Reporting a claim

What to report: Your policy requires you to notify us as soon as reasonably possible after becoming aware of a claim covered by your policy. Please notify TMLT immediately if you receive any of the following:

A notice of claim letter -- a letter that refers to Civil Practice and Remedies Code Section 74.052 or refers to a notice of claim. Upon receipt of a 74.052 letter, a physician and his insurer have 60 days to investigate and evaluate the patient's claim.
A lawsuit -- will contain a citation, which informs you of a lawsuit, and a petition, which lists the plaintiff versus the defendants. A lawsuit will also include the allegations made against the defendant. Once you are served with a citation and petition, TMLT has a limited time to respond to the suit by retaining a defense attorney to file an answer on your behalf.
Records request -- A request for a patient's medical records may come from the patient, the patient's spouse, an attorney, a record service or from a court reporting service in the form of a subpoena. Requests for records should include an authorization signed by the patient or by the patient's legal representative. It is best to respond to a request as soon as possible.
Request for deposition -- a deposition is testimony given under oath before a court reporter. You may be served a subpoena for oral deposition, or you may be contacted by an attorney directly. If you are asked to give testimony regarding a patient, particularly if that patient is suing another health care provider, contact the TMLT claims department immediately. Depositions carry with them the potential of becoming claims and you should be properly represented at any such proceeding.

In the event of a claim, it is essential that you contact the TMLT claim department as soon as possible. In many cases, we will have limited time to investigate and evaluate the claim. Any delay in reporting could compromise your defense.

How to report a claim: If you have received a notice of claim, a lawsuit, a medical records request or a request for deposition, immediately do the following:

Report the claim to TMLT by calling 800-580-8658. Please allow about 20 minutes for the report and have whatever notice you may have received available for reference.

Report the claim via email

Fax or send via overnight mail, a copy of the notice of claim letter or the lawsuit. Do not fax your medical records.

Gather a complete and unaltered copy of all pertinent medical records, including a copy of the hospital chart and any prior or subsequent treatment records. Forward a copy of these records to TMLT as soon as possible.

What to do after reporting to TMLT
Do not discuss the case with anyone except a TMLT claims representative or the attorney assigned to defend you.
Maintain your original medical records in a secure place for future reference. Do not make any additions, deletions, or any other type of alteration to the medical records. Secure any other pertinent information or items in your possession, such as billing records, x-rays, hospital charts, etc.
All correspondence to and from TMLT and your assigned attorney should be kept in a separate and secure file. These items should not be co-mingled with the original medical chart on the patient. Do not release these materials to anyone unless cleared through your assigned attorney or the TMLT claims department.

The TMLT claims representative assigned to your case will keep you fully informed as the case proceeds, both directly and through your assigned attorney. If you have questions, do not hesitate to call the assigned claims supervisor.

The claim process

1. TMLT is notified of a claim.
2. If the policyholder reports the following, a claim file is set up:
   a notice of claim letter
   a lawsuit
   a written demand from a patient for monetary compensation
3. If the policyholder reports something other than a notice of claim letter, a lawsuit or a written demand from a patient, the claim department makes note of the report but does not open a claim file. This includes reports of unusual incidents, medical record requests and verbal threats.
4. Once a claim file is set up, the loss is assigned to a claim supervisor and coverage is entered and verified.
5. A response letter is sent to the policyholder and the plaintiff's attorney.
6. The Claim Supervisor performs a preliminary investigation over the next several months. This includes collecting and reviewing the relevant medical records and referring the case to independent medical consultants for evaluation. During this time, the case may become a law suit or it may stay a claim.
7. If a suit is not filed, the case remains a claim. After the initial investigation, the claim is re-evaluated on a routine basis. A decision is made during this time frame as to whether the claim can be closed. If no law suit is filed or if we get no response from the plaintiff's attorney after the initial claim letter or after we deny the claim, we will often close the claim. There are other times we will wait until the statute of limitations expires before closing the claim.
8. If a lawsuit is filed, then we assign a defense attorney. The policyholder receives a letter from the claim supervisor advising of the attorney assignment. TMLT also notifies the Texas State Board of Medical Examiners (TSBME) when a lawsuit is filed.
9. Under the direction of the TMLT claim supervisor, the defense attorney now prepares the case for trial, conducting discovery, locating expert witness testimony and taking depositions. The claim supervisor, the attorney and the policyholder work together to develop a defense strategy.
10. After the investigation, the policyholder, the attorney and the claim supervisor may decide to settle the case. Policyholder consent must be given for any settlement. If settlement is agreed to, negotiations begin. If acceptable terms are reached during settlement negotiations, the case is settled.
11. The case may also be settled before trial during mediation. At mediation, all parties involved in the suit meet with an independent mediator who helps resolve the case
12. If the decision is made to proceed with the trial, a trial date is scheduled.
13. A trial may last anywhere from a few days to a few months. On occasion, a trial can last longer.
14. If the defense wins at trial, the claim is then closed. If the defense loses at trial, TMLT pays the award. However, if we feel the jury award is excessive we will try to negotiate a fair settlement.
15. When a claim is closed, TMLT submits a final report to the TSBME. If a claim is closed with indemnity payment to the plaintiff, we notify the National Practitioner Data Bank. TMLT also reports claims with indemnity payments over $10,000 to the Texas Department of Insurance. The report made to TDI is for statistical purposes only.
16. If we decide to appeal a jury verdict, we will continue to defend the insured throughout the appellate process.