Because the threat of a disciplinary action is all too real, every TMLT policy includes Medefense coverage. Medefense covers legal expenses, fines, and penalties associated with disciplinary actions, such as actions by the TMB, a hospital review committee, or a federal regulatory agency.
If you receive notice of any disciplinary action, you are strongly urged to do the following as possible.
- Call the Claim Department at 800-580-8658 to report a Medefense claim as soon as you receive the initial letter from the TMB or other disciplinary authority. You can also start the claim reporting process through myPortal (log in required.) You have 60 days to report an insured event to receive reimbursement for covered expenses under Medefense.
- Consider retaining an attorney to help draft your initial response to the TMB. TMLT can provide you with the contact information of attorneys who have experience handling disciplinary proceedings.
Working with an attorney who is knowledgeable of TMB proceedings can result in an early dismissal of the complaint. “I have seen too many examples of cases where the physician responds on his own, or forwards a copy of the medical records without a response. Often the physician’s response does not contain what it should and can actually make matters worse,” says Gregory Myers, an attorney with the Myers and Doyle Law Firm in Houston.
- If you do not choose an attorney from TMLT’s panel of attorneys, promptly send the following information to TMLT to expedite the payment process under Medefense:
- copies of all legal expense invoices pertaining to the defense of the claim — the legal or audit expenses should be itemized on an hourly basis showing the services provided, the time incurred, and the hourly rate;
- copies of all payments made to the attorney or law firm representing the policyholder in the matter; and
- a copy of the dispositive letter describing the final outcome so the claim can be closed.
Because the TMB can impose a range of disciplinary actions — including revoking or suspending your medical license — it’s important to respond appropriately when you receive a notice of investigation.
At TMLT, we have encountered a number of cases where physicians did not hire an attorney or notify us when they received the initial complaint notice from the TMB. These physicians believed they could prepare a response to the Board and hoped the matter would go away. They learned otherwise when they received a notice of investigation or notice that the matter was set for an Informal Settlement Conference. Ultimately, once an attorney was finally hired, the physician and attorney were at a disadvantage in preparing a defense.