You may pay your premium monthly, quarterly, or annually. To enroll in our automatic payment plan, please visit the Payment Options page and select "Enroll/update automatic payment plan" or contact our Customer Service Department at 800-580-8658 ext. 5050.
Can I pay by credit card?
Yes, you may pay your premium with Visa, MasterCard or American Express by visiting the Payment Options page and selecting "Pay by credit card". You may also enroll in our automatic payment plan by visiting the Payment Options page and selecting "Enroll/update automatic payment plan" or contact our Customer Service Department at 800-580-8658 ext. 5050.
How can I determine if you have received my premium payment?
To check the status of your premium payment, you may contact our Customer Service Department at 800-580-8658 ext. 5050.
Who do I make my payment to?
Please remit payment to: Texas Medical Liability Trust or Texas Medical Insurance Company.
Where should I send my premium payment?
All payments should be mailed to:
TMLT
P.O. Box 847512
Dallas, Texas 75284-7512
TMIC
P.O. Box 840168
Dallas, Texas 75284-0168
If you wish to send your payment by an overnight express delivery service, please send payments to:
TMLT
Bank of America Lockbox Services
Lockbox # 847512
1950 N. Stemmons Fwy, Ste 5010
Dallas, TX 75207
TMIC
Bank of America Lockbox Services
Lockbox # 840168
1950 N. Stemmons Fwy, Ste 5010
Dallas, TX 75207
When can I expect to receive my bill?
Billing frequency is determined by the payment plan selected — either monthly, quarterly, or annual payment plan. To provide ample time to make these payments, bills are mailed to policyholders approximately 30 days prior to the due dates. For policyholders who have enrolled in our automatic payment plans, statements are mailed 15 days prior to the draft/charge date as a confirmation.
When is coverage effective?
For coverage to begin, we must have your surplus deposit monies, confirmation of pending TMA membership, and your completed application underwritten and approved.
I received a check from TMLT/TMIC, but not sure what it is for?
Please send your inquires to payables@tmlt.org and include the check number and amount. Your inquiry will be answered within two business days.
We've been told we need to submit an ID such as SS# or FEIN. What form do we use and how do we submit this information?
The form can be downloaded here. Please complete page 1, sign, and date the form. The form can be emailed to payables@tmlt.org or sent by fax to 512-328-5637, attention: accounts payable.
Once a notice of claim is reported, the loss is assigned to a claim supervisor and coverage is entered and verified. Once the claim file is set up in our system, the following occurs:
A letter is sent to the policyholder requesting a copy of all medical records regarding the physician's care of this patient.
A response letter is sent to the plaintiff's attorney or pro-se plaintiff requesting specific allegations, damage information, and a medical authorization that when signed by the patient, allows us to request the pertinent medical records;
If the new loss is a lawsuit, the Texas Medical Board (TMB) is notified;
If a lawsuit has already been filed, then we dispense with the response letter to the plaintiff's attorney. We assign a defense attorney to answer the lawsuit and defend the physician. The policyholder receives a letter from the claim supervisor advising of the attorney assignment.
The average time to complete this from the day the loss is called in is about 5-10 working days.
I am renewing my medical license and the application asks whether there are any claims or suits that have not been reported to the Texas Medical Board (TMB). Has my current claim been reported?
That depends if your claim is a lawsuit. The claim department now routinely notifies the TMB of all lawsuits reported to us by the policyholder. We also file a report with the TMB when the lawsuit is resolved and the file is closed. Per changes in 2003 to the regulations that govern TMLT's reporting requirements to the TMB, claims that are not in suit are no longer reported.
What constitutes a claim that should be reported to TMLT?
According to the TMLT policy language, a "claim" means (a) the receipt by the Named Insured of a summons or citation in a lawsuit, (b) the receipt by the Named Insured of a written notice of claim sent pursuant to applicable law or (c) the receipt by the Named Insured of a written demand from a patient or representative of such patient, provided the lawsuit, notice of claim or written demand from a patient seeks compensatory damages because of injury resulting from an insured incident occurring on or after the retroactive date of this policy. A claim directed to any insured under this policy does not constitute a claim against any other physician or entity even if the other physician or entity is insured by the Trust or any of its subsidiaries under the same or different policies. A request for medical records or copies of medical records is not a claim.
However, even if there is no "claim" as defined above, please do not hesitate to contact a TMLT claims representative to discuss an unexpected patient outcome or other adverse event that has the potential to result in a claim.
Can I choose my own defense attorney?
TMLT selects only the most qualified and experienced defense attorneys for policyholder defense. While we will consider specific requests, TMLT reserves the right to choose appropriate counsel to represent our policyholders for claims covered under the TMLT policy.
How do I obtain a copy of my claims history?
You can visit the myTMLT web site and download a copy of your claim history, or you can contact your underwriting team by phone, fax, or email. You can also use the Contact Us form to submit your request.
How will a claim affect my rates/premiums at TMLT?
An indemnity payment on your TMLT policy in excess of $50,000 would necessitate removal of any earned experience discount. The time period to again earn this credit is three years and begins immediately after the indemnity is paid.
What does indemnify mean?
Refers to a total shifting of economic loss to the party directly responsible for that loss. To indemnify is to compensate for damage, loss, or injury.
What is an indemnity agreement?
An indemnity agreement is an agreement where one party attempts to shift responsibility for economic loss or potential liability.
What is vicarious liability?
Vicarious liability means that a policyholder can be held legally responsible for the actions of another person. Typically in medical liability claims, physicians can be found vicariously liable for the actions of nurses, medical assistants, or employed physicians.
What is a claim reporting requirement?
The claim reporting requirement is the contractual obligation of the policyholder to promptly report to the carrier any claim for damage asserted against the policyholder. What constitutes a claim that must be reported varies from company to company, but is always defined in the policy. Please see the report a claim section of our web site for more information.
What does reservation of rights mean?
Reservation of rights means that there is a question of whether or not a particular incident is covered under the policy. Typically, an insurer is obligated to defend a claim during the time the coverage question between the insurer and policyholder is being resolved.
What does claims frequency mean?
Claim frequency refers to the number of claims filed. Claim frequency is one factor used to determine insurance premiums.
What is claim severity?
Claim severity refers to the dollar value of a claim as determined by a jury verdict or settlement agreement. Like claim frequency, claim severity is one factor used to determine insurance premiums.
Texas Medical Liability Trust (TMLT) is a unique, not-for-profit health care liability claim trust owned by its physician policyholders. TMLT is not an insurance company, but a self-insured trust created by the Texas legislature in 1979 to provide medical liability coverage (commonly referred to as medical malpractice insurance) to members of the Texas Medical Association.
What are your business hours?
Our business hours are 8 a.m. to 5 p.m., Monday through Thursday and 8 a.m. to 1 p.m. on Friday.
Where are you located?
TMLT is located at 901 South Mopac Expressway
Barton Oaks Plaza Building V Suite 500
Austin, Texas 78746 View map Driving directions
When can I expect to receive my bill?
Billing frequency is determined by the payment plan selected — either monthly, quarterly, or annual payment plan. To provide ample time to make these payments, bills are mailed to policyholders approximately 30 days prior to the due dates. For policyholders who have enrolled in our automatic payment plans, statements are mailed 15 days prior to the draft/charge date as a confirmation.
When is coverage effective?
For coverage to begin, we must have your surplus deposit monies, confirmation of pending TMA membership, and your completed application underwritten and approved.
Why do I have to be a member of Texas Medical Association to purchase TMLT coverage?
TMLT was created by the Texas legislature in 1979 to provide medical liability coverage (commonly referred to as medical malpractice insurance) for physician members of the Texas Medical Association. The legislation that created TMLT included the provision that policyholders must be members of the TMA. Therefore, by law, policyholders must also be members of the TMA.
What are limits of coverage?
Limits of coverage spell out the maximum amounts your policy will pay. In professional liability policies, there are typically two limits. One limit states the maximum per claim, while the second limit spells out the maximum amount that will be paid during the policy period. The first limit is called an "each claim" limit and the second one is called an "all claims" limit.
How much coverage is right for me? What limits of liability do you suggest?
We cannot advise you about what limits to carry, but we do recommend that you speak with colleagues who practice in your specialty and location to see what limits of liability they carry. You may also contact your local county medical society; often their legal counsel is available to advise you. Your personal financial advisor may also have recommendations in consideration of your personal assets. Read more about limits of liability.
What is TMLT's dividend program?
TMLT's dividend program is an effort to return a portion of premiums previously paid back to policyholders.
Who is eligible for TMLT's dividend program?
All renewing policyholders are eligible for the dividend program.
I am new to TMLT, will I receive a dividend?
Only renewing policyholders are eligible to receive a dividend.
How much will I receive for my dividend?
The dividend is calculated as a percentage of your expiring premium. The TMLT Board of Governors reviews dividend considerations annually.
How much will my dividend be?
Overall dividend percentages are announced on our web site. Your specific dividend amount will be detailed in the rate letter you receive prior to the renewal of your policy.
When will I receive my dividend check?
The dividend will show as a credit on your invoice; a check will not be sent.
What if I did not receive an invoice?
If your dividend amount was enough to fully pay your installment, you were not mailed an invoice.
Why don't I see my dividend credit on my declarations page?
The dividend is not a policy credit; it is a return of premiums previously paid. Therefore, the dividend is deducted directly from your invoice.
Will TMLT always offer a dividend?
The continuation of TMLT's dividend program is based on the continued strength of the company's financial position and a favorable claims environment. TMLT's Board of Governors will evaluate the continuation of the dividend program on a yearly basis.
What does claims-made mean?
A claims-made policy is designed to protect you during the active policy period, usually one year. If you do not renew your claims-made policy when it expires, you no longer have coverage for any claims that may arise in the future that are alleged to have occurred during the time your policy was in force. Read more about claims-made coverage.
What is an occurrence policy?
An occurrence policy provides ongoing insurance coverage for incidents that occur during the policy period, even if they are reported after the policy expires or is cancelled. Therefore, it is not necessary to purchase tail coverage when an occurrence policy is cancelled. Read more about occurrence coverage.
What is prior acts coverage?
A supplement to a claims-made policy, prior acts coverage is purchased from a new carrier when you change carriers. This coverage, also known as nose coverage, covers incidents that occurred before the beginning of the new insurance relationship, but have not yet been brought to your attention as a claim. Prior acts coverage is an alternative to tail coverage, which is purchased from the original carrier when a change in carriers is made. Companies typically require new policyholders to purchase either prior acts or tail coverage to protect against claims arising from prior acts. Read more about prior acts coverage.
What is tail coverage?
When a claims-made policy is discontinued, tail coverage (sometimes called a reporting endorsement) is an option available from your former carrier to continue coverage for those dates that claims-made coverage was in effect. Once a claims-made policy is cancelled, coverage does not continue in the future for any claims that might be reported unless tail coverage or prior acts coverage is secured at the time the policy is cancelled. If neither is purchased, any future claims that might arise from services performed during the policy period will no longer be covered. Read more about tail coverage.
What is surplus?
Surplus is critical to the financial stability of an insurance company, as it indicates whether or not a company has adequate capitalization and financing to pay future claims. Surplus provides the cushion required to handle the inherent variability in estimating claims losses.
What coverage is available for my entity?
Entities, which are defined as an incorporated formation of two or more shareholder physicians practicing under the group's "dba" name, are eligible for a separate entity policy. The policy provides defense and indemnity coverage when the entity is held to be legally responsible for the actions of the member physicians. Physicians that are incorporated as a Solo Professional Association are provided coverage under their Individual policy on a shared-limit basis.
What does assessable mean?
Some policies will ask that you pay an assessment in addition to the yearly premiums. Assessments can occur if a company experiences higher claims costs than anticipated. In some cases, assessments can be as much as the full premium. All TMLT medical liability policies are non-assessable.
What is a declarations page?
The declarations page is the first page of the insurance policy that contains information specific to the policyholder. The declarations page contains the policyholder's name, address, specialty, limits of liability, premium amount, and policy effective date.
What is an endorsement?
An endorsement is a document that changes the terms of the insurance policy to allow for special situations or to fit special needs of the policyholder.
What is risk classification?
An insurance term referring to the classification of groups with similar risks to evaluate those groups based on their claims experience. Typically, groups are classified by specialty, geographic location, and procedures performed. Risk classification is one factor used in determining premium.
What does indemnify mean?
Refers to a total shifting of economic loss to the party directly responsible for that loss. To indemnify is to compensate for damage, loss, or injury.
What is an indemnity agreement?
An indemnity agreement is an agreement where one party attempts to shift responsibility for economic loss or potential liability.
What is vicarious liability?
Vicarious liability means that a policyholder can be held legally responsible for the actions of another person. Typically in medical liability claims, physicians can be found vicariously liable for the actions of nurses, medical assistants, or employed physicians.
What is underwriting?
Underwriting is the process of qualifying an applicant for insurance and determining the appropriate type and amount of insurance for the applicant.
What constitutes a claim that should be reported to TMLT?
According to the TMLT policy language, a "claim" means (a) the receipt by the Named Insured of a summons or citation in a lawsuit, (b) the receipt by the Named Insured of a written notice of claim sent pursuant to applicable law or (c) the receipt by the Named Insured of a written demand from a patient or representative of such patient, provided the lawsuit, notice of claim or written demand from a patient seeks compensatory damages because of injury resulting from an insured incident occurring on or after the retroactive date of this policy. A claim directed to any insured under this policy does not constitute a claim against any other physician or entity even if the other physician or entity is insured by the Trust or any of its subsidiaries under the same or different policies. A request for medical records or copies of medical records is not a claim.
However, even if there is no "claim" as defined above, please do not hesitate to contact a TMLT claims representative to discuss an unexpected patient outcome or other adverse event that has the potential to result in a claim.
How will a claim affect my rates/premiums at TMLT?
An indemnity payment on your TMLT policy in excess of $50,000 would necessitate removal of any earned experience discount. The time period to again earn this credit is three years and begins immediately after the indemnity is paid.
How do I obtain a copy of my claims history?
You can visit the myTMLT web site and download a copy of your claim history, or you can contact your underwriting team by phone, fax, or email. You can also use the Contact Us form to submit your request.
What is a claim reporting requirement?
The claim reporting requirement is the contractual obligation of the policyholder to promptly report to the carrier any claim for damage asserted against the policyholder. What constitutes a claim that must be reported varies from company to company, but is always defined in the policy. Please see the report a claim section of our web site for more information.
A hospital has requested my policy information/claims history from TMLT. Why has it been mailed to me? What should I do with it?
When TMLT receives a request for policy information or claim history from a hospital or insurance company, the requested information is produced and forwarded to the policyholder. This information is sent — along with the original request and a cover letter of explanation — so the policyholder can review the information. Once the information has been reviewed, forward it directly to the hospital or insurance company that made the request.
Policyholders can now authorize TMLT to release their claim history directly to any hospital, health insurance company, or credentialing organization requesting this information by enrolling in TMLT's Claim History Release Program.
To enroll, please complete and sign the claim history release form, and return it by fax to 512-425-5999. You can also mail the form to TMLT Underwriting Services, PO Box 160140, Austin, TX 78716-0410.
What does reservation of rights mean?
Reservation of rights means that there is a question of whether or not a particular incident is covered under the policy. Typically, an insurer is obligated to defend a claim during the time the coverage question between the insurer and policyholder is being resolved.
What does claims frequency mean?
Claim frequency refers to the number of claims filed. Claim frequency is one factor used to determine insurance premiums.
What is claim severity?
Claim severity refers to the dollar value of a claim as determined by a jury verdict or settlement agreement. Like claim frequency, claim severity is one factor used to determine insurance premiums.
What is an insurance trust?
In reference to TMLT, a medical liability claim trust owned by physician policyholders. TMLT was created by the Texas Legislature to provide medical liability insurance to members of the Texas Medical Association. In general, trusts are not regulated by state insurance departments, but a trust like TMLT complies voluntarily with the rules and regulations for commercial insurance companies.
What is a captive insurance company?
A captive insurance company is a provider-owned insurance company, where the provider may be a hospital or a group of physicians.
What is a mutual company?
A mutual is an insurance company that is structured like a corporation, but has no stockholders. The policyholders own the company.
What is a stock company?
A stock company is an insurance company formed as a corporation with stockholders who have invested capital in the company.
What is an actuary?
An actuary uses statistical analysis to compute insurance risks and premiums. Actuaries are often used to help insurance companies set premium rates.
What is general liability insurance?
General liability insurance refers to a type of business liability insurance other than automobile, workers' compensation, or employer's liability that covers property damage or bodily injury. In a health care setting, general liability insurance would cover such incidents as a visitor slipping on a wet floor of a hospital or office.
What is reinsurance?
Practice where an insurance company (the insurer) transfers a portion of its risks to another (the reinsurer).
What are reserves?
Reserves are funds set aside by insurance companies to pay estimated future losses. A company's claim department typically specifies a reserve amount for every claim filed, which can be modified as the claim proceeds to resolution.
Which application do I fill out?
If you are a physician and you want medical liability coverage for yourself, please fill out the Individual application.
If you are a physician who is joining a group that is currently insured with TMLT and is set up to apply online, please fill out the Individual joining a group application.
If you would like medical liability coverage for your group and for the physicians in your group, please fill out the Group application.
If you are a physician assuming responsibility for another physician's patients during a scheduled absence and want medical liability coverage, please fill out the Locum tenens application. (The physician you are substituting for must be a current TMLT policyholder in order for you to obtain coverage from TMLT.)
If you are currently a resident and you plan on "moonlighting" outside of your residency program and want medical liability coverage, please fill out the Moonlighting application.
If you are a physician entering your first or second year of practice, please fill out the Rising Star application.
If you are a DO and want coverage through TMLT's wholly owned subsidiary, Texas Medical Insurance Company, please fill out the TMIC Individual Application for DOs. Read more about our DO coverage.
If you are physician's assistant, nurse (including nurse midwife, nurse practitioner, CRNA), technician, therapist, chiropractor, or podiatrist working with a TMLT policyholder and you want professional liability coverage, please fill out the TMIC individual application.
If you are a dentist and would like professional dental liability coverage, please fill out the TMIC dental application.
According to TMB Rule 166.2, Texas physicians are required to complete 48 hours of credit every 24 months. At least 24 credits must be from formal courses designated as Category I. At least two of the 24 formal credits must involve the study of medical ethics. The remaining 24 credits may comprise informal self-study, attendance at hospital lectures, grand rounds, or case conferences not approved for formal CME.
How much is the CME discount and when will it apply?
TMLT policyholders who complete a 2.5-hour risk management CME activity may be eligible for a 3% premium discount (up to $1,000 per course). The discount will be applied to your next eligible policy period.
What CME courses can I take to receive the risk management discount?
I am trying to complete an online CME course and it is asking for a user name and password.
If you have previously completed a TMLT online CME course and you do not have your user name and password, please go to our online CME site and click "I forgot my password."
If you have not completed a TMLT online course, please click the "New student registration" link at our online CME site. You will be prompted to create your own user name and password.
I completed a TMLT course and cannot find my certificate.
During a practice review, a risk management professional will visit your practice to help you and your staff determine your risk exposures. Before the scheduled review date, an office questionnaire that varies by specialty will be sent to the practice. The representative will then review approximately 10 medical records for each physician in the practice. He/she will also review your practice's policy and procedure manual, take a quick tour of the office, and conclude the review with a wrap-up discussion with the physician(s).
How long will the practice review take?
The time for a review varies depending on the size of your practice. Plan on a representative being in the office for several hours. However, the majority of the representative's time will be spent reviewing medical records, and he/she will not require time from anyone in your office.
Does the physician have to be present during the practice review?
Physicians are encouraged to continue their regular schedule during the review. Once the risk management representative has completed the review, he/she will need to spend approximately 45 minutes with the physician(s) to discuss general risk management concerns and any specific recommendations. This meeting will be scheduled when the practice review is scheduled.
Do I need to de-identify patient information in the medical records that will be reviewed during a practice review?
No. TMLT has a HIPAA business associate's agreement on file with all of our policyholders. This allows us to review the medical records under HIPAA guidelines. No patient information will be removed from the practice.
Can one physician in a group request a practice review if the other physicians do not wish to participate?
When a practice review is requested for a group, it is recommended that all TMLT-insured physicians agree to be included before scheduling the review.
Can a physician who is not a TMLT policyholder request a practice review?
Yes. Practice reviews are free to all TMLT policyholders. However, if a physician who is not insured by TMLT would like to request a practice review, that physician can contact the TMLT Risk Management Department to obtain information regarding the fees for a review.
Can a hospital-based physician (hospitalist, radiologist, pathologist, anesthesiologist, emergency medicine physician) request a practice review?
Yes. TMLT can conduct practice reviews for physicians in all specialties and practice types.
How long will the practice review premium discount remain in effect?
Once the physician has adequately responded to any recommendations made during the review, the 5% practice review discount is effective for the remainder of the current policy period plus an additional two full policy periods, as long as the physician is continuously insured with TMLT.
How long will it take before I hear from someone about scheduling the review?
Typically, risk management representatives are out of the office conducting practice reviews 2 to 3 days per week. Therefore, it may take up to 2 weeks before a representative contacts you to schedule the review.
Americans with Disabilities Act
What am I required to do under the Americans with Disabilities Act (ADA) to accommodate patients who are hearing impaired?
Appropriate auxiliary aids and services may include qualified interpreters, assistive listening devices, note takers, and written materials for individuals with hearing impairments, qualified readers, taped texts, and Braille or large print material. The ADA does not require modifications that would fundamentally alter the nature of the services provided or result in an "undue burden" on the provider. What constitutes an "undue burden" is determined on a case-by-case basis. At least one court has found in favor of the plaintiff over the provision of an interpreter for a hearing-impaired patient in a primary care physician's office.
What does the ADA require for mobility-impaired patients?
A public accommodation is required to remove architectural barriers in existing facilities where such removal is "readily achievable," which is defined as "easily accomplished and able to be carried out without much difficulty or expense." Examples of steps to remove barriers include installing ramps, widening doors, installing grab bars in bathroom stalls, installing a raised toilet seat, removing deep pile carpeting and creating designated, accessible parking spaces. Please refer to the ADA web site for more information.
What about those patients who do not speak English? I am a small office, and interpreters can be costly. Am I required to provide and absorb the cost of an interpreter?
According to the Office for Civil Rights, an entity receiving federal reimbursement (such as Medicaid or Medicare) is responsible for ensuring that effective oral and written communication occurs with program beneficiaries who are Limited English Proficient (LEP). The entity can take several steps to meet its obligations to LEP patients. Providing interpreters, at no cost to the client, is one method. Please visit the Office of Civil Right's web site for more information.
Who has responsibility for ADA compliance in leased buildings, the landlord or the tenant?
The ADA places legal responsibility to remove barriers or provide auxiliary aids on both the landlord and the tenant.
What is my responsibility as an employer under the ADA?
Employers with 15 or more employees must comply with the ADA in their employment practices. The ADA protects individuals with disabilities from discrimination related to employment practices. Individuals with disabilities who meet "the skill, experience, education, and other job-related requirements of a position held or desired, and who, with or without reasonable accommodation, can perform the essential functions of a job" are protected. To be covered by the ADA, an individual must have a mental or physical impairment that (even with corrective or mitigating measures, such as corrective lenses) substantially limits one or more major life activities. In addition, the ADA prohibits discrimination against persons who are perceived to have a disability. Please refer to the ADA web site for more information.
Who can I contact if I need specific information about the ADA?
TMLT Risk Management representatives are available to assist you. Please call (800) 580-8658 and ask for the Risk Management Department. You can also call the Southwest ADA Center at (800) 949-4232.
Advance directives
What is an advance directive?
According to the Texas Advance Directive Act, the current definition of an advance directive is: "an instruction to administer, withhold or withdraw life-sustaining treatment in the event of a terminal or irreversible condition [A Directive to Physicians and Family or Surrogates]; or an out-of-hospital DNR order; or a medical power of attorney."
Advance directive documents include:
Directive to Physicians, instructing health care professionals to administer, withhold, or withdraw life-sustaining treatment in the event of a terminal or irreversible condition (previously called a "living will");
out-of-hospital do-not-resuscitate orders; and
medical power of attorneys.
Please refer to the January-February 2004 issue of the Reporter for the article entitled, End-of-life decisions: protecting your patients and yourself for a more detailed explanation.
What is a terminal condition?
A terminal condition means an incurable condition caused by injury, disease or illness that according to reasonable medical judgment will produce death within six months, even with available life-sustaining treatment provided in accordance with the prevailing standard of medical care. A person admitted to a licensed hospice program is presumed to have a terminal condition.
Do both witnesses to advance directives need to meet the statutory requirements?
No. While both witnesses must be competent adults, only one must meet certain statutory requirements, such as:
not designated by the declarant to make treatment decisions;
not related to the patient by blood or marriage;
not mentioned in the patient's will or having any claim to his/her estate; and
not the attending physician, his/her employees, or certain employees of the health care facility in which the patient is being treated.
Are advance directives executed in another state valid?
Yes, a directive executed in another state is enforceable provided that it complies with the laws of the state of Texas. For guidelines, please go to the Texas Medical Association's Death Act: Directive to Physicians.
Who can execute a directive on the behalf of a minor?
A directive may be executed on behalf of a qualified minor by:
the patient's spouse, if the spouse is an adult;
the patient's parents; or
the patient's legal guardian.
Do advance directives need to be notarized?
No, in fact a physician or health care facility may not require that a directive be notarized or that a person use a form provided by the health care professionals.
What about advance directives for pregnant patients?
A person may not withdraw or withhold life-sustaining treatment from a pregnant patient.
What is my liability in following or refusing to follow an advance directive?
A physician, health care facility, or health care professional with no knowledge of a directive is not civilly or criminally liable for failing to act in accordance with the directive. However, if an attending physician refuses to comply with the directive, life-sustaining treatment must be provided to the patient only until a reasonable opportunity has been afforded for the transfer of the patient to another physician willing to comply with the directive or treatment decision. Failure to follow a qualified patient's directive will subject the physician or health care professional to review and disciplinary action by the appropriate licensing board.
What can I do when I disagree with the surrogate decision-maker?
Whether the physician is recommending that treatment be continued or that it be stopped because it is medically futile, the new law codifies a process that includes a mandatory ethics consultation; a reasonable attempt to transfer the patient to another physician or institution willing to honor the directive; and, in the case of medical futility disputes, continuation of life-sustaining procedures for at least 10 days after the ethics committee explains its conclusion in writing to the patient's surrogate.
Staffing issues
Should I perform background checks on employees?
Under the legal doctrine of respondeat superior, physicians are responsible for the actions of their employees committed within the scope of employment. Like any employer, a physician is required to select, train, supervise, and discipline his or her employees in a manner consistent with providing quality patient care. Checking references and performing background checks reflects your efforts to employ qualified personnel. The information should be documented in the employee's personnel file.
In Texas, criminal background checks can be performed through the Texas Department of Public Safety (DPS). A full set of fingerprints (which can be obtained at your local law enforcement department or at the DPS office), a signed written request, and a $15 fee are required. Please visit the Texas DPS web site for more information.
What is my responsibility when supervising physician assistants (PAs)?
The Medical Practice Act (MPA) establishes minimum standards for supervision by physicians of PAs for provision of services at various sites. At a physician's primary practice site, he/she is limited to supervising five PAs. Standing delegation orders, standing medical orders, physician's orders, or other orders or protocols may authorize diagnosis of the patient's condition and treatment. Neither the MPA nor the Texas Medical Board rules authorize the exercise of independent medical judgment by PAs. The supervising physician remains responsible to patients for acts performed under the physician's delegated authority.
Physician supervision shall conform to what a reasonable, prudent physician would find consistent with sound medical judgment, and may vary with the education and experience of the PA. A physician shall provide continuous supervision, but the constant presence of the physician is not required. The physician must be easily contacted by radio, telephone, or other telecommunication device. Please see TMB rules Chapter 185 and Chapter 193 for more information.
What is my responsibility when delegating tasks to unlicensed employees?
Provided that you are satisfied with the competence of your employee, with due regard to the safety of the patient, and in keeping with sound medical practice, standing delegation orders may be authorized for the performance of acts and duties that do not require the exercise of independent medical judgment Please see TMB Standing Delegation Orders, Chapter 193 for more information.
Unlicensed employees can be trained to perform some tasks associated with the delivery of patient care; however, some tasks are inappropriate to delegate and the accountability for the competent performance of that task remains with the physician. In determining the appropriate role for unlicensed personnel, you should consider the capabilities of the employee, the complexity of the task, and the amount of supervision required. Employers can be held liable for negligent delegation if they:
delegate a task they know or should know the person does not have the training or experience to complete;
do not provide the degree of supervision the employer knows or should know is needed;
delegate tasks contrary to the medical/nurse practice act;
delegate tasks that pose substantial risk of harm to a patient or are present and fail to take action when possible to avoid patient injury; and
do not properly allocate the time of available staff.
Should I be checking prospective employees and vendors to see if they're excluded from federally funded programs?
Physicians may want to check potential employees for exclusion from Medicare and Medicaid programs, as part of pre-employment screening. Physicians can be fined if they enter into contracts with excluded individuals or entities to provide items or services to federal program beneficiaries.
A physician or entity receiving federal health care funding may only employ an excluded individual in limited situations, such as when the physician is able to pay the individual exclusively with private funds or from other non-federal funding sources, and where the services furnished by the excluded individual relate solely to non-federal program patients.
Can I test a patient for HIV after one of my employees has been accidentally exposed?
In a case of accidental exposure to blood or other body fluids, the health care facility may test the person who may have exposed the health care worker to HIV without the person's specific consent to test. Any identifying information concerning the person should be destroyed as soon as the testing is complete and the person who may have been exposed is notified. For further information contact, the Texas Department of State Health Services.
What type of consent is required for HIV testing?
Except as otherwise provided by law, a person may not perform an HIV test without first obtaining the informed consent of the person to be tested. This consent does not need to be written. Documentation in the medical record that the test has been explained and consent has been obtained is sufficient.
What is the law concerning spousal notification of positive HIV test results?
The Texas Health and Safety Code provides that the physician or other person authorized by law who ordered the test may release the result to the spouse of the person tested if the person tests positive for AIDS or HIV infection, antibodies to HIV, or infection with any other probable causative agent of AIDS.
Can I test for HIV before a procedure?
Texas law provides that a person (such as a physician) may require another person to have an HIV test if a medical procedure is to be performed that could expose health care personnel to AIDS or HIV infection, and there is sufficient time to receive the test result before the procedure is conducted. However, HIV-positive patients are considered "disabled" under the Americans with Disabilities Act (ADA), which supersedes state law. The ADA also prohibits discrimination against persons who are perceived to have a disability. Thus, refusing to perform a procedure based on HIV status or the patient's refusal to undergo an HIV test would likely be in violation of the ADA.
Does the Americans with Disabilities Act (ADA) require me to treat individuals with HIV?
While the ADA expressly provides that a public accommodation may exclude an individual if that individual poses a "direct threat" to the health or safety of others that cannot be mitigated by appropriate modifications in the accommodation policies or procedures, one cannot justify the refusal to treat HIV-positive or AIDS patients in the policies of organized medicine or public health. The Centers for Disease Control and Prevention and the American Medical Association recommend the use of "universal precautions" to prevent the transmission of blood-borne diseases in the health care setting.
How do the 2010 changes in reporting HIV and STDs apply to my practice?
Effective January 1, 2010, Texas health care professionals must report all primary and secondary syphilis diagnoses by telephone within one working day of diagnosis. In addition, all public health, hospital and commercial laboratories serving Texas will be required to report the following information:
All CD4 T-lymphocyte (CD4) counts for adults and adolescents over the age of 12
All HIV viral loads (both detectable and undetectable)
Positive and negative HIV DNA or RNA virologic test results for infants up to 3 years of age
Positive and negative confirmatory syphilis test results within 3 working days
HIV genotype resistance results (FASTA files)
The new rules also allow use of a Texas-specific HIV/AIDS case report form and clarify that point-of-care HIV tests (HIV rapid tests) are reportable. These rule changes will help increase the number of STD cases identified, facilitate early public health intervention to control the spread of STDs and improve medical care for HIV-infected patients.
Health care professionals and laboratories not using electronic reporting should report to their designated local health authority. In most areas of the state, this is the local or regional health department. In addition, hospital-based laboratories are now required to report test results directly to their local health authority and cannot report results via a delegate, such as an infection control officer.
Laboratories reporting electronically should report to the Department of State Health Services (DSHS) central office in Austin. Although paper laboratory results will continue to be accepted, electronic laboratory reporting is encouraged.
If you have questions about the reporting rule changes, contact Nicole Hawkins, DSHS Epidemiologist at 512-533-3043. To learn more about electronic laboratory reporting, contact Jennifer Chase, DSHS Epidemiologist at 512-533-3046.
Medication
What are the risks of prescribing a medication for off-label use?
Because a particular use of the drug may be beneficial but uncommon, many drug manufacturers choose not to seek FDA approval for an off-label use due to cost and time factors. Congress has not prohibited the prescription of medications for non-FDA-approved (off-label) use.
However, prescribing a medication for off-label use is not without risk, particularly in pediatrics. Physicians are still responsible for practicing prudent medicine. The available literature and the practices of similarly situated physicians would be evidence of compliance to the standard of care. In addition, physicians are encouraged to obtain a signed, written consent indicating the rationale for the medication, its risks, benefits, and alternatives. Information is available at the FDA web site.
Do I have to keep my sample medications and prescription pads locked away?
Not necessarily. Health care professionals have a responsibility to guard against theft of sample medications and prescription pads. Sample medications should be stored in areas accessible only to physicians and clinical staff members. Prescription pads should not be readily accessible to patients, visitors, or some staff members.
What should I do if prescription pads or controlled substances are missing?
Prescription pad or controlled substance theft should be reported to local law enforcement and the Drug Enforcement Agency. If prescription pads are missing, local pharmacies and the Board of Pharmacy should also be notified. Additional information is available from the Texas Pharmacy Association.
Do I need to keep receipts of sample medications?
Yes. The Texas Administrative Code requires that all physicians maintain a copy of each signed request form for sample dangerous drugs for a period of two years from the date of acquisition. Dangerous drugs are defined as any medications that require a prescription.
Can Schedule II drugs be prescribed electronically in Texas?
Effective September 1, 2011, Schedule II drugs may be prescribed using electronic prescriptions.
During the 82nd Texas Legislative session, Senate Bill 594 was passed. It amends the Texas Health & Safety Code to allow Schedule II drugs to be prescribed with an electronic prescription, to match changes to the federal law. Read the full text of the bill.
I've heard that physicians can be fined for purchasing drugs or medical devices from a vendor unlicensed to sell in Texas. Is this true?
Texas physicians should be aware that the Texas attorney general and the federal government are taking actions against physicians arising from the purchase and use of medical products and drugs that are allegedly not legal for use in the United States. Most of these cases arise when physicians attempt to save money for their patients by buying drugs and devices from Internet sites or distributors who offer product discounts.
The typical scenarios that give rise to these actions include:
Physicians purchase medical products over the Internet believing the goods are approved for use in the U.S., but the products are not "FDA approved" or labeled for domestic distribution. This renders the products "misbranded."
Physicians may unknowingly purchase a medical product from a distributor unlicensed or unauthorized to do business in Texas or the U.S.
Either of these actions may give rise to a charge of numerous "laundry list" acts that violate Texas law, most prominently the Texas Deceptive Trade Practices Act (DTPA). The DTPA has been interpreted as essentially a strict liability statute, so that fines may be pursued even if the doctor had no intent to violate the law.
Under Texas law, each proven violation may result in a civil penalty of not more than $20,000 per violation, with additional penalties if the consumer was over the age of 65. Each individual use of the product may be deemed a distinct statutory violation by the attorney general, so the fines can be very large.
How can I participate in the state's prescription drug recycling and re-distribution program?
In 2007, the Texas legislature passed a law allowing for recycling or redistribution of prescription drugs in very limited situations. The law does not have a provision for physicians to recycle medications through their office.
The law requires a pharmacist who practices in or serves as a consultant for a health care facility or licensed health care professions responsible for the administration of drugs in a penal institution may recycle medications to eligible patients. However, the drugs must be sealed in unopened, tamper-evident packaging and either individually packaged or packed in unit-dose packaging.
Other regulations
What does the Occupational Safety and Health Administration (OSHA) require for medical practices?
OSHA standards require that medical practices develop and comply with safety policies and procedures related to blood-borne pathogens, regulated waste disposal, and chemical hazard communication. Employee training is required initially and annually thereafter. Records of all OSHA training should be maintained for three years. Employers are required to make Hepatitis B vaccination available at no cost to all employees whose job classifications indicate potential exposure. Employees who refuse vaccination must sign a declination form. All employee medical records must be kept confidential and retained for at least the duration of employment plus 30 years. More information is available at the OSHA web site.
Since I perform only a few simple tests in my office, do Clinical Laboratory Improvement Amendments (CLIA) regulations apply to my practice?
Yes, CLIA does apply. However, simple tests are waived from specific CLIA requirements. These include:
dipstick or tablet urinalysis;
fecal occult blood;
ovulation test using visual color comparison;
urine pregnancy test using visual color comparison;
erythrocyte sedimentation rate;
hemoglobin by copper sulfate method;
spun microhematocrit;
blood glucose using certain devices cleared by the FDA specifically for home use; and
hemoglobin by single analyte instruments self-contained specimen/ reagents interaction with direct measurement and readout.
A complete list of CLIA-waived tests is available at the CLIA Categorization of Tests web site. If you perform only these tests, a CLIA certificate of waiver is required.
What are the requirements for medical waste management?
The Texas Administrative Code defines the requirements for medical waste management, disposal, transportation, collection, and storage. In general, generators of medical waste are required to maintain receipts of its disposal for a period of three years.
Where can I find information on Senate Bill 316, which requires physicians to provide parents of newborns with information on postpartum depression, shaken baby syndrome, immunizations, and newborn screening requirements?
Where can I find information about umbilical cord blood banking?
During the 2007 regular legislative session, legislators passed House Bill 709, which requires physicians to provide pregnant patients with a brochure on umbilical cord blood banking. The brochure and additional information is available from the Texas Department of State Health Services.
What does the law require for physicians to sign death certificates?
Texas physicians who are asked to sign a death certificate must do so electronically or face fines of up to $500 per violation.
A medical certifier on a death certificate must submit the medical certification and attest to its validity electronically. Physicians must register with the Texas Electronic Death Registrar (TEDR), before signing a death certificate. Any physician who signs a death certificate, and is not registered with TEDR, may be fined up to $500 by the TMB.
Physicians who have not yet registered can do so at the TEDR web site.
If you need assistance, send an email to help-TER@dshs.state.tx.us or call the TER at 888-963-7111 ext. 3490.
Fetal death certificates — fetal death certificates are only available on paper; if a fetus is delivered without vital signs, a fetal death certificate must be signed on paper.
Medical records
What is the proper procedure for the release of medical records?
In order to be acceptable under the Health Insurance Portability and Accountability Act (HIPAA) and compliant with state law, an authorization for the release of protected health information (PHI) must:
be in writing;
identify who is authorized to make the disclosure;
identify who may receive the PHI;
identify who may make the authorization;
identify the specific information to be disclosed, particularly for sensitive information, such as HIV/AIDS testing and treatment, mental health and substance abuse treatment;
describe the purpose of the disclosure;
note when the authorization expires; and
contain a signature and date (of the patient or personal representative).
A valid authorization must also have these statements:
the patient has the right to revoke the authorization, with instructions on how to revoke;
clarification that under most circumstances medical care may not be conditional on the signing of the authorization; and
a warning that the PHI may be re-disclosed by the receiving entity.
The patient must receive a copy of the authorization and the provider must also maintain a copy.
Pursuant to HIPAA regulations, if your medical record contains any notes forwarded to you by a mental health professional you cannot re-disclose that information, even under subpoena. HIPAA defines mental health professionals as psychiatrists, psychologists, and Licensed Professional Counselors.
Who can authorize the release of medical records?
The authorization to release medical records may be signed by:
a parent or legal guardian if the patient is a minor;
legal guardian if the patient has been adjudicated incompetent to manage his/her own personal affairs;
an agent of the patient authorized under a durable power of attorney for health care;
an attorney ad litem or guardian ad litem appointed for the patient;
a personal representative or statutory beneficiary if the patient is deceased; and
an attorney retained by the patient or by the patient's legally authorized representative.
Who "owns" the medical record?
The physical pieces of paper are the tangible, personal property of the person or entity who created them. However, by law patients have the right to obtain copies of their medical records. The only clear exception is in the Medical Practice Act, "If the physician determines that access to the information would be harmful to the physical, mental or emotional health of the patient." The physician might be asked to produce a reasonable explanation as to why the records or information may be harmful to the patient.
Never release the original record, except under subpoena and then retain a copy.
What constitutes a medical record?
Medical records include "any records pertaining to the history, diagnosis, treatment, prognosis of the patient including copies of medical records of other health care practitioners contained in the records of the physician to whom a request for release of records has been made."
Is there a time limit to respond to requests for medical records?
The physician has 15 business days (from the date the request is received) to respond to the request.
May I charge for copying medical records?
Physicians may charge $25 for the first 20 pages and 50 cents for each additional page. No specific retrieval or "pull fee" is allowed.
May I withhold copies of medical records until the copies are paid for?
You are entitled to receive the fee for records preparation before releasing the records, except where the records are requested by a licensed Texas health care provider or any American or Canadian licensed physician for acute or emergency medical care. The other exception includes records needed to support an application for disability or other benefits or assistance under: Aid to Families with Dependent Children, Medicaid, Medicare, Supplemental Social Security Income, and Federal Old-Age and Survivors Insurance.
What about medical records for other physicians?
"A physician shall furnish copies of medical records requested, or a summary or narrative of the records, including records received from another physician or health care provider involved in the care or treatment of the patient, pursuant to a written authorization for release of the information." The exception would be psychiatric records.
If a physician feels it would be harmful to release copies of medical records to a patient, what should be done?
When a physician deems it necessary to deny a request to release medical records, that physician must provide the patient a written statement within 15 business days of receipt of the request, and file a copy of the statement in the medical record. The statement must specify the reason for the denial and how the patient can file a complaint with the federal Department of Health and Human Services and the Texas Medical Board.
Can information from medical records be released without the patient's consent?
Some information must be released without the patient's consent. These situations include:
treatment of gunshot wounds to law enforcement officials;
suspected child and elder abuse to the Texas Department of Protective and Regulatory Services and law enforcement; and
positive HIV tests (without the patient's name) and AIDS diagnoses (with the patient's name) to the Texas Department of State Health Services and local health department.
Medicare records must be made available promptly to representatives of the Department of Health and Human Services.
Medicaid records must be made available promptly to Texas Department of State Health Services, the Texas Attorney General's Medicaid Fraud Control Unit, Texas Medicaid Health Partnership, and the Department of Protective and Regulatory Services.
In none of these situations is the patient's authorization for release of information required.
May I release health information to an insurance company without the patient's consent?
You may file an insurance claim without a written signed consent accompanying each claim.
What about releasing health information to law enforcement officials?
If you think a patient poses a danger of imminent physical harm to himself or others, you may release information to law enforcement officials without the patient's consent.
When do I need the patient's written consent to release medical records in order to respond to a civil subpoena?
This is a somewhat complicated issue. In general, if you receive a subpoena in a case where your patient is party to the suit, and which includes a "deposition upon written questions," you may safely assume that all parties have been notified and have had an opportunity to object or to quash the subpoena. Records can then be released under the subpoena.
If your patient is not a party to the suit, or the subpoena does not include a "deposition upon written questions," then you cannot assume all parties have been notified. In such cases, consider this advice published in Texas Medicine:
"If you cannot determine from the subpoena that the patient's medical records can be released or if you have some well-justified concern about releasing patient records (for example, confidential information about another person who has not consented to the release is in the medical records), then you may contact the requesting attorney and ask for a signed written authorization under Rule 166(b)(2)(H), Texas Rules of Civil Procedure. Rule 166(b)(2)(H) states that "any party alleging physical or mental injury and damages arising from the occurrence which is the subject of the case shall be required, upon request, to produce or furnish an authorization permitting the full disclosure of medical records not theretofore furnished and which are reasonably related to injury or damages asserted.' The attorney who represents a party may seek the medical release, which can then be forwarded to the physician. Medical records may then be provided as directed by the subpoena."
Pursuant to HIPAA regulations, if your medical record contains any notes forwarded to you by a mental health care professional you cannot re-disclose that information, even under subpoena. HIPAA defines mental health care professionals as psychiatrists, psychologists, and Licensed Professional Counselors.
How long do I need to keep medical records?
For adults — all records must be kept for at least seven years from the date of the last treatment. (Hospitals are required to keep records for 10 years, so some physicians may choose to keep office records for 10 years also.)
For minors — records for minor patients must be kept for at least seven years from the date of last treatment or until the child turns 21, whichever is longer. For more information, please visit the see the Texas Medical Board rules.
Minors
Who is considered a minor?
A minor is a person under age 18 who has never been married and never been declared an adult by a court. The Texas Family Code lists instances where a minor child can consent to certain types of medical treatment on his or her own. These include:
a minor on active duty with the armed forces of the United States;
a minor who is 16 years of age or older, residing apart from his/her parents or guardian, and managing his/her own financial affairs;
a minor who is unmarried and pregnant can consent to treatment related to the pregnancy other than abortion;
a minor can consent to diagnosis and treatment of infectious, contagious, or communicable disease that are reportable to the Texas Department of State Health Services; and
a minor can consent to counseling for suicide prevention, chemical or alcohol addiction or dependency, or sexual, physical or emotional abuse.
A physician may rely on a written statement by the minor containing the grounds on which the minor has capacity to consent to treatment.
Who can consent for the treatment of the child of an unmarried minor?
An unmarried minor who has "actual custody" of his/her own biological child can consent to medical, dental, psychological, and surgical treatment for the child.
What are my legal obligations when treating minors for contraception and pregnancy?
In general, minors cannot give consent to medical treatment. Contraception is not specifically addressed by law as an exception, and is therefore not a treatment for which a minor can give consent unless he or she is an "emancipated minor."
As of September 1, 1999, parental notification is required before performing an abortion on a minor. There is a judicial bypass provision to the notice requirement if parental notification is not in the child's best interest.
Do both divorced parents have a right to review the information in their minor child's medical records?
Unless the court finds it would not be in the best interest of the child, "both parents shall be appointed as joint managing conservators of the child." (Texas Family Code Section 153.131) Joint managing conservator is the modern term for "joint custody."
The court granting the divorce may allocate the rights and duties of the joint managing conservators. Thus, both may have the right to consent to invasive procedures, or only one may have that right. Ask to see a copy of the court order when in doubt. Both joint managing conservators have the right to access the child's medical records unless specifically limited by the court granting the divorce.
Unless limited by a court order, both the possessory conservator (custodial parent) and the managing conservator (noncustodial parent), have the following rights at all times:
right of access to medical, dental, psychological, and educational records;
the right to consult with a physician, dentist, or psychologist of the child; and
the right to be designated on the child's records as a person to be notified in case of an emergency.
When can a non-parent consent to treatment of a minor?
When the person having the power to consent cannot be contacted and actual notice to the contrary has not been given, other persons and entities can give consent. These include:
grandparents;
adult siblings;
aunts and uncles;
an educational institution with written authorization;
any adult who has actual care, control, and possession of the minor with written authorization;
a court having jurisdiction over a suit affecting the parent-child relationship;
an adult responsible for the actual care, control, and possession of a child under the jurisdiction of a juvenile court or committed by a juvenile court to the care of an agency of the state or county;
a peace officer who has lawfully taken custody and has reasonable grounds to believe immediate medical treatment is needed; and
for immunizations only, a guardian or any person authorized under law or court order to consent for the child or, if these persons are not available, any one of the persons listed above.
When documenting consent by a non-parent, it must be in writing and include: the name of the child; the name of one or both parents, if known; the name of any managing conservator or guardian of the child; the name and relationship of the person giving consent; the treatment to be given; and the date the treatment is to begin.
Miscellaneous risk management questions
Should I talk with an attorney "off the record" regarding a medical malpractice lawsuit in which I am not a party?
Medical records should never be released without consent of the patient or the patient's authorized representative. Instruct the attorney you are willing to cooperate within the confines of the law and the litigation process (e.g. giving deposition or testimony by subpoena). Do not "volunteer" information to the attorney even though you are not a party to the lawsuit. You need to protect yourself against any potential action that may result from an "off the record" conversation.
How do I terminate the physician-patient relationship?
Your relationship with a patient should be terminated in a manner that reduces liability for patient abandonment and facilitates patient care. The patient should be notified in writing by first class U.S. mail and certified mail, return receipt requested. Keep a copy of the letter and return receipt in the patient's chart. You are not required to state a reason for termination and in fact, it is not advisable to state a reason such as incompatible personality, hostile behavior, etc. You may state "failure to follow medical advice" or "failure to keep appointments that are medically indicated." Agree to treat the patient for 30 days. Clearly state the date on which the termination will be effective. Provide resources to help the patient find a new physician, (e.g. health insurance plan, county medical society), but do not make a specific physician referral. Offer to send a copy of the medical record to the new physician upon receipt of signed authorization.
What testing does the law require for pregnant patients?
Texas law requires that pregnant women be tested for HIV, Hepatitis B, and syphilis at the first visit and at the time of delivery. These tests must be performed at the first exam regardless of whether it occurs during gestation or at the time of delivery. The law requires that test reports be retained for nine months and be delivered to any subsequent provider. The woman must be informed of the HIV test before the testing and advised that the result of the test is confidential, not anonymous. The woman has the right to refuse HIV testing and refusal should be documented in the record. Before testing for HIV, the health care professional must:
Distribute printed materials about HIV, AIDS, Hepatitis B and syphilis to the patient. (Printed materials are available from the Texas Department of State Health Services.)
Notify the patient of the law requiring the provider to test for Hepatitis B, syphilis and HIV and inform the patient of her right to refuse testing. Explain the difference between confidential and anonymous testing.
Provide the patient with a referral to an anonymous testing facility if the patient objects to testing.
Document the HIV test was explained, printed materials were given, and consent was obtained.
If tests indicate a woman is infected with HIV, the provider who submitted the sample for testing must provide the woman with:
Information relating to HIV infection and AIDS in a manner understandable to that patient.
Counseling in a manner that complies with the Health and Safety Code, which allows for referral to an entity that provides counseling/treatment for individuals infected with HIV. Please see the Texas Department of State Health Services web site for more information.
You can request a quote from the TMLT web site or you can contact a sales representative by calling 800-580-8658. You can also email sales@tmlt.org.
How do I apply for coverage?
You can apply for coverage using our online application or you can download an application, fill it out, and return it to TMLT. A representative from TMLT will contact you once your application forms or information has been received.
Why do I have to be a member of Texas Medical Association to purchase TMLT coverage?
TMLT was created by the Texas legislature in 1979 to provide medical liability coverage (commonly referred to as medical malpractice insurance) for physician members of the Texas Medical Association. The legislation that created TMLT included the provision that policyholders must be members of the TMA. Therefore, by law, policyholders must also be members of the TMA.
What does claims-made mean?
A claims-made policy is designed to protect you during the active policy period, usually one year. If you do not renew your claims-made policy when it expires, you no longer have coverage for any claims that may arise in the future that are alleged to have occurred during the time your policy was in force. Read more about claims-made coverage.
What is an occurrence policy?
An occurrence policy provides ongoing insurance coverage for incidents that occur during the policy period, even if they are reported after the policy expires or is cancelled. Therefore, it is not necessary to purchase tail coverage when an occurrence policy is cancelled. Read more about occurrence coverage.
What are limits of coverage?
Limits of coverage spell out the maximum amounts your policy will pay. In professional liability policies, there are typically two limits. One limit states the maximum per claim, while the second limit spells out the maximum amount that will be paid during the policy period. The first limit is called an "each claim" limit and the second one is called an "all claims" limit.
How much coverage is right for me? What limits of liability do you suggest?
We cannot advise you about what limits to carry, but we do recommend that you speak with colleagues who practice in your specialty and location to see what limits of liability they carry. You may also contact your local county medical society; often their legal counsel is available to advise you. Your personal financial advisor may also have recommendations in consideration of your personal assets. Read more about limits of liability.
What is prior acts coverage?
A supplement to a claims-made policy, prior acts coverage is purchased from a new carrier when you change carriers. This coverage, also known as nose coverage, covers incidents that occurred before the beginning of the new insurance relationship, but have not yet been brought to your attention as a claim. Prior acts coverage is an alternative to tail coverage, which is purchased from the original carrier when a change in carriers is made. Companies typically require new policyholders to purchase either prior acts or tail coverage to protect against claims arising from prior acts. Read more about prior acts coverage.
What is tail coverage?
When a claims-made policy is discontinued, tail coverage (sometimes called a reporting endorsement) is an option available from your former carrier to continue coverage for those dates that claims-made coverage was in effect. Once a claims-made policy is cancelled, coverage does not continue in the future for any claims that might be reported unless tail coverage or prior acts coverage is secured at the time the policy is cancelled. If neither is purchased, any future claims that might arise from services performed during the policy period will no longer be covered. Read more about tail coverage.
What is surplus?
Surplus is critical to the financial stability of an insurance company, as it indicates whether or not a company has adequate capitalization and financing to pay future claims. Surplus provides the cushion required to handle the inherent variability in estimating claims losses.
What coverage is available for my entity?
Entities, which are defined as an incorporated formation of two or more shareholder physicians practicing under the group's "dba" name, are eligible for a separate entity policy. The policy provides defense and indemnity coverage when the entity is held to be legally responsible for the actions of the member physicians. Physicians that are incorporated as a Solo Professional Association are provided coverage under their Individual policy on a shared-limit basis.
Which application do I fill out?
If you are a physician and you want medical liability coverage for yourself, please fill out the Individual application.
If you are a physician who is joining a group that is currently insured with TMLT and is set up to apply online, please fill out the Individual joining a group application.
If you would like medical liability coverage for your group and for the physicians in your group, please fill out the Group application.
If you are a physician assuming responsibility for another physician's patients during a scheduled absence and want medical liability coverage, please fill out the Locum tenens application. (The physician you are substituting for must be a current TMLT policyholder in order for you to obtain coverage from TMLT.)
If you are currently a resident and you plan on "moonlighting" outside of your residency program and want medical liability coverage, please fill out the Moonlighting application.
If you are a physician entering your first or second year of practice, please fill out the Rising Star application.
If you are a DO and want coverage through TMLT's wholly owned subsidiary, Texas Medical Insurance Company, please fill out the TMIC Individual Application for DOs. Read more about our DO coverage.
If you are physician's assistant, nurse (including nurse midwife, nurse practitioner, CRNA), technician, therapist, chiropractor, or podiatrist working with a TMLT policyholder and you want professional liability coverage, please fill out the TMIC individual application.
If you are a dentist and would like professional dental liability coverage, please fill out the TMIC dental application.
Underwriting is the process of qualifying an applicant for insurance and determining the appropriate type and amount of insurance for the applicant.
How long does it take to process an application?
The average time to process an application is 7 to 10 business days. However, please make sure that your application is filled out completely. Incomplete information may delay the underwriting process.
When is coverage effective?
For coverage to begin, we must have your surplus deposit monies, confirmation of pending TMA membership, and your completed application underwritten and approved.
How do I make changes to my TMLT policy?
All requests for changes to a policy must be received in writing. You can request changes by email, fax, or mail. Changes typically take 7 to 10 business days to process.
How can I obtain a copy of my policy or proof of coverage?
You can visit the myTMLT web site and download a proof of coverage, or you can contact your underwriting team by phone, fax, or email. You can also use the Contact Us form to submit your request.
How do I obtain a copy of my claims history?
You can visit the myTMLT web site and download a copy of your claim history, or you can contact your underwriting team by phone, fax, or email. You can also use the Contact Us form to submit your request.
A hospital has requested my policy information/claims history from TMLT. Why has it been mailed to me? What should I do with it?
When TMLT receives a request for policy information or claim history from a hospital or insurance company, the requested information is produced and forwarded to the policyholder. This information is sent — along with the original request and a cover letter of explanation — so the policyholder can review the information. Once the information has been reviewed, forward it directly to the hospital or insurance company that made the request.
Policyholders can now authorize TMLT to release their claim history directly to any hospital, health insurance company, or credentialing organization requesting this information by enrolling in TMLT's Claim History Release Program.
To enroll, please complete and sign the claim history release form, and return it by fax to 512-425-5999. You can also mail the form to TMLT Underwriting Services, PO Box 160140, Austin, TX 78716-0410.
How will a claim affect my rates/premiums at TMLT?
An indemnity payment on your TMLT policy in excess of $50,000 would necessitate removal of any earned experience discount. The time period to again earn this credit is three years and begins immediately after the indemnity is paid.
What is a declarations page?
The declarations page is the first page of the insurance policy that contains information specific to the policyholder. The declarations page contains the policyholder's name, address, specialty, limits of liability, premium amount, and policy effective date.
What is an endorsement?
An endorsement is a document that changes the terms of the insurance policy to allow for special situations or to fit special needs of the policyholder.
Are my ancillary staff (nurses, medical assistants, technicians) covered under my TMLT medical liability policy?
TMLT policies do not cover ancillary staff. However, if the physician is named in a claim or a lawsuit due to the actions of a staff member for whom the physician may be considered "legally responsible," coverage may be provided for the physician. Please be aware that coverage for a claim is ultimately determined after a thorough investigation by the TMLT Claim Operations Department.
Ancillary staff working with TMLT policyholders can obtain medical liability coverage through Texas Medial Insurance Company, our wholly-owned subsidiary. Visit the TMIC web site for more information.
What is vicarious liability?
Vicarious liability means that a policyholder can be held legally responsible for the actions of another person. Typically in medical liability claims, physicians can be found vicariously liable for the actions of nurses, medical assistants, or employed physicians.
What coverage is available for my entity?
Entities, which are defined as an incorporated formation of two or more shareholder physicians practicing under the group's "dba" name, are eligible for a separate entity policy. The policy provides defense and indemnity coverage when the entity is held to be legally responsible for the actions of the member physicians. Physicians that are incorporated as a Solo Professional Association are provided coverage under their Individual policy on a shared-limit basis.
Does my TMLT policy cover me for my activities as a medical director?
No, your TMLT policy does not cover your administrative activities as a medical director. However, the policy does provide coverage for any direct patient care given by you in such a setting. Again, please note that coverage is ultimately determined after a thorough investigation by the TMLT Claim Operations Department.
What is risk classification?
An insurance term referring to the classification of groups with similar risks to evaluate those groups based on their claims experience. Typically, groups are classified by specialty, geographic location, and procedures performed. Risk classification is one factor used in determining premium.
What are limits of coverage?
Limits of coverage spell out the maximum amounts your policy will pay. In professional liability policies, there are typically two limits. One limit states the maximum per claim, while the second limit spells out the maximum amount that will be paid during the policy period. The first limit is called an "each claim" limit and the second one is called an "all claims" limit.
How much coverage is right for me? What limits of liability do you suggest?
We cannot advise you about what limits to carry, but we do recommend that you speak with colleagues who practice in your specialty and location to see what limits of liability they carry. You may also contact your local county medical society; often their legal counsel is available to advise you. Your personal financial advisor may also have recommendations in consideration of your personal assets. Read more about limits of liability.
What is an occurrence policy?
An occurrence policy provides ongoing insurance coverage for incidents that occur during the policy period, even if they are reported after the policy expires or is cancelled. Therefore, it is not necessary to purchase tail coverage when an occurrence policy is cancelled. Read more about occurrence coverage.
What does claims-made mean?
A claims-made policy is designed to protect you during the active policy period, usually one year. If you do not renew your claims-made policy when it expires, you no longer have coverage for any claims that may arise in the future that are alleged to have occurred during the time your policy was in force. Read more about claims-made coverage.
What is prior acts coverage?
A supplement to a claims-made policy, prior acts coverage is purchased from a new carrier when you change carriers. This coverage, also known as nose coverage, covers incidents that occurred before the beginning of the new insurance relationship, but have not yet been brought to your attention as a claim. Prior acts coverage is an alternative to tail coverage, which is purchased from the original carrier when a change in carriers is made. Companies typically require new policyholders to purchase either prior acts or tail coverage to protect against claims arising from prior acts. Read more about prior acts coverage.
What is tail coverage?
When a claims-made policy is discontinued, tail coverage (sometimes called a reporting endorsement) is an option available from your former carrier to continue coverage for those dates that claims-made coverage was in effect. Once a claims-made policy is cancelled, coverage does not continue in the future for any claims that might be reported unless tail coverage or prior acts coverage is secured at the time the policy is cancelled. If neither is purchased, any future claims that might arise from services performed during the policy period will no longer be covered. Read more about tail coverage.
What is an insurance trust?
In reference to TMLT, a medical liability claim trust owned by physician policyholders. TMLT was created by the Texas Legislature to provide medical liability insurance to members of the Texas Medical Association. In general, trusts are not regulated by state insurance departments, but a trust like TMLT complies voluntarily with the rules and regulations for commercial insurance companies.
What is reinsurance?
Practice where an insurance company (the insurer) transfers a portion of its risks to another (the reinsurer).
Dividend
What is TMLT's dividend program?
TMLT's dividend program is an effort to return a portion of premiums previously paid back to policyholders.
Who is eligible for TMLT's dividend program?
All renewing policyholders are eligible for the dividend program.
I am new to TMLT, will I receive a dividend?
Only renewing policyholders are eligible to receive a dividend.
How much will I receive for my dividend?
The dividend is calculated as a percentage of your expiring premium. The TMLT Board of Governors reviews dividend considerations annually.
How much will my dividend be?
Overall dividend percentages are announced on our web site. Your specific dividend amount will be detailed in the rate letter you receive prior to the renewal of your policy.
When will I receive my dividend check?
The dividend will show as a credit on your invoice; a check will not be sent.
What if I did not receive an invoice?
If your dividend amount was enough to fully pay your installment, you were not mailed an invoice.
Why don't I see my dividend credit on my declarations page?
The dividend is not a policy credit; it is a return of premiums previously paid. Therefore, the dividend is deducted directly from your invoice.
Will TMLT always offer a dividend?
The continuation of TMLT's dividend program is based on the continued strength of the company's financial position and a favorable claims environment. TMLT's Board of Governors will evaluate the continuation of the dividend program on a yearly basis.
