W. Va. Code R. § 115-6-4 - Miscellaneous Provisions

4.1. Administration of Claims. The board may implement such policies and procedures for the administration of all claims as against the preferred medical liability program and the high risk medical liability program.

4.2. Designation of Agents. The board may implement such policies and procedures for the use and commissions of designated agents, if any, for the procurement of insurance.

4.3. Settlement of Claims. The board may implement such policies and procedures as needed to negotiate and effect settlement of any and all insurance claims arising from losses or damages under the preferred medical liability program or the high risk medical liability program. The execution and delivery and settlement of claims and releases, need not be done with the consent of either the insured or the knowledge and consent of the Attorney General.

4.3.a. The board is hereby authorized and empowered to negotiate and effect settlement of any and all insurance claims arising from the insurance coverage afforded by the West Virginia Health Care Provider Professional Liability Availability Act [W. Va. Code § 29-12B-1 et seq.].

4.3.b. The Executive Director, or his designees, shall have the authority to issue a written settlement determination on behalf of the board and/or to approve payment of judgments or settlements under this program after receipt and review of one of the following:

4.3.b.1. A certified copy of a final judgment against a health care provider insured by either of the medical liability programs created pursuant to the act;

4.3.b.2. A certified copy of an order approving settlement in a summary proceeding; or

4.3.b.3. Appropriate documentation that justifies the proposed settlement.

4.3.c. The form and substance of what constitutes "a written settlement determination" shall be developed by, and at the discretion of, the Executive Director.

4.3.d. All payments in satisfaction of any settlement or judgment shall be in accordance with established board policies and procedures.

4.3.e. If claim payments are issued by way of a check or draft drawn on an account issued to the State of West Virginia, payment shall be deemed to have been made at the time a request for issuance of a state check or draft is made by or on behalf of the board notwithstanding the length of time required for actual issuance of the check or draft.

4.4. Annual Certification. (Procedure for Annual Certificate of "Diligent Search, as Prescribed by W. Va. Code § 29-12-5(c)(2)(I)(iv)") The physician or health care provider seeking to provide annual certification that they have made a diligent search for comparable coverage in the voluntary insurance market and have been unable to obtain the insurance must follow the requirements for this certification as determined by the board.

4.5. Coverage Criteria. The following criteria may be reviewed by the Board of Risk and Insurance Management to determine whether insurance coverage will be provided to a physician whose loss experience or current professional training and capability or other matters are such that the physician represents an unacceptable risk of loss if coverage is provided:

4.5.a. The number of prior claims of medical malpractice against the physician in the last five-year period.

4.5.b. The number of adverse verdicts rendered against the physician in the previous five-year period.

4.5.c. The status of the physician with the West Virginia Board of Medicine.

4.5.d. The number and amount of settlements reached on behalf of said physician in regard to the claims asserted in the previous five-year period.

4.5.e. Provisions for coverage may also be made pursuant to the policies and procedures of the board for part-time practicing physicians and for the financing of insurance premiums.

All of these items may be taken into consideration among others and any refusal to insure a physician based on this act shall be made in writing together with the reasons therefore. Any physician aggrieved under this act shall have the right to appeal this decision.

4.6. Appeal. In the event that a health care provider who has made application to the program believes that they are aggrieved by the underwriting decisions made pursuant to the act, the board may institute and implement policies and procedures for an appeal. The appeal may be made to the executive director. In the event that the aggrieved individual or entity disagrees with the decision of the executive director, the appeal may be taken to the full board. The decision of the full board by majority vote when a quorum is present shall be final. The appeal process is confidential and subject to being heard in executive session. There is no appeal from claims, claims resolution or other matters not specifically addressed herein.

4.7. Discontinuation of the Preferred Medical Liability Program or the High Risk Medical Liability Program. The board may implement policies and procedures consistent with the statute allowing the discontinuation of the preferred medical liability program or the high risk medical liability program.

Notes

W. Va. Code R. § 115-6-4