Glossary

Allied Health Personnel
The following types of employees for which a specific premium is paid:

  • Certified Registered Nurse Anesthetist
  • Certified Clinical Nurse Specialist
  • Certified Nurse Midwife
  • Certified Nurse Practitioner
  • Dialysis Technician
  • Obstetrical Nurse
  • Orthopedic Technician/Orthopedic Nurse
  • Physician’s Assistant
  • Psychologist/Psychotherapist
  • Social Worker

Certificate of Insurance
A certificate of insurance can be issued to any third party credentialing body. It is used as proof of coverage on an annual basis and is issued automatically at each policy renewal. The certificate holder is also notified in the event of policy cancellation.

Claim
A suit, a formal demand for damages or incident.

Damages
Monetary compensation which is owed as a result of personal injury.

Disability
The inability to continue to perform one’s working or professional career duties due to physical or mental impairment that has lasted continuously for not less than six months and which is certified by a medical exam conducted by a physician chosen by ISMIE Mutual to be continuous and permanent.

First Made
The earliest of either the date ISMIE Mutual receives written notice or the date ISMIE Mutual acknowledges in writing the existence of a claim. Oral contact with ISMIE Mutual or mailing notice of a claim to ISMIE Mutual will not result in coverage. Notice by one insured under our policy does not satisfy the notice requirement of the other insureds under our policy.

Incident
A specific event that a named insured has reason to believe will result in a formal demand for damages or suit in the future. There must be some specific basis for the belief that the patient will pursue an insured for damages in the future. Reporting a list of patients treated or simply reporting an unexpected outcome will not be considered an incident under our policy.

Insured
Any person or organization identified in our policy under Article IV (Persons Insured).

Insured Physician
Any physician who is an insured under our policy.

ISMIE Mutual
ISMIE Mutual Insurance Company.

Legal Expenses
All costs necessary to represent the insured physician in a proceeding or Medicare investigation. These costs include but are not limited to: attorney fees, expert witness fees, filing fees, court reporters, transcripts, copying and travel. These costs do not include any taxes, fines, penalties, damages or damages which may be multiplied by statute.

Loss History Letters
Loss history letters show a summary of all claims reported either for all years or the most recent 10-year period. The majority of third party credentialing entities and/or hospitals will only require the “10-year version”.

Management (Entrepreneurial Activities)
The operation, administration, or ownership of any entity. This includes but is not limited to any:

  1. Hospital, sanitarium, infirmary; clinic, clinic with bed and board facilities, nursing home, abortion clinic, drug abuse clinic, surgical center, ambulatory care center, blood bank, or
  2. Commercial laboratory or other professional enterprise, but with respect to the term commercial laboratory this shall not apply to laboratory facilities maintained primarily for the testing of the insured's own patients nor to any X-ray or pathological facility or laboratory if owned by the named insured or
  3. Health maintenance organization, preferred provider organization physician network, physician organization, or any other health care delivery or financing entity.

Medicare Investigation
Any investigation or action instituted by or on behalf of a government health benefit payer, including but not limited to Medicare and Medicaid, on account of alleged or actual erroneous billings for professional services which were wrongfully submitted or allowed to be submitted, to a government health benefit payer or intermediary for which a named insured seeks payment or reimbursement. However, Medicare investigation does not include any customary or routine audit or reconciliation conducted by or at the behest of a government health benefit payer.

Named Insured
Any person or organization that is specifically identified by name in the Declarations Page or any endorsement attached to our policy as a named insured.

Personal Injury
Bodily injury to, death of, libel of, slander of, defamation of character of or invasion of privacy of any patient and bodily injury to or death of any other person involved in providing health care services to patients which arises out of the rendering or failure to render professional services.

Physician
A person licensed to provide health care services to patients in all of its branches by the state identified in the mailing address on the Declarations Page or the state of practice identified in the application attached to our policy.

Policy Documents
These documents are copies of your policy which you receive each year at your policy renewal. They contain your declarations page and any supporting endorsement which have been issued for the current policy term.

Policy Period
The period of time which commences with the policy effective date specified on the Declarations Page and expires upon cancellation, renewal or non-renewal of the policy. The policy period is never more than 365 days except for 366 days in a leap year.

Policy Summary
This page provides you with a quick snapshot of your current policy information (e.g., policy status, limits of liability, specialty). This page also includes the name of the underwriter who is servicing your account, and his or her direct phone number and e-mail address.

Premium Invoices
ISMIE Mutual issues invoices on a quarterly basis. The annual premium is divided evenly between each invoice. A policy can be cancelled on any quarter due to failure to pay at the designated time. Changes resulting a premium change are reflected as policy credits on the next premium invoice.

Proceeding
Any investigation or hearing or series of investigations or hearings initiated by the Illinois Department of Financial and Professional Regulation in which the outcome of such investigation or hearing or series of investigations or hearings potentially could result in discipline against the insured physician's license to provide health care services to patients. Such discipline includes, but is not limited to: non-renewal, revocation, termination, suspension, restriction or probation of the insured physician’s license to provide health care services to patients.

Professional Entity
An entity organized under the Medical Corporation Act, Professional Service Corporation Act, a Limited Liability Company Act, a partnership or documented joint venture of the state identified in the mailing address on the Declarations Page or the state of practice identified in the application attached to our policy.

Professional Services
Those services which an insured is licensed to perform and disclosed in the application for our policy that are performed in providing health care services to patients.

Retirement
The permanent conclusion of and complete withdrawal from providing health care services to patients by a person who is a named insured under our policy.

Retroactive Date
The first date on or after which professional services giving rise to a claim may be covered during the policy period. This date is specified either in the Declarations Page or in any endorsement attached to our policy as the retroactive date for the named insured.

Suit
A lawsuit, or arbitration proceeding seeking damages and includes a counterclaim asserted against any insured.