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What Is A Qualified Healthcare Provider?

Legal Team

To determine what constitutes a qualified healthcare provider we do not want to look at their qualifications. As you will find out, doctors and healthcare providers must meet a criteria to get benefits from the New Mexico Medical Malpractice Act.

The term “qualified” does not refer to a provider’s professional qualifications, but rather a health care provider who meets certain criteria. The only medical professional allowed to participate in Patient’s Compensation Fund are medical doctors, doctors of osteopathy, chiropractors, podiatrists, nurse anesthetist, and physician’s assistants.  Additionally, hospitals, outpatient healthcare facilities, professional corporations and other business entities comprised of doctors and other medical professionals are eligible to participate in the Fund. Nurses, midwives, dentists, and nursing homes cannot participate. If the healthcare provider does not qualify, then they do not get the benefits of the New Mexico Medical Malpractice Act including a cap on damages.

To qualify, an individual physician or other individual healthcare provider must (1) file proof of professional liability insurance of $200,000 per occurrence of malpractice with the New Mexico Superintendent of Insurance or deposit $600,000 in cash with the Superintendent (obviously, most doctors just purchase an insurance policy) and (2) pay an annual fee to the Patient Compensation Fund (PCF) in an amount determined by the Superintendent of Insurance.  For a hospital, outpatient health care facility, or business entity (professional corporation, limited liability company, etc.), the Superintendent of Insurance determines the amount of base insurance coverage required for the facility and the annual fee paid by the hospital or facility into the PCF.

To determine if a doctor or other healthcare professional is qualified, a licensed attorney can register with the Department of Insurance to electronically search for a provider for the date(s) the malpractice is alleged to have occurred. The Department of Insurance will no longer allow attorneys to request a healthcare provider’s “qualified” status in writing.

A patient also has the opportunity to voluntary obtain a panel hearing if the healthcare provider is not qualified if all parties must agree to be heard before the voluntary panel.  If all parties agree, the patient must pay a $25.00 application fee.

Now that you know what constitutes a qualified healthcare provider, it is important to find out if your healthcare provider is qualified. This will save you time in the long run because usually the amount of time it takes to file an application and a lawsuit is much shorter when the provider is qualified. Do you need help determining if your doctor is qualified? Reach out to us at 505-242-7200 and we will help you find out.

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