Washington Administrative Code

The types of closed medical malpractice claims that must be reported to the OIC include:(1) Claims closed with an indemnity payment;(2) Claims closed with paid allocated loss adjustment expenses; and(3) Claims closed with both indemnity payments and allocated loss adjustment expe…

If a self-insurer, facility or provider waives copayments, forgives bills or deductibles, or makes other similar accommodations to a client, it is not a claim under RCW 48.140.010(1). Reporting entities are not required to report these types of accommodations to the commissioner.…

A claim is closed on the date the reporting entity takes final administrative action to close the claim. Final administrative action occurs after the reporting entity:(1) Issues the final payment to the claimant in the form of a check or draft;(2) Pays all outstanding bills for a…

Under RCW 48.140.020, reporting entities must report all claims closed in the preceding calendar year to the commissioner.(1) Beginning in 2009, closed claim reports for the prior calendar year are due by March 1.(2) A reporting entity may report a closed claim any time after the…

The reporting site will allow the reporting entity to change previously reported closed claim data, subject to these rules:(1) OIC will freeze data contained in the reporting site from March 15 through June 30 each year so the OIC can prepare reports and statistical summaries as …

(1) Consistent with requirements of RCW 48.140.030(1), the reporting entity must assign a different claim identification number to each closed claim report.(a) The claim identifier must consist solely of numbers. When the reporting entity enters a claim into the reporting site, t…

Primary insuring entities are principally responsible for reporting closed claim data required under chapter 48.140 RCW and this chapter to the commissioner.(1) The primary insuring entity must report the total amounts paid to settle the claim, including any claim payments or ALA…

(1) If an excess insuring entity insures a self-insurer and makes indemnity payments or incurs allocated loss adjustment expenses, the excess insuring entity is principally responsible to report closed claim data required under chapter 48.140 RCW and this chapter.(a) Self-insurer…

If a closed claim payment falls within its self-insured retention, the self-insurer must report closed claim data required under chapter 48.140 RCW and this chapter to the commissioner.[Statutory Authority: RCW 48.02.060, 48.140.060, and 7.70.140. WSR 07-12-057 (Matter No. R 2006…

A self-insurer may designate itself to be the principal reporting entity and report closed claim data on behalf of itself and any excess insurer. If the self-insurer designates itself to be the principal reporting entity, the self-insurer must:(1) Notify the commissioner in writi…

Under RCW 48.140.020(1), a facility or provider must report closed claims if the facility or provider:(1)(a) Makes indemnity payments directly to the claimant or incurs ALAE expenses to defend the claim, or both; and(b) There is no insurance coverage available from an insuring en…

RCW 48.140.030 (8)(b) says that reporting entities must report the date that the insuring entity, self-insurer, facility or provider is presented with the claim. For reporting purposes, the "date of notice" is the date on which the:(1) Insured notifies the primary insuring entity…

When reporting medical specialties as required under RCW 48.140.030(2), reporting entities must use the Specialty Codes published by the National Practitioner Data Bank (NPDB).[Statutory Authority: RCW 48.02.060, 48.140.060, and 7.70.140. WSR 07-12-057 (Matter No. R 2006-02), § 2…

When reporting the type of health care facility under RCW 48.140.030(3), the reporting entity must use the Type of Organization Codes published by the NPDB. Public facilities, such as prisons and universities, must review the NPDB Type of Organization Codes and enter the most sim…

When reporting the location within a facility where the incident occurred under RCW 48.140.030(4), the reporting entity must use the incident locations published by the Physician Insurers Association of America in conjunction with its data-sharing project. The reporting entity mu…

When reporting the incident city under RCW 48.140.030(5), the reporting entity must report the incident city based on the location of the facility where the incident occurred. If more than one incident led to the claim, the reporting entity must choose the location where the inci…

When reporting the severity of an injury under RCW 48.140.030(7), the reporting entity must report using the NPDB severity scale. This scale shows the medical outcome for temporary and permanent injuries, and is included below.(1) Temporary injuries include:(a) Emotional injury o…

When reporting the reason for a medical malpractice claim under RCW 48.140.030(11), the reporting entity must use the same Allegation Group and Specific Allegation Codes published by the National Practitioner Data Bank.[Statutory Authority: RCW 48.02.060, 48.140.060, and 7.70.140…

When reporting the final method of claim disposition under RCW 48.140.030(9), reporting entities must describe the method of claim disposition using one of the descriptions listed below:(1) Claim abandoned by claimant.(2) Claim settled by the parties.(3) Claim is disposed of by a…

When reporting the timing of the settlement under RCW 48.140.030(9), reporting entities must report whether the claim is settled:(1) Before filing suit, requesting arbitration or mediation hearing;(2) Before trial, arbitration or mediation;(3) During trial, arbitration or mediati…

Reporting entities must report claim payments on a gross basis and provide the total amount paid to the claimant to settle the claim. The reporting entity must not deduct the value of offsets or recoverables, such as:(1) Reimbursement for a deductible by the insured;(2) Reimburse…

When damages exceed the policy limits, the insuring entity must report the total amount it paid on behalf of its insured. The reporting entity must report:(1) The actual claim payment, which may be either:(a) The policy limit; or(b) The actual amount paid on behalf of the insured…

Subrogation between insuring entities or self-insurers may occur if there is a dispute over which entity should respond to a lawsuit. If an insuring entity or self-insurer receives a subrogation payment, it must report subrogation proceeds and any ALAE incurred to obtain those pr…

(1) If a claim is paid with a structured settlement agreement, the reporting entity must report the lump-sum payment for the purchase of the annuity.(2) If a claim is paid with a combination of a lump-sum payment to the claimant and a structured settlement, the reporting entity m…

If the court itemizes damages, the reporting entity must report these itemized damages:(1) The total amount of the verdict, judgment, or settlement;(2) The gross amount paid to indemnify the claimant;(3) Itemized economic and noneconomic damages as allocated by the court; and(4) …

When reporting claims under RCW 48.140.030 (10)(b), the reporting entity must report losses on a gross basis, including:(1) The total amount of the verdict, judgment, or settlement;(2) The gross amount paid to indemnify the claimant;(3) Paid and estimated economic damages; and(4)…

If more than one claim is filed with a reporting entity due to an incident of medical malpractice, the reporting entity must report companion claims in this manner:(1) If a claimant makes a claim against more than one facility or provider, the reporting entity must assign the sam…

When reporting allocated loss adjustment expenses under RCW 48.140.030 (10)(a)(v) or (b)(iv), the reporting entity must report:(1) ALAE for defense counsel, including both in-house and outside counsel;(2) ALAE for expert witnesses, including both in-house and outside experts;(3) …

(1) Some insuring entities and self-insurers use the services of internal staff to defend claims. For example, an insuring entity or self-insurer may:(a) Ask its professional medical staff to:(i) Evaluate medical care;(ii) Review medical records; or(iii) Assist in case preparatio…

If the reporting entity makes indemnity payments to a claimant, the reporting entity must allocate economic damages based on documented evidence obtained during the claim resolution process. Reporting entities may not allocate using a fixed formula, such as fifty percent of total…

When reporting paid and estimated economic damages, reporting entities must use reasonable judgment to estimate the following elements of loss:(1) Medical expenses;(2) Loss of earnings;(3) Burial costs;(4) Cost of obtaining substitute domestic services;(5) Loss of employment; and…

If a reporting entity makes indemnity payments to a claimant that include compensation for future economic damages, the person calculating damages must use the principles listed in this section.(1) Where appropriate, the person estimating economic damages must:(a) Project the ele…

When estimating economic damages, the person estimating damages may use data from public sources, such as the Bureau of Labor Statistics, to supplement data collected during the claim investigation.[Statutory Authority: RCW 48.02.060, 48.140.060, and 7.70.140. WSR 07-12-057 (Matt…

From time to time, the OIC may publish information or suggestions that reporting entities can use when estimating economic damages. Periodically, the OIC will update its internet site to include links to documents or information of interest to reporting entities.[Statutory Author…

A reporting entity must:(1) Combine all elements of paid and estimated economic loss described in WAC 284-24D-360; and(2) Report one figure for paid and estimated economic loss to the commissioner.[Statutory Authority: RCW 48.02.060, 48.140.060, and 7.70.140. WSR 07-12-057 (Matte…

This chapter contains procedural rules to implement RCW 7.70.140. This chapter describes the rules, practices and procedures that claimants and their attorneys must use to report claim settlement data to the commissioner.[Statutory Authority: RCW 48.02.060, 48.140.060, and 7.70.1…

The definitions in this section apply throughout this chapter.(1) "Claim" means the same as in RCW 48.140.010(1).(2) "Claimant" means the same as in RCW 48.140.010(2), and, for reporting purposes, includes a claimant's legal representative.(3) "Commissioner" means the insurance c…

RCW 42.56.400(11) protects data filed under RCW 7.70.140 from public disclosure. To ensure data confidentiality, the commissioner will:(1) Develop a secure web-based data reporting application;(2) Train OIC staff on applicable laws and agency practices related to protecting confi…

Persons reporting claim settlement data must use the reporting site maintained by the commissioner. To help attorneys and claimants collect data, the commissioner will post a reporting form on the OIC internet site so that claim settlement data can be organized before it is enter…

The reporting site will assign a permanent user ID to an attorney or claimant the first time the attorney or claimant enters claim settlement data into the reporting site.[Statutory Authority: RCW 48.02.060, 48.140.060, and 7.70.140. WSR 07-12-057 (Matter No. R 2006-02), § 284-24…

If a medical malpractice claim is actionable under chapter 7.70 RCW and the claimant receives an indemnity payment from an insuring entity, self-insurer, facility or provider, the claimant or his or her attorney must report claim settlement data to the commissioner.[Statutory Aut…

A claim is settled when the claimant:(1) Receives final indemnity payment(s) from all defendants;(2) Pays all related legal expenses; and(3) Pays all related attorney fees agreed to by the claimant and his or her attorney.[Statutory Authority: RCW 48.02.060, 48.140.060, and 7.70.…

If a self-insurer, facility or provider waives copayments, forgives bills or deductibles, or makes other similar accommodations to a client, it is not a claim under RCW 48.140.010(1). Claimants are not required to report these types of accommodations to the commissioner.[Statutor…

(1) If a claimant is represented by an attorney, the attorney must report claim settlement data to the commissioner after the claim is settled.(2) If a claimant is not represented by an attorney:(a) The claimant must report claim settlement data to the commissioner; and(b) An ins…

Under RCW 7.70.140, a claimant or his or her attorney must report claims settled in the preceding calendar year to the commissioner.(1) Beginning in 2009, claim settlement reports for the prior calendar year are due by March 1.(2) An attorney or claimant may enter data into the r…

The reporting site will allow an attorney or claimant to change previously reported claim settlement data, subject to these rules:(1) OIC will freeze data contained in the reporting site from March 15 through June 30 each year so the OIC can prepare reports and statistical summar…

When reporting the final method of claim disposition under RCW 7.70.140 (2)(b)(v), an attorney or claimant must describe the method of claim disposition using one of the descriptions listed below:(1) Claim is settled by the parties.(2) Claim is disposed of by a court when the cou…

Persons reporting claims must report whether the claim is settled:(1) Before trial, arbitration or mediation;(2) During trial, arbitration or mediation;(3) After trial or hearing, but before judgment or award;(4) After judgment or decision, but before appeal;(5) During an appeal;…

Persons reporting claims must report the total amount paid by all defendants to the claimant to settle the claim.[Statutory Authority: RCW 48.02.060, 48.140.060, and 7.70.140. WSR 07-12-057 (Matter No. R 2006-02), § 284-24E-130, filed 6/4/07, effective 7/22/07.]

(1) If a claim is settled with a structured settlement agreement, the attorney or claimant must report the lump-sum payment that is paid for the annuity.(2) If a claim is settled with a combination of a lump-sum payment to the claimant and a structured settlement, the attorney or…