Informe Estadístico Sobre el Seguro de Responsabilidad Profesional Medico-Hospitalario en Puerto Rico

ESTADO LIBRE ASOCIADO DE PUERTO RICO OFICINA DEL COMISIONADO DE SEGUROS 20 de diciembre de 2013 # CARTA NORMATIVA NÚMERO: CN-2013-166-AF A TODOS LOS ASEGURADORES AUTORIZADOS A TRAMITAR SEGUROS DE PROPIEDAD Y CONTINGENCIA EN PUERTO RICO # INFORME ESTADÍSTICO SOBRE EL SEGURO DE RESPONSABILIDAD PROFESIONAL MEDICO-HOSPITALARIO EN PUERTO RICO Estimados señores y señoras: De conformidad con lo dispuesto en la Carta Circular AE-I-5-1123-88 de 15 de noviembre de 1988, enmendada por la Carta Circular AM-I-1-1216-91 de 8 de febrero de 1991, todo asegurador que esté tramitando el seguro de responsabilidad profesional médico-hospitalario o haya tramitado el mismo en el pasado, debe presentar semestralmente ante esta Oficina, el informe estadístico sobre el seguro de responsabilidad profesional médico-hospitalario y copia de las resoluciones judiciales, adjudicaciones y transacciones judiciales y extrajudiciales. El informe deberá ser presentado en o antes del último día del mes siguiente a la terminación del semestre al que corresponda el informe. La presentación debe incluir: 1. Los informes semestrales se presentaran en original, tres copias electronas en un CD utilizing Microsoft Excel 97-2003. 2. Cada copia de los informes semestrales se presentaran en un CD分开ados para ser remitidos a las entidades correspondientes. 3. Los informes deben presentarse en las formas previstas por esta Oficina. Todos los aseguradores deben llenar los cinco (5) formularios incluidos. El formulario AM-I-12 (Ed 11-13) es un informe de sintesis de la informacion contenta en los formularios AM-I-9 (Ed 11-13), AM-I-10 (Ed 11-13) y AM-I-11 (Ed 11-13). El formulario I-AM-10 ADD (Ed 11-13) es un suplemento para la forma AM-I-10 (Ed 11-13). El numero de reclamaciones reportado en la Forma AM -I- 10 ADD (Ed 11-13) deben ser identicos a los reportados en el Formulario I-AM-10 (Ed 11-13). Se deben proveer datos para cada reclamacion cerrada, ya sea con o sin pago. B5 Calle Tabonuco Suite 216 • PMB 356 • Guaynabo, PR 00968-3029 • Tel: (787) 304-8686 • Fax: (787) 273-6082 www.ocs.gobierno.pr 2 4. Los cinco formularios que componen el informe son las reclamaciones de responsabilidad del hospital separado de médicos, cirujanos y dentistas. Favor de indicar con una marca de verificación en el encabezado de cada formulario si el informe corresponde a reclamaciones de los médicos, cirujanos y dentistas, o a reclamaciones de responsabilidad del hospital. 5. Si no hay transacciones que informar, el formulario debe contener lo siguiente: "Ninguna reclamación informada" o "No hay reclamación pendiente" o "No hubo reclamaciones cerradas", según sea el caso. 6. Los aseguradores que manejan pocas reclamaciones favor de utilizar la página del formulario que prevé para la firma de un funcionario autorizado. 7. Los aseguradores que manejan muchas reclamaciones pueden utilizar una o más copias del formulario y una copia de página del formulario que prevé para la firma de un funcionario autorizado. En dicho caso las páginas deben estar enumeradas. 8. Las reclamaciones a ser incluidas en el informe debe ser solamente las reclamaciones cuyo demandado posee una cubierta de seguros de responsabilidad profesional médico-hospitalaria con el Asegurador. 9. Bajo los formularios AM-I-9 (Ed 11-13), AM-I-10 (Ed 11-13) y AM-I-11 (Ed 11-13), los totales deben ser provisto en la última página. Esto incluye el número total de Reclamaciones, Monto de la Reserva y la Cantidad Reclamada. El Formulario AM-1-10 (Ed 11-13) debe incluir el total de la Cantidad Pagada, tanto para pérdidas económicas y no económicas. 10. La evidencia a ser incluida con las reclamaciones cerradas deberá ser identificadas con el número de reclamación según fueron listados en el formulario AM-I-11 (Ed. 11-13). Todo informe provisto en una forma o formato diferente a los aquí requeridos, será considerado por esta Oficina como no presentado. Se requiere, por la presente, estricto cumplimiento con las disposiciones de esta Carta Normativa. Cordialmente, Angela Weyne-Roig Comisionada de Seguros # COMMONWEALTH OF PUERTO RICO # OFFICE OF THE COMMISSIONER OF INSURANCE REPORT OF PROFESSIONAL LIABILITY CLAIMS REOPENED DURING THE SEMESTER ENDING ON ________________________ Report for:¹ [ ] Physicians, Surgeons & Dentists [ ] Hospitals | Item No. | Policy Number | Claim No. | Type of Policy | Effective Date | Expiration Date | Date of Medical Incident | Date Claim Was Closed | Date Claim Was Reopened | Limits of Liability | Amount of Reserve | Specialty of Insured | Amount Claimed | Name & Address of the Insured | | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | Total of Claims | | | | | | | | | | | | | | Date Report is Filed Name of Insurer 1 Provide two separate reports, one for Physicians, Surgeons & Dentist claims, and another one for Hospital claims. Identify it on the heading. 2 List first all claims on primary policies and provide a subtotal for them, then list all claims on excess policies, if any, providing also a subtotal. Signature of Authorized Official Name and Position of Official Signing Above Form No. AM-I-9 (Ed 11-13) [LOGO] OFFICE OF THE COMMISSIONER OF INSURANCE COMMONWEALTH OF PUERTO RICO REPORT OF PROFESSIONAL LIABILITY CLAIMS FIRST RECEIVED DURING THE SEMESTER ENDING ON ________________________ 2 Report for:¹ [ ] Physicians, Surgeons & Dentists [ ] Hospitals | Item No. | Policy Number | Claim No. | Type of Policy | Effective Date | Expiration Date | Date of Medical Incident | Date Claim Was Filed | Limits of Liability | Amount of Reserve | Specialty of Insured | Amount Claimed | Name & Address of the Insured | | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | Total of Claims | | | | | | | | | | | | | Date Report is Filed Name of Insurer ¹ Provide two separate reports, one for Physicians, Surgeons & Dentist claims, and another one for Hospital claims. Identify it on the heading. ² List first all claims on primary policies and provide a subtotal for them, then list all claims on excess policies, if any, providing also a subtotal. Signature of Authorized Official Form No. AMA-10 (Ed 11-13) Name and Position of Official Signing Above COMMONWEALTH OF PUERTO RICO OFFICE OF THE COMMISSIONER OF INSURANCE REPORT OF PROFESSIONAL LIABILITY CLAIMS OUTSTANDING FROM PREVIOUS SEMESTERS AND OF CLAIMS CLOSED DURING THE SEMESTER ENDING ON ________________________ Report for: 1 [ ] Physicians, Surgeons & Dentists [ ] Hospitals | OUTSTANDING CLAIMS AT THE END OF PREVIOUS SEMESTER^{3} | | | | | CLOSED CLAIMS DURING THE SEMESTER | | | | | | | | | | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | | Policy Number | Specialty of Insured | Claim No. | Date Claim Was First Filed | Amount of Reserve | Policy Number | Specialty of Insured | Claim No. | Date Claim Was First Filed | Amount Paid | | Date Amount Was Paid | Allocated Loss Adjustment Expense (ALAE) Incurred^{4} | | | | | | | | | | | | Economic Losses | Non Economic Losses | | Amount of Legal Fees | Others | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | Total of Claims | | | | | Total of Claims | | | | | | | | | For Closed Claims provide: 1) Number of Court Resolutions Received ______________, 2) Number of Judicial Awards ______________, and 3) Number of Settlements Outside of Courts ______________. Please include with this report a copy of each of these documents. Name of Insurer $^{1}$ Provide two separate reports, one for Physicians, Surgeons & Dentist claims, and another one for Hospital claims. Identify it on the heading. $^{2}$ List first all claims on primary policies and provide a subtotal for them, then list all claims on excess policies, if any, providing also a subtotal. $^{3}$ The information on outstanding claims and on closed claims required in this form may be provided in separate forms. $^{4}$ ALAE = Include total ALAE incurred since claim was filed on claims closed with payment and claims denied or closed without payments. Under others, include expenses paid for other than legal, such as those paid for expert witnesses or translators. Signature of Authorized Official Name and Position of Official Signing Above Form No. AM-I-11 (Ed 11-13) Date Report is Filed [LOGO] COMMONWEALTH OF PUERTO RICO OFFICE OF THE COMMISSIONER OF INSURANCE REPORT CONTAINING A SUMMARY OF STATISTICAL DATA IN CONNECTION WITH PHYSICIANS, SURGEONS, DENTISTS AND HOSPITAL PROFESSIONAL LIABILITY CLAIMS DURING THE SEMESTER ENDING ON | Coverage | Numbers of Claims First Received | Amount Claimed | Numbers of Claims Reopened | Amount Claimed | Numbers of Claims Paid | Amount of Claims Paid | | Allocated Loss Adjustment Expense (ALOE) Incurred^{3} | | Number of Claims Denied or Closed Without Payments | Allocated Loss Adjustment Expense (ALOE) Incurred^{4} | | Number of Outstanding Claims at End of Semester^{5} | Reserve for Payment of Outstanding Claims | | | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | | | | | | | | Economic Losses^{1} | Non Economic Losses^{2} | Legal Fees | Others | | Legal Fees | Others | | | | | Hospitals | primary | | | | | | | | | | | | | | | | | excess | | | | | | | | | | | | | | | | Physicians | primary | | | | | | | | | | | | | | | | | excess | | | | | | | | | | | | | | | | Surgeons | primary | | | | | | | | | | | | | | | | | excess | | | | | | | | | | | | | | | | Dentists | primary | | | | | | | | | | | | | | | | | excess | | | | | | | | | | | | | | | Date Report is Filed $^{1}$ Economic losses means payment for: 1) loss of earnings, 2) medical & funeral expenses, and 3) property damage restoration expenses such as for prothesis. $^{2}$ Non economic losses such as payments for pain & suffering, and loss of consortium. $^{3}$ ALAE = Include total ALAE incurred since claim was filed on claims closed with payment. Under others, include expenses paid for other than legal, such as those paid for expert witnesses or translators. $^{4}$ ALAE = Include total ALAE incurred since claim was filed on claims denied or closed without payments. Under others, include expenses paid for other than legal, such as those paid for expert witnesses or translators. $^{5}$ Must be the result of the following formula: Pending claims at end of previous semester + Number of claims first received + Number of claims reopened - (Claims Paid + Claims denied or closed without payments). Name of Insurer Signature of Authorized Official Form No. AM-1-12 (Ed 11-13) Name and Position Of Official Signing Above