Frequently Asked Questions

What is Lone Star Alliance, RRG?

• Lone Star Alliance (LSA) is a risk retention group and an affiliated company of Texas Medical Liability Trust (TMLT). It was established to provide medical liability and similar types of insurance to physicians, groups, health care facilities, and health care professionals in multiple states. LSA can meet the needs of TMLT’s new and existing policyholders by writing insurance for those who have operations in states other than Texas.
• LSA is domiciled in Washington DC and began writing business in December 2013.

What is a risk retention group (RRG)?

• An RRG is an alternative insurance entity created by the federal Liability Risk Retention Act (LRRA). RRGs must form as liability insurance companies under the laws of at least one state — its charter state or domicile. The policyholders of the RRG are also its owners. Membership must be limited to organizations or persons engaged in similar businesses or activities, thus being exposed to the same types of liability.

Does TMLT own LSA?

• No. While LSA is affiliated with TMLT, as an RRG it is owned by its policyholders. TMLT — directly and through its subsidiaries — provides LSA with essential operational support. Such support includes financial and accounting services, information technology, underwriting, sales, marketing, claims handling, and risk management functions. These services are provided according to a management services agreement.

Where is LSA located?

• LSA is domiciled in Washington DC, but our office is located in Austin, Texas.

What kind of policies does LSA offer?

• LSA offers a full range of medical liability coverage options for individual and physician groups, and allied health care professionals. We offer claims-made (including prior acts or “nose coverage”) and occurrence policies at a variety of limits. Per-patient policies are also available. Policies may include cyber liability protection, regulatory actions protection, medical director coverage, and employment practices liability insurance.

Who can apply for coverage?

• Any physician, group practice, allied health care professional, or health care entity located outside of Texas can apply for coverage with LSA.
• If a practice located in multiple states applies for coverage, the Texas-based physicians may be insured through TMLT and the physicians based outside of Texas will be insured through LSA.

Do I have to become a member of the Texas Medical Association (TMA) to purchase coverage with LSA?

• No. TMA membership does not apply to LSA. TMA membership remains a requirement for coverage with TMLT.

I am a TMLT policyholder. How do I continue coverage if I decide to leave Texas? Do I have to re-apply for coverage in LSA?

• Because we will need information about your new practice, we will ask you to complete a short application. Please contact your underwriter at 800-580-8658.

What is the difference between LSA coverage and TMLT coverage?

• The LSA policy mirrors the TMLT policy with the exception of state-specific requirements. LSA policies are flexible, and specific policy needs can be modified or endorsed.

Do I qualify for Trust Rewards in LSA?

• TMLT Trust Rewards cannot be extended to LSA policyholders.

What happens to my Trust Rewards balance if I move to LSA?

• Because LSA policyholders are not eligible for the TMLT Trust Rewards program, you will not receive additional Trust Rewards allocations while you are insured with LSA. However, your existing Trust Rewards balance will remain intact while you are with LSA and you will be eligible for payout distributions when a qualifying event occurs.

Does LSA offer dividends?

• LSA does not have a dividend program at this time.

What discounts are available through LSA?

• LSA rewards physicians for their patient safety efforts. The following premium discount opportunities are available in most states:
  • discounts for favorable claim experience;
  • group purchasing credits;
  • discounts for risk management participation;
  • discounts for new-to-practice physicians;
  • part-time discounts; and
  • discounts for completing an LSA CME course (up to 5% for two courses).

Does LSA offer CME?

• Through our Risk Management Department, LSA offers home-study programs and online courses to help reduce liability risk.

Can I take a TMLT CME course and receive a discount for LSA?

• No. You must take an LSA CME course to earn the discount.

Can I apply my TMLT practice review discount to my LSA policy?

• No. Your TMLT practice review discount will not apply to your LSA policy.

Does the LSA claims philosophy align with TMLT’s claims philosophy?

• Yes. Each claim is aggressively defended and we do not settle non-meritorious lawsuits. If a case requires a compromise settlement, our claims staff negotiates to obtain the best possible result. Additionally, we only hire experienced, specialized, medical malpractice defense attorneys to represent our policyholders.

What is considered a claim and what am I required to report?

• Your policy requires you to notify LSA as soon as reasonably possible if you receive any of the following:
  • A demand for compensation — any written communication from or on behalf of a patient that seeks monetary payment or other compensation because of a perceived error in treatment or an unexpected outcome.
  • A notice of claim letter.
  • A lawsuit — will contain a citation (which informs you of a lawsuit) and a petition (which lists the plaintiff versus the defendant). A lawsuit will also include the allegations made against you. Once you are served with a citation and petition, LSA has a limited time to respond by retaining a defense attorney to file an answer on your behalf.
• In the event of a claim, it is essential that you contact the Claims Operations Department as soon as possible. In many cases, we will have limited time to investigate and evaluate the claim. Any delay in reporting could compromise your defense.
• Although not considered "claims" that trigger coverage under your policy, you may want to report these situations and seek advice to possibly prevent the matter from evolving into a future claim:
  • Unexpected outcome — any complication or failure of treatment in which the patient or a patient’s family member may have expressed disappointment with the outcome or if you suspect that a claim may be asserted in the future.
  • Records request — a request for a patient’s medical records may come from the patient, the patient’s spouse, an attorney, a record service, or from a court reporting service in the form of a subpoena. Requests for records should include an authorization signed by the patient or by the patient’s legal representative. It is best to respond to a request as soon as possible. If you suspect that the records request is for potential or ongoing litigation, or if you question the validity of the records request, you should contact LSA for advice.
  • Request for deposition — a deposition is testimony given under oath before a court reporter. You may be served a subpoena for oral deposition, or an attorney may contact you directly. If you are asked to give testimony regarding a patient, particularly if that patient is suing another health care professional, please contact the Claims Operations Department immediately. Depositions can potentially become claims and you should be properly represented at any such proceeding.

How do I report a claim?

• Report the claim to LSA by calling 800-580-8658. Please allow about 20 minutes for the report and have whatever notice you received available for reference. It may also be helpful to have the patient’s medical record available.
   
• 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 LSA policy requires that all such lawsuit papers be delivered to LSA within 10 days of service or receipt of the lawsuit papers, and that you must obtain a delivery receipt from LSA. "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 Corporation."
   
• 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 LSA as soon as possible.

I have reported a claim. What happens next?

• Once a notice of claim is reported, the loss is assigned to a claim supervisor and coverage is entered and verified. Once the claim file is set up in our system, the following occurs:
  • A letter is sent to the policyholder requesting a copy of all medical records regarding the physician’s care of this patient.
  • A response letter is sent to the plaintiff’s attorney or pro-se plaintiff requesting specific allegations, damage information, and a medical authorization that when signed by the patient, allows us to request the pertinent medical records;
  • If a lawsuit has already been filed, then we dispense with the response letter to the plaintiff’s attorney. We assign a defense attorney to answer the lawsuit and defend the physician. The policyholder receives a letter from the claim supervisor advising of the attorney assignment.
• The average time to complete this from the day the loss is called in is about 5 to 10 working days.
• Do not discuss the case with anyone except an LSA claims representative or the attorney assigned to defend you.
  • 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.
  • All correspondence to and from LSA and your assigned attorney should be kept 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 LSA Claims Operations Department.
  • The LSA 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 claim supervisor.

What does claims-made mean?

• A claims-made policy is designed to protect you during the active policy period, usually one year. If you do not renew your claims-made policy when it expires, you no longer have coverage for any claims that may arise in the future that are alleged to have occurred during the time your policy was in force.
• Physicians who wish to continue coverage under a claims-made policy must purchase supplemental coverage, such as tail coverage or prior acts coverage. If neither tail coverage nor prior acts coverage are purchased when a claims-made policy expires, any future claims that might arise from services performed during the policy period will not be covered.

What is an occurrence policy?

• An occurrence policy provides ongoing insurance protection for events that occur during the policy period, even if they are reported after the policy is cancelled.
• Occurrence policies are generally more expensive, but it is not necessary to buy supplemental coverage like tail or prior acts coverage after an occurrence policy expires.

What is prior acts coverage?

• A supplement to a claims-made policy, prior acts coverage is purchased from a new carrier when you change insurance companies. This coverage, also known as nose coverage, covers claims from unknown incidents that occurred before the beginning of your new policy. Prior acts coverage is an alternative to tail coverage, which is purchased from the original carrier when a change in insurance companies is made.
• Companies typically require new policyholders to purchase either prior acts from them, or tail coverage from their prior carrier, to protect against claims arising from prior acts.

What is tail coverage?

• Tail coverage, also called a reporting endorsement, is available for purchase when your claims-made policy is cancelled or non-renewed. Tail coverage continues insurance protection under your claims made policy for claims reported in the future but arising from incidents that occurred while your policy was in force. Tail coverage payment is due within 30 days of policy cancellation.
• LSA offers free tail coverage to physicians who:
  • are 50 years of age or older;
  • have been continuously insured with LSA/TMLT for 5 years or more on a claims-made policy; and
  • the cancellation of the policy is due to retirement from the practice of medicine.
• In addition, LSA waives the tail premium at any time if the physician should stop practicing due to medical disability or death.

What is per-patient based coverage?

• Per-patient based coverage is designed for emergency physicians and urgent care groups, as well as other groups that are structured on a per-encounter basis.
• This type of coverage is more cost effective because pricing is based on the number of visits rather than rated on the number of physicians in the group.

What is cyber liability coverage?

• Cyber liability coverage provides coverage for privacy-related claims that occur as a result of lost laptops, theft of hardware or data, improper disposal of medical records, hacking or virus attacks, and disgruntled employees.
• Cyber liability coverage is included with all LSA policies.

What is Medefense coverage?

• Medefense covers legal expenses, fines, and penalties arising out of medical board and other disciplinary proceedings.
• Medefense coverage is included with all LSA policies.

What is employment practices liability (EPLI) coverage?

• EPLI covers claims that arise from alleged wrongful employment practices, such as discrimination, harassment, and retaliation.
• EPLI coverage is included with all LSA policies.

What coverage is available for my entity?

• Entities, which are defined as an incorporated formation of two or more shareholder physicians practicing under the group's "DBA" name, are eligible for a separate entity policy. The policy provides defense and indemnity coverage when the entity is held legally responsible for the actions of the member physicians. Physicians that are incorporated as a Solo Professional Association or Solo PLLC are provided coverage under their Individual policy on a shared-limit basis.

What does assessable mean?

• Some policies will ask that you pay an assessment in addition to the yearly premiums. Assessments can occur if a company experiences higher claims costs than anticipated. In some cases, assessments can be as much as the full premium. All LSA medical liability policies are non-assessable.

What is general liability insurance?

• General liability insurance refers to a type of business liability insurance other than automobile, workers' compensation, or employer's liability that covers property damage or bodily injury. In a health care setting, general liability insurance would cover such incidents as a visitor slipping on a wet floor of a hospital or office.