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Rule 3364-10-01 | Formulation and issuance of policies.
Effective:
September 30, 2019
Promulgated Under:
View Rule Text Last updated May 6, 2021 at 9:03 PM Supplemental Information
Authorized By:
3364
Amplifies: 3364 |
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Rule 3364-10-02 | Public records policy.
Effective:
October 26, 2018
Promulgated Under:
View Rule Text Last updated May 6, 2021 at 9:03 PM Supplemental Information
Authorized By:
3364
Amplifies: 3364 |
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Rule 3364-10-03 | Standard of care committee.
Effective:
March 23, 2020
Promulgated Under:
View Rule Text Last updated May 6, 2021 at 9:03 PM Supplemental Information
Authorized By:
3364
Amplifies: 3364 Prior Effective Dates: 10/26/2018 |
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Rule 3364-10-04 | Claims management committee.
(A) Policy statement The university of Toledo ("UT") will create and maintain a claims management committee ("committee"), as part of its litigation management process, that will evaluate claims made against UT, the university of Toledo physicians, limited liability partnership ("UTP"), or other entities or individuals insured by the university insurance program to determine approximate economic severity, set reserves, assist with defense and litigation strategy, and do other things necessary for management of litigation. (B) Purpose of policy The committee is established to assist UT in the litigation management process. (C) Committee functions (1) Review findings from the standard of care committee for claims where damages are alleged by patients or their legal representatives against the insureds of the university insurance company. (2) Determine legal defensibility and formulate defense strategy based on strength of internal and external review, quality of documentation, damage assessment, risk exposure of institution and physicians and discovery issues to date. (3) Determine the pragmatic course for disposition and make recommendations for settlement to the executive vice president for clinical affairs. (4) Establish, in consult with defense counsel, an indemnity reserve for each claim and divide the reserve according to the percentage of responsibility allocated to each co-defendant as determined by the standard of care committee. Expense reserves will be established administratively by risk management in consult with defense counsel. Monitor the reserves as the claim develops and amend as appropriate. (5) Coordinate claims between UT and UTP as needed and ensure no conflicts and a presence of attorney-client privilege. (6) Do other things necessary for management of litigation. (D) Committee membership Members of the claims management committee will be: (1) Executive vice president for clinical affairs (chair); (2) Hospital finance representative; (3) UTP executive director; (4) UTP chief financial officer; (5) Defense counsel*; and (6) Risk manager. * Non-voting members (E) Meetings The claims management committee will meet on a monthly basis or as often as necessary. (F) Protected information The claims management committee supports legal counsel in anticipation or preparation of litigation, defense strategies, and resolution decisions. The activities of the claims management committee, including any information, data, reports, or records are attorney-client privileged/work product, are peer review protected and are not subject to disclosure. Last updated June 25, 2021 at 7:06 PM Supplemental Information
Authorized By:
3364
Amplifies: 3364 |
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Rule 3364-10-05 | Underwriting committee.
Effective:
October 26, 2018
Promulgated Under:
View Rule Text Last updated May 6, 2021 at 9:03 PM Supplemental Information
Authorized By:
3364
Amplifies: 3364 |
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Rule 3364-10-06 | Practice location aproval.
(A) Policy statement The university of Toledo ("UT") professional liability insurance program provides coverage to physicians and certain clinical associates ("insured(s)") of the university of Toledo physicians, limited liability corporation ("UTP") who practice at practice locations that have been approved by the executive vice president for clinical affairs and UT dean, college of medicine and life sciences ("executive VP"). Practice locations owned or controlled by UT or UTP (see appendix A to this rule) have been pre-approved, however, practice location fact sheets and procedure checklists do need to be submitted to risk management for entry into the practice location database. (B) Purpose of policy To provide a procedure for approving the practice locations of insureds for coverage under the UT professional liability insurance program. (C) Procedure (1) Professional liability insurance underwriting An individual's underwriting approval for professional liability insurance coverage in the UT professional liability insurance program will not be delayed pending the practice location review process, however, all attempts will be made to identify and approve the locations as soon as practical so the insurance program will be able to keep an accurate, up to date record of the insurance coverage dates and locations. (2) Practice location approval process at the time of initial hiring or staff appointment (a) The administrator for risk management will review the fact sheets and procedure checklists that are part of the application for appointment. If any additional information is needed, the administrator for risk management will obtain it directly from the insured. (b) When the fact sheets and procedure checklists are deemed complete, the administrator for risk management will attach an approval form to the set of forms for each practice location requiring approval (i.e. those locations not listed in appendix A to this rule). This makes up the approval packet for each practice location. (c) The approval packets will be sent to the following individuals, in the order listed on the approval form. Each individual will indicate either approval or non-approval and forward the forms on to the next individual. (i) Insured's department chairperson; then to (ii) Executive VP; then to (iii) UTP chief physician executive or UTP chief operating officer; and then return to (iv) Administrator for risk management. (d) Approval with conditions may also be granted. The condition or restriction applying to a particular practice location will be noted in the comments of the approval section of the approval form by the individual setting the condition. (e) The completed approval packet (whether approved or denied) will be returned to the administrator for risk management, who will then forward a copy to the insured, department chairperson, UTP human resources and the central verification office (for provider enrollment). (f) Risk management will update its practice location database. (3) New practice location approval process after initial appointment (a) An insured wishing to have a new practice location added to his/her current approved locations will fill out a fact sheet and procedure checklist for that new location. (b) If the location is not listed on appendix A to this rule as pre-approved, the Insured will complete the upper part of the approval form and attach it to the fact sheet and procedure checklist specific to the location. This makes up the approval packet for that practice location. (c) Paragraphs (C)(2)(c) to (C)(2)(f) of this rule are completed. (d) If the location is listed on appendix A of this rule and does not require further approval, then the fact sheet and procedure checklist are sent directly to risk management. (4) Annual practice location audit (a) Each insured will be surveyed on an annual basis with respect to their practice locations. (i) On even numbered years, the administrator for risk management will provide each insured with a listing of their locations that are in the risk management practice location database and the insured will update the list as appropriate. (ii) On odd numbered years, the administrator for risk management will provide each insured with a copy of the fact sheet and procedure checklist for each location that is in the risk management practice location database and the insured will update the information as appropriate. (b) During the annual audit, insureds will be instructed to complete a new fact sheet and procedure checklist for any location where they practice but forms are lacking. (c) Any returned forms that contain significant changes or any form for a new location requiring approval will have an approval form attached by the administrator for risk management and will be forwarded for approval as outlined in paragraph (C) of this rule. (5) Appeal process for non-approval or conditional approval The insured or department chairperson may appeal the non-approval or conditional approval of any location to the individual who disapproved or placed a conditional approval on the location. The administrator for risk management will be advised of any change in approval status following the appeal. (6) Forms The following three forms will make up a practice location approval packet ("approval packet") and will be completed by insureds for each location where they are seeking to practice. (a) Practice location approval form: This form is used for any location that requires approval and is not listed on appendix A to this rule. It serves as the cover page that is attached to each practice location fact sheet and procedure checklist and documents the approval process for a particular practice location. This form will be signed off by the insured's department chairperson, executive VP and UTP's chief physician executive or chief operating officer. (b) Practice location fact sheet: This form must be completed for every location where an insured intends to practice. It is used to evaluate that particular location's role in supporting the teaching mission, research mission and strategic mission of UT. This form is completed for all practice locations, even those pre-approved locations listed in appendix A to this rule. (c) Practice location procedure checklist: This form must be completed for every location where an insured intends to practice. It is used to evaluate the type of practice and procedures that will be done at that particular location and helps establish the insurance risk rating for that location. The checklist has nothing to do with credentialing or privileging at that location. This form is completed for all practice locations, even those pre-approved locations listed in appendix A to this rule. (7) Quarterly practice location reports The administrator for risk management will provide the executive VP, UTP chief financial officer and director of the central verification office a quarterly report of all UTP insureds and their practice locations. Last updated June 25, 2021 at 7:06 PM Supplemental Information
Authorized By:
3364
Amplifies: 3364 Prior Effective Dates: 8/24/2020 |
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Rule 3364-10-07 | Delegation of authority for development, review and signature of university policies.
Effective:
September 30, 2019
Promulgated Under:
View Rule Text Last updated May 6, 2021 at 9:03 PM Supplemental Information
Authorized By:
3364
Amplifies: 3364 |
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Rule 3364-10-09 | Reporting professional liability claim payments.
(A) Policy statement It is the policy of the university of Toledo ("university") to follow a consistent and legally compliant procedure when the university makes payment(s) in settlement of a professional liability claim or to satisfy a judgment order pertaining to allegations of professional liability and when such payments are made on behalf of a named defendant ("defendant") who is a participant ("participant") in the university of Toledo's professional liability insurance program ("insurance program"). (B) Purpose of policy To define the responsibilities of the university in regard to the reporting of payments made as a result of alleged professional liability to assure compliance to all state and federal laws and regulations. (C) Procedure (1) Reporting to the state medical board of Ohio (a) The university will notify the state medical board of Ohio within thirty days after the final disposition of any written claim for damages, arising from patient care, when: (i) The physician, physician assistant, or anesthesiology assistant who is a defendant of the written claim is a participant in the university's insurance program; and (ii) The final disposition of the written claim results in payment made on behalf of a defendant which exceeds twenty-five thousand dollars or as such other requirements set forth in Ohio law as they may be amended from time to time. (b) For purposes of reporting to the state medical board of Ohio, the following will apply: (i) The amount of payment will mean the aggregate gross settlement, not including court costs or other litigation costs. (ii) The present value of future payments will be used in calculating the aggregate gross settlement in cases of structured payments. (iii) In cases involving multiple insurance program defendants where payment exceeds twenty-five thousand dollars but no specific allocation is made in the disposition of the claim by the settlement or judgment order, a report will be filed with the state medical board for each of the defendants upon whose behalf the payment is made. (iv) Payments made solely for damages not arising from patient care will not be reported. (v) The waiver of an outstanding debt or charge for services will not be construed as a payment. (c) Each notification to the state medical board will include the following: (i) The name and address of the person submitting the notification; (ii) The name of the university of Toledo; (iii) The name and address of the defendant of the claim; (iv) The name of the person filing the written claim (plaintiff); (v) The date of final disposition; (vi) The amount of payment; and (vii) If applicable, the identity of the court in which the final disposition took place. (2) Reporting to the national practitioner data bank ("NPDB"): (a) The university will notify the NPDB within thirty days of the date that a payment is made in settlement of, or in satisfaction in whole or in part of a written claim or judgment, arising from patient care for a participant in the university's insurance program with regard to the physician, dentist, or other health care provider who is the subject of the claim. (b) For purposes of reporting to the NPDB, the following will apply: (i) Reporting payment(s) to the NPDB requires that: (a) The participant be named in the caption or body of a written complaint or claim demanding monetary payment for alleged damages; and (b) The participant is named in a settlement release or final adjudication related to the alleged incident. (ii) Reports will be submitted to the NPDB when professional liability payments are made for the benefit of licensed residents or fellows who are participants in the insurance program; (iii) Payments made for the benefit of medical or dental students are not reportable to the NPDB, but all other health care professionals licensed under Ohio law are reportable; (iv) A payment made to settle a professional liability claim or action is not reportable to the NPDB if the participant is dismissed from the lawsuit prior to the settlement or judgment due to lack of involvement in the alleged incident. (v) A payment made at the low end of a high-low agreement that is in place prior to a verdict will not be reported to the NPDB if the fact-finder rules in favor of the participant and assigns no liability to the participant; and (vi) A complaint filed in any competent court asserting a professional liability claim and demanding payment constitutes a written claim for damages. (c) Each notification to the NPDB will include a narrative description of the acts or omissions and injuries and illnesses upon which the professional liability action or claim was based, including the following: (i) Age of the claimant at the time of the initial alleged event; (ii) Sex of the claimant; (iii) Patient type (inpatient, outpatient, or both); (iv) Initial event or medical condition of the patient (words that best describe the diagnosis); (v) Procedure performed or treatment rendered by the participant as provider to the patient for the medical condition described; (vi) Claimant's allegation (the occurrence that precipitated the claim of damages); (vii) Associated legal or other issues which have an impact on the claim; and (viii) The outcome. Last updated June 25, 2021 at 7:06 PM Supplemental Information
Authorized By:
3364
Amplifies: 3364 |
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Rule 3364-10-10 | Reporting and processing on the job injuries for workers' compensation purposes.
(A) Policy statement It is the policy of the university of Toledo that when a university employee has a work related injury or occupational disease, they will seek appropriate medical care, report the injury to their supervisor and complete and submit the injury and illness report form to the workers' compensation department or their supervisor. (B) Purpose of policy This policy provides direction to the employee and their supervisor on how to assure that an employee with a work related injury or occupational disease: (1) Receives proper medical care; and (2) Submits the documentations that will initiate a workers' compensation claim when appropriate, and provide information for accident investigation and safety hazard elimination, when appropriate. (C) Procedure: Caring for the injured employee is the first concern. The university will provide any necessary emergency medical care through its health facilities and/or other qualified health care providers for employees who are injured during the performance of their duties, and to properly record pertinent information for accident investigation, safety hazard elimination, and workers' compensation, when appropriate. (1) This policy applies to all university of Toledo employees, full or part-time, who are injured in the course and scope of university employment. (a) All injuries must be reported to the supervisor by the injured party or, if the injured party is not able to do so, a co-worker, by the end of the shift or as soon as is practical. (b) Anyone who is aware of unsafe conditions or working practices has an obligation to report them to their supervisor and the office of safety and health. (2) When on-the-job injury or illness occurs: (a) As soon as possible after an injury, the supervisor or department chairman will notify the workers' compensation department of the occurrence of the injury. In the absence of a supervisor, a fellow supervisor should notify the workers' compensation department via phone, voice mail, or e-mail. (b) When employees are seen in the emergency department of university health services, the treating department will immediately notify the workers' compensation department. (c) Workers' compensation personnel will inform the office of safety and health of any safety issues pertaining to the employees injury/illness. (3) Completing injury and illness incident form: (a) As soon as physically able, the injured employee will file with his or her supervisor a written statement explaining the accident, using part one of the injury and illness incident form. Where necessary, the supervisor will assist the employee in preparing this statement. Copies of the injury and illness incident form can be obtained in the workers' compensation department or on-line at http://www.utoledo.edu/depts/risk/pdfs/EmployeeIncidentForm.pdf. (b) The supervisor will obtain signed statements from individuals who witnessed the accident. These statements may be recorded in the supervisor's analysis of the original, or copies of the injury and illness incident form filed by the injured employee. (c) The supervisor will complete supervisor's analysis of the injury and illness incident form, including the identified causes of the accident. (i) The supervisor will file the completed injury and illness incident form with the workers' compensation department as soon as possible after the accident. (ii) If the severity of the injury prevents the injured employee from filing a report, even with assistance, the supervisor will file a preliminary report giving all available information and will file supplemental reports with additional information, and the employee's report, at the earliest possible date. (d) In addition to the reports of the incident, the main campus classified employee's absence and return to work will be reported on the regular absence report (form "PE" 203 195). (4) Workers' compensation department role: (a) The workers' compensation department will provide the necessary forms to initiate a claim with the Ohio bureau of workers' compensation ("BWC"). "BWC" then assesses the claim and makes the decision to allow or disallow the claim. (5) After a claim has been submitted: (a) Upon receipt of the claim, "BWC" will mail out notification of the assigned claim number. It is then the employee/claimant's responsibility to provide said claim number to all health care providers, along with any other information request to ensure proper billing of claim related charges. (b) In the event the claim is disallowed, the employee will have appeal options as outlined in the "BWC" order, or industrial commission correspondence. (6) Contact information: if an employee or supervisor has any questions regarding this policy or procedure, they can contact the main campus office (419-530-3655), or the health science campus office (419-383-4567). Last updated June 25, 2021 at 7:06 PM Supplemental Information
Authorized By:
3364
Amplifies: 3364 |
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Rule 3364-10-13 | Use of legal counsel.
Effective:
November 3, 2016
Promulgated Under:
View Rule Text Supplemental Information
Authorized By:
3364
Amplifies: 3364 |
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Rule 3364-10-14 | Contract review and approval process.
Effective:
November 26, 2018
Promulgated Under:
View Rule Text Last updated May 6, 2021 at 9:03 PM Supplemental Information
Authorized By:
3364
Amplifies: 3364 |
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Rule 3364-10-15 | Subpoenas.
Effective:
July 11, 2016
Promulgated Under:
View Rule Text Supplemental Information
Authorized By:
3364
Amplifies: 3364 |
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Rule 3364-10-16 | Professional liability claims reporting and management.
Effective:
October 29, 2018
Promulgated Under:
View Rule Text Last updated May 6, 2021 at 9:03 PM Supplemental Information
Authorized By:
3364
Amplifies: 3364 |
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Rule 3364-10-17 | Minors on campus.
Effective:
March 23, 2020
Promulgated Under:
View Rule Text Last updated May 6, 2021 at 9:03 PM Supplemental Information
Authorized By:
3364
Amplifies: 3364 Prior Effective Dates: 10/26/2018 |