Tag: Insurance

Workers comp premiums drop in California
Welfare

Workers comp premiums drop in California

California written premium for 2017 is 2% below that for 2016 and represents the first decrease in seven years, according to the Workers Compensation Insurance Rating Bureau of California’s quarterly report for year-end 2017, released Friday.
The projected industry average charged rate per $100 of payroll for policies incepting in 2017 is $2.46, which is 10% below that for 2016 and 17% below the peak in 2015, the Oakland-based WCIRB said in the report.
The WCIRB projects an ultimate accident year combined loss and expense ratio of 92% for 2017, a projection that is 5 points higher than that for 2016, as premium levels have lowered while average claim severities increased moderately, the bureau said in a statement.
Other highlights of the report include: Indemnity claims continue to settle quicker, and the ratio of claim closure for 2017 represents a 17-year high.
The WCIRB projects indemnity claim frequency for accident year 2016 to be 3% below the frequency for 2015.
However, claim frequency for 2017 shows a modest increase of 1%, similar to other recent years.
The bureau projects the average cost, or severity, of a 2016 indemnity claim to be approximately $77,000, which is 4% higher than the projected severity for 2016 following several years of relatively flat severities.
Average pharmaceutical costs per claim for the first three quarters of 2017 are 70% below the levels from 2012.
This is prior to the impact of the new drug formulary effective in 2018, which is expected to further reduce pharmaceutical costs.
The average number of liens filed in 2017 is 40% below the averages experienced shortly prior to the implementation of the state 1244 reforms impacting lien filings.

Property/casualty insurance rates up in first quarter: MarketScout
Welfare

Property/casualty insurance rates up in first quarter: MarketScout

The composite rate for property/casualty insurance in the United States rose 2% in the first quarter of 2018, MarketScout said Friday, continuing the upward trend from the fourth quarter of last year.
Workers compensation posted a 2% decrease, the only coverage that did not see a year-over-year rate increase, the Dallas-based insurance exchanged said in a statement.
Business interruption, inland marine and professional lines all raised rates 1% more than they did in the fourth quarter of 2017.
Only employment practices liability insurance rates moderated.
Rates for medium accounts of $25,001 to $250,000 increased from up 2% in the fourth quarter to up 3% in the first quarter.
Professional liability was up 2%, while directors and officers liability was up 1% in the first quarter, MarketScout said.
By industry group, service contractors, public entities and energy accounts were assessed larger rate increases in the first quarter than in fourth quarter.
Transportation account rate hikes moderated quarter over quarter, up 4% from up 5%.
“Automobile and transportation exposures continued to experience the greatest rate increases due to increasing expenses and adverse claim development,” MarketScout CEO Richard Kerr said in a statement.
Part of the problem is actual underwriting results, part is expense ratios, and in our view, a larger part is the uncertainty of the long-term prospects for the auto insurance industry.” Traditional auto insurer opportunities, Mr. Kerr added, “will shrink unless they adapt their business model to get in the middle of the autonomous vehicle parade.” On Thursday, insurance exchange Ivans reported that nearly all major commercial insurance lines saw renewal rate increases in the first quarter.

Workers comp provider acquires insurer
Welfare

Workers comp provider acquires insurer

To expand its geographic reach, privately held Service Insurance Holdings Inc., parent of Texas-based Service Lloyds Insurance Co., is acquiring Oklahoma City-based American Healthcare Indemnity Co., the Austin-based company announced Tuesday.
The new entity will be rebranded as Service American Indemnity Co., according to a press release.
The acquisition will allow Service American Indemnity Co. to write workers compensation insurance in up to 48 states.
The new entity will also identify and introduce new programs that will create significant opportunities for growth and profitability, according to the release.
Specifics on the acquisition were not available.
“The launch of Service American Indemnity Co., integrated with Service Lloyds, represents one of the first steps in our strategy to execute measured, organic growth into targeted areas over the next few years,” said J. Kelly Gray, CEO of Service Insurance Holdings Inc., in a press statement.
“It will allow us to continue our tradition of unparalleled service in the workers compensation market as well as be responsive to the growing needs of customers and stakeholders.” The acquisition will result in a planned pooling and reinsurance agreement under Service Insurance Holdings, whose business will remain headquartered in Austin.

CBA sold credit card insurance to jobless people who couldn’t use it
Unemployment

CBA sold credit card insurance to jobless people who couldn’t use it

The Commonwealth Bank sold insurance for credit cards to people who couldn’t claim benefits, a senior bank executive told the Royal Commission into Financial Services.
Under questioning, Clive van Horen, the executive general manager of retail products, agreed that credit card insurance was sold to people who couldn’t claim because they didn’t have a job, including those on unemployment benefits, pensioners and students.
Earlier, a witness gave evidence that she had been pre-approved by CBA for a credit card with a $4000 limit when she was on unemployment benefits.
CBA sold her the insurance even though she gave the bank documentation — her Centrelink income statement — showing she didn’t have a job.
The then-unemployed mother says she tried to cancel the insurance multiple times without success.
Shen she did eventually succeeded in cancelling the insurance she was offered a refund of $88.73.
Up to 140,000 customers would be refunded $26 million.
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Comp insurer not liable for death benefits for out-of-state driver: Judge
Welfare

Comp insurer not liable for death benefits for out-of-state driver: Judge

A U.S. District judge ruled in favor of an insurer who filed a summary judgment on a claim involving an Iowa workers compensation policy for a company that hired an Illinois truck driver who only worked in his home state before dying from a work-related injury, according to the ruling issued in U.S. District Court in Chicago on Friday.
Eldridge, Iowa-based Worldwide Transportation Shipping Co. hired the driver, who worked in Illinois 100% of the time, in August 2014.
The trucking company had workers compensation only for drivers in Iowa, according to documents in Hartford Underwriters Insurance Co. v. Worldwide Transportation Shipping Co.
In October 2014, the insurer was notified that the driver had been involved in a fatal accident in Illinois in September 2014.
In 2015, the driver’s widow filed an Application for Adjustment of Claim against Worldwide, seeking benefits under the Illinois Workers Compensation Act.
“Worldwide hired an Illinois resident for Illinois work in August 2014, but it was not until Jan. 7, 2015, that Worldwide first requested (its insurer) to add coverage in Illinois.
… For a company with mostly out-of-state operations, Worldwide took a risk by only applying for coverage in Iowa, and none of Hartford’s conduct suggested that Worldwide would be protected in taking that risk.
Therefore, Hartford’s Motion for Summary Judgment on the affirmative defenses is granted,” the ruling states.

Insurer not off hook for claim over suspected worker intoxication
Welfare

Insurer not off hook for claim over suspected worker intoxication

A Florida appeals court ruled Friday that an insurer’s failure to meet the 120-day deadline to deny the compensability of an injury claim waived the insurer’s intoxicated-worker rights.
“We find no competent substantial evidence that the (employer/insurer) demonstrated material facts, relevant to the issue of compensability, which they could not have discovered through a reasonable investigation during the 120-day, pay-and-investigate period of the statute,” the Florida 1st District Court of Appeals ruling states.
On Aug. 22, 2015, an employee at Neptune Fish Market fell on the right side of his body while emptying garbage in the outside dumpster, later testifying he slipped on a piece of fish.
The owner was informed of the accident that day, but he never reported the accident to his workers compensation insurer, according to documents in Edward Paradise v. Neptune Fish Market/RetailFirst Insurance Co. After being taken by ambulance to a Veterans Administration hospital, which provides care for U.S. service veterans at low to no cost, the employee was diagnosed with a fractured right hip and eventually underwent surgery.
His recovery was complicated by repeated infection and he ultimately had five surgeries with the last resulting in removal of his right hip joint.
He was hospitalized almost continuously from the date of the accident through November 2016.
Nearly a year later, on May 12, 2016, the worker filed the first notice of the injury with the Fish Market’s insurer, which elected to pay and investigate under Florida’s 120-day rule.
That investigation ran from May 25, 2016, to Sept. 22, 2016, but the insurer did not file a notice denying compensability of the workplace injuries until Dec. 14, 2016, court records state.
In the notice of denial, the insurer asserted that no compensation was due because “claimant’s injuries were primarily occasioned by intoxication,” according to court documents.

Judge rules against insurer that fired adjuster after comp claim
Welfare

Judge rules against insurer that fired adjuster after comp claim

A federal judge in Chicago on Tuesday ruled against an insurance company’s summary judgment in a suit filed by a former employee fired after an 11-month, unresolved workers comp claim.
Timothy Buhe worked as a claims adjuster for Lincoln, Rhode Island-based Amica Mutual Insurance Co. when in early 2013 he fell off a roof while investigating a homeowner’s claim, according to court documents in Timothy Buhe v. Amica Mutual Insurance Co., filed in U.S. District Court in Illinois’s Eastern Division.
In discussions with two Amica representatives, Mr. Buhe indicated he needed at least two surgeries and was “confused” by the company policy on disability leave, according to court documents.
Complicating matters, Mr. Buhe ran a mortgage business on the side, one which his employer had known about.
In November, an adjuster with Amica’s workers comp insurer Chubb Ltd. contacted the company to inform them that Mr. Buhe had been surveilled and was working for his own company while collecting workers compensation.
In 2016, Mr. Buhe filed for bankruptcy, failing to disclose his workers compensation claim and subsequently claimed he did not know he was supposed to, according to court documents.
Judge Jorge Alonso ruled in part against the summary judgment, finding merit in both claims related to the ADA and retaliatory termination: “…A disability leave of absence that an employee seeks as a reasonable accommodation ‘is a factual issue well suited to a jury determination,’ ” his ruling stated.
He also found that “a reasonable jury could conclude that the real reason for plaintiff’s termination was not the violation of company policy but the fact that plaintiff had filed a workers compensation claim against defendant.
A jury could reasonably conclude that Amica seized on the pretext of a violation of company policy as soon as it presented itself in order to terminate plaintiff, but that the real reason for the termination was retaliatory animus against plaintiff for pursuing a workers compensation claim.
There is a genuine issue of material fact as to plaintiff’s claim of retaliatory discharge, and defendant’s motion for summary judgment on this claim is denied.” Judge Alonso granted the summary judgment related to the estoppel claim, as Mr. Buhe voluntarily requested to dismiss this part of his suit, according to court records.

Judge rules against insurer that fired adjuster after comp claim
Welfare

Judge rules against insurer that fired adjuster after comp claim

A federal judge in Chicago on Tuesday ruled against an insurance company’s summary judgment in a suit filed by a former employee fired after an 11-month, unresolved workers comp claim.
Timothy Buhe worked as a claims adjuster for Lincoln, Rhode Island-based Amica Mutual Insurance Co. when in early 2013 he fell off a roof while investigating a homeowner’s claim, according to court documents in Timothy Buhe v. Amica Mutual Insurance Co., filed in U.S. District Court in Illinois’s Eastern Division.
In discussions with two Amica representatives, Mr. Buhe indicated he needed at least two surgeries and was “confused” by the company policy on disability leave, according to court documents.
Complicating matters, Mr. Buhe ran a mortgage business on the side, one which his employer had known about.
In November, an adjuster with Amica’s workers comp insurer Chubb Ltd. contacted the company to inform them that Mr. Buhe had been surveilled and was working for his own company while collecting workers compensation.
In 2016, Mr. Buhe filed for bankruptcy, failing to disclose his workers compensation claim and subsequently claimed he did not know he was supposed to, according to court documents.
Judge Jorge Alonso ruled in part against the summary judgment, finding merit in both claims related to the ADA and retaliatory termination: “…A disability leave of absence that an employee seeks as a reasonable accommodation ‘is a factual issue well suited to a jury determination,’ ” his ruling stated.
He also found that “a reasonable jury could conclude that the real reason for plaintiff’s termination was not the violation of company policy but the fact that plaintiff had filed a workers compensation claim against defendant.
A jury could reasonably conclude that Amica seized on the pretext of a violation of company policy as soon as it presented itself in order to terminate plaintiff, but that the real reason for the termination was retaliatory animus against plaintiff for pursuing a workers compensation claim.
There is a genuine issue of material fact as to plaintiff’s claim of retaliatory discharge, and defendant’s motion for summary judgment on this claim is denied.” Judge Alonso granted the summary judgment related to the estoppel claim, as Mr. Buhe voluntarily requested to dismiss this part of his suit, according to court records.

Insurance legislators reintroduce physician dispensing model law
Welfare

Insurance legislators reintroduce physician dispensing model law

Reprints Louise Esola The National Council of Insurance Legislators’ latest model law on pharmaceutical reimbursement in workers compensation is a reintroduction of a 2013 model law that represents a new push to help educate more state lawmakers on the importance of reining in drug costs for injured workers, according to the organization’s leader.
The model law aims to re-establish clear guidelines for doctors when it comes to reimbursement and distribution of drugs to help reduce workers compensation insurance costs, according to a draft of the Workers Compensation Pharmaceutical Reimbursement Rates Model Act included in NCOIL’s spring meeting agenda, set for March 2-4 in Atlanta.
It zeros in on physician dispensing and drug compounding in workers compensation — issues states are grappling with, NCOIL CEO Tom Considine told Business Insurance from his office in Manasquan, New Jersey.
“We believe this is a hidden accelerator in health costs,” he said, echoing the sentiments of many in comp circles who believe physicians dispensing drugs can raise costs significantly.
1846, which introduced physician prescribing rules, during the 2013-14 session of the Pennsylvania House of Representatives.
She could not be reached for comment.
NCOIL’s model law aims to get more states on board with change, Mr. Considine said, adding that NCOIL is now in the process of tallying which states enacted laws based on the organization’s 2013 adopted model law on the practice of physician dispensing.
Twenty-two states have limits on physician dispensing practices, according to data gathered in early 2017 by Matrix Healthcare Services Inc., then doing business as MyMatrixx and recently acquired by Express Scripts Holding Co.
A spokeswoman for the Washington-based National Association of Insurance Commissioners told Business Insurance that model laws can be effective in inspiring change.
The act also limits physician-distributed drugs to no more than a first fill within seven days from the date of injury, according to the draft.

S.D. bill aims to prevent lawsuits against comp insurers, employers
Welfare

S.D. bill aims to prevent lawsuits against comp insurers, employers

Reprints Louise Esola Lawmakers in South Dakota are slated Tuesday to hear about proposed legislation that would prevent injured workers from suing their employers, workers compensation insurers and third-party administrators on bad faith claims.
S.B.
145, sponsored by a total of 21 state senators and representatives, will leave bad faith claims up to the state’s Department of Labor and Regulation, which oversees the state’s workers compensation program, and would ensure that an employee receives that which is due.
Currently, parties involved in workers comp claims can be sued in civil court if an employee finds that he or she has been treated unfairly.
The department, if it finds favor in the employee’s claim, can “allow the employee a reasonable sum for attorney’s fees to be recovered and collected as part of the costs following a separate hearing of record,” according to a draft of the legislation.
“No person may bring or maintain a cause of action in relation to workers’ compensation benefits sounding in tort or in contract against any employer, employer who is self insured, a risk sharing pool, a third-party administrator, or any insurance company, including any reciprocal or interinsurance exchange, based on a wrongful act, omission, wrongful denial or any claim for refusal to investigate a claim or pay a loss that was considered vexatious, without reasonable cause, or in bad faith,” the draft states.