Title: Section 69-10.2 - Application and Enrollment Process
69-10.2 Application and
(a) An application for enrollment into the Fund may be submitted by:
(1) a qualified plaintiff;
(2) a person who is authorized to act on a qualified plaintiff's behalf; or
(3) a defendant in a medical malpractice claim or action that results in a court-approved settlement or judgment issued on or after April 1, 2011, stating that the plaintiff sustained a "birth-related neurological injury."
(b) An application for enrollment shall be submitted on the application form provided by the Fund Administrator, which may be obtained either by downloading it from the Fund Administrator's website or by requesting a form from the Fund Administrator by phone or by making a written request. The completed application shall be accompanied by the following:
(1) a medical release form, which shall be in compliance with applicable laws and regulations pertaining to patient confidentiality and shall be made available by the Fund Administrator, and signed by a person authorized to act on the plaintiff's or claimant's behalf;
(2) a certified copy of the court-approved settlement or judgment, including all documents and/or exhibits referenced in the settlement or judgment;
(3) documentation regarding the specific nature and degree of the applicant's birth-related neurological injury or injuries, including diagnoses and impact on the applicant's activities of daily living and instrumental activities of daily living. A copy of the life plan or the summary provided by the applicant's treating physician or other such documentation that was provided to the court in support of the settlement agreement or as part of the applicant's medical malpractice action and contains the required information or any other documentation submitted on behalf of the enrollee for purposes of enrollment in another health related program can be provided in lieu of submitting entirely new documentation, provided that such documentation still accurately reflects the applicant's condition;
(4) documentation in the form of copies of medical records that supports the allegation that the applicant's injuries, condition or impairments occurred as a result of oxygen deprivation, a mechanical injury or other action or failure to act during the birth delivery admission;
(5) the names, addresses, and phone numbers of all providers providing services to the applicant at time of enrollment; and
(6) documentation of all other present sources of health care coverage or reimbursement, including commercial insurance and/or government program(s).
(c) Documentation submitted on behalf of the applicant for purposes of enrollment in another health related program also may be submitted for purposes of paragraphs (b)(4) and (5) of this section if the documentation is still current.
(d) Upon receipt of an application, the Fund Administrator shall review the court approved settlement or the judgment, whichever is applicable, to ensure that the document states that the plaintiff or claimant has been deemed or found to have sustained a birth-related neurological injury as defined in section 69-10.1 of this Subpart and that the settlement or judgment provides that, in the the event the plaintiff becomes an enrollee of the Fund, all future medical expenses of the plaintiff or claimant will be paid by the Fund in lieu of that portion of the settlement or award that provides for payment of future medical expenses. If the language regarding the nature of the injury and/or the Fund being the payor of the future medical expenses of the plaintiff or claimant is missing or is not clear, the application shall not be considered complete and the Fund Administrator shall inform the applicant to go back to the court that approved the settlement or issued the judgment to add clarifying language.
(e) The Fund Administrator shall also review all additional required documentation provided with the application and shall notify the person who submitted the application on behalf of the plaintiff or claimant of any information still needed to complete the application within fifteen business days from receipt of the application. No application will be deemed to have been submitted until all required documentation has been provided to the Fund Administrator.
(f) Upon (1) determining that the court-approved settlement or the judgment deems or finds the plaintiff or claimant to have sustained a birth-related neurological injury, and provides that the Fund shall be the payer of all future medical expenses for the plaintiff or claimant in lieu of that portion of the settlement or award that provides for payment of future medical expenses, and (2) the receipt of all required documentation set forth in subdivision (b) of the section, the Fund Administrator shall enroll the qualified plaintiff within five business days of such determination and provide written notification of enrollment to the qualified plaintiff or a person who is authorized to act on the qualified plaintiff's behalf, if known to the Fund Administrator, and to the defendant. The Fund will reimburse all appropriate costs incurred to meet the enrollee's health care needs between the date the court approved the settlement or judgment for the qualified plaintiff and the date the qualified plaintiff becomes a Fund enrollee.
(g) Upon enrolling a qualified plaintiff, the Fund Administrator shall assign the enrollee to a case manager and notify the enrollee of the name of and contact information for such case manager within seven business days from the date of enrollment.
(h) The Fund Administrator shall provide each enrollee with an enrollment card that contains a unique enrollment identification number.
VOLUME A-1a (Title 10)