New York State seal

April 17, 1987

SUBJECT: INSURANCE

Circular Letter No. 6 (1987)

TO: ALL INSURERS LICENSED TO WRITE PROFESSIONAL MEDICAL MALPRACTICE INSURANCE IN NEW YORK STATE AND HOSPITALS WHICH ARE SELF-INSURED FOR PROFESSIONAL MEDICAL MALPRACTICE

RE: MEDICAL PROFESSIONAL LIABILITY INSURANCE CLAIM REPORTING REQUIREMENTS

In the Insurance Department's Circular Letter No. 6 (1986), dated July 9, 1986, all insurers authorized to write medical malpractice insurance in New York State, and all New York State hospitals which are self insured for medical malpractice, were advised that Section 315 of the Insurance Law had been amended to require that claims reported pursuant to that section be reported on a quarterly basis and on the newly introduced MEDICAL PROFESSIONAL LIABILITY INSURANCE CLAIM REPORT FORM, DOH-787. This form had been developed to replace the NAIC-79 claim report form in use at that time.

It has recently come to the Department's attention that some of the subject reporters have continued to submit reports on the obsolete NAIC form, or have failed to file the required reports.

The purpose of this Circular Letter is to remind all entities required to file claim reports pursuant to Section 315 of their obligation to do so on a timely basis, and to clarify any possible confusion regarding the form on which to file these reports.

Claims Closed On or Before December 31, 1985

Reports for claims closed between January 1, 1980 and December 31, 1985 must be submitted on the form in use at that time, the NAIC-79. Reports for closed claims not previously reported were due no later than December 8, 1986. As a sizable backlog exists, some flexibility has been granted. Previously non reported claims will contiune to be accepted without penalty until May 15, 1987.

Claims Opened and/or Closed On and After January 1, 1986

Effective January 1, 1986, all open and closed claims were to be reported using the DOH-787.

Those claims that were opened between January 1, 1980 and December 31, 1985, and remained open on or after January 1, 1986, must, at time of closure, be integrated onto the DOH-787 Medical Malpractice Database. Therefore, all claims closed on or after Janaury 1, 1986 must be reported on the DOH-787. If these claims were not previously reported, a temporary edit has been established to assist reporters in eliminating the delinquent report backlog. The edit allows for both the opening and closing of the claim using the DOH-787 form. This option may only be used to eliminate the backlog; it cannot be used for claims filed on or after January 1, 1987 that did not open and close in the same annual quarter.

Biennial Reports

As Section 315 of the Insurance Law requires biennial report updates, all longstanding open claims must be reported in accordance with the schedule published in Circular Letter No. 6 (1986). These are claims that have been open for several years and need to be integrated in the DOH-787 Medical Malpractice Database. This activity is, in effect, a report update that will accommodate a match for the claim upon closure. For example, for currently open claims opened prior to January 1, 1980, the updated reports were due February 15, 1987 (please note -- this date was erroneously shown as February 15, 1989 in the example in Circular Letter No. 6).

Report Information and Filing Requirements

A. DOH-787 forms for both opened and closed claims must be submitted within 45 days following the end of the quarter in which they are opened or closed. For example, all claims opened or closed during the period October 1, 1986 through December 31, 1986 were due on February 15, 1987; those claims opened or closed during the period January 1, 1987 through March 31, 1987 are due by May 15, 1987, etc.

B. When opening a claim, the minimum amount of information acceptable upon reporting is the completion of DOH-787 Sections I and II, and questions 31, 32b, 45 and 49. Any known additional information may be provided at this time. That information not provided when a claim is opened must be furnished either during an update or upon closure.

C. An updated report is required to be submitted every two years after the initial filing of the report until the claim is closed. Using a new DOH-787, questions 2, 7, 9, 11 and 19, where applicable, must be completed to identify the claim. Then include only new or changed information that has been obtained during investigation and discovery. These updates are to be submitted within 45 days following the biennial anniversary date of the quarter and year in which they were origianlly reported. For example, all claims opened and reported during the third quarter of 1986 that remain open as of the third quarter of 1988 would require an update no later than November 15, 1988. If the claim remains open a second updated report would be due on November 15, 1990, and every two years thereafter until the claim is closed.

D. Once a claim is closed using one of the disposition codes in the Medical Professional Liability Insurance Claim Coding Manual, it should be reported within 45 days following the quarter in which it was closed. A new DOH-787 claim form should be used. Questions 2, 7, 9, 11 and 19 must be completed with each submission to identify the claim. Then include only new or changed information to complete the form.

E. All claim forms and tape submissions should be sent directly to the New York State Department of Health, as the database is being managed by that Department's Medical Malpractice Unit within its Office of Professional Medical Conduct. The Department of Health will, on a routine basis, provide the Insurance Department with total database transfer, so the Insurance Department will deem the submission of the reports to the Health Department to be equivalent to filing with both departments in compliance with the requirements of Section 315. This arrangement creates a nonduplicative, efficient reporting process of benefit to the insurer community responsible for claim reporting, and allows for significant cost savings in that one database serves both agencies. The cooperative sharing of the database allows each agency to do their own respective research and analysis to accomplish their legislative mandates.

Any questions should be addressed to either:

State of New York Department of Insurance

Ms. Laurel Presser, Supervising Examiner

Professional Liability Unit

Property and Casualty Insurance Bureau

160 West Broadway

New York, New York 10013

212-602-0382

or

State of New York Department of Health

Mr. Christopher Coward, Administrator

Medical Malpractice Unit

Office of Professional Medical Conduct

E.S.P., Corning Tower # 2538

Albany, New York 12237

518-474-8357

Very truly yours,

[SIGNATURE]

JAMES P. CORCORAN

Superintendent of Insurance