Frequently Asked Questions

Lone Star Alliance, Inc., a Risk Retention Group (RRG), is an affiliated company of TMLT. It was established to provide medical liability and similar types of insurance to physicians, groups, health care facilities, and health care professionals in multiple states. Lone Star Alliance, Inc. (LSA) can meet the needs of TMLT's new and existing policyholders by writing insurance for those who have operations in states other than Texas. LSA is domiciled in Washington DC.

Texas Medical Liability Trust (TMLT) is a health care liability claim trust created to provide medical malpractice insurance to members of the Texas Medical Association.

An RRG is an alternative insurance entity allowed under the federal Liability Risk Retention Act (LRRA). RRGs must be domiciled in a state or in Washington DC , and formed accoring to the rules of its jurisdiction. Generally, RRGs are mutual companies, meaning they are owned by their members (policyholders). Membership must be limited to organizations or persons engaged in similar businesses or activities, thus being exposed to the same types of liability.

No. While Lone Star Alliance, Inc., a Risk Retention Group (RRG), is affiliated with TMLT, as an RRG it is owned by its members. TMLT — directly and through its subsidiaries — provides LSA with all essential operational support. Such support includes financial and accounting services, information technology, underwriting, sales, marketing, claims handling, and risk management functions. These services are provided according to a management services agreement.

LSA is domiciled in Washington DC, but our office is located in Austin, Texas.

LSA offers a full range of medical liability coverage options for individual and physician groups, and allied health care professionals. We offer claims-made (including prior acts or “nose coverage”) and occurrence policies at a variety of limits. Per-patient rated policies and shared-limit policies are also available. Policies include cyber liability protection, regulatory actions protection, medical director coverage, and employment practices liability insurance.

Any physician, group practice, allied health care professional, or health care entity located outside of Texas can apply for coverage with LSA.

If a practice located in multiple states applies for coverage, the Texas-based physicians may be insured through TMLT and the physicians based outside of Texas will be insured through LSA.

Please go to the "Join" section of the website or contact your agent or a LSA representative by calling 844-595-8866.

No. TMA membership does not apply to LSA. TMA membership remains a requirement for coverage with TMLT.

Because we will need information about your new practice, we will ask you to complete an application. You can start the application in myPortal or call 844-595-8866.

While LSA and TMLT policies are similar, there are some important differences, and therefore you are encouraged to contact LSA, consult with an agent, and/or read your LSA policy to understand the coverage provided. LSA policies are flexible and specific policy needs can be modified or endorsed.

TMLT Trust Rewards cannot be extended to LSA policyholders.

LSA does not have a dividend program at this time.

LSA rewards physicians for their patient safety efforts. The following premium discount opportunities are available in most states.

• discounts for favorable claim experience
• group purchasing credits
• discounts for risk management participation
• discounts for new-to-practice physicians
• part-time discounts
• discounts for completing a LSA CME course (up to 5 percent for two courses)

Through our Risk Management Department, LSA offers home-study programs and online courses to help reduce liability risk. Courses are available at the LSA CME site.

No. You must take an LSA CME course to earn the discount. Courses are available at the LSA CME site.

No. Your TMLT practice review discount will not apply to your LSA policy.

We offer a monthly payment plan with 10 payments. The first installment is 20%, with the balance due in remaining nine payments.

We also offer a quarterly plan with installments of 35%, 25%, 25%, and 15%.

There are no finance charges associated with LSA payment plans.

Pay online or through our policyholder site, myPortal. You can set up recurring automatic payments or make a one-time payment. You can also mail payments to:

Lone Star Alliance
Attn: Accounts Receivable - Payments
P.O. Box 160140
Austin, TX 78716

You can visit our members-only site, myPortal or call customer service at 844-595-8866.

Yes. There is a fee charged by the processing company for use of its services, but those are not LSA fees. This 2.99%* fee applies to all premium payments made by credit or debit card, regardless of policy type or size. The fee also applies to any other payment a policyholder makes by credit or debit card.

 *2.99% fee subject to a minimum fee of $2.95

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Yes. The 2.99%* fee will apply to each individual installment payment made by credit or debit card.

*2.99% fee subject to a minimum fee of $2.95

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Switch to ACH payments by:

1. Logging in to our members only portal and following the prompts.
2. Calling customer service at 800-580-8658 ext. 5050.

 You will need your bank account number and routing number,which can be found on your checks or through your online banking portal.

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To ensure your next payment does not incur the fee, we recommend switching to ACH payments at least 5 business days before your next scheduled payment date.

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ACH (automated clearing house) transactions transfer funds electronically between bank accounts. ACH transactions have lower processing fees for merchants compared to credit card transactions. ACH fees are often flat and nominal, even for large transactions.  

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ACH transactions are generally considered less risky than credit card payments because the funds are transferred directly between bank accounts, reducing the potential for fraud. Credit card transactions carry a higher risk of fraud and chargebacks.  

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No. The fee applies to all card payments processed through credit card networks, including debit cards. To avoid the fee, please use ACH (electronic bank draft).

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Yes. But generally, ACH payments are considered safer than paying with checks. ACH payments are electronic and offer features like fraud prevention and faster processing, while checks are physical and can be lost, stolen, or used fraudulently. 

 If paying by check, mail your payment to:

Lone Star Alliance
Attn: Accounts Receivable - Payments
P.O. Box 160140
Austin, TX 78716

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According to your policy, a claim can be any of the following:

A demand for compensation — any written communication from or on behalf of a patient that seeks monetary payment or other compensation because of a perceived error in treatment or an unexpected outcome.

A notice of claim letter — a letter that refers to Civil Practice and Remedies Code Section 74.052 or refers to a notice of claim. Upon receipt of a 74.052 letter, a physician and his or her insurer have 60 days to investigate and evaluate the patient's claim.

A lawsuit — will contain a citation (which informs you of a lawsuit) and a petition (which lists the plaintiff versus the defendant). A lawsuit will also include the allegations made against you. Once you are served with a citation and petition, LSA has a limited time to respond by retaining a defense attorney to file an answer on your behalf.

If you receive any of the above items, contact the LSA Claims Department at 800-580-8658 as soon as possible. You can also start the claim reporting process through myPortal (log in required.) We may have limited time to investigate and evaluate the claim. Any delay in reporting could compromise your defense.

If you are reporting a Medefense or Cyber Liability claim you must report it to LSA no later than 60 days from the date you became aware of the claim.

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Although not considered a "claim" that would trigger coverage under your policy, you may want to report the following situations to seek advice to possibly prevent the matter from evolving into a claim:

Unexpected outcome — any complication or failure of treatment in which the patient or a patient's family member may have expressed disappointment with the outcome or if you suspect that a claim may be asserted in the future.


Records request — a request for a patient's medical records may come from the patient, the patient's spouse, an attorney, a record service, or from a court reporting service in the form of a subpoena. Requests for records should include an authorization signed by the patient or by the patient's legal representative. It is best to respond to a request as soon as possible. If you suspect that the records request is for potential or ongoing litigation, or if you question the validity of the records request, you should contact LSA for advice.


Request for deposition — a deposition is testimony given under oath before a court reporter. You may be served a subpoena for oral deposition, or an attorney may contact you directly. If you are asked to give testimony regarding a patient, particularly if that patient is suing another health care professional, please contact the LSA Claim Operations Department immediately. Depositions can potentially become claims and you should be properly represented at any such proceeding.

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Submit documents

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Once a notice of claim is reported, the loss is assigned to a claim supervisor and coverage is entered and verified. Once the claim file is set up in our system, the following occurs:

• A letter is sent to the policyholder requesting a copy of all medical records regarding the physician's care of this patient.

• A response letter is sent to the plaintiff's attorney or pro-se plaintiff requesting specific allegations, damage nformation, and a medical authorization that when signed by the patient, allows us to request the pertinent medical records;

• If the new loss is a lawsuit, the Texas Medical Board (TMB) is notified;

• If a lawsuit has already been filed, then we dispense with the response letter to the plaintiff's attorney. We assign a defense attorney to answer the lawsuit and defend the physician. The policyholder receives a letter from the claim supervisor advising of the attorney assignment.

The average time to complete this from the day the loss is reported is about 5-10 working days.

Do not discuss the case with anyone except an LSA claims representative or the attorney assigned to defend you.

Maintain your original medical records in a secure place for future reference. Do not make any additions, deletions, or any other type of alteration to the medical records. Secure any other pertinent information or items in your possession, such as billing records, x-rays, hospital charts, etc.

All correspondence to and from LSA and your assigned attorney should be kept in a separate and secure file. These items should not be co-mingled with the original medical chart on the patient. Do not release these materials to anyone unless cleared through your assigned attorney or the LSA Claims Operations Department.

The LSA claims representative assigned to your case will keep you fully informed as the case proceeds, both directly and through your assigned attorney. If you have questions, do not hesitate to call your claim supervisor.

You can request a quote here or you can contact a sales representative by calling 844-595-8866.

You can apply for coverage using our online application. A representative from LSA will contact you once your application has been received.

The average time to process an application is approximately 10 business days. Please make sure that your application is filled out completely, as incomplete information may delay the underwriting process.

When joining or renewing with LSA, you may add or opt in coverage for your administrative activities as a medical director. Please contact your underwriter at 844-595-8866 to add this coverage.

Your insurance premium is based on your location, specialty, procedures performed, the limits of liability that you choose, the number of years of you've been in practice, and your claims experience.

We cannot advise you about what limits to carry, but we recommend that you speak with colleagues who practice in your specialty and location to see what limits of liability they carry. You may also contact your local county medical society; often their legal counsel is available to advise you. Your personal financial advisor may also have recommendations in consideration of your personal assets.

LSA policyholders can take two 2-hour courses per policy period for a maximum CME discount of 5%. The courses must be completed before your policy renewal date.

LSA policyholders who complete a 2-hour risk management CME activity may be eligible for a 2.5% premium discount. The discount will be applied to your next eligible policy period. Two 2-hour courses can be taken per policy period for a maximum 5% discount. Multiple 1-hour courses cannot be combined for the discount.

If you have previously completed an LSA online course and you do not have your username or password, please go to our online CME log in page. Hover over“Hello Guest. Sign in” on the right side of the page and then select “Sign Up”from the dropdown menu. Once redirected to the MyPortal site, click “Forgot Password” and enter the required information. If you have not completed an LSA online CME course, please go to our online CME login page and click “New User Registration-Individual” once redirected to the MyPortal site. You will need to enter your LSA policy number and your medical license number. After entering this information, you will receive a welcome email with a link to activate your account. Once activated, you may log in with the username and password you set up during registration.

You can reprint a certificate from any online LSA CME course by logging on to our online CME login page, clicking “My Courses” and selecting the course. Click the “Take Test/Get Certificate” button to print your certificate.

If you attended a live seminar and need a copy of your certificate, please contact the risk managementCME team at cmemail@tmlt.org and a copy of your certificate will be emailed to you.

Please contact the risk management CME team at cmemail@tmlt.org for a course transcript, go to our online CME log in page and click “My Courses”, or log in to myPortal and click “See more” on the CME Overview pod to view your CME credits for the last three years.

We offer online CME courses and CME in our publication, the Reporter. View a complete listing of all LSA CME courses.

Yes. You can carry over up to two courses per year. However, there are time limitations for how long completed courses may be applied for a discount. Contact cmemail@tmlt.org with your questions.  

Generally, most health care professionals — including nurses, nurse midwives, advanced practice nurses, CRNAs, physician assistants, physicians, dentists, and podiatrists — are required to have malpractice insurance, either as a part of their employment or to maintain privileges or payer contracts.

While both types of insurance can protect you, they cover different risks.
 
General liability insurance for a practice may typically cover:

• slips and falls in your office/facility
• damage to someone’s personal property (broken glasses, damaged phone)
• injuries caused by a premises defect
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Medical malpractice insurance generally covers injuries arising out of professional services rendered by a physician, such as:

• misdiagnosis or delayed diagnosis
• surgical errors or complications
• medication errors (wrong drug, wrong dose, adverse reactions)
• failure to order appropriate tests
• improper treatment or failure to treat

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The answer to this question may largely depend on the corporate structure and ownership of your practice and the provisions of your policy. Here’s how your LSA policy generally works.

• If you are the sole proprietary member of a professional association (PA) or professional limited liability company (PLLC), the association or company will have coverage under your individual LSA policy on a shared-limit basis.
 
• If the ownership of a solely owned PA or PLLC changes to joint ownership with other physicians, coverage is no longer afforded under your individual LSA coverage. You may need entity coverage. 


• If you employ more than 3 physicians under your solely owned PA or PLLC, you may need to discuss your coverage and the coverage of your employed physicians with the LSA Underwriting Department.
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Coverage for an entity can be a good idea because in a lawsuit, the patient may name you (personally) and your practice.

The answer to this question depends on the provisions of your policy. That’s why it’s important to understand the details of the policy your employer provides. Consider these factors.
 

• Understand your employment contract and its provisions for your coverage.
• What are the requirements for the group’s malpractice insurance?
• Does the policy cover all your activities as a physician?
• Who has consent to settle a claim. You? The insurance carrier? Your group?
• Who “owns” the policy?
• Who pays for the insurance?
• Who pays for tail coverage?
• What if there is a dispute between you and your employer about a claim?
• Always notify your insurance carrier of any changes you make to your practice.
• Request a copy of the policy including the declarations page. Keep copies of all documentation.
• When leaving employment or a group, request a copy of your tail policy.
• Remember to ask questions, keep proper documentation, and that everything is negotiable.

Determining what limits to carry is a personal choice depending on many factors including your personal assets and your overall risk tolerance.
 
Limits spell out the maximum amount your policy will pay. With malpractice coverage, there are two limits. The first limit states the maximum paid per claim, while the second limit states the maximum paid during the policy period (usually one year). Medical malpractice limits for physicians typically range from $100,000/$300,000 to $1 million/$3 million.
 
In general, insurance carriers cannot tell you what limits to carry. But you can speak with colleagues who practice in your specialty and location to see what limits of liability they carry. Your personal financial advisor, attorney, or insurance agent can also recommend limits. You should also consider any contractual obligations when deciding on limits of liability. (The hospital you have privileges at or the health insurance companies you contract with may require you to carry certain limits.)

Yes. Tort reforms vary in form and function from state to state. However, even in states with some form of tort reform, large awards against a physician may still be possible as even caps on damages generally only limit certain types of damages awarded.

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In a medical malpractice insurance policy, a “consent to settle” provision defines whether the insurance carrier can settle a claim without the policyholder’s permission.
 
Generally, LSA cannot settle any claim against you without your consent. Not all medical malpractice carriers offer a similar provision. Some are silent on the issue, while others stipulate that the carrier retains the power to settle a claim.
 
Why it matters
Specific consent-to-settle terms vary by policy, so it’s important to understand which type of provision your policy contains and what financial exposure you might face if you reject a settlement recommendation.