Step 3-B: LPL Specific Claim Forms

Who is Required to File an LPL Form?

The Department of Insurance requires the Lawyers Professional Liability Form to be submitted by insurers providing coverage for members of the Florida Bar for any claim resulting from error, omission, or negligence in the performance of the insured.

How to Submit an LPL Form

Now that you've completed the initial steps of creating your new closed claim form, and you understand the claim summary page you're ready to get into the details of your LPL form.  

 

On the LPL Claim Summary page below, you'll notice that the LPL form has five primary sections:

  1. Insured/General Claim Information

  2. Attorney Information

  3. Plaintiff Information

  4. Legal Information

  5. Financial Information

 

The status of each of these five sections must be complete in order to submit the form to the Office of Insurance Regulation for review.

 

Note: Completing all sections of the LPL form may take some time.  Feel free to save your data in the current section of the form and return to other sections as your time permits.

 

The LPL Claim Summary Page

Section 1: Insured Information

The first section of the LPL form provides fields in which you will enter information about the insured person or entity.  The Insured Information page is displayed below.

 

The Insured Information Page

 

To Edit the Insured Information Page:

  1. Fill in the following list of fields (Fields in blue apply only if Type: Individual is selected):

 

Type

Type indicates whether the insured is an individual or entity.  Select Individual or Entity from the drop down box as appropriate.

First Name

The given name of the insured if the Type is Individual.

Middle Initial

The middle initial of the insured if the Type is Individual.

Last Name

The family name/surname of the insured if the Type is Individual.

Entity Name

The name of the insured company if the Type is Entity

Street Address of Business Practice

The street address of the insured's business.

City

The city in which the insured's business is located.

State

The state in which the insured's business is located.

County

The county in which the insured's business is located.

Zip Code

The ZIP/Postal Code address in which the insured's business is located.

Policy Number

The insured's insurance policy number.

Per Claim Policy Limits

The per claim policy limits on the insured's policy.

Aggregate Policy Limits

The aggregate policy limits on the insured's policy.

Type of Claim

This field specifies the type of claim filed against the insured.

Other

If the type of claim you're looking for does not appear in the Type of Claim list, select "Other" from the Type of Claim list and type a description of the claim in this field.

Date of Occurrence

The date of the claim's occurrence.

Date Reported to the Insurer

The date on which the claim was reported to the insurer.

 

  1. Click the Save button to save your changes and return to the LPL Claim Summary Page.

    • Clicking the Reset button will reset all fields to blank.

    • Clicking the Cancel button will return you to the LPL Claim Summary page without saving your changes.  

 

Upon clicking the Save button all address fields are verified using CODE1 validation.  If the CODE1 validation does not find the address you input into the address fields, the following Address Validation page will display.

 

The CODE1 Address Validation Page

 

The CODE1 validation page will display the address data you supplied, CODE1 data that offers a possible known address that is correct, and remarks regarding the address data.

 

You may choose to either:

  1. Select "User Data".  Selecting this option will use the address information you supplied, rather than the CODE1 suggested address.

  2. Select "CODE1 Data".  Selecting this option will use the CODE1 address data found by CODE1 and replace the address information you supplied.

  3. Select "Reject Report".  This will ignore the CODE1 validation report entirely.

 

Click the Done button after making your selection to return to the Insured Information page.

Section 2: Attorney Information

The next section of the LPL form allows you to add additional attorneys involved in this particular claim that are not covered by the policy.  The Attorney Information page is displayed below.

 

The Attorney Information Page

To Add an Attorney:

  1. Enter the first name of the attorney.

  2. Enter the middle initial of the attorney.

  3. Enter the last name of the attorney.

  4. Click the Add button. You will notice the name of the attorney you added will appear in the List of Attorneys box.

  5. Click the Save button to save your changes and return to the LPL Claim Summary Page.

    • Clicking the Reset button will reset all fields to blank.

    • Clicking the Cancel button will return you to the LPL Claim Summary page without saving your changes.  

 

To Remove an Attorney:

  1. Select the attorney from the List of Attorneys box.

  2. Click the Remove button.  The attorney will be deleted.

  3. Click the Save button to save your changes and return to the LPL Claim Summary Page.

    • Clicking the Reset button will reset all fields to blank.

    • Clicking the Cancel button will return you to the LPL Claim Summary page without saving your changes.  

  4. To Update an Attorney:

  1. Select the attorney from the List of Attorneys box.

  2. Alter the name of the attorney as appropriate.

  3. Click the Update button to finalize the change.

  4. Click the Save button to save your changes and return to the LPL Claim Summary Page.

    • Clicking the Reset button will reset all fields to blank.

    • Clicking the Cancel button will return you to the LPL Claim Summary page without saving your changes.  

Section 3: Plaintiff Information

This section of the LPL form allows you to enter the name of the individual or entity acting as the plaintiff in the lawsuit.

 

The Plaintiff Information Page

To Edit the Plaintiff Information Page:

  1. Fill in the following list of fields (Fields in blue apply only if Type: Individual is selected):

 

Type

Type indicates whether the plaintiff is an individual or entity.  Select Individual or Entity from the drop down box as appropriate.

First Name

The given name of the plaintiff if the Type is Individual.

Middle Initial

The middle initial of the plaintiff if the Type is Individual.

Last Name

The family name/surname of the plaintiff if the Type is Individual.

Entity Name

The name of the plaintiff company if the Type is Entity

 

  1. Click the Save button to save your changes and return to the LPL Claim Summary Page.

    • Clicking the Reset button will reset all fields to blank.

    • Clicking the Cancel button will return you to the LPL Claim Summary page without saving your changes.  

 

Section 4: Legal Information

Next is the Legal Information section of the LPL form.  In this form you'll fill out information pertaining to the legal action taken on the liability claim.  The Legal Information page is displayed below.

 

The Legal Information Page

To Edit the Legal Information Page:

  1. Fill in the following list of fields:

 

Date of Suit

The date the lawsuit of the injured individual was filed against the insured attorney.

Circuit Court Case Number

The circuit court case number assigned to the lawsuit.

County Suit Filed In

The county in which the lawsuit was officially filed.

Date of Final Disposition

The date of the final outcome of the lawsuit (i.e., date of the settlement or court verdict, etc.).

Final Method of Claim Disposition

The method that resolved the lawsuit (e.g., settled by parties, disposed of by court, etc.).

Court Decision

The final decision of the court on the lawsuit, if the lawsuit was not resolved out of court.  If the lawsuit was resolved out of court, select "No Court Proceedings".

Other Court Decision

If the Court Decision rendered does not appear in the drop down list of Court Decision options, select "Other" from the list of court decisions and type in the type of court decision.

Date of Final Payment

Enter the date on which the malpractice claim was paid by the insurer, if a verdict rendered payment necessary.  If no payment was made, leave this field blank.

Stage of Legal System at Which Settlement was Reached

At what point in the legal process was the lawsuit resolved (i.e., after arbitration, after court verdict, etc.).

Arbitration

Describes the result of the arbitration used to settle the case, if any.

List of Other Defendants

This is an area where you may add other defendants involved in the case that are not covered under this policy.  If there are no other defendants, be sure click the checkbox next to the text "No Other Defendants Involved in this Claim". See step 3 below for more information.

 

  1. Click the Save button to save your changes and return to the LPL Claim Summary Page.

    • Clicking the Reset button will reset all fields to blank.

    • Clicking the Cancel button will return you to the LPL Claim Summary page without saving your changes.  

  2. If you need to add additional defendants involved in the case that are not covered under this policy or update the list of defendants, click the Add/Update/Remove Defendant button.  The Other Defendant Information page will display.  If you do not need to add or update additional defendants, proceed to step 6.

 

The Other Defendant Information Page

 

To Add a Defendant:

      1. Select Individual or Entity from the Type drop down list.

      2. Enter the name of the entity or individual.

      3. Enter the license number of the entity or individual.

      4. Click the Add button. You will notice the name of the entity or individual you added will appear in the Defendants Involved in this Claim box.

To Remove a Defendant:

      1. Select the individual or entity from the Defendants Involved in this Claim box.

      2. Click the Remove button.  The defendant will be deleted.

To Update a Defendant:

      1. Select the individual or entity from the Defendants Involved in this Claim box.

      2. Alter the name of the individual or entity as appropriate.

      3. Alter the license number as appropriate.

      4. Click the Update button to finalize the change.

 

  1. When you are finished updating defendant information, click the Done button.  This will return you to the Legal Information page.

  2. Click the Save button to save your changes and return to the LPL Claim Summary Page.

    • Clicking the Reset button will reset all fields to blank.

    • Clicking the Cancel button will return you to the LPL Claim Summary page without saving your changes.  

 

Section 5: Financial Information

The last section of the LPL form you'll need to fill out is the Financial Information section.  This section captures the monetary values paid to the plaintiff, if any, as well as costs incurred by the defendant.  The Financial Information page is displayed below.

 

The Financial Information Page

To Edit the Financial Information Page:

  1. Fill in the following list of fields:

 

Plaintiff Payment Indicator

Click the radio button next to Yes or No to indicate whether there was a settlement or judgment resulting in payment to the plaintiff.

Indemnity Paid by Insurer

If the plaintiff received payment as a result of the settlement or judgment, list the amount of the indemnity paid by the insurer on behalf of the insured individual.

Deductible Paid by Defendant

List the amount of the deductible paid by the defendant.

Defense Counsel Expense

List the amount of loss adjustment expense paid to the defense counsel.

Other Expenses

List all other loss adjustment expenses paid.

Safety Management

List any safety management steps that were taken as a result of this incident of medical malpractice, if any were necessary.

 

  1. Click the Save button to save your changes and return to the LPL Claim Summary Page.

    • Clicking the Reset button will reset all fields to blank.

    • Clicking the Cancel button will return you to the LPL Claim Summary page without saving your changes.