Report A Claim

If you have received a notice of claim, a lawsuit, or a demand for compensation, you should:

  1. Report the claim to TMIC by calling 800-580-8658. Please allow about 20 minutes for the report call, and have whatever notice you received available for reference. It may also be helpful to have the patient’s medical record available. If calling after hours, please follow the phone prompts to contact the claim supervisor on call.

  2. Fax to 512-328-8067 or send by overnight mail a copy of the notice of claim letter or the lawsuit. Do not fax your medical records. Note that if you are served with a lawsuit, your TMIC policy requires as a condition of coverage that all such lawsuit papers be delivered to TMIC within 10 days of service or receipt of the lawsuit papers, and that you must obtain a delivery receipt from TMIC.  “Delivery of lawsuit papers means sending by certified mail with return receipt requested, personal delivery, messenger, or electronic transmission. Proof of delivery of the lawsuit papers, however, may only be established by the obtaining a written receipt of such delivery from the Company."

  3. Gather a complete and unaltered copy of all pertinent medical records, including a copy of the hospital chart and any prior or subsequent treatment records. Mail a copy of these records to TMIC as soon as possible.

Do not discuss the case with anyone except a TMIC claims representative or the attorney assigned to defend you. You should also:

  1. Maintain your original medical records in a secure place for future reference. Do not make any additions, deletions, or any other type of alteration to the medical records. Secure any other pertinent information or items in your possession, such as billing records, x-rays, hospital charts, etc.

  2. Keep all correspondence to and from TMIC and your assigned attorney in a separate and secure file. These items should not be co-mingled with the original medical chart on the patient. Do not release these materials to anyone unless cleared through your assigned attorney or the TMIC Claims Operations Department.

  3. The TMIC claims representative assigned to your case will keep you fully informed as the case proceeds, both directly and through your assigned attorney. If you have questions, do not hesitate to call your claims supervisor.

The Claim Process

The claim process may take a few months or several years. You will be required to participate in several steps of the process (such as giving a deposition), but often months may pass without the need for your involvement. TMIC claims staff will keep you updated.

  1. TMIC is notified of a claim.

  2. If the policyholder reports the following, a claim file is set up:
    • a notice of claim letter;
    • a lawsuit; or
    • a written demand from a patient for monetary compensation.

  3. If the policyholder reports something other than a notice of claim letter, a lawsuit, or a written demand from a patient, the claims department makes note of the report but does not open a claim file in most instances. This includes reports of unusual incidents, medical record requests, and oral threats.

  4. Once a claim file is set up, the loss is assigned to a claims supervisor and coverage is entered and verified.

  5. A response letter is sent to the policyholder and the plaintiff’s attorney.

  6. The claims supervisor investigates the claim over the next several months. This includes collecting and reviewing the medical records and referring the case to independent medical consultants for evaluation. During this time, the case may become a lawsuit or it may remain as a claim.

  7. If a suit is not filed, the case remains a claim. After the investigation, the claim is re-evaluated on a routine basis. At this time, we will often close a claim if:
    • no lawsuit is filed;
    • there is  no response from the plaintiff’s attorney; or
    • TMIC denies the claim.

    At other times, we will wait until the statute of limitations expires before closing the claim.

  8. If a lawsuit is filed, then we assign a defense attorney. The policyholder receives a letter advising of the attorney assignment.

  9. Under the direction of the TMIC claims supervisor, the defense attorney prepares the case for trial by conducting discovery, locating expert witness testimony, and taking depositions. The claims supervisor, the attorney, and the policyholder work together to develop a defense strategy.

  10. After the investigation, the policyholder, the attorney, and the claims supervisor may decide to settle the case. In most instances, policyholder consent must be given for any settlement.

  11. If settlement is warranted and physician consent is granted (where applicable), negotiations begin. If acceptable terms are reached during negotiations, the case is settled.

  12. The case may also be settled before trial during mediation. At mediation, all parties meet with an independent mediator who may help resolve the case.

  13. If the decision is made to proceed with the trial, a date is scheduled.

  14. The length of a trial varies by complexity and the number of parties involved.

  15. If the defense wins at trial, TMIC may be able to close the claim file. However, the plaintiff may appeal the verdict. If the plaintiff wins at trial, TMIC and defense counsel evaluate the case to determine if there is a legal basis to appeal. Such an appeal may result in a new trial or an opportunity to settle the case.

  16. If we decide to appeal a jury verdict, we will continue to defend the policyholder throughout the appellate process.