House File 161 H-1013 Amend the amendment, H-1007, to House File 161, as follows: 1 1. By striking page 1, line 1, through page 2, line 15, and 2 inserting: 3 < Amend House File 161 as follows: 4 1. By striking everything after the enacting clause and 5 inserting: 6 < Section 1. NEW SECTION . 135P.5 Demand for policy limits 7 —— prima facie evidence of bad faith. 8 1. If a health care provider or health facility makes an 9 offer of compensation under section 135P.3, subsection 3, 10 paragraph “d” , subparagraph (2), the health care provider or 11 health facility may provide the patient with the contents of 12 any insurance agreement under which any person carrying on 13 an insurance business may be liable to satisfy part or all 14 of a judgment which may be entered in any civil action or 15 to indemnify or reimburse for payments made to satisfy any 16 judgment entered in any civil action filed by the patient 17 against the health care provider or health facility. 18 2. If, at the end of the compensation discussion between 19 a health care provider or health facility and a patient, the 20 patient or patient’s legal representative has made a demand 21 for an amount that is less than or equal to the applicable 22 policy limits, and the health care provider or health facility 23 consents in writing to the payment by the insurance carrier 24 of the demand, then the insurance carrier identified in 25 any insurance agreement produced under subsection 1 shall 26 respond in writing to the patient’s demand within thirty days 27 of receipt. If the insurance carrier refuses to pay the 28 demand and the patient subsequently receives a verdict or 29 judgment against the health care provider or health facility 30 in an amount exceeding the applicable policy limits, then 31 notwithstanding section 135P.2, the patient’s demand for 32 an amount that was less than or equal to the applicable 33 policy limits, the health care provider or health facility’s 34 consent, and the insurance carrier’s refusal to pay shall be 35 -1- H 1007.253 (2) 90 cm/ns 1/ 4 #1.

discoverable and admissible in any subsequent action against 1 the insurance carrier for bad faith. 2 3. If the requirements of subsections 1 and 2 have been met 3 and if a bad-faith action is filed against an insurance carrier 4 for failure to pay a demand under subsection 2, then there 5 shall be a rebuttable presumption of bad faith against the 6 insurance carrier and in favor of the health care provider or 7 health facility. Any subsequent verdict amount entered against 8 an insurance carrier for bad faith under this subsection shall 9 not be used by the insurance carrier to increase premiums 10 charged to the insured health care provider, the insured health 11 facility, or the health care industry as a whole. 12 4. If the requirements of subsections 1 and 2 have been 13 met, any insurance carrier that refuses to settle the patient’s 14 demand within the applicable policy limits shall reimburse 15 any defendant health care provider or health facility and any 16 plaintiff court costs and incurred litigation expenses from the 17 insurance carrier’s refusal to settle the claim. 18 Sec. 2. Section 147.136A, subsection 2, Code 2023, is 19 amended to read as follows: 20 2. The Subject to subsection 4, the total amount recoverable 21 in any civil action for noneconomic damages for personal injury 22 or death, whether in tort, contract, or otherwise, against a 23 health care provider shall be limited to two hundred fifty 24 thousand dollars for any occurrence resulting in injury or 25 death of a patient regardless of the number of plaintiffs, 26 derivative claims, theories of liability, or defendants in 27 the civil action, shall not exceed two hundred fifty thousand 28 dollars unless the jury or judge determines that there is 29 a substantial or permanent loss or impairment of a bodily 30 function, substantial disfigurement, or death, which warrants a 31 finding that imposition of such a limitation would deprive the 32 plaintiff of just compensation for the injuries sustained , in 33 which case the amount recoverable shall not exceed five million 34 dollars . 35 -2- H 1007.253 (2) 90 cm/ns 2/ 4

Sec. 3. Section 147.136A, Code 2023, is amended by adding 1 the following new subsections: 2 NEW SUBSECTION . 4. The limitations on damages contained 3 in subsection 2 shall increase by two and one-tenth percent 4 on January 1, 2028, and each January 1 thereafter. In any 5 civil action described in this section, such limitations on 6 damages shall be the amount effective at the time of the 7 occurrence. The commissioner of insurance shall publish the 8 amount of the limitations on damages contained in this section 9 on the insurances division’s internet site and shall update the 10 published amount annually. 11 NEW SUBSECTION . 5. Until January 1, 2028, an insurance 12 carrier that writes medical malpractice insurance in this state 13 shall not increase the premium paid by, charged to, or offered 14 to any health care provider for medical malpractice insurance 15 as of July 1, 2023. On January 1, 2028, an insurance carrier 16 that writes medical malpractice insurance in this state may 17 increase the premium paid by, charged to, or offered to any 18 health care provider for medical malpractice insurance as of 19 July 1, 2023, by no more than two and one-tenth percent, and 20 may increase such premium by no more than two and one-tenth 21 percent each January 1 thereafter. The commissioner of 22 insurance shall approve any premium increase proposed by an 23 insurance carrier under this subsection prior to the premium 24 increase being imposed on a health care provider. For the 25 purpose of this subsection, “medical malpractice insurance” 26 means the same as defined in section 519A.2. 27 Sec. 4. APPLICABILITY. This Act applies to causes of action 28 that accrue on or after the effective date of this Act. > 29 2. Title page, line 1, after < to > by inserting < adverse 30 health care incidents, including > 31 3. Title page, line 1, after < against > by inserting < and 32 medical malpractice insurance of > 33 4. Title page, line 2, by striking < effective date and >> 34 -3- H 1007.253 (2) 90 cm/ns 3/ 4 #2. #3.