W. Va. Code R. § 115-6-3 - Implementation of Insurance Coverage
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.
Notes
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