Medical liability coverage for Texas physicians

Medefense

TMLT's Medefense Coverage will either reimburse or pay directly the legal expenses incurred by a physician and/or the entity from a disciplinary proceeding. Fines and/or penalties arising out of a disciplinary proceeding are also covered (on a reimbursement basis only).

The covered disciplinary proceedings include:

• A review instituted by any state medical licensing authority such as the Texas Medical Board.
• A professional review action instituted by a review body of a hospital, HMO, PPO, or managed care organization, which could adversely affect clinical privileges that a physician already possesses.
• A proceeding for the purpose of imposing sanctions under the Quality Improvement Organization (QIO) program. The Texas Health Quality Institute is the QIO for Texas.
• A proceeding instituted by a state department of insurance, state worker's compensation commission, state department of health and human services, the U. S. Department of Health and Human Services, or CMS alleging medical services were performed in violation of guidelines.
• A proceeding by a state or federal governmental agency such as a Medicare billing audit conducted by Recovery Audit Contractors (RAC) or other private contractors, as well as allegations of non-compliance with Medicare/Medicaid regulations or procedures.
• A violation of the Emergency Medical Treatment and Active Labor Act (EMTALA), also known as the anti-dumping statute.
• A violation of the Health Insurance Portability and Accountability Act (HIPAA).
• A violation of the Stark Law.

TMLT's Medefense Endorsement also covers tax expenses for a tax practitioner's fees to assist a physician and, if applicable, an insured entity in an IRS audit of their federal tax return.

Policy Limits

(Higher limits are available)

• Maximum legal expense — $50,000 per insured event up to $100,000 per policy period.
• Maximum tax expense — $5,000 per policy period (included in the maximum legal expense).
• Deductible — $1,000 per insured event.*
• Coinsurance — 10% per insured event.*

* Policyholders have free choice of counsel. However, we will waive the deductible and coinsurance and pay legal expenses directly if they hire an attorney from a panel provided by TMLT.

To take advantage of Medefense coverage, policyholders should:

• Notify TMLT as soon as you receive written notice of a disciplinary proceeding. The policy states that a policyholder has 60 days in which to report an insured event in order to receive coverage.
• Consider retaining an attorney. Upon request, TMLT can provide policyholders with a list of attorneys who have experience handling disciplinary proceedings.