NOTICES
INSURANCE DEPARTMENT
Medical Professional Liability Catastrophe Loss Fund; Changes to the C-416 Claim Reporting Form; Bulletin No. 76
[32 Pa.B. 3448] The purpose of this Bulletin is to notify primary carriers and self-insured providers of two changes to the C-416 Claim Reporting Form that these entities must submit to the Medical Professional Liability Catastrophe Loss Fund (Fund) for Excess, Section 605, Drop Down claims and any other coverage requests.
The C-416 Claim Reporting Form has been revised to include Block ''4b.'' Section 308(b) of the Medical Care Availability and Reduction of Error Act of March 20, 2002 requires a medical facility to provide written notification to a patient affected by a serious event or, with the consent of the patient, to an available family member or designee, within 7 days of the occurrence or discovery of a serious event. The date of notification should be entered in Block ''4b'' of the C-416 Claim Reporting Form.
The C-416 Claim Reporting Form has also been revised to include Block ''6a,'' which will now require the primary carrier or self-insured provider to indicate the ''Severity of the Injury'' based upon the following codes:
0--Unknown
1--Emotional Injury Only (upset, fright)
2--Insignificant Injury (small cuts, lacerations, contusions, minor scars, rash, and the like)
3--Minor Temporary Injury (infections, fractures, minor burns, missed or delayed diagnosis and/or recovery without complications)
4--Major Temporary Injury (retained foreign object, other burns, side effects from medication or treatment, brain damage that resolves, infection after surgery, and the like)
5--Minor Permanent Injury (loss of fingers, loss or damage to organs, heart damage with recovery, removal of bowel, loss of one testicle or ovary, and the like)
6--Significant Permanent Injury (deafness, complete or partial loss of limb, eye, one kidney or lung, brachial plexus injury, reflex sympathetic dystrophy which is disabling, and the like)
7--Major Permanent Injury (paraplegia, blindness, loss of two limbs, brain damage, severe and visible disfigurement, permanent colostomy or aseptic necrosis of a joint, a central nervous system injury which is not totally disabling, and the like)
8--Grave Permanent Injury (quadriplegia, severe brain damage, lifelong care or fatal prognosis, cerebral palsy, persistent coma, and the like)
9--Death
If more than one severity code applies to the injuries sustained, all applicable codes should be noted in Block ''6a.'' If no severity code is listed in Block ''6a'' on the C-416 Claim Reporting Form, the form will be returned to the primary carrier for completion.
Because of the many changes occurring as a result of Act 13 of 2002, the C-416 Claim Reporting Form may be further modified. Copies of the current revised C-416 Claim Reporting Form reflecting the changes noted may be obtained at www.pamedcat.state.pa.us or by directly contacting the Fund.
This Bulletin is effective immediately.
M. DIANE KOKEN,
Insurance Commissioner
[Pa.B. Doc. No. 02-1219. Filed for public inspection July 12, 2002, 9:00 a.m.]
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