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MEDICAL PROFESSIONAL LIABILITY INSURANCE CLAIM REPORT - insurance mo

MEDICAL PROFESSIONAL LIABILITY INSURANCE CLAIM REPORT - insurance mo 2025

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The document is a Medical Professional Liability Insurance Claim Report from the Missouri Department of Insurance, detailing the information required for reporting medical malpractice claims. It includes sections for insurer details, claim identification, dates of injury and reporting, insured information, nature of the claim, allegations, severity of injury, and financial details related to damages and expenses. The report must be submitted quarterly and includes specific instructions for both open and closed claims.

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Click ‘Get Form’ to open the MEDICAL PROFESSIONAL LIABILITY INSURANCE CLAIM REPORT in the editor.
Begin by filling out Section 1A with the name of the insurer and their NAIC Group & Company Code. This information is crucial for identifying the reporting entity.
In Section 1B, assign a unique claim file identification number to track this specific claim effectively.
Proceed to Sections 2A through 2D to enter important dates related to the injury, including the date of injury, date reported to the insurer, and any reopening dates.
Complete Sections 3A through 3G with details about the insured individual, including their license number, name, age, and address.
Fill out Sections 4A through 5D regarding profession codes and location details where the injury occurred. Ensure accuracy for proper categorization.
Continue with Sections 7A through 9D for information on the injured person and their attorney. This includes names, addresses, and contact details.
Finally, provide detailed descriptions in Sections 10A through 25 regarding the nature of the claim, injuries sustained, and any financial implications.

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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What is proof of professional liability insurance coverage?

Proof of PLI insurance can be in the form of: a copy of the PLI policy certificate (you may need to request this from some providers)

What is not covered by professional liability insurance?

However, these policies do not cover a companys employment practices, illegal acts, work-related bodily injury, property damage, or work-related illness. Because of these differences in coverage, a business may not be fully covered without carrying multiple types of insurance.

What is a professional liability insurance claim?

Professional liability claims arise when: a professional fails, or allegedly fails, to fulfill their legal obligation, a third party suffers a financial loss (as a result of professional negligence), and. the third party sues to recoup those costs.

What does medical professional liability insurance cover?

Overview: A medical professional liability insurance policy covers bodily injury or property damage. It also covers liability for personal injury such as mental anguish.

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