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IPFCF Claims Paid Report FAQ

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​​​​Last​​ upda​ted: April 11, 2024​

Overview

​The Claims Paid R​eport is required by s. 655.26, Wis. Stat., and s. Ins 17.285, Wis. Adm. Code, to be filed by the 15th day of the month following the date on which there has been a final determination of the aggregate indemnity to be paid to or on behalf of any claimant. Intentional omissions or failure to report in a timely manner may result in a forfeiture of not more than $1,000 for each violation and each week of delay. Whoever intentionally violates or intentionally permits any person over whom he or she has authority to violate or intentionally aids any person in violating any insurance statute or rule of this state may be subject to criminal penalties.

The form may be filed online here ​​.​​

How do I correct a Claims Paid Report after I have submit​ted it electronically to IPFCF?

To make a correction to a Claims Paid Report that has been electronically submitted to IPFCF, go to the Claims Paid Report Form​ ​​ and under "Type of Filing" select "​Correcting a report previously submitted" to file a new report with the correct information.​

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Definitions and Examples of Coded Allegations

​Below is ​a list of definitions and examples of allegation codes to be used on item ​10 of the Claims Paid Report form.​



01 Delay in diagnosis—abnormal condition was not immediately recognized
EXAMPLE: A delay in diagnosing acute appendicitis led to a ruptured appendix and the onset of peritonitis.

02 Failure to diagnose—no diagnosis was made of an abnormal condition
EXAMPLE: Said the patient was healthy when in fact he had diabetes.

03 Misdiagnosis—original diagnosis was incorrect
EXAMPLE: Original diagnosis was "stomach ulcers" and the new diagnosis was "cancer of the stomach."

04 Failure to obtain consent for diagnostic procedure—conducted diagnostic test without patient's permission and/or knowledge

05 Unnecessary diagnostic test—diagnostic procedure conducted which was not needed to make diagnosis

06 Improper performance of diagnostic test—adverse outcome from incorrect procedural methods
EXAMPLE: Cardiac arrest resulted from improperly performed angiogram.

07 Other diagnosis-related error—diagnosis not specified above​


08 Failure to complete patient assessment—inadequately assessed patient's condition
EXAMPLE: Overlooked an abnormal lab report of a preoperative patient.

09 Failure to monitor—failed to keep sufficient watch over patient and/or failed to notice something was wrong
EXAMPLE: Unattended anesthetized patient injured from fall.

10 Failure to test equipment—failed to ensure equipment was operating properly before use
EXAMPLE: Nerve damage to a patient's arm caused by a defective train-of-4 nerve stimulator.

11 Improper choice of anesthesia—selected an inappropriate type of anesthesia
EXAMPLE: Death from hepatitis resulted from the inappropriate choice of halothane anesthesia.

12 Improper administration of anesthesia—incorrect or incomplete performance in administering anesthetic
EXAMPLE: Inadvertently administered 100% nitrous oxide to a patient.

13 Improper use of equipment—misused equipment or used it in a way other than that for which it was intended
EXAMPLE: Inadvertently turned the wrong knob or jerry-rigged equipment to use in a manner not intended by the manufacturer.

14 Improper intubation—improperly inserted or managed tubes
EXAMPLE: Tooth or vocal cord damage resulted from improper insertion of tube.

15 Improper positioning—placed patient in a position which resulted in injury
EXAMPLE: Anesthetized patient suffered back injury after sliding off the operating table.

16 Other anesthesia-related error—anesthesia error not specified above


17 Failure to obtain consent for surgery—conducted surgical procedure without patient's permission and/or knowledge

18 Improper performance—adverse outcome from incorrect surgical procedure
EXAMPLE: Perforated intestine during a hysterectomy.

19 Improper positioning—placed patient in a position which resulted in injury

20 Retained foreign bodies—failure to remove all instruments, sponges, packing, etc.

21 Unnecessary surgery—surgical procedure conducted which was not needed

22 Wrong body part—procedure performed on an incorrect body part

23 Other surgery-related error—surgery error not specified above


24 Wrong medication ordered—physician ordered an inappropriate drug

25 Wrong dosage ordered—physician ordered an inappropriate dosage of drug to be given to the patient​


27 Wrong drug given—the patient was given a drug that was not the drug ordered
EXAMPLE: Gave the patient aspirin when Tylenol was ordered.

28 Wrong dosage given—the patient was given a does of a drug which was not the dosage ordered
EXAMPLE: Gave the patient an inadequate dose or an overdose.

29 Wrong patient—gave one patient's medication to another patient
EXAMPLE: Gave Mr. Smith's medication to his roommate, Mr. Jones.

30 Improper route of administration—gave the drug to the patient by one route when it should have been given by another route
EXAMPLE: Gave a drug orally when it should have been given by injection.

31 Improper method of administration—improper performance of giving the drug
EXAMPLE: Gave an injection into a muscle and failed to assure through aspiration that in fact the needle had not entered a blood vessel.

32 Other medication administration-related error​


33 Failure to monitor—failed to notice something was wrong with IV or patient's reaction to IV

34 Improper performance—IV administered incorrectly

35 Other IV-related error​


36 Failure to obtain consent—informed consent was not solicited or obtained

37 Improper management of pregnancy—ultimate delivery had complications because problems were not spotted or properly treated during pregnancy
EXAMPLE: Baby suffered because physician never advised 40 year old mother to have amniosynthesis.

38 Failure to properly manage labor—adverse outcome resulted from incorrect procedural methods
EXAMPLE: Hemorrhaging went unnoticed because patient was left unattended.

39 Improper choice of delivery method—an inappropriate method of delivery was selected

40 Improperly performed vaginal delivery—delivery conducted incorrectly
EXAMPLE: Cut too much during episiotomy.

41 Delay in C-section—mother suffered unnecessarily or child was damaged because C-section was not promptly performed

42 Improperly performed C-section—adverse outcome resulted from incorrect procedural methods
EXAMPLE: Incision was made too high or too low.

43 Failure to identify fetal distress—failed to use fetal monitor or used a malfunctioning fetal monitor

44 Failure to treat fetal distress—failed to take appropriate action after fetal distress was identified

45 Delay to treat fetal distress—mother or child suffered because fetal distress was not treated in a timely manner

46 Wrongful life-birth
EXAMPLE: Vasectomy patient's spouse became pregnant.
Birth of a child born with Tay-Sachs disease could have been avoided had appropriate diagnostic tests been conducted.

47 Abandonment—patient's treatment was prematurely discontinued

48 Other obstetrics-related error—obstetrical error not specified above

49 Failure to obtain consent for treatment—informed consent not solicited or obtained

50 Delay in treatment—patient suffered because treatment was not given in a timely manner

51 Failure to render treatment—patient suffered because treatment was withheld
EXAMPLE: Treatment refused for economic reasons or because patient was considered too high a risk.

52 Improper choice of treatment—an inappropriate form of treatment was selected
EXAMPLE: Performing surgery even though medication would have been an equally effective treatment.

53 Improper performance—incorrect administration of treatment​

54 Premature end of treatment—patient abandonment or treatment ended too soon
EXAMPLE: Patient did not complete whole course of chemotherapy because physician thought she was cured.

55 Failure to instruct—patient not adequately instructed to perform home treatments or to correctly care for him or herself
EXAMPLE: Patient who was not instructed to keep new incision dry, took a bath, and infection resulted.

56 Other treatment-related error


57 Failure to monitor—failed to notice something was wrong

58 Failure to report—failed to notify appropriate personnel that something was wrong and/or failed to record the problem

59 Failure to respond—failed to make appropriate response to a recognized problem

60 Other monitoring-related error​


61 Failure to inspect—failed to ensure that equipment was functioning properly before use

62 Inadequate maintenance/repair—failed to maintain equipment properly and keep in good repair

63 Improper use—used a piece of equipment in a way not intended by manufacturer
EXAMPLE: Inadvertently turned the wrong knob or jerry-rigged piece of equipment to use in a manner other than that for which it was intended.

64 Malfunction/failure—a piece of equipment failed to operate properly

65 Failure to respond to product warnings—failed to use equipment as directed

66 Other equipment-related error


67 Contamination from blood product (blood and plasma)
EXAMPLE: Patient given a transfusion of blood contaminated with hepatitis or AIDS.

68 Wrong type of blood product—failed to check the patient's identification against the identification on the blood
EXAMPLE: Giving patient Rh- blood when she should have been given Rh+.

69 Other blood products-related error


70 Failure to follow consent policies—failed to obtain patient consent in the proper manner

71 Failure to follow policy/procedure—failed to observe or comply with operating and/or reporting policies and procedures established by the hospital, office, or common use
EXAMPLE: Failed to notify Medical Examiner that an autopsy was to be performed.

​72 Failure to review provider performance—failed to adequately supervise or monitor performance of health care providers

73 Failure to ensure patient safety—failed to protect patient from environmental hazards
EXAMPLE: Failed to adequately protect patient from heat and cold or failed to use side rails or restraints.

74 Transportation—patient injured while being moved or while walking
EXAMPLE: Injured patient while moving her from stretcher to bed or bumping her against a wall while being wheeled in a chair.

75 Failure to protect third parties
EXAMPLE: Third party injured by a violent patient who was not adequately restrained.

76 Falls
EXAMPLE: Falls from beds, falls in bathrooms, falls from table, etc.

​77 Other

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Questions? Contact​ the F​und​ or call us at​ (608) 707-5481
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