Whether you are new to college, single and dating or newly divorced (because you panicked and confessed when news of the Ashley Madison hack hit the media), I’ll bet there is at least one socially transmitted disease you haven’t started worrying about: identity theft. If you use Facebook, you’re making easy work for identity thieves. The same goes for the whole cosmos of social media whether you favor Twitter, Instagram, Reddit, Pinterest, YouTube or LinkedIn or prefer to Tumblr your thoughts, preferences and predilections to anyone who cares to know what they are. The more you put out there in publicly viewable spaces, the more your personal identity mosaic is exposed. An identity thief’s day job is piecing together that mosaic into a passable, or usable, version of you: one that will get through the authentication process of financial, medical or governmental organizations. The echo of another kind of disease here is intentional. Like the more widely known kind of STD, the socially transmitted diseases that fall under the rubric of identity-related crimes are contracted by unsafe personal information practices. Unlike the more familiar variety, where safety is taught in high school, tacked to college community boards and heralded by countless other media new and old, not as many people these days know how to stay as safe as possible from the threat of identity theft, especially online. How to practice "safe social":

1. Don’t overshare. It’s okay to let the world know you’re on vacation so long as you have a great security system at home or you have a house sitter. Traditional trespassers use social media to know when houses are unguarded. It is far better to share the memory than report the experience as it’s unfolding.
2. Be careful when posting pictures. While it’s fun to brag about a purchase—whether that be a diamond ring, a car or the smartest TV on the market, just be aware that anyone following you now knows where they can get your newest trophy or indulgence for free.
3. Geotagging is for victims. There is no upside for you here. Companies like geotagging photos and other people-powered media assets because it gives them bankable information that could lead to future sales. Whether you are letting Twitter or Facebook or FourSquare narrowcast (or broadcast, depending on your privacy settings) your location, failure to disable location services on your device permits geotagging, which also gives thieves bankable info that could lead to future crimes.
4. Know your privacy settings. Make sure you understand how your posts are being displayed or distributed by the social network you use. For instance, on Facebook you can set a post to “Public” or “Only Me,” with many choices in between.
5. Lying is good. Facebook, especially, is a perfectly acceptable place to not be forthcoming about your age, hometown, place of employment or even the college you attended and what years you were there. Identity thieves comb social sites for information to complete dossiers of personally identifiable information that will allow them to correctly answer security questions and thus open new financial accounts or empty existing ones. If you don’t want to actively fabricate answers to these questions, just don’t fill out those parts of your profile.
6. Beware of quizzes that require personally identifiable information. Make no mistake, your email address and name count.

There is no immunization Unlike the other kind of STD, the socially transmitted disease of identity theft is not avoidable. There is no immunization, no safe way to avoid it—not even complete abstinence. There have been too many breaches with too much data for anyone but those living entirely off the grid to be completely safe. (And even still you can’t be sure.) Your best bet, in my opinion, is a system detailed in my book (forthcoming in November). A key element to that approach is acceptance. Specifically, you need to come to terms with the fact that it’s no longer a question of “if” but “when” you will become a victim of at least one type, if not multiple types, of identity theft. Anyone who tells you that they can keep you from getting got is selling snake oil. In fact, they are running afoul of the Federal Trade Commission. There is no guarantee. There are, however, best practices. THE THREE M'S If you accept the basic premise that you are at risk for identity theft no matter what you do, here are some thoughts as to how you might stay as safe as possible. The good news may actually be that you are a seasoned and intelligent user of social media, because that means you already have several of the habits in place that you will need. Minimize your exposure The same strategies you can adopt to make yourself a harder-to-hit target on social media go for the rest of your life. Whether that means saying “no” when asked for your Social Security number, limiting the amount of sensitive personal information you provide to anyone who contacts you, making sure all your accounts (email, social networking, financial or retail) have different user names paired with unique, long and strong passwords, properly securing your computers and mobile devices or freezing your credit—there are a variety of things you can do to make your attackable surface smaller. Monitor your accounts If you use social media regularly, you are used to checking in on a regular basis—the Pew Research Center found that 70% of Facebook users check in daily, as did about half of Instagram users, and nearly 40% of Tweeps. The same behavior, applied to your financial life, may keep you from getting got … or help you undo or minimize the damage in case you do. Check your bank and credit card accounts daily. Other things you can do include signing up for free transactional monitoring alerts at your bank, credit union or credit card provider, or purchasing more sophisticated credit and noncredit monitoring programs. Manage the damage When the dark day comes that your daily practice of monitoring your credit or financial life yields a compromise, you need to get on it immediately by informing the institution of the account that is involved, as well as law enforcement and the fraud department of at least one credit reporting agency. Because many insurance companies, a number of financial services organizations and the human resources departments at a number of companies offer complimentary or low-cost identity theft assistance as a perk of your relationship with the institution, check to see if you are covered or, if not, how you can get covered. Resolution experts can greatly help you speed your way back to normalcy. Identity theft is a permanent threat. The best way to stay safe is to change your behavior. The above tips are only some of the ways to do that. In the age of universal data vulnerability, practicing safe information hygiene is a must—lest you contract the one STD that may haunt you for the rest of your life.

Forward-thinking insurance companies are leveraging technology to improve customer experience and differentiate themselves from the competition. Here are the top five insurance apps you should download today, to help with tasks ranging from creating a home inventory to improving your driving skills.

1. Home Gallery App Cost: Free Benefit: Helps you create a home inventory

A home inventory makes filing an insurance claim easier should your things be stolen or damaged. It also gives you an estimate of how much your possessions are worth, which is helpful when you shop for homeowners insurance. Fortunately, the Home Gallery app from Liberty Mutual makes cataloging your possessions a cinch. The app allows you to take photos of your items, note important information such as purchase price and date and share your inventory with family members or your insurer. Best yet, you can use the Home Gallery app whether or not you’re a Liberty Mutual customer.

2. Driver Feedback App Cost: Free Benefit: Gives you information to become a better driver

State Farm’s Driver Feedback app helps you become aware of driving habits that increase your chance of being involved in an accident, which could raise your auto insurance premium. The app uses your smartphone’s accelerometer and GPS locator to collect data about how you brake, corner and accelerate. Once you arrive at your destination, the app gives you a score for your trip and offers tips about how to improve your driving. Using the Driver Feedback app, you can also compare data from one trip with another and share the results via email or text. These features can help new drivers form good driving habits and allow parents to monitor their teen’s performance behind the wheel. Plus, using a driving app is one way your teen might reduce her auto insurance premium. You don’t need to be insured with State Farm to use the app, and your driving data isn’t shared with your insurance company.

3. Text4Baby App Cost: Free Benefit: Provides tips to help expectant moms stay healthy during pregnancy

The Text4Baby app provides pregnant women with a wealth of information to help them have a healthy pregnancy and avoid preventable complications. When a mom signs up, she receives a “starter pack” of messages. Then, every week, she receives three text messages about prenatal care, ranging from doctor appointment reminders to information about symptoms that could warrant concern. Major insurance providers, like Aetna, CIGNA and Blue Cross and Blue Shield, are Text4Baby “outreach partners.” This means the companies encourage expectant moms to use the app to stay healthy, which can reduce the chance of complications that can make pregnancy-related costs skyrocket.

4. Infinity App Cost: Free Benefit: Allows you to create a secure digital inventory

The MetLife Infinity app gives you the power to create a digital inventory of photos, videos and audio files, plus important documents like wills and insurance policies. The app stores as much as five GB of data in the cloud, and it’s password-protected and permanently backed up. You can organize your information in collections and securely share the information with anyone, from a family member to your insurance agent. You can take advantage of the app even if you’re not a MetLife policyholder.

5. Defend Your Income Cost: Free Benefit: Explains how a disability can affect your life

Defend Your Income is an online game produced by the Council for Disability Awareness. Its goal is to help you understand how a disability may affect your life. Throughout the game you defend yourself from health-related issues like pregnancy complications, cancer, and respiratory disease. After you complete each round, you answer trivia questions and learn miscellaneous facts about the disability. By the end of the game, you’re more aware of your disability likelihood and have an idea of how much income you could lose if you become disabled. This information is useful when you’re calculating the amount of disability insurance you need. These apps are transforming the insurance industry by elevating customer service to a new level. Download one or more of them and then share your experience. We’d love to hear your thoughts.

If you read our most recent article, “Dinner With Warren Buffett,” you’ll already know that I've truly earned the title "insurance nerd" after dreaming about hours-long insurance conversations. After I woke up, we started this series to share Warren Buffett’s insurance industry wisdom from his annual letters to shareholders. Last week, we talked about the fundamentals; today, we’re going to share three challenges of the industry and two of its strengths. Challenges of the Insurance Industry 1. Dismal Economics: In the 1987 letter, Buffett explains that the insurance industry is “cursed” with “dismal economic characteristics” because there are hundreds of competitors, easy entry and a product that cannot be properly differentiated for a durable competitive advantage. This makes personal lines insurance a "commodity-like" business where, in his opinion, only a company that enjoys a cost advantage or one that operates in a very small niche can sustain high profitability levels in the long term. He goes on to explain that Berkshire’s differentiator is its ability to be the low-cost provider in personal lines through Geico and its financial strength for large specialized commercial lines and reinsurance. Competing on cost is always challenging in our industry, and maintaining financial strength in a turbulent world is also a feat not to be taken lightly. We think it’s funny that he talks about dismal economics when he has made most of his billions in our beloved industry, and he's very clear in the letters that Berkshire will always be heavily invested in insurance. However, we love insurance not because it's a great investment but rather because it’s a great place to work, one that’s interesting and rewarding and one where we are being a positive influence in the world. In that sense, we are very different from Uncle Warren, who sees insurance simply as an investment vehicle. If you see it only as a financial investment, some of its characteristics would make it tough. 2. Commoditization of the product can lead to poor returns: “Insurers have generally earned poor returns for a single reason: They sell a commodity-like product. Policy forms are standard, and the product is available from many suppliers, some of whom are mutual companies (‘owned’ by their policyholders rather than stockholders) with profit goals that are limited. Moreover, most insureds don’t care from whom they buy. Customers by the millions say, ‘I need some Gillette blades’ or ‘I’ll have a Coke,’ but we wait in vain for ‘I’d like a National Indemnity policy, please.’ Consequently, price competition in insurance is usually fierce.” -- 2004 letter, page 5. We’ve written about the commoditization of insurance before. Personal lines insurers are particularly aware of the struggles in that arena. Agents fight against it, regularly, and some companies are actively innovating to move away from this strategy. Some of the bigger companies add features to their policies that they hope others will be slow to follow, and newer companies, like MetroMile, aim to change the industry, but ultimately policies and endorsements must be filed and thus can be copied by competitors. Ironically, Buffett's own billions in advertising spending for Geico, almost exclusively focused on price, have done more to commoditize our industry in the eyes of the customer than anything else in its ingrained characteristics. 3. Maintaining underwriting discipline at the expense of growth is a challenge unique to the insurance industry: “Most American businesses harbor an ‘institutional imperative’ that rejects extended decreases in volume. What CEO wants to report to his shareholders that not only did business contract this year but that it will continue to drop? In insurance, the urge to keep writing business is also intensified because the consequences of foolishly priced policies may not become apparent for some time. If an insurer is optimistic in its reserving, reported earnings will be overstated, and years may pass before true loss costs are revealed. […] Finally, there is a fear factor at work, in that a shrinking business usually leads to layoffs. To avoid pink slips, employees will rationalize inadequate pricing, telling themselves the poorly priced business must be tolerated in order to keep the organization intact and the distribution system happy. […] [Underwriting] is not labor-intensive, and... we can live with excess overhead. We can’t live, however, with underpriced business and breakdown in underwriting discipline that accompanies it.” -- 2004 letter, page 5-7. Stock companies, particularly, will have challenges in maintaining underwriting discipline. If certain markets cannot show growth because of underwriting or capacity restraints, it requires that a clear picture be painted for stockholders to justify why the company has exercised this restraint. In addition, companies should be wary of laying off employees because of a temporary downturn. We think this one long paragraph really captures the spirit of the insurance industry and the innate contradictions of always pursuing growth. Uncle Warren's professed philosophy for the Berkshire companies is to only write business that is expected to be profitable and to always be willing to stand by and accept premium declines if the market is soft and proper rates can't be secured. We love that he professes to be willing to carry excess staff during quiet times, instead of endless waves of rightsizing and rehiring, and we think all insurance companies should consider similar policies. Advantages of the Insurance Industry 1. Profits can be outstanding if you manage your business well. “It is not easy to buy a good insurance business, but our experience has been that it is easier to buy one than create one. However, we will continue to try both approaches since the rewards for success in this field can be exceptional.” -- 1978 letter, page 5. Whether one buys or creates an agency or a carrier, managing the insurance portfolio well will typically lead to high payouts. The business also has the opportunity to truly provide for its customers, and it is very rewarding beyond the financial aspect at that time of need. On the carrier side, where Buffett focuses, ultimately it comes down to float: Premiums are received up front, and losses aren't paid until later, sometimes much later, allowing him to invest and multiply those funds. 2. You will never be bored. “You can get a lot of surprises in insurance.” -- 1978 letter, page 6. Finally, the element of surprise in insurance is exciting! Most people think of it as a boring, unchanging industry. But, particularly now, the industry is ripe for disruption. Beyond that, if you work for a carrier, you never know what your agents will call you with, and if you’re an agent or service representative, you never know what your customer will call you for. We are learning something every day and know that we will to do so throughout our careers! It is one of the best aspects of the profession.

It’s okay to get help! Recently, we hired a business development professional. In learning our business model and marketing strategy, he asked, “Who is your biggest competitor?” We said: our customers -- the “do-it-yourselfers.” This struck him as odd, but it is the absolute truth. We are in the business of preparing property claims that usually involve physical damage and business interruption. This is a very specialized practice that is part accounting, part insurance and part art. However, the companies we approach often feel they are in the best position to handle this process and do not need outside assistance. Why is that? When a claim is reported, the insurance company will assign an adjuster to the claim -- either an inside adjuster or an independent adjuster -- sometimes both. The adjuster is hired by and paid for by the insurance company to make sure the claim fits within terms and conditions of the insurance contract. The adjuster will rely on specialists of his own -- usually forensic accountants and forensic engineers. The specialists allow the adjuster to focus on his job of interpreting the coverage, reporting back to the insurance company and negotiating settlement on behalf of the insurance company. The specialists are there to verify the details of the claim that is presented to them by the policyholder. The insurance adjuster alone cannot and does not take on all of the responsibilities. The adjusters are the experts at this process -- it is their business and they do it every day -- but they still get specialized help. So if the insurer handles claims this way, why would the insured not get expert help? Think of the “do-it-yourselfer” project at home. Let’s say you're pretty handy around the house, so you look at that bathroom that needs remodeling and decide, “I’ll do it myself this weekend.” Technically, you CAN do it yourself -- you can take your crowbar and sawzall and do the demolition; you can handle laying the tile; and, with a little research, you could figure out the plumbing. The first weekend you go out to buy the extra tools you need and some supplies, and you get to work. Maybe the demo will go easily, but if you’ve ever tackled a home project, you know nothing is as easy as it seems, and it always takes more time than expected. If you make it through the demo, you spend the rest of the weekend figuring out your strategy for the new bathroom. Because you have a day job, each evening that next week you try to make progress, but by the end of the week you are bleary-eyed from the stress of this unfamiliar work and the late nights of trial and error. The next weekend, you cannot get back to the work, because you have family activities. When the vanity arrives, you realize it does not quite fit the way it should. Next, you realize you need more tools. Your weekend project turns into months of disarray. If you stay the course, months later you’ll have a functional bathroom, but there are usually a few steps that you decide you’ll have to get to eventually. At this point, you're getting busier at work, and you just don’t have the bandwidth to get back to the myriad of subsequent bathroom issues, so you consider bringing in an expert to bail you out. Preparing a claim is very similar, if you do it yourself. In addition to saving time, stress and compromising the results, your claim preparation expert has the tools of the trade, the skills and the experience to achieve an accurate and timely recovery. In contrast to the home improvement example, though, your claim preparer's fees should be covered, in part or in full, by your property policy. So, if you're not saving time or money by doing it yourself, and an expert will get you a better result, why would you not engage a professional claim preparer? That question seems like a no-brainer, yet so many still take the DIY approach to property claims. To sum up, it is okay to ask for help. The policyholder is not expected to be able to “do it yourself.” That is why you have professional fees coverage. The insurance company assigns its experts to adjust and audit your claims, and they’ll be better-equipped to meet their objectives than you will if you take the DIY approach. They are the insurers experts, so it is advisable for you to bring in your experts to represent your interests. Here are a few suggestions of what to look for in a firm to prepare your claims.

1. A loss accounting specialist, because insurance accounting is a unique trade. Typically, the firm will identify itself as forensic accountants.
2. Experience with the types of property claims you have, in your industry or similar ones, and with at least 10 years in the field.
3. Independence. This will ensure the firm is on your side with no conflicts of interest. Avoid allowing your insurer's accountants to calculate your losses. The same hold for any other party that may have a conflict.
4. A firm that qualifies for professional fees coverage. The fees should be based on an hourly rating scale, not on contingencies. Property policies will have specific exclusions, such as public adjusters and broker affiliated services.
5. A firm that is respected by insurers, adjusters and brokers. Your accountants should not threaten your relationships to achieve the result.

If you see the benefit of engaging a team to prepare your property and business interruption claims, do your due diligence ahead of a loss. Interview any qualifying candidates and make your choice. The firm should be involved in your claim from the very beginning. If you take this advice, your claims will go much smoother, and the claim will be free of leaks and loose tiles.

Texas physician Dennis B. Barson Jr. and his medical clinic administrator are headed to prison. The 10-year prison sentence imposed against Barson, like an $8 million-plus healthcare fraud civil settlement announced by the Justice Department on July 24, 2014, illustrate the significant legal risks that physicians and other healthcare providers face when physician charges are improperly billed to Medicare, Medicaid, Tricare or other federal or state healthcare programs for services actually provided by non-physician staff.

Physicians and others should heed the lessons from these and other similar federal and state healthcare fraud enforcement actions when deciding when it is appropriate to bill federal healthcare programs for physician services where physicians assistants, nurse practitioners or other nursing staff or other non-physicians perform part or all of the procedures billed.

Dr. Barson Prison Sentence Highlights Criminal Risks

On Monday, July 27, 2015, U.S. District Court Judge Melinda Harmon ordered Barson to serve 120 months in prison, followed by three years of supervised release, and to pay restitution of approximately $1.2 million for his Nov. 5, 2014, conviction on all 20 counts of conspiracy to defraud Medicare of $2.1 million.

With Judge Harmon presiding, a Houston jury found Barson and his medical clinic administrator, Dario Juarez, 55 years old, guilty on the Medicare fraud charges last November. Another co-defendant, Edgar Shakbazyan, entered a guilty plea to the 21-count original indictment on Oct. 27, 2014. Shakbazyan, of Glendale, CA, was sentenced to 97 months in prison, while Juarez, of Beeville, Texas, received 130 months. Both will also serve three years of supervised release.

The jury convictions of Barson and Juarez followed a trial where Department of Justice prosecutors proved the healthcare fraud charges based on evidence that Barson, Juarez and Shakbazyan fraudulently billed Medicare for rectal sensation tests and electromyogram (EMG) studies of the anal or urethral sphincter that were never performed. Shakbazyan was additionally charged and pled guilty to conspiracy to pay kickbacks for payments made to recruiters and beneficiaries.

According to the testimony at trial, Barson was the only doctor affiliated with the medical clinic located at 8470 Gulf Freeway in Houston. However, Juarez represented himself to be a doctor and was the one who actually saw patients at the clinic. Barson, Juarez and Shakbazyan caused Medicare to be billed for procedures on 429 patients in just two months. The three men also billed Medicare for seeing more than 100 patients on 13 different days, including a high of 156 patients on July 13, 2009.

Barson's defense attempted to convince the jury that he was a victim of identity theft and was not the perpetrator of the crimes. The conviction shows the jurors did not believe his story. The criminal charges are the result of a joint investigation conducted by agents of the FBI, Department of Health and Human Services-Office of Inspector General and the Medicaid Fraud Control Unit of the Texas Attorney General’s Office.

Margossian Settlement Shows Even More Common Civil Penalty Risks

Barson's sentencing is one of a growing series of criminal convictions and sentencing of physicians and other healthcare providers for healthcare fraud by participating in arrangements where Medicare, Medicaid or other federal healthcare programs are billed for services not provided or not provided as required to qualify for reimbursement. On July 24, 2015, for instance, the U.S. Attorney for the Eastern District of New York and the State of New York announced that Brooklyn, NY, OB/GYN Haroutyoun Margossian will pay $8 million as part of a civil settlement with the U.S. and the state of New York. The settlement resolves charges brought under the federal False Claims Act and the New York False Claims Act that Margossian wrongfully billed Medicare and Medicaid for physician services for treatments of women suffering from urinary incontinence that unlicensed and often unsupervised staff, rather than Margossian or another physician, actually administered. The government has also filed a criminal charge against Margossian for making false statements to Medicare and entered into a deferred prosecution agreement with him.

Healthcare Fraud Investigations Raise Other Licensing and Practice Risks

The Barson and Margossian actions are just two of the already long and ever-growing list of criminal convictions, civil sanctions and civil settlements that federal and state healthcare fraud fighters already can count as notches of success in their war against healthcare fraud by physicians and other healthcare providers. With these successes fueling more investigations, physicians and others should be prepared to "do time" for improperly billing physician fees to federal healthcare programs for services not provided by the billing physician or for engaging in other inappropriate billing practices. Targets of audits and investigations also must prepare to deal with a host of other threats to their practices that almost inevitably arise regardless of whether the government investigation leads to a conviction, civil sanctions or a settlement.

As demonstrated by the Margossian settlement, even if physicians, practice management and others swept up into these investigations escape being criminally charged, subjected to civil sanctions or penalties or suspended or excluded from Medicare or other federal healthcare programs, healthcare fraud investigations or charges still will carry a heavy cost. Healthcare fraud warriors are realizing great success in securing civil sanctions and settlements, federal program exclusions and other civil and administrative punishments against physicians and other healthcare providers that the government accuses of violating the False Claims Act or other federal healthcare fraud rules.

Of course, whether healthcare fraud investigations ultimately result in any civil or criminal prosecution, conviction or settlement, physicians and other licensed healthcare providers under suspicion of healthcare fraud inevitably must deal with a broad range of other professional fallout. These activities almost always trigger scrutiny or other actions by employers and medical practices, healthcare organizations and licensing boards.

Act to Strengthen Your Defenses

Physicians and others should take steps to minimize the risk of an investigation or audit as well as take steps to help ensure sufficient resources to defend themselves if the government comes knocking.

Of course, the first step should be to take proper, well-documented efforts to comply with the rules. Physicians and the clinics, hospitals and management working with them should carefully evaluate what can be defensibly billed as physician services to Medicare or another federal healthcare program -- keeping in mind that the billing party, not the government, generally bears the burden of proving that the amount bill qualifies for coverage. Physicians and others must carefully consider the adequacy of the physician's involvement in prescribing and delivering services intended to be billed as physician services. In areas where questions could be raised, physicians and their organizations are strongly urged to take extra care to retain documentation of their analysis and efforts to verify their compliance, including consulting legal counsel for advice within the scope of attorney-client privilege.

Physicians and others working with them also should familiarize themselves with their obligations and rights under employment agreements, shareholder or partnership agreements, medical staff bylaws, managed care contracts, medical licensing board rules and the Health Care Quality And Improvement Act. In many cases, these arrangements will compel a physician to provide notice of an investigation, audit, allegation or charge, will trigger separate investigatory or disciplinary action against the physician, or both.

Along with the stiff civil sanctions or settlements imposed, physicians and others investigated or charged with healthcare fraud often incur significant legal and other costs. Physicians and others should consider if they can expect to have sufficient funds to pay the legal and other costs of their defense. Physicians and their organizations concerned about the adequacy of these resources may wish to explore, where available, raising their malpractice policy coverage limits, purchasing other supplemental coverage and taking similar steps to better position themselves. Physicians generally will want to review the adequacy and limits of the coverages that their practices provide, as well as consider the reliability of that coverage in the event that the physician is terminated or leaves the practice.

Because of the 10-year statute of limitations applicable to False Claims Act claims, billings can come back to haunt a physician 10 years after their submission. With this tremendously long liability period, even in the absence of government investigation, a significant risk exists that a physician may experience a practice relocation or other change that would affect his coverage during this period. When an investigation happens, the possibility that the physician will relocate his practice skyrockets. Consequently, physicians should consider purchasing tail coverage, maintaining separate, portable professional liability coverage or both.

Physicians and their practices also should consider the adequacy of the coverage provided by their professional liability or other policies. If the policy provides no or limited coverage, both the physician and his associated organization or practice may want to explore purchasing additional riders on the existing policy, purchasing separate coverage or both, as well as to raise the limits on the coverages.

Practice leaders, hospitals and other organizations that would be swept up into these investigations generally share an interest in ensuring that the physician possesses adequate resources to defend herself, as their organization and its billings are likely to be hurt if the physician is unable to defend the billings.

Lots of industries face criticism because they talk the talk but don't walk the talk -- the computer industry, for instance, long talked about making machines intuitive but required users to work their way through manuals and memorize long series of steps before they could accomplish anything. But the insurance industry doesn't even talk the talk yet.

Sure, everyone is talking about improving the customer experience, but look at the words we use. Many are opaque -- the industry talks to itself, somehow unaware that customers are listening and are turned off by the gobbledygook. Some words are even offensive -- we're saying things to customers that we really don't want to be saying.

We have to at least get our talk -- our vocabulary -- straight before we tackle the much deeper issues and figure out to really engage customers and address their evolving needs.

My least-favorite word is one so widely used that few will find it offensive: "adjuster." My problem: If I'm filing a claim, I don't want it adjusted. I want it paid.

Yes, I realize that processing claims is complicated and that all sorts of adjustments need to be made. I also realize that no industry simply pays when a claim is made against a company. But if you send me an "adjuster," you're telling me right off the bat that you don't trust me, and that's a lousy way to start an interaction. It certainly isn't any way to start a relationship, which is what insurers insist they want with customers these days. Don't trust me, if you must, but send me a "claims professional" or simply a "customer service representative." Don't send me an "adjuster."

Less offensive but still unnecessarily bad are words like "excess" and "surplus." The insurance may be categorized as excess and surplus to you, but not to me, the customer. I'll thank you to treat my needs with the respect they deserve (says the customer).

Some words need to go away because they already have meanings -- and they aren't the meanings assigned to the words by the insurance industry. A binder is a plastic cover with three rings that you buy for your kids at this time of year as they head back to school; it is not temporary evidence of insurance. An endorsement is something you put on the back of a check -- or at least used to, before banks simplified deposits. An endorsement is not something that modifies an insurance policy.

Mostly, many terms need to be revisited because they are opaque, and often archaic:

• "Underwriting"? How about "assessing risk"?
• "Actuary"? That's a legitimate word, but I prefer the European form: "mathematician." ("What do you do at XYZ Insurance Co.?" "I'm the mathematician.") "Mathematician" just seems friendlier.
• "Capitation" and "subrogation"? Important functions, but there have to be layman's terms that can be substituted.
• If I'm buying life insurance, good luck getting me to grasp intuitively the difference between whole life and universal life; "whole" and "universal" are practically synonyms in this context.
• "Inland marine"? Please.

While we're at it, let's do away with the acronyms. All of them -- at least on first reference, and mostly in subsequent references, too.

Changing the language will be hard because so many in the industry subscribe to what I think of as a 19th century sort of approach to business: Let's make things seem as complicated as possible to justify the existence of lots of experts and intermediaries and to demand nearly blind faith by clients. This is sort of the "don't try this at home, folks," approach to business. Leave the complicated terms to us.

The approach has worked for insurers for a very long time. It has worked for doctors and lawyers. If a cynical T.A. in a philosophy class in college way back when is to be believed, it worked for Hegel, too -- he supposedly wrote a short, clear version of his big idea (thesis/antithesis/synthesis), and no one took him seriously; he then wrote a 1,000-page, nearly impenetrable version, called it merely the introduction to his ideas and found lasting fame.

But things have changed since Hegel wrote in the early 1800s. Now, if I want to remind myself about Hegel, I turn to Wikipedia and its clear, little summary; I don't crack open The Phenomenology of Spirit. Change has accelerated in recent years, to the point where even doctors find themselves having to communicate more with patients in plain English.

If doctors can simplify how they communicate about the mind-boggling issues involved in medicine, then the rest of us can figure out how to talk the talk in insurance. We need to begin by taking a hard look at every term we use and revising many of them, from the perspective of a total newbie customer, so we talk to customers the way they expect us to talk to them.

That's the only way to lay the groundwork for the broad improvements in the customer experience that we all want to deliver and that customers are increasingly demanding.

Lots of industries face criticism because they talk the talk but don't walk the talk -- the computer industry, for instance, long talked about making machines intuitive but required users to work their way through manuals and memorize long series of steps before they could accomplish anything. But the insurance industry doesn't even talk the talk yet. Sure, everyone is talking about improving the customer experience, but look at the words we use. Many are opaque -- the industry talks to itself, somehow unaware that customers are listening and are turned off by the gobbledygook. Some words are even offensive -- we're saying things to customers that we really don't want to be saying. We have to at least get our talk -- our vocabulary -- straight before we tackle the much deeper issues and figure out to really engage customers and address their evolving needs. My least-favorite word is one so widely used that few will find it offensive: "adjuster." My problem: If I'm filing a claim, I don't want it adjusted. I want it paid. Yes, I realize that processing claims is complicated and that all sorts of adjustments need to be made. I also realize that no industry simply pays when a claim is made against a company. But if you send me an "adjuster," you're telling me right off the bat that you don't trust me, and that's a lousy way to start an interaction. It certainly isn't any way to start a relationship, which is what insurers insist they want with customers these days. Don't trust me, if you must, but send me a "claims professional" or simply a "customer service representative." Don't send me an "adjuster." Less offensive but still unnecessarily bad are words like "excess" and "surplus." The insurance may be categorized as excess and surplus to you, but not to me, the customer. I'll thank you to treat my needs with the respect they deserve (says the customer). Some words need to go away because they already have meanings -- and they aren't the meanings assigned to the words by the insurance industry. A binder is a plastic cover with three rings that you buy for your kids at this time of year as they head back to school; it is not temporary evidence of insurance. An endorsement is something you put on the back of a check -- or at least used to, before banks simplified deposits. An endorsement is not something that modifies an insurance policy. Mostly, many terms need to be revisited because they are opaque, and often archaic:

• "Underwriting"? How about "assessing risk"?
• "Actuary"? That's a legitimate word, but I prefer the European form: "mathematician." ("What do you do at XYZ Insurance Co.?" "I'm the mathematician.") "Mathematician" just seems friendlier.
• "Capitation" and "subrogation"? Important functions, but there have to be layman's terms that can be substituted.
• If I'm buying life insurance, good luck getting me to grasp intuitively the difference between whole life and universal life; "whole" and "universal" are practically synonyms in this context.
• "Inland marine"? Please.

While we're at it, let's do away with the acronyms. All of them -- at least on first reference, and mostly in subsequent references, too. Changing the language will be hard because so many in the industry subscribe to what I think of as a 19th century sort of approach to business: Let's make things seem as complicated as possible to justify the existence of lots of experts and intermediaries and to demand nearly blind faith by clients. This is sort of the "don't try this at home, folks," approach to business. Leave the complicated terms to us. The approach has worked for insurers for a very long time. It has worked for doctors and lawyers. If a cynical T.A. in a philosophy class in college way back when is to be believed, it worked for Hegel, too -- he supposedly wrote a short, clear version of his big idea (thesis/antithesis/synthesis), and no one took him seriously; he then wrote a 1,000-page, nearly impenetrable version, called it merely the introduction to his ideas and found lasting fame. But things have changed since Hegel wrote in the early 1800s. Now, if I want to remind myself about Hegel, I turn to Wikipedia and its clear, little summary; I don't crack open The Phenomenology of Spirit. Change has accelerated in recent years, to the point where even doctors find themselves having to communicate more with patients in plain English. If doctors can simplify how they communicate about the mind-boggling issues involved in medicine, then the rest of us can figure out how to talk the talk in insurance. We need to begin by taking a hard look at every term we use and revising many of them, from the perspective of a total newbie customer, so we talk to customers the way they expect us to talk to them. That's the only way to lay the groundwork for the broad improvements in the customer experience that we all want to deliver and that customers are increasingly demanding.

The hashtag phenomenon dates back to 2007, when Twitter launched a tool that allowed users to search and share topics by using the # symbol. Since then, the symbol has gone mainstream, and you will commonly find it in other social media sites, such as Instagram and Vine. Insurance companies caught on to the trend and incorporated hashtags into their digital strategies, adding humor, wordplay and aspirational connotations. Insurance Entertainment benchmarked seven hashtags used by insurance companies to provide some insight into how hashtags can be best used: #DreamFearlessly by American Family #ThinkSafe by Travelers #SummerIsMayhem by Allstate #MakeSafeHappen by Nationwide #BeTheJake by State Farm #InFlovation by Progressive #GeckoPhilosophy by Geico The hashtags fall into two categories: 1) branded hashtags, which refer to the brand directly or indirectly (e.g. #InFlovation), and 2) interest-based hashtags, which speak to shared topics (e.g. #ThinkSafe). Some companies use Twitter to position themselves as aspirational brands by building communities around shared values. Here’s the bird’s-eye-view of who’s doing what and why: Geico and Progressive, for example, opt for "branded hashtags," while American Family and Nationwide promote "interest-based hashtags" in an attempt to target like-minded individuals. 7. Geico - #GeckoPhilosophy Twitter: @GEICO, @TheGEICOGecko, Hashtag: #GeckoPhilosophy #InspirationalQuotes are abundant, shareable and, generally speaking, positive. Geico took notice and added the Gecko flavor to its version of inspirational quotes, forming what is known as the #GeckoPhilosophy. Geico gets an A for creativity but a C for execution, as the tweets are often dull on screen. The idea has merit and is an example of a branded hashtag, tailored to the audience on social media, which in the long run may see more pickup by users. 6. Progressive - #InFlovation Twitter: @Progressive, @ItsFlo, Hashtag: #InFlovation #InFlovation is Progressive's playful take on innovation and Flo. Similar to Geico’s #GeckoPhilosophy, it’s a branded hashtag targeting those who enjoy interaction with Flo. By the way, at this time, Flo does not make public appearances. Someone asked. Progressive answered. 5. State Farm - #BeTheJake Twitter: @StateFarm, @JakeStateFarm, Hashtag: #BeTheJake Another branded hashtag around the real Jake from State Farm. 4. Nationwide - #MakeSafeHappen Twitter: @Nationwide, Hashtag: #MakeSafeHappen, Powered by MakeSafeHappen Nationwide’s marketing team drew some heat for its Super Bowl ad featuring a "dead boy" with the tagline #MakeSafeHappen. But let’s face it, the #1 cause of childhood deaths is preventable accidents, and you know that thanks to Nationwide. So, aside from completely reshuffling its marketing team, the company "stands behind the commercial and the message." Since then, #MakeSafeHappen has taken a less controversial route, but not without consequences: MakeSafeHappen.com desktop traffic tumbled to an all-time low of approximately 1,000 monthly visits compared with 85,000 when the ad premiered. Better safe than sorry? 3. Allstate - #SummerIsMayhem Twitter:@Allstate, @Mayhem, Hashtag: #SummerIsMayhem Mayhem is the third most-recognized insurance advertising character, behind the Geico gecko and Flo. With more than 79,000 Twitter followers for @Mayhem compared with about 61,000 for @Allstate, it is obvious why Mayhem’s dark humor is an integral part of Allstate’s digital strategy. 2. Travelers - #ThinkSafe Twitter: @Travelers, Hashtag: #ThinkSafe Surprise. An insurance company posting safety tips. There is actually more to this strategy than meets the eye. Aside from its relevant and practical content, albeit dry at times, Travelers is also looking out for its independent agents by producing content they can easily share. Travelers gets an A for thoughtfulness, an F for entertainment. 1. American Family - #DreamFearlessly Twitter: @amfam, Hashtag: #DreamFearlessly powered by DreamFearlessly American Family has one of the best brand extensions an insurance company can hope for. In the land of cost savings by Geico, price comparison by Progressive and 3:00am customer service by State Farm, nothing says different like American Family. A slogan turned interest-based hashtag, #DreamFearlessly is a branding initiative that allows American Family to move away from functional attributes and create an aspirational brand. There is one caveat, though – which is true of all interest-based hashtags. They are not exclusive. While they do generate more reach, sometimes the tweets have very little to do with the insurance brand seeking to be associated with that message. So while #InFlovation offers a direct association to Progressive, interest-based hashtags such as #ThinkSafe, #MakeSafeHappen and #DreamFearlessly require a bigger marketing push. The outcome, once successful, is worth it. As the graph below shows, in the last 30 days #DreamFearlessly enjoyed more than 10X the reach of #GeckoPhilosophy. Clearly, Americans love to dream. In sum, hashtags are only as great as one’s offline strategy (American Family, Travelers); there is no harm in plain fun (Progressive, Geico, State Farm); and never underestimate the size of the fight in the dog (Nationwide). After all, there are no low talkers on social media. Bottom Line: In a zero-sum game, the score is American Family (1), Geico (-1).

Securities litigation has a culture defined by multiple elements: the types of cases filed, the plaintiffs’ lawyers who file them, the defense counsel who defend them, the characteristics of the insurance that covers them, the way insurance representatives approach coverage, the government’s investigative policies – and, of course, the attitude of public companies and their directors and officers toward disclosure and governance. This culture has been largely stable over the nearly 20 years I’ve defended securities litigation matters full-time. The array of private securities litigation matters (in the way I define securities litigation) remains the same – in order of virulence: securities class actions, shareholder derivative litigation matters (derivative actions, board demands and books-and-records inspections) and shareholder challenges to mergers. The world of disclosure-related SEC enforcement and internal corporate investigations is basically unchanged, as well. And the art of managing a disclosure crisis, involving the convergence of shareholder litigation, SEC enforcement and an internal investigation, involves the same basic skills and instincts. But I’ve noted significant changes to other characteristics of securities-litigation culture recently, which portend a paradigm shift. Over the past few years, smaller plaintiffs’ firms have initiated more securities class actions on behalf of individual, retail investors, largely against smaller companies that have suffered what I call “lawsuit blueprint” problems such as auditor resignations and short-seller reports. This trend – which has now become ingrained into the securities-litigation culture – will significantly influence the way securities cases are defended and by whom, and change the way that D&O insurance coverage and claims need to be handled. Changes in the Plaintiffs’ Bar Discussion of the history of securities plaintiffs’ counsel usually focuses on the impact of the departures of giants Bill Lerach and Mel Weiss. But although the two of them did indeed cut a wide swath, the plaintiffs’ bar survived their departures just fine. Lerach’s former firm is thriving, and there are strong leaders there and at other prominent plaintiffs’ firms. The more fundamental shifts in the plaintiffs’ bar concern changes to filing trends. Securities class action filings are down significantly over the past several years, but I’m confident they will remain the mainstay of securities litigation and won’t be replaced by merger cases or derivative actions. There is a large group of plaintiffs’ lawyers who specialize in securities class actions, and there are plenty of stock drops that give them good opportunities to file cases. Securities class action filings tend to come in waves, both in the number of cases and type. Filings have been down over the last several years for multiple reasons, including the lack of plaintiff-firm resources to file new cases as they continue to litigate stubborn and labor-intensive credit-crisis cases, the rising stock market and the lack of significant financial-statement restatements. Although I don’t think the downturn in filings is, in and of itself, very meaningful, it has created the opportunity for smaller plaintiffs’ firms to file more securities class actions. The Reform Act gave plaintiffs’ firms incentives to recruit institutional investors to serve as plaintiffs. For the most part, institutional investors, whether smaller unions or large funds, have retained the more prominent plaintiffs’ firms, and smaller plaintiffs’ firms have been left with individual investor clients who usually can’t beat out institutions for the lead-plaintiff role. At the same time, securities class action economics tightened in all but the largest cases. Dismissal rates under the Reform Act are pretty high, and defeating a motion to dismiss often requires significant investigative costs and intensive legal work. And the median settlement amount of cases that survive dismissal motions is fairly low. These dynamics placed a premium on experience, efficiency and scale. Larger firms filed most of the cases, and smaller plaintiffs’ firms were unable to compete effectively for the lead plaintiff role, or make much money on their litigation investments. This started to change with the wave of cases against Chinese issuers in 2010. Smaller plaintiffs’ firms initiated most of them, as the larger firms were swamped with credit-crisis cases and likely were deterred by the relatively small damages, potentially high discovery costs and uncertain insurance and company financial resources. Moreover, these cases fit smaller firms’ capabilities well; nearly all of the cases had “lawsuit blueprints” such as auditor resignations or short-seller reports, thereby reducing the smaller firms’ investigative costs and increasing their likelihood of surviving a motion to dismiss. The dismissal rate has indeed been low, and limited insurance and company resources have prompted early settlements in amounts that, while on the low side, appear to have yielded good outcomes for the smaller plaintiffs’ firms. The smaller plaintiffs’ firms thus built up a head of steam that has kept them going, even after the wave of China cases subsided. For the last year or two, following almost every “lawsuit blueprint” announcement, a smaller firm has launched an “investigation” of the company, and these firms have initiated an increasing number of cases. Like the China cases, these cases tend to be against smaller companies. Thus, smaller plaintiffs’ firms have discovered a class of cases – cases against smaller companies that have suffered well-publicized problems that reduce the plaintiffs’ firms’ investigative costs – for which they can win the lead plaintiff role and can prosecute at a sufficient profit margin. To be sure, the larger firms still mostly will beat out the smaller firms for the cases they want. But it increasingly seems clear that the larger firms don’t want to take the lead in initiating many of the cases against smaller companies, and are content to focus on larger cases on behalf of their institutional investor clients. These dynamics are confirmed by recent securities litigation filing statistics. Cornerstone Research’s “Securities Class Action Filings: 2014 Year in Review” concludes that (1) aggregate market capitalization loss of sued companies was at its lowest level since 1997, and (2) the percentage of S&P 500 companies sued in securities class actions “was the lowest on record.” Cornerstone’s “Securities Class Action Filings: 2015 Midyear Assessment” reports that two key measures of the size of cases filed in the first half of 2015 were 43% and 65% lower than the 1997-2014 semiannual historical averages. NERA Economic Consulting’s “Recent Trends in Securities Class Action Litigation: 2014 Full-Year Review” reports that 2013 and 2014 “aggregate investor losses” were far lower than in any of the prior eight years. And PricewaterhouseCoopers’ “Coming into Focus: 2014 Securities Litigation Study” reflects that in 2013 and 2014, two-thirds of securities class actions were against small-cap companies (market capitalization less than $2 billion), and one-quarter were against micro-cap companies (market capitalization less than $300 million). These numbers confirm the trend toward filing smaller cases against smaller companies, so that now most securities class actions are relatively small cases. Consequences for Securities Litigation Defense Securities litigation defense must adjust to this change. Smaller securities class actions are still important and labor-intensive matters – a “small” securities class action is still a big deal for a small company and the individuals accused of fraud, and the number of hours of legal work to defend a small case is still significant. This is especially so for the “lawsuit blueprint” cases, which typically involve a difficult set of facts. Yet most securities defense practices are in firms with high billing rates and high associate-to-partner ratios, which make it uneconomical for them to defend smaller litigation matters. It obviously makes no sense for a firm to charge $6 million to defend a case that can settle for $6 million. It is even worse for that same firm to attempt to defend the case for $3 million instead of $6 million by cutting corners – whether by under-staffing, over-delegation to junior lawyers or avoiding important tasks. It is worse still for a firm to charge $2 million through the motion to dismiss briefing and then, if it loses, to settle for more than $6 million just because it can’t defend the case economically past that point. And it is a strategic and ethical minefield for a firm to charge $6 million and then settle for a larger amount than necessary so that the fees appear to be in line with the size of the case. . Nor is the answer to hire general commercial litigators at lower rates. Securities class actions are specialized matters that demand expertise, consisting not just of knowledge of the law but of relationships with plaintiffs’ counsel, defense counsel, economists, mediators and D&O brokers and insurers. Rather, what is necessary is genuine reform of the economics of securities litigation defense through the creation of a class of experienced securities litigators who charge lower rates and exhibit tighter economic control. Undoubtedly, that will be difficult to achieve for most securities defense lawyers, who practice at firms with supercharged economics. The lawyers who wish to remain securities litigation specialists will thus face a choice:

1. Accept that the volume of their case load will be reduced, as they forego smaller matters and focus on the largest matters (which big law firms are uniquely situated to handle well, on the whole);
2. Rein in the economics of their practices, by lowering billing rates of all lawyers on securities litigation matters and by reducing staffing and associate-to-partner ratios; or
3. Move their practices to smaller, regional defense firms that naturally have more reasonable economics.

I’ve taken the third path, and I hope that a number of other securities litigation defense lawyers will also make that shift toward regional defense firms. A regional practice can handle cases around the country, because litigation matters can be effectively and efficiently handled by a firm based outside of the forum city. And they can be handled especially efficiently by regional firms outside of larger cities, which can offer a better quality of life for their associates and a more reasonable economic model for their clients. Consequences for D&O Insurance D&O insurance needs to change, as well. For public companies, D&O insurance is indemnity insurance, and the insurer doesn’t have the duty or right to defend the litigation. Thus, the insured selects counsel, and the insurer has a right to consent to the insured’s selection, but such consent can’t be unreasonably withheld. D&O insurers are in a bad spot in a great many cases. Because most experienced securities defense lawyers are from expensive firms, most insureds select an expensive firm. But in many cases, that spells a highly uneconomical or prejudicial result, through higher than necessary defense costs or an early settlement that doesn’t reflect the merits, but that is necessary to avoid using most or all of the policy limits on defense costs. Given the economics, it certainly seems reasonable for an insurer to at least require an insured to look at less expensive (but just as experienced) defense counsel before consenting to the choice of counsel – if not outright withholding consent to a choice that does not make economic sense for a particular case. If that isn’t practical from an insurance law or commercial standpoint, insurers may well need to look at enhancing their contractual right to refuse consent, or even to offer a set of experienced but lower-cost securities defense practices in exchange for a lower premium. It is my strong belief that a great many public company CFOs would choose a lower D&O insurance premium over an unfettered right to choose their own defense lawyers. Because I’m not a D&O insurance lawyer, I obviously can’t say what is right for D&O insurers from a commercial or legal perspective. But it seems obvious to me that the economics of securities litigation must change, both in terms of defense costs and defense-counsel selection, to avoid increasingly irrational economic results.

At the 2015 Harbor Health MPN Medical Directors Meeting, a panel discussed current issues affecting workers’ compensation. The panel consisted of:

• Dr. Tedd Blatt (moderator)
• Dr. Craig Uejo
• Dr. Don Dinwoodie
• Dr. Minh Nguyen
• Dr. Kayvon Yadidi

Question: What are the things physicians can do or should do to improve workers comp?

• Physicians need to assist in training their peers. There is inadequate training of occupational medicine physicians on the nuances of the workers’ compensation system. This is something other stakeholders in the system could also assist with.
• Physicians need to be considering psycho-social issues in the treatment of patients. These can have a significant impact on claim outcomes.
• There is not enough training for physicians on how to properly write medical reports, especially in the workers’ compensation arena.
• It is imperative that physicians are responsive to questions from the payers. Failure to respond in a timely way to questions causes delays in reimbursement and creates animosity.

Question: How should physicians be approaching the issues of opioids, and are payers willing to consider alternatives?

• This is something that needs to be considered from the initial visit forward. These drugs can lead to long-term issues, and prescribing them cannot be taken lightly. Too many physicians just prescribe these to make the patient happy.
• There are inadequate detox programs to wean people off these drugs. Patients tend to bounce from one pain clinic to the next, which just continues the cycle of using these drugs.
• Payers are often hesitant to authorize detox programs or non-pharmaceutical pain management alternatives because they view these things as experimental.
• Physicians will soon be required to utilize CURES, the California prescription drug monitoring program, prior to prescribing opioids. This is intended to identify people who are doctor-shopping to abuse the opioids.
• If you don’t prescribe the opioids, the patient will find someone else who does. Until there is a consistent approach to how these drugs are prescribed, this will continue to be a problem.
• This is the greatest physician-created public health crisis in the history of the U.S. These drugs are massively overprescribed and should only be used for a very short term for post-operative care. They should never be used for long-term treatment.

Question: What do you think about utilization review? Are there things that you feel should always be subject to utilization review?

• All surgeries should be subject to mandatory utilization review. Too many physicians are conducting unnecessary surgeries, which cause harm to their patients.
• Compound medications and medications not usually prescribed in workers’ comp should be subject to utilization review.
• There needs to be a level of common sense in UR. It should not be used if the recommended treatment is part of the normal course of care for an injury. Payers also are sometimes paying more for the UR review than the actual service requested costs.
• If you have quantified that a physician is producing better outcomes for injured workers, these physicians should be subject to less utilization review.
• The UR process needs to be more selective and focus on the outliers, not routine care. The perception from providers is that UR is being grossly overused. Physicians view this as punitive.

Question: More physicians are becoming part of larger health systems. Is this a positive change?

• This is a positive change because the physicians have a better support structure to assist in writing reports and navigating the nuances of the workers’ compensation system.

Question: Is the Affordable Care Act going to affect workers’ compensation?

• We will see an increased focus on outcomes, and, if a physician does not deliver superior outcomes, then payers will not refer patients to them for treatment.
• Many of the policies under the exchanges have high deductibles and, because of this, it is likely we will continue to see pressure to push treatment into the workers’ compensation space.

Question: What changes would you recommend on the claims administrator side?

• There needs to be more focus on better internal communication within claims organizations. Physicians end up sending reports and responding to requests multiple times because the claims organization does not have good internal communication.
• The fee structure is affecting the number of physicians willing to treat workers’ compensation patients. Many specialists have stopped treating workers’ compensation patients because they do not feel adequately compensated for the amount of work required.