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Coverage for disciplinary or regulatory actions

Every TMLT policy includes Medefense. Medefense covers legal expenses, fines, and penalties associated with disciplinary actions, such as actions by the Texas Medical Board, a hospital review committee, or a federal regulatory agency.

Covered disciplinary proceedings include:

  • actions by a state medical licensing authority;
  • a professional review action regarding clinical privileges;
  • a proceeding instituted by a state department of insurance, state workers’ compensation commission, state department of health and human services, the U.S. Department of Health and Human Services, or Centers for Medicare and Medicaid Services alleging medical services were performed in violation of guidelines;
  • Medicare billing audits conducted by Recovery Audit Contractors (RAC) or other private contractors as well as allegations of non-compli­ance with Medicare/Medicaid regulations or procedures;
  • proceedings alleging violations of EMTALA, HIPAA, Stark law; and
  • a tax practitioner's fees to assist a policyholder in an IRS audit of a federal tax return.

Available limits

$50,000 per claim/$100,000 per policy period.

An aggregate of $250,000 for all members of your group per policy period. This includes a maximum tax expense of $5,000 per policy period that provides for tax audit expenses, fines, or other penalties.

  • There is a $1,000 deductible per insured event.
  • This coverage also include a 60-day reporting period.
  • Policyholders have free choice of counsel. However, we will waive the deductible and pay legal expenses directly if the policyholder hires an attorney from a panel provided by TMLT.
  • Higher limits require approval by the TMLT Underwriting Department.

Higher limits are available

  • $100,000/$100,000 per risk — $250
  • $200,000/$200,000 per risk — $350
  • $500,000/$500,000 per risk  — $550

Tail coverage

Policyholders also have the option to purchase tail coverage for Medefense. This coverage allows for continuous reporting of Medefense claims that arise during the time a physician was insured with TMLT. This coverage is available only at time of cancellation.