---
title: "A malpractice claim or a board complaint"
canonical: "https://www.joinandwise.com/crossings/a-claim-or-a-complaint"
checked: "2026-11-03"
claim: "andwise:crossing/a-claim-or-a-complaint@2026-11-03"
license: "CC BY 4.0"
---

# A malpractice claim or a board complaint

What a claim notice or a board letter sets in motion: which policy responds, who decides a settlement, what is reported to the National Practitioner Data Bank and when, and how each party in the matter is paid.

**The decision:** Receiving notice of a malpractice claim or suit, or a letter from a state medical board about a complaint.

## What changes

- Any entity, including an insurer, that pays any part of a written malpractice claim or judgment for the benefit of a physician reports the payment to the National Practitioner Data Bank and to the state licensing board within 30 days of the payment. The NPDB Guidebook sets no minimum amount. The regulation says a settlement payment does not create a presumption that malpractice occurred. ([45 CFR 60.7, reporting medical malpractice payments](https://www.ecfr.gov/current/title-45/section-60.7); [45 CFR 60.5, when information must be reported](https://www.ecfr.gov/current/title-45/section-60.5); [NPDB Guidebook, Chapter E: reporting medical malpractice payments](https://www.npdb.hrsa.gov/guidebook/EMMPR.jsp); checked 2026-11-03)
- A payment a physician makes from personal funds for their own benefit is not reported; a payment made by the physician's own professional corporation is. A physician dismissed from a suit is not reported unless the dismissal is a condition of the settlement or release. ([NPDB Guidebook, Chapter E: reporting medical malpractice payments](https://www.npdb.hrsa.gov/guidebook/EMMPR.jsp); checked 2026-11-03)
- The NPDB sends the physician a copy of each report. The physician can place a report in disputed status, ask the Secretary of HHS to review its accuracy when the reporting entity does not revise it or respond within 60 days, and add a statement that stays with the report. The Secretary reviews accuracy only, not the merits of the payment. ([45 CFR 60.21, disputing the accuracy of NPDB information](https://www.ecfr.gov/current/title-45/section-60.21); checked 2026-11-03)
- A hospital queries the NPDB when a physician applies for medical staff membership or privileges, and every 2 years after that. ([45 CFR 60.17, information hospitals must request](https://www.ecfr.gov/current/title-45/section-60.17); checked 2026-11-03)
- A state medical board reports to the NPDB, within 30 days, any action based on competence or conduct that revokes, suspends or restricts a license, censures or reprimands a physician, places them on probation, or accepts a license surrender. How a complaint is received, investigated and heard is set by each state's law and board. ([45 CFR 60.8, licensure actions by boards of medical examiners](https://www.ecfr.gov/current/title-45/section-60.8); [45 CFR 60.5, when information must be reported](https://www.ecfr.gov/current/title-45/section-60.5); checked 2026-11-03)
- Two states' statutes, as examples. Texas: the medical board tells the physician a complaint has been filed and its nature unless that would jeopardize the investigation, gives each party the projected time requirements, and completes a preliminary investigation within 45 days of receiving the complaint, or 15 days more for good cause; a complaint that needs a determination of medical competency goes to an expert physician panel in the same or a similar specialty. Washington: the license holder is notified on receipt of a complaint unless that would impede the investigation, can submit a written statement that goes in the file, and the time periods for assessment, investigation, charging, settlement and adjudication are set by rule. ([Tex. Occ. Code ch. 154, subch. B, §§154.053, 154.057, 154.058, complaints](https://tcss.legis.texas.gov/resources/OC/htm/OC.154.htm); [Rev. Code Wash. §18.130.095, uniform procedural rules](https://app.leg.wa.gov/RCW/default.aspx?cite=18.130.095); checked 2026-11-03)
- A claims-made policy covers a claim only when the incident falls on or after the retroactive (prior acts) date and the claim is first made and reported during the policy period or an extended reporting period. A claim that arrives after a claims-made policy ends needs tail or a new policy's prior-acts coverage. One carrier describes an occurrence policy as covering claims that occur while the policy is active, and a claims-made policy as covering claims that occur and are reported while it is in force. ([Curi physicians medical professional liability specimen policy, form IAMPLC01 01.2025, with endorsement ENMPL37](https://go.curi.com/hubfs/Curi%20Physicians%20Medical%20Professional%20Liability%20Specimen%20Policy.pdf); [Andwise: malpractice tail coverage costs by specialty](https://www.joinandwise.com/contracts/tail-coverage); [Healthcare Providers Service Organization, claims-made vs. occurrence](https://www.hpso.com/Resources/Coverage-Information/Claims-made-vs-occurrence); checked 2026-11-03)
- Consent to settle is a policy term, not a rule. In one carrier's specimen policy, the carrier does not settle without the insured physician's written consent, except when the physician has died or been adjudicated incompetent, cannot be located, has a suspended, revoked or surrendered license, or has a verdict entered against them. Another carrier's consent endorsement adds a hammer: if the insured refuses a settlement the carrier recommends and the claimant accepts, the carrier's liability stops at the amount the claim could have been settled for, plus claim expenses to the date of the refusal. ([Curi physicians medical professional liability specimen policy, form IAMPLC01 01.2025, with endorsement ENMPL37](https://go.curi.com/hubfs/Curi%20Physicians%20Medical%20Professional%20Liability%20Specimen%20Policy.pdf); [Healthcare Providers Service Organization, consent to settle endorsement, form G-121493-B (07 01)](https://www.hpso.com/getmedia/9b17788e-ceb2-4c27-b45c-7a142373e0b8/G-121493-B-(07-01)-Consent-to-Settle.pdf); checked 2026-11-03)
- The same specimen pays legal expenses in addition to the limits of liability and stops paying them once settlements or judgments use up the limits. It gives the carrier sole discretion to control the defense and to retain the attorney. Whether defense costs sit inside or outside the limits is written in each policy. ([Curi physicians medical professional liability specimen policy, form IAMPLC01 01.2025, with endorsement ENMPL37](https://go.curi.com/hubfs/Curi%20Physicians%20Medical%20Professional%20Liability%20Specimen%20Policy.pdf); checked 2026-11-03)
- The specimen requires the insured to give the carrier prompt written notice of a claim, to tell it of any investigation by a state medical licensing agency or hospital, and not to admit negligence or make a payment without its written consent. ([Curi physicians medical professional liability specimen policy, form IAMPLC01 01.2025, with endorsement ENMPL37](https://go.curi.com/hubfs/Curi%20Physicians%20Medical%20Professional%20Liability%20Specimen%20Policy.pdf); checked 2026-11-03)
- Board defense can be a separate coverage with its own limits. The specimen's regulatory endorsement reimburses the costs of a licensing board or peer review proceeding on competence or conduct, with no duty to defend: 100% of covered costs with the carrier's panel counsel, 50% with counsel the physician chooses off the panel. ([Curi physicians medical professional liability specimen policy, form IAMPLC01 01.2025, with endorsement ENMPL37](https://go.curi.com/hubfs/Curi%20Physicians%20Medical%20Professional%20Liability%20Specimen%20Policy.pdf); checked 2026-11-03)
- Not measured: How each state investigates and hears a board complaint, and how long it takes. Texas and Washington are the only states quoted.
- Not measured: How many physician policies include consent to settle or a hammer clause.

## Who is paid for what

- **Malpractice carrier.** Collects the premium. Under the specimen policy, pays damages up to the limits and the legal expenses of the attorney it retains, and controls the defense. ([Curi physicians medical professional liability specimen policy, form IAMPLC01 01.2025, with endorsement ENMPL37](https://go.curi.com/hubfs/Curi%20Physicians%20Medical%20Professional%20Liability%20Specimen%20Policy.pdf)) Not part of its role: Matters outside the policy's coverage, such as an amount above the limits or a board matter the policy does not cover.
- **Defense counsel the carrier retains.** Retained and paid by the carrier: the specimen defines legal expenses as the fees of an attorney retained by the carrier to investigate or defend a covered claim. ([Curi physicians medical professional liability specimen policy, form IAMPLC01 01.2025, with endorsement ENMPL37](https://go.curi.com/hubfs/Curi%20Physicians%20Medical%20Professional%20Liability%20Specimen%20Policy.pdf)) Not part of its role: Advice on the policy's coverage terms, the employer or the license, unless engaged for them.
- **Board-defense coverage, where the policy has it.** Reimburses covered costs of a board proceeding under its own limits: 100% with panel counsel and 50% with counsel off the panel, in the specimen endorsement. ([Curi physicians medical professional liability specimen policy, form IAMPLC01 01.2025, with endorsement ENMPL37](https://go.curi.com/hubfs/Curi%20Physicians%20Medical%20Professional%20Liability%20Specimen%20Policy.pdf)) Not part of its role: A duty to defend; the specimen endorsement reimburses costs only.
- **Personal counsel the physician engages.** Set by the engagement's fee terms. Washington's RPC 1.5(b), for example, has the lawyer communicate the scope of the representation and the basis or rate of the fee and expenses the client is responsible for, preferably in writing, before or within a reasonable time after the work starts. In a board matter, the specimen's regulatory endorsement leaves the choice of counsel to the physician and reimburses 100% of covered costs with panel counsel, or 50% with the physician paying the other 50% as co-insurance off the panel. ([Washington Rules of Professional Conduct, RPC 1.5, fees](https://www.courts.wa.gov/court_rules/pdf/RPC/GA_RPC_01_05_00.pdf); [Curi physicians medical professional liability specimen policy, form IAMPLC01 01.2025, with endorsement ENMPL37](https://go.curi.com/hubfs/Curi%20Physicians%20Medical%20Professional%20Liability%20Specimen%20Policy.pdf)) Not part of its role: Defending the covered claim for the carrier; the counsel the carrier retains does that.

## Costs that come later

- Claims-made or occurrence, and the retroactive date (at signing) → Whether a claim arriving after the job ended is covered — https://www.joinandwise.com/contracts/tail-coverage
- Who pays tail (at signing) → A claim made after the last day — https://www.joinandwise.com/contracts/exit-cost
- Consent to settle and any hammer clause (in the policy form) → A settlement the carrier recommends — https://www.joinandwise.com/documents
- Limits, and whether defense costs reduce them → A settlement or judgment near the limits — https://www.joinandwise.com/documents

## Deadlines

- NPDB report of a malpractice payment: within 30 days of the payment, by whoever pays — Set by law
- NPDB report of a board action on a license: within 30 days of the action — Set by law
- NPDB dispute: a review by the Secretary of HHS can be requested when the reporting entity does not revise the report or respond within 60 days — Set by law
- Notice to the carrier of a claim, or of a board or hospital investigation: written, and prompt, in the specimen policy — Set in the contract
- The date a response to the board is due, as its letter states — Set by the other party

## Tools

- [Read a declarations page](https://www.joinandwise.com/documents): Policy type, retroactive date, limits and tail prices, quoted from the page.
- [Tail coverage costs](https://www.joinandwise.com/contracts/tail-coverage): Estimated tail cost by specialty, and how claims-made coverage ends.
- [Cost of leaving](https://www.joinandwise.com/contracts/exit-cost): Who pays tail under each exit, beside the other exit costs.
- [Malpractice premiums by state](https://www.joinandwise.com/malpractice): Premium benchmarks and the state's claims climate.

## Questions

### The malpractice carrier

- Is this claim within the retroactive date and the policy period, or does it fall to tail or a new policy's prior-acts coverage?
- Does the policy require my written consent to settle, and does it limit the carrier's liability if I decline a settlement it recommends?
- Are defense costs paid in addition to the limits, or do they reduce them?
- Does the policy cover a licensing board matter, under what limits, and does counsel of my choice change the share reimbursed?

### Defense counsel

- Whom does counsel represent in this matter, and how are reports to the carrier handled?
- Would a settlement on the terms discussed be reported to the NPDB, and in whose name?

### Personal counsel

- Which parts of this matter sit outside what the carrier's counsel covers, such as the board, the employer or an amount above the limits?
- What does the engagement cost, and does any policy term reimburse it?

### The employer or former employer

- Which policy covers the dates of the incident, and who pays tail if the job has ended?

Whether to settle, contest or answer in a given way is a question for counsel. The documents, dates and payment structures are where that conversation starts.

## Sources

- [45 CFR 60.7, reporting medical malpractice payments](https://www.ecfr.gov/current/title-45/section-60.7)
- [45 CFR 60.5, when information must be reported](https://www.ecfr.gov/current/title-45/section-60.5)
- [NPDB Guidebook, Chapter E: reporting medical malpractice payments](https://www.npdb.hrsa.gov/guidebook/EMMPR.jsp)
- [45 CFR 60.21, disputing the accuracy of NPDB information](https://www.ecfr.gov/current/title-45/section-60.21)
- [45 CFR 60.17, information hospitals must request](https://www.ecfr.gov/current/title-45/section-60.17)
- [45 CFR 60.8, licensure actions by boards of medical examiners](https://www.ecfr.gov/current/title-45/section-60.8)
- [Tex. Occ. Code ch. 154, subch. B, §§154.053, 154.057, 154.058, complaints](https://tcss.legis.texas.gov/resources/OC/htm/OC.154.htm)
- [Rev. Code Wash. §18.130.095, uniform procedural rules](https://app.leg.wa.gov/RCW/default.aspx?cite=18.130.095)
- [Curi physicians medical professional liability specimen policy, form IAMPLC01 01.2025, with endorsement ENMPL37](https://go.curi.com/hubfs/Curi%20Physicians%20Medical%20Professional%20Liability%20Specimen%20Policy.pdf)
- [Andwise: malpractice tail coverage costs by specialty](https://www.joinandwise.com/contracts/tail-coverage)
- [Healthcare Providers Service Organization, claims-made vs. occurrence](https://www.hpso.com/Resources/Coverage-Information/Claims-made-vs-occurrence)
- [Healthcare Providers Service Organization, consent to settle endorsement, form G-121493-B (07 01)](https://www.hpso.com/getmedia/9b17788e-ceb2-4c27-b45c-7a142373e0b8/G-121493-B-(07-01)-Consent-to-Settle.pdf)
- [Washington Rules of Professional Conduct, RPC 1.5, fees](https://www.courts.wa.gov/court_rules/pdf/RPC/GA_RPC_01_05_00.pdf)

Reviewed 2026-11-03; oldest source check 2026-11-03. General information, not legal, tax or financial advice. The text states what the law and rules say; applying them to a contract is a question for a licensed professional.