Use of redesigned forms for medical malpractice reports

Issued and entered October 30, 1986 by Herman W. Coleman, Commissioner of Insurance

In accordance with Section 2477 of the Insurance Code of 1956, as amended, MCLA 500.2477; MSA 24.12477, all insurers are required to report specific medical malpractice claims information to the Michigan Commissioner of Insurance. Bulletin 85-2, issued on January 31, 1985, is hereby superseded by this bulletin. Forms A-77 and B-77 (REV), which were transmitted by Bulletin 85-2, are withdrawn. They have been revised and replaced by the attached Forms A-77 and B-77 (REV 7-86). This revision is to improve processing efficiency and to secure all necessary information.

Public Act 173 of 1986, MCLA 500.2477(b&c); MSA 24.12477(b&c) requires that every person other than an insurer who pays or has assumed liability to pay a professional liability claim and every attorney who represents a plaintiff or defendant in a professional liability claim shall submit Forms A and B. Both forms have been redesigned to comply with this statute. Additionally, it is no longer necessary to submit a copy of the complaint and the answer. All forms are due thirty (30) days after filing and closure.

ATTORNEYS -- Please note that if you currently file a Form A or B on behalf of an insurer, you need not submit any additional forms. If you are a plaintiff's attorney, please complete the appropriate spaces.

In completing these forms, please use the following guidelines:

FORM A

Name: Last name, first name, middle initial. It is not necessary to put professional designation after the name.

License Number: This is the five (5) digit number assigned to the individual by the Department of Licensing and Regulation.

Profession and Speciality: Please use the profession coding listed on the reverse of the form. The speciality code is to be taken from the insured's policy. If you are completing on behalf of the plaintiff, use the code 15.

County Code and Court Identification: County code refers to the county where the case is filed. Place a 1 or 2 in the space to indicate District or Circuit court.

FORM B

This form is now a computer entry document and is to be used when a case is settled, withdrawn or any other dismissal or disposition. Please complete the boxes with the appropriate number. Pursuant to P.A. 173 of 1986, all indemnity amounts must show the amount attributable to economic and non-economic damages.

A sample of a completed form has been included. Any questions regarding this bulletin should be directed to:

Medical Malpractice Reporting
Michigan Insurance Bureau
P.O. Box 30220
Lansing, MI 48909

Attention: Randy A. Watkins
Phone: 517/373-2984