Frequently Asked Questions

Texas Medical Liability Trust (TMLT) is a health care liability claim trust led by a Board of Trustees who are elected by TMLT policyholders. TMLT is not an insurance company, but a self-insured trust created by the Texas legislature in 1979 to provide medical malpractice insurance to members of the Texas Medical Association.

In reference to TMLT, it is a medical liability trust led by a Board of Trustees who are elected by TMLT policyholders. TMLT was created by the Texas Legislature to provide medical liability insurance to members of the Texas Medical Association. In general, trusts are not regulated by state insurance departments, but TMLT complies voluntarily with the rules and regulations for commercial insurance companies.

TMLT was created by the Texas legislature in 1979 to provide medical liability coverage for physician members of the Texas Medical Association. The legislation that created TMLT included the provision that policyholders must be members of the TMA. Therefore, by law, policyholders must also be members of the TMA.

We offer a monthly payment plan with 10 payments. The first installment is 20%, with the balance due in remaining nine payments.

We also offer a quarterly plan with installments of 35%, 25%, 25%, and 15%.

There are no finance charges or transaction fees associated with TMLT payment plans.

Pay online or through our policyholder site, myPortal. You can set up recurring automatic payments or make a one-time payment. You can also mail payments to:

Texas Medical Liability Trust
Attn: Accounts Receivable - Payments
P.O. Box 160140
Austin, TX 78716

You can visit our members-only site, myPortal or call customer service at 800-580-8658 ext. 5050.

According to your policy, a claim can be any of the following:

A demand for compensation — any written communication from or on behalf of a patient that seeks monetary payment or other compensation because of a perceived error in treatment or an unexpected outcome.

A notice of claim letter — a letter that refers to Civil Practice and Remedies Code Section 74.052 or refers to a notice of claim. Upon receipt of a 74.052 letter, a physician and his or her insurer have 60 days to investigate and evaluate the patient's claim.

A lawsuit — will contain a citation (which informs you of a lawsuit) and a petition (which lists the plaintiff versus the defendant). A lawsuit will also include the allegations made against you. Once you are served with a citation and petition, TMLT has a limited time to respond by retaining a defense attorney to file an answer on your behalf.

If you receive any of the above items, contact the TMLT Claims Department at 800-580-8658 as soon as possible. You can also start the claim reporting process through myPortal (log in required.) We may have limited time to investigate and evaluate the claim. Any delay in reporting could compromise your defense.

If you are reporting a Medefense or Cyber Liability, claim you must report it to TMLT no later than 60 days from the date you became aware of the claim.

Although not considered a "claim" that would trigger coverage under your policy, you may want to report the following situations to seek advice to possibly prevent the matter from evolving into a claim:

Unexpected outcome — any complication or failure of treatment in which the patient or a patient's family member may have expressed disappointment with the outcome or if you suspect that a claim may be asserted in the future.


Records request — a request for a patient's medical records may come from the patient, the patient's spouse, an attorney, a record service, or from a court reporting service in the form of a subpoena. Requests for records should include an authorization signed by the patient or by the patient's legal representative. It is best to respond to a request as soon as possible. If you suspect that the records request is for potential or ongoing litigation, or if you question the validity of the records request, you should contact TMLT for advice.


Request for deposition — a deposition is testimony given under oath before a court reporter. You may be served a subpoena for oral deposition, or an attorney may contact you directly. If you are asked to give testimony regarding a patient, particularly if that patient is suing another health care professional, please contact the TMLT Claim Operations Department immediately. Depositions can potentially become claims and you should be properly represented at any such proceeding.

Report the claim to TMLT by calling 800-580-8658. You can also start the claim reporting process through myPortal (log in required.) Please allow about 20 minutes for the report and have whatever notice you received available for reference. It may also be helpful to have the patient's medical record available.

Fax to 512-328-8067 or send by overnight mail a copy of the notice of claim letter or the lawsuit. Do not fax your medical records. Note that if you are served with a lawsuit, your TMLT policy requires as a condition of coverage that all such lawsuit papers be delivered to TMLT within 10 days of service or receipt of the lawsuit papers, and that you must obtain a delivery receipt from TMLT.

"Delivery of lawsuit papers means sending by certified mail with return receipt requested, personal delivery, messenger, or electronic transmission. Proof of delivery of the lawsuit papers, however, may only be established by the obtaining a written receipt of such delivery from the Trust."

Gather a complete and unaltered copy of all pertinent medical records, including a copy of the hospital chart and any prior or subsequent treatment records. Mail a copy of these records to TMLT as soon as possible.

Once a notice of claim is reported, the loss is assigned to a claim supervisor and coverage is entered and verified. Once the claim file is set up in our system, the following occurs:

• A letter is sent to the policyholder requesting a copy of all medical records regarding the physician's care of this patient.

• A response letter is sent to the plaintiff's attorney or pro-se plaintiff requesting specific allegations, damage nformation, and a medical authorization that when signed by the patient, allows us to request the pertinent medical records;

• If the new loss is a lawsuit, the Texas Medical Board (TMB) is notified;

• If a lawsuit has already been filed, then we dispense with the response letter to the plaintiff's attorney. We assign a defense attorney to answer the lawsuit and defend the physician. The policyholder receives a letter from the claim supervisor advising of the attorney assignment.

The average time to complete this from the day the loss is reported is about 5-10 working days.

Do not discuss the case with anyone except a TMLT claims representative or the attorney assigned to defend you.

Maintain your original medical records in a secure place for future reference. Do not make any additions, deletions, or any other type of alteration to the medical records. Secure any other pertinent information or items in your possession, such as billing records, x-rays, hospital charts, etc.

All correspondence to and from TMLT and your assigned attorney should be kept in a separate and secure file. These items should not be co-mingled with the original medical chart on the patient. Do not release these materials to anyone unless cleared through your assigned attorney or the TMLT Claims Operations Department.

The TMLT claims representative assigned to your case will keep you fully informed as the case proceeds, both directly and through your assigned attorney. If you have questions, do not hesitate to call your claim supervisor.

Most health care professionals — including nurses, nurse midwives, advanced practice nurses, CRNAs, physician assistants, physicians, dentists, and podiatrists — are required to have malpractice insurance, either as a part of their employment or to maintain privileges or payer contracts.

You can request a quote from the TMLT website or you can contact a sales representative by calling 800-580-8658. You can also email sales@tmlt.org.

You can apply for coverage using our online application. A representative from TMLT will contact you once your application has been received.

TMLT was created by the Texas legislature in 1979 to provide medical liability coverage for physician members of the Texas Medical Association. The legislation that created TMLT included the provision that policyholders must be members of the TMA. Therefore, by law, policyholders must also be members of the TMA.

The average time to process an application is approximately 10 business days. Please make sure that your application is filled out completely, as incomplete information may delay the underwriting process.

For coverage to begin, we must have confirmation of pending TMA membership and your completed application underwritten and approved. You must also provide a current CV and proof of any previous or current medical liability coverage.

TMLT policies do not cover ancillary staff. However, if the physician is named in a claim or a lawsuit due to the actions of a staff member for whom the physician may be considered "legally responsible," coverage may be provided for the physician. Please be aware that coverage for a claim is ultimately determined after a thorough investigation by the TMLT Claims Operations Department.

Ancillary staff working with TMLT policyholders can obtain medical liability coverage through Texas Medical Insurance Company, our subsidiary.

Yes, all TMLT policies include coverage for your administrative activities as a medical director. This coverage is at a sublimit of $100,000 of your existing policy limit. You may contact TMLT at 800-580-8658 to decline this coverage.

Your insurance premium is based on your location, specialty, procedures performed, the limits of liability that you choose, the number of years of you've been in practice, and your claims experience.

We cannot advise you about what limits to carry, but we recommend that you speak with colleagues who practice in your specialty and location to see what limits of liability they carry. You may also contact your local county medical society; often their legal counsel is available to advise you. Your personal financial advisor may also have recommendations in consideration of your personal assets.

Lone Star Alliance is a risk retention group and an affiliated company of TMLT. It was established to provide medical liability and similar types of insurance to physicians, groups, health care facilities, and health care professionals in multiple states. Lone Star can meet the needs of TMLT's new and existing policyholders by writing insurance for those who have operations in states other than Texas.

Lone Star is domiciled in Washington DC and began writing business in December 2013.

An RRG is an alternative insurance entity created by the federal Liability Risk Retention Act (LRRA). RRGs must form as liability insurance companies under the laws of at least one state — its charter state or domicile. The policyholders of the RRG are also its owners. Membership must be limited to organizations or persons engaged in similar businesses or activities, thus being exposed to the same types of liability.

No. While LSA is affiliated with TMLT, as an RRG it is owned by its policyholders. TMLT — directly and through its subsidiaries — provides LSA with all essential operational support. Such support includes financial and accounting services, information technology, underwriting, sales, marketing, claims handling, and risk management functions. These services are provided according to a management services agreement.

Lone Star is domiciled in Washington DC, but our office is located in Austin, Texas.

Lone Star offers a full range of medical liability coverage options for individual and physician groups, and allied health care professionals. We offer claims-made (including prior acts or “nose coverage”) and occurrence policies at a variety of limits. Per-patient rated policies and shared-limit policies are also available. Policies include cyber liability protection, regulatory actions protection, medical director coverage, and employment practices liability insurance. View policy options.

Any physician, group practice, allied health care professional, or health care entity located outside of Texas can apply for coverage with Lone Star.

If a practice located in multiple states applies for coverage, the Texas-based physicians may be insured through TMLT and the physicians based outside of Texas will be insured through Lone Star.

Please contact your agent or a Lone Star representative at sales@lonestara.com or call 512-425-5890.

No. TMA membership does not apply to Lone Star Alliance. TMA membership remains a requirement for coverage with TMLT.

Because we will need information about your new practice, we will ask you to complete a short application. Please contact your underwriter at 800-580-8658.

The Lone Star policy mirrors the TMLT policy with the exception of state-specific requirements. Lone Star policies are flexible and specific policy needs can be modified or endorsed.

TMLT Trust Rewards cannot be extended to Lone Star Alliance policyholders.

Because Lone Star policyholders are not eligible for the TMLT Trust Rewards program, you will not receive additional Trust Rewards allocations while you are insured with Lone Star. However, your existing Trust Rewards balance will remain intact while you are with Lone Star and you will be eligible for payout distributions pursuant to qualifying events.

Lone Star does not have a dividend program at this time.

Lone Star rewards physicians for their patient safety efforts. The following premium discount opportunities are available in most states.

• discounts for favorable claim experience
• group purchasing credits
• discounts for risk management participation
• discounts for new-to-practice physicians
• part-time discounts
• discounts for completing a Lone Star CME course (up to 5 percent for two courses)

Through our Risk Management Department, Lone Star offers home-study programs and online courses to help reduce liability risk. Courses are available at the Lone Star CME site.

No. You must take a Lone Star CME course to earn the discount. Courses are available at the Lone Star CME site.

No. Your TMLT practice review discount will not apply to your Lone Star policy.

According to IMB Rule 166.2, C Texas physicians are required to complete 48 hours of credit every 24 months. At least 24 credits must be from formal courses designated as AMA/PRA Category 1. At least two of the 24 formal credits must involve the study of medical ethics. The remaining 24 credits may comprise informal self-study, attendance at hospital lectures, grand rounds, or case conferences not approved for formal CME.

TMLT policyholders who complete a 2-hour risk management CME activity may be eligible for a 3% premium discount. The discount will be applied to your next eligible policy period. Two 2-hour courses can be taken per policy period for a maximum 6% discount. Multiple 1-hour courses cannot be combined for the discount.

We offer online CME courses and CME in Volume 4 of our publication, the Reporter. You can also attend one of our seminars or a seminar that we co-sponsor with the Texas Medical Association. View a complete listing of all IMLT CME courses.

TMLT policyholders can take two 2-hour courses per policy period for a maximum CME discount of 6%. The courses must be completed prior to your policy renewal date.

Yes. You can carry over up to two courses per year.

If you have previously completed a TMLT online course and you do not have your user name and password, please go to our online CME login page. Click "sign in" in the upper right corner and click "I forgot my password." If you have not completed a TMLT online CME course, please go to our online CME login page and click "New User Registration — Individual." You will need to enter your TMLT policy number and your medical license number. Once you enter this information, you will receive a welcome email with a link to activate your account. Once activated, you may log in with the username and password you set up during registration. Detailed CME instructions, including how to create an account, access our online, discount-eligible CME courses, make payments, and download materials, are available here.

You can reprint a certificate from any online TMLT CME course by going to our online CME login page and clicking "My Courses" and selecting the course. Click the orange "Take Test/Get Certificate" button to print your certificate. See also detailed instructions for printing IMIT certificates.

If you attended a live seminar and need a copy of your certificate, please contact the risk management department and a copy of your certificate will be emailed to you.

Please contact the risk management department for a course transcript, or go to our online CME login page and click "My Courses" or log in to myPortal and click "See more" on the CME Overview pod to. view your TMLT CME credit for the last three years.

During a practice review, a risk management professional will visit your practice to help determine your risk exposures. Before the scheduled review date, questionnaires will be emailed to you. The representative will then review approximately 10 medical records for each physician in the practice. He/she will also review your practice's policy and procedure manual, take a quick tour of the office, and conclude the review with a wrap-up discussion with the physician(s).

The time for a review varies depending on the size of your practice. Plan on a representative being in the office for several hours. However, the majority of the representative's time will be spent reviewing medical records, and he/she will not require time from anyone in your office.

Physicians are encouraged to continue their regular schedule during the review. Once the risk management representative has completed the review, he/she will need to spend approximately 45 to 60 minutes with the physician(s) to discuss general risk management concerns and any specific recommendations. This meeting will be arranged when the practice review is scheduled.

No. TMLT has a HIPAA business associate's agreement on file with all of our policyholders. This allows us to review the medical records under HIPAA guidelines. No patient information will be removed from the practice.

When a practice review is requested for a group, it is recommended that all TMLT-insured physicians agree to be included before scheduling the review.

Yes. Practice reviews are free to all TMLT policyholders. However, if a physician who is not insured by TMLT would like to request a practice review, that physician can contact the TMIT Risk Management Department for information regarding the fees for a review.

Yes. TMLT can conduct practice reviews for physicians in all specialties and practice types.

Once the physician has adequately responded in writing to any recommendations made during the review, the 596 practice review discount is effective for the remainder of the current policy period plus an additional two full policy periods, as long as the physician is continuously insured with TMLT.

Typically, risk management representatives are out of the office conducting practice reviews 2 to 3 days per week. Therefore, it may take up to 2 weeks for a representative to contact you and schedule the review.

The idea behind the program is to reward physicians for their loyalty and to encourage them to remain TMLT policyholders.

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All full-time and part-time individual physicians who are insured by TMLT under an individual or group policy are eligible.

No. You are not eligible.

Yes. All eligible physicians are automatically enrolled in the program upon obtaining coverage through TMLT.

You forfeit the balance in your Trust Rewards account.

Yes. You can be enrolled again, but the funds accumulated in the past were forfeited when you terminated your previous coverage, unless your account is in a suspended status. If you previously retired and received disbursement of your Trust Rewards account, you will not be eligible to enroll again.

Your account may be placed in suspended status should you cancel your policy or cease coverage through TMLT. An account can remain in suspended status for up to 60 months so long as you do not obtain coverage from an unaffiliated insurer. Upon obtaining coverage through an unaffiliated insurer, or should you not return to being insured with TMLT or an affiliate before the end of the 60 month suspension period, your Trust Rewards account balance will be forfeited.

As long as you remain insured with an affiliated insurer, including Lone Star Alliance, and are otherwise eligible to participate, you will not forfeit your accumulated Trust Rewards balance. However, your balance will not grow if you are not insured by TMLT.

The program is designed to benefit the individual physician. Your balance can grow regardless of who pays the premium. However, you can designate the group to be the recipient of the program in case of your qualified retirement, disability, or death.

You are eligible for distribution of your Trust Rewards benefits upon your qualified retirement, disability, or death. We must be notified if a qualifying event occurs and receive proper documentation.

A qualified retirement is the complete and permanent withdrawal from the practice of medicine by an enrolled physician if, at the time of such retirement, the Participant (1) holds a medical license in good standing with the Texas Medical Board, (2) is 50 years of age or older, and (3) has been insured continuously with TMLT for at least three consecutive years immediately preceding retirement.

Disability means that the individual insured physician of TMLT: (1) is unable to practice medicine in his or her trained specialty due to a medically determinable physical or mental impairment; and (2) is under a physician’s care for such impairment and it is expected to be permanent or is expected to last for a continuous period of not less than 12 months.

In case of your death, the funds become part of your estate, unless you have completed the optional group designation form. You can designate your beneficiaries when planning your estate settlement.

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Enrolled physicians, group administrators, and agents can view current Trust Rewards balances for active accounts on myPortal, our member portal. If you do not have a myPortal account, you can sign up here by following the on-screen instructions. If you need assistance, please contact the TMLT Customer Service team or call 800-580-8658 ext. 5050.

No. Any funds made available for the benefit of a Trust Rewards account shall be unrestricted surplus of TMLT until and unless distributed to the participant and, as such, remain available to TMLT for the satisfaction of policyholder obligations and general creditors. No participant shall have any individual claim to any funds made available for the benefit of a Trust Rewards account until and unless such funds are distributed to the participant. All disbursements are subject to board approval.

Yes. However, TMLT seldom non-renews policies and the decision to non-renew is made by our Underwriting Committee, which consists entirely of physicians.

Your account will only be affected if you are non-renewed or your policy is subject to a surcharge due to poor loss history. New allocations are suspended during the time your policy is surcharged, but you will not forfeit your existing balance.

The program is structured to avoid tax liability until the funds are distributed to you.

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No, when you receive the funds, it is your responsibility to meet your tax obligations.

We will issue a 1099-MISC for the year in which the balance was distributed. Please consult your tax advisor regarding the distribution.

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The plan document is available here.

No.

No. The Program is designed for physicians only.

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Contact the TMLT Customer Service team or call 512-425-5050.