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Louisiana Administrative Code › Title 37 - INSURANCE › Part III - Patient's Compensation Fund Oversight Board › Chapter 5 - Enrollment with the Fund › Section III-505 - Financial Responsibility: Insurance

Current through Register Vol. 50, No. 6, June 20, 2024
A. A health care provider shall be deemed to
				have demonstrated the financial responsibility requisite to enrollment with the
				fund by submitting certification in the form of a certificate of insurance or
				policy declaration page that the health care provider is or will be insured on
				a specific date under a policy of insurance, insuring the health care provider
				against professional malpractice liability claims with indemnity limits of not
				less than $100,000, plus interest per claim, aggregate annual indemnity limits
				of not less than $300,000 plus interest for all claims arising or asserted
				within a 12-month policy period.
B.
				To be acceptable as evidence of financial responsibility pursuant to §505, an
				insurance policy:
1. must be issued:
a. by an insurance company admitted to do
				business in this state; or
b. by an
				unauthorized insurer which is on the list of approved unauthorized insurers
				maintained by the Commissioner of Insurance pursuant to
				R.S.
				22:436 and which has:
i. a rating by A.M. Best and Co. of "A-" or
				higher; or
ii. a rating by Standard
				and Poor's of "AA-" or higher; or
iii. a rating by Moody's of "Aa" or higher;
				or
c. by a risk
				retention group organized and operating in this state pursuant to the Federal
				Liability Risk Retention Act of 1986,
				15
				U.S.C. 3901 et seq., and which has given
				notice of its operation within this state to the Commissioner of Insurance and
				is otherwise in compliance with the Louisiana Risk Retention Group Law,
				R.S.
				22:481 et seq.; or
d. by the Louisiana Residual Malpractice
				Insurance Authority,
				R.S.
				40:1299.46;
Louisiana Administrative Code › Title 37 - INSURANCE › Part III - Patient's Compensation Fund Oversight Board › Chapter 5 - Enrollment with the Fund › Section III-507 - Financial Responsibility: Self-Insurance

Current through Register Vol. 50, No. 6, June 20, 2024
A. A health care provider shall be deemed to
				have demonstrated the financial responsibility requisite to enrollment with the
				fund by depositing with the board $125,000, in money or represented by
				irrevocable letters of credit, federally insured certificates of deposit, or in
				bonds, securities cash values of insurance, or other securities approved by the
				executive director of the principal value of not less than $125,000. All money,
				certificates of deposit, bonds or securities deposited pursuant to
				§507 shall be conditioned only for, dedicated
				exclusively to, and held in trust for the benefit and protection of and as
				security for the prompt payment of all malpractice claims arising or asserted
				against the health care provider.
B. For purposes of §507, upon approval by the
				board of an application filed by the group, any group of health care providers
				organized to and actually practicing together or otherwise related by
				ownership, whether as a corporation, partnership, limited liability partnership
				or limited liability company, shall be deemed a single health care provider and
				shall not be required to post more than one deposit. Proof of such status may
				include a notarized copy of the articles of incorporation, partnership
				agreement, articles of organization, joint or consolidated entity tax returns,
				or other documents demonstrating the ownership relation among or between the
				members of the group, or other evidence which indicates that the members of the
				group actually practice together for the purpose of health care delivery.
1. This proof of group status shall be
				submitted to the board:
a. with the group's
				original application;
b. within 30
				days of any change in the group's status, organization, or membership;
				and
c. within 10 calendar days of
				receipt of a written demand therefor from the board.
Louisiana Administrative Code › Title 37 - INSURANCE › Part III - Patient's Compensation Fund Oversight Board › Chapter 5 - Enrollment with the Fund › Section III-509 - Financial Responsibility: Self-Insurance Trusts

Current through Register Vol. 50, No. 6, June 20, 2024
A. The shareholders of a professional
				corporation, the partners of a professional partnership, a solo practitioner, a
				health care provider institution, or a group of such institutions may
				demonstrate the financial responsibility requisite to enrollment with the fund
				by the establishment and maintenance of a financially and actuarially sound
				self-insurance trust, approved by the executive director, and making and
				maintaining, on behalf of such trust as an entity, a deposit of not less than
				$125,000 in money or represented by irrevocable letters of credit,
				federally-insured certificates of deposit, or in bonds or securities approved
				by the executive director, of the principal value of not less than
				$125,000.
B.
1. The following bonds and securities shall
				be deemed approved by the board for purposes of the deposit required by §509:
a. bonds or securities not in default as to
				principal or interest which are the direct obligations of, or which are secured
				or guaranteed as to principal and interest by full faith and credit of the
				United States, any state or territory of the United States, or the District of
				Columbia;
b. government sponsored
				AAA rated securities which carry an implied guarantee from the United States
				Government;
c. bonds or evidence of
				indebtedness not in default as to principal or interest which are the direct
				obligations of, or which are secured or guaranteed as to principal and interest
				by the issuing body, the state, or political subdivision of this state, or any
				other state or territory of the United States or the District of
				Columbia;
d. the bond of an
				authorized surety company engaged in business in the state of Louisiana which
				has an A.M. Best rating of A+ VIII or better. In addition, the company should
				meet the stated minimum rating criteria for two of the following rating
				services:
i. Standard and Poor AA;
ii. Duff and Phelps AA;
iii. Moody's Aa2;
e. an unconditional letter of credit with an
				automatic renewal provision where the issuing bank carries a commercial paper
				rating of P-1 by Moody's and/or an A-1 by Standard and Poor;
f. an escrow account in the name of Patient's
				Compensation Fund where the issuing bank carries a commercial paper rating of
				P-1 by Moody's and/or an A-1 by Standard and Poor.
Louisiana Administrative Code › Title 37 - INSURANCE › Part III - Patient's Compensation Fund Oversight Board › Chapter 5 - Enrollment with the Fund › Section III-511 - Coverage: Partnerships and Professional Corporations

Current through Register Vol. 50, No. 6, June 20, 2024
A. When, and during the period that, each
				shareholder, partner, member, agent, officer, or employee of a corporation,
				partnership, limited liability partnership, or limited liability company, who
				is eligible for qualification as a health care provider under the Act, and who
				is providing health care on behalf of such corporation, partnership, or limited
				liability company, is enrolled with the fund as a health care provider, having
				paid the applicable surcharges due the fund and demonstrated and maintained
				financial responsibility in accordance with the standards prescribed by
				§503-511 for enrollment of such individual, such corporation, partnership,
				limited liability partnership, or limited liability company shall, without the
				payment of an additional surcharge, be deemed concurrently qualified and
				enrolled as a health care provider with the fund when, and during the period
				that such corporation, partnership, limited liability partnership, or limited
				liability company demonstrates and maintains financial responsibility in
				accordance with the standards prescribed by §503-511 Any such corporation,
				partnership, limited liability partnership, or limited liability company which
				fails to provide proof of financial responsibility upon request of the fund
				after the filing of a request for review of a claim under
				R.S.
				40:1299.47 or after the filing of a lawsuit
				alleging medical malpractice, shall not be deemed concurrently qualified and
				enrolled as a health care provider under this Part.
B. The corporation, partnership, limited
				liability partnership, or limited liability company shall furnish to the board,
				concurrently with its enrollment and renewal application, the name(s) of each
				shareholder, partner, member, agent, officer, or employee who is eligible for
				qualification and enrollment with the fund as a health care provider and
				evidence of its financial responsibility in accordance with the standards
				prescribed by §503-511
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  40:1299.44(D)(3).
Louisiana Administrative Code › Title 37 - INSURANCE › Part III - Patient's Compensation Fund Oversight Board › Chapter 5 - Enrollment with the Fund › Section III-513 - Enrollment Procedure

Current through Register Vol. 50, No. 6, June 20, 2024
A.
				Application for enrollment with the fund shall be made upon forms prescribed
				and supplied by the executive director. The executive director shall require
				that each applicant supply his or its proper legal name, the applicant's
				principal professional address, the address of other professional offices or
				places of practice of the applicant, the applicant's professional license,
				certification, or registration number, information relating to the nature and
				scope of the applicant's practice sufficient to identify the class or category
				of the practitioner, information on malpractice claims previously concluded or
				then pending against the applicant, and such other information as the executive
				director may prescribe.
B. The
				application shall be accompanied by evidence of financial responsibility in the
				form prescribed by §505-509 of these rules, as applicable, and the applicable
				surcharge.
C. If the executive
				director determines that an applicant is not eligible for enrollment with the
				fund, he shall notify the applicant within 15 days of receipt of the completed
				application. The applicant may, within 15 days of receipt of the notice, appeal
				the determination to the board by mailing notice of said appeal to the
				executive director If appealed timely, the matter shall be placed on the agenda
				of the next meeting of the board, at which time the board may hear such
				evidence as it deems appropriate and uphold or reverse the decision of the
				executive director. The decision of the board shall be final.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  40:1299.44(D)(3).
Louisiana Administrative Code › Title 37 - INSURANCE › Part III - Patient's Compensation Fund Oversight Board › Chapter 5 - Enrollment with the Fund › Section III-515 - Certification of Enrollment

Current through Register Vol. 50, No. 6, June 20, 2024
A. Upon
				receipt and approval of a completed application (including evidence of
				financial responsibility pursuant to §505,
				§507 or §509) and payment of the
				applicable surcharge by or on behalf of the applicant health care provider, the
				executive director shall issue and deliver to the health care provider a
				certificate of enrollment with the fund, identifying the health care provider
				and specifying the effective date and term of such enrollment and the scope of
				the fund's coverage for that health care provider.
B. Duplicate or additional certificates of
				enrollment shall be available to and upon the request of an enrolled health
				care provider or his or its attorney, or professional liability insurance
				underwriter when such certification is required to evidence enrollment or
				qualification with the fund in connection with an actual or proposed
				malpractice claim against the health care provider.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  40:1299.44(D)(3).
Louisiana Administrative Code › Title 37 - INSURANCE › Part III - Patient's Compensation Fund Oversight Board › Chapter 5 - Enrollment with the Fund › Section III-517 - Expiration, Renewal of Enrollment

Current through Register Vol. 50, No. 6, June 20, 2024
A. Enrollment with the fund expires:
1. as to a health care provider evidencing
				financial responsibility by certification of insurance pursuant to
				§505 of these rules, on and as of:
a. the effective date and time of termination
				or cancellation of the policy of the health care provider's professional
				liability insurance coverage; or
b.
				the last day of the applicable period for which the prior annual surcharge
				applied in the event that the annual surcharge for renewal coverage is not paid
				by the health care provider to the insurer on or before 30 days following the
				expiration of the prior enrollment period.
Louisiana Administrative Code › Title 37 - INSURANCE › Part III - Patient's Compensation Fund Oversight Board › Chapter 5 - Enrollment with the Fund › Section III-519 - Cancellation, Termination of Enrollment

Current through Register Vol. 50, No. 6, June 20, 2024
A. A health care provider's enrollment with
				the fund for all claims filed against the healthcare provider shall be canceled
				and terminated:
1. as to a health care
				provider evidencing financial responsibility by certification of insurance
				pursuant to
				§505 of these rules, on and as the
				effective date of cancellation of the health care provider's professional
				liability insurance coverage;
2. as
				to a health care provider evidencing financial responsibility pursuant to
				§507-509 of these rules, on and as of any date on which:
a. the health care provider or self-insurance
				trust, as applicable, ceases to maintain financial responsibility in the amount
				and form prescribed by these rules; or
b. the health care provider or self-insurance
				trust, as applicable, fails, within the allowed time after notice by the
				executive director, to provide additional security for financial responsibility
				when existing financial responsibility security is impaired all as provided in
				§507-509 of these rules.
3. on any date that the health care
				provider's professional or institutional license, certification, or
				registration is suspended or revoked or that the health care provider ceases to
				be a health care provider as defined by the Act and these rules or otherwise
				ceases to be eligible for enrollment hereunder.
Louisiana Administrative Code › Title 37 - INSURANCE › Part III - Patient's Compensation Fund Oversight Board › Chapter 7 - Surcharges › Section III-703 - Annual Actuarial Study

Current through Register Vol. 50, No. 6, June 20, 2024
A. An
				actuarial study of the fund and the surcharge rate structure necessary and
				appropriate to ensure that it is and remains financially and actuarially sound
				shall be performed annually by the board's consulting actuary on the basis of
				an actuarial analysis of all relevant claims experience data collected and
				maintained by the board.
B. In the
				performance of the board's annual actuarial study and the development of a
				financially sound and appropriate surcharge rate structure for the fund, the
				board's consulting actuary and the executive director shall accord the greatest
				weight to the claims experience of the fund and of commercial professional
				health care liability insurance underwriters and self-insurance funds with
				respect to the risk underwritten by such insurers and self-insurance funds in
				this state and as particularly reflected in such insurers' then most recent
				premium rate filings with the Louisiana Department of Insurance (LDOI) or such
				self-insurance funds' current rate structure and supporting data, provided,
				however, that such data shall be viewed in light of national claims experience
				data and provided further that the board's consulting actuary may place
				reliance on national claims experience data when, in the opinion of such
				actuary, claims experience within the state of Louisiana as to any class of
				risks provides an insufficient basis for reliance thereon for purposes of
				actuarial analysis or in calculating indicated surcharge rates.
C. Without respect to the rate structure
				indicated by any annual actuarial study of the fund, no changes to surcharge
				rates or to the surcharge rate structure shall be approved by the board when
				the total assets of the fund could become less than the amount provided for in
				R.S. 40:1299.44(A)(6)(a)
				and (b).
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  40:1299.44(D)(3).
Louisiana Administrative Code › Title 37 - INSURANCE › Part III - Patient's Compensation Fund Oversight Board › Chapter 7 - Surcharges › Section III-705 - Risk Rating

Current through Register Vol. 50, No. 6, June 20, 2024
A. Surcharge
				rates collected by the board shall be based on and classified according to the
				classes and categories of health care liability risks underwritten by the fund
				with respect to each class of health care practitioners and institutions
				eligible for enrollment with the fund. With regard to hospitals, surcharge
				rates collected by the board shall be based on the annual average number of
				occupied beds. Risk classifications and ratings adopted by the board shall be
				based on actuarial analysis of the claims experience of health care provider
				groups enrolled with the fund and equivalent data and practices of commercial
				insurance underwriters and self-insurance funds insuring such groups. Risk
				rating classifications for health care providers eligible for enrollment with
				the fund shall be based on Louisiana claims experience data, including the
				fund's own claims experience, unless the board's actuary affirmatively
				demonstrates that, as respects any class of provider, reasonably obtainable,
				competent, and credible Louisiana claims experience data provides an
				insufficient basis for such classifications under generally accepted insurance
				actuarial standards, in which case regional or national claims experience data
				and statistics relative to such classes of health care provider may be
				utilized.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  40:1299.44(D)(3).
Louisiana Administrative Code › Title 37 - INSURANCE › Part III - Patient's Compensation Fund Oversight Board › Chapter 7 - Surcharges › Section III-707 - Determination of Rates; Notice of Rates

Current through Register Vol. 50, No. 6, June 20, 2024
A. The board shall determine surcharge rates
				in a public meeting held pursuant to Louisiana's open meetings laws based upon
				actuarial principles and reports, experience and prudent judgment of the board.
				The board shall provide written or electronic notice of the meeting at least 15
				days in advance of the meeting and provide an opportunity for public comment at
				the meeting before determining surcharge rates.
B. Within 30 days of the date on which the
				board determines surcharges rates or rate changes, the executive director shall
				give notice of such rates or rate changes via the board's website and any other
				means at the discretion of the executive director.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  40:1299.44(D)(3).
Louisiana Administrative Code › Title 37 - INSURANCE › Part III - Patient's Compensation Fund Oversight Board › Chapter 7 - Surcharges › Section III-709 - Interim, Emergency Rates

Current through Register Vol. 50, No. 6, June 20, 2024
A.
				Interim or emergency surcharge rates or rate changes may be determined by the
				board at any time when the board, in consultation with its consulting actuary,
				determines that a new surcharge rate or rate changes are necessary. The board
				shall comply with the notice and comment provisions set forth in
				§707 prior to determining interim or
				emergency surcharge rates or rate changes.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  40:1299.44(D)(3).
Louisiana Administrative Code › Title 37 - INSURANCE › Part III - Patient's Compensation Fund Oversight Board › Chapter 7 - Surcharges › Section III-713 - Payment of Surcharges: Self-Insureds

Current through Register Vol. 50, No. 6, June 20, 2024
A. Not less than 60 days prior to the
				termination of enrollment of a health care provider, the executive director
				shall cause each self-insured health care provider enrolled with the fund and
				each self-insured health care provider having been approved for enrollment with
				the fund, to receive a statement of surcharges due the fund by the health care
				provider for enrollment with the fund during the succeeding enrollment
				year.
B. Annual surcharges for
				initial PCF coverage for self-insured health care providers for enrollment and
				qualification with the fund shall be due and payable to the board on or before
				the date of initial PCF coverage. Surcharges due the board by self-insured
				health care providers for enrollment with the fund for an enrollment year shall
				be due and payable to the board on or before 30 days following the expiration
				of the prior enrollment period. Remittance of surcharges to the board shall be
				made in such form and accompanied by records in such form or on such forms as
				may be prescribed by the executive director so as to provide for proper
				accounting of remitted surcharges and the identity and class of health care
				provider remitting surcharges.
C.
				If the instrument used to pay the surcharge is returned to the board by the
				payor institution and/or payment hereon is denied for any reason, the health
				care provider shall be notified thereof by the board. If the surcharge and any
				insufficient funds (NSF) charge incurred by the board is not paid in full by
				certified check, cashier's check, money order, or cash equivalent funds
				received by the board within 10 calendar days of the provider's receipt of said
				notice, then the provider's coverage with the fund shall be terminated as of
				the end of the previous enrollment period.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  40:1299.44(D)(3).
Louisiana Administrative Code › Title 37 - INSURANCE › Part III - Patient's Compensation Fund Oversight Board › Chapter 9 - Scope of Coverage › Section III-901 - Effective Date

Current through Register Vol. 50, No. 6, June 20, 2024
A. A health
				care provider who qualifies for enrollment with the fund by demonstrating
				financial responsibility through professional liability insurance pursuant to
				§505 of these rules or by participation
				in an approved self-insurance trust pursuant to
				§509 of these rules, shall be deemed to
				become and be enrolled with the fund effective as of the date on which the
				surcharge payable by or on behalf of such health care provider is timely
				collected in accordance with
				§711 hereof and the applicable policies
				and procedures of the insurer or trust for premium payments. If such surcharge
				is not timely collected, the effective date of enrollment with the fund shall
				be the date on which such surcharge is paid to the fund, the insurer, agent or
				trust.
B. A health care provider
				who qualifies for enrollment with the fund by demonstrating financial
				responsibility by self-insurance pursuant to
				§507 of these rules, shall be deemed to
				become and be enrolled with the fund effective as of the date on which the
				surcharge payable by or on behalf of such health care provider is timely
				collected by the board in accordance with
				§713 hereof. If such surcharge is not
				timely collected, the effective date of enrollment with the fund shall be the
				date on which such surcharge is collected or accepted by the board.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  40:1299.44(D)(3).
Louisiana Administrative Code › Title 37 - INSURANCE › Part III - Patient's Compensation Fund Oversight Board › Chapter 9 - Scope of Coverage › Section III-903 - Term of Enrollment

Current through Register Vol. 50, No. 6, June 20, 2024
A. The
				enrollment of a health care provider qualified for enrollment by evidence of
				liability insurance pursuant to
				§505 hereof shall expire on and as of the
				earlier of the date on which the policy period of the insurance policy
				evidencing such financial responsibility expires or not more than one year from
				the date on which such health care provider's enrollment became
				effective.
B. The enrollment of a
				health care provider qualified for enrollment by evidence of self-insurance
				pursuant to
				§507 hereof shall expire not more than
				one year from the date on which such health care provider's enrollment became
				effective.
C. The enrollment of a
				health care provider qualified for enrollment by evidence of participation in
				approved self-insurance trust pursuant to
				§509 of these rules shall expire on and
				as of the earlier of the date on which the health care provider ceases to be a
				participating member of such trust or not more than one year from the date on
				which such health care provider's enrollment became effective.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  40:1299.44(D)(3).
Louisiana Administrative Code › Title 37 - INSURANCE › Part III - Patient's Compensation Fund Oversight Board › Chapter 9 - Scope of Coverage › Section III-905 - Scope of Coverage: Insureds

Current through Register Vol. 50, No. 6, June 20, 2024
A.
				With respect to health care providers enrolled with the fund by evidence of
				liability insurance pursuant to
				§505 hereof, subject to the limitation of
				liability prescribed by the Act, the fund shall be liable for compensation for
				claims asserted against the health care provider only within the scope of
				coverage afforded by, and subject to the limitations and exclusions of, the
				policy of professional liability insurance evidencing the health care
				provider's financial responsibility and subject to the payment of the
				applicable surcharges.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  40:1299.44(D)(3).
Louisiana Administrative Code › Title 37 - INSURANCE › Part III - Patient's Compensation Fund Oversight Board › Chapter 9 - Scope of Coverage › Section III-907 - Scope of Coverage: Self-Insureds

Current through Register Vol. 50, No. 6, June 20, 2024
A. With respect to health care providers
				enrolled with the fund by evidence of self-insurance pursuant to
				§507 hereof, the fund shall be obligated
				to pay compensation to the extent provided by the Act only with respect to
				claims arising from an incident which occurred during the effective period of
				enrollment, regardless of whether the provider was actively enrolled on the
				date on which the claim was reported, so long as the provider continues to meet
				the financial responsibility requirements of
				R.S.
				40:1299.42 for continued
				qualification.
B. The fund's
				obligation for compensation shall extend to the vicarious liability of an
				enrolled health care provider for acts or omissions of any employee or agent of
				the provider when acting within the course and scope of his or her employment,
				except any employee individually eligible for enrollment with the fund employed
				by the health provider when such employed person is not enrolled with the fund.
				The fund's obligation for compensation does not and shall not extend to any
				liability or obligation of a health care provider, which the health care
				provider has assumed or undertaken by contract or agreement, to indemnify,
				defend or hold harmless any other person, firm or corporation.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  40:1299.44(D)(3).
Louisiana Administrative Code › Title 37 - INSURANCE › Part III - Patient's Compensation Fund Oversight Board › Chapter 9 - Scope of Coverage › Section III-909 - Scope of Coverage: Self-Insurance Trusts

Current through Register Vol. 50, No. 6, June 20, 2024
A. With respect to health care providers
				enrolled with the fund by evidence of participation in an approved
				self-insurance trust pursuant to
				§509 hereof, subject to the limitation of
				liability prescribed by the Act, the fund shall be liable for compensation for
				claims asserted against the health care provider only within the scope of
				coverage afforded by, and subject to the limitations and exclusions of, the
				self-insurance trust instrument evidencing the health care provider's financial
				responsibility and subject to the payment of the applicable
				surcharges.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  40:1299.44(D)(3).
Louisiana Administrative Code › Title 37 - INSURANCE › Part III - Patient's Compensation Fund Oversight Board › Chapter 11 - Reporting › Section III-1103 - Claims Experience Reporting: Insurers, Institutions and Self-Insured

Current through Register Vol. 50, No. 6, June 20, 2024
A. On or before
				August 1 of each year, each insurance company, approved risk retention group,
				and approved self-insurance trust fund then providing professional health care
				liability insurance to any health care providers enrolled with the fund, and
				each enrolled self-insured health care provider shall file with the fund,
				through the executive director, a summary of the health care liability claims
				experience of such health care provider or insurer fully developed for each of
				the most recently concluded 5 calendar years or for such fewer years as the
				health care provider or insurer has engaged in business in the state. Claims
				experience data filed by insurance companies shall include data for all health
				care providers insured by such insurer in the state and enrolled with the
				fund.
B. The reports required by
				this rule shall contain such information and data and shall be made and filed
				upon and in accordance with such forms, instructions, and array as may be
				specified and supplied by the executive director, all of which shall be
				distributed to those required to report no later than the preceding April
				1.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  40:1299.44(D)(3).
Louisiana Administrative Code › Title 37 - INSURANCE › Part III - Patient's Compensation Fund Oversight Board › Chapter 11 - Reporting › Section III-1105 - Noncompliance; Failure to Report

Current through Register Vol. 50, No. 6, June 20, 2024
A.
				Noncompliance with the reporting and notice requirements prescribed by these
				rules shall be deemed adequate and sufficient legal grounds for the
				cancellation and termination of enrollment of any enrollee of the fund. The
				executive director shall give written notice via certified mail to any health
				care provider and if applicable, the insurer or trust which, being required to
				provide reports under these rules, fails to do so within the time specified.
				The enrollment of a health care provider who does not submit, or have submitted
				by his insurer, trust or legal representative, the required reports in proper
				form may be terminated 30 days following the mailing of such notice by the
				executive director if the health care provider has not before such date filed
				the required reports in proper form.
B. Noncompliance with the reporting and
				notice requirements prescribed by these rules shall be deemed adequate and
				sufficient legal grounds for the cancellation and termination of the enrollment
				of any self-insured health care provider, approved risk retention group or
				self-insurance trust failing or refusing to report as required by these rules.
				The executive director shall give written notice by certified mail to any
				self-insured health care provider which, being required to provide reports
				under these rules, fails to do so within the time specified. The enrollment of
				a health care provider who does not submit the required reports in proper form
				may be terminated 30 days following the mailing of such notice by the executive
				director if the health care provider has not before such date filed the
				required reports in proper form.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  40:1299.44(D)(3).
Louisiana Administrative Code › Title 37 - INSURANCE › Part III - Patient's Compensation Fund Oversight Board › Chapter 11 - Reporting › Section III-1107 - Confidentiality

Current through Register Vol. 50, No. 6, June 20, 2024
A. All reports,
				notices, communications, information, records, and data made or given to the
				executive director, the board or to their agents or contractors pursuant to the
				provisions of Chapter 11 shall be deemed privileged and confidential by and in
				the possession of the executive director, the board and/or their agents and
				contractors, and unless ordered by a court of competent jurisdiction after a
				contradictory hearing, shall not be disclosed to any third party pursuant to
				request, subpoena, or otherwise without the express written authorization and
				consent of the person, office, or entity making or giving, or originally
				possessing any such reports, notices, communications, information, records, or
				data. This rule shall not, however, prohibit disclosure or publication after
				prior consent of the board of aggregated information or data from which
				information or data relative to individual health care providers may not be
				discerned.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  40:1299.44(D)(3).
Louisiana Administrative Code › Title 37 - INSURANCE › Part III - Patient's Compensation Fund Oversight Board › Chapter 13 - Fund Data Collection, Maintenance; Accounting and Reporting › Section III-1301 - Fund Data Collection, Maintenance

Current through Register Vol. 50, No. 6, June 20, 2024
A. All information and data collected by or
				reported to the board relating to the administration, operation, or defense of
				the fund shall be recorded and maintained by the board. All of such information
				and data shall, to the extent reasonably possible, be electronically computer
				database stored and maintained so as to be readily and efficiently accessible
				for utilization in the processing of applications for enrollment, in
				establishment and adjustment of claim reserves and reserves for incurred but
				not reported claims, in the preparation and analysis of claims experience data
				in connection with the development of surcharge rate filings, and in the
				defense of the fund.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  40:1299.44(D)(3).
Louisiana Administrative Code › Title 37 - INSURANCE › Part III - Patient's Compensation Fund Oversight Board › Chapter 13 - Fund Data Collection, Maintenance; Accounting and Reporting › Section III-1303 - Fund Accounting

Current through Register Vol. 50, No. 6, June 20, 2024
A. The
				executive director shall be responsible for maintaining accounts and records
				for the board as may be necessary and appropriate to accurately reflect the
				financial condition of the fund on a continuing basis.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  40:1299.44(D)(3).
Louisiana Administrative Code › Title 37 - INSURANCE › Part III - Patient's Compensation Fund Oversight Board › Chapter 13 - Fund Data Collection, Maintenance; Accounting and Reporting › Section III-1305 - Annual Budget

Current through Register Vol. 50, No. 6, June 20, 2024
A. The
				executive director shall annually project revenue and expense budgets for the
				fund for the succeeding fiscal year in accordance with the provisions of
				R.S.
				40:1299.44(A)(5)(f). Such
				budget shall reflect all revenues projected to be collected or received by or
				accruing to the fund during such fiscal year, together with the projected
				expenses of the administration, operation, and defense of the fund and
				satisfaction of its liabilities and obligations. Such budgets shall be
				submitted to the board for its approval, and as approved by the board,
				submitted on or before the following January 1 to the joint legislative
				committee on the budget, Senate Judiciary A, House Civil Law and Procedures,
				Legislative Auditor, Division of Administration and the legislative fiscal
				office, in accordance with
				R.S.
				40:1299.44(A)(5)(f).
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  40:1299.44(D)(3).
Louisiana Administrative Code › Title 37 - INSURANCE › Part III - Patient's Compensation Fund Oversight Board › Chapter 13 - Fund Data Collection, Maintenance; Accounting and Reporting › Section III-1309 - Periodic Reports

Current through Register Vol. 50, No. 6, June 20, 2024
A. The
				executive director shall prepare or cause to be prepared statements of the
				financial condition of the fund at least quarterly and shall post such reports
				on the board's website. Such statement may be prepared, at the election of the
				executive director, in accordance with generally accepted accounting principles
				relating to accounting for governmental funds.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  40:1299.44(D)(3).
Louisiana Administrative Code › Title 37 - INSURANCE › Part III - Patient's Compensation Fund Oversight Board › Chapter 13 - Fund Data Collection, Maintenance; Accounting and Reporting › Section III-1311 - Annual Report

Current through Register Vol. 50, No. 6, June 20, 2024
A. Each year,
				the executive director shall cause to be prepared an annual statement of the
				financial condition of the fund, which statement shall be in the form of the
				annual report required to be filed by the Division of Administration and the
				Legislative Auditor. Such statement shall be submitted to the board, Division
				of Administration and the legislative auditor. Such statement shall be a public
				record and posted on the board's website.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  40:1299.44(D)(3).
Louisiana Administrative Code › Title 37 - INSURANCE › Part III - Patient's Compensation Fund Oversight Board › Chapter 14 - Medical Review Panels › Section III-1401 - Procedure

Current through Register Vol. 50, No. 6, June 20, 2024
A. Except as
				otherwise provided by the Act, all malpractice claims against health care
				providers shall be reviewed by a medical review panel. The composition and
				operation of a medical review panel shall be in accordance with
				R.S.
				40:1299.47.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  40:1299.44(D)(3).
Louisiana Administrative Code › Title 37 - INSURANCE › Part III - Patient's Compensation Fund Oversight Board › Chapter 14 - Medical Review Panels › Section III-1403 - Malpractice Complaint

Current through Register Vol. 50, No. 6, June 20, 2024
A. A
				"request for review of a malpractice claim" or "malpractice complaint" shall
				contain, at a minimum:
1. a request for the
				formation of a medical review panel;
2. full name of only one patient for whom, or
				on whose behalf, the request for review is being filed; however, if the claim
				involves the care of a pregnant mother and her unborn child, then naming only
				the mother as the patient shall be sufficient;
3. full name(s) of the claimant(s);
4. full name(s) of defendant health care
				providers;
5. date(s) of alleged
				malpractice;
6. brief description
				of alleged malpractice as to each named defendant; and
7. brief description of alleged
				injuries.
Louisiana Administrative Code › Title 37 - INSURANCE › Part III - Patient's Compensation Fund Oversight Board › Chapter 14 - Medical Review Panels › Section III-1405 - Attorney Chairman

Current through Register Vol. 50, No. 6, June 20, 2024
A. An
				attorney chairman of a medical review panel is to be chosen by the parties
				according to
				R.S.
				40:1299.47.(A)(2)(c). An attorney chairman
				must be selected within one year from the date the request for review of the
				claim was filed. If, after one year, an attorney chairman has not been secured,
				the board shall send notice by certified mail to the claimant or the claimant's
				attorney stating that the claim will be dismissed after 90 days if no attorney
				chairman is appointed. If no attorney chairman is selected within 90 days of
				the certified notice, the board shall dismiss the claim.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  40:1299.44(D)(3).
Louisiana Administrative Code › Title 37 - INSURANCE › Part III - Patient's Compensation Fund Oversight Board › Chapter 15 - Defense of the Fund › Section III-1501 - Claims Defense

Current through Register Vol. 50, No. 6, June 20, 2024
A. Through its
				executive director, the board shall be responsible for the administration and
				processing of claims against and legal defense of claims against the fund. The
				executive director shall be responsible, and accountable to the board, for
				coordination and management of defense of the fund against claims to the extent
				of the responsibilities imposed on the board by the Act . Without limitation on
				the scope of such responsibility, the executive director shall be responsible
				for:
1. evaluating all malpractice claims made
				under the Act against enrolled health care providers to the potential liability
				of the fund;
2. recommending,
				fixing, establishing, and periodically modifying, as required, appropriate
				reserves against claims made against enrolled health care providers or the
				fund, subject to the approval of the board;
3. retaining, subject to qualifications and
				standards prescribed by the board, and supervising the services of attorneys
				at law to defend the fund against claims;
4. review and approval of fee and costs
				statements for services rendered by attorneys at law retained to defend the
				fund, ensuring that such statements accurately reflect services reasonably
				necessary or appropriate to the defense of the fund;
5. supervision and coordination of the
				defense of claims against or involving the fund by attorneys retained and
				representing enrolled health care providers;
6. negotiating and recommending reasonable
				and appropriate compromises and settlements of the fund's liability respecting
				any claim against the fund;
7.
				maintenance of current, accurate, and complete records and data on all pending
				and concluded claims against or involving the fund;
8. retaining an appropriately qualified
				claims manager or principal assistant and delegating to such claims manager
				those duties and responsibilities as deemed appropriate by the executive
				director; and
9. the discharge and
				performance of such other duties, responsibilities, functions, and activities
				as are delegated by the board.
Louisiana Administrative Code › Title 37 - INSURANCE › Part III - Patient's Compensation Fund Oversight Board › Chapter 15 - Defense of the Fund › Section III-1503 - Claims Accounting

Current through Register Vol. 50, No. 6, June 20, 2024
A. All
				expenses incurred in the legal defense, disposition, payment on individual
				claims, judgments, or settlements shall be accounted for and allocated among
				such respective claims.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  40:1299.44(D)(3).
Louisiana Administrative Code › Title 37 - INSURANCE › Part III - Patient's Compensation Fund Oversight Board › Chapter 15 - Defense of the Fund › Section III-1505 - Claim Reserves

Current through Register Vol. 50, No. 6, June 20, 2024
A. Within
				30 days of receipt of notice of a claim against or potentially involving
				liability of the fund, the board may establish a reserve against such claim
				representing the total amount of compensation and compensation adjustment
				expenses which the fund is anticipated to be liable for and incur in respect of
				and allocable to such claim. Reserves respecting individual claims against the
				fund shall be established in consultation, as appropriate, with legal counsel
				representing the board with respect to such claim, with legal counsel for the
				enrolled health care providers against whom the claim is primarily asserted,
				and with claims personnel managing such claim for the commercial insurers of
				the enrolled health care providers against whom the claim is asserted. Reserves
				respecting individual claims against the fund shall be adjusted from time to
				time as changing circumstances or evaluations may warrant.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  40:1299.44(D)(3).
Louisiana Administrative Code › Title 37 - INSURANCE › Part III - Patient's Compensation Fund Oversight Board › Chapter 15 - Defense of the Fund › Section III-1507 - Settlement of Claims

Current through Register Vol. 50, No. 6, June 20, 2024
A. Claims
				against the fund may be compromised and settled upon the recommendation of the
				executive director and the approval of the board. The executive director shall,
				however, have authority, without the necessity of prior approval by the board,
				to compromise and settle any individual claim against the fund for an amount
				not exceeding $25,000.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  40:1299.44(D)(3).
Louisiana Administrative Code › Title 37 - INSURANCE › Part III - Patient's Compensation Fund Oversight Board › Chapter 15 - Defense of the Fund › Section III-1509 - Privileged Communications, Records

Current through Register Vol. 50, No. 6, June 20, 2024
A. All communications made and documents,
				records, and data developed between, by, or among the board, executive
				director, Office of Risk Management, PCF general counsel, the Attorney General
				or his representative, contracted legal counsel, and enrolled health care
				providers and their insurers respecting malpractice claims asserted against
				enrolled health care providers or the fund shall be deemed privileged and
				confidential and, unless so ordered by a court of competent jurisdiction after
				a contradictory hearing, shall not be disclosed to any third party pursuant to
				request, subpoena, or otherwise, without the express written authorization and
				consent of the person, office, or entity making any such communication or
				originally possessing any such documents, records, or data. This rule shall
				not, however, prohibit disclosure or publication by the board of aggregated
				information or data from which information or data relative to individual
				health care providers or individual claims may not be discerned.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  40:1299.44(D)(3).
Louisiana Administrative Code › Title 37 - INSURANCE › Part III - Patient's Compensation Fund Oversight Board › Chapter 19 - Future Medical Care and Related Benefits › Section III-1901 - Scope of Chapter

Current through Register Vol. 50, No. 6, June 20, 2024
A. The rules of
				Chapter 19 provide for and govern the administration and payment by the fund of
				future medical care and related benefits for patients deemed to be in need of
				future care and related benefits pursuant to a final judgment issued by a court
				of competent jurisdiction or agreed to in a settlement reached between a
				patient and the fund.
B. The rules
				of Chapter 19 shall be applicable to all malpractice claims, including those
				brought under
				R.S.
				40:1299.39.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  40:1299.44(D)(3).