Glossary

Binding Arbitration:

This is an alternative method of resolving disputes, in which the case is decided by an arbitrator (or panel of three arbitrators) selected by the litigants. While the discovery process in medical malpractice arbitration is similar to that used in Court litigation, the arbitration is conducted privately and is usually less time consuming. The arbitrator(s) render a formal written decision which is final, binding and cannot be appealed except on very limited grounds.

Californians Allied for Patient Protection (CAPP):

Californians Allied for Patient Protection (CAPP) is a broad-based coalition of health care providers, business, labor and consumer organizations, and insurers created to preserve the provisions of MICRA.

Claims Made Coverage:

Liability insurance coverage for claims that occur and are reported during the period in which the insurance policy is in force. Conversely, if a claim is filed after the policy period, it will not be covered unless the policyholder has purchased additional coverage allowing an extended reporting period.

Declarations Page:  

This is the summary page of PRF’s insurance policy, which contains the key information about the policy and policyholder, including the full name of the policyholder, his or her practice location(s), dates the policy is in effect and the limits of coverage. PRF issues a new Declarations Page annually.

Informal Negotiation:

Informal negotiations can take many forms. Even when a formal Complaint has been filed with the Court, PRF attorneys are often able to negotiate with the plaintiff's attorney to resolve the matter before it goes to arbitration or trial. 

Jury Trial:

When there is not an agreement to arbitrate, and the parties cannot resolve the dispute through negotiation or mediation, the case will proceed to trial by jury. A jury trial is a formal, public process. Twelve jurors are selected, and usually the plaintiff and the defendant testify. Other interested parties may also be called to testify, such as family members, treating providers, and expert witnesses. A trial can take several weeks to complete.

Mediation:

Unlike arbitration, mediation is a voluntary process which can only produce a resolution if both parties agree. Typically, the litigants choose a neutral person, such as a retired judge, who has experience with medical malpractice cases. The mediator cannot force the parties to settle, but skilled mediators can often bring about a resolution. If successful, the result includes a binding settlement agreement and dismissal of the lawsuit.

Medical Injury Compensation Reform Act of 1976 (MICRA):

MICRA is legislation that arose from the medical malpractice liability crisis of 1975 when malpractice insurers either drastically increased their rates or withdrew from the market entirely due to the skyrocketing cost of medical injury awards. MICRA is responsible for containing the cost of medical malpractice liability insurance in California.

Occurrence Based Coverage:

Liability insurance coverage for events that occur during the period in which the policy is in force, regardless of when a claim is filed. Occurrence based coverage eliminates the need to purchase tail coverage if the policyholder elects to change malpractice insurance carriers. PRF has offered occurrence based coverage since its inception and is one of the few insurers that continues to provide its policyholders with this level of protection at no additional cost.

PRF Annual General Meeting:

In April or May of each year, PRF has an Annual General Meeting and all policyholders are invited to attend. Proxies are sent out to all shareholders in PRF's holding company, Sphargis, Inc. (all PRF policyholders) and via the proxy vote and the vote of those members in attendance, the Board of Directors is elected. The Board presents a review of the events of the previous year regarding the financial and administrative state of the Company.

Prior Acts Coverage:

Liability insurance coverage for claims arising from acts that occurred before the beginning of the policy period. Policies written on a claims made basis cover only claims filed during the policy period, unless additional tail coverage or extended reporting coverage is purchased when the policy ends. Prior acts coverage is an alternative to tail coverage in which the new insurance carrier provides coverage for the risk normally covered by a tail policy.  

Risk Retention Group (RRG):

An RRG is an insurance company organized under the Federal Liability Risk Retention Act of 1986. By law it may only be owned and capitalized by its policyholders, and must provide liability insurance to an identifiable group facing similar liability exposures, e.g., health care providers facing the risk of malpractice liability to patients. PRF is licensed as a risk retention group by the Vermont Department of Financial Regulation and is registered with the State of California. 

Tail Coverage:

Liability insurance that extends beyond the end of the policy period of a liability insurance policy written on a claims made basis. Liability claims are often made long after the accident or event that allegedly caused the injury. Claims made policies do not cover claims arising during the policy term but which are reported later. To fill the coverage gap, the policyholder must purchase tail coverage separately from the insurer or prior acts coverage from a new insurer.

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Physicians Reimbursement Fund, Inc.

3 Harbor Drive, Suite 116

Sausalito, CA 94965

PHONE: (415) 332-3041  •  FAX: (415) 332-3243