05 LC 28
2103
Senate
Bill 76
By: Senators Hill of the 32nd, Smith of the 52nd, Seabaugh of the 28th, Carter of the 13th, Whitehead, Sr. of the 24th and others
By: Senators Hill of the 32nd, Smith of the 52nd, Seabaugh of the 28th, Carter of the 13th, Whitehead, Sr. of the 24th and others
A
BILL TO BE ENTITLED
AN ACT
AN ACT
To
amend Title 33 of the Official Code of Georgia Annotated, relating to insurance,
so as to change certain provisions relating to medical malpractice insurance
rate filings; to change certain provisions relating to rate increases for
medical malpractice insurance; to provide for approval or rejection of such rate
increases; to provide for certain hearings in connection with such rate increase
approvals; to provide for certain notices and reports; to provide for related
matters; to provide an effective date; to repeal conflicting laws; and for other
purposes.
BE
IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:
SECTION
1.
Title
33 of the Official Code of Georgia Annotated, relating to insurance, is amended
by striking Code Section 33_3_27, relating to reports of awards under medical
malpractice insurance policies, in its entirety and inserting in lieu thereof a
new Code Section 33_3_27 to read as follows:
"33_3_27.
(a)
For the purposes of this Code section, the term 'medical malpractice claim'
means any claim for damages resulting from the death of or injury to any person
arising out of health, medical, or surgical service, diagnosis, prescription,
treatment, or care rendered by a person authorized by law to practice medicine
in this state or by any person acting under such person´s supervision and
control.
(b)
Every insurer providing medical malpractice insurance coverage in this
state,
including authorized insurers, captive insurers, risk retention groups, and
persons or entities self_insured against medical malpractice
claims, shall notify in writing the
Composite State Board of Medical Examiners
and the
Commissioner when it pays a judgment in
excess of $10,000.00 or
enters into
an agreement to pay an amount
makes a
payment in excess of $10,000.00 to settle
a medical malpractice claim against a person authorized by law to practice
medicine in this state; such judgments or
agreements
payments
shall be reported to the board regardless of the dollar amount if the records of
the insurer establish that there have been two or more previous judgments
against or settlements with a licensed physician which relate to the practice of
medicine. Such notice shall be sent within 30 days after the judgment has been
paid or the
agreement has been entered into by the parties involved in the
claim
a payment has
been made to settle a medical malpractice claim against a person authorized by
law to practice medicine in this state. Such report shall include:
(1)
The insured´s name;
(2)
The insurer´s claim number;
(3)
The hospital where the incident occurred;
(4)
The physician´s Georgia medical license number;
(5)
A description of the injury;
(6)
The claimant´s name;
(7)
The patient´s name;
(8)
The insurer´s name;
(9)
The payment amount;
(10)
The date of payment;
(11)
If a civil action was filed, a copy of the complaint and affidavit;
(12)
If a civil action was not filed, a copy of the claim letter from the
plaintiff´s attorney or the patient; and
(13)
A copy of the insured´s National Practitioner Data Bank form.
(c)
Every insurer providing medical malpractice insurance coverage in this state,
including authorized insurers, captive insurers, risk retention groups, and
persons or entities self_insured against medical malpractice claims, shall
submit an annual report on or before March 31 of each year to the Commissioner
containing the following information relating to the immediately preceding
calendar year:
(1)
The number of medical malpractice claims pending at the beginning of the
year;
(2)
The number of medical malpractice claims pending at the end of the
year;
(3)
The number of medical malpractice claims paid;
(4)
The number of medical malpractice claims closed with no payment;
(5)
The number and amounts of medical malpractice claims in which a judgment was
paid, including an identification of the following:
(A)
Highest amount;
(B)
Lowest amount;
(C)
Average amount; and
(D)
Median amount;
(6)
The number and amounts of medical malpractice claims in which a settlement was
paid, including an identification of the following:
(A)
Highest amount;
(B)
Lowest amount;
(C)
Average amount; and
(D)
Median amount;
(7)
The total premium collected;
(8)
The total general and administrative expenses paid; and
(9)
The total loss adjustment expenses paid.
(d)(1)
All information provided pursuant to subsection (c) of this Code section by an
insurer to the Commissioner or the Composite State Board of Medical Examiners
shall be provided on an aggregate basis only and shall not provide specific
information on any individual claim, payment, or settlement.
(2)
The Commissioner shall be authorized to develop data elements and formats for
the filing of reports pursuant to subsections (b) and (c) of this Code section
and to request additional information for all reports submitted pursuant to
subsections (b) and (c) of this Code section in order for the Commissioner to
fulfill his or her duties and to ensure compliance with this Code
section.
(e)
All information submitted to the Commissioner or the Composite State Board of
Medical Examiners pursuant to subsection (b) or (c) of this Code Section shall
not be subject to the provisions of Article 4 of Chapter 18 of Title 50,
relating to the inspection of public records, and thereby shall not be disclosed
or otherwise made public. However, nothing in this subsection shall prohibit
the Commissioner from using or analyzing such information for the purpose of
conducting actuarial or market analysis so long as such use or analysis is
performed in a manner which does not identify, either directly or by reference
to other publicly available information, the case, parties, or sums involved in
any payment or settlement
agreement."
SECTION
2.
Said
title is further amended by adding a new Code section 33_9_21.3 to read as
follows:
"33_9_21.3
(a)
Every domestic, foreign, and alien insurer that is authorized to write medical
malpractice insurance in this state shall maintain with the Commissioner copies
of the rates, rating plans, rating systems, underwriting rules, and policy or
bond forms used by it. The maintenance of rates, rating plans, rating systems,
underwriting rules, and policy or bond forms with the Commissioner by a licensed
rating organization of which an insurer is a member or subscriber will be
sufficient compliance with this Code section for any insurer maintaining
membership or subscriberships in such organization, to the extent that the
insurer uses the rates, rating plans, rating systems, underwriting rules, and
policy or bond forms of such organization; provided, however, that the
Commissioner, when he or she deems it necessary, without compliance with the
rule_making procedures of this title or Chapter 13 of Title 50, the 'Georgia
Administrative Procedure Act,' may require any such insurer to file the required
rates, rating plans, rating systems, underwriting rules, and policy or bond
forms used independent of any filing made on its behalf or as a member of a
licensed rating organization, as the Commissioner shall deem to be necessary to
ensure compliance with the standards of this chapter and for the best interests
of the citizens of this state.
(b)
Any domestic, foreign, or alien insurer that is authorized to write medical
malpractice insurance in this state must file with the Commissioner any rate,
rating plan, rating system, or underwriting rule used in connection with such
insurance. No such rate, rating plan, rating system, or underwriting rule shall
become effective nor shall any premium be collected by any insurer unless the
filing has been received by the Commissioner in his or her office and such
filing has been approved by the Commissioner or a period of 45 days has elapsed
from the date such filing was received by the Commissioner during which time
such filing has not been disapproved by the Commissioner. The Commissioner
shall be authorized to extend such 45 day period by no more than 45 days at his
or her discretion. If a filing is disapproved, notice of such disapproval order
shall be given within 90 days of receipt of filing by the Commissioner,
specifying in what respects such filing fails to meet the requirements of this
chapter. The filer shall be given a hearing upon written request made within 30
days after the issuance of the disapproval order and such hearing shall commence
within 30 days after such request unless postponed by mutual consent. Such
hearing, once commenced, may be postponed or recessed by the Commissioner only
for weekends, holidays, or after normal business hours or at any time by mutual
consent of all parties to the hearing. After such a hearing, the Commissioner
must affirm, modify, or reverse his or her previous action within the time
period provided in subsection (a) of Code Section 33_2_23 relative to orders of
the Commissioner. The requirement of approval or disapproval of a rate filing
by the Commissioner under this subsection shall not prohibit actions by the
Commissioner regarding compliance of such rate filing with the requirements of
Code Section 33_9_4 brought after such approval or disapproval.
(c)
When a rate filing of an insurer required under subsection (b) of this Code
section is not accompanied by the information upon which the insurer supports
the filing and the Commissioner does not have sufficient information to
determine whether the filing meets the requirements of this chapter, then the
Commissioner must request in writing, within 20 days of the date he or she
receives the filing, the specifics of such additional information as he or she
requires and the insurer shall be required to furnish such information and in
such event the 45 day period provided for in subsection (b) of this Code section
shall commence as of the date such information is furnished.
(d)
When a rate filing of an insurer required under subsection (b) of this Code
section will result in any overall rate increase of 10 percent within any 12
month period, the Commissioner shall order an examination of that insurer to
determine the accuracy of the claim reserves, the applicability of the claim
reserve practices for the loss data used in support of such filing, and any
other component of the rate filing; provided, however, that, in the event the
overall increase is less than 25 percent within any 12 month period and the
Commissioner affirmatively determines that he or she has sufficient information
to evaluate such rate increase and that the cost thereof would not be justified,
he or she may waive all or part of such examination. In all other rate filings
required under subsection (b) of this Code section, the Commissioner may order
an examination of that insurer as provided in this subsection. Such examination
shall be conducted in accordance with the provisions of Chapter 2 of this title.
Upon notification by the Commissioner of his or her intent to conduct such
examination, the insurer shall be prohibited from placing the rates so filed in
effect until such examination has been reviewed and certified by the
Commissioner as being complete. Such examination, if conducted by the
Commissioner, shall be reviewed and certified within 90 days of the date such
rate, rating plan, rating system, or underwriting rule is filed; provided,
however, that, if the Commissioner makes an affirmative finding that the
examination may not be completed within the 90 day period, he or she may extend
such time for one additional 60 day period. Any examination required under this
Code section shall be conducted in accordance with Chapter 2 of this
title.
(e)
Rates for medical malpractice insurance shall be based upon each individual
insurer´s experience in this state to the extent actuarially credible.
However, to the extent that an individual insurer´s data is not credible,
then the insurer may utilize the data of other similar admitted insurers in this
state. The experience filed by the insurer shall include, at a minimum, the
loss ratios, allocated and unallocated loss adjustment expenses related to
claims, expenses including commissions and dividends paid, prospective
investment income reasonably expected by the insurer, and pure premium data
adjusted for loss development and loss trending. The insurer´s submission
may also include a consideration for a profit or contingency. The Commissioner
is authorized to accept such rate classifications as are reasonable and
necessary for compliance with this chapter.
(f)
Notwithstanding the provisions of subsection (d) of this Code section, in the
event the filing of any rate, rating plan, rating system, or underwriting rule
under subsection (b) of this Code section is not necessary, in the judgment of
the Commissioner, to accomplish the purposes of this chapter as set forth in
Code Section 33_9_1, then the Commissioner may exempt all domestic, foreign, and
alien insurers from being required to file such rate, rating plan, rating
system, or underwriting rule.
(g)
Filings required pursuant to this Code section shall be accompanied by a fee or
fees as provided in Code Section
33_8_1."
SECTION
3.
Said
title is further amended by adding a new Code Section 33_9_21.4 to read as
follows:
"33_9_21.4
When
a rate filing of an insurer submitted under subsection (b) of Code Section
33_9_21.3 will result in an average base rate increase greater than 25 percent
within any 12 month period, the Commissioner may notify the public of such
proposed rate increase and may hold a public hearing as to the appropriateness
of such rate increase. The hearing shall be conducted in accordance with the
provisions of Chapter 2 of this title. Any person or group that can demonstrate
that they would be affected by the proposed rate increase may intervene in or be
heard in such hearing in accordance with the provisions of Code Section
33_2_21."
SECTION
4.
Said
title is further amended by striking Code Section 33_24_47, relating to notice
required of termination or nonrenewal, in its entirety and inserting in lieu
thereof a new Code Section 33_24_47 to read as follows:
"33_24_47.
(a)
Each insurer licensed to transact business in this state which issues or issues
for delivery in this state policies or contracts of insurance insuring risks or
residents in this state and insuring against liability for loss of, damage to,
or injury to persons or property shall comply with the provisions of this Code
section. This Code section shall not apply to personal automobile or personal
property and casualty insurance policies. Cancellation of a policy for failure
of the named insured to discharge when due any obligations in connection with
the payment of premiums or cancellation for any reason of a policy that has been
in effect for less than 60 days shall be governed by the provisions of Code
Section 33_24_44.
(b)
A notice of termination, including a notice of cancellation or nonrenewal, by
the insurer, a notice of an increase in premiums, other than an increase in
premiums due to a change in risk or exposure, including a change in experience
modification or resulting from an audit of auditable coverages, which exceeds 15
percent of the current policy´s premium, or a notice of change in any
policy provision which limits or restricts coverage shall be delivered to the
insured in person or by depositing the notice in the United States mail, to be
dispatched by at least first_class mail to the last address of record of the
insured, at least 45 days prior to the termination date of such policy;
provided, however, that a notice of cancellation or nonrenewal of a policy of
workers´ compensation insurance shall be controlled by the provisions of
subsection (f) of this Code section. In those instances where an increase in
premium exceeds 15 percent, the notice to the insured shall indicate the dollar
amount of the increase. The insurer may obtain a receipt provided by the United
States Postal Service as evidence of mailing such notice or such other evidence
of mailing as prescribed or accepted by the United States Postal
Service.
(c)
The failure of an insurer to comply with the requirements of subsection (b) of
this Code section
or the failure
of a medical malpractice insurer to comply with the requirements of subsection
(g) of this Code section shall entitle the
policyholder to purchase, under the same premiums and policy terms and
conditions, an additional 30 day period of insurance coverage beyond the
termination date of such policy; provided, however, that the policyholder shall
tender the premium amount, computed on a pro rata basis, to the insurer on or
before the termination date. No provision of this Code section shall be
construed as requiring the insurance coverage under a policy to be extended for
more than 30 days from the termination date stated in such policy. An insurer
shall not be subject to any other penalty for the failure to comply with the
requirements of subsection (b) of this Code section unless the Commissioner
finds, after a hearing, that such noncompliance by the insurer has occurred with
such frequency as to indicate a general business practice by the insurer of
noncompliance with subsection (b) of this Code section. There shall be no
liability on the part of and no cause of action of any nature shall arise
against the Commissioner or the Commissioner´s employees or against any
insurer, its authorized representatives, its agents, its employees, or any firm,
person, or corporation furnishing to the insurer information as to reasons for
cancellation or nonrenewal for any statement made by any of them and in written
notice of cancellation or nonrenewal or in any other communication, oral or
written, specifying the reasons for cancellation or nonrenewal or providing
information pertaining thereto or for statements made or evidence submitted at
any formal or informal hearing conducted in connection therewith.
(d)
This Code section shall not apply to policies canceled in accordance with the
provisions of Chapter 22 of this title.
(e)
Cancellation by the insured shall be accomplished in accordance with Code
Section 33_24_44.1.
(f)
A notice of cancellation or nonrenewal of a policy of workers´ compensation
insurance shall be dispatched to the insured by certified mail or statutory
overnight delivery, return receipt requested, to the last address of record of
the insured at least 75 days prior to the termination date of such policy. The
workers´ compensation insurer shall retain the receipt of mailing provided
by the United States Postal Service as evidence of mailing.
(g)
A notice of increase in premium of a policy of medical malpractice insurance,
other than an increase in premium due to a change in risk or exposure, including
a change of experience modification or resulting from an audit of auditable
coverages, which exceeds 15 percent of the current policy´s premium shall
be delivered to the insured in person or by depositing the notice in the United
States mail, to be dispatched by at least first_class mail to the last address
of record of the insured, at least 60 days prior to the termination date of such
policy. In those instances in which an increase in premium exceeds 15 percent,
the notice to the insured shall indicate the dollar amount of the increase. The
insurer may obtain a receipt provided by the United States Postal Service as
evidence of mailing such notice or such other evidence of mailing as prescribed
or accepted by the United States Postal
Service."
SECTION
5.
This
Act shall become effective upon its approval by the Governor or upon its
becoming law without such approval. This Act shall apply only to those rate
filings that are first filed with the Commissioner on or after the effective
date of this Act.
SECTION
6.
All
laws and parts of laws in conflict with this Act are repealed.