IPFCF Frequently Asked Questions

Last Upd​ated: November 15, 2018

Claims
Fees
Participation and Eligibility


Claims

How do you file a medical malpractice claim with the Injured Patients and Families Compensation Fund (Fund)?

The Fund pays the portion of a medical malpractice claim which is in excess of the limits provided by a provider’s primary insurer or self-insurer, currently $1 million. A person filing a claim may recover from the fund only if:

  • the health care provider or the employee of the health care provider has coverage under the fund;

  • the fund is named as a party in the legal action; and 

  • the legal action against the fund is commenced within the same time limitation within which the action against the health care provider or employee of the health care provider must be commenced.     

The Fund contracts with an outside vendor to manage the adjudication of claims.

The process can be outlined as follows:

  • The Fund is named in a suit by the plaintiff, which is served on various parties and the Fund.

  • The Fund verifies whether the provider(s) named in the suit had Fund coverage at the time of the claim incident.

  • The claims contractor establishes claim files.

  • The claims contractor, with approval from the Fund director, hires outside counsel.

  • The claims contractor monitors the case progress with defense counsel.

  • The claim is either settled through negotiations with the plaintiff or is decided at trial.

How do I serve the Fund?

You may serve in person at our office:

    Office of the Commissioner of Insurance
    125 South Webster Street, 2nd floor
    Madison, WI 53703

Service of process should include two authenticated copies of the papers to be served and a self-addressed, stamped envelope to return the certificate to the attorney. There is no charge for personal service.

If you choose to serve the Fund by mail, the requirements are the same; however, there is a $10.00 charge for serving via mail. Enclose a check for $10.00 made out to the Office of the Commissioner of Insurance with the two authenticated copies of the papers to be served and a self-addressed, stamped envelope.

Contact DuWayne Kottwitz at 608-266-0953 or duwayne.kottwitz@wisconsin.gov ​for more information on claims.

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Fees

How are Fund-eligible physicians assessed?

Per s. Ins 17.28, Wis. Adm. Code, providers are charged a fee for participation in the fund based on four risk classes. “Class” is defined as “a group of physicians whose specialties or types of practice are similar in their degree of exposure to loss.”  [s. Ins 17.28 (3) (c), Wis. Adm. Code.] Section Ins 17.28, Wis. Adm. Code, determines which of the four risk classes apply by matching the providers practice with the closest ISO code listed in the administrative code. There are multiple codes for most general practice areas.   

In short, providers are to be classified by determining the ISO code that most closely matches their specialty or type of practice. While board certification may be relevant to determining general categories, not every physician who has the same certification will fall within the same ISO code and risk class. 

How are Fund-eligible facilities assessed?

Entities' charges are determined by the type and corporate structure of the entity.

  • Hospitals: number of occupied beds and outpatients visits

  • Nursing Homes: number of occupied beds

  • Ambulatory Surgery Centers: number of outpatient visits

  • Hospital Affiliates: percentage of the primary malpractice assessment

  • Service Corporations and Limited Liability Corporations: base count consisting of the number of physicians and CRNAs, with additional charges for various allied health professionals

The Fund's Fee page includes a fee schedule showing the current charges for all Fund participants.

Contact Mary Moore at 608-266-7525 or mary.moore@wisconsin.gov for more information about Fund fees.

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Participation and Eligibility

Who must participate in the Fund?

​​Doctors, Certified Registered Nurse A​nesthetists (CRNA) who primarily practice in Wisconsin​, and many types of health care facilities are required to participate in the Fund. The complete list of individuals and facilities is outlined in s. 655.002 (1), Wis. Stat.​

Are corporations and limited liability companies required to participate in the Wisconsin Fund?

The answer depends on whether the organization meets the definition of Fund provider found in s. 655.002 (1), Wis. Stat. If the organization meets all three criteria listed below, Fund participation is mandatory:

  • It is a partnership, corporation, or other organization or enterprise that is organized in Wisconsin.
  • It is operated in Wisconsin.
  • It has the primary purpose of providing the medical services of physicians or nurse anesthetists.

Are medical spas required to participate in the Wisconsin Fund?

The answer depends on whether the medical spa meets the definition of Fund provider found in s. 655.002 (1), Wis. Stat. If a medical spa meets all three criteria listed below, Fund participation is mandatory:

  • It is a partnership, corporation, or other organization or enterprise that is organized in Wisconsin.
  • It Is operated in Wisconsin.
  • It has the primary purpose of providing the medical services of physicians or nurse anesthetists.

If the medical spa has the primary purpose of providing services of allied health care professionals, it would not meet the definition of Fund provider and would not, therefore, be eligible for Fund coverage.  

Are nursing homes required or eligible to participate in the Fund?

Skilled nursing facilities that are subject to s. 655, Wis. Stat., Health Care Liability and Injured Patients and Families Compensation Fund, are nursing homes whose operations are combined as a single entity with a hospital, whether or not the nursing home operations are physically separate from the hospital operations.  You may refer to the statutory definition.

NOTE: Skilled nursing facilities that are operated by governmental agencies are exempt and, therefore,  not subject to s. 655, Wis. Stat. 

Do Fund participants have coverage for employees?

Health care providers who are Fund participants have coverage for employees for damages for bodily injury or death due to acts or omissions of the employee acting with the scope of his or her employment and providing health care services per s. 655.005, Wis.Stat.

Administrative code provides further clarification regarding the reference to supervision and direction of employees in s. 655.005 (2) (a), Wis. Stat.

As a newly licensed physician in Wisconsin, what do I need to know to maintain compliance?

Here is a link to the document that we provide to newly licensed physicians in Wisconsin outlining the requirements of ch. 655, Wis. Stats.

The main points are these:

  • EXEMPTIONS OR EXCLUSIONS: A provider who claims an exemption is not protected by the Fund and may be personally liable for damages awarded for malpractice.

  • BENEFITS: The personal liability of a health care provider who complies with the requirements of ch. 655, Wis. Stat., for acts of malpractice is limited to the mandatory insurance limits required by law. The Fund pays all damages in excess of those amounts. In addition, all claims are required to be processed through mediation prior to civil litigation.

Who is responsible for maintaining compliance with the Fund?

Providers whose participation is mandated and all physicians licensed in Wisconsin are responsible for maintaining compliance with the requirements of ch. 655, Wis. Stat.  

Verification of primary coverage is provided by an insurer or self-insurer authorized to write malpractice insurance in Wisconsin. Payment of Fund fees may be made by the provider or an employer or staffing agency on the provider’s behalf.  

However, the provider is ultimately responsible for maintaining account compliance. That is, any issues resulting from an insurer failing to file a certificate of primary insurance with the Fund or an employer failing to make the minimum payment by the due date may result in licensing action for the provider.

NOTE: Providers who are eligible and elect to file exemption are also considered compliant. 

It is recommended that providers check their accounts periodically. To access the records, please visit our “Search for Provider” webpage. 

How do I verify that I am in compliance with Fund requirements?

The Fund maintains all malpractice coverage records online. In an effort to ensure all records are accurately maintained, the Fund recommends you regularly review your information. To access the records, please visit our “Search for Provider” webpage.

On the “Search for Provider” Web page, a search box is displayed. Please enter a name, license number or city in the search box and the system will display all records matching the search criteria. Next, click on the name you wish to review.

The “Provider Information” page will display three tabs: Coverage, Affiliation, and Noncompliance. 

  • Coverage displays all primary certificates of insurance on file with the Fund (and coverage gaps, if any). Should the provider wish to file for an exemption, click on Online Exemption Form and follow the instructions provided.

  • Affiliation displays groups that have requested to make Fund payments on a provider’s behalf.

  • Noncompliance displays any unresolved issues (e.g., nonpayment or coverage gap). 

To address a coverage noncompliance issue (no certificate of insurance on file with the Fund), please select one of the three options below:

  1. If the provider was not practicing in Wisconsin for the specified period or is otherwise eligible for exemption, the provider may complete a request for exemption by clicking on the “Online Exemption Form” on the Coverage page and following the instructions provided.

  2. If primary coverage is being provided for this period by an insurance carrier, the provider may request the carrier to file a certificate with the Fund.

  3. If primary coverage is not being provided and the provider requires primary and Fund coverage, the provider may complete the request for retroactive coverage by clicking on “Online Retroactive Coverage Form” on the Noncompliance page and following the instructions provided. 

To address a financial noncompliance issue (late/nonpayment of Fund fees), the provider may complete the request for retroactive coverage by clicking on “Online Retroactive Coverage Financial Form” on the Noncompliance page and following the instructions provided.   

For who is participation in the Fund voluntary?

Fund participation is voluntary for doctors and CRNAs for whom Wisconsin is not their principal place of practice or who work less than 240 hours in a fiscal year. More information can be found in s. 655.002 (2), Wis. Stat.​

If Fund coverage is not required but I choose to opt-in, what coverage would the Fund provide?

If your principal place of practice is outside of Wisconsin and you opt to participate in the Fund, coverage would be provided for the Wisconsin portion of your practice only.

Will the Fund provide coverage for the portion of my practice that occurs in Wisconsin for patients who do not reside in Wisconsin?

Whether there is Fund coverage will depend on the specific facts of any claim. That said, in determining where the principal place of practice is located, the Fund reviews whether there was any income earned in Wisconsin and whether there were services involving Wisconsin patients. If income is generated outside of Wisconsin and involves patients from outside of Wisconsin, it would appear that the principal place of practice is not Wisconsin and this work would likely not be covered by the Fund.

If a provider is working for a government entity in Wisconsin is the provider required to participate in the Fund?

Fund coverage does not apply to a provider who is a state, county, or municipal employee, or federal employee or contractor covered under the federal tort claims act, who is acting within the scope of his or her employment or contractual duties (see s. 655.003, Wis. Stat.). Such providers who are licensed in Wisconsin, not practicing outside of such employment for more than 240 hours per fiscal year, may file for exemption from Fund participation.

NOTE: If a provider is not a state, county, or municipal employee but is in a contractual arrangement with a state, county, or municipality, the standard requirements for Fund participation apply.

The exemption form can be found by going to the Fund's public access site. Use the Search for Provider box to find the employee's record. Click the link to the online exemption form on the Coverage page.

Are physicians who volunteer services required to participate in the Fund?

The answer depends on whether the volunteer services fall under the Wisconsin Volunteer Health Care Provider Program (VHCP) as outlined in s. 146.89, Wis. Stat.

If official volunteer status is granted for the services to be provided [through application to the Department of Health Services (DHS)], the volunteer services would be exempted from/ineligible for Fund coverage. Volunteer health care providers are considered state agents of DHS for volunteer services. Coverage would be through the state, not the Fund. Contact DHS for details of participation and coverage. Contact and application information can be found at the DHS VHCP page.

If volunteer status is not sought, or if application is denied, the usual underlying primary malpractice coverage and Fund coverage requirements would apply. The state would not cover Fund fees under this scenario.

Do doctors and CRNAs practicing at tribal clinics participate in the Fund?

It depends where the clinic is located. Providers practicing in clinics located on tribal lands, or lands granted to the tribes tax free, do not participate in the Fund. These clinics are not considered to be owned and operated in Wisconsin.

Doctors and CRNAs practicing in tribal clinics located on nontribal land are required to participate in the Fund.

Are medical directors required to participate in the Fund?

​Yes, medical directors are required to participate in the Fund, as outlined in a bulletin dated April, 1, 2004​.

Are locum tenens physicians practicing in Wisconsin required to participate in the Wisconsin Fund?

Fund participation is required for the entire scope of Wisconsin practice if all three of the following conditions are met:

  • More than 50% of patients are from Wisconsin.

  • More than 50% of income is derived from Wisconsin.

  • Practice in Wisconsin exceeds 240 hours per fiscal year.

If a physician’s principal place of practice is outside of Wisconsin, Fund participation is optional.  

  • If Fund coverage is desired for the Wisconsin portion of practice, a physician must obtain a primary professional liability insurance policy from a Wisconsin-licensed insurer with limits equal to the statutory requirement. 

  • If Fund coverage is not desired, it may be waived by filing exemption.

NOTE: Although the State of Wisconsin does not require Fund participation for physicians whose principal place of practice is outside of Wisconsin, the State of Wisconsin does not monitor specific contractual agreements for locum tenens assignments that may require Fund coverage.

Is a physician practicing telemedicine required to participate in the Wisconsin Fund?

Regardless of the practice location of the physician, Fund participation is REQUIRED for the entire scope of Wisconsin practice if all three of the following conditions are met:

  • More than 50% of patients are from Wisconsin.

  • More than 50% of income is derived from Wisconsin.

  • Practice in Wisconsin exceeds 240 hours per fiscal year.

If a physician’s principal place of practice is outside of Wisconsin, Fund participation is OPTIONAL.  

  • If Fund coverage is desired for the Wisconsin portion of practice, a physician must obtain a primary professional liability insurance policy from a Wisconsin-licensed insurer with limits equal to the statutory requirement. 

  • If Fund coverage is not desired, it may be waived by filing exemption.

How do I change the default dates on the exemption form?

The default dates on the exemption form reflect periods where there is no certificate of primary insurance on file. That is, each date range reflects a gap in coverage gap. If these dates do not correspond with the dates for which you will be waiving Fund coverage,

  • Click the red “Remove” button to the right of the date range. 
  • Click the green “Add More Dates” button to enter the dates for which you will be waiving Fund coverage.
  • Click the blue “Proceed to confirmation” button to complete the process.   

Contact Andrea Nelson at 608-266-9895 or andrea.nelson@wisconsin.gov​ for more information on Fund participation and eligibility.

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​​​Que​stions? Contact the Fund at 608-266-6830 or ociipfcf@wisconsin.gov