Contents
Medical Malpractice Information
All medical malpractice payments (including settlements, judgments, and arbitration awards) made within the past 5 years
Review any pre-printed information for factual accuracy.
Respond to the question regarding malpractice payments made on your behalf in the last 5 years by clicking Yes or No.
If the information is accurate and complete, you don't need to do anything further.
If any of the pre-printed malpractice events are under appeal, click on the box next to the pre-printed malpractice event. (Click on the box again to de-select).
If the pre-printed information is not factually accurate, you can dispute the action by following the disputed steps.
Disputed - The Default is NO. If you want to dispute this event, please choose YES
Dispute Reason - Required when choosing YES to an action.
Your dispute will be directed to the New Jersey Board of Medical Examiners for review.
Add New Malpractice Item
If a medical malpractice payment made on your behalf in the past five years is not pre-printed, select the Click here to add a malpractice item link.
Enter data in the following fields:
Date of Payment - Enter date (Ex. 03-24-2015)
Dollar Amount - Enter amount (Round to nearest $)
Type - Click on arrow, select from list
Medical Malpractice Insurance Carrier - Click on arrow to select from list or enter the name of the insurance carrier directly in the space provided
Under Appeal - Click on the box if this event is under appeal
Dispute Yes/No - (if the data was entered or modified by the State of New Jersey)
Dispute Reason - (if the data was entered or modified by the State of New Jersey)
Your dispute will be directed to the New Jersey Board of Medical Examiners for review.
When finished, click one of the buttons at the bottom of the screen:
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Save & stop for now
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