Section 242.2. Definitions

The following words and terms, when used in this chapter, have the following meanings, unless the context clearly indicates otherwise:

Act—The Health Care Services Malpractice Act (40 P. S. § § 1301.101—1301.1006).

Basic insurance coverage—Insurance or self-insurance with limits of liability which comply with the occurrence-based requirements of the act in section 701 of the act (40 P. S. § 1301.701). In the case of a claims made policy permitted under sections 103 and 807 of the act (40 P. S. § § 1301.103 and 1301.807), the insurance requirements of the act require purchase of the reporting endorsement (that is, tail coverage) or prior acts coverage or its substantial equivalent by the health care provider, upon cancellation or termination of the claims made policy.

Cost to each health care provider—The gross premium, including experience and schedule rating for basic coverage professional liability insurance.

Department—The Insurance Department of the Commonwealth.

Director—The Office of the Director of the Medical Professional Liability Catastrophe Loss Fund.

Emergency surcharge—A surcharge levied by the Insurance Commissioner under section 701(e) of the act (40 P. S. § 1301.701(e)).

Fund—The Medical Professional Liability Catastrophe Loss Fund established by section 701 of the act (40 P. S. § 1301.701).

Gross premium—The entire premium charged the insured, including, but not limited to, binder charges and policy fees, as is generated to secure an occurrence-based policy. In the case of a claims made policy, the gross premium shall be computed as the sum of all the premiums charged for the claims made policy including the reporting endorsement (that is, tail coverage) or prior acts coverage or its substantial equivalent. Payment of the surcharge shall be made at the time that the respective premium is collected subject to the limitation of § 242.6(a)(3) (relating to reporting forms and procedures).

Health care provider—Health care provider as defined by the act.

Insurer—The insurance company providing basic coverage insurance.

The provisions of this § 242.2 adopted October 15, 1976, effective October 16, 1976, 6 Pa.B. 2565; amended October 7, 1977, effective October 8, 1977, 7 Pa.B. 2893; renumbered February 9, 1979, 9 Pa.B. 498; amended August 29, 1980, effective August 30, 1980, 10 Pa.B. 3514; amended September 30, 1983, effective October 1, 1983, 13 Pa.B. 2969; amended through April 27, 1984, effective April 28, 1984, 14 Pa.B. 1453. Immediately preceding text appears at serial pages (85378) to (85379).

Notation

Authority

The provisions of this § 242.2 issued under sections 206 and 506 of The Administrative Code of 1929 (71 P. S. § § 66 and 186); and sections 701(e)(4) and 702(a) of the Health Care Services Malpractice Act (40 P. S. § § 1301.701(e)(4) and 1301.702(a)).

Notes of Decisions

Adequate Remedy

These provisions provide for resolution of complaints of adverse agency action, and as such, do not provide adequate remedy or preclude litigant from seeking relief in court, where issue is Cat Fund’s failure to pay share of malpractice claim settlement, which places Fund in position of defendant, as opposed to its designed position of participant and/or arbiter. Ohio Cas. Group of Ins. Companies v. Argonaut Ins. Co., 525 A.2d 1195 (Pa. 1987).

Validity of Regulations

Director of Medical Professional Liability Catastrophe Loss Fund (CAT Fund) had statutory authority to adopt regulations requiring health care provider with claims policy to also purchase primary insurance to maintain CAT coverage for claims that involve alleged malpractice occurring during period covered by claims policy but filed after expiration of claims policy. Paternaster v. Lee, 863 A.2d 487, 493 (Pa. 2004)