Medefense

Because the threat of a disciplinary action is all too real, every TMLT policy includes Medefense coverage. 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.    

AVAILABLE LIMITS

  • Legal expenses: $50,000 per claim / $100,000 per policy period
  • Tax expenses: $5,000 per policy period (included in legal expense)
  • Deductible: $1,000 per claim.

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 AVAILABLE FOR PURCHASE*

  • $100,000 per claim — for $250
  • $200,000 per claim — for $350
  • $500,000 per claim — for $550

For current TMLT policyholders, new limits can be purchased at renewal. For prospects, new limit options can be offered during the quoting/application process.

* Subject to approval by the Underwriting Department.

The 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; and
  • proceedings alleging violations of EMTALA, HIPAA, Stark law.

Medefense also covers a tax practitioner's fees to assist a policyholder in an IRS audit of a federal tax return.

Medefense claims must be reported to TMLT no later than 60 days from the date you became aware of the claim.


TAIL COVERAGE
TMLT policyholders have the option to purchase tail coverage for Medefense. This coverage is subject to underwriting approval and is available at the following limits:   

  • $50,000/$100,000
  • $100,000/$100,000
  • $200,000/$200,000
  • $500,000/$500,000

This coverage allows for continuous reporting of Medefense claims that arise for professional services rendered during the time a physician was insured with TMLT. This coverage is available only at time of cancellation. Questions? Please contact your underwriter.
 

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