Last Updated: April 4, 2024
Overview
The Injured Patients and Families Compensation Fund (Fund) provides medical malpractice coverage on an occurrence basis for physicians, certified registered nurse anesthetists (CRNA), and eligible facilities. Payment of the premium for a given period of practice entitles the participant to coverage for claims filed for any acts of malpractice that occur in the period for which the premium is paid. This includes claims that are filed subsequent to the Fund coverage cancellation date if the incident occurred during a period in which the Fund coverage was in force.
Claims Made Policies and Tail Coverage
Primary insurance, from a carrier fully licensed and authorized to write business in Wisconsin, may be obtained on an occurrence or claims-made basis. A claims-made policy only covers those claims reported during the policy period. If a provider has claims-made coverage, a tail policy or extended reporting endorsement must be purchased to cover incurred claims reported after the claims-made policy has been terminated. The tail coverage is required in order for the provider to be in compliance with Fund requirements.
If a provider changes from a claims-made policy to an occurrence policy, "tail," "nose," or prior-acts coverage must be obtained to cover those claims occurring prior to the effective date of the occurrence-based policy.
All claims-made policies must have a retro date back to the date at which the provider’s first claims-made policy was written. The retro date extends coverage to the provider for any incidents reported in the policy period with an incident date from the retro date to the expiration date of the current policy.
Coverage Requirements
The filing of a certificate of insurance (certifying primary insurance coverage) triggers Fund enrollment and Fund coverage for the health care provider. The primary insurance carrier must submit a certificate of coverage, in the format prescribed by the Commissioner of Insurance, which indicates both the provider ISO code and provider type. This information will be used by the Fund to classify and bill the provider.
Every physician and CRNA must purchase primary medical malpractice coverage at the levels defined in s. 655.23, Wis. Stat. (currently $1,000,000 per occurrence/$3,000,000 annual aggregate). The primary insurer is required by law to file a certificate of primary coverage with the Fund for each MD, DO, and CRNA provided the primary layer of coverage. Certificates should be filed as close to the effective date of the policy as possible, but no later than 45 days from the start date of the policy.
Noncompliance Process
A health care provider who does not have a certificate or renewal on file within 45 days of licensure, or within 45 days of the expiration date of the most recent certificate on file, is considered delinquent. He or she will be notified by mail.
- The initial notice is sent 45 days after expiration.
- A second notice is sent 30 days later (day 75),
- Referral is made to the Department of Safety and Professional Services after another 30 days (day 105).
For certificates received within 105 days of the primary policy or licensure effective date, a file is created in the Fund’s system and an assessment is mailed to the provider at the next quarterly billing.
For certificates filed late, the insurer may be subject to a late filing fee, and the provider must petition for retroactive coverage. The process for requesting retroactive coverage requires that the health care provider submit an affidavit to the Fund stating that he or she has no notice of any pending claim(s), threatened claim(s), or occurrence(s) that might give rise to a claim during the late period. A provider may request coverage for a period of coverage noncompliance by completing the Request for Retroactive Coverage – Coverage. The form specific to the provider can be found on the provider’s account in the Provider Portal, under the Coverage tab. When you fill out the form via the Provider Portal, the system will prefill much of the required information. Here is a blank form for reference purposes. If the provider cannot attest to this, then retroactive coverage cannot be granted by the Fund Board of Governors.
If a health care provider does not resolve noncompliance coverage issues, the Department of Safety and Professional Services is notified and the Medical Examining Board may suspend or put a hold on the provider’s license.
The Fund Legal Committee reviews the petition for retroactive coverage and makes a recommendation to the Board of Governors to either approve or deny the request. The Board makes the final determination to approve or deny a retroactive coverage request.