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| Home > Statutes > Usa Missouri |
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USA Statutes : missouri
Title : BUSINESS AND FINANCIAL INSTITUTIONS
Chapter : Chapter 383 Malpractice Insurance
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1. Notwithstanding any direct or implied prohibitions in chapter
375, 377, or 379, RSMo, any three or more persons, residents of this
state, being licensed under the provisions of chapter 330, 331, 332, 334,
335, 336, 338 or 339, RSMo, or under rule 8 of the supreme court of
Missouri or architects licensed pursuant to chapter 327, RSMo, may, as
provided in sections 383.010 to 383.040, form a business entity for the
purpose of providing malpractice insurance or indemnification for such
persons upon the assessment plan, and upon compliance with section
379.260, RSMo, liability and automobile insurance as defined in
subdivisions (1) and (3) of section 379.230, RSMo, may be provided upon
the assessment plan to those persons licensed pursuant to chapter 197,
RSMo, and for whom medical malpractice insurance is provided under this
section, except that automobile insurance shall be provided only for
ambulances as defined in section 190.100, RSMo. Hospitals, public or
private, whether incorporated or not, as defined in chapter 197, RSMo, if
licensed by the state of Missouri, professional corporations formed under
the provisions of chapter 356, RSMo, for the practice of law and
corporations, copartnerships or associations licensed under the
provisions of chapter 339, RSMo, may also become members of any such
entity. The term "persons" as used in sections 383.010 to 383.040
includes such hospitals, professional corporations and real estate
business entities.
2. Anything in this section to the contrary notwithstanding, any persons
duly licensed under the provisions of the laws of any other state who, if
licensed under any similar provisions of the laws of this state, would be
eligible to become members and insureds of an entity created under the
authority of this section, may become members and insureds of such an
entity, irrespective of whether such persons are residents of this state;
provided, however, that any such persons must be employed by, or be a
partner, shareholder or member of, a professional corporation,
corporation, copartnership or association insured by or to be insured by
such an entity.
3. Notwithstanding any provision of law which might be construed to the
contrary, sections 379.882 and 379.888, RSMo, defining "commercial
casualty insurance", shall not include professional malpractice insurance
policies issued by any insurer in this state. (L. 1975 S.B. 458 § 1, A.L.
1977 S.B. 245, A.L. 1978 S.B. 744, A.L. 1985 H.B. 657 & 337, A.L. 1986
H.B. 1392, A.L. 1989 H.B. 774, A.L. 1990 H.B. 1739)
1. Any such group of persons desiring to provide malpractice
insurance or indemnification for its members shall pay a license fee of
one hundred dollars and shall file articles of association with the
director of insurance. The articles shall be filed in accordance with the
provisions of sections 375.201 to 375.236, RSMo, and shall also include
the names of persons initially associated, the method by which other
persons may be admitted to the association as members, the purposes for
which organized, the amount of the initial assessment which has been paid
into the association, the method of assessment thereafter, and the
maximum amount of any assessment which the association may make against
any member. The articles of association shall provide for bylaws and for
the amendment of the articles of association and bylaws.
2. Each association shall designate and maintain a registered agent
within this state, and service upon the agent shall be service upon the
association and each of its members.
3. The articles of association shall be accompanied by a copy of the
initial bylaws of the association. The bylaws shall provide for a
governing body for the association, a manner of election thereof, the
manner in which assessments will be made, the specific kinds of insurance
or indemnification which will be offered, the classes of membership which
will be offered, and may provide that assessments of various amounts for
particular classes of membership may be made. All assessments shall be
uniform within classes. The bylaws may provide for the transfer of risks
to other insurance companies or for reinsurance. (L. 1975 S.B. 458 § 2)
Effective 6-26-75
The director of insurance shall, within thirty days after any
such articles of association are filed with him, determine if the
proposed association meets the requirements of sections 383.010 to
383.040, and if it does, shall issue a license to the association
authorizing it to do business for a one-year period. (L. 1975 S.B. 458 §
3)
Effective 6-26-75
The association may, on the seventh day thereafter, commence to
do business. The association shall be a body corporate, and shall do
business as a corporation. No member of the association shall be liable
for any amounts because of his membership in the association other than
his assessments as provided in the articles of association, the bylaws of
the association or as ordered by the director of the department of
insurance pursuant to section 383.035. The business of the association
shall be conducted so as to preclude any distribution of income, profit
or property of the association to the individual members thereof except
in payment of claims or indemnities or upon the final dissolution of the
association, but the association may pay dividends to its members as long
as the association has a positive surplus both before and after any such
dividend is declared. (L. 1975 S.B. 458 § 4, A.L. 1989 H.B. 774, A.L.
1992 S.B. 831)
1. The director of the department of insurance shall be
authorized in accordance with sections 374.190 and 374.200, RSMo, or in
the event that either or both of such sections are repealed, then any
successor sections relating to financial examination, to examine the
financial condition, affairs and management of any association organized
under the provisions of sections 383.010 to 383.040, and the association
shall pay the expenses of any such examination in accordance with
sections 374.160 and 374.220, RSMo. Annually thereafter, within thirty
days before the expiration of its license, each association shall pay a
renewal license fee of one hundred dollars.
2. Any existing association shall also, at the time it files for renewal
of its license, file any amendments to its articles of association or
bylaws which have been adopted in the preceding year. (L. 1975 S.B. 458 §
5, A.L. 1992 S.B. 831)
A Missouri nonprofit corporation formed for the purpose of
providing malpractice insurance upon the assessment plan pursuant to
sections 383.010 to 383.041 shall be treated as a Missouri mutual
insurance company organized under chapter 380, RSMo, for purposes of
subdivision (4) of subsection 2 of section 143.441, RSMo. (L. 1992 S.B.
831 §§ C, 1)
1. Any association licensed pursuant to the provisions of
sections 383.010 to 383.040 shall be subject to the provisions of the
following provisions of the revised statutes of Missouri:
(1) Sections 374.010, 374.040, 374.046, 374.110, 374.115, 374.122,
374.170, 374.210, 374.215, 374.216, 374.230, 374.240, 374.250 and
374.280, RSMo, relating to the general authority of the director of the
department of insurance;
(2) Sections 375.022, 375.031, 375.033, 375.035, 375.037 and 375.039,
RSMo, relating to dealings with licensed agents and brokers;
(3) Sections 375.041 and 379.105, RSMo, relating to annual statements;
(4) Section 375.163, RSMo, relating to the competence of managing
officers;
(5) Section 375.246, RSMo, relating to reinsurance requirements, except
that no association shall be required to maintain reinsurance, and for
insurance issued to members who joined the association on or before
January 1, 1993, an association shall be allowed credit, as an asset or
as a deduction from liability, for reinsurance which is payable to the
ceding association's insured by the assuming insurer on the basis of the
liability of the ceding association under contracts reinsured without
diminution because of the insolvency of the ceding association;
(6) Section 375.390, RSMo, relating to the use of funds by officers for
private gain;
(7) Section 375.445, RSMo, relating to insurers operating fraudulently;
(8) Section 379.080, RSMo, relating to permissible investments, except
that limitations in such section shall apply only to assets equal to such
positive surplus as is actually maintained by the association;
(9) Section 379.102, RSMo, relating to the maintenance of unearned
premium and loss reserves as liabilities, except that any such loss
reserves may be discounted in accordance with reasonable actuarial
assumptions.
2. Any association which was licensed pursuant to the provisions of
sections 383.010 to 383.040 on or before January 1, 1992, shall be
allowed until December 31, 1995, to comply with the provisions of this
section as they relate to investments, reserves and reinsurance.
3. Any association licensed pursuant to the provisions of sections
383.010 to 383.040 shall file with its annual statement a certification
by a fellow or an associate of the Casualty Actuarial Society. Such
certification shall conform to the National Association of Insurance
Commissioners annual statement instructions unless otherwise provided by
the director of the department of insurance.
4. The director of the department of insurance shall have authority in
accordance with section 374.045, RSMo, to make all reasonable rules and
regulations to accomplish the purpose of sections 383.010 to 383.040,
including the extent to which insurance provided by an association may be
extended to provide payment to a covered person resulting from a specific
illness possessed by such covered person; except that no rule or
regulation may place limitations or restrictions on the amount of premium
an association may write or on the amount of insurance or limit of
liability an association may provide.
5. Other than as provided in this section, no other insurance law of the
state of Missouri shall apply to an association licensed pursuant to the
provisions of this chapter, unless such law shall expressly state it is
applicable to such associations.
6. If, after August 28, 1992, and after its second full calendar year of
operation, any association licensed under the provisions of sections
383.010 to 383.040 shall file an annual statement which shows a surplus
as regards policyholders of less than zero dollars, or if the director of
the department of insurance has other conclusive and credible evidence
more recent than the last annual statement indicating the surplus as
regards policyholders of an association is less than zero dollars, the
director of the department of insurance may order such association to
submit, within ninety days following such order, a voluntary plan under
which the association will restore its surplus as regards policyholders
to at least zero dollars. The director of the department of insurance may
monitor the performance of the association's plan and may order
modifications thereto, including assessments or rate or premium
increases, if the association fails to meet any targets proposed in such
plan for three consecutive quarters.
7. If the director of the department of insurance issues an order in
accordance with subsection 6 of this section, the association may, in
accordance with chapter 536, RSMo, file a petition for review of such
order. Any association subject to an order issued in accordance with
subsection 6 of this section shall be allowed a period of three years, or
such longer period as the director may allow, to accomplish its plan to
restore its surplus as regards policyholders to at least zero dollars. If
at the end of the authorized period of time the association has failed to
restore its surplus to at least zero dollars, or if the director of the
department of insurance has ordered modifications of the voluntary plan
and the association's surplus has failed to increase within three
consecutive quarters after such modification, the director of the
department of insurance may allow an additional time for the
implementation of the voluntary plan or may exercise his powers to take
charge of the association as he would a mutual casualty company pursuant
to sections 375.1150 to 375.1246, RSMo. Sections 375.1150 to 375.1246,
RSMo, shall apply to associations licensed pursuant to sections 383.010
to 383.040 only after the conditions set forth in this section are met.
When the surplus as regards policyholders of an association subject to
subsection 6 of this section has been restored to at least zero dollars,
the authority and jurisdiction of the director of the department of
insurance under subsections 6 and 7 of this section shall terminate, but
this subsection may again thereafter apply to such association if the
conditions set forth in subsection 6 of this section for its application
are again satisfied.
8. Any association licensed pursuant to the provisions of sections
383.010 to 383.040 shall place on file with the director of the
department of insurance, except as to excess liability risks which by
general custom are not written according to manual rates or rating plans,
a copy of every manual of classifications, rules, underwriting rules and
rates, every rating plan and every modification of the foregoing which it
uses. Filing with the director of the department of insurance within ten
days after such manuals, rating plans or modifications thereof are
effective shall be sufficient compliance with this subsection. Any rates,
rating plans, rules, classifications or systems in effect or in use by an
association on August 28, 1992, may continue to be used by the
association. Upon written application of a member of an association,
stating his reasons therefor, filed with the association, a rate in
excess of that provided by a filing otherwise applicable may be used by
the association for that member. (L. 1975 S.B. 458 § 6, A.L. 1992 S.B.
831)
The rates made by each association licensed pursuant to sections
383.010 to 383.040 shall be subject to the following provisions:
(1) Rates shall not be excessive or inadequate, nor shall they be
unfairly discriminatory;
(2) No rate shall be held to be excessive unless such rate is
unreasonably high for the insurance provided with respect to the
classification to which such rate is applicable;
(3) No rate shall be held to be inadequate unless such rate is
unreasonably low for the insurance provided with respect to the
classification to which such rate is applicable. (L. 1992 S.B. 831)
No association organized pursuant to the provisions of sections
383.010 to 383.040 shall be required to pay any premium tax in connection
with the conduct of its business. (L. 1975 S.B. 458 § 7)
Effective 6-26-75
As used in sections 383.060 to 383.069, the following terms mean:
(1) "Director", the director of the department of insurance;
(2) "Real estate malpractice insurance", insurance coverage against a
civil liability arising against the insured resulting from an act or
omission by the insured, his agents or his employees acting in their
professional capacity. (L. 1986 H.B. 1393 § 1)
1. Every insurer providing real estate malpractice insurance to
persons, corporations, copartnerships or associations licensed under the
provisions of chapter 339, RSMo, and all employees of the foregoing
acting in the course and scope of their employment shall submit a
confidential report to the director on January first of each year
containing all claims for real estate malpractice made against any of its
insureds during the preceding twelve-month period.
2. The report shall be in writing and on a form prescribed by the
director. One form shall be completed for each claim and the form shall
contain the following information relating to each claim:
(1) The insurer's claim number;
(2) The city population where the claim was made;
(3) How many real estate brokers and agents are insured under the policy;
(4) How many years the insured had been licensed at the time of the
alleged act or omission;
(5) The type of real estate office or entity of which the insured is a
member;
(6) The relationship of the insured to the claimant;
(7) Whether the claim arose after the insured made an attempt to collect
a fee;
(8) The month and year of the occurrence on which the claim was based;
(9) The month and year when the claim was first reported to the insurer;
(10) The alleged act or omission which was the most significantly related
to the cause of the claim being made;
(11) The reserve established for loss payment;
(12) The reserve established for loss expenses; and
(13) The amount of the insured's deductible.
3. The insurer shall, within six months of final disposition of the
claim, report to the director the final outcome of the claim including
any payments made. (L. 1986 H.B. 1393 § 2)
There shall be no liability or cause of action of any nature
against any insurer's agents or employees, or the director or his
representatives, for any action taken pursuant to sections 383.060 to
383.069. (L. 1986 H.B. 1393 § 4)
None of the information reported, compiled or summarized
pursuant to sections 383.060 to 383.069 shall be discoverable or
admissible in any proceeding. (L. 1986 H.B. 1393 § 5)
As used in sections 383.075 to 383.083, the following terms mean:
(1) "Director", the director of the department of insurance;
(2) "Legal malpractice insurance", insurance coverage against a civil
liability arising against the insured resulting from an act of omission
by the insured or his employees acting in their professional capacity.
(L. 1985 H.B. 657 & 337 § 1)
1. Every insurer providing legal malpractice insurance to
attorneys at law or a professional corporation duly engaged in the
practice of law in Missouri and all employees of the foregoing acting in
the course and scope of their employment shall submit a confidential
report to the director on January first of each year containing all
claims for legal malpractice made against any of its insureds during the
preceding twelve-month period.
2. The report shall be in writing and on a form prescribed by the
director. One form shall be completed for each claim and the form shall
contain the following information relating to each claim:
(1) The insurer's claim number;
(2) The city population where the claim was made;
(3) How many lawyers are insured under the policy;
(4) How many years the insured had been in practice at the time of the
alleged act or omission;
(5) The type of law office of which the insured is a member;
(6) The relationship of the insured to the claimant;
(7) Whether the claim arose after the insured made an attempt to collect
a fee;
(8) Whether the claim arose from an area of law normal to the insured's
practice;
(9) The month and year of the occurrence on which the claim was based;
(10) The month and year when the claim was first reported to the insurer;
(11) The area of law in which the insured was retained by the claimant;
(12) The major activity in which the lawyer was engaged at the time the
alleged act or omission occurred;
(13) The alleged act or omission which was the most significantly related
to the cause of the claim being made;
(14) The reserve established for loss payment;
(15) The reserve established for loss expenses; and
(16) The amount of the insured's deductible.
3. The insurer shall, within six months of final disposition of the
claim, report to the director the final outcome of the claim including
any payments made. (L. 1985 H.B. 657 & 337 § 2)
The director shall compile a statistical summary of all data
submitted and shall issue a public report to the Missouri Bar and the
supreme court of the state of Missouri. (L. 1985 H.B. 657 & 337 § 3)
There shall be no liability or cause of action of any nature
against any insurer's agents or employees, or the director or his
representatives, for any action taken pursuant to sections 383.075 to
383.083. (L. 1985 H.B. 657 & 337 § 4)
None of the information reported, compiled or summarized
pursuant to sections 383.075 to 383.083 shall be discoverable or
admissible in any proceeding. (L. 1985 H.B. 657 & 337 § 5)
As used in sections 383.100 to 383.125, the following terms mean:
(1) "Director", the director shall be the director of the department of
insurance;
(2) "Health care provider" includes physicians, dentists, clinical
psychologists, pharmacists, optometrists, podiatrists, registered nurses,
physicians' assistants, chiropractors, physical therapists, nurse
anesthetists, anesthetists, emergency medical technicians, hospitals,
nursing homes and extended care facilities; but shall not include any
nursing service or nursing facility conducted by and for those who rely
upon treatment by spiritual means alone in accordance with the creed or
tenets of any well-recognized church or religious denomination;
(3) "Medical malpractice insurance" means insurance coverage against the
legal liability of the insured and against loss, damage, or expense
incident to a claim arising out of the death or injury of any person as a
result of the negligence or malpractice in rendering professional service
by any health care provider. (L. 1976 H.B. 1308 § 1)
1. Every insurer providing medical malpractice insurance to a
Missouri health care provider and every health care provider who
maintains professional liability coverage through a plan of
self-insurance shall submit to the director of the department of
insurance a report of all claims, both open claims filed during the
reporting period and closed claims filed during the reporting period, for
medical malpractice made against any of its Missouri insureds during the
preceding three-month period.
2. The report shall be in writing and contain the following information:
(1) Name and address of the insured and the person working for the
insured who rendered the service which gave rise to the claim, if the two
are different;
(2) Specialty coverage of the insured;
(3) Insured's policy number;
(4) Nature and substance of the claim;
(5) Date and place in which the claim arose;
(6) Name, address and age of the claimant or plaintiff;
(7) Within six months after final disposition of the claim, the amounts
paid, if any, and the date and manner of disposition (judgment,
settlement or otherwise);
(8) Expenses incurred; and
(9) Such additional information as the director may require.
3. As used in this section, "insurer" includes every insurance company
authorized to transact insurance business in this state, every
unauthorized insurance company transacting business pursuant to chapter
384, RSMo, every risk retention group, every insurance company issuing
insurance to or through a purchasing group, and any other person
providing insurance coverage in this state. With respect to any insurer
transacting business pursuant to chapter 384, RSMo, filing the report
required by this section shall be the obligation of the surplus lines
broker or licensee originating or accepting the insurance. (L. 1976 H.B.
1308 § 2, A.L. 1986 S.B. 663, A.L. 1999 H.B. 445)
Such reports shall be made to the director of the department of
insurance quarterly on dates and in the form to be determined by the
director. (L. 1976 H.B. 1308 § 3, A.L. 1986 S.B. 663)
1. Information submitted pursuant to subsection 2 of section
383.105, subdivisions (1), (3) and (6) shall be deemed to be confidential
communication except as provided in section 383.125.
2. Statistics in summary form of the information submitted pursuant to
sections 383.100 to 383.125, except as provided in subsection 1, shall be
a matter of public record. (L. 1976 H.B. 1308 § 4)
There shall be no liability on the part of and a cause of action
of any nature shall not arise against an insurer reporting hereunder, or
its agents or employees, or the director or his representatives, for any
action taken by them pursuant to this section. (L. 1976 H.B. 1308 § 5)
The director shall, upon receipt, submit in writing the
pertinent and appropriate data and information submitted pursuant to
subsection 2 of section 383.105 to the applicable health care licensing
board. The director shall also submit a report containing the information
described in subdivisions (3) to (8) of subsection 2 of section 383.105
to the director of the department of social services or the director's
designee. Information shall be disclosed to the department of social
services so that the department of social services can determine whether
the claimant or plaintiff was concurrently enrolled in the Medicaid
program during the period in which the alleged incident occurred. The
information provided to the department shall be subject to the
confidentiality restrictions provided in subsection 7 of section 208.217,
RSMo, and of section 383.115. (L. 1976 H.B. 1308 § 6, A.L. 1993 H.B. 564)
As used in sections 383.130, 383.133 and 383.500, the following
terms shall mean:
(1) "Disciplinary action", any final action taken by the board of
trustees or similarly empowered officials of a hospital or ambulatory
surgical center to reprimand, discipline or restrict the practice of a
health care professional. If the health care professional is a physician
or surgeon, only such reprimands, discipline, or restrictions in response
to activities which are also grounds for disciplinary actions pursuant to
section 334.100, RSMo, shall be considered disciplinary actions for the
purposes of this definition. If the health care professional is a
dentist, only such reprimands, discipline, or restrictions in response to
activities which are also grounds for disciplinary actions pursuant to
section 332.321, RSMo, shall be considered disciplinary actions for the
purposes of this definition;
(2) "Health care professional", a physician or surgeon licensed under the
provisions of chapter 334, RSMo, a dentist licensed under the provisions
of chapter 332, RSMo, or a podiatrist licensed under the provisions of
chapter 330, RSMo, or a pharmacist licensed under the provisions of
chapter 338, RSMo, a psychologist licensed under the provisions of
chapter 337, RSMo, or a nurse licensed under the provisions of chapter
335, RSMo, while acting within their scope of practice;
(3) "Hospital", a place devoted primarily to the maintenance and
operation of facilities for the diagnosis, treatment or care for not less
than twenty-four hours in any week of three or more nonrelated
individuals suffering from illness, disease, injury, deformity or other
abnormal physical conditions; or a place devoted primarily to provide for
not less than twenty-four hours in any week medical or nursing care for
three or more nonrelated individuals. The term "hospital" does not
include convalescent, nursing, shelter or boarding homes as defined in
chapter 198, RSMo;
(4) "Licensing authority", the appropriate board or authority which is
responsible for the licensing or regulation of the health care
professional. (L. 1986 S.B. 663 § 1)
1. Beginning on January 1, 1987, the chief executive officer of
any hospital or ambulatory surgical center, as such term is defined in
section 197.200, RSMo, shall report to the appropriate health care
professional licensing authority any disciplinary action against any
health care professional or the voluntary resignation of any health care
professional against whom any complaints or reports have been made which
might have led to disciplinary action.
2. All reports required by this section shall be submitted within fifteen
days of the final disciplinary action and shall contain, but need not be
limited to, the following information:
(1) The name, address and telephone number of the person making the
report;
(2) The name, address and telephone number of the person who is the
subject of the report;
(3) A brief description of the facts which gave rise to the issuance of
the report, including the dates of occurrence deemed to necessitate the
filing of the report;
(4) If court action is involved and known to the reporting agent, the
identity of the court, including the date of filing and the docket number
of the action.
3. Upon request, the licensing authority may furnish a report of any
disciplinary action received by it under the provisions of this section
to any of the hospitals or ambulatory surgical centers required to
report. Such licensing authority may also furnish, upon request, a report
of disciplinary action taken by the licensing authority to any other
administrative or law enforcement agency acting within the scope of its
statutory authority.
4. There shall be no liability on the part of, and no cause of action of
any nature shall arise against any health care professional licensing
authority or any hospital or ambulatory surgical center required to
report under this section, or any of their agents or employees for any
action taken in good faith and without malice in carrying out the
provisions of this section.
5. Neither a report required to be filed under subsection 2 of this
section nor the record of any proceeding shall be used against a health
care professional in any other administrative or judicial proceeding.
6. Violation of any provision of this section is an infraction. (L. 1986
S.B. 663 § 2)
(2001) Statements made in incident report by hospital to state board of
nursing about nurse were not, in absence of actual proceedings pending
against that nurse, entitled to absolute immunity from nurse's libel
claim. Haynes-Wilkinson v. Barnes-Jewish Hospital, 131 F.Supp.2d 1140
(E.D.Mo.).
As used in sections 383.150 to 383.195, the following terms
shall mean:
(1) "Association" means the joint underwriting association established
pursuant to the provisions of sections 383.150 to 383.195;
(2) "Director" means the director of the department of insurance;
(3) "Health care provider" includes physicians, dentists, clinical
psychologists, pharmacists, optometrists, podiatrists, registered nurses,
physicians' assistants, chiropractors, physical therapists, nurse
anesthetists, anesthetists, emergency medical technicians, hospitals,
nursing homes and extended care facilities; but shall not include any
nursing service or nursing facility conducted by and for those who rely
upon treatment by spiritual means alone in accordance with the creed or
tenets of any well-recognized church or religious denomination;
(4) "Medical malpractice insurance" means insurance coverage against the
legal liability of the insured and against loss, damage, or expense
incident to a claim arising out of the death or injury of any person as a
result of the negligence or malpractice in rendering professional service
by any health care provider;
(5) "Net direct premiums" means gross direct premiums written on casualty
insurance in the state of Missouri by companies authorized to write
casualty insurance under chapter 379, RSMo 1969, in the state of
Missouri, less return premiums thereon and dividends paid or credited to
policyholders on such direct business. (L. 1976 H.B. 1309 § 1)
1. A joint underwriting association may be created upon
determination by the director after a public hearing that medical
malpractice liability insurance is not reasonably available for health
care providers in the voluntary market. The association shall contain as
members all companies authorized to write and engaged in writing, on a
direct basis, any insurance or benefit, the premium for which is included
under the definition of "net direct premiums". Membership in the
association shall be a condition of continued authority to do business in
this state.
2. A plan of operation shall be adopted to be effective concurrently with
the effective date of the association.
3. The association shall, pursuant to the provisions of sections 383.150
to 383.195 and the plan of operation, with respect to medical malpractice
insurance, have the authority on behalf of its members:
(1) To issue, or to cause to be issued, policies of insurance to
applicants, including incidental coverages and subject to limits as
specified in the plan of operation but not to exceed one million dollars
for each claimant under one policy and three million dollars for all
claimants under one policy in any one policy year;
(2) To underwrite such insurance and to adjust and pay losses with
respect thereto, or to appoint a service company to perform those
functions;
(3) To assume reinsurance from its members; and
(4) To cede reinsurance.
4. Within forty-five days following the creation of the association, the
directors of the association shall submit to the director for his review,
a proposed plan of operation, consistent with the provisions of sections
383.150 to 383.195.
5. The plan of operation shall provide for economic, fair and
nondiscriminatory administration and for the prompt and efficient
distribution of medical malpractice insurance, and shall contain other
provisions including, but not limited to, preliminary assessment of all
members for initial expenses to commence operations, establishment of
necessary facilities, management of the association, assessment of
members to defray losses and expenses, reasonable and objective
underwriting standards, acceptance and cession of reinsurance,
appointment of a servicing company and procedures for determining amounts
of insurance to be provided by the association. The preliminary
assessment shall be an advance to be recouped under the provisions of
subsection 5 of section 383.160.
6. The plan of operation shall be subject to approval by the director
after consultation with the members of the association, representatives
of the public and other affected* individuals and organizations. If the
director disapproves all or any part of the proposed plan of operation,
the directors shall within fifteen days submit for review a revised plan
of operation. If the directors fail to do so, the director shall
promulgate a plan of operation or part thereof, as the case may be. The
plan of operation approved or promulgated by the director shall become
effective and operational upon his order.
7. Amendments to the plan of operation may be made by the directors of
the association, subject to the approval of the director or shall be made
at his direction. (L. 1976 H.B. 1309 § 2)
*Word "effected" appears in original rolls.
1. All association policies of insurance shall be written so as
to apply to injury which results from acts or omissions occurring during
the policy period. No policy form shall be used by the association unless
it has been filed with the director and approved or thirty days have
elapsed and he has not delivered to the board written disapproval of it
as misleading or not in the public interest. The director shall have the
power to disapprove any policy form previously approved if found by him
after hearing to be misleading or not in the public interest.
2. Cancellation of the association's policies shall be governed by law.
3. The rates, rating plans, rating rules, rating classifications and
territories applicable to the insurance written by the association and
statistics relating thereto shall be subject to the casualty rate
regulation law giving due consideration to the past and prospective loss
and expense experience in medical malpractice insurance of all of the
insurers, trends in the frequency and severity of losses, the investment
income of the association, and such other information as the director may
require. All rates shall be actuarially sound and shall be calculated to
be self-supporting.
4. In the event sufficient funds are not available for the sound
financial operation of the association, additional funds shall be raised
by making an assessment on all member companies. Assessments shall be
made against members in the proportion that the net direct premiums for
the preceding calendar year of each member for each line of insurance
requiring it to participate in said plan bear to the net direct premiums
for the preceding calendar year of all members for such line of
insurance; provided that, assessments made pursuant to sections 383.150
to 383.195 shall not exceed in any calendar year one percent of each
member's net direct premiums attributable to the line or lines of
insurance the writing of which requires it to be a member.
5. All members shall deduct the amount of any assessment from past or
future premium taxes due but not yet paid the state.
6. Any funds which result from policyholder premiums and other revenues
received in excess of those funds required for reserves, loss payments
and expenses incurred and accrued at the end of any calendar year shall
be paid proportionately to the general fund to the extent that credit
against premium tax liability has been granted pursuant to subsection 5
and to members which have been assessed but have not received tax credits
as provided in subsection 5. (L. 1976 H.B. 1309 § 3)
Each policyholder shall pay to the association in the first
policy year, in addition to the premium payment due for insurance through
the association, an amount equal to said premium payment. Such charge
shall be separately stated in the policy. (L. 1976 H.B. 1309 § 4)
1. Any health care provider shall be entitled to apply to the
association for medical malpractice liability insurance. Such application
may be made on behalf of an applicant by a broker or agent authorized by
the applicant.
2. If the association determines that the applicant meets the
underwriting standards of the association as prescribed in the plan of
operation and there is no unpaid, uncontested premium due from the
applicant for prior insurance, then the association, upon receipt of the
premium, or such portion thereof as is prescribed in the plan of
operation, shall cause to be issued a policy of medical malpractice
liability insurance. (L. 1976 H.B. 1309 § 5)
The association shall be governed by a board of eight directors,
to be appointed by the director for the terms specified in the plan of
operation. Two directors shall represent insurers which write bodily
injury insurance in Missouri and are members of the National Association
of Independent Insurers, two shall represent insurers which write bodily
injury insurance in Missouri and are members of the American Mutual
Insurance Alliance, two shall represent insurers which write bodily
injury insurance in Missouri and are members of the American Insurance
Association, and two shall represent insurers which write bodily injury
insurance in Missouri but are not members of any of the foregoing trade
associations. The directors shall be reimbursed out of the administrative
funds of the association only for necessary and actual expenses incurred
for attending meetings of the governing board. (L. 1976 H.B. 1309 § 6)
The association shall file in the office of the director
annually on or before the first day of April, a statement which shall
contain information with respect to its transactions, condition,
operations and affairs during the preceding year. Such statement shall
contain such matters and information as are prescribed and shall be in
such form as is approved by the director. The director may, at any time,
require the association to furnish additional information with respect to
its transactions, condition or any matter connected therewith considered
to be material and of assistance in evaluating the scope, operation and
experience of the association. (L. 1976 H.B. 1309 § 7)
The director shall make an examination into the affairs of the
association at least annually. The expenses of every such examination
shall be borne and paid by the association. (L. 1976 H.B. 1309 § 8)
Appeals and judicial review.
(1) Any applicant to the association, any person insured pursuant to this
article, or their representatives, or any affected* insurer, agent or
agency, may appeal to the director within thirty days after any ruling,
action or decision by or on behalf of the association, with respect to
those items the plan of operation defines as appealable matters.
(2) Any person aggrieved hereunder by any order or act of the director of
the department of insurance may, within ten days after notice thereof,
file a petition in the circuit court of the county of Cole for a review
thereof. The court shall summarily hear the petition and may make any
appropriate order or decree. (L. 1976 H.B. 1309 § 9)
*Word "effected" appears in original rolls.
Termination of any plan created pursuant to the authority of
sections 383.150 to 383.195 shall be by the director pursuant to a public
hearing in which it is determined that medical malpractice liability
insurance is reasonably available to health care providers in the
voluntary market. (L. 1976 H.B. 1309 § 10)
1. Beginning on January 1, 1987, any physician or surgeon who is
on the medical staff of any hospital located in a county which has a
population of more than seventy-five thousand inhabitants shall, as a
condition to his admission to or retention on the hospital medical staff,
furnish satisfactory evidence of a medical malpractice insurance policy
of at least five hundred thousand dollars. The provisions of this section
shall not apply to physicians or surgeons who:
(1) Limit their practice exclusively to patients seen or treated at the
hospital; and
(2) Are insured exclusively under the hospital's policy of insurance or
the hospital's self-insurance program.
2. This section shall not in any way limit or restrict the authority of
any hospital in this state to issue rules or regulations requiring
physicians or other health care professionals to carry minimum levels of
professional liability insurance as a condition of membership on a
hospital medical staff. (L. 1986 S.B. 663 § 3)
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