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Training the Future Claims Adjuster

Despite the impending retirement of so many claims adjusters and a lack of enthusiasm among Millennial prospects, a solution is in sight.

Unless you've been frozen in carbonite for the past 15 years, you're probably aware that the insurance industry is facing two imminent HR crises:

  1. A Brain Drain- Twenty-five percent of the industry workforce is expected to retire by 2018, according to Insurance Business America. But wait! It gets better. In addition to filling vacancies caused by attrition, companies will have to recruit workers to staff the 200,000 new jobs the Bureau of Labor Statistics expects the industry to create by 2022.
  1. An Enthusiasm Gap- Even today, the industry is struggling to attract young talent. According to a 2012 study by the Griffith Insurance Education Foundation, only 5% of Millennial students describe themselves as "very interested" in working in the insurance industry. When it comes to considering a career as a claims adjuster, the "Y" in Generation Y stands for "yawn."

Two Problems, One Solution

I believe new and emerging information technologies will play a critical role in overcoming both the Brain Drain and Enthusiasm Gap.

Many young people would rather view an endless loop of piano-playing cat videos on YouTube than work as a claims adjuster. Or so they think...

With the imminent arrival of usage-based insurance, there is a lot of excitement developing in the underwriting sector, and I believe the same level of enthusiasm will also attach to technologies such as cognitive analytic computing. These new technologies are innovative. They're challenging. They're fun.

More important: Technologies like cognitive computing will change the very nature of the claims adjuster's job - from one that requires a fair amount of dull administrative tasks to one that places much more emphasis on analysis, creative problem-solving and people skills.

Skills Will Trump Experience

In the future, we'll see fewer claims adjusters in the workforce, but this smaller pool of talent will be trained in a different ways and in different skillsets than previous generations. Tomorrow's adjuster will not possess - and will not need - the wealth of experience, knowledge and (to some extent) skills as today's adjuster. Instead, new technologies will provide them with the tools to instantaneously obtain that knowledge, experience and skill.

The future adjuster won't be trained in many of the manual and repetitive tasks his predecessor had to learn. Tasks with little or no value will be automated. Rather, the adjuster will have to be tech-savvy. She will have to know how to analyze information because, even with the help of cognitive computing, she'll still need to analyze reams of information - data related to vehicles, collision-avoidance technology and event data recorders.

She will also have to be familiar with product liability issues. When self-driving cars become commonplace, adjusters may not be dealing with losses involving driver fault. Instead, they may encounter instances in which the vehicles malfunctioned - product-liability claims - and will have to know how to process claims with vehicle manufacturers and the suppliers of advanced collision-avoidance systems. Future adjusters will need to tap skills and knowledge that their forbears never dreamed of.

Tech-Savvy and People-Savvy

Future adjusters will have to be much more tech-savvy, even though they'll be responsible for performing fewer tasks. At the same time, they'll need superior people skills to ensure that customer service isn't lost amid increasingly automated processes. Although the industry will automate many tasks, and many customers will be pleased with this development, customers are already demanding higher levels of customer service. The "personal touch" isn't just a side benefit: It's often the main driver behind a consumer's decision to choose one carrier over another.

So adjusters of the future will be people who are very customer-oriented, very tech-savvy, very intelligent and very skilled at interpreting mountains of data. They won't have to perform a lot of clerical and administrative tasks. Automation will virtually eliminate that work. But they will have to know how to optimize new technologies to deliver superior customer service and the best possible outcome to every claim.

We in the claims industry have to find ways to inspire, energize and interest young people in careers as claims adjusters. Currently, this isn't a vocation many Millennials seek. With the help of new and emerging technologies, however, we can be seen as a fun, innovative and inventive sector that adds value to the lives of ordinary people. After all, getting into accidents causes a great deal of stress for most vehicle owners. For that reason, our industry needs adjusters who are adept at a wide variety of claims-processing and customer-service challenges.


Ernie Bray

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Ernie Bray

Ernie Bray, chairman and CEO of ACD, has more than 20 years of experience in the insurance and automobile claims industry. Bray is a dynamic force in driving innovation and technology to transform the auto claims industry and connect a highly fragmented business sector.

Hope on Depression in the Workplace

Depression devastates nearly one adult in 10 and costs 200 million lost workdays a year. With two simple steps, employers can help -- a lot.

There is a silent epidemic taking a toll on the American workforce. This illness affects 9.5% of the adult population and is to blame for 200 million lost workdays each year. Those lost workdays cost employers an estimated $17 billion to $44 billion. Despite these staggering statistics, only one-third of those affected by this common illness will ever seek professional help. What is this cause of disability, absenteeism and productivity loss? Depression.

There are many reasons an employee may keep concerns about his mental health private. Stigma, fear of losing his job and lack of awareness can prevent an individual from seeking help. Despite these hurdles, there are strategies employers can implement to not only connect their employees with the help they need but to also improve productivity. Employers that address mental health issues have happier, healthier employees and see increased productivity and profits.

Confidential online depression screenings are a proven way to reach those in need and help direct them to appropriate assistance. For more than a decade, the WorkplaceResponse program has worked with organizations to address mental health issues in the workplace. Developed by the nonprofit Screening for Mental Health, WorkplaceResponse is a mental health education and screening program that easily integrates into existing employee assistance programs or enhances existing wellness initiatives hosted by human resource departments or employee assistance programs.

The program offers screenings for common mental health concerns, including depression, bipolar disorder, generalized anxiety disorder, post-traumatic stress disorder, eating disorders and alcohol use disorders. Screenings are anonymous and engage employees in becoming active participants in their own well-being. Upon completion of a screening, employees are provided with immediate results and linked back to employee assistance program (EAP), local or company resources.

Health promotion programs can also have positive effects in the workplace. These programs serve as excellent tools to increase mental health awareness and educate workers on the signs and symptoms of depression. Managers and employees who can identify these symptoms can assist at-risk individuals with receiving the help they need.

National Depression Screening Day (NDSD), held annually on the Thursday of the first full week in October, is dedicated to raising awareness and screening people for depression and related mood and anxiety disorders. NDSD is the nation's oldest voluntary, community-based screening program that gives access to validated screening questionnaires and provides referral information for treatment.

Oct. 8 marks the 25th year of the revolutionary campaign. This milestone allows for opportunities to begin the conversation about mental health in the workplace. Identifying workplace risk factors, taking action to reduce employee stress and initiating organizational wellness programs can be productive first steps.

Employers can make a difference by encouraging employees to take a quick, anonymous mental health assessment at http://helpyourselfhelpothers.org/ or by launching a 25-day wellness challenge. To encourage employees to take care of their mental health, a 25-day wellness challenge provides ideas and actions individuals can take to relieve stress, boost mindfulness and foster healthy behaviors. Examples include walking, cooking with family and taking a break from technology. Simple methods like the challenge can help increase awareness in the workplace.

It is time to address workplace depression. Effective screening tools are available, and treatment works. The early detection and prevention of mental health conditions can improve the lives of individual employees as well as the health of an organization.


Candice Porter

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Candice Porter

Candice Porter is executive director of screening for Mental Health. She is a licensed independent clinical social worker and has more than a decade of experience working in public and private settings. She also serves on the Workplace Taskforce under the National Action Alliance for Suicide Prevention.

How Insurance Helps End Hunger, Poverty

Remarks delivered at a UN summit explain how insurance provides protection from the unique set of risks faced by the world’s poor.

These remarks were delivered at the United Nations Sustainable Development Summit on Friday, Sept. 25, 2015.

Good afternoon, excellencies, ministers, ladies and gentlemen. My name is Mike Morrissey, and I'm president and CEO of the International Insurance Society. We are a nonprofit research and idea exchange organization representing life and non-life insurers, as well as regulators and risk management scholars, from nearly 100 countries.

Professor Shawn Cole of Harvard, a world-leading expert in development economics, has said, "Risk is one of the greatest challenges faced by poor people around the world."

This can be seen as the risk of flood, earthquake, hurricane or cyclone. It can also be experienced as crop failure, livestock mortality, illness or death of a family member or in food or water security. The ability to manage and finance risk is therefore a key element in the development of societies, and thus in alleviating poverty and hunger.

The insurance industry has played a key role in this effort by expanding access to risk protection and risk management advice, for centuries in the developed world, and now very broadly in Sub Saharan Africa, South Asia, Latin America and in other less-developed areas. With nearly one billion people living on about one U.S. dollar a day, this form of social protection is vital, since the poor are often those most exposed, just one loss event away from calamity for themselves, their families and their possessions.

At the UN Insurance Sector Summit, which took place at the ECOSOC Chamber here last June, I sat next to Secretary General Ban Ki-moon as he complimented the insurance industry for its vital role in mitigating and reducing risk and thereby raising living standards where help is needed most. But he also called for the industry to do more in the future, and so the industry continues to innovate in ways that offer more protection for more people, and makes a major contribution to reducing poverty and hunger.

A few examples are worthwhile to make the insurance industry's role clear.

German Insurer Allianz is a world leader in microinsurance, the protection of low-income people. Allianz provides crop, livestock and other coverage for 125 million farmers in India and China, and participates in the Africa Risk Capacity pool to insure governments against natural catastrophes. Peruvian insurer La Positiva has tailored agricultural coverage for rural farmers who have limited access to communications and healthcare. A new Bermuda-based venture called Blue Marble Microinsurance has developed savings and protection products, among them some linked to poor women's key life-cycle triggers.

These efforts, and many more like them, link the worlds of finance and development, expanding access to protection from the unique set of risks faced by the world's poor. Through our industry's efforts, and through public private partnerships with governments and international institutions to capitalize on both the risk assessment and long-term investing capabilities of insurance organizations, the sustainable development goals of ending extreme poverty and hunger can and will be achieved.


Michael Morrissey

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Michael Morrissey

Mike Morrissey is chairman of Protective Life, a Fortune 500 provider of life insurance, annuities and other financial products. Protective Life is owned by Dai Ichi Life Group, one of the world’s largest life insurance companies.

Previously, he was president and chief executive officer of the International Insurance Society (IIS) for 11 years. He continues his 30-year involvement in the leadership of the IIS as a member of its executive council and as its special adviser. He is a steering committee member of the World Economic Forum’s “Longevity Economy” initiative, as well as chairman of Legeis Capital, an alternative asset management firm.

Morrissey earned a BA from Boston College and an MBA from Dartmouth. He has completed the Harvard Business School Corporate Financial Management Program and has a Chartered Financial Analyst (CFA) designation.

A Child's View of Workers' Comp

My daughter, then age six, was "helping" me with some client reports and cut to the essence of what workers' comp should be about.

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Step back and consider how simple workers' comp should be.

If every professional from all corners of our industry took time away from their narrow daily focus and considered the big picture in general terms, we might all experience a collective re-setting of the communal respect we should carry for the essence of workers' comp's intent.

One evening in 2005, my daughter, then six years old, was "helping" me do work in my office. (As my good clients know, on any given day Risk Acuity might run a robust second or third shift!) I was reconciling a monthly pile of client first-reports, and she was making sure my finished stack was in date-order. At one point, she decided to create a report of her own on a blank paper, mimicking the lines, boxes and random numbers.

When she showed me her finished product, I was puzzled. In one area, she wrote "Jhon Elbort." Near the top, she wrote "Broke hes legs." Every other line was either blank or filled with a scribble. I asked if she wanted to know the kinds of information she could make up for other boxes (like the date, doctor's name, birthday, address, etc.). She replied, "If he broke his legs, why do you need to know anything else?"

If only every aspect of our industry had such simple respect for this essence. In a perfect world of integrity, we would all uphold our ends of the bargain. Imagine employers, claim providers, doctors and employees making honest efforts to support what the system should be and make reasonable expectations about the limits of what the system owes. This would obviate most of the other tactical, legal and profit-driven "busy work" we all do that has no direct impact on an injured person's recovery.

We should never forget that WC is all about the employee experience.

Needless to say, Jhon Elbort's first report remains framed on my wall.


Barry Thompson

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Barry Thompson

Barry Thompson is a 35-year-plus industry veteran. He founded Risk Acuity in 2002 as an independent consultancy focused on workers’ compensation. His expert perspective transcends status quo to build highly effective employer-centered programs.

The Future of Telematics Is... Italy

Insurers in Italy, where UBI has gone mainstream, offer three types of services that enhance auto policies and improve customer satisfaction.

The black box used for telematics makes it possible for insurers to enrich their auto insurance value proposition by adding services built upon data. These services represent a way of de-commoditizing the car insurance policy and are also a source of income. In the medium/long term, such services will become more and more important as the risks covered by car insurance decrease because of technological progress on security and connected cars. These services also increase the number of interactions with the client, creating a richer connection and improving customer satisfaction. This is true both for Italy and at an international level.

There are three macro categories when it comes to services:

  1. Informational services related to the UBI (usage-based insurance) policy, typically delivered through a smartphone app or a dedicated area on a website. These services concern: quantification of pricing adjustment at the moment of the contract renewal based on previous driving behavior; coaching and advice regarding the style of driving; advice on how to save more while behind the wheel; "gamification" that allows a comparison of one's own driving style with that of friends. A Canada-based company called Intact and Discovery, which is based in South Africa, can be considered among the most advanced examples that currently use this type of approach. According to recent data made available by a telematics service provider, four out of five clients owning a telematics insurance policy check put their driver score at least once a month. Furthermore, there is evidence that remote coaching programs can lead to concrete results in modifying driving behavior.
  2. Product offers related to the client's automobile -- like Discovery has done in South Africa with the Tires or like Allstate Rewards -- or insurance policies sold "on the go" using data collected from the boxes installed on cars (a process known as reverse geocoding). Tokio Marine (Japan-based) and telephone operator NTT Docomo have shown that impulse "cross-selling" of low-value insurance coverage is a valid approach.
  3. Services related to the customer journey in a connected car.

There is a vast array of services that can be developed within the connected car ecosystem, and the technology is moving fast. There are start-ups and innovative business models popping up everywhere around the world. To cite just a recent Italian example, there is WoW -- a digital wallet created by CheBanca! -- which has integrated a parking payment service called Smarticket.it.

Services could be observed on three stages of the customer journey:

  • While behind the wheel. Services include bad weather alert, speeding alert, dedicated concierge and even an alert that is activated if the car leaves a pre-defined "safe area" (family "control" options for young or old members of the family). Discovery's approach in this field is highly relevant and includes an anti-theft service that signals to the client if the driver has a different driving style compared with the usual one;
  • In case of an incident. Here the Italian market is considered to be an international best practice because of how it has perfected the usage of telematics data to manage services. Many companies here have invested in creating a valuable customer experience by involving partners specialized in assistance. The solutions provided in case of an incident start with contacting the client and -- depending on the gravity of the event -- continue with sending help directly and taking care of all the logistic and case management problems that can arise. Innovation is now focusing more on simplifying the FNOL (first notice of loss) procedure. One such example is Ania, Italian Association of Insurers, which has announced for 2016 the launch of an app for FNOL.
  • While the car is parked. Beyond locating and recovering the car in case of theft, the blackbox can send alerts when the vehicle is moved or damaged in any way. This also allows a driver to locate a parked vehicle. There are three Italian companies - TUA, Cattolica and Cargeas - that have recently launched innovative value propositions for parked cars. One of the best practices is the street sweeping alert by Metromile.

In this new service ecosystem, insurers will find themselves forced to co-compete (that is collaborate and compete) with different actors that are active in the connected car sector.

Italy is at the moment one of the most advanced countries in terms of service development connected to telematics; they have become mainstream, not just a niche. At the end of 2014, telematics represented 15% of motor insurance sales and renewals in Italy, reaching 30% in some regions, as underlined by a recent analysis by IVASS.

This creates the perfect conditions for the consolidation of approaches driven by insurance companies.

Insurance Industry Can Solve Cyber

Although cyber security seems to be an intractable problem, the insurance industry has unique insight that can bring it under control.

Before explaining the basis for the strong statement in the headline, it's necessary to redefine what "solve" means. After all, we live in a world where the myth of impenetrability was long ago debunked, where there are no silver bullet technology solutions and where continued cyber events are as certain as the sun rising tomorrow. Anybody who knows anything about cyber is likely thinking, "It's impossible to solve cyber risk!" But what if we redefine "solve" as: "to provide security leaders and firms with an accurate picture of their cyber exposure, with the ability to effectively manage the risk and with resiliency when an event happens."

With that as the definition, why is the insurance industry best-positioned to solve cyber? It's a matter of insight and the scope of that insight. The insurance industry is the only industry that has the ability to correlate controls and protective actions (insight gained during the underwriting process) with losses resulting from the failure of such controls and protective actions (insight gained by paying claims), thus occupying a front-row seat to what is working and what is not. Most importantly, because the industry serves this function across all classes of risk, across all industry verticals and on a continuous basis, the insurance industry should be the primary source of actionable cyber risk management insight. No technology or network appliance can do that, and even the best assessment is merely a snapshot in time.

Let's drill a little deeper by considering each element of the new definition individually.

First, the ability to provide firms with an accurate picture of their risk is a critical step toward managing it. An insurance-linked approach can help firms understand the context of their cyber exposure and do it in a way that is both easily comparable and lays a foundation to capture loss and claims data. We recommend starting with four categories of loss: 1st party financial, 3rd party financial, 1st party tangible and 3rd party tangible. Then drill deeper within each category, with subcategories tied to specific types of insurance coverage and areas of un-insurability -- an incredibly helpful data point itself (meaningful areas of un-insurable cyber risk should see an overweight deployment of controls). Ultimately, this approach paints a complete picture of the cyber risk spectrum and then facilitates the easy utilization of claims data for exposure modeling and benchmarking.

Next, the ability to effectively manage cyber risk certainly trumps the other two elements based on what is most sought by the security community right now. I've often described the job of a cyber security leader as akin to putting together a puzzle in which one-third of the puzzle pieces are missing, another third don't fit together and, to make matters worse, the board changes every 30 minutes. This characterization of cyber will probably never tire -- hence the need to redefine "solve" -- but this is the very challenge that the insurance industry is best positioned to attack. Why? Because the insurance industry underwrites the cyber security programs of firms of all shapes and sizes on a daily basis and pays claims resulting from the failure of those cyber security programs on a daily basis. If information on both fronts can be appropriately harnessed and correlated in something akin to real time, the underwriting process itself should serve not as an interrogation but rather as an actionable intelligence session for firms to understand how to best evolve their cyber programs. And why stop there? Security leaders should welcome the opportunity to call their insurance companies anytime for an update on the risk climate and for guidance with strategic planning.

Finally, the ability to provide resiliency. This is where insurance coverage itself comes into play -- as it is the only type of control that can reduce, or even eliminate, the cost of an event. The ability to survive is the true measure of resiliency, so while a robust set of controls, policies and procedures wards off antigens and increases the likelihood of surviving, the financial resources to pay for an event will be most meaningful in determining the firm's and security leaders' fates.

Imagine the post-event press conference if the insurance industry solved cyber: "Ladies and gentlemen, we've experienced a cyber event. It will likely be large but nowhere near catastrophic. We've been planning accordingly; we knew what our exposure was, and we have been continually updating our defenses in accordance with best-in-class recommendations from our insurance partners. We can validate that by virtue of the fact that we have been able to maintain a comprehensive insurance program that will cover all of our costs as well any claims against us. The organization will emerge whole."

The insurance industry has answered the challenge before. Decades ago, insurers started to correlate the causes of events like fire and boiler explosions and subsequently provided invaluable risk-engineering insight to firms. Nobody can dispute the relevance of the industry for minimizing property risk. While some characteristics of cyber are definitely unique, all of the foundational pieces are in place for the insurance industry to do the same here. If the industry succeeds, cyber can be solved.


Scott Kannry

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Scott Kannry

Scott M. Kannry is the chief executive officer of Axio Global. Axio is a cyber risk-engineering firm that helps organizations achieve more comprehensive cyber risk management through an approach that harmonizes cybersecurity technology/controls and cyber risk transfer.

Assisted Driving Is Taking Over

While many await the driverless car, the future of safety is already here, through assisted driving. Insurers and regulators must act.

The power of 35.

The Insurance Institute for Highway Safety (IIHS) estimates that automatic emergency braking and forward-collision warning features could curtail injury claims by as much as 35%. The California Department of Motor Vehicles estimates that in 35% of crashes the brakes were not applied. It is striking that these two numbers match.

These savings are not surprising. Automatic braking will avoid some accidents altogether. When an accident nevertheless occurs, automatic braking may greatly reduce the speed on impact. As a matter of simple physics, a reduction in speed results in an exponential reduction in the kinetic energy that must be absorbed in a collision. The formula, for those interested, is Kinetic Energy = 1/2mv2, where "m" is the mass of the vehicle and "v" is the vehicle's velocity. Thus, a vehicle that collides at 30 mph has only one-fourth the kinetic energy of a vehicle that collides at 60 mph.

While automatic emergency braking and forward-collision warning are standard in some luxury cars and are available as options in many others, 10 automakers have agreed with the National Highway Traffic Administration and the IIHS to establish a time frame for making assisted driving features standard in all cars.

These are significant developments for insurers and for public policy makers.

For insurers, a 35% decrease in injury claims will result in a significant reduction in premium. This may be offset, at least in part, by an increase in the cost of repair for more sophisticated vehicles and the continuing increase in healthcare costs.

Public policy makers should contemplate the potential benefits of a 35% reduction in injuries and deaths because of assisted driving. At present, highway deaths in the U.S. account for 33,000 to 35,000 deaths per year (depending on how one correlates deaths to auto accidents). Over 10 years this is the equivalent to the population of some major cities-St. Louis, Minneapolis, Des Moines or the city of your choice. A 35% reduction would reduce deaths from 33,000 to 21,450. Every year, 11,550 more people would continue to go about their lives. Add a similar reduction in the more than 2.5 million injuries per year, and the public benefit is overwhelming.

These benefits only accrue as assisted driving features find their way into the fleet. This can be a slow process. It is estimated that electronic stability control, which has been available as an option for many years and has been mandatory since 2012, will not reach 95% penetration until 2029. This is because the average age of automobiles is a bit more than 11 years. Thus, anything that can hasten the adoption of these safety features (and others that are to come) benefits everyone.

Encouraging adoption directly implicates insurance. Auto insurance is one of the more expensive costs of owning a car. The cost of these safety features, either as an option or as a standard feature, is also an expense of owning a car. It is critical that savings from the lower frequency and severity of accidents be rapidly passed on to car owners in lower insurance rates, which will help offset the added cost and promote more rapid adoption.

Even when assisted driving features become standard, which will be some years in the future, the majority of the existing fleet may still be on the road for another 11 years or so. Passing substantial insurance savings to potential purchasers will make retiring the old heap more palatable.

Policy makers and regulators can play an important part in facilitating adoption of these safer cars. Laws and regulations that may impede the rapid distribution of insurance savings to insureds should be streamlined. Likewise, some driver-centric rating systems that may distort rates by artificially depressing the weight given to the safety of the vehicle should be reviewed.

Self-driving vehicles of the future have captured the attention of the public and the insurance industry. While many have been looking toward that day, enormous improvements in safety-critical technology are taking place right now. In a sense, the future is already here. Cars are taking over many safety-critical functions from their more fallible drivers. Insurers and policy makers must adjust.

Those interested in a lengthier treatment of this topic can read this article by Thomas Gage and Richard Bishop. And here is a Bloomberg article on a Boston Consulting Group study of the issue.


Robert Peterson

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Robert Peterson

Professor Robert Peterson has been very active throughout his career with the Santa Clara University School of Law community. He served as associate dean for academic affairs of the law school for five years and is currently the director of graduate legal programs.

Will ACA Shift Claims to Workers' Comp?

A new WCRI study says yes. The result could be $100 million of additional, annual workers' compensation claims in a state like Illinois.

Hundreds of millions of dollars of claims could shift from group health to workers' compensation as accountable care organizations (ACO) expand under the Affordable Care Act (ACA), according to our new study: Will the Affordable Care Act Shift Claims to Workers' Compensation Payors?

Although pundits have written about "cost shifting" to workers' compensation, a significant and underappreciated effect of the ACA is "case-shifting" from group health to workers' compensation.

The ACA seeks to greatly expand the use of ACOs-where providers are rewarded for meeting cost and quality goals. This effort will expand the use of "capitated" health insurance plans. Under these plans, providers are paid a fixed insurance premium per insured regardless of the amount of care provided to a given patient during the year. Under traditional fee-for-service insurance plans, providers are paid for each individual service rendered.

The question addressed in the study is to what extent do the financial incentives facing providers and their healthcare organizations influence whether a case is deemed to be work-related. In other words, how many cases will get moved to workers' comp, which covers fees for each additional service, from group health, where the fixed fee under capitation means providers wouldn't get any additional payment.

The study found that a back injury was as much as 30% more likely to be called "work-related" (and paid by workers' compensation) if the patient's group health insurance was capitated rather than fee for service. The study can be extrapolated to different states-for example, the study predicts about a $100 million increase in workers' compensation costs in a state like Illinois if the share of capitated patients rises from 12% to 42%.

Case-shifting was more likely in states where a higher percentage of workers were covered by capitated group health plans. In a state where at least 22% of workers had capitated group health plans, the odds of a soft tissue case being called work-related were 31% higher for patients covered by capitated plans than for similar workers covered by fee-for-service group health plans. By contrast, in states where capitation was less common, there was no case-shifting seen. This is more than just the result of having fewer capitated patients seeking care. It also appears that, when capitation was infrequent, the providers were less aware of the financial incentives.

This study relies on workers' compensation and group health medical data coming from a large commercial database. This database is based on a large sample of health insurers and self-insured employers. It includes individuals employed by mostly large employers and insured or administered by a variety of health plans. The database is unique in that, for a given employee, it contains information on both the group health services used and the workers' compensation services used.

For more information about this study, visit http://www.wcrinet.org/result/will_aca_shift_wc_result.html.


Ramona Tanabe

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Ramona Tanabe

Ramona Tanabe is executive vice president and counsel at the Workers Compensation Research Institute in Cambridge, MA. Tanabe oversees the data collection and analysis efforts for numerous research projects, including the CompScope Multistate Benchmarks.

The Problem With Telematics

sixthings

When I attended the Insurance Telematics USA conference in Chicago earlier this month, I expected to see much more enthusiasm. I first wrote about Progressive's venture into telematics all the way back in the late 1990s, and technology has improved so much since then that the telematics industry would surely be bragging about its breakout into the mainstream or at least predicting that one was imminent. The idea just makes so much sense: being able to track cars so that insurance risks can be determined very precisely for individual drivers, while even providing feedback that improves driving.

While the telematics technology is, in fact, stunning and while there are reasons for great optimism, what I found was not an industry brimming with confidence. I found an industry still searching for the right business model.

Until the industry solves that problem, progress will remain limited.

The Problem

The current approach to telematics is generally to install a device in a customer's car for six months and have it relay the driver's actions back to the insurer for evaluation. At the end of the six months, the device is uninstalled, and the insurer tells the driver what sort of discount, if any, she will receive based on her driving habits. A key point is that the issue at hand only concerns discounts; insurers have promised that they won't raise rates if they find that someone is a worse risk than expected.

Think about the expense that goes into that model: manufacturing the telematics devices; installing and uninstalling them; and transmitting lots of data over a wireless network on which the insurer has to buy bandwidth.

Now think about the benefits. The prospect of a discount has attracted enough good drivers that, if all telematics-based auto policies were rolled into one company, it would be close to being in the top 10 among auto insurers in the U.S. Ptolemus, a strategy consulting firm, said there are 4.4 million cars in the U.S. carrying usage-based insurance (UBI). That's a lot of cars. But there are 253 million cars and trucks in the U.S., so the market penetration of UBI is just 1.7%. Even in the main ballroom of the conference, full of ardent proponents, only about 5% raised their hands when asked if they had UBI.

Many customers turn out to not be that focused on discounts. They would prefer receiving free access to other services, such as roadside assistance -- but what services customers want, how to bundle those services, etc. has yet to be worked out.

Even if some new package of free services drove 10 times as many people to buy UBI auto policies, telematics wouldn't do much to make roads safer. Insurers are offering incentives to a self-selected group of drivers who are already among the safest on the road but, because insurers have decided they can't raise rates for bad drivers, won't be doing anything about the people who cause a huge portion of the accidents and, thus, the costs.

The current business model works -- barely. The costs are too high, the offering to consumers isn't right and the benefits to insurers are too low.

The Potential

Help is on the way from two main sources, which I have seen drive innovation in industry after industry since I started following the world of information technology almost 30 years ago. One source is what I think of as the power of "free." The other is the power of a platform.

The Power of "Free"

The behavioral economist Dan Ariely has done all sorts of experiments about the power of free and found that it is almost magic. For instance, if someone does volunteer work and you decide to thank him by paying him a little, he will likely cut back on the work he does for you or even stop. Ariely reasons that people evaluate paid work in a hard-nosed way -- how many hours do I work, how hard or skilled is the work, how much do others get paid for this work, etc.? -- and evaluate volunteer work based on altruistic measures, such as the quality of a cause. If you have people evaluate the return from their free work on a paid scale, you'll lose them. Similarly, he says, you can get people to do all kinds of uneconomic things if remove a paltry cost and make something free.

The power of free computing and communication has driven the upheaval of business over the past 30 years, spawning the wide adoption of the Internet, smartphones, etc. and all the business models that have come along with them. (Obviously, we still pay for computers and storage devices, but they are essentially free by comparison with where they were in the 1980s -- a gigabyte of memory, which cost $300,000 then, costs about a penny today. Communication costs have gone way down and are headed toward something approaching free, even though telecom and cable companies will fight a rear guard action as long as they can.)

Now the power of free is coming to telematics, because the cost of acquiring information on drivers is heading toward zero.

In the short term, that will be because of smartphone apps. Although some say the data they generate isn't quite as precise as that from sensors in cars, the apps are good enough for the vast majority of uses, and they cost roughly nothing. There isn't any need to make a dongle for the car and install and uninstall it. Nor is there a need for the insurer to buy a wireless data plan for the car. The app can do most of the analysis on the phone and just send modest amounts of data back to the insurer, using the driver's wireless plan.

In the long term, things will get even better as "connected cars" move into the market. These cars, already connected wirelessly to the Internet, will automatically generate the kind of information that insurers need. Insurers will be able to know what kind of a driver someone is at the moment she applies, rather than having to guess and then wait six months to know for sure.

The Power of a Platform

From the 1950s through the early 1980s, when IBM controlled the computer industry, the pace of innovation was glacial by today's standards. Part of the reason was that the pace let IBM milk maximum profits, but part was also because IBM had to produce what software types would call the "full stack." IBM had to develop the semiconductor technology that allowed for faster processors; design those processors; manufacture the processors; design and manufacture just about all the support chips, especially memory; assemble the mainframes; code the operating system; and generate the major pieces of application software. Everything had to come together, from one company, before the next step in innovation happened.

When the PC came along in 1981, with its open architecture, innovation became a free-for-all. Intel owned the chip, and Microsoft the operating system, but everything else was fair game. Companies flooded into the market, innovating in all kinds of smart ways, especially with applications such as the spreadsheet, and the market took off.

The telematics market is well on its way to making the transition from the IBM mainframe days to the open days of the PC and beyond. Initially, Progressive had to pull an IBM and invent the whole process for telematics from beginning to end. Now, an ecosystem has developed, and all sorts of companies are free to innovate at any part of the process.

Verisk has announced an exchange, to which car makers and insurers can contribute data on drivers and from which they can pull information. GM has said it will contribute data from its OnStar system, and GM has one million 4G-connected cars on the road in the U.S. So, the need for everyone to generate their own data is going away.

The Weather Channel (represented on the panel I moderated at the conference) has information that can correlate bad weather very precisely with driving behavior -- the company is even working to aggregate information on the speed at which cars' wipers are operating, to understand in a very granular way just how severe a storm is in a certain spot.

Many other companies are innovating in new parts of the ecosystem, rather than just focusing on pricing risks better or acquiring customers. For instance, my friend and colleague Stefan Heck, a former director at McKinsey with whom I wrote a book (along with Matt Rogers) about how innovation can overcome resource scarcity, just unveiled an extremely ambitious approach to improving safety, through a company called Nauto. (A writeup in re/code is here.) Agero made a presentation at the conference about how telematics can speed claims processing and cut costs while making customers happy -- essentially, the telematics system notifies the insurer instantly about an accident, so the insurer can provide whatever reassurance and help is necessary, while also sending someone to the scene so fast that it can take control of the process, rather than deferring to, among others, municipal towing companies.

The Future

The power of free and the power of a platform ensure that, before too many years go by, the costs for telematics will drop drastically and the benefits to insurers and customers will increase greatly. That still leaves insurers with the task of figuring out the right offering to customers, but, in my experience, once costs get low enough and lots of innovators get interested, experimentation eventually produces the right business model.

The question to me is: Who will that winner be?


Paul Carroll

Profile picture for user PaulCarroll

Paul Carroll

Paul Carroll is the editor-in-chief of Insurance Thought Leadership.

He is also co-author of A Brief History of a Perfect Future: Inventing the Future We Can Proudly Leave Our Kids by 2050 and Billion Dollar Lessons: What You Can Learn From the Most Inexcusable Business Failures of the Last 25 Years and the author of a best-seller on IBM, published in 1993.

Carroll spent 17 years at the Wall Street Journal as an editor and reporter; he was nominated twice for the Pulitzer Prize. He later was a finalist for a National Magazine Award.

The Problem With Telematics

After decades of effort, telematics and usage-based auto insurance have made modest inroads because the business model still isn't right.

When I attended the Insurance Telematics USA conference in Chicago earlier this month, I expected to see much more enthusiasm. I first wrote about Progressive's venture into telematics all the way back in the late 1990s, and technology has improved so much since then that the telematics industry would surely be bragging about its breakout into the mainstream or at least predicting that one was imminent. The idea just makes so much sense: being able to track cars so that insurance risks can be determined very precisely for individual drivers, while even providing feedback that improves driving.

While the telematics technology is, in fact, stunning and while there are reasons for great optimism, what I found was not an industry brimming with confidence. I found an industry still searching for the right business model.

Until the industry solves that problem, progress will remain limited.

The Problem

The current approach to telematics is generally to install a device in a customer's car for six months and have it relay the driver's actions back to the insurer for evaluation. At the end of the six months, the device is uninstalled, and the insurer tells the driver what sort of discount, if any, she will receive based on her driving habits. A key point is that the issue at hand only concerns discounts; insurers have promised that they won't raise rates if they find that someone is a worse risk than expected.

Think about the expense that goes into that model: manufacturing the telematics devices; installing and uninstalling them; and transmitting lots of data over a wireless network on which the insurer has to buy bandwidth.

Now think about the benefits. The prospect of a discount has attracted enough good drivers that, if all telematics-based auto policies were rolled into one company, it would be close to being in the top 10 among auto insurers in the U.S. Ptolemus, a strategy consulting firm, said there are 4.4 million cars in the U.S. carrying usage-based insurance (UBI). That's a lot of cars. But there are 253 million cars and trucks in the U.S., so the market penetration of UBI is just 1.7%. Even in the main ballroom of the conference, full of ardent proponents, only about 5% raised their hands when asked if they had UBI.

Many customers turn out to not be that focused on discounts. They would prefer receiving free access to other services, such as roadside assistance -- but what services customers want, how to bundle those services, etc. has yet to be worked out.

Even if some new package of free services drove 10 times as many people to buy UBI auto policies, telematics wouldn't do much to make roads safer. Insurers are offering incentives to a self-selected group of drivers who are already among the safest on the road but, because insurers have decided they can't raise rates for bad drivers, won't be doing anything about the people who cause a huge portion of the accidents and, thus, the costs.

The current business model works -- barely. The costs are too high, the offering to consumers isn't right and the benefits to insurers are too low.

The Potential

Help is on the way from two main sources, which I have seen drive innovation in industry after industry since I started following the world of information technology almost 30 years ago. One source is what I think of as the power of "free." The other is the power of a platform.

The Power of "Free"

The behavioral economist Dan Ariely has done all sorts of experiments about the power of free and found that it is almost magic. For instance, if someone does volunteer work and you decide to thank him by paying him a little, he will likely cut back on the work he does for you or even stop. Ariely reasons that people evaluate paid work in a hard-nosed way -- how many hours do I work, how hard or skilled is the work, how much do others get paid for this work, etc.? -- and evaluate volunteer work based on altruistic measures, such as the quality of a cause. If you have people evaluate the return from their free work on a paid scale, you'll lose them. Similarly, he says, you can get people to do all kinds of uneconomic things if remove a paltry cost and make something free.

The power of free computing and communication has driven the upheaval of business over the past 30 years, spawning the wide adoption of the Internet, smartphones, etc. and all the business models that have come along with them. (Obviously, we still pay for computers and storage devices, but they are essentially free by comparison with where they were in the 1980s -- a gigabyte of memory, which cost $300,000 then, costs about a penny today. Communication costs have gone way down and are headed toward something approaching free, even though telecom and cable companies will fight a rear guard action as long as they can.)

Now the power of free is coming to telematics, because the cost of acquiring information on drivers is heading toward zero.

In the short term, that will be because of smartphone apps. Although some say the data they generate isn't quite as precise as that from sensors in cars, the apps are good enough for the vast majority of uses, and they cost roughly nothing. There isn't any need to make a dongle for the car and install and uninstall it. Nor is there a need for the insurer to buy a wireless data plan for the car. The app can do most of the analysis on the phone and just send modest amounts of data back to the insurer, using the driver's wireless plan.

In the long term, things will get even better as "connected cars" move into the market. These cars, already connected wirelessly to the Internet, will automatically generate the kind of information that insurers need. Insurers will be able to know what kind of a driver someone is at the moment she applies, rather than having to guess and then wait six months to know for sure.

The Power of a Platform

From the 1950s through the early 1980s, when IBM controlled the computer industry, the pace of innovation was glacial by today's standards. Part of the reason was that the pace let IBM milk maximum profits, but part was also because IBM had to produce what software types would call the "full stack." IBM had to develop the semiconductor technology that allowed for faster processors; design those processors; manufacture the processors; design and manufacture just about all the support chips, especially memory; assemble the mainframes; code the operating system; and generate the major pieces of application software. Everything had to come together, from one company, before the next step in innovation happened.

When the PC came along in 1981, with its open architecture, innovation became a free-for-all. Intel owned the chip, and Microsoft the operating system, but everything else was fair game. Companies flooded into the market, innovating in all kinds of smart ways, especially with applications such as the spreadsheet, and the market took off.

The telematics market is well on its way to making the transition from the IBM mainframe days to the open days of the PC and beyond. Initially, Progressive had to pull an IBM and invent the whole process for telematics from beginning to end. Now, an ecosystem has developed, and all sorts of companies are free to innovate at any part of the process.

Verisk has announced an exchange, to which car makers and insurers can contribute data on drivers and from which they can pull information. GM has said it will contribute data from its OnStar system, and GM has one million 4G-connected cars on the road in the U.S. So, the need for everyone to generate their own data is going away.

The Weather Channel (represented on the panel I moderated at the conference) has information that can correlate bad weather very precisely with driving behavior -- the company is even working to aggregate information on the speed at which cars' wipers are operating, to understand in a very granular way just how severe a storm is in a certain spot.

Many other companies are innovating in new parts of the ecosystem, rather than just focusing on pricing risks better or acquiring customers. For instance, my friend and colleague Stefan Heck, a former director at McKinsey with whom I wrote a book (along with Matt Rogers) about how innovation can overcome resource scarcity, just unveiled an extremely ambitious approach to improving safety, through a company called Nauto. (A writeup in re/code is here.) Agero made a presentation at the conference about how telematics can speed claims processing and cut costs while making customers happy -- essentially, the telematics system notifies the insurer instantly about an accident, so the insurer can provide whatever reassurance and help is necessary, while also sending someone to the scene so fast that it can take control of the process, rather than deferring to, among others, municipal towing companies.

The Future

The power of free and the power of a platform ensure that, before too many years go by, the costs for telematics will drop drastically and the benefits to insurers and customers will increase greatly. That still leaves insurers with the task of figuring out the right offering to customers, but, in my experience, once costs get low enough and lots of innovators get interested, experimentation eventually produces the right business model.

The question to me is: Who will that winner be?


Paul Carroll

Profile picture for user PaulCarroll

Paul Carroll

Paul Carroll is the editor-in-chief of Insurance Thought Leadership.

He is also co-author of A Brief History of a Perfect Future: Inventing the Future We Can Proudly Leave Our Kids by 2050 and Billion Dollar Lessons: What You Can Learn From the Most Inexcusable Business Failures of the Last 25 Years and the author of a best-seller on IBM, published in 1993.

Carroll spent 17 years at the Wall Street Journal as an editor and reporter; he was nominated twice for the Pulitzer Prize. He later was a finalist for a National Magazine Award.