All Texas Medical Liability Trust (TMLT) policies covering individual physicians include the Medefense Endorsement, which provides reimbursement for legal and tax audit expenses for disciplinary proceedings.
The endorsement covers:
- Review actions by the Texas Medical Board (TMB);
- Hospital actions regarding clinical privileges;
- Actions by the Texas Department of State Health Services or the U.S. Department of Health and Human Services;
- Noncompliance with Medicare/Medicaid regulations, including the Recovery Audit Contractor Program;
- Proceedings alleging violations of EMTALA, HIPAA, or Stark laws; and
- Federal tax audits.
In 2011, TMLT enhanced the Medefense endorsement to cover payment of civil fines and penalties associated with disciplinary proceedings. It also increased Medefense limits to $50,000 per insured event, with an annual aggregate limit of $100,000 per policy period.
Medefense benefits are subject to a $1,000 deductible. After the deductible, the physician pays 10 percent of the legal expenses as coinsurance. TMLT will waive the deductible and coinsurance and pay legal expenses directly if you hire an attorney from a panel it provides. The coverage for tax audits is limited to a $5,000 maximum reimbursement.
To take advantage of Medefense coverage:
- Notify TMLT as soon as you receive an initial letter from TMB or another disciplinary authority. Policyholders have 60 days to report an event or letter to be reimbursed for covered expenses.
- Consider retaining an attorney to help draft a narrative and to respond to the disciplinary authority. Upon request, TMLT can furnish policyholders a list of attorneys with experience handling disciplinary proceedings.
In January, TMLT began the $100 million TMLT Trust Rewards Program to reward policyholders for their loyalty. TMLT will fund a Trust Rewards account, based on earned premium, for each policyholder in the program, and the money will be available upon retirement or other qualifying events.
Physicians who become policyholders in 2012 and who sign up for the program will receive a bonus to be credited to their account. Participating physicians will receive quarterly statements documenting the growth of their account. As a member of TMLT and an eligible Trust Rewards enrollee, you will receive money from TMLT when you retire. To continue to be eligible to receive your Trust Reward benefit, you must stay with TMLT. To do that, you need to continue your TMA and county medical society membership.
To participate in this program, eligible physician policyholders must sign up. Online enrollment is available on the TMLT website. Physicians interested in applying for TMLT coverage or who would like more information may call TMLT's sales department at (800) 580-8658.
TMLT is the only medical professional liability insurance provider created and exclusively endorsed by TMA.
Action, April 17, 2012