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206 Cards in this Set

  • Front
  • Back
A type of healthcare facility designed to deal with many kinds of disease and injury. Typically, it has an Emergency Room to care for patients in immediate need of treatment.
Acute Care Hospital
Also called a general hospital
Acute Care Hospital
An Insurance Professional who acts as an intermediary between an Insured and an insurance company.
Agent/Broker
The maximum amount the Insurer will pay for all of the liabilities incurred for a certain insurance policy in a specific policy period.
Aggregate Limit
Healthcare providers with specialized training, education, and knowledge who provide direct care or complement patient care in a variety of ways. They typically work under the direct or indirect supervision of a Physician, Surgeon, or Dentist.
Allied Healthcare Professionals
What are some examples of Allied Healthcare Professionals?
-Registered Nurses (RNs)
-Physician Assistants (PAs)
-Nurse Practitioners (NPs)
A form of Medical Professional Liability Insurance (MPLI) that protects allied healthcare professionals from potential liability in the performance of their duties.
Allied Healthcare Professional Liability Insurance
Physician who holds an MD degree.
Allopathic Physician
Refers to methods of settling disputes by means other than court trial. Such methods are typically less costly and more expeditious than the litigation process.
Alternative Dispute Resolution (ADR)
A type of healthcare facility that specializes in providing surgery, pain management, and certain diagnostic services in an outpatient setting.
Ambulatory Surgery Center
A non-profit organization that represents 24 medical specialty boards that establish and maintain standards for Physician certification and the delivery of safe, quality medical care by certified Physician specialists.
American Board of Medical Specialists (ABMS)
An organization which develops standards of nursing practice and provides guidelines for a competent nursing practice.
American Nurses Association (ANA)
This is composed of the members of the American Hospital Association, and also includes healthcare, insurance and law professionals, as well as actual healthcare providers. The primary goal of this is to promote and develop risk management strategies and policies in the healthcare industry.
American Society for Healthcare Risk Management (ASHRM)
Allied healthcare professional who works under the direction of licensed Anesthesiologists. They help in the administration of anesthesia to patients.
Anesthesiology Assistant (AA)
A type of vicarious liability under which a healthcare facility or professional can be held liable for the negligence of another healthcare provider. Such liability is based on appearances that led the patient to believe that the healthcare provider was under the employ and control of the facility or other professional.
Apparent Agency Doctrine
Apparent Agency Doctrine is also called:
Ostensible Agency Doctrine
A method of ADR where the parties present arguments and evidence to an independent and impartial third party.
Arbitration
An agreement between parties in a dispute to voluntarily submit to arbitration. In MPLI, arbitration agreements can exist between the Healthcare Professional or facility and the patient, as well as between a Healthcare Professional/facility and its MPLI Insurer.
Arbitration Agreement
An independent and impartial third party who makes a decision to resolve a dispute submitted arbitration.
Arbitrator
Probable claim event is also known as:
Awareness Provision
Refers to unauthorized touching. It is alleged when surgery exceeds the scope of the patient's consent.
Battery
A term used to refer to Physician-owned insurance companies
Bedpan Mutuals
A doctrine that provides that, while the healthcare facility did employ a staff, the staff acted under the supervision of the Physicians, not of the healthcare facility itself. The errors and omissions of the staff, therefore, are the responsibility of the Physicians and not the healthcare facility.
Borrowed Servant Doctrine
This doctrine is based on the concept that hospitals merely provide the facilities and staff for Physicians to provide services to patients. This is specifically applicable in treatment procedures in an Operating Room where the Surgeon, as the captain iof the surgical team, is responsible for all errors and omissions that happen during the operation.
Captain of the ship doctrine
This is the medical procedure used to revive a patient's heartbeat and breathing when the patient suffers heart failure. This may involve simple methods, such as mouth-to-mouth resuscitation, or advanced methods, such as the use of electric shock.
Cardiopulmonary Resuscitation (CPR)
This is one of the four elements required to establish negligence. A plaintiff must prove that the defendant's negligence was the cause of the alleged injury or damage.
Causation
Causation is also called:
Proximate cause
This is another type of advanced practice nurse who is trained to deliver babies and provide care to women before and after child birth and specializes in the practice of obstetrical and gynecological care.
Certified Nurse Midwife (CNM)
They administer anesthesia for all types of surgical cases, in collaboration with Surgeons, Anesthesiologists, Dentists, Podiatrists and other healthcare providers.
Certified Registered Nurse Anesthetist (CRNA)
This doctrine provides that hospitals are charitable institutions, not businesses for profit. Thus, it would be against the public's interest to allow an injured patient to recover a judgment against a hospital because such a judgment would consume the hospital's resources, which could otherwise be used to treat other patients.
Charitable immunity doctrine
Medical specialists who focus on the diagnosis and treatment of conditions related to the mechanical dysfunction of joints and muscles.
Chiropractor
The first step in the MPLI claims management process, which begins with the first Notice of Claim against the insured healthcare provider.
Claim
This type of coverage requires that a medical incident occur after the retroactive date and that the claim be made against the Insured while the policy is in effect in order to trigger coverage.
Claims-made coverage
In addition to the requirements of claims-made coverage, claims-made and reported coverage requires that the Insured also report the claim to the Insurer during the same policy period.
Claims-made and reported
This type of coverage is triggered once the claim is actually adjudicated or settled.
Claims-paid
It provides that the cost of claims-made coverage increases each year during the early years of coverage due to the increasing amount of risk assumed by the insurer each year of claims-made coverage.
Claims-made progression
This type of coverage does not require that the claim be made against the insured in order to trigger coverage. Rather, the policy is triggered by submitting a written report to the insurer of either a claim or incident.
Claims-reported
An insurance professional who investigates claims and determines if losses are covered by an insurer's policy. They establish case reserves, manage litigation and, if needed, settle claims.
Claims Professional
The method of setting rates by grouping Physician specialties into defined classes.
Class rating
A defense used in a lawsuit when the patient (plaintiff) is alleged to have been negligent and thus caused or contributed to his own injury. This does not relieve the defendant from liability, but it reduces the amount of damages that may be owed to the plaintiff, in proportion to the plaintiff's own negligence.
Comparative Negligence
A component of an insurance policy that establishes responsibilities that the insured must meet in order for coverage to apply, and may limit or qualify an insurer's promises.
Conditions
Conditions is also known as:
General Rules
This consists on educational programs that Healthcare provides take to keep current on the rapid advancements in medicine.
Continuing Medical Education (CME)
This insurance concept provides that as the size of a healthcare facility increases, it is more likely that their own loss history will be better predictor of the facility’s future losses.
Credibility
A defense used in a lawsuit when the patient (plaintiff) is alleged to have been negligent and thus caused or contributed to his/her own injury. Generally, plaintiffs in this situation are barred to recover from the named defendants
Contributory Negligence
This consists on educational programs that Healthcare provides take to keep current on the rapid advancements in medicine.
Continuing Medical Education (CME)
A defense used in a lawsuit when the patient (plaintiff) is alleged to have been negligent and thus caused or contributed to his/her own injury. Generally, plaintiffs in this situation are barred to recover from the named defendants
Contributory Negligence
This insurance concept provides that as the size of a healthcare facility increases, it is more likely that their own loss history will be better predictor of the facility’s future losses.
Credibility
A component of an insurance policy, usually the first page, that provides information about the property, person(s), or activity(ies) that are insured, policy limits, deductibles, and coverages.
Declarations Page
Dec page is also called:
Coverage Summary
A component of an insurance policy, usually the first page, that provides information about the property, person(s), or activity(ies) that are insured, policy limits, deductibles, and coverages.
Declarations Page
The portion of a loss for which the Insured is responsible. It may apply to the indemnity payment or defense costs, or both. The payment is typically paid by the Insurer and then collected from the Insured.
Deductible
Dec page is also called:
Coverage Summary
A policy provision that describes the Insurer's obligation for the defense and settlement costs involved in a covered claim.
Defense and Settlement
A phenomenon whereby Healthcare providers are induced to perform diagnostic and treatment procedures, some of which may not be necessary, or avoid high-risk patients, to reduce their exposure to medical professional liability.
Defensive Medicine
A licensed healthcare provider who treats the teeth or gums.
Dentist
The portion of a loss for which the Insured is responsible. It may apply to the indemnity payment or defense costs, or both. The payment is typically paid by the Insurer and then collected from the Insured.
Deductible
A section of an insurance policy that outlines the definitions of various terms that are used throughout the policy.
Definitions
This consists on educational programs that Healthcare provides take to keep current on the rapid advancements in medicine.
Continuing Medical Education (CME)
A policy provision that describes the Insurer's obligation for the defense and settlement costs involved in a covered claim.
Defense and Settlement
A phenomenon whereby Healthcare providers are induced to perform diagnostic and treatment procedures, some of which may not be necessary, or avoid high-risk patients, to reduce their exposure to medical professional liability.
Defensive Medicine
A defense used in a lawsuit when the patient (plaintiff) is alleged to have been negligent and thus caused or contributed to his/her own injury. Generally, plaintiffs in this situation are barred to recover from the named defendants
Contributory Negligence
A licensed healthcare provider who treats the teeth or gums.
Dentist
This consists on educational programs that Healthcare provides take to keep current on the rapid advancements in medicine.
Continuing Medical Education (CME)
A defense used in a lawsuit when the patient (plaintiff) is alleged to have been negligent and thus caused or contributed to his/her own injury. Generally, plaintiffs in this situation are barred to recover from the named defendants
Contributory Negligence
This insurance concept provides that as the size of a healthcare facility increases, it is more likely that their own loss history will be better predictor of the facility’s future losses.
Credibility
A section of an insurance policy that outlines the definitions of various terms that are used throughout the policy.
Definitions
This insurance concept provides that as the size of a healthcare facility increases, it is more likely that their own loss history will be better predictor of the facility’s future losses.
Credibility
A component of an insurance policy, usually the first page, that provides information about the property, person(s), or activity(ies) that are insured, policy limits, deductibles, and coverages.
Declarations Page
A component of an insurance policy, usually the first page, that provides information about the property, person(s), or activity(ies) that are insured, policy limits, deductibles, and coverages.
Declarations Page
Dec page is also called:
Coverage Summary
The portion of a loss for which the Insured is responsible. It may apply to the indemnity payment or defense costs, or both. The payment is typically paid by the Insurer and then collected from the Insured.
Deductible
Dec page is also called:
Coverage Summary
A policy provision that describes the Insurer's obligation for the defense and settlement costs involved in a covered claim.
Defense and Settlement
The portion of a loss for which the Insured is responsible. It may apply to the indemnity payment or defense costs, or both. The payment is typically paid by the Insurer and then collected from the Insured.
Deductible
A policy provision that describes the Insurer's obligation for the defense and settlement costs involved in a covered claim.
Defense and Settlement
A phenomenon whereby Healthcare providers are induced to perform diagnostic and treatment procedures, some of which may not be necessary, or avoid high-risk patients, to reduce their exposure to medical professional liability.
Defensive Medicine
A phenomenon whereby Healthcare providers are induced to perform diagnostic and treatment procedures, some of which may not be necessary, or avoid high-risk patients, to reduce their exposure to medical professional liability.
Defensive Medicine
A licensed healthcare provider who treats the teeth or gums.
Dentist
A licensed healthcare provider who treats the teeth or gums.
Dentist
A section of an insurance policy that outlines the definitions of various terms that are used throughout the policy.
Definitions
A section of an insurance policy that outlines the definitions of various terms that are used throughout the policy.
Definitions
Refers to question and answer sessions in which witnesses provide sworn testimony
Deposition
Refers to a Physician who is successful in achieving certification from their respective specialty board.
Diplomate
A stage in the litigation process where each party has the opportunity to obtain relevant information and documents from the other parties involved in the lawsuit.
Discovery
Discovery clause is also called:
Probable Claim Event
This type of order is a request to not perform CPR if a patient's heart stops or if a patient stops breathing. These decisions about resuscitation are made in advance after careful consultation between the patient, the Physicians, and, sometimes, the patient's family members, and are documented in the DNR Order.
Do Not Resuscitate (DNR) Order
An alleged act or omission by a healthcare provider which causes harm or distress to an elderly or dependent patient. Abuse of the elderly may be in the form of neglect, physical abuse, psychological or emotional abuse, sexual abuse, or financial abuse.
Elder Abuse
A federal law that requires hospitals to provide a screening examination for emergency patients and prohibits hospitals from discharging a woman in active labor or allowing the transfer of patients who have not been stabilized, unless the benefits of transfer outweigh the risks.
Emergency Medical Treatment and Active Labor Act (EMTALA)
A written document attached to the original policy that may add, delete, or modify the provisions of the original insurance policy.
Endorsement
A step in the MPLI claims management process where the Claims Professional assesses all the information obtained from medical records and expert opinions.
Evaluation
A section of an insurance policy that identifies incidents, types of exposures, or damages that are not covered by the policy.
Exclusions
Refers to question and answer sessions in which witnesses provide sworn testimony
Deposition
Refers to a Physician who is successful in achieving certification from their respective specialty board.
Diplomate
A stage in the litigation process where each party has the opportunity to obtain relevant information and documents from the other parties involved in the lawsuit.
Discovery
Discovery clause is also called:
Probable Claim Event
This type of order is a request to not perform CPR if a patient's heart stops or if a patient stops breathing. These decisions about resuscitation are made in advance after careful consultation between the patient, the Physicians, and, sometimes, the patient's family members, and are documented in the DNR Order.
Do Not Resuscitate (DNR) Order
An alleged act or omission by a healthcare provider which causes harm or distress to an elderly or dependent patient. Abuse of the elderly may be in the form of neglect, physical abuse, psychological or emotional abuse, sexual abuse, or financial abuse.
Elder Abuse
A federal law that requires hospitals to provide a screening examination for emergency patients and prohibits hospitals from discharging a woman in active labor or allowing the transfer of patients who have not been stabilized, unless the benefits of transfer outweigh the risks.
Emergency Medical Treatment and Active Labor Act (EMTALA)
A written document attached to the original policy that may add, delete, or modify the provisions of the original insurance policy.
Endorsement
A step in the MPLI claims management process where the Claims Professional assesses all the information obtained from medical records and expert opinions.
Evaluation
A section of an insurance policy that identifies incidents, types of exposures, or damages that are not covered by the policy.
Exclusions
A method of adjusting premiums according to the Insured's loss history in prior years.
Experience Rating
An evaluation or review by an Expert witness as to whether or not the insured healthcare provider's conduct met the applicable standard of care, or whether an alleged breach of the standard caused the
alleged injury.
Expert Opinion
A person qualified by sufficient knowledge, education, training, or experience to provide expert opinion regarding the specific issue at hand. They are commonly required to establish the standard of care, as well as whether or not the standard was violated.
Expert Witness
This extends the claims-reporting provisions for a specific time period beyond the policy expiration date, for any claims arising from medical incidents that occurred after the retroactive date and prior to the expiration of the policy. Also called Tail coverage.
ERP
An Insured, typically the primary insurance purchaser, who is named on the policy declarations. They have special rights and duties, and also pays premiums and receives return premiums,
First Named Insured
In MPLI, it refers to the insured healthcare provider or the healthcare facility.
First Party
Refers to the first year coverage is purchased on a claims-made basis. Also called retro date inception (RDI) coverage.
First Year Coverage
An Extended Reporting Period of specified or unlimited duration that extends past any automatic ERP provisions. It can be purchased when a claims-made policy is cancelled or terminated, for an additional
premium.
Full ERP
An exposure base that converts the number of part-time Physician coverage to its equivalent number of full-time employed Physicians, usually based on a 40-hour work week.
Full Time Equivalent (FTE)
A type of hospital designed to deal with many kinds of. disease and injury. Typically, it has an Emergency Room to care for patients in immediate need of treatment. Also called an acute care hospital.
General Hospital
A component of an insurance policy that limits or qualifies an Insurer's promises.
General Rules
Describes laws that provide immunity to persons who, out of kindness, provide emergency care and treatment to injured persons, with no expectation of compensation. The main purpose of these statutes is to encourage healthcare professionals to come to the aid of others, and not have to worry about an MPL exposure as a result of their actions.
Good Samaritan Statutes
This doctrine provides that no governmental body can be sued unless it gave its permission to be sued.
Governmental Immunity Doctrine
A point in the insurance market cycle when there is limited availability because Insurers have stopped writing MPL, or limited affordability because Insurers will offer coverage, but only at prices that are unaffordable
Hard Market
A law that requires healthcare providers to protect the privacy and security of their patients’ medical information.
Health Insurance Portability and Accountability Act (HIPAA)
A form of MPLI that protects hospitals and long term care and other types of healthcare facilities against the risks associated with professional liability claims.
Hospital Professional Liability Insurance (HPL)
Incident Reporting Provision is also called:
Probable Claims Event
A rating factor applied to a base rate when a higher limit is purchased. They adjusts the premium to reflect the increased exposure that exists when a higher limit of liability is purchased.
Increased Limit Factor (ILF)
Refers to claims that have been incurred (the adverse event has already occurred) but have not yet been
reported to the Insurer.
Incurred but not reported (IBNR)
Refers to the payment made to the plaintiff for special and general damages that is assessed against the insured healthcare provider.
Indemnity Payment
This is a process whereby a healthcare provider informs a patient of the potential benefits, major risks, and alternatives involved in any surgical procedure, medical procedure, or other course of
treatment, and obtains the patient's consent to proceed.
Informed Consent
A provision that defines and describes the types of activities that are covered by the policy.
Insuring Agreement
Refers to written questions served by one party to a lawsuit on another party, and answered under oath.
Interrogatories
A step in the MPLI claims management process where the Claims Professional investigates the facts of the claim, based on the medical records of the Insured and
other treating healthcare providers, and discussions with the Insured and, possibly, with other treating Physicians.
Investigation
If parties are "jointly and severally liable" for a certain obligation, it means that each party is liable to pay the full obligation, regardless of their proportion of responsibility. The party who pays the full obligation, however, can seek from other parties their contribution or share of the liability.
Joint and Several Liability
An allied healthcare professional who works under the close supervision of experienced laboratory personnel.
Laboratory Technician
A fundamental statistical theory that provides that as the number of samples increases, the average of these samples is more likely to reach the average of the whole population.
Law of Large Numbers
They help care for ill or injured people and perform health maintenance duties under the direction of Physicians and Registered Nurses. Most provide basic bedside care to patients, such as taking their temperature, blood pressure, pulse, and respiration, and applying dressings.
Licensed Practical Nurse (LPN)
Refers to the maximum amount the policy will pay during the policy period. In MPLI, they are commonly provided per claim, subject to an aggregate. Limit that applies for the applicable policy period.
Limits of Liability
The legal process by which a dispute proceeds through the court system until resolution, whether by settlement, dismissal, or trial.
Litigation
A Physician working temporarily in place of another Physician as a substitute or replacement. Designed to fill Physician vacancies on a short-term basis.
Locum Tenens
A type of healthcare facility that provides custodial care and a wide range of healthcare and personal support services, skilled nursing care, and other services for persons who are not capable of performing daily activities.
Long Term Care Facilities (LTC)
Refers to the documentation of prior loss experience; a list of previous claims.
Loss History
A method of alternative dispute resolution where the parties are guided in resolving their differences and encouraged to come up with their own solutions to settle the dispute. This process is not binding on the parties.
Mediation
An impartial third party, often an attorney or retired judge, who assists the parties in a dispute submitted for mediation.
Mediator
A California state law that provides for unlimited recovery of economic losses such as past and future medical costs or lost wages, and caps awards for noneconomic damages, such as pain and suffering, at $250,000.
Medical Injury Compensation Reform Act (MICRA)
The failure of a healthcare provider to meet the standard of care and degree of skill that other healthcare providers would use under similar circumstances, resulting in injury to a patient.
Medical Malpractice
An insurance product that offers financial protection to healthcare providers for liability arising from errors and omissions in the practice of their profession.
Medical Professional Liability Insurance
Documents detailing information about the medical care received by patients from healthcare providers
Medical Records
A type of coverage that provides for ERP coverage at the same time the claims-made policy is purchased.
Modified Claims-Made
An Insured specifically named in the policy declarations or in an endorsement to a policy.
Named Insured
Modified Claims-Made is also called:
Pre-Paid Tail Coverage
Refers to compensation for the plaintiffs physical, mental, and emotional pain and suffering.
Non-Economic Damages
Non-economic damages is also called:
General Damages
Another term used to refer to Prior Acts coverage.
Nose Coverage
A letter from the patient or his attorney notifying a healthcare provider of the intent to sue. This can be in the form of a letter or notice that a lawsuit has already
been filed, the form for which may be specified by applicable state law.
Notice of Claim
They are Registered Nurses who have completed more advanced education with extensive clinical training. They obtain health histories, perform physical examinations, monitor patients, order and interpret laboratory tests and x-rays, and provide health education.
Nurse Practitioner (NP)
Used as the primary exposure unit for hospital professional liability. This number measures the number of patients actually cared for by the healthcare facility and, therefore, the hospital's exposure to MPL.
Occupied beds
Provides coverage based on when the accident or injury actually happens; thus, claims arising from injuries that occurred within a policy's effective dates are covered by that policy, regardless of when the claim is actually made against the Insured or presented to the insurance company.
Occurrence Coverage
Ostensible Agency Doctrine is also called:
Apparent Agency Doctrine
They practice a holistic approach to
healthcare instead of treating specific illnesses. They focus on the musculoskeletal system and promote the
body's natural tendency toward self-healing.
Osteopathic Physician
Refers to the number of patients who receive outpatient (I.e. not overnight) services at a hospital.
Outpatient Visits
The prevention of healthcare errors, and the elimination or mitigation of patient injury caused by healthcare errors.
Patient Safety
The maximum amount the Insurer will pay for each claim covered by the policy. The per claim limit may apply to damages only, or to both damages and defense costs
Per Claim Limit
An allied healthcare professional that is responsible for collecting blood from patients for laboratory examination
Phlebotomist
They are healthcare providers with extensive education and training that are licensed to practice medicine.
Physician
Refers to MPLI carriers that are founded and owned by Physicians and dentists
Physician-owned insurance companies
An allied healthcare professional licensed to practice medicine under a Physician's supervision. Their responsibilities may include conducting physical exams, making diagnoses, and treating illnesses
Physician Assistant (PA)
A group of allied healthcare professionals that provides hands-on care with little supervision. They have a more significant level of MPL exposure than other allied healthcare professionals due to the level of hands-on care that they provide.
Physician Extenders
An organization represented by its member companies in legislation advocacy efforts and initiating education, risk management, and research programs.
Physician Insurers Association of American (PIAA)
A form of MPLI that provides Professional Liability Insurance coverage to Physicians, Surgeons, and Dentists.
Physician Professional Liability (PPL) Insurance
Refers to the complainant or the party who files a case in court.
Plaintiff
Governmental Immunity Doctrine is also called:
Sovereign Immunity Doctrine
A medical specialist who provides medical diagnoses and treatments for foot and ankle problems, including sprains, fractures, corns, and calluses.
Podiatrist
A type of coverage that provides for ERP coverage at the time the claims-made policy is purchased.
Pre-paid tail
A claims-made policy feature that protects the Insured for claims arising from medical incidents that happened after the Retroactive Date and before the inception of the current policy for which a claim is not made until after the policy is in force. Under this policy feature, the Insurer includes the retroactive date established under an earlier claims-made policy.
Prior Acts coverage
A policy provision that allows an Insured to trigger coverage under its Medical Professional Liability policy by reporting a medical incident that is reasonably expected to later result in a claim.
Probable Claim Event
Pre-paid tail is also called:
Modified claims-made coverage
A type of healthcare facility that is primarily engaged in providing medical services for the diagnosis and treatment of mental illnesses.
Psychiatric Hospital
They are degreed, licensed healthcare providers who care for patients with a
significant degree of knowledge, skill, and judgment. They observe patients to assess symptoms, reactions to treatment, and progress.
Registered Nurse (RN)
A risk management tool that allows Insurers to spread exposures across other insurance companies, so that no single Insurer is vulnerable to total financial collapse from unanticipated, severe, or catastrophic losses. The parties in this type of agreement are the CedantlReinsured and the Reinsurer.
Reinsurance
Refers to the specialty training under supervision that graduates of medical school undergo.
Residency
This legal doctrine applies when the patient's claim involves a type of injury that would not have occurred without negligence on the part of the healthcare provider.
Res Ipsa Loquitor
Latin for "the thing speaks for itself."
Res Ipsa Loquitor
A type of vicarious liability that holds an employer to be liable for an employee's negligent actions.
Respondeat Superior
Latin for "let the master answer."
Respondeat Superior
Refers to the first year of a claims-made policy, where the Retroactive Date is the same date as the policy effective date
Retro date inception
The inception date of the Insured's first claims-made policy.
Retroactive Date
This step of the risk management process involves either the prevention of losses or the mitigation of the losses that do occur.
Risk Control
This step of the risk management process includes the identification and analysis of situations or problems that may give rise to events or incidents of potential liability for the hospital, its employees, Physicians, and
other healthcare providers.
Risk Identification and Analysis
A systematic approach to identify and analyze the potential exposure to financial losses.
Risk Management
They are insurance companies owned and controlled by a group engaged in similar or related businesses for the purpose of insuring the liability exposures of its members.
Risk Retention Group (RRG)
A method of adjusting premiums applied when the Insured has a unique risk characteristic that the Underwriter believes makes it more or less likely than average to incur a loss.
Schedule Rating
Refers to the Insurer.
Second Party
Refers to a specific sum or percentage of loss that is the Insured's responsibility and is not covered under the policy. Claims within the Insured's SIR are usually handled and paid by the Insured.
Self-Insured Retention (SIR)
A step in the MPLI claims management process that involves out of court negotiations to resolve the claim, thereby avoiding or shortening the litigation process.
Settlement
Laws that allow healthcare providers to express sympathy and concern regarding a patient's injury without it being considered an admission of guilt if there is a medical malpractice action.
Sorry Works
This doctrine provided that no governmental body could be sued unless it gave its permission to be sued.
Sovereign Immunity Doctrine
A Physician who has completed residency training in a specialty recognized by the American Board of Medical Specialties (ABMS).
Specialist
A type of healthcare facility that specializes in a particular medical field, such as cardiology, orthopedic surgery, or rehabilitation.
Specialty Hospital
A rating methodology whereby different rates are set for the various Physician specialties.
Specialty Rating
Refers to the level of care expected from a healthcare provider in similar circumstances who has similar education, background, and training.
Standard of Care
A law that specifies the amount of time within which a plaintiff must pursue legal remedies.
Statutes of Limitations
They refer to percentages of the mature claims made rate that are used to determine rates in the first few years of the claims-made progression, until the mature rate level is reached.
Step Factors
A healthcare provider educated and trained in performing surgical procedures.
Surgeon
ERP is also called:
Tail Coverage
A type of healthcare facility that provides training programs, including internships, residencies, and fellowships for Physicians and other healthcare providers, in addition to treating patients.
Teaching Hospital
In MPLI, it refers to the injured patient or his family.
Third Party
An insurance professional who evaluates an Applicant for acceptability for insurance coverage and makes sure that Applicants are appropriately classified and rated, in an effort to create a profitable book of business.
Underwriter
Types of activities that are either within an Insured's control or are so catastrophic that it is not feasible to provide insurance coverage at an affordable price.
Uninsurable Exposures
A multi-part professional exam sponsored by the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners (NBME). . Physicians must pass this before being permitted to practice medicine in the United States.
United States Medical Licensing Examination (USMLE)
A doctrine that provides that a party is held responsible for the negligence of another based solely on the relationship between the parties, such as employer and employee or principal and agent.
Vicarious Liability
A claim brought by parents or a child against a Physician for failure to diagnose the fetus' or mother's illness in the early stages of pregnancy, preventing the woman from having an opportunity to abort the fetus.
Wrongful Life Action
Parties that are involved in a reinsurance agreement :
CedantlReinsured and the Reinsurer.