Frequently Asked Questions

What is TMLT?

• 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.

What is an insurance trust?

• 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.

What are your business hours?

• Our business hours are Monday through Friday, from 8 a.m. and 5 p.m. (central standard time)

Where are you located?

• TMLT headquarters is located at 901 S. Mopac Expressway, Building 5, Suite 500, Austin, Texas  78746

Why is TMLT no longer collecting surplus?

• When TMLT was formed, policyholders were required to make a "contribution to surplus." This amount provided capital for the company to operate and to be in compliance with financial guidelines of the Texas Department of Insurance.
• At this time, TMLT has accumulated sufficient surplus to meet all statutory requirements and to be assigned an "A" rating by AM Best. This rating stands for having "an excellent ability to meet our ongoing obligations to policyholders." Therefore, it is not necessary for TMLT to collect surplus.

What premium payment plans are available?

• 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.

How do I pay my premium?

• Pay online at our policyholder site, myPortal. You can set up recurring automatic payments or make a one-time payment.
• You can also mail payments to:
  • Bank of America Attn: 5th floor, Lockbox 847512 1401 Elm Street Dallas, TX 75201

Where can I find my account information?

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

How many hours of CME do I need per year?

• According to TMB Rule 166.2, Texas physicians are required to complete 48 hours of credit every 24 months. At least 24 credits must be from formal courses designated as Category I. 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.

How much is the CME discount and when will it apply?

• TMLT and TMIC 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. Please note: multiple 1-hour courses cannot be combined for the discount.

What CME courses can I take to receive the risk management discount?

• We offer online CME, Case Closed publications, 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 TMLT CME courses.

How many risk management courses can I take per policy period to be eligible for the TMLT risk management discount?

• TMLT policyholders can take two 2-hour courses per policy period.

What if I take more than two risk management courses? Can I carry them over to the next policy period for the risk management discount?

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

What is my policy period?

• Your policy period is listed on your current policy declarations page.

I am trying to complete an online CME course and it is asking for a user name and password.

• If you have previously completed a TMLT online CME course and you do not have your user name and password, please go to our online CME login page.  Click "log in" in the upper right corner and click "I forgot my password."
• If you have not completed a TMLT online 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. 

I completed a TMLT course and cannot find my certificate.

• You can reprint a certificate from any online 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. If you attended a live seminar and need a copy of your certificate, please contact the risk management department and a duplicate copy of your certificate will be emailed to you.

I think I have taken all the online courses available. Can you check and see if there is something I have not taken?

• 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 select "CME history" from the Quick Links menu on the right.

What happens during a practice review?

• 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).

How long will the practice review take?

• 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.

Does the physician have to be present during the practice review?

• 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.

Do I need to de-identify patient information in the medical records that will be reviewed during a practice review?

• 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.

Can one physician in a group request a practice review if the other physicians do not wish to participate?

• 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.

Can a physician who is not a TMLT policyholder request a practice 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 TMLT Risk Management Department for information regarding the fees for a review.

Can a hospital-based physician (hospitalist, radiologist, pathologist, anesthesiologist, emergency medicine physician) request a practice review?

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

How long will the practice review premium discount remain in effect?

• Once the physician has adequately responded in writing to any recommendations made during the review, the 5% 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.

How long will it take before I hear from someone about scheduling the review?

• 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 before a representative contacts you to schedule the review.

Do I need cyber liability insurance if my practice is proactive about Internet security and safeguarding ePHI?

• There is no "fail safe" cyber security per se. The level of sophistication and persistence of hackers today is remarkable. They are constantly probing for any weakness in systems or people. Even well defended organizations can experience a data breach from employees who run malicious code or attempt to gain unauthorized access to a network. It’s all about likelihood, vulnerabilities, and impact. Data breaches can arise from many sources, including:
  • hackers gaining access through a malicious malware or phishing attack;
  • lost or stolen unencrypted mobile storage devices;
  • employee negligence or malfeasance; and
  • lack of internal policies and/or system failures.
• Health care records contain sensitive and valuable information for medical identity theft. A cyber criminal can get $50 or more for a complete medical record. Two common objections we hear from medical practices are "A data breach won’t happen to us. We’re too small" or "Our data is 100% secure." Yet, you can have the best cyber security and still have a data breach. For example, an employee inadvertently gave out his password, as described in The Current State of CyberCrime 2014.

What about the cost of cyber liability insurance?

• Cyber insurance plays a vital role in financing and managing cyber risks. Simply completing the insurance application can be a "mini risk assessment." Doing so can lead to a better understanding of your cyber security risks. Data breaches and their potential financial impact are often under-appreciated.
• Direct costs of a data breach can include legal expenses for breach notifications or to defend third-party lawsuits; IT forensics for data restoration; public relations; credit monitoring services; call center support; and potential regulatory fines and penalties. The indirect costs can include a loss of revenue; loss of patient good will and reputation (from adverse media reports); and the loss of employee and business productivity.
• For health care providers, most medical professional liability policies include some level of cyber liability coverage. The limits of liability are typically in the range of $25,000 to $100,000 per claim and in the aggregate. However, in certain data breach incidents, the costs of a breach can quickly exceed these underlying limits. Therefore, it’s very important for any organization who suspects a data breach to call their professional liability or cyber liability carrier immediately to report the incident. Each breach requires a specific response and there are required reporting timelines.
• Because the total cost of a data breach can be significant, we recommend organizations maintain high limits of liability ($1 million or above per claim and in the aggregate). This is important because if the organization's underlying cyber liability limits are exhausted to pay the costs of a data breach, all further investigation, defense, and remediation expenses will fall to the organization. Because an Office of Civil Rights (OCR) investigation can linger, the organization may not know for several years if any fines or penalties will be imposed.

Can you give an example of a cyber claim?

• TMLT policyholders have reported more than 430 breach incidents since we added cyber liability coverage to our policies in December 2011. One policyholder received an investigation letter from the OCR because the practice’s office computers, including an unencrypted laptop, had been stolen. Office staff were unable to access patient electronic records during appointments and (allegedly) failed to notify patients of the breach of their protected health information (PHI). The OCR also requested a matrix of other documentation, including a copy of the policyholder’s most recent security risk assessment. Their TMLT cyber liability coverage paid for their breach-related expenses.

What does a cyber risk insurance policy typically cover?

• There is no uniformity of cyber liability coverage forms. The majority of cyber liability insurance policies include coverage for both first-party and third-party losses, although some coverage forms may lack important protection, such as for cyber extortion/ransomware or regulatory fines and penalties.
  • First-party coverage typically includes coverage to restore or recover the policyholder’s lost or damaged computer programs and data; for breach response services for patient notifications and credit monitoring expenses; for crisis management and public/media relations; for cyber extortion and cyber terrorism; and for cyber crime/financial fraud. Some cyber liability policies also include first-party coverage for the loss of revenue and extra expenses due to a business interruption.
  • Third-party coverage typically includes coverage to defend and indemnify liability claims related to security and privacy breaches resulting in the disclosure of confidential information; for regulatory investigations and fines and penalties; and for claims related to media liability alleging personal injury or invasion of privacy. Some policies also include coverage for errors and omissions.

What is excluded from a cyber liability policy?

• Common exclusions include no coverage for unencrypted data on mobile devices; bodily injury; criminal acts (there’s usually an exception for innocent parties); or, in some policies, the insured’s failure to maintain the security of its network in accordance with industry standards, internal policies, and/or regulations.
• Some providers also provided fee-based technology services to other practices. Losses arising from this type of professional service are typically not covered by cyber liability policies. If the practice provides technology services to others such as hosting, managing or administering someone else’s computer systems and data or designing, programming, installing, servicing, and supporting others’ IT infrastructure—they need to also purchase technology errors and omissions coverage.

How is the cost of a cyber liability insurance policy typically calculated?

• In most cases, the rating factors are the number of personally identifiable records stored electronically and in paper files; the estimated annual gross revenue; or the number of physicians, as well as the limits of liability and any optional endorsements desired by the insured.
• Key to the acceptability and affordability of coverage is the "security posture" of the organization. If the organization answers "No" to essential underwriting questions such as: "Do you enforce a security policy that must be followed by all employees, contractors, or any other person with access to your network?" or "Does your security and privacy policy include mandatory training for all employees?" or "Is all data in transit or stored on mobile devices encrypted and remote access to your network authenticated?" then coverage may be declined or a higher premium charged.

What should we consider before buying cyber risk insurance?

• Cyber insurance is not a substitute for a good cyber security program, as not all losses can be covered by insurance. The benefits of an effective cyber risk management program and disaster recovery plan include prevention of cyber losses; preservation of electronic data; continuity of business with minimal loss of productivity; fulfillment of service commitments to patients; compliance with state and federal privacy and security laws; and protection of the practice’s reputation.
• Many smaller organizations who handle electronic protected health information (ePHI) mistakenly believe that HIPAA's required Security Risk Analysis is optional for them. They may also believe that installing an EHR fulfills the risk analysis requirement for meaningful use, or that the EHR vendor "took care of privacy and security." These assumptions are incorrect. All covered entities subject to the HIPAA Security Rule must conduct a risk assessment of their administrative, physical, and technical safeguards, as well as their compliance with HIPAA's privacy rule and Breach Notification Rule, including up-to-date policies and procedures. In most cases, this includes the following steps:
  • establish an enterprise-wide security culture;
  • encrypt data on mobile and storage devices;
  • back up data in real-time and store it offline;
  • use firewalls;
  • immediately install software updates/patches;
  • use strong passwords and change them regularly;
  • use two-factor authentication;
  • limit network and physical access to sensitive data;
  • obtain business associate agreements from all service providers who have access to the practice’s data; and
  • select your service providers carefully — and assess their data security to ensure they are HIPAA compliant.
• Lost or stolen laptops and mobile storage devices containing the ePHI of patients is a recurring problem. ePHI is being stored more frequently on portable devices, and there will be more breaches involving these devices. Mitigating that risk by encrypting the data would significantly reduce the likelihood of breach claims. Indeed, encryption must become a higher priority throughout the health care industry, and it will also help an organization maintain insurability and perhaps obtain a lower price for cyber insurance.
• Complacency is not a risk management strategy. An Incident Response Plan to address cyber risks is good for the business side of your organization. Clients expect their sensitive personal information to be secure; it protects the organization's reputation; and it avoids downtime and the potential loss of income and extra expenses. Guarding against cyber threats requires a multi-layered, proactive risk management strategy that is focused on identifying, assessing, and responding to potential risks. And that requires leadership to actively promote policies and procedures, best practices, risk controls, accountability, and privacy training.
• Today there are many external resources available to assist your organization with its IT systems, risk assessments, and privacy training. TMLT offers cyber security tools and resources to help policyholders and non-policyholders prepare for and to mitigate breach incidents. Organizations often need external assistance with their cyber risk management, as cyber attacks continue to grow in sophistication and frequency.

Why is contract due diligence so important?

• Contractual risk transfer is common today and is increasingly imposed upon health care entities that handle sensitive personal information. The need for careful contract review is vital—particularly in the area of liability assumed under contract, in the form of a written hold-harmless or indemnity agreement.
• Attempts to contractually transfer all or part of the financial consequences of a loss to another party (who is not an insurer) occurs in a myriad of contracts, including website privacy statements, company privacy policies, and third party services contracts (e.g., with cloud service providers), and Merchant Service Agreements.
• It is imperative that organizations also review these contracts for any insurance requirements. Signing contracts without due consideration of whether you have applicable cyber liability or professional liability coverage could put your organization at financial risk.
• Insurance is a form of risk financing and depending upon the coverage provisions, it may (or may not) provide the funding of some liabilities/indemnities assumed under contract. If there are any specified insurance requirements, you should try to obtain coverage that "dovetails" with the indemnity obligations, if possible.

What is considered a claim and what am I required to report?

• Your policy requires you to notify TMLT as soon as reasonably possible if you receive 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.
• In the event of a claim, it is essential that you contact the TMLT Claims Operations Department as soon as possible. In many cases, we will 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 "claims" that trigger coverage under your policy, you may want to report these situations and seek advice to possibly prevent the matter from evolving into a future 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.

How do I report a claim?

• If you have received a notice of claim, a lawsuit, a medical records request, or a request for deposition, you should:
  1. Report the claim to TMLT by calling 800-580-8658. 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.
  2. 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.”
  3. 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.

I have reported a claim. What happens next?

• 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 information, 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 called in 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.
  1. 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.
  2. 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.
  3. 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.

What is Lone Star Alliance, RRG?

• 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.

What is a risk retention group (RRG)?

• 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.

Does TMLT own Lone Star Alliance?

• 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.

Where is Lone Star Alliance located?

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

What kind of policies does Lone Star offer?

• 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.

Who can apply for coverage?

• 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.

How do I obtain a quote?

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

How do I apply for coverage?

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

Do I have to become a member of the Texas Medical Association to purchase coverage with Lone Star?

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

How do I continue coverage if I decide to leave Texas? Do I have to re-apply for coverage in Lone Star?

• 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.

What is the difference between Lone Star coverage and TMLT coverage?

• 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.

Do I qualify for Trust Rewards in Lone Star?

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

What happens to my Trust Rewards balance if I move to Lone Star?

• 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.

Will I receive a dividend through Lone Star?

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

What discounts are available through Lone Star?

• 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)

Does Lone Star offer CME?

• 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.

Can I take a TMLT CME course and receive a discount for Lone Star?

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

Can I apply my TMLT practice review discount to my Lone Star policy?

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

Does Lone Star claims philosophy align with TMLT's claim philosophy?

• Yes. Each claim is aggressively defended and we do not settle non-meritorious lawsuits. If a case requires a compromise settlement, our experienced claims staff negotiates to obtain the best possible result. Additionally, TMLT/Lone Star only hires experienced, specialized, medical malpractice defense attorneys to represent our policyholders.

How do I obtain a quote?

• You can request a quote from the TMLT web site or you can contact a sales representative by calling 800-580-8658. You can also email sales.

How do I apply for coverage?

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

Why do I have to be a member of Texas Medical Association to purchase TMLT coverage?

• 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.

How long does it take to process an application?

• 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.

When is coverage effective?

• 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.

Are my ancillary staff (nurses, medical assistants, technicians) covered under my TMLT medical liability policy?

• 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.

Does my TMLT policy cover me for my activities as a medical director?

• 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.

How is my premium determined?

• Premium is based on geographic location, specialty, procedures performed, limits of liability, number of years of exposure covered, and claims experience.

What are limits of coverage?

• Limits of coverage spell out the maximum amounts your policy will pay. In professional liability policies, there are typically two limits. One limit states the maximum per claim, while the second limit spells out the maximum amount that will be paid during the policy period. The first limit is called an "each claim" limit and the second one is called an "all claims" limit.

How much coverage is right for me? What limits of liability do you recommend?

• 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.

What is a declarations page?

• The declarations page is the first page of the insurance policy that contains information specific to the policyholder. The declarations page contains the policyholder's name, address, specialty, limits of liability, premium amount, policy effective date, endorsements, etc.

What is an endorsement?

• An endorsement is a document that changes the terms of the insurance policy.

What is vicarious liability?

• Vicarious liability is when a policyholder can be held legally responsible for the actions of another person. Typically in medical liability claims, physicians can be found vicariously liable for the actions of nurses, medical assistants, employed physicians, or other people for whom they are legally responsible.

What does claims frequency mean?

• Claim frequency refers to the number of claims filed. Claim frequency is one factor used to determine insurance premiums.

What is claim severity?

• Claim severity refers to the dollar value of a claim as determined by a jury verdict or settlement agreement. Claim severity is another factor used to determine insurance premiums.

What is reinsurance?

• Reinsurance is a transfer of risk by one insurance company (the insurer) to another (the reinsurer).

What are reserves?

• Reserves are funds set aside by insurance companies to pay estimated future losses. A company's claim department typically specifies a reserve amount for every claim filed, which can be modified as the claim proceeds to resolution.

What does claims-made mean?

• A claims-made policy is designed to protect you during the active policy period, usually one year. If you do not renew your claims-made policy when it expires, you no longer have coverage for any claims that may arise in the future that are alleged to have occurred during the time your policy was in force.
• Physicians who wish to continue coverage under a claims-made policy must purchase supplemental coverage, such as tail coverage or prior acts coverage. If neither tail coverage nor prior acts coverage are purchased when a claims-made policy expires, any future claims that might arise from services performed during the policy period will not be covered.

What is an occurrence policy?

• An occurrence policy provides ongoing insurance protection for events that occur during the policy period, even if they are reported after the policy is cancelled.
• Occurrence policies are generally more expensive, but it is not necessary to buy supplemental coverage like tail or prior acts coverage after an occurrence policy expires.

What is prior acts coverage?

• A supplement to a claims-made policy, prior acts coverage is purchased from a new carrier when you change insurance companies. This coverage, also known as nose coverage, covers claims from unknown incidents that occurred before the beginning of your new policy. Prior acts coverage is an alternative to tail coverage, which is purchased from the original carrier when a change in insurance companies is made.
• Companies typically require new policyholders to purchase either prior acts from them, or tail coverage from their prior carrier, to protect against claims arising from prior acts.

What is tail coverage?

• Tail coverage, also called a reporting endorsement, is available for purchase when your claims-made policy is cancelled or non-renewed. Tail coverage continues insurance protection under your claims-made policy for claims reported in the future but arising from incidents that occurred while your policy was in force. Tail coverage payment is due within 60 days of policy cancellation.
• TMLT offers free tail coverage to physicians who:
  • are 50 years of age or older;
  • have been continuously insured with TMLT for 5 years or more on a claims-made policy; and
  • the cancellation of the policy is due to retirement from the practice of medicine.
• In addition, TMLT waives the tail premium at any time if the physician should stop practicing due to medical disability or death.

What is per-patient based coverage?

• Per-patient based coverage is designed for emergency physicians and urgent care groups, as well as other groups that are structured on a per-encounter basis.
• This type of coverage is more cost effective because pricing is based on the number of visits rather than rated on the number of physicians in the group.

What is cyber liability coverage?

• Cyber liability coverage provides coverage for privacy-related claims that occur as a result of lost laptops, theft of hardware or data, improper disposal of medical records, hacking or virus attacks, and disgruntled employees.
• Cyber liability coverage is included with all TMLT policies.

What is Medefense coverage?

• Medefense covers legal expenses, fines, and penalties arising out of medical board and other disciplinary proceedings.
• Medefense coverage is included with all TMLT policies.

What is employment practices liability EPLI coverage?

• EPLI covers claims that arise from alleged wrongful employment practices, such as discrimination, harassment, and retaliation.
• EPLI coverage is included with all TMLT policies.

What coverage is available for my entity?

• Entities, which are defined as an incorporated formation of two or more shareholder physicians practicing under the group's "DBA" name, are eligible for a separate entity policy. The policy provides defense and indemnity coverage when the entity is held legally responsible for the actions of the member physicians. Physicians that are incorporated as a Solo Professional Association or Solo PLLC are provided coverage under their Individual policy on a shared-limit basis.

What does assessable mean?

• Some policies will ask that you pay an assessment in addition to the yearly premiums. Assessments can occur if a company experiences higher claims costs than anticipated. In some cases, assessments can be as much as the full premium. All TMLT medical liability policies are non-assessable.

What is general liability insurance?

• General liability insurance refers to a type of business liability insurance other than automobile, workers' compensation, or employer's liability that covers property damage or bodily injury. In a health care setting, general liability insurance would cover such incidents as a visitor slipping on a wet floor of a hospital or office.