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284-24D-010  <<  284-24D-020 >>   284-24D-030

WAC 284-24D-020

Agency filings affecting this section

Definitions.

The definitions in this section apply throughout this chapter.
(1) "Allocated loss adjustment expense" or "ALAE" means defense and cost containment expenses paid or incurred for defense, litigation and medical cost containment expenses and services. Either internal staff, such as in-house counsel or professional medical staff, or external staff, such as defense counsel or expert witnesses, may provide defense and cost containment services.
(a) Defense and cost containment expenses and services include:
(i) Defense services provided by:
(A) Attorneys or expert witnesses; and
(B) Private investigators, hearing representatives or fraud investigators.
(ii) Cost containment activities and services performed by external or internal experts to defend the claim, including:
(A) Case evaluation, such as evaluating whether the medical care provided met professional standards;
(B) Risk assessment;
(C) Case preparation and management;
(D) Medical record review; and
(E) Settlement negotiations.
(iii) Specific case-related expenses, such as:
(A) Surveillance expenses;
(B) Court costs;
(C) Medical examination fees;
(D) The costs of laboratory, X-ray and other medical tests;
(E) Autopsy expenses;
(F) Stenographic expenses;
(G) Fees associated with witnesses and summonses; and
(H) The costs to obtain copies of documents.
(b) Allocated loss adjustment expenses do not include:
(i) Expenses incurred to determine whether coverage is available; or
(ii) Expenses or costs associated with external or internal claims adjusting staff.
(2) "Claim" means the same as in RCW 48.140.010(1).
(3) "Claim identifier" means the unique number assigned to a claim by the reporting entity as required by RCW 48.140.030 (1)(a).
(4) "Claimant" means the same as in RCW 48.140.010(2).
(5) "Closed claim" means the same as in RCW 48.140.010(3).
(6) "Commissioner" means the insurance commissioner.
(7) "Companion claims" means the same as in RCW 48.140.030 (1)(b).
(8) "Economic damages" means the same as in RCW 4.56.250 (1)(a).
(9) "Excess insuring entity" means an insuring entity that provides insurance coverage above the limits of primary insurance or a self-insured retention.
(10) "Facility" means the same as in RCW 48.140.010(6).
(11) "Paid and estimated economic damages" means economic damages paid to a claimant based on:
(a) Objectively verifiable evidence; and
(b) Estimates developed from the injured person's available personal data and related economic data. Estimated economic damages typically include, but are not limited to:
(i) Lost earnings and benefits;
(ii) Lost earnings potential;
(iii) Lost value of household services; and
(iv) Future medical care costs.
(12) "Incident identifier" means the unique number assigned by the reporting entity to a series of closed claims that result from a single incident or related series of incidents of actual or alleged medical malpractice.
(13) "Insuring entity" means the same as in RCW 48.140.010(8).
(14) "Medical malpractice" means the same as in RCW 48.140.010(9).
(15) "OIC" means office of insurance commissioner.
(16) "Primary insuring entity" means the insuring entity that originates the primary layer of insurance coverage.
(17) "Provider" means the same as in RCW 48.140.010(7).
(18) "Record identifier" means a number assigned to a claim by the reporting site when a reporting entity first enters closed claim data.
(19) "Reporting entity" means any person or entity required to report data under RCW 48.140.020.
(20) "Reporting site" means the OIC web-based application that insuring entities, facilities, providers, and self-insurers must use to report medical malpractice closed claim data.
(21) "Self-insurer" means the same as in RCW 48.140.010(11).
(22) "User ID" is a permanent number assigned by the reporting site to each insuring entity, self-insurer, facility or provider.
[Statutory Authority: RCW 48.02.060, 48.140.060, and 7.70.140. WSR 07-12-057 (Matter No. R 2006-02), ยง 284-24D-020, filed 6/4/07, effective 7/22/07.]