The 2^nd Appellate District has issued the first of what should prove to be several appellate decisions on the timeliness of independent medical review (IMR) decisions. The court was considering the assertion by a W.C.A.B. panel that IMR timelines are mandatory and that late IMR means the W.C.A.B. -- and not doctors -- will determine whether treatment is medically necessary. In SCIF v W.C.A.B. (Margaris), the court annulled the W.C.A.B. decision and remanded with instructions to issue a new decision. The court’s reason for accepting this case was set out early in the decision: “…We issued a writ of review because this case presents an important issue of first impression regarding the interpretation of section 4610.6, and because it relates to an issue upon which the appeals board has rendered conflicting decisions.” In its analysis, the court provided an extensive discussion of the history of authorization for medical treatment, the implementation of utilization review (UR) for treatment requests and the enactment of the statutory scheme for IMR.  As noted by the court in SB 228 and 899, the legislature changed both the standards and process used by an employer to evaluate a request for medical treatment. The legislature adopted the medical treatment utilization schedule (MTUS). The legislature then removed the existing process for resolving medical disputes using dueling doctors and required the use of utilization review, which required review of treatment requests in light of the MTUS. In 2012, the legislature enacted another set of reforms to address disputes over UR determinations. As noted by the court, a UR determination authorizing medical treatment was binding on the employer but became subject to further review through IMR — but only for the employee. The court further observed that even where an IMR determination is ultimately reversed by the W.C.A.B., the issue of medical appropriateness was to be returned to IMR for further review, not decided by the W.C.A.B. See also: IMR Practices May Be Legal, Yet…   Turning to the specific issue before it, the court determined the use of “shall” in Labor Code 4610.6 was directive, not mandatory: “…The appeals board concluded that section 4610.6, subdivision (d), is clear and unambiguous.  According to the appeals board, “shall” is mandatory, and any IMR determination issued after the 30-day time frame is necessarily invalid. In support of this interpretation, the appeals board cited section 15, which provides “‘[s]hall’ is mandatory and ‘may’ is permissive” (§ 15.). Thus, the appeals board concluded that construing “shall” as mandatory, such that an untimely IMR determination is invalid, comports with both the ordinary meaning and the statutory definition of “shall.” As we explain, however, the issue is more nuanced than the appeals board recognized. … We note that section 15, upon which the appeals board relied in this case to support its interpretation of section 4610.6, subdivision (d), juxtaposes “mandatory” against “permissive,” which arguably suggests the legislature used “shall” in the obligatory permissive sense rather than in the mandatory-directory sense, as the appeals board concluded. (See McGee, supra, 19 Cal.3d at p. 960 [discussing section 15 and concluding that “on its face, the statutory language suggests that the legislature intended the present provision to be mandatory (i.e., obligatory), rather than permissive.”]) However, given the difference in meaning given to “shall” in the statutory context, we conclude section 4610.6, subdivision (d), is ambiguous. Accordingly, we move beyond the plain language of that section and consider its meaning with reference to the rest of the statutory scheme and the intent of the legislature.” The court commented further on this issue: "Generally, time limits applicable to government action are deemed to be directory, unless the legislature clearly expresses a contrary intent.  (Edwards, supra, 25 Cal.3d at p. 410.) “‘In ascertaining probable intent, California courts have expressed a variety of tests. In some cases, focus has been directed at the likely consequences of holding a particular time limitation mandatory, in an attempt to ascertain whether those consequences would defeat or promote the purpose of the enactment.  [Citations.] Other cases have suggested that a time limitation is deemed merely directory ‘unless a consequence or penalty is provided for failure to do the act within the time commanded.’” The court also found the lack of a penalty or consequence for noncompliance to be significant. Citing similar language in actions by the state personnel board, which had been held to be directive rather than mandatory, the court suggested a failure to meet the statutory time frame did not result in a loss of jurisdiction. The court also indicates in its review of the mandatory vs. directory dichotomy that statutes that set time frames for government actions that do not include a self-executing consequence are almost universally construed as directory. The court also noted that construing the 30-day time frame as directory furthers the legislative objective of SB 863. “We conclude from these findings that the legislature intended to remove the authority to make decisions about medical necessity of proposed treatment for injured workers from the appeals board and place it in the hands of independent, unbiased medical professionals. Construing section 4610.6, subdivision (d), as directory best furthers the legislature’s intent in this regard. The appeals board’s conclusion in this case — that an untimely IMR determination terminates the IMR process and vests jurisdiction in the appeals board to determine medical necessity — is wholly inconsistent with the legislature’s stated goals and their evident intent. … Finally, and perhaps most tellingly, the legislature provided that, “[i]n no event shall a workers’ compensation administrative law judge, the appeals board, or any higher court make a determination of medical necessity contrary to the determination of the independent medical review organization” (Stats. 2012, ch. 363, § 45, codified at § 4610.6, subd. (i)). We find this portion of the statute — particularly the use of the phrase “in no event” — to be a frank expression of the legislature’s desire to remove the issue of medical necessity of proposed treatment from the jurisdiction of the appeals board in all cases subject to IMR. The legislature’s intent would be defeated by giving section 4610.6, subdivision (d), mandatory effect, as the appeals board did in the present case.” See also: 20 Work Comp Issues to Watch in 2016 Additionally, the applicant attorney argued that the W.C.A.B.’s holding in the Dubon case (Dubon 2) supported the W.C.A.B's usurpation of authority to decide medical treatment. The court noted the holding in Dubon 2 is supported by the AD’s regulations providing that IMR applies solely to timely and procedurally proper UR but that no similar regulation existed for IMR. The court declined to comment on the W.C.A.B.’s decision in Dubon 2 as the issue was not before it. Comments and Conclusions: There are currently two other cases pending in the appellate courts, both in the 3^rd appellate district — on this same issue and, interestingly, this case was not the first grant on the issue. However, the court set a very aggressive briefing schedule and, even with multiple amicus briefs it heard, considered and decided this case in, what is by appellate standards, a very short time (less than six months). Clearly the court was very interested in this issue, which had multiple W.C.A.B. panel decisions with conflicting holdings. The court, in its decision, also rejected arguments offered by both the applicant and the W.C.A.B. that untimely IMR resulted in unnecessary delays — a rationale offered by the majority panel in both Dubon and Margaris. The court, very astutely, noted this argument made no sense given the time frame for obtaining QME opinions or litigating medical treatment issues before the W.C.A.B.  The court pointed out that, even with the delays in completing IMR, the W.C.A.B. decision was more than 13 months after the initial decision in UR and more than 10 months after Maximus rendered its decision. The court was clearly, and properly, skeptical of the argument that letting the W.C.A.B. decide medical issues would result in a more prompt disposition. The court did offer an option to applicants to challenge untimely UR through the ability to file a petition for writ of mandate to compel a decision. While a statutorily viable option, this is impractical, especially in light of the current timeliness of most IMR determinations. Further, the issue here has never really been the timeliness of IMR. The goal for the applicant attorney bar, and apparently some of the commissioners, has been to usurp the medical decision making process from being medically driven to being litigation-based. The decision does not provide a lot of nourishment for those who are waiting for some sliver of light on the Dubon 2 issue. The court, in its footnote, declined to really comment on Dubon 2, but it did note there was some basis for the W.C.A.B.’s decision. However, the very strong language of the court emphasizing the public and legislative policy behind having medical decisions made by physicians, and the much greater speed and certainty of the UR/IMR process over the legislatively disfavored litigation process, may provide some hope that, given a chance, the appellate court would also reject the W.C.A.B.’s arguments in support of Dubon 2.

This essay takes issue with the Oklahoma Supreme Court’s recent decision in Torres v. Seaboard Foods to declare some workers’ compensation (WC) laws unconstitutional. The problem with the opinions of Justices Edmonson, Combs and Colbert isn’t simply that they reached the wrong conclusion — but that they reached it for the wrong reasons. To justify their decision, all three justices went out of their way to invoke the grand bargain, a historic compromise between employers and employees that guarantees medical and wage replacement benefits to injured workers. Before the grand bargain was struck in 1917, most U.S. employees injured on the job had to sue their employers for damages. The process was often prohibitively expensive, onerous and time-consuming for hardworking citizens who found themselves unable to earn a paycheck — when they needed funds to cover medical bills and other expenses during their convalescence. The grand bargain is worth championing because it put an end to this intolerable state of affairs, thanks, in part, to luminaries such as Crystal Eastman, who thought an injured worker shouldn’t have to spend “nearly half of (his settlement) to pay the cost of fighting for it.” See also: Taking a New Look at the ‘Grand Bargain’ Eastman’s emphasis on avoiding long, costly court battles was typical of the thinking that guided the U.S. into embracing the grand bargain. It is therefore disappointing to see Justice Colbert argue that he is “forced to insure that claimants and employers in the (WC) system have their day in court." Colbert’s rationale is contrary to grand bargain principles. The only thing forcing Colbert to such a conclusion is his decision to put the interests of injury lawyers ahead of the interests of injured workers and of the employers who provide the benefits those workers deserve. If the Oklahoma Supreme Court is as committed to preserving grand bargain principles as Justice Colbert claims, it doesn’t need to do anything revolutionary. It only needs to rule in the same way that it did in 1917, when it initially recognized the state legislature's ability to pass special legislation concerning WC in the interest of the general public. This article is the summary of a much longer essay on the topic, which draws on numerous primary and secondary sources and which you can find here.

If insurance were a map, we would be surveying a whole new world. The fences and boundaries of tradition have fallen. The snow-capped mountains of certainty are melting away. The rivers of market share are changing course, and streams of data are coming directly to our doors. We know there are still products to plant and fields to harvest, but how will our planting change in the months and years to come? Many insurers will be looking at greenfields for the answer. Greenfields, start-ups and incubators are different ways of looking at the same essential concept — starting from scratch. Each is a new beginning. Greenfields are new initiatives often aimed at developing new markets. Start-ups are most often new initiatives that will reach existing markets. Incubators are designed to test new products within new or existing markets. For our purposes, we will lump them all together under the title of greenfields, because from an organizational perspective the need for them and preparation for them are similar. See also: Start-Ups Set Sights on Small Businesses Cultivating the soil Think about how insurance has grown, just based on the questions we have asked ourselves over time. Insurers used to ask, “How do we do what we do better?” They were thinking of underwriting, selling and meeting market demand. As the internet and the digital realm arose, they began asking themselves, “How do we do what we do differently?” They needed to know how to reach the same people with better channel management and improved customer service. Now, they are asking, “How do we do what we don’t currently do at all?” They want to know how to identify, build and capitalize on new risk needs, new markets and social networks, how to use technology to its fullest, how to become a trusted resource for services outside of insurance and how to reinvent the organization and brand so that it is prepared to be profitable no matter what initiatives lie on the horizon. It is the preparation that is an important first step. A great idea can’t take root in an organization that won’t support it. How can insurers prepare for greenfield development? Abandoning silos Greenfield insurance companies that are starting outside of a traditional insurance organization and those that are starting under the umbrella of traditional insurance companies both value “fresh air” and an environment that is unclouded by tradition. Starting from scratch allows them to think without constraint, test without constraint and operate without constraint. They do have barriers. Most are operating within a window of opportunity, and all are operating under the assumption that investments need to pay off. But for the most part, greenfields take advantage of the fact that organizational politics, processes, traditional technologies and time-honored ideals are all open to reassessment, replacement or removal. Organizational silos need to be bridged, if not completely abandoned. The new opportunities where greenfields will work best will be created by cross-functional teams that understand how to integrate new technologies with the best ideas. This is one reason hackathons have recently grown in popularity. They are simply borrowing a common concept from ad agencies, TedX events and jazz musicians…the idea that walls and ideas aren’t compatible. The best fertilizer for ideas is a diverse set of perspectives on how the idea will be constructed and how it will work in practice. Teams need functional area experts, but they also need general leadership with a holistic perspective as well as input from technology partners who grasp what is technologically possible. Investing in seeds Seeds are investments, and most investments have phases. The greenfields in insurance are ripe for these investments, and they are bearing fruit. But those that will be most successful will pay close attention to planting methods. For example, farmers don’t take the newest seeds and plant 1,000 acres. They test them in plots. In insurance, our ideas need to be cultivated quickly, first in small pots, in our incubators and centers of excellence — we can call these our insurance greenhouses. If they appear to be working, we test them in small geographies, then roll them out to larger segments. Seed planting is speed planting. The idea works, or it doesn’t. We scale up quickly or toss the idea out. We invest wisely by investing small, until the investment proves itself and then we invest more. As we watch seed money flowing into InsurTech, we know that some of these investments won’t pay off. Many venture firms will have invested more in a proof of concept than they should have. Some will attempt a rollout before the concept is mature. The best growth will happen through organizations that know how to phase greenfield investment. See also: Investment Oversight: Look Beyond Scores! Greenfields will be capitalizing on technology to save investment funding. This includes reusing technologies and sharing systems. Cloud platforms with a “pay as you go” pricing model are perfect for greenfield development because they answer the demand for agility, innovation and speed (low implementation time, quick speed to market, light or no customization) with lower investment and maintenance costs … allowing the investment to focus on the business, not the infrastructure. Greenfields are creative pursuits to new opportunities. Their back-end solutions will require just as much creativity as their front-end marketing, but they will want solutions that don’t require massive customization. Greenfields will therefore capitalize on what they don’t need to build from scratch. Modern core platforms will allow them to use pre-built, integrated content and data sources, pre-built best practices and products and pre-built channel options. They will use their creativity to build new business models around pre-built infrastructures, instead of building new systems from the ground up. The passion for planting In the coming weeks, we will take a more in-depth look at greenfields, start-ups and incubators. We’ll look at the surprising growth of insurance innovation investment and what it means to existing businesses. We will discuss how deeply the choice of platform can affect insurer preparation, and we’ll also look at the greenfield spectrum that includes new value-chain technologies, new aggregator channels and completely new types of insurance. Our goal is not to gawk at the high number of entrants into the market, but to glean a whole new perspective on opportunities. You may find that your unique position will allow you to have market-capturing ideas ahead of others. And you may develop a passion for planting your own seeds in the greenfields of opportunity. Is your organization ready for your team’s next great idea?

You’ll get no argument from anyone in the global cybersecurity community if you make this statement: “There needs to be a paradigm shift in the way organizations of all sizes view information security.” There are unmistakable signs that such a sea change is underway, driven by intensifying cyber exposures. But organizational change at a macro level won’t happen overnight. And a certain level of turmoil can be expected as the productivity side of the house battles for budget with the security side. That’s the upshot of an impromptu discussion I recently had with three top cybersecurity experts from consulting giant Deloitte. Ed Powers and Scott Keoseyan—U.S. managing principal and cyber threat intelligence director, respectively, at Deloitte’s Cyber Risk Services practice—and Adnan Amjad, a partner with Deloitte’s U.S. Cyber Threat Risk Management practice, helped lead Deloitte’s cybersecurity consulting services, which last year assisted nearly 1,000 clients with cybersecurity planning, including numerous large enterprises and federal agencies. See also: How to Eliminate Cybersecurity Clutter What Powers, Keoseyan and Amjad continue to hear is that the frustration level among senior management is rising. Despite truckloads of cash being spent on the latest defensive technologies, cyber risks continue to intensify, seemingly with no end in sight. Keeping tabs on information Powers told me many organizations have been unsuccessful because they “predominantly use technologies for sharing information rather than protecting it.” That approach includes virtualized data centers and cloud computing. While both can boost productivity, collaboration and innovation, they also introduce complexity, which translates into new exposures to intruders with malicious intent. Organizations must remember that they often are using technologies that have not—from a security standpoint—kept up with the pace of broader business innovation, Powers said. See also: How Good Is Your Cybersecurity? A very fundamental shift—the organizational thinking—must take root, Amjad said. Security must be built into systems from the beginning, and organizations must be more vigilant monitoring them. It’s also critical that the systems have capabilities to respond to cyber attacks. Not just an IT problem And the productivity side of the house needs to work more in concert with the security side of the house. People must be cognizant that cybersecurity is a business issue— not just a technology issue. Of the nearly 1,000 cyber clients Deloitte served last year, many said security is a first-order business risk. That way of thinking may be a difficult transition for lots of companies, so it must start at the top of the organization and permeate down. Security landscape evolves Some industries have caught on. Big banks recognize that security is a business issue for them. They are aware that the safety of their and their customers’ data is important. And some companies in the health care, manufacturing and energy industries have come to understand that cybersecurity is a critical part of their operations. Many organizations, however, lag way behind in cybersecurity and must catch up. Like their counterparts with better security measures, they should determine the actual risk they face. Even the board members should be trying to understand this. Organizations—even sophisticated ones—also must realize that protecting their own four walls is not sufficient. There are too many bad actors using numerous methods and routes to penetrate through the barriers and get access to critical information. Organizations must understand the vulnerability footprint of the people with whom they do business on a regular basis and be certain their supply chains also are secure. This article first appeared at Third Certainty.

In 1965, as college freshmen in the Deep South, we were oblivious to the cultural revolution that was starting to sweep campuses around the country. We were tradition-bound and institutionally managed by a dress code. Our hair could not touch our shirt collars (shirts with collars were mandatory) or cover our ears. Our shirts had to be tucked in, and a belt was required, as were socks. We were free to dress anyway we wanted within those restrictions, and we did. Most chose blue shirts with blue socks or yellow shirts with yellow socks, and, for the bold members of our class, there were pink shirts with pink socks. We wore the same uniforms; only the colors differed. Obviously, these clothes were so “1964 and high school.” So as we grew into sophisticated freshmen with a larger world view we advanced our wardrobe to include Madras (bleeding Madras) in shirts, shorts and some slacks. At last we were different – we were all different – just in the same way. In less than another 18 months, the craziness that was the West Coast – the hippie movement – arrived on campus. Our dress code was gone as fast as our belts and socks. Our bleeding Madras was replaced by cut-offs and tie-dyed T-shirts. At last, we were free to be individuals – to do our own thing – and we did. All of us did our own thing – just the same thing. Fast forward 40 years, and I’m in an agency board room listening to an agency’s management team discussing plans for a new website and a new proposal format to showcase the agency's uniqueness – how it differs from competitors. My question was simple: What makes you different? Give me five or six real, definable and measurable examples of offerings that you bring to the market that your competitors don’t or can’t. The discussions were bold (like college freshmen) and the ideas as diverse as our then-new wardrobes, but to me the sameness was obvious. As they bragged – I gagged. What they saw as “bleeding” Madras, a revolutionary new look, I saw as yellow socks and yellow shirts – and I knew that the competitors were wearing the same wardrobe, because I had been in their closets, too. After several hours and more “styling,” the team agreed on what made them different. I listened politely, then restated their list to be sure that what I heard was what they said. All agreed. Now the challenge was to bring this list to life in a website and presentation. I could live their delusion no longer. I stated, “I know most of your competitors, and they make these same claims and provide the same offerings. In fact, some of them use the same resources to deliver these same offerings. Where’s the difference?” I hit a nerve. One of the producers said, with significant frustration, “Yeah, but we really do it.” With equal frustration, I stated confidently, “I can call each of the principals of all of your competitors and ask them if they really do these things, and I promise you they will each say, Yes.” To prove the point, I created a spreadsheet with the nine major competitors of their agency listed. I then studied the website of each and captured two or three of the most significant “brag points.” Finally, I hid the names and brought the spreadsheet with me to the next meeting. I said, “Tell me which is your agency - it should be easy because you are unique.” After many attempts, they acknowledged that they couldn’t because they weren’t. Before you discount this article and this challenge as not applying to your shop, I have one suggestion. Try it. Can you find your uniqueness? Would your clients find it? Would they believe it? How long have you had that nice Madras shirt? See also: Dare to Be Different: It's the Only Approach That Works

From tracking our steps and calorie intake to the way we request taxis, technology has bled into almost every area of our existence. But not every industry has been able to move to a digital experience. The insurance industry is one of the least tech-savvy industries out there -- but it’s also a $1.1 trillion market. That is is why investors and entrepreneurs have begun tackling it, vowing to make every process within the insurance realm friendlier, easier and, most of all, digital. Where the industry stands today Emerging technologies have had little impact on improving the carrier side of things. Though carriers have built systems to make a broker’s life easier, these systems are largely outdated and clunky. These systems also have not addressed a larger issue: Small businesses are largely underserved in the commercial insurance world. Because the cost of acquiring a customer is high, brokers spend the majority of their time serving bigger businesses, which have more risk and higher premiums. Insurance brokers do not have the means to acquire small businesses in a cost-effective way, nor do they have the structures in place to support the digital customer. See also: Technology and the Economic Divide Unless you’re a company like Apple, you likely don’t have the luxury of innovating quickly; that is because there are often many layers of management standing in the way of making a quick decision. The insurance industry has found itself woefully unprepared to respond to the drastic change in our economy. The scrappiness you see in corporate innovators was absent; the status quo of bad process was king. Customers have higher expectations today than they did 20 years ago; couple that with changing demographics, and insurance companies start to feel the burn. Customers expect a seamless experience: that is, easily educating themselves, getting a quote, purchasing insurance and easily managing that insurance. However, insurance is a much more complex buying process than consumers are used to. Customer expectations are mismatched with the way insurance is currently purchased, and Insurtech start-ups are seizing the opportunity to redefine this process. Insurance is necessary. It allows us to protect ourselves, our businesses and our worldly possessions. But the process is outdated. So, nothing has changed? No one entity owns the insurance buying process, which makes it a slow-moving and often disjointed experience for customers. Things ARE heading for a change, though; it’s just been a slower change than other industries because of the complicated web of reinsurers, insurers, intermediaries and retail agencies that all have a stake in crafting the process. The right financial resources are being allocated to figuring out this process; insights are being learned from making consumer applications intuitive; and the incredible power of the internet is becoming easier to access within the insurance industry. Here’s what we’re already seeing:

• Data: Carriers are using data in a smarter, better way. Machine learning and the computational power that is available nowadays allow carriers to slice and dice data in ways that were never a possibility before. As a result, rates are better matched to a customer’s risk.

The use of data in insurance has been game-changing from a customer perspective, a carrier perspective and a broker perspective. One of the earliest ways data was adopted by the industry? Price comparison tools for auto insurance. Now? Progressive is offering cheaper pricing for safe drivers by measuring things like speed and braking through a tool called Snapshot--which plugs directly into a consumer’s vehicle. See also: Blockchain Technology and Insurance In life and health, carriers are using data gleaned from wearables, such as the ever-popular Fitbit, to create an experience that encourages insureds to participate in less risky behavior and provides incentives to participate in healthy activities.

• Speed and Ease: The use of third-party data has also opened the door for carriers to ask only the most relevant questions during the application process, which means shorter, better and less nitpicky applications overall.

SEMCI, or Single Entry Multiple Company Inquiry, is something we see more and more carriers take advantage of. The SEMCI approach enables brokers to obtain quotes from their markets. So, instead of spending hours filling in data and searching for quotes one at a time, I can get four quotes from four carriers within 90 seconds. Customers are now used to driving to their agent’s office and signing paperwork or faxing paperwork directly to a carrier, but this has become too arduous in a world where everything is fast-moving. So, companies like CoverWallet are creating a more digital experience for business owners seeking insurance. CoverWallet allows customers to buy and manage insurance from the comfort of their own homes by leveraging technology and taking a more intuitive approach to interviewing the customer. Paper applications were replaced by carrier portals where agencies manually entered data into their systems. Now, portals are being replaced by APIs and web services to stream information in an efficient and low-cost way. There’s still a long way to go It would be unfair to say that start-ups alone will change the face of the industry; the truth is carriers, brokers and innovators will all have to work together to create real, lasting change. The industry has taken steps in the right direction, but it’s nowhere near game over for innovation. Over the next year we’ll see:

• Improvements in accessing information and education: The information that’s found online surrounding insurance will become more personalized. For instance, what insurance does your business need if you live in a certain state and work in a specific industry?
• Emerging technologies present new opportunities: From data breaches to drones, new technologies have made carriers and start-ups take a look second look. How do you access risk and intelligently price new technologies with little information?
• Even smarter incentives: Wearables might be just the beginning for incentive-based pricing. We’re looking at an untapped market for incentive-based commercial insurance, but expect that to change in the near future.
• Friendlier service, any way you want it: Most carriers are providing service on the phone, but it’s impossible to think that won’t change, and fast. Expect to get in touch with a carrier or broker via email and chat--sooner rather than later.

See also: 4 Technology Trends to Watch for   At some point, change becomes easier than staying the same, and that’s where the insurance industry is now, if for no other reason than the consumer demanding it. Venture capitalists and entrepreneurs who have entered the space see the opportunity, and it’s up to carriers and brokers to seize it by working with entrepreneurs or innovating themselves. What they’ll choose is yet to be seen.

Benjamin Franklin famously said, “In this world, nothing can be sure to be certain except death and taxes.” If he was alive today, he might want to rewrite that quote to include increasing insurance premiums. Every year, without fail, premiums rise. That's great news if you’re an insurance company, but it's not so great when you’re renewing your annual policy. And while there’s a weary public acceptance that insurance premiums will inevitably go up because insurance companies do, after all, have to make money like any other business, transparency around premiums and how they are calculated is an issue. Insurers still fall short when it comes to explaining to their customers about rates. Jargon is rife in communications to customers and is often indecipherable, which just makes matters worse. Consider my own recent experience: I purchased travel insurance online and was sent a 22-page policy document to decipher — most of which would have benefited from a lawyer’s expertise to help me understand it. Nine pages of the document were spent explaining what wasn’t included in my policy!    See also: The Insurance Renaissance, Part 2 More insurance companies could ensure greater customer loyalty and instill trust by doing a better job at explaining some of the policies and clauses. For example, some international health insurance clauses that consumers may not be aware of but which are highly beneficial:

• Many health insurers will provide protection for any unexpected cost in the future and keep providing cover even when a condition develops. They will keep paying the cost of any treatment required, up until the policy limits.

• International health insurance will cover medical costs abroad, even if the insured chooses to travel for surgery outside her country of residence. So if there is a famous specialist in another country and someone wants to have surgery there, their insurance will pay the medical costs.

• Most insurance companies will provide cover until very old age, 80 to 120-plus. This is important to know because if someone has an insurance policy that only provides cover up to the age of 60, it will be difficult to find insurance to cover any conditions subsequently developed. And this is the age when health insurance is more useful than ever.

• There are now insurers that are rewarding customers who don’t make a claim with a "No Claims Discount."  

And one that could cause confusion:

• A person may think he is covered for as much as $1 million under health insurance for hospital bills and treatment etc., but what is often unclear is what conditions are not covered by that sum.    

See also: Important Alliance to Fight Health Costs At the end of the day, buying insurance should be viewed as an investment that provides peace of mind and reduces a person’s financial liabilities — and everyone would agree that this is worth paying for. But consumers should be given the opportunity to make a much more informed choice when renewing a policy by having much greater visibility on how premiums are determined. For the insurance industry, a continuing lack of transparency around the calculations of premiums can only be bad for business in the long run. In a fiercely competitive industry like insurance, consumers now have more choice than ever when choosing a policy. So maintaining customer loyalty is everything and, together with consistently good customer service and swift settling of claims, the key to ensuring customer loyalty is better communication and transparency across the industry. After all, it’s much harder to win new business than to retain existing customers. A more consumer-focused insurance industry will also encourage more people to purchase their products, so getting better at communicating can only be a win-win situation. It’s also about making the process simpler, easier, transparent and giving an online experience that customers would expect. Most people can take bad or difficult news if it is explained to them properly — and getting a clear, jargon-free and understandable explanation for insurance premiums puts the purchasing decision power back where it should be: in the hands of the consumer.  

As the June 30 deadline approaches for the 2016 SMA Innovation in Action Award submissions, let’s take a look back at our insurer winners from 2015: Haven Life Insurance Agency, John Hancock and USAA. Their innovative projects and initiatives have demonstrated how they are rethinking and reinventing the business of insurance and furthering their progress toward becoming a Next-Gen insurer. Insurers that are considering submitting an application to the 2016 Innovation in Action Awards program can see from these examples what a winning business and technology project/initiative might look like. See also: How to Enable the Next-Gen Insurer The Next-Gen insurer model is based on five foundational areas of transformation: customer, products and services, technology and data, business model and innovative culture. (For more information on the Next-Gen Insurer model and its foundational areas, click here.) Insurers are taking creative approaches in all of these areas, and the 2015 winners are no exception. Winners are listed in alphabetical order.

• Haven Life Insurance Agency made a real leap forward for the entire insurance industry in the area of products and services by offering medically underwritten life insurance that can be purchased online. Haven simplified an arduous paper-based application process of four to six weeks to better meet the expectations of today’s customer. The company did this by leveraging technology and data – specifically, external data fed through sophisticated algorithms – to greatly reduce the amount of information that the customer has to provide to receive a quote. A partnership with MassMutual gives Haven Life access to the resources of a large organization while retaining the innovative culture that sparked the transformative approach to selling, underwriting and administering life insurance.

• The John Hancock Vitality Program reimagined the relationship between an insurer and its policyholders, creating a unique customer experience in the traditionally low-touch world of life insurance. The program rewards policyholders for healthy behavior such as exercising and getting annual physicals. These activities can be tracked through wearables technology and data via a free Fitbit or logged online through a computer or a mobile app. John Hancock uses this data in an online rewards program that offers premium savings, among other rewards, changing the business model for this life insurance product. In addition to rewards, policyholders can receive individualized encouragement toward further healthy behavior, a value-added service that represents a real advance in life insurance products and services.

• USAA pioneered the use of drones in the insurance industry, showing what this technology and data can do for insurers, especially in P&C claims. After mudslides hit Oso, WA, USAA’s deployment of drones for damage assessment established a new and vital service for policyholders in post-disaster situations, pushing the envelope in the foundational area of products and services.

See also: 6 Key Ways to Drive Innovation The real progress that these three insurers are making toward becoming Next-Gen insurers is evident in the effects these groundbreaking initiatives have on the five Next-Gen Insurer foundational areas. They are also fantastic examples of how thoughtful approaches to innovation can make insurers stand out from the crowd in the industry. This is the fifth year of our SMA Innovation in Action Awards program, which honors insurers and solution providers that are putting innovation into action with creative projects, initiatives, technologies or solutions that further insurers’ progress toward the goal of becoming Next-Gen Insurers. We encourage you to apply for the SMA Innovation in Action Insurer Award or the Solution Provider Award to share your successful innovations! Submissions are due by June 30, 2016. A full program description, FAQs and links to the applications for both awards can all be found on the SMA website.

After going through the process of finding candidates, interviewing prospects and eventually choosing the individual who's perfect for the customer service representative (CSR) position you're trying to fill, it may be tempting to take a deep breath, sit back and think that the hard part is mostly over. And while taking a deep breath is certainly never a bad idea, thinking that new employees will simply figure everything out on their own is. This is especially true for CSRs, whose main responsibilities include being the face of the company, answering questions and helping clients and customers through their issues. In this case, proper onboarding couldn't be more critical. Providing CSRs with the information and tools they need to feel comfortable on the phone, via chat or in person, will not only make them better at their own jobs, but it will ensure that the image your company portrays is accurate at all levels of the business. Here are five ways to onboard new CSRs to help make their transition much smoother and to make them productive team members sooner.

• Create or customize a customer service employee handbook

Having a go-to source for every question and concern, while a sizable undertaking to start from scratch, can be extremely helpful for new employees. Fill a CSR handbook with information about the company, policies, FAQs, insights about customers and anything else that would help new CSRs feel as though they've been with the company for years. Or personalize an existing handbook by adding notes with tips, tricks and helpful message points. Your advice and suggestions can help new hires feel welcome and comfortable with you as a colleague or boss. See also: How to Redesign Customer Experience

• Set up new employee meet-and-greets

Usually during the first few days on the job, employees are bombarded with countless names and titles, making it stressful for them if they believe they are expected to remember everyone immediately. By organizing ice-breaking meet-and-greets between new and current employees, supervisors can provide everyone with the chance to learn a bit more about each other, and new hires may more quickly feel like part of the collective group.

• Organize regular check-ins

Starting a new job is overwhelming. It's often difficult to know how you're doing, if you're doing the job right and if there's anything you should be doing differently. By setting up weekly check-ins with new hires, even just for 10 minutes in the morning, employees can ask any questions they have, and you can provide helpful feedback on their performance. This can also be a great time to review customer service reports or calls to ensure that all steps are being taken to solve customers' issues. This small time commitment can help employees stay on track early in their development.

• Write an onboarding checklist

During the first few weeks of a new job, there are seemingly dozens of forms, meetings, technology setups and more that an employee has to complete. Developing a checklist for new employees to make sure they are prepared to do their job is a great way to take the full onboarding onus off of you or HR. This checklist can also be a great place to set immediate, concrete goals that you'd like new employees to achieve within a scheduled timeframe. To ensure that the checklist doesn't seem like one more piece of paperwork, make it a little less formal by adding a few must-visit lunch spots, important people to meet or other fun aspects of your corporate culture.

• Run through some mock customer service calls

New CSRs are ideally hired for interpersonal skills and their ability to solve problems. However, the way those things are conveyed to customers can vary dramatically from one company to the next, and new employees will often default to the methods and messages they used at their last employer. To gauge how new employees will respond to your company's calls and test whether they're staying on message, run through some mock customer service calls — from simple to exasperating — before allowing them to answer phones on behalf of the company. If adjustments need to be made, you can alert them to how things are done at your company and correct any issues before they present themselves during a live call. See also: Are We Listening to Our Customers? These suggestions are surely just a few ways to optimize your onboarding process. Do you have anything to add that you've found helpful? Please share your advice below so other professionals can learn from your experience. Thanks!

With a growing recognition that employees are a company’s greatest asset, it is increasingly important to consider how to keep staff in different countries happy and engaged. According to some studies, happy, comfortable employees are 12% more productive. Further studies suggest that benefits such as health insurance can reduce employee turnover by up to 25%. There is also increasing evidence that ensuring employees get enough time off and don’t work too many hours can boost productivity — as well as your workforce’s long-term health. A recent Aon survey of multinational companies found that 56% don’t have a global benefits database, despite global benefit reviews being a top priority. For companies operating in more than one country, setting benefits centrally can cut administrative costs, while simplifying reporting and reducing resentment between cross-border teams who may perceive the perks their colleagues receive to be unfair. Understanding what is normal in different countries is the best starting point to work out how to develop appropriate packages, from local working cultures — such as working hours, vacation time, salaries, levels of tax on earnings — to indirect benefits like the availability of state healthcare, statutory sick days and age of retirement. But when considering a working location, remember that simple top-level overviews like those shown below are never sufficient to make a decision — the devil is in the details, so seek out expert advice. In Depth Talking Points “There is a clear trend of centralization at multinationals, yet it isn’t flowing through to the way that employee benefits are managed…. The vast majority of decisions are still being taken by local stakeholders. [Effectiveness of global planning] is generally being restricted by a lack of up-to-date information and administration activities.” – Carl Redondo, Aon Global Benefits “When considering the impact of local laws, care should be taken to note cultural differences and issues of discrimination. Employers should question whether or not a particular benefit will integrate with cultural norms.” – Personnel Today “You need to understand what impact [benefit schemes] are having on behavior… a big alarm bell should be ringing if they perceive it to be unfair” – Jonny Gifford, Chartered Institute of Personnel and Development “This article originally appeared on TheOneBrief.com, Aon’s weekly guide to the most important issues affecting business, the economy and people’s lives in the world today.” Further Reading

• Benefits Are the New Salary – Bloomberg Business, June 30, 2015
• The Employee Benefits That Make a Real Difference – Fast Company, June 2, 2015
• The World Bank Group and ILO Universal Social Protection Initiative – International Labour Organization, July 29 2015
• 5 Affordable Benefits Employees Appreciate but Few Companies Offer – Entrepreneur, July 6, 2015
• 15 Companies With Incredible Employee Perks – Business Insider, Aug. 13, 2015
• Centralising Global Benefits Held Back by Operational Realities – Employee Benefits, June 9, 2015
• Trends in Global Employee Engagement – Aon report
• Global Benefits Study – Aon report