A healthcare provider must pay the surcharge to their primary insurer within 30 days of the effective date of coverage. The insurance carrier then has an additional 30 days to remit the PCF surcharge to the PCF administrator.
The PCF is governed by the Medical Malpractice Act, NMSA 41-5, and specifically by NMSA 41-5-25. The Superintendent of Insurance has promulgated rules to assist the administration of the PCF, which can be found in NMAC 13-21.
The PCF is funded solely through surcharges (i.e. premiums) levied against its member healthcare providers.
No. The PCF does not issue its own policy form, but follows the coverage provisions and rules contained in the healthcare provider’s primary policy.
Periodic actuarial studies of the PCF are completed to evaluate the solvency of the PCF and set appropriate surcharges. The latest actuarial report may be accessed here:
According to federal law, yes. There is currently one risk retention group providing primary coverage in the PCF.
This is uncertain and may depend on court interpretations of the Medical Malpractice Act.
Upon the application of the eligible entity to the PCF, the Superintendent will perform a risk assessment which will determine that applicant’s level of base coverage or self-insured deposit. After demonstrating the appropriate financial responsibility and paying the applicable surcharge, the entity will be admitted into the PCF.
The Patient’s Compensation Fund (“PCF”), which was established by the New Mexico Medical Malpractice Act of 1976, provides an excess layer of professional liability coverage for its member healthcare providers.
No. The current approved participating carriers are:
- The Doctor’s Company (34495)
- Medical Protective Company (11843)
- National Union Fire Insurance Company of Pittsburg (19445)
- Capital Indemnity Corp (10472)
- AEIX (10903)
- Applied Medico Solutions (11598)
- California Medical Group Insurance Company (12180)
- NCMIC (15865)
- PPIC/Coverys (36234)
- Mag Mutual (42617)
- Lone Star Alliance (15211)
- Norcal Group (33200)
The surcharges for individual practitioners are determined through a periodic actuarial study, and are based on classification of risks with respect to practice type and doctor specialty.
For hospitals or outpatient care facilities, a separate actuarial study is done to determine the appropriate surcharges.
Doctors of medicine, doctors of osteopathy, chiropractors, podiatrists, nurse anesthetists, physician’s assistants, certified nurse practitioners, clinical nurse specialists, certified nurse-midwives, hospitals and outpatient healthcare facilities are eligible to be in the PCF.
Any new carriers wishing to become a participating carrier will need to contact the PCF administration. The requirements for participating carriers include filing the underlying occurrence-form (or claims-made with indefinite tail) medical malpractice policy for approval on SERFF and certifying the company’s agreement to provide claim defense throughout the lifetime of the claim.
The PCF is administered by Integrion Group, Inc., a third-party administrator in Albuquerque. The Superintendent of Insurance is the custodian of the PCF.
No. Only the types of healthcare providers listed in “What kinds of healthcare providers are covered under the PCF” FAQ.
There are three main benefits:
- Awards are capped at $750,000, except for medical care and punitive damages, which are not capped. This cap applies to independent providers. Higher limits apply to hospitals.
- All malpractice claims against independent healthcare providers in the PCF must first be reviewed by the New Mexico Medical Review Commission before they can be filed in court.
- There’s a three-year statute of limitations for claims brought against healthcare providers in the PCF. The only exception is that minors under the age of six have until their ninth birthday to file a claim.
There are four basic requirements to get into the PCF:
- Practitioner must belong to a specialty that is eligible for coverage under the PCF.
- Practitioner must demonstrate and maintain financial responsibility by obtaining the primary layer of medical malpractice insurance from a participating insurance carrier, or through self-insurance.
- An acceptable underlying insurance policy must be on an occurrence basis, with indemnity limits of $250,000 per occurrence and must provide coverage for three occurrences. Claims-made coverage with indefinite tail is also acceptable coverage.
- In lieu of the primary layer of coverage, the practitioner may choose to continuously maintain $750,000 on deposit with the Superintendent of Insurance.
- Practitioner must apply for admission to the PCF through their primary insurance carrier.
- Practitioner must pay the applicable PCF surcharge on a timely basis.