Disclaimer: These regulations may not be the most recent version. Ohio may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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