TMLT Claim Management
From trial venues to claim trends, no one knows the medical liability landscape better than TMLT. We employ a team of experienced claim professionals and attorneys who specialize in the defense of medical liability claims and regulatory actions.
Protecting Your Career and Reputation
Since 1979, TMLT has been dedicated to defending Texas physicians. We bring decades of experience, ensuring the protection of your reputation and your career.
Peer-to-peer Expertise
Your case is evaluated by physicians who understand the complexities of medical practice.
Strength & Experience
More than 48,000 claims resolved since we were founded in 1979.
The Best Defense
TMLT aggressively defends non-meritorious claims
Starting the Claims Process
If you’ve received a notice of claim, lawsuit, demand for compensation, or disciplinary action, here’s how to notify TMLT report the event.
1. Contact Us
- Call: Dial 800-580-8658.
- Calls take approximately 20 minutes, so please have the notice or lawsuit on hand.
- If possible, also have the patient’s medical records available.
- For after-hours calls, follow the prompts to reach the claim supervisor on call.
- Fax: Send a copy of the claim letter or lawsuit to 512-328-8067. Do not fax medical records.
- Mail: Overnight a copy of the notice or lawsuit papers to TMLT.
- MyPortal: If you have a TMLT account, you can also start the claim process online.
2. Submit Lawsuit Papers
- Deliver lawsuit papers to TMLT within 10 days of receipt, using certified mail, messenger, or personal delivery.
- Obtain and retain a written receipt from TMLT as proof of delivery.
3. Secure Documents
- Gather and protect all medical records, x-rays, hospital charts, and billing information related to the case.
- Do not prepare a written summary or make any additions, deletions, or alterations to the records.
4. Special Situations
- Cyber Liability Claims: Report within 60 days of discovery or immediately after identifying a ransomware attack.
- Avoid wiping or erasing any servers or drives before consulting TMLT, as this may destroy crucial evidence.
- Medefense or Employment Practices Claims:
- Report disciplinary actions within 60 days of notice.
- Report employment-related claims within 75 days of notice.
5. What to Avoid
- Do not discuss the case with anyone other than your TMLT claims representative or assigned attorney.
- Keep all correspondence from TMLT and your attorney in a separate, secure file.
Need Help? Your assigned TMLT claims representative will guide you through the process and keep you informed at every stage.
Step-by-Step Overview
Resolving a claim can take a few months or several years. You will be required to participate in several steps of the process (such as giving a deposition), but often months may pass without the need for your involvement. TMLT claim operations staff manage this process and will keep you updated.
Notification and Claim Setup
- Notify TMLT of any of the following to initiate a claim:
- A notice of claim letter.
- A lawsuit.
- A written demand from a patient for monetary compensation.
- Other types of reports, such as unusual incidents, medical record requests, or oral threats, will be noted by the claims department but may not result in a claim file being opened.
Once a claim is reported:
- A claim file is created.
- The case is assigned to a claims supervisor, and coverage is verified. and coverage is verified.
- A response letter is sent to both the policyholder and the plaintiff’s attorney.
Investigation and Monitoring
- The claims supervisor begins an investigation, which may include:
- Collecting and reviewing medical records.
- Consulting with independent medical experts to evaluate the case.
- Over the next several months, the claim is reviewed and re-evaluated regularly.
A claim may be closed during this stage if:
- No lawsuit is filed.
- There is no response from the plaintiff’s attorney.
- TMLT denies the claim.
If a Lawsuit is Filed
- TMLT assigns a defense attorney, and the policyholder is notified.
- The Texas Medical Board (TMB) is informed of the lawsuit.
- The defense attorney, under the guidance of the claims supervisor, prepares the case by:
- Conducting discovery.
- Locating expert witnesses.
- Taking depositions.
- Together, the claims supervisor, attorney, and policyholder develop a defense strategy.
Settlement or Trial
- After the investigation, a decision is made to settle or proceed to trial.
- Most settlements require policyholder consent.
- Negotiations or mediation may resolve the case before trial.
If the case goes to trial:
- A trial date is set, and its duration depends on the case’s complexity and the number of parties involved.
Verdict Outcomes:
- If the defense wins, the claim file may be closed (subject to appeal).
- If the plaintiff wins, TMLT and the defense team may decide to appeal.
Final Steps
- Upon closing a claim, TMLT submits a final report to the TMB.
- If the claim involves an indemnity payment, TMLT notifies the National Practitioner Data Bank (NPDB).
- If a verdict is appealed, TMLT continues to defend the policyholder throughout the appellate process.
Claims FAQs
What is considered a claim and what am I required to report?
According to your policy, a claim can be any of the following:
A demand for compensation — any written communication from or on behalf of a patient that seeks monetary payment or other compensation because of a perceived error in treatment or an unexpected outcome.
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 or her 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 defendant). A lawsuit will also include the allegations made against you. Once you are served with a citation and petition, TMLT has a limited time to respond by retaining a defense attorney to file an answer on your behalf.
If you receive any of the above items, contact the TMLT Claims Department at 800-580-8658 as soon as possible. You can also start the claim reporting process through myPortal (log in required.) We may have limited time to investigate and evaluate the claim. Any delay in reporting could compromise your defense.
If you are reporting a Medefense or Cyber Liability, claim you must report it to TMLT no later than 60 days from the date you became aware of the claim.
Although not considered a "claim" that would trigger coverage under your policy, you may want to report the following situations to seek advice to possibly prevent the matter from evolving into a claim:
Unexpected outcome — any complication or failure of treatment in which the patient or a patient's family member may have expressed disappointment with the outcome or if you suspect that a claim may be asserted in the future.
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. If you suspect that the records request is for potential or ongoing litigation, or if you question the validity of the records request, you should contact TMLT for advice.
Request for deposition — a deposition is testimony given under oath before a court reporter. You may be served a subpoena for oral deposition, or an attorney may contact you directly. If you are asked to give testimony regarding a patient, particularly if that patient is suing another health care professional, please contact the TMLT Claim Operations Department immediately. Depositions can potentially become claims and you should be properly represented at any such proceeding.
How do I report a claim?
Report the claim to TMLT by calling 800-580-8658. You can also start the claim reporting process through myPortal (log in required.) Please allow about 20 minutes for the report and have whatever notice you received available for reference. It may also be helpful to have the patient's medical record available.
Fax to 512-328-8067 or send by overnight mail a copy of the notice of claim letter or the lawsuit. Do not fax your medical records. Note that if you are served with a lawsuit, your TMLT policy requires as a condition of coverage that all such lawsuit papers be delivered to TMLT within 10 days of service or receipt of the lawsuit papers, and that you must obtain a delivery receipt from TMLT.
"Delivery of lawsuit papers means sending by certified mail with return receipt requested, personal delivery, messenger, or electronic transmission. Proof of delivery of the lawsuit papers, however, may only be established by the obtaining a written receipt of such delivery from the Trust."
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. Mail a copy of these records to TMLT as soon as possible.
I have reported a claim. What happens next?
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 nformation, 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 reported is about 5-10 working days.
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 Operations 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 your claim supervisor.
Why do physicians get sued?
Medical liability suits are rarely the result of one error, but rather a cascade or system of factors.