Glossary

A medical fee schedule is a provision of most state workers compensation laws that establishes the maximum amount a healthcare provider may collect for injuries treatable under the act.

The Medical Injury Compensation Reform Act (MICRA) of 1975 is a California tort reform act, passed in 1975, that may be replicated in other states. It has shown success in limiting the increases of medical malpractice costs. Several of MICRA's important features include (1) noneconomic damages that are capped for medical negligence at $250,000; (2) economic damages that are not capped; (3) damage limitations that are provided through the collateral source rule; (4) a sliding scale for lawyers' contingency fees; (5) a 90-day advance notice for filing a claim; and (6) a statute of limitations that requires notification within 1 year from discovery and within 3 years of the date of injury.

Medical malpractice "caps" are statutory limitations, currently on the books in a number of states (and being considered in others, as well as on the federal level), limiting the dollar amount of noneconomic damages recoverable in a claim alleging medical malpractice. Such legislation is most prevalent in states where high medical liability claim levels have made it difficult or even impossible for substantial numbers of doctors to obtain professional liability coverage. "Caps" place a limit on damages for items such as pain and suffering, loss of companionship, and permanent disfigurement, generally in the amount of either $250,000 or $500,000 per claimant. However, "caps" are inapplicable to economic losses, such as medical expenses and lost wages that result from medical negligence.

Medical malpractice insurance covers the acts, errors, and omissions of physicians and surgeons, encompassing physicians professional liability insurance, hospital professional liability (HPL) insurance, and allied healthcare (e.g., nurses) professional liability insurance.

Medical payments, auto, is optional coverage under an auto policy to pay for medical expenses for an insured who sustains bodily injury (BI) caused by an auto accident, without regard to fault. Coverage for persons other than the named insured and their family members is typically restricted to circumstances when they are occupants of the insured auto.

Medical payments, general liability, is coverage that reimburses others, without regard to the insured's liability, for medical or funeral expenses incurred by such persons as a result of bodily injury (BI) or death sustained by accident under the conditions specified in the policy.

Medical payments, homeowners, is coverage designed to pay for medical expenses to others who are accidentally injured on an insured location or by the activities of an insured, resident employee, or an animal owned by or in the care of an insured.

Medicare is the US government program providing medical expense benefits for persons over the age of 65 or who are disabled if they qualify for benefits under Social Security.

Medicare fraud and abuse insurance covers allegations that an insured healthcare provider overbilled the federal government in seeking reimbursement for services performed under Medicare. Offered as an endorsement to physicians and hospital professional liability insurance policies, this coverage became prevalent in the late 1990s when the federal government initiated concerted efforts to pursue Medicare billing violations by healthcare providers. The policies exclude coverage for fines, penalties, and punitive damages, and coverage is limited to defense cost reimbursement only.

The Medicare, Medicaid, and SCHIP Extension Act (MMSEA) of 2007 is a law that extended and expanded provisions of the Social Security Act relating to Medicare, Medicaid, and the State Children's Health Insurance Program (SCHIP). Of particular note, Section 111 of the Act addresses Medicare secondary payer issues. This section establishes the mandatory reporting to the Centers for Medicare and Medicaid Services (CMS) of all monetary compensation provided to an individual eligible for Medicare resulting from a workers compensation, general liability, or automobile no-fault claim.