New York State seal

December 22, 1980

SUBJECT: INSURANCE

Circular Letter No. 19 (1980)

December 22, 1980

TO: ALL INSURERS AUTHORIZED TO WRITE PROFESSIONAL LIABILITY INSURANCE IN NEW YORK STATE

RE: PROFESSIONAL LIABILITY INSURANCE

a) REPORTS OF CLAIMS

b) REPORTS ON TERMINATIONS

Chapter 866 of the Laws of 1980 added a new Section 335-a to the Insurance Law, effective January 1, 1981, which requires the reporting to the Education Department of any disposition, whether by judgment, settlement or otherwise, of any claim made against an individual licensed under Title 8 of the Education Law, with the exception of physicians, physician's assistants and specialist's assistants, of incidents of professional malpractice or misconduct, where the claim was based upon fraud, incompetence or negligence. The Section also requires the reporting of cancellation of professional liability insurance, for reasons other than non-payment of premiums, of such licensed individuals.

Every insurer engaged in the writing of professional liability insurance in this state shall file on the attached forms information on closed claims and terminations, in accordance with the enclosed instructions. Such reports shall be made to the Education Department.

It is intended that claims be reported only by the primary carrier, in those cases where payment was made under the policy. However, an excess or umbrella carrier would be required to submit reports of claims if the primary carrier is not licensed in New York.

Reports of claims and terminations on or after January 1, 1981 are due within 60 days following the date of disposition of any claim or termination of insurance.

The Law provides that any report furnished in accordance with the provisions of Section 335-a shall be deemed a confidential communication and shall not be subject to inspection or disclosure in any manner except upon formal written request by a duly authorized public agency or pursuant to a judicial subpoena issued in a pending action or proceeding.

The completed forms shall be mailed to:

New York State Education Department

Office of Professional Discipline

622 Third Avenue

New York, NY 10017

Very truly yours,

[SIGNATURE]

Albert B. Lewis

Superintendent of Insurance

ATTACHMENT

Professional Liability Insurance Claims Report

(See Instruction Sheet Attached)

1. Name of Insurer____________________

2. Claim file identification No.____________________

3a. Date(s) of Occurrence(s)____________________

3b. Date reported to Insurer____________________

3c. Date reopened (if any)____________________

3d. Date Occurrence reported to Insured____________________

3e. Place(s) of Occurrence(s)____________________

4a. Insured's Name____________________

4b. Insured's Address____________________

5a. Defendant's Name____________________

5b. Defendant's Address____________________

5c. Defendant's License No., if known____________________

5d. Defendant's Date of Birth____________________

6. Profession or business (CODE)____________________

7a. Injured Person's Name____________________

7b. Injured Person's Address____________________

7c. Injured Person's Date of Birth____________________

8. Plaintiff attorney's name, address & telephone No.____________________

9a. Total number of defendants involved in claim____________________

9b. Names and license No.s of other defendants, if known_____

_____________________________________________________________

_____________________________________________________________

9c. Name and address of company insuring other defendants_____

_____________________________________________________________

_____________________________________________________________

9d. Claim file No.s of additional defendants, if insured by your company__________________________________________________________

_____________________________________________________________

10. Basis of claim:    a) Fraud__________

b) Incompetence__________   c) Negligence__________

d) Other (specify)____________________

11. Describe action(s) which caused claim to be made. Include copy of complaint and copy of settlement agreement.

12. Associated issues (CODE)____________________

13a. Claim Disposition (CODE)____________________

13b. Settlement (CODE)____________________

13c. Court (CODE)____________________

14. Date of payment or closure____________________

15. Indemnity paid by you on behalf of this defendant $_______

16. Other indemnity paid by or on behalf of this defendant

   _____________________

   Deductible [] Excess []

______________________________

Contact Person's Name (Please Print)

____________________   _______________

Address

____________________  

Person Responsible

for Preparation of

Report

________________

Telephone No.

Complete all blocks on the form. Whenever information is not available or not applicable insert "N.A.". When an item calls for a dollar amount and no amount is involved, enter -0- in the space after the $ sign. When you prepare a report on a reopened case on which a previous report has been made, mark "Previously Reported" at the top of the report. Record all amounts in the whole dollars only, all dates as MM YY. All fields are self-explanatory except as follows:

3a. Date of Alleged Occurrence, 3b. Date Reported and 3c. Date Reopened. Enter two digits each for month and year of occurrence and registration of incident as claim. Enter date in field provided on reopened cases.

5c. If insured defendant has a license number or operating certificate number, specify, if known.

6. Enter appropriate Code of insured's profession or business

01 Acupuncture

02 Architecture

03 Audiology

04 Certified Shorthand Reporting

05 Chiropractic

06 Dentist

07 Dental Hygienist

08 Landscape Architecture

09 Land Surveying

10 Massage

11 Registered Professional Nurse

12 Licensed Practical Nurse

13 Occupational Therapist

14 Occupational Therapy Assistant

15 Opthalmic Dispensing

16 Optometry

17 Pharmacy

18 Physical Therapy

19 Podiatry

20 Professional Engineering

21 Psychology

22 Certified Public Accountant

23 Public Accountant

24 Social Work

25 Speech Pathology

26 Veterinarian

27 Animal Health Technician

9a. Enter the Total Number of Defendants (persons and institutions other than John Does) Involved in Claim. Enter 1 if there is only one defendant.

10. Check item or items which are the basis of the claim. If d) Other, please specify.

11. Give a complete description of all actions and circumstances causing the claim. Include copy of complaint and settlement agreement.

12. Enter the appropriate Code(s) if one or more of the following factors were Associated Issues in the claim: 1) abandonment, 2) premature discharge from services, 3) false imprisonment, 4) lack or delay of consultation, 5) lack of supervision, 6) improper delegation of duty, 7) practice beyond scope, 8) breach of confidentiality, 9) failure to prevent an abnormal condition, 10) failure to accomplish intended result, 11) failure to conform with regulation or statutory rule, 12) lack of adequate facilities or equipment, 13) laboratory error, 14) pharmacy error, 15) failure to timely disclose, 16) failure to provide warning instructions, 17) lack of consent from proper person, 18) inadequate information for informed consent, 19) procedure exceeded consensual understanding, 20) unauthorized substitution or modification, 21) unwarranted treatment, 22) breach of contract, 23) guarantee, 24) assault and battery, 25) sterilization of equipment, 26) aseptic technique, 27) records, 28) billing and collection, 29) inter-professional relations, 30) codes, 31) failure to report fraudulent association, 32) failure to report disregard of specifications, 33) failure to provide prescription, 34) res ipsa loquitur, 35) vicarious liability, 36) statute of limitations, 37) punitive damages.

13a. Enter final method of Claim Disposition: 1) settled by parties, 2) disposed of by a court, 3) disposed of by binding arbitration.

13b. If settled by agreement of parties, enter appropriate Settlement Code: 1) before filing suit or demanding hearing, 2) before trial or hearing, 3) during trial or hearing, 4) after trial or hearing, but before judgment or decision (award), 5) after judgment or decision, but before appeal, 6) during appeal, 7) after appeal, 8) claim or suit abandoned, 9) during review panel or non-binding arbitration.

13c. Enter the appropriate Court Code: 0) no court proceedings, 1) directed verdict for plaintiff, 2) directed verdict for defendant, 3) judgment notwithstanding the verdict for the plaintiff, 4) judgment notwithstanding the verdict for the defendant, 5) judgment for the plaintiff, 6) judgment for the defendant, 7) for plaintiff after appeal, 8) for defendant after appeal, 9) all other.

16. Mark appropriate box if this amount was deductible paid by the insured or indemnity paid under an excess limits policy by another insurer.

NEW YORK STATE INSURANCE DEPARTMENT

PROFESSIONAL MEDICAL LIABILITY INSURANCE

REPORT ON TERMINATION

OTHER THAN NON-PAYMENT

(See Instruction sheet attached)

1a. Name of Insurer____________________1b. Policy Number____________________

2a. Type of Termination (CODE)____________________

2b. Effective Date of Termination____________________

3a. Insured's Name____________________

3b. Insured's Address____________________

3c. Insured's License Number____________________

3d. Insured's Date of Birth________________________

4a. Profession or business (CODE)________________________

4b. Specialty (CODE)____________________

5a. Board Certification (CODE)____________________

5b. Foreign Medical Graduate?____________________ 5c. Country____________________

6. Describe the specific reasons why this policy was terminated by the Company.________________________________________________________

____________________________________________________________

____________________  

_________________

Contact Person and  

Person Responsible

telephone No. (Please Print)  

for Report

____________________

Address

Professional Liability Insurance

Report On Termination

Other Than Non-Payment

(See Instruction Sheet Attached)

1. Name of Insurer____________________

2. Policy No._________________________________

3a. Type of Termination (CODE)______________________

3b. Effective Date of Termination____________________

4a. Insured's Name____________________

4b. Insured's Address__________________________________

4c. Insured's License No., if known___________________

5. Profession or Business of Insured (CODE)____________________

6. Describe the specific reason(s) why this policy was terminated by the Company____________________

____________________

____________________

__________________________________

Contact Person's Name (Please Print)

Person Responsible for

Preparation of Report

____________________

Address

____________________

Telephone No.

Instruction Sheet For Report On Termination

The following instructions apply to the items listed below:

3a. Enter CODE for type of termination:

1. cancellation by company (other than for non-payment of premiums)

2. non-renewal by company

5. Enter CODE of Profession or Business of Insured

01 Acupuncture

02 Architecture

03 Audiology

04 Certified Shorthand Reporting

05 Chiropractic

06 Dentist

07 Dental Hygienist

08 Landscape Architecture

09 Land Surveying

10 Massage

11 Registered Professional Nurse

12 Licensed Practical Nurse

13 Occupational Therapist

14 Occupational Therapist Assistant

15 Ophthalmic Dispensing

16 Optometry

17 Pharmacy

18 Physical Therapy

19 Podiatry

20 Professional Engineering

21 Psychology

22 Certified Public Accountant

23 Public Accountant

24 Social Work

25 Speech Pathology

26 Veterinarian

27 Animal Health Technician

6. Enter specific reason(s) for termination by the company. An acceptable specific reason shall not be an unsupported general statement such as "underwriting judgment".