Ins 17.40(3)(3) Failure to give notice. If the primary insurer or self-insurer fails to give notice to the fund as required in sub. (2), the board shall deny fund coverage for the action filed outside this state unless the primary insurer demonstrates, and the board finds, all of the following:

Ins 17.40(3)(a)(a) The fund was not prejudiced by the failure to give notice as required, and

Ins 17.40(3)(b)(b) It was not reasonably possible to give notice within the time limit.

Ins 17.40(4)(4) Failure to act in good faith. If the board denies coverage pursuant to sub. (3), then failure to give notice to the fund of the filing of an action outside this state as required in sub. (2) constitutes a failure to act in good faith on the part of the insurer or self-insurer in violation of s. 655.27 (5) (b), Stats.

Ins 17.50(2)(a)(a) “Actuarial” means prepared by an actuary meeting the requirements of s. Ins 6.12 who has experience in the field of medical malpractice liability insurance.

Ins 17.50(2)(am)(am) “Affiliated health care providers” means two or more health care providers delivering services as described in s. 655.002 (1), Stats., and who satisfy all of the following:

Ins 17.50(2)(am)1.1. The health care providers are either legal entities or are employed by one or more separate legal entities over which operating control is exercised by a common controlling legal entity. The controlling legal entity need not be a health care provider.

Ins 17.50(2)(am)2.2. The incomes of the health care providers are consolidated with the controlling legal entity in audited financial statements prepared under generally accepted accounting principles.

Ins 17.50(2)(b)(b) “Level of confidence” means a percentage describing the probability that a certain funding level will be adequate to cover actual losses.

Ins 17.50(2)(c)(c) “Occurrence coverage” means coverage for acts or omissions occurring during the period in which a self-insured plan is in effect.

Ins 17.50(2)(d)(d) “Office” means the office of the commissioner of insurance.

Ins 17.50(2)(e)(e) “Provider,” when used without modification, means a health care provider as defined in s. 655.001 (8), Stats., or affiliated health care providers as defined in par. (am), responsible for the establishment and operation of a self-insured plan.

Ins 17.50(2)(f)(f) “Risk margin” means the amount that must be added to estimated liabilities to achieve a specified confidence level.

Ins 17.50(2)(g)(g) “Self-insured plan” means a method, other than through the purchase of insurance, by which a provider may furnish professional liability coverage which meets the requirements of ch. 655, Stats.

Ins 17.50(2)(h)(h) “Year” means the self-insured plan’s fiscal year.

Ins 17.50(3)(a)(a) A self-insured plan shall provide professional liability occurrence coverage with limits of liability in the amounts specified in s. 655.23 (4), Stats., for the provider, the provider’s employees, other than employees who are natural persons defined as health care providers under s. 655.001 (8), Stats., and any other person for whom the provider is legally responsible while the employee or other person is acting within the scope of his or her duties for the provider.

Ins 17.50(3)(b)(b) A self-insured plan may also provide occurrence coverage for any natural person who is a health care provider, as defined in s. 655.001 (8), Stats., and who is an employee, partner or shareholder of the provider. The self-insured plan shall provide separate limits of liability in the amounts specified in s. 655.23 (4), Stats., for each such natural person covered.

Ins 17.50(3)(c)(c) A self-insured plan shall also provide for supplemental expenses in addition to the limits of liability in s. 655.23 (4), Stats., including attorney fees, litigation expenses, costs and interest incurred in connection with the settlement or defense of claims.

Ins 17.50(3)(d)(d) A self-insured plan may not provide coverage for anything other than the professional liability coverage required under ch. 655, Stats., or for any other person than those specified in pars. (a) and (b).

Ins 17.50(4)(4) Initial filing. A provider that intends to establish a self-insured plan shall file with the office a proposal which shall include all of the following:

Ins 17.50(4)(a)(a) If the provider is not a natural person, the history and organization of the provider.

Ins 17.50(4)(b)(b) If the provider is not a natural person, a resolution adopted by the provider’s governing body approving the establishment and operation of a self-insured plan.

Ins 17.50(4)(c)(c) A description of the proposed method of establishing and operating the self-insured plan.

Ins 17.50(4)(d)(d) An actuarial estimate of the liabilities that will be incurred by the self-insured plan in the first year of operation, an actuarial review of the cost of the first year’s funding and a description of how the self-insured plan will be funded.