(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).
