Chapter 383 Malpractice Insurance

383.107 - Publication of market rate.

Steven Groce, Attorney Advertisement

Not later than December 31, 2009, and at least annually thereafter, the director shall, utilizing the information provided pursuant to section 383.106, establish and publish a market rate reflecting the median of the actual rates charged for each of the risk reporting categories for the preceding year by all insurers with at least a three percent market share of the medical malpractice insurance market as of December thirty-first of the prior year, which are certified to have rates which are not inadequate by an actuary selected and approved by the director.

(L. 2006 H.B. 1837)

383.203 - Rates filed with director — form — open to public, copies.

1.Every insurer shall file with the director all rates and supplementary rate information which is to be used in this state.Such rates and supplementary rate information shall be filed before use.

2.Rates filed pursuant to this section shall be filed in such form and manner as prescribed by the director.Whenever a filing is not accompanied by such information as the director has required under this section, the director shall so inform the insurer within thirty days.

3.All rates and supplementary rate information shall, as soon as filed, be open to public inspection at any reasonable time.Copies may be obtained by any person on request and upon payment of a reasonable charge.

(L. 2006 H.B. 1837 § 383.197)

383.037 - Rates, requirements.

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)

383.133 - Reports by hospitals, ambulatory surgical centers, nursing homes, and licensing authorities, when, contents, limited use, penalty.

1.The chief executive office or similarly empowered official of any hospital, ambulatory surgical center, as such terms are defined in chapter 197, temporary nursing staffing agency, nursing home, any nursing facility as such term is defined in chapter 198, or any entity that employs or contracts with licensed health care professionals to provide health care services to individuals 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 description of the facts, including as much detail and information as possible, 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 entity required to report under this section.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 entity 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, A.L. 2007 H.B. 780 merged with S.B. 308, A.L. 2010 H.B. 2226, et al.)

(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.).

383.033 - Association treated as mutual insurance company, tax purposes.

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 for purposes of subdivision (4) of subsection 2 of section 143.441.

(L. 1992 S.B. 831 §§ C, 1)

383.081 - Immunity granted person reporting and director.

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)

383.185 - Annual examination required, cost of, how paid.

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)

383.062 - Reports of real estate malpractice, contents.

1.Every insurer providing real estate malpractice insurance to persons, corporations, copartnerships or associations licensed under the provisions of chapter 339 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)

383.195 - Termination of plan, when.

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)

383.077 - Reports of legal malpractice claims, contents.

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)

383.190 - Appeals and review.

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, financial institutions and professional registration 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.

383.180 - Annual statement, when due, contents of.

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)

383.067 - Immunity granted person reporting and director.

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)

383.016 - Articles of association and bylaws, additional contents.

The articles of association and the bylaws of any association created under the provisions of sections 383.010 to 383.040 shall:

(1)Specify and define the types of assessments, including but not limited to initial, regular, operating, special, any other assessment to cover losses and expenses incurred in the operation of the association, or any other assessment to maintain or restore the association's assets, solvency, or surplus;

(2)Specify by type of assessment the assessments that shall apply to members, former members, or both members and former members of the association; and

(3)With respect to any assessment to cover losses and expenses incurred in the operation of the association and any assessment to maintain or restore the association's assets, solvency, or surplus specify:

(a)The exact method and criteria by which the amounts of each type of assessment are to be determined;

(b)The time in which the assessments must be paid;

(c)That such assessments shall be made without limitation as to frequency;

(d)The maximum amount of any single assessment; and

(e)How such assessments apply to members and former members.

(L. 2006 H.B. 1837)

383.206 - Sale of health care provider policy prohibited, when — determining factors — insurer may charge additional premium or grant discount, when — supporting data — rulemaking authority.

1.Notwithstanding the provisions of sections 383.037 and 383.160, no insurer shall issue or sell in the state of Missouri a policy insuring a health care provider, as defined in section 538.205, for damages for personal injury or death arising out of the rendering of or failure to render health care services if the director finds, based upon competent and compelling evidence, that the base rates of such insurer are excessive, inadequate, or unfairly discriminatory.A rate may be used by an insurer immediately after it has been filed with the director, until or unless the director has determined under this section that a rate is excessive, inadequate, or unfairly discriminatory.

2.In making a determination under subsection 1 of this section, the director of the department of insurance, financial institutions and professional registration may use the following factors:

(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 proved 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;

(4)To the extent Missouri loss experience is available, rates and projected losses shall be based on Missouri loss experience and not the insurance company's or the insurance industry's loss experiences in states other than Missouri unless the failure to do so jeopardizes the financial stability of the insurer; provided however, that loss experiences relating to the specific proposed insured occurring outside the state of Missouri may be considered in allowing a surcharge to such insured's premium rate;

(5)Investment income or investment losses of the insurance company for the ten-year period prior to the request for rate approval may be considered in reviewing rates.Investment income or investment losses for a period of less than ten years shall not be considered in reviewing rates.Industrywide investment income or investment losses for the ten-year period prior to the request for rate approval may be considered for any insurance company that has not been authorized to issue insurance for more than ten years;

(6)The locale in which the health care practice is occurring;

(7)Inflation;

(8)Reasonable administrative costs of the insurer;

(9)Reasonable costs of defense of claims against Missouri health care providers;

(10)A reasonable rate of return on investment for the owners or shareholders of the insurer when compared to other similar investments at the time of the rate request; except that, such factor shall not be used to offset losses in other states or in activities of the insurer other than the sale of policies of insurance to Missouri health care providers; and

(11)Any other reasonable factors may be considered in the disapproval of the rate request.

3.The director's determination under subsection 1 of this section of whether a base rate is excessive, inadequate, or unfairly discriminatory may be based on any subcategory or subspecialty of the health care industry that the director determines to be reasonable.

4.If actuarially supported and included in a filed rate, rating plan, rule, manual, or rating system, an insurer may charge an additional premium or grant a discount rate to any health care provider based on criteria as it relates to a specified insured health care provider or other specific health care providers within the specific insured's employ or business entity.Such criteria may include:

(1)Loss experiences;

(2)Training and experience;

(3)Number of employees of the insured entity;

(4)Availability of equipment, capital, or hospital privileges;

(5)Loss prevention measures taken by the insured;

(6)The number and extent of claims not resulting in losses;

(7)The specialty or subspecialty of the health care provider;

(8)Access to equipment and hospital privileges; and

(9)Any other reasonable criteria identified by the insurer and filed with the department of insurance, financial institutions and professional registration.

5.Supporting actuarial data shall be filed in support of a rate, rating plan, or rating system filing, when requested by the director to determine whether rates should be disapproved as excessive, inadequate, or unfairly discriminatory, whether or not the insurer has begun using the rate.

6.The director of the department of insurance, financial institutions and professional registration shall promulgate rules for the administration and enforcement of this section.Any rule or portion of a rule, as that term is defined in section 536.010, that is created under the authority delegated in this section shall become effective only if it complies with and is subject to all of the provisions of chapter 536 and, if applicable, section 536.028.This section and chapter 536 are nonseverable and if any of the powers vested with the general assembly pursuant to chapter 536 to review, to delay the effective date, or to disapprove and annul a rule are subsequently held unconstitutional, then the grant of rulemaking authority and any rule proposed or adopted after August 28, 2006, shall be invalid and void.

(L. 2006 H.B. 1837 § 383.198)

383.106 - Reporting standards — risk reporting categories — information compiled — report of rates.

1.To effectively monitor the insurance marketplace, rates, financial solvency, and affordability and availability of medical malpractice coverage, the director shall establish by rule or order reporting standards for insurers by which the insurers, or an advisory organization designated by the director, shall annually report such Missouri medical malpractice insurance premium, loss, exposure, and other information as the director may require.

2.The director shall, prior to May 30, 2007, establish risk reporting categories for medical malpractice insurance, as defined in section 383.150, and shall establish regulations for the reporting of all base rates and premiums charged in those categories as determined by the director.The director shall consider the history of prior court judgments for claims under this chapter in each county of the state in establishing the risk reporting categories.

3.The director shall collect the information required in this section and compile it in a manner appropriate for assisting Missouri medical malpractice insurers in developing their future base rates, schedule rating, or individual risk rating factors and other aspects of their rating plans.In compiling the information and making it available to Missouri insurers and the public, the director shall remove any individualized information that identifies a particular insurer as the source of the information.The director may combine such information with similar information obtained through insurer examinations so as to cover periods of more than one year.

4.All insurers with regards to medical malpractice insurance as defined in section 383.150 shall provide to the director, beginning on June 1, 2008, and not less than annually thereafter, an accurate report as to the actual rates, including assessments levied against members, charged by such company for such insurance, for each of the risk reporting categories established under this section.

(L. 2006 H.B. 1837)

383.010 - Authority to form business entity to provide malpractice insurance — nonresidents may be members, when.

1.Notwithstanding any direct or implied prohibitions in chapter 375, 377, or 379, 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, or under rule 8 of the supreme court of Missouri or architects licensed pursuant to chapter 327, 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, liability and automobile insurance as defined in subdivisions (1) and (3) of section 379.230 may be provided upon the assessment plan to those persons licensed pursuant to chapter 197 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.Any entity licensed under chapter 197, professional corporations, and limited liability companies, corporations, limited liability partnerships, partnerships, and other similar entities formed for the practice of law or medicine 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, 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, A.L. 2006 H.B. 1837)

383.110 - Reports, when due, form of.

Such reports shall be made to the director of the department of insurance, financial institutions and professional registration 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)

383.500 - Physicians or surgeons on staff of certain hospitals to furnish malpractice insurance, exceptions.

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)

383.200 - Definition of insurer.

As used in sections 383.200 to 383.209, "insurer" includes any insurance company, mutual insurance company, medical malpractice association, any entity created under this chapter, or other entity providing any insurance to any health care provider, as defined in section 538.205, practicing in the state of Missouri, against claims for malpractice or professional negligence; provided, however, that the term "insurer" or "insurers" shall not mean any surplus lines insurer operating under chapter 384 or any entity to the extent it is self-insuring its exposure to medical malpractice liability.

(L. 2006 H.B. 1837 § 383.196)

383.100 - Definitions.

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, financial institutions and professional registration;

(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)

383.108 - Publication of comparison of base rates.

The director shall, utilizing the information provided under section 383.106, publish comparisons of the base rates charged by each insurer actively writing medical malpractice insurance.

(L. 2006 H.B. 1837)

383.155 - Association created, when — limits of coverage — plan of operation, when due, contents of, amended, how.

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.

383.079 - Duty of director to issue statistical summary.

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)

383.124 - Administrative orders for violations of state laws or rules — civil action for violations.

1.If the director determines that a person has engaged, is engaging, or is about to engage in a violation of sections 383.100 to 383.125 or a rule adopted or order issued pursuant thereto, or that a person has materially aided, is materially aiding, or is about to materially aid an act, practice, omission, or course of business constituting a violation of sections 383.100 to 383.125 or a rule adopted or order issued pursuant thereto, the director may issue such administrative orders as authorized under section 374.046. A violation of any provisions under these sections is a level two violation under section 374.049.The director of the department of insurance, financial institutions and professional registration may also suspend or revoke the license or certificate of authority of any person for any such willful violation as authorized under section 374.047.

2.If the director believes that a person has engaged, is engaging, or is about to engage in a violation of sections 383.100 to 383.125 or a rule adopted or order issued pursuant thereto, or that a person has materially aided, is materially aiding, or is about to materially aid an act, practice, omission, or course of business constituting a violation of sections 383.100 to 383.125 or a rule adopted or order issued pursuant thereto, the director may maintain a civil action for relief authorized under section 374.048.A violation of any provision under these sections is a level two violation under section 374.049.

(L. 2006 H.B. 1837)

383.120 - Immunity granted persons reporting and to director.

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)

383.020 - Director to issue license, when.

The director of the department of insurance, financial institutions and professional registration 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

383.075 - Definitions.

As used in sections 383.075 to 383.083, the following terms mean:

(1)"Director", the director of the department of insurance, financial institutions and professional registration;

(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)

383.175 - Board of directors, qualifications — terms, expenses, payment of authorized.

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 Property Casualty Insurers Association of America, two shall represent insurers which write bodily injury insurance in Missouri and are members of the Missouri Insurance Coalition, 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, A.L. 2006 S.B. 837)

383.165 - Additional first year charge to policyholders.

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)

383.069 - Confidentiality of information and reports.

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)

383.030 - Examination by director authorized — annual license fee — amendments to bylaws filed, when.

1.The director shall be authorized in accordance with sections 374.202 to 374.207, 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.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.L. 2008 S.B. 788)

383.130 - Definitions.

As used in sections 383.130 and 383.133, the following terms shall mean:

(1)"Disciplinary action", any final action taken by the board of trustees or similarly empowered officials of a hospital, ambulatory surgical center, owner or operator of a temporary nursing staffing agency, home health agency, nursing home or any nursing facility as such term is defined in chapter 198, or any entity that employs or contracts with licensed health care professionals to provide health care services to individuals to reprimand, discipline or restrict the practice of a health care professional.Only such reprimands, discipline, or restrictions in response to activities which are also grounds for disciplinary actions according to the professional licensing law for that health care professional 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, a dentist licensed under the provisions of chapter 332, or a podiatrist licensed under the provisions of chapter 330, or a pharmacist licensed under the provisions of chapter 338, a psychologist licensed under the provisions of chapter 337, or a nurse licensed under the provisions of chapter 335, 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;

(4)"Licensing authority", the appropriate board or authority which is responsible for the licensing or regulation of the health care professional;

(5)"Temporary nursing staffing agency", any person, firm, partnership, or corporation doing business within the state that supplies, on a temporary basis, registered nurses, licensed practical nurses to a hospital, nursing home, or other facility requiring the services of those persons.

(L. 1986 S.B. 663 § 1, A.L. 2007 H.B. 780 merged with S.B. 308, A.L. 2010 H.B. 2226, et al.)

383.160 - Policies, period covered — form of policy to be approved — rates, how regulated — assessments, how made — excess funds, disposition of.

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)

383.060 - Definitions.

As used in sections 383.060 to 383.069, the following terms mean:

(1)"Director", the director of the department of insurance, financial institutions and professional registration;

(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)

383.083 - Confidentiality of information and reports.

None of the information reported, compiled or summarized pursuant to sections 383.075to 383.083 shall be discoverable or admissible in any proceeding.

(L. 1985 H.B. 657 & 337 § 5)

383.035 - Association subject to certain laws — grace period for certain associations, limitations — certification filed with annual statement — rules and regulations, director may promulgate — impaired association, director's powers, review of — rating plans, filing of.

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 to 374.049, 374.110, 374.115*, 374.122**, 374.170, 374.190, 374.210, 374.215, 374.216, 374.230, 374.240, 374.250 and 374.280, relating to the general authority of the director of the department of insurance, financial institutions and professional registration;

(2)Sections 375.022, 375.031, 375.033, 375.035, 375.037 and 375.039, relating to dealings with licensed agents and brokers;

(3)Sections 375.041 and 379.105, relating to annual statements;

(4)Section 375.163, relating to the competence of managing officers;

(5)Section 375.246, 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, relating to the use of funds by officers for private gain;

(7)Section 375.445, relating to insurers operating fraudulently;

(8)Section 379.080, 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, 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;

(10)Sections 383.100 to 383.125 relating to reports from medical malpractice insurers;

(11)Sections 383.200 to 383.209 and 383.225 relating to notification, data reporting, and rating requirements.

2.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.

3.The director shall have authority in accordance with section 374.045 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.

4.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.

5.If, 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 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 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 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.

6.If the director issues an order in accordance with subsection 5 of this section, the association may, in accordance with chapter 536, file a petition for review of such order.Any association subject to an order issued in accordance with subsection 5 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 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 may allow an additional time for the implementation of the voluntary plan or may exercise the director's powers to take charge of the association as the director would a mutual casualty company pursuant to sections 375.1150 to 375.1246.Sections 375.1150 to 375.1246 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 5 of this section has been restored to at least zero dollars, the authority and jurisdiction of the director under subsections 5 and 6 of this section shall terminate, but this subsection may again thereafter apply to such association if the conditions set forth in subsection 5 of this section for its application are again satisfied.

7.Any association licensed pursuant to the provisions of sections 383.010 to 383.040 shall place on file with the director, 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 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 or her 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, A.L. 2006 H.B. 1837)

*Section 374.115 was repealed by S.B. 982, 2018.

**Section 374.122 was repealed by H.B. 1090, 1998.

383.125 - Director to forward reported information to appropriate licensing board — further reports, contents, requirements.

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 and of section 383.115.

(L. 1976 H.B. 1308 § 6, A.L. 1993 H.B. 564)

383.025 - Association to commence business, when — liability of members limited — business to be nonprofit, dividends may be paid, how.

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, financial institutions and professional registration 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)

383.225 - Insurer defined — prohibitions on insurers — failure to provide notice, continuation of coverage.

1.As used in this section, "insurer" includes every insurance company authorized to transact business in this state, every unauthorized insurance company transacting business pursuant to chapter 384, every risk retention group, every insurance company issuing policies or providing benefits to or through a purchasing group, and any other person providing medical malpractice insurance coverage in this state.

2.Notwithstanding any other provision of law, no insurer shall, with regards to medical malpractice insurance, as defined in section 383.150:

(1)Fail or refuse to renew the insurance without first providing written notice by certified United States mail to the insured at least sixty days prior to the effective date of such actions, unless such failure or refusal to renew is based upon a failure to pay sums due or a termination or suspension of the health care provider's license to practice medicine in the state of Missouri, termination of the insurer's reinsurance program, or a material change in the nature of the insured's health care practice; or

(2)Cease the issuance of such policies of insurance in the state of Missouri without first providing written notice by certified United States mail to the insured and to the Missouri department of insurance, financial institutions and professional registration at least one hundred eighty days prior to the effective date of such actions.

3.Any insurer that fails to provide the notice required under subdivision (1) of subsection 2 of this section shall, at the option of the insured, continue the coverage for the remainder of the notice period plus an additional thirty days at the premium rate of the existing policy.

(L. 2006 H.B. 1837 § 383.450)

383.170 - Persons eligible to apply for coverage — eligibility requirements.

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)

383.105 - Report of medical malpractice claims by certain insurers, contents, insurer defined.

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 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 sections 383.100 to 383.125, "insurer" includes every insurance company authorized to transact insurance business in this state, every unauthorized insurance company transacting business pursuant to chapter 384, every risk retention group, every insurance company issuing insurance to or through a purchasing group, every entity operating under this chapter, and any other person providing insurance coverage in this state, including self-insured health care providers.

(L. 1976 H.B. 1308 § 2, A.L. 1986 S.B. 663, A.L. 1999 H.B. 445, A.L. 2006 H.B. 1837)

383.005 - Definitions.

As used in this chapter, unless otherwise clearly indicated by the context, the following words mean:

(1)"Department", the department of insurance, financial institutions and professional registration; and

(2)"Director", the director of the department of insurance, financial institutions and professional registration.

(L. 2008 S.B. 788)

383.150 - Definitions.

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, financial institutions and professional registration;

(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)

383.209 - Rate increases over fifteen percent prohibited without notice, exception.

Notwithstanding any other provision of law, no insurer shall, with regards to medical malpractice insurance, as defined in section 383.150, implement any rate increase of more than fifteen percent without first providing clear and conspicuous written notice by United States mail to the insured at least sixty days prior to implementation of the rate increase, unless the increase is due to the request of the insured or due to a material change in the nature of the insured's health care practice or individual's risk characteristics.

(L. 2006 H.B. 1837 § 383.199)

383.040 - Medical malpractice association exempt from premium tax.

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

383.015 - License fee — registered agent required — articles of association required, contents of — bylaws, provisions required and allowed.

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 the department of insurance, financial institutions and professional registration.The articles shall be filed in accordance with the provisions of sections 375.201 to 375.236 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

383.115 - Information confidential, exception.

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.