La. Admin. Code tit. 37 § III-109

Current through Register Vol. 50, No. 4, April 20, 2024
Section III-109 - General Definitions
A. As used in these rules, the following terms shall have the meanings specified:
1. Terminology Definitions

Act- the Louisiana Medical Malpractice Act, Act 1975, Number 817, as amended, R.S. 40:1299.41-1299.48.

Board-the Louisiana Patients' Compensation Fund Oversight Board established pursuant to R.S. 40:1299.44.D.

Executive Director- the Executive Director of the Louisiana Patients' Compensation Fund Oversight Board, as designated, appointed, and delegated authority pursuant to §303.

2. Coverage Definitions

Claims-Made Coverage- a form of professional liability coverage which provides coverage for a claim arising from an incident which both occurred and was reported during the effective period of qualification with the fund. Provider must meet all requirements for continued qualification.

Extended Reporting Endorsement- tail coverage.

Occurrence Coverage- a form of professional liability coverage which provides coverage for a claim arising from an incident which occurred during the effective period of qualification, regardless of whether the provider was actively enrolled on the date on which the claim was reported. Provider must meet all requirements for continued qualification.

Self-Insured Coverage- a form of professional liability coverage which provides coverage for a claim arising from an incident which occurred during the effective period of qualification, regardless of whether the provider was actively enrolled on the date on which the claim was reported. Provider must meet all requirements for continued qualification.

Tail Coverage- an endorsement which, when purchased by a provider at the end of his claims-made coverage period, provides coverage for a claim arising from an incident which occurred during the effective period of enrollment but was reported following the termination of active enrollment. Provider must meet all requirements for continued qualification.

3. Provider Definitions

Enrolled Provider- an enrolled provider is one who has met the requirements for qualification in the Louisiana Patient's Compensation Fund (including the financial responsibility requirements of R.S. 40:1299.42) who also:

i. is currently actively involved in medical practice and/or providing medical services in Louisiana; and
ii. has paid the appropriate surcharge for such practice to the fund for their current policy year.

Qualified Provider - any provider who has met the statutory requirements for malpractice coverage with the Louisiana Patient's Compensation Fund. As long as the financial responsibility requirements for continued qualification in the form prescribed by §505-509 of these rules, as applicable, are met, a provider need not be currently enrolled in the PCF.

4. General Definitions

Accept or Collect- with reference to the acceptance or collection of payments of applicable surcharges for enrollment with the fund, such surcharges will be deemed to have been accepted or collected by the commercial professional health care liability insurance companies and approved self-insurance trust funds when the first agent, employee, representative, or other person acting or purporting to act on behalf of the insurer or the trust fund who has the responsibility to process such surcharges accepts delivery of same.

Disability- for purposes of determining eligibility for the provisions of §715. D of these rules, the inability to continue the practice of medicine due to a permanent illness, injury, or physical impairment. However, for purposes of consideration for a waiver under the provisions of §715. C.3 of these rules, disability may also include any permanent illness, injury, or physical impairment which prevents a provider from continuing the practice of his existing medical specialty, surgical class, or risk rating classification as provided in §705 of these rules, whether or not such disability prevents the provider from engaging in the active practice of medicine.

La. Admin. Code tit. 37, § III-109

Promulgated by the Office of the Governor, Patients' Compensation Fund Oversight Board, LR 18:168 (February 1992), amended LR 23:68 (January 1997), LR 29:344 (March 2003), amended by the Office of the Governor, Division of Administration, Patients' Compensation Fund Oversight Board, LR 38:2534 (October 2012).
AUTHORITY NOTE: Promulgated in accordance with R.S. 40:1299.44(D)(3).