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Claim Administration

This section provides general information about the claim.  The information from these fields will provide a unique identifier for this claim.  Please read the edit information carefully.  All information in this section is required.

  Field No.   Field Name   Entry Description
  1   Company ID   Required Enter your Company ID from either of of the following tables.

PIAA Regular Member Companies
101   ProAssurance Corporation 141   Northwest Physicians Mutual Insurance Company
103   Mutual Insurance Company of Arizona 142   PIC Wisconsin
104   The Doctors' Company 144   Intermed Mutual Insurance Company
105   Medical Insurance Exchange of California 146   Kansas Medical Mutual Insurance Company
106   NORCAL Mutual Insurance Company 147   Ophthalmic Mutual Insurance Company
108   COPIC Insurance Company 149   ProMutual Group
110   First Professionals Insurance Company 152   CAP-MPT
112   MAG Mutual Insurance Company 154   Controlled Risk Insurance Co. of Vermont
113   ISMIE Mutual Insurance Company 155   Princeton Insurance Company
115   Louisiana Medical Mutual Insurance Company 156   Piedmont Liability Trust
116   Medical Mutual Insurance Company of Maine 157   MedAmerica Mutual Risk Retention Group, Inc.
117   Medical Mutual Liability Ins. Soc. of Maryland 158   OMS National Insurance Company, RRG
118   American Physicians Assurance Corporation 159   West Virginia Physicians' Mutual Insurance Co.
120   Midwest Medical Insurance Company 160   Michigan Professional Insurance Company
121   Medical Assurance Company of Mississippi 161   Emergency Physicians Insurance Company
126   Medical Liability Mutual Insurance Company 162   Pennsylvania Healthcare Providers Ins. Exchange
127   Medical Mutual Insurance Co. of North Carolina 163   Florida Healthcare Providers Insurance Exchange
129   Physicians Liability Insurance Company 164   Eastern Dentists Insurance Company
130   PMSLIC Insurance Company 165   Superior Insurance Company, RRG
131   State Volunteer Mutual Insurance Company 166   Tristate Medical Insurance Company, RRG
132   Texas Medical Liability Trust 167   Conventus Inter-Insurance Exchange
133   American Physicians Insurance Exchange 168   MDAdvantage Insurance Company of New Jersey
134   Utah Medical Insurance Association 169   The Dentists Insurance Company
136   Physicians Insurance A Mutual Company 170   NOVUS Insurance Company, RRG
138   Connecticut Medical Insurance Company    

Table A

PIAA Associate Member Companies
400   Podiatry Insurance Company of America 404   OHA Insurance Solutions, Inc.
401   NCMIC Insurance Company 405   Medical Alliance Insurance Company
402   Health Providers Insurance Reciprocal, RRG 406   MHA Insurance Company
403   Health Care Indemnity, Inc. 407   HSLI/Louisiana Hospital Association Physicians Trust

Table B

PIAA International Member Companies
300   Professional Indemnity Ins. Co. Australia Pty. Ltd. 308   MDA National Insurance Pty., Ltd.
301   Australasian Medical Insurance, Ltd. 309   San Pacific S.A.
302   Le Sou Medical / MACSF Groupe 310   Landstingens Ömsesidiga Försäkringsbolag (LOF)
303   Medical Protection Society, Ltd. 311   La Société Hospitalière d'Assurances Mutuelles (SHAM)
304   VVAA Groep bv. 312   Medical Insurance Australia Pty. Ltd. (MIGA)
305   The Medical & Dental Defence Union of Scotland 313   The Professional's Company
306   The Canadian Medical Protection Association    
307   AMMA Assurances - AMMA Verzekeringen    

Table C

PIAA Affiliate Member Companies
900   Psychiatrists' Purchasing Group, Inc. 923   FTN Financial Group
902   Benfield, Inc. 924   AMLIN PLC
903   Brown Brothers Harriman & Company 926   Transatlantic Reinsurance Company (TransRe)
904   Carvill 928   ReSource Intermediaries, Inc.
905   Delphi Technology, Inc. 929   International Sureties, Ltd.
906   Huggins Actuarial Services, Inc. 930   ImageRight
907   Medical Risk Management, Inc. 931   Max Re, Ltd.
908   Mercer Oliver Wyman - Actuarial 932   Aspen Re
909   Milliman, Inc. 933   Holborn Corporation
910   NAS Insurance Services, Inc. 934   Acuity Services
912   Prime Advisors, Inc. 935   Funk & Bolton, P.A.
913   Professional Risk Management Services, Inc. 936   Freeman Enterprises
914   Towers Perrin Reinsurance 937   Guy Carpenter & Company, Inc.
915   Optimal Services Group of Wachovia Securities, LLC 938   Aon Re Inc.
916   Willis Re, Inc. 939   Cooper Gay Intermediaries, LLC
917   FACIS (r) 940   Wells, Canning & Associates
918   General Reinsurance Corporation 941   Endurance Reinsurance Corporation of America
919   Dwight Asset Management Company 942   Ebix, Inc.
920   BMS Group 943   LMS Medical Systems
921   Select Actuarial Services    
922   John B. Collins Associates, Inc    

Table D

 

  Field No.   Field Name   Entry Description
  2   Incident Number   Required Enter the claim ID number utilized by your company.  This number is identifies the general claim or incident.  Make sure this number is the same when reporting closed claims previously reported as open.
  3   Insured Number (Insured ID)   Required Enter the number assigned to the insured involved in the claim as listed above.  If there are other insureds involved in the claim, list them separately.  Make sure this number is the same when reporting closed claims previously reported as open.
  4   Accident Date   Required Enter the date (YYYY/MM/DD) the accident or incident occurred.

EDIT - Accident date CANNOT be later then report date.
  5   Report Date   Required Enter the date (YYYY/MM/DD) your company received first notice of the incident.
  6   Close Date   Required Required if closed.  Enter the date (YYYY/MM/DD) the file was closed by your company.
  7   Status   Required Enter "c" if you file is a claim (demand for compensation; no litigation) or
"s" if it is a suit (formal litigation instituted).  See the following Status table.

  Code   Status
  c   Claim
  s   Suit
  e   Early Offer

Table 2-A

  Field No.   Field Name   Entry Description
  8   Coverage Type   Required Enter the code for type of coverage the insured has from the following Coverage Table.

  Code   Coverage
  c   Claims made
  n   Claims made "nose" (prior acts)
  o   Occurrence
  p   Claims paid
  q   Slot coverage "tail" (reporting endorsement)
  r   Slot coverage - occurrence
  s   Slot coverage - claims made
  t   Claims made "tail" (reporting endorsement)

Table 2-B
 

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