N.J. Admin. Code § 11:1-7.3

Current through Register Vol. 56, No. 24, December 18, 2024

Section 11:1-7.3 - Medical malpractice reporting requirements

(a) Any insurer or insurance association authorized to issue medical malpractice liability insurance in the State shall notify the Medical Practitioner Review Panel in writing of the following:

1. Any medical malpractice claim settlement, judgment or arbitration award involving any practitioner licensed by the State Board of Medical Examiners and insured by an insurer or insurance association.

i. The notification requirement set forth in (a)1 above shall not apply to payments made under agreements for minimum and maximum payments irrespective of the verdict (commonly referred to as high/low agreements) where there is a finding by an arbitrator or a verdict in a civil action of no liability on the part of the practitioner;

2. Any termination or denial of medical malpractice liability coverage to a practitioner; and

3. Any surcharge assessed against a practitioner because of the practitioner's practice method or medical malpractice claims history.

(b) Any practitioner licensed by the State Board of Medical Examiners who is not covered by a policy of medical malpractice liability insurance issued in this State, or has coverage through a self-insured health care facility or health maintenance organization, or has medical malpractice liability insurance which has been issued by an insurer or insurance association from outside the State, shall notify the Panel in writing of any medical malpractice claim settlement, judgment or arbitration award to which the practitioner is a party.

(c) The initial written notice referred to in (a) and (b) above may be either in letter form or the malpractice report form of the National Practitioner Data Bank and shall contain at least the following information:

1. The name and address of the insurer, insurance association or practitioner submitting the information;

2. The name and address and any other information relating to the identity of the practitioner about whom the information is being submitted; and

3. In the case of a claim settlement, judgment or arbitration award, the name, address and other information relevant to the identity of the claimant making the medical malpractice liability claim against the practitioner, as well as the amount and relevant details of the claim settlement, judgment or arbitration award.

(d) The initial written notice referred to in (a) and (b) above shall be mailed by regular mail or delivered no later than seven days after the settlement, judgment or arbitration award is officially agreed to or entered, the notice of termination or denial of coverage is issued to the practitioner, or notice of the surcharge has been issued to the practitioner.

(e) In addition to the information provided in the initial written notice referred to in this section, the Panel may request in writing such supplemental relevant information as it determines to be necessary, which shall be received by the Panel no later than 30 days following the date of the Panel's written request.

(f) Reports to the Medical Review Board shall be addressed to: Medical Practitioner Review Panel

PO Box 183

Trenton, NJ 08625-0183

(g) All insurers or insurance associations authorized to issue medical malpractice liability insurance in the State shall notify the Commissioner of any medical malpractice claim settlement, judgment or arbitration award involving any practitioner licensed by the State Board of Medical Examiners and insured by the insurer or association. The notification shall be made regardless of whether the practitioner is currently insured by the insurer or association at the time of the settlement, judgment or arbitration award. The notification shall not include the name or other identifying information of the practitioner or claimant, but shall contain the following information:

1. The claim number;

2. An indicator if the form is amending a previously filed report;

3. The specialty or area of professional practice of the practitioner;

4. The practitioner's zip code;

5. The date of the loss;

6. A description of the claim/loss;

7. The final disposition;

8. The settlement date; and

9. The amount of the settlement, judgment or arbitration award.

(h) The notice referred to in (g) above shall be delivered to the Department electronically no later than seven days after the settlement, judgment, or arbitration award is officially agreed to or entered. The notice shall be e-mailed to the Department at medmalclrep@dobi.nj.gov.

N.J. Admin. Code § 11:1-7.3

Amended by 51 N.J.R. 765(a), effective 5/20/2019