West Virginia Code of State Rules › Agency 115 - Risk And Insurance Management › Title 115 - LEGISLATIVE RULES STATE BOARD OF RISK AND INSURANCE MANAGEMENT › Series 115-06 - Preferred Medical Liability And High Risk Medical Liability Program › Section 115-6-3 - Implementation of Insurance Coverage

Current through Register Vol. XLI, No. 28, July 12, 2024
3.1. Date coverage to be offered. Coverage
				may be offered pursuant to the statute, and may have an effective date
				retroactive to the effective date of Article 12B, Chapter 29 of the West
				Virginia Code.
3.2. Amount of
				Coverage. The amount of insurance coverage available to the particular health
				care provider is determined by statute, and subject to the policies and
				procedures of the board.
3.3.
				Premium Rates. The premium rate schedule is to be established by the board
				using the criteria of the statute under the board's policies and
				procedures.
3.4. Coverage Form.
				Insurance issued through the "West Virginia Health Care Provider Professional
				Liability Insurance Availability Act" will be issued under the policies and
				procedures of the board with such forms and policy provisions consistent with
				the providing of insurance to health care providers in West Virginia under this
				act.
3.5. Excess Coverage. The
				Board may, but is not required, to obtain excess verdict liability coverage for
				the programs described in this act.
3.6. Administration. The board may establish
				such policies and procedures to administer the preferred medical liability
				program and the high risk medical liability program and exercise and perform
				other powers and duties and functions specified in the statute. The board may
				set the time and place of the meeting, may allow attendance by speaker phone,
				teleconferencing or other means where necessary. Three members of the
				five-member board shall be a quorum. The vote of the majority of the quorum
				present is required for a motion to be approved.
3.7. Actuary. The Board may establish such
				policies and procedures necessary to obtain and implement (at least annually)
				from an independent outside source ratings to be used for premiums for the
				preferred medical liability program and high risk medical liability
				program.
3.8. Underwriting
				Criteria. The board may prepare such policies and procedures to determine and
				annually review the underwriting criteria for the preferred medical liability
				program and high risk medical liability program.
3.9. Legislative Reports. The board may
				implement such policies and procedures to prepare and publish separate
				summaries for the preferred medical liability program and the high risk medical
				liability program during the proceeding fiscal year before each regular session
				of the Legislature.
3.10.
				Surcharge. The board may implement such policies and procedures to determine
				and annually review the claims history, debit or surcharge for the high risk
				medical liability program.
3.11.
				Transfer. The board may implement such policies and procedures to determine and
				annually review the criteria for transfer from the preferred medical liability
				program to the high risk medical liability program.
3.12. Agents. The board may implement such
				policies and procedures to determine and annually review the role of agents and
				the amount of commission, if any, to be paid, in the preferred medical
				liability program and the high risk medical liability program.
3.13. Legislative Recommendations. The board
				may implement such policies and procedures to study and annually evaluate the
				operation of the preferred medial liability program and the high risk medical
				liability program and make such recommendations to the legislature to insure
				its continued viability including but not limited to recommendations for civil
				justice reform.
3.14. Five Year
				Plan. The Board may implement such policies and procedures to establish a five
				year financial plan to insure an adequate premium base to cover the long tail
				nature of the claims-made coverage provided by the preferred medical liability
				program and the high risk medical liability program. The board may approve such
				policies and procedures to retain the services of an impartial professional to
				determine that the plan may reasonably be expected to generate sufficient
				revenues and meet all estimated program and administrative costs: The board may
				implement such policies and procedures to submit its final approved five year
				financial plan to the Governor and the Legislature by the first day of January
				preceding the fiscal year; The board may implement such policies and procedures
				to identify factors that the board shall consider appropriate including the
				trends for the program in the industry and the claims history and the number
				and category participants in each program and the settlement claims and
				judicial results; The board may implement such policies and procedures to
				identify that the participants in the program have made a diligent search for
				comparable coverage in the voluntarily insurance market and have been unable to
				obtain the same.
3.15. Meetings.
				The board may implement such policies and procedures for board meetings to
				review the implementation of its current financial plan in light of its actual
				experience.
3.16. Reinsurance. The
				board may implement such policies and procedures for the purchase of
				reinsurance if it deems it to be appropriate.
3.17. Tail Coverage Availability. The board
				shall implement such policies and procedures to establish an optional extended
				reporting coverage or tail coverage availability.
3.18. Settlements. The board may implement
				such policies and procedures to enter into settlements or structured
				settlements where appropriate for claims made against the preferred medical
				liability program or the high risk medical liability program.
3.19. Unacceptable Risk. The board may
				implement such policies and procedures for the refusal of the Board to provide
				insurance coverage for individual physicians whose prior loss experience or
				current professional training and capability or other issues are such that the
				physician represents an unacceptable risk of loss if coverage is
				provided.
3.20. Termination. The
				board may implement such policies and procedures for the termination of
				coverage for nonpayment of premiums upon written notice of the termination
				forwarded to the health care provider not less than 30 days prior to the
				termination of coverage.
3.21.
				Transfer of Insurance Obligations. The board may implement such policies and
				procedures to assign coverage or transfer all insurance obligations and/or risk
				of existing or in-force contracts of insurance to a third-party medical
				professional liability insurance carrier with the comparable coverage
				conditions as determined by the board. These policies and procedures shall
				effect a novation of the transferred contract of insurance, which such novation
				shall extinguish all liability of the board and the state of West
				Virginia.
3.22. Medical Malpractice
				Advisory Panel. The board may implement such policies and procedures that it
				deems appropriate to meet and consult with the medical malpractice advisory
				panel.
3.23. Medical Malpractice
				Advisory Panel Administration. The board may institute such policies and
				procedures as needed to consult with and/or administer the state medical
				malpractice advisory panel, its creation, composition, duties, and
				compensation; the board may implement such policies and procedures for the
				organization, meetings, records, and reports of the panel as it deems
				necessary; the board may implement such policies and procedures as it deems
				necessary for the establishment and maintenance of health care provider
				professional liability insurance programs; the board may implement such
				policies and procedures as it deems necessary to establish the eligibility
				criteria for participation in the health care provider professional liability
				insurance programs including the preferred medical liability program and the
				high risk professional liability insurance program; the board may implement
				such policies and procedures as necessary for the deposit, expenditure, and
				investment of premiums and for the payment for settlements or judgments; the
				board may implement such policies and procedures as necessary to maintain
				confidential information from disclosure; the board may implement such policies
				and procedures as it deems necessary for the issuance of any appeal bond, if
				necessary.