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Options to Work Comp: Public Policy Analysis

Analysis of the Texas workers' compensation system shows that, as a matter of public policy, "opt-out" programs make sense.

For more than 100 years, Texas has allowed most private employers the option of either purchasing workers’ compensation insurance or developing their own system of injured employee care. Today, 33% of all Texas employers have exercised their option and “nonsubscribe” from the state workers’ compensation system. This paper focuses on public policy that has provided Texas the most successful occupational injury management system in the U.S. – a dual system represented by both traditional workers’ compensation and an option. Following a brief discussion of the need for options to workers’ compensation and the main components of the Texas Option, foundational public policy is examined. Then, this paper breaks new ground by detailing the size and superior performance of the Texas Option compared with Texas workers’ compensation. Data is provided regarding fewer lost time claims, faster return to work, fewer claim denials, fewer disputed claims, savings on state government expense and lower employer costs. These same public policies and claim results undergird the “Oklahoma Option” legislation that became effective in 2014 and are informing and advancing option legislation now in Tennessee and other states. This paper will not focus on option program feasibility analysis, design, implementation or funding for a particular employer. This paper also will not provide a detailed analysis of negligence liability exposures or how to administer a nonsubscriber claim. Resources on those subjects are available upon request. Read the report on Partnersource.com.

How Much Cyber Risk Should You Take?

Boards don't like to hear that they are accepting some level of cyber risk, but they are. Twelve questions can help define and manage it.

I have been spending a fair amount of time over the last few months, talking and listening to board members and advisers, including industry experts, about cyber risk. A number of things are clear:
  • Boards, not just those members who are on the audit or risk committee, are concerned about cyber and the risk it represents to their organizations. They are concerned because they don’t understand it – and the actions they should take as directors. The level of concern is sufficient for them to attend conferences dedicated to the topic rather than relying on their organizations.
  • They are not comfortable with the information they are receiving on cyber risk from management – management’s assessment of the risk that it represents to their organization; the measures management has taken to (a) prevent intrusions, (b) detect intrusions that got past defenses and (c) respond to such intrusions; how cyber risk is or may be affected by changes in the business, including new business initiatives; and, the current level and trend of intrusion attacks (some form of metrics).
  • The risk should be assessed, evaluated and addressed, not in isolation as a separate IT or cyber risk, but in terms of its potential effect on the business. Cyber risk should be integrated into enterprise risk management. Not only does it need to be assessed in terms of its potential effect on organizational business objectives, but it is only one of several risks that may affect each business objective.
  • It is impossible to eliminate cyber risk. In fact, it is broadly recognized that it is impossible to have impenetrable defenses (although every reasonable effort should be made to harden them). That recognition mandates increased attention to the timely detection of those who have breached the defenses, as well as the capability to respond at speed.
  • Because it is impossible to eliminate risk, a decision has to be made (by the board and management, with advice and counsel from IT, information security, the risk officer and internal audit) as to the level of risk that is acceptable. How much will the organization invest in cyber compared with the level of risk and the need for those same resources to be invested in other initiatives? The board members did not like to hear talk of accepting a level of risk, but that is an uncomfortable fact of life – they need to get over and deal with it!
The National Association of Corporate Directors has published a handbook on cyber for directors (free after registration). Here is a list of questions I believe directors should consider. They should be asked of executive management (not just the CIO or CISO) in a session dedicated to cyber.
  1. How do you identify and assess cyber-related risks?
  2. Is your assessment of cyber-related risks integrated with your enterprise-wide risk management program so you can include all the potential effects on the business (including business disruption, reputation risk, inability to bill customers, loss of IP, compliance risk and so on) and not just “IT-risk”?
  3. How do you evaluate the risk to know whether it is too high?
  4. How do you decide what actions to take and how much resource to allocate?
  5. How often do you update your cyber risk assessment? Do you have sufficient insight into changes in cyber-related risks?
  6. How do you assess the potential risks introduced by new technology? How do you determine when to take the risk because of the business value?
  7. Are you satisfied that you have an appropriate level of protection in place to minimize the risk of a successful attack?
  8. How will you know when your defenses have been breached? Will you know fast enough to minimize any loss or damage?
  9. Can you respond appropriately at speed?
  10. What procedures are in place to notify you, and then the board, in the event of a breach?
  11. Who has responsibility for cybersecurity, and do they have the access they need to senior management?
  12. Is there an appropriate risk-aware culture within the organization, especially given the potential for any manager to introduce risks by signing up for new cloud services?
I welcome your thoughts, perspectives and comments.

Who Is Your Chief Customer Officer?

Figuring out who should play the role of chief customer officer begins with a few simple questions -- and perhaps a change in mindset.

In my role as market connector, I constantly meet people with all kinds of job titles, many of which did not exist even a few years ago. Some reflect a “cool” factor more than substance. Others signal strategic intent translated into an organizational decision. Recently, there’s been a burst of senior-level titles speaking to a new view of the customer. These include chief customer officer, chief customer experience officer and variants. What are these roles about, and what value can they bring? I’m not one to believe that titles by themselves matter much. In fact, I think the hierarchical behavior and entitlements that titles convey can be destructive to the collaborative environment needed to nurture enduring, customer-centric results. But I also think it’s worth any executive’s time to contemplate the value of an empowered chief customer or experience officer and why other companies might be going down this path. Is it right for you? Is it real or is it window dressing? What can it potentially accomplish? Who should wear this hat to generate impact? Why have a chief customer or experience officer? Last month, I wrote about marketing myths and truths in an age of technology disruption and customer empowerment. Any leader should look at all of her resources – including people, dollars and infrastructure – and drive the changes required to attract and win the loyalty of target customers. For the vast majority of companies, the status quo is not the answer. The chief customer or experience officer defines and steers the transformation by defining the execution plan aligning resources to deliver on the customer needs that matter. The plan should link customer priorities to a business’ financial objectives. He mobilizes employees, and his appointment can be a powerful signal from the CEO that the customer must be at the center of everything the company does. Why won’t status quo work? Traditional company structures were not built around the customer. Companies were organized for efficiency, control and predictability. The problem is that these priorities by themselves end up constraining the agility fundamental to delivering a productive, positive customer experience – one that motivates trial, purchase, recommendation and other behaviors reflecting loyalty to a brand. The chief customer or experience officer provides leadership to help the company embrace agility as key to a customer experience that is managed to deliver business results – top and bottom line. At the same time, she must partner with peers to ensure the company does not lose sight of the basics of efficiency and control, especially to meet regulatory mandates that are “lights on” needs in the insurance sector. What’s going on in your organization? Start by asking yourself a few questions:
  • When decisions are being made, are employees at all levels and functions contemplating the impact on the customer? Do employees shape their actions around delivering value to the customer? Does anyone ask, “What’s the impact on the customer?” And, do other participants in the conversation care?
  • Does your organization act as though the right experience will deliver business results, or do people express the belief that doing what the customer wants is a tradeoff to financial results? If the latter is the case, you are likely receiving a strong signal that your journey to a great customer experience may require a sharp pivot.
  • Do you measure customer satisfaction across the entire experience? Does your methodology gather only customer service feedback for the subset of customers who are reaching out, or do you look at channel results holistically?
  • Are you using a methodology that connects customer satisfaction to the end-to-end experience of doing business with you all the way through to how satisfaction levels directly affect financials? A “yes” to this last question means you are closer to best-in-class practices.
What’s right for my organization? If you want to steer your organization toward being truly customer-focused – if you believe this is a must-do in today’s economy – a chief customer or experience officer provides one approach that can be a mobilizing force for change. As with any business goal, the buck has to stop with an individual, and that individual has to be someone below the CEO for day-to-day actions toward results. The title matters less than the accountability, leadership profile and empowerment of whoever is given this mission. Be aware that merely appointing someone to a role accomplishes little. Driving customer metrics requires the same kind of ownership as any result you are trying to achieve. But such an appointment does not absolve the CEO or the rest of the C-suite from taking accountability for the transformation to customer-centricity. The rest of the executive team must align with the chief customer or experience officer’s plans and engage to drive action among the people they lead. What does it take to set the role up for success? This role is not for the faint-hearted. Frankly, the technical skill background can be just about anything. The make-or-break will be the leadership profile: an influencer, a collaborator, a team-builder and someone who is a dot-connector, a naturally customer-obsessed person who is curious enough to always ask, “What would our customers want/say/think/do?" And an astute observer who recognizes that great experiences come from deep understanding of people’s behavior - how they complete tasks and go about solving life’s daily problems. Then there are the must-dos for any role to be taken seriously and set up for success – real resources to get the job done, shared expectations of time-to-impact and metrics that link your customer strategy to bottom-line impact along with the IT capability to get at the metrics with accuracy on a routine basis. What’s the downside? The chief customer or experience officer is a change agent. As in any change agent role, there are above-average risks to carrying out the mission with success. As in any transformation role there will be conflict. Make the conflict a stimulus for constructive steps forward, and see it as a way to achieve big breakthroughs, but be ready for conflict to happen. Strong leaders know how to convert conflict into opportunity. The bottom line Even exploring the value and impact of a chief customer or experience officer means you recognize the need to boost your organization’s customer focus. Remember, being customer-focused doesn’t mean giving customers anything they want. It’s about:
  • Zeroing in on the audience you want to serve
  • Being able to identify audience members so you can establish and build authentic relationships
  • Inspiring them to see your brand and offerings as relevant to their lives
  • Achieving win/win outcomes for these individuals as well as for your business.
What business does not want to make this happen? So, what are you waiting for?

It's Time to Discuss the Upside of Cyber

There's been plenty of focus on the cyber risks associated with big data. It's time to focus on the upside that smart companies can exploit.

Based on what our clients are telling us, I can’t imagine that there are many boards of directors that haven’t recently talked about data. With everyone focusing on security issues and the risks inherent in not adequately plugging data vulnerabilities, every board has had its wake-up call. Managing the downside is only one part of the issue. There is also great upside to be found in the data to drive strategic growth. Studies have shown that organizations that have already transformed themselves through data continue to get better at using data faster than others. The leaders are still increasing their leads. Where there is the opportunity for revolutionary data use, there is also the possibility of being left in the dust. For every WalMart and Uber, there’s a Sears and Yellow Cab company. So, boards need to look at the upside and see data as the means to cross-enterprise improvement. For better market penetration, use your data. For greater operational efficiency, look to your data. For lower risk or reduced fraud or stronger service, create a data framework that will give you both utility and knowledge. We are entering into an explosive period of data availability from outside the organization. If we use it well, it will yield insights that will make today’s decision-making look like the punch-card era. Though these data conversations are started at the highest levels, they must be continued and fostered at every level. In coming weeks, we will be looking at the opportunities and consequences of data conversations — where to start, what to avoid, building a data culture and understanding data’s true value to your organization. I hope you’ll join the discussion.

'Un-Healthcare' Work Deserves Focus

"Un-healthcare workers," on the periphery of medicine, often are ignored but play a powerful role in patient care and community wellness.

Some, like me, who have dedicated their lives to the maintenance and improvement of physical and mental health, may not consider themselves traditional, clinical “healthcare workers.” We may feel as if we work on the fringe, on the outside. We are not nurses or physicians. We work in public health, wellness, nutrition, occupational safety, health economics, fitness, risk management, pharmacy, laboratory, research, insurance and other similar non-traditional clinical professions. We may feel we make a lesser impact on patient care and overall community wellness and vitality. Given historical reference, however, this is absolutely untrue. The term "healthcare" (whether one word or two) has not been used at all in books, papers, references or published text over hundreds of years, until the mid-1980s. But since the late 1700s, those of us “living on the fringes” have been healthcare workers in the true sense of the practice. We may not provide bedside patient care in a healthcare or hospital setting, but we do:
  • Prevent infectious disease by promoting the use of vaccines;
  • Protect the public from pathogenic organisms through water and food sanitation;
  • Prevent addiction and antibiotic resistance through pharmaceutical stewardship;
  • Manage repercussions from post-traumatic stress with mental health interventions;
  • Research global disease trends to stop them in their tracks;
  • Manage risk by improving safety, security and improving quality;
  • Decrease work-related injury and illness by creating safe workplaces, and
  • Prevent heart disease and weight-related cancers by promoting regular exercise.
Those efforts ensure that a population’s health (both physical and mental) does not suffer, that it is either maintained or, better yet, improved. We are the “Un-Healthcare Workers.” It is especially important that traditional healthcare organizations and healthcare workers know this now. As healthcare systems around the world are caring for patients with emerging infectious diseases like Ebola and re-emerging vaccine-preventable diseases like measles, they need to consider that we un-healthcare workers have responsibility for protecting our communities. If we can prevent diseases from becoming epidemic in our communities, healthcare providers working in healthcare settings like hospitals can focus more on providing needed care to those with emergent injuries and chronic disease. The American Public Health Association (APHA), which has represented people protecting the public since 1872, announced a policy in November on preventing Ebola and "globally emerging infectious disease threats" that marked a significant change in the recognition of the "un-healthcare worker." The APHA identified the need to focus efforts on preventing infectious disease in the community and workplaces as a means to protect healthcare systems from exposure to diseases that may change the overall landscape of inpatient care. In the process, the APHA advocates for the role that we “un-healthcare workers” have in maintaining and improving the physical and mental health of our population so that healthcare workers can focus on medical interventions for those who really need it. Sound, science-based public policy and fiscally grounded public health funding can do what it did for the hundreds of years prior to the mid-1980s; it can protect our communities from disease, so that we can protect the vitality of our healthcare systems.

Major Regulatory Change in Asia-Pacific

Change in Asia-Pacific, particularly on risk-based capital, will affect product offerings, investment strategy, capital utilization and more.

The global insurance industry is undergoing significant regulatory change, with regulators in the more developed markets endeavoring to synchronize their efforts. Similar occurrences can be observed in the Asia-Pacific region, where a number of countries are reviewing and undergoing changes in their approach to insurance regulation and holistic risk management. Most notably, a number of regulators are either introducing risk-based capital (RBC) or revisiting their existing RBC frameworks. The maturing regulatory approaches in Asia-Pacific will be a significant factor in managing systematic risk and enhancing policyholder protection. Asia-Pacific is different While the proposed RBC framework in Asia-Pacific may have similarities with the European Solvency II standard, there is wide disparity in the level of sophistication and application. Many of the changes are being driven by local market nuances, such as characteristics of the insurance products being sold and maturity of the insurers who operate in the various jurisdictions. For example, Australia has recently implemented its second-generation solvency regime. Singapore and Thailand are consulting with the industry on second- generation RBC frameworks, while others such as China and its Hong Kong SAR are considering moving in that direction. These moves are particularly encouraging in providing a regulatory framework that will allow for a degree of consistency, especially for those insurers that have multiple offices across the region. In addition to the changes in reserving and solvency calculations, a number of regions are also strengthening their risk management efforts (e.g., China with C-ROSS). This exemplifies how regulators are paying more attention to embedding risk management activities in the business. They look to ensure that senior management has sufficient oversight to allow them to consider and discharge their fiduciary responsibilities. It is important that organizations have an operational infrastructure and that the risk profile is within business risk appetite levels.
What does this mean for insurers? Advances in regulation in the Asia-Pacific region are far-reaching. The implications are expected to improve the way businesses will operate to create long-term sustainability. These implications, in our view, will affect product offerings, investment strategy, capital utilization, risk transfer opportunities and infrastructure. In particular, we foresee several implications: • Robust regulatory framework will provide comfort to the overall financial soundness of the insurance industry. However, the cost of regulatory compliance is expected to increase significantly. • Changing regulations will provide more room for innovation and incentives to enhance or change organizational metrics. Better-managed companies will potentially benefit from lower capital requirements, making their products more attractive. • Companies traditionally focusing on new business value will have to rethink the continuing profitability of past years and will need to understand options available for in-force value management. This will be particularly crucial given that existing forms of new business may be capital-intensive. • A better understanding of the business risk profile will be needed. This will necessitate implementing sophisticated techniques in modeling/optimizing risk- adjusted returns and outlining a more systematic process for risk appetite. • Investment will be required to enhance the modeling and reporting systems to meet regulatory timelines. • Convergence of regulations toward RBC will also mean that there is less disparity between local and foreign players. This will make Asia-Pacific insurance markets potentially more attractive for foreign investments. Moreover, customers may eventually benefit from new ideas and solutions from both foreign and domestic insurers. This will create a healthy competitive market place for policyholders.
Challenges and opportunities Based on experience in more developed insurance markets, changes in regulations produce both challenges and opportunities for insurers. In the short term, it is anticipated that there will be more investment demands on insurance companies. Insurers have the prerogative to make the best use of these investments to define long-term opportunities. In Europe, for example, some insurers have used Solvency II as a means to further enhance their risk management systems, capital allocation mechanisms and reporting infrastructure, and redefine their key performance Indicators. This, in turn, has convinced shareholders and analysts that investments because of regulatory changes should not be for mere compliance, but rather as a means of enhancing competitive advantage. We believe that insurers in Asia-Pacific should draw upon the experiences and challenges in more developed markets to establish an approach for Asia-Pacific markets that considers regulation, economic nuances and the purchasing behavior of policyholders.
Looking ahead There will be many changes within the industry over the next few years, and companies will need to consider the operational implications for their businesses. Based on our conversations and experience in the region, we see an increasing number of insurers making adjustments to their future business plans and investment needs. Some of these modifications are tactical, such as enhancing their existing processes, while others have the potential to have a wholesale effect on entity rationalization and strategic initiatives, such as capital optimization. We are very engaged with the regulators, industry bodies and insurance companies in the emerging discussions and are helping insurers to consider these regulatory changes with a strategic mindset. China
The China Insurance Regulatory Commission (CIRC) has adopted a factor-based solvency system similar to Europe’s Solvency I regime. It is composed of internal risk management, solvency reporting, financial analysis and supervision, regulatory intervention and bankruptcy remediation. This solvency regulation system was built from 2003 to 2007. Over the past 30 years, the Chinese insurance market has become one of the fastest-growing in the world, and its complexity and risk have increased accordingly. The existing static solvency system no longer properly reflects asset and liability risks facing insurance companies. Therefore, it has limitations in providing good guidance for insurers to improve risk management quality and capabilities. Globally, there is a trend toward more risk-oriented regulation and governance, such as Europe’s Solvency II, the US NAIC’s solvency modernization initiative and Singapore’s RBC 2. Developing a new solvency system for mainland China would not only meet local market needs but could also provide pragmatic and invaluable experience for other emerging markets, as well as the international insurance community. Australia
Australia has two primary supervisory authorities, the Australian Prudential Regulation Authority (APRA) and the Australian Securities and Investments Commission (ASIC). Both bodies have authority over the entire retail financial sector, comprising deposit-taking institutions, life and non-life insurance companies, friendly societies and superannuation schemes. APRA is responsible for the licensing and prudential regulation of financial institutions, while ASIC deals with consumer protection issues. The most significant recent enhancement to the regulatory regime is the capital adequacy framework and draft conglomerate supervision. This is supplemented by a corporate governance regime. Hong Kong
The insurance industry in the Hong Kong SAR has witnessed considerable growth in the past decade. As of Oct. 14, 2014, there were 155 authorized insurers in Hong Kong, including 44 long-term insurers, 92 general business or non-life insurance companies and 19 composite insurers (i.e., life and non-life insurers). In Hong Kong, the Office of the Commissioner of Insurance (OCI) is the Insurance Authority (IA) under the Insurance Companies Ordinance (ICO) and oversees the financial conditions and operations of authorized insurers. The OCI is part of the Financial Services and the Treasury Bureau of the Hong Kong Government. India
The Indian life insurance industry has witnessed a phenomenal change in the last 14 years since it was opened to private players. It experienced strong growth (a CAGR of 30%) for almost a decade, until a wave of regulatory changes capped charges for unit-linked products. This compelled insurers to shift focus from unit-linked investments to traditional protection products, significantly slowing industry growth. With reduced shareholder margins on unit-linked plans, sales of traditional products have increased and now constitute at least half of new life insurance business, whereas unit-linked plans are facing negative growth. General insurers have seen growth of 16% CAGR over the past decade. This is attributed to the evolving regulatory environment, new private companies entering the market, changing demographics, greater disposable income and business development in the corporate sector. In fact, growth was significantly higher in the financial year 2012–13 — up 24%, primarily as a result of policies sold and rate adjustments. Against the backdrop of a relatively underpenetrated market, there is a significant potential for sustainable long-term growth. Currently, there are 24 life insurance and 28 general insurance companies in the market. A few mergers and acquisitions are in the pipeline. The industry today is in a state of flux. Surrounded by political uncertainty, slower economic growth, regulatory changes and increased competition, insurance companies are looking to increase profitability, manage expenses and improve persistency. Indonesia
Indonesia is one of Southeast Asia’s largest economies and presents a huge untapped market for the insurance industry. An expanding middle class and the young demographics of the population is creating a vast platform for savings and investment products, and as life insurance continues to show exponential growth, the microinsurance market is gaining traction with low- income consumers. Against this backdrop, the Indonesian insurance industry is being shaped by changing regulations and stricter capital requirements that are aimed at introducing greater transparency and stability. In this transformed regulatory landscape, there are more new entrants to the market and greater opportunities for mergers, acquisitions and joint partnerships. Malaysia 
Malaysia has a well-developed, stable economy that continues to attract insurers. The GDP is growing at nearly 6%, and unemployment and inflation are relatively low. Demographics and strong economic growth have helped to develop a strong market for takaful insurance and bancassurance. In recent years, the country has undertaken wide-ranging reforms aimed at improving regulatory efficiency and opening the door to greater competition in financial services. The Malaysian insurance industry, like others in the Asia-Pacific region, is struggling with depressed investment returns, higher volatility in capital markets and increased pressure on the cost of capital. Against this business landscape, the industry appears to welcome regulatory changes. However, there are also concerns that some of these changes are diverting attention from key issues, such as improving portfolio returns and new business. Singapore
The Monetary Authority of Singapore is finalizing the risk calibration and features of the RBC framework, with implementation expected from Jan. 1, 2017. The RBC framework for insurers was first introduced in Singapore in 2004. It adopts a risk-focused approach to assessing capital adequacy and seeks to reflect most of the relevant risks that insurers face. The minimum capital prescribed under the framework serves as a buffer to absorb losses. The framework also facilitates an early intervention by the Monetary Authority of Singapore (MAS), if necessary. While the RBC framework has served the Singapore insurance industry well, MAS has embarked on a review of the framework (coined “RBC 2 review”) in light of evolving market practices and global regulatory developments. The first industry consultation was conducted in June 2012, in which the MAS proposed a number of changes and an RBC 2 roadmap for implementation. South Korea
The regulatory authority for the Korean financial services industry, the Financial Supervisory Service (FSS), introduced RBC in April 2009. In replacing the Solvency I requirement, the RBC scheme aims to strengthen the soundness and stability of the overall insurance industry. In the rapidly changing insurance market, FSS has to review the RBC regime continuously to ensure that it serves the intended purpose. This effort included some changes in 2012, such as subdividing capital classes and categorizing risk factors in accordance to the types of risks transferred to insurance companies. Moreover, FSS enhanced the RBC calculation methodology by adding reverse margin risk as part of interest rate risk in 2013 and by raising the confidence level of risk factors for insurance risk early in 2014. In light of the recent enhancements, some insurance companies’ solvency margin ratio has fallen below the FSS’s recommended ratio of 150%. As a result, these insurers have had to raise capital through alternative options such as issuing subordinated bonds. Thailand
The Office of Insurance Commission (OIC) implemented a risk- based capital (RBC) framework and gross premium valuation (GPV) regime in Thailand in September 2011. The OIC rolled out two phases of parallel tests before the actual implementation of the RBC framework to gauge the impact on insurers and to gather industry response. The solvency requirement was also increased from 125% at the initial implementation to 140%. This became effective Jan. 1, 2013, to give insurers more time to respond to the changes. In 2011, the Thai regulator granted temporary RBC exemptions and relaxed some of the restrictions. This was an effort to help local general insurers overcome financial difficulty caused by flood losses that occurred that year, as the floods coincided with implementation of the RBC framework. The OIC rolled out two phases of parallel tests before the actual implementation of the RBC framework to gauge the impact on insurers and to gather industry response.

Ranjit Jaswal

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Ranjit Jaswal

Ranjit Jaswal focuses on the financial services sector and has worked both in industry and as a client adviser; Jaswal leads EY's financial risk and capital management practice across Asia Pacific, which has a focus on regulation, balance sheet optimization, target operating models, governance and risk frameworks.

5 Takeaways From First Cyber Case

A ruling shows the importance of obtaining the best initial cyber policy language -- and it can be improved, often at no increase in price.

On May 11, 2015, in a case that is being widely celebrated as one of the first coverage rulings involving a “cyber” insurance policy, a federal court ruled that Travelers has no duty to defend its insured in Travelers Property Casualty Company of America, et al. v. Federal Recovery Services, Inc., et al. Although the Travelers case does not involve cyber-specific coverage issues, the case nonetheless carries some important takeaways for insureds, insurers and many other interested spectators. Here is a brief summary of the ruling and five key takeaways: The Facts The insured, Federal Recovery, was in the business of providing processing, storage, transmission and other handling of electronic data for its customers, including Global Fitness. In particular, Federal Recovery agreed to process Global Fitness’s gym members’ payments under a servicing retail installment agreement. Global Fitness sued Federal Recovery, alleging that Federal Recovery wrongfully refused to return member account data to Global Fitness, including member credit card and bank account information. Global Fitness asserted claims for tortious interference, promissory estoppel, conversion, breach of contract and breach of the implied covenant of good faith and fair dealing. The Cyber Policy The policy at issue was a “CyberFirst” policy issued by Travelers. The policy included a technology errors and omissions liability form, which stated that Travelers “will pay those sums that [Federal Recovery] must pay as ‘damages’ because of loss ... caused by an ‘errors and omissions wrongful act’....” The key term “errors and omissions wrongful act” was defined to include “any error, omission or negligent act.” In addition to covering potential damages, the Travelers policy provided defense coverage, stating that Travelers “will have the right and duty to defend [Federal Recovery] against any claim or ‘suit’ seeking damages for loss to which the insurance provided under one or more of ‘your cyber liability forms’ applies.” Federal Recovery tendered the defense of the underlying Global action to Travelers, which initiated litigation seeking a declaration that it wasn't required to provide coverage. Travelers argued that it did “not have a duty to defend [Federal Recovery] against the original or amended complaints in the Global action because Global [Fitness] does not allege damages from an ‘error, omission or negligent act.’” The Coverage Disputes: Scope of Coverage and Duty to Defend Although Travelers involves underlying cyber-related facts and a “cyber” insurance policy, the coverage issues arising out of the facts and policy certainly are not cyber-specific. Travelers’ declaratory judgment action raises two coverage disputes concerning: (1) the scope of coverage afforded by the technology errors and omissions policy at issue, as shaped by its key “wrongful act” definition; and (2) the scope of an insurer’s duty to defend under Utah law. While arising in the context of “cyber”-related facts surrounding electronic account and payment data, and under a “cyber” insurance policy, the coverage disputes at issue in the Travelers case are precisely the types of disputes that we routinely see in the context of errors and omissions and other claims-made liability coverages. (1) The Scope of Coverage As to the scope of coverage, errors and omissions, D&O, professional liability and other claims-made policies, like the policy at issue in the Travelers case, typically cover “wrongful acts,” a term that typically in turn is defined as “any negligent act, error or omission,” or similar language. There are scores of cases addressing whether intentional and non-negligent acts fall within or outside the purview of a covered “wrongful act.” Unfortunately, and in contrast to other decisions, the U.S. District Court for the District of Utah in the Travelers case took a narrow view of the key language, ruling that “[t]o trigger Travelers’ duty to defend, there must be allegations in the [underlying] action that sound in negligence.” The court further found that there were “no such allegations.” In contrast, other courts have appropriately upheld coverage for various types of intentional and non-negligent conduct under errors and omissions and other claims-made policies. As one commentator has summarized: Claims-made policies typically afford coverage for claims by reason of any “negligent act, error or omission.” What if an insured is held liable for a non-negligent act? Most courts have held that the insured is still entitled to coverage. The strongest argument in favor of that conclusion is that (i) an “error” or “omission” encompasses more than negligent conduct, and (ii) if only negligent errors and negligent omissions were covered, the “error or omission” language would be rendered redundant. To the extent some may wish to reference other cases addressing cyber-related fact patterns, those cases exist. For example, in 1995, the Supreme Judicial Court of Massachusetts in USM Corp. v. First State Ins. Co.10 upheld coverage under an errors and omissions policy for a breach of express warranty claim involving the insured’s failure to develop and deliver a turnkey computer system that would perform certain functional specifications. The errors and omissions policy at issue in the USM case, similar to the policy at issue in the Travelers case, covered claims against the insured “by reason of any negligent act, error or omission.” Also, the insurers in USM, like the insurers in Travelers, argued that the policy only covered the insured for negligent acts. The USM court rejected the insurers’ arguments, noting that courts have not limited coverage under errors and omissions policies to circumstances involving negligence: Other courts have not limited liability under “errors and omissions” policies to circumstances involving negligence but have recognized certain non-negligent errors as being within the coverage afforded. Cases involving the words such as “negligent act, error or omission” (the crucial language of the policies before us) have not consistently determined that an error must be a negligent one if coverage is to be available. *** Because some, but not all, judicial opinions have rejected the interpretation of errors and omissions policies for which the insurers contend, if it was the insurers’ intention, the crucial words of the policy should have been amended to eliminate the ambiguity and to make clear that coverage extended only to negligent errors. Potential policyholders could then have more accurately determined whether such coverage met their needs. Because of the uncertainty about the scope of the word “error,” the insurers as authors of the policies must suffer the consequences of the ambiguity. The New York Appellate Division’s decision in Volney Residence, Inc. v. Atlantic Mut. Ins. Co. is likewise instructive. In that case, the Appellate Division held that the insurer had a duty to defend a federal RICO action in which the insured defendants “were alleged intentionally to have committed acts of self-dealing and fraud.” Applying well-established rules of contract interpretation, the court ruled that there was a duty to defend: The policy provision in question covers claims arising from “a negligent act, error or omission,” which term is defined as “any negligent act, error or omission or breach of duty of [the] directors or officers while acting in their capacity as such.” The definition is susceptible of more than one meaning and can be understood to cover any breach of duty of the directors or officers, not exclusively negligent breaches of duty. Ambiguities in an insurance policy are to be resolved against the insurer. Other cases are to the same effect. (2) Scope of the Duty to Defend Turning to the separate issue of the duty to defend, it is well established that the duty to defend is very broad—broader than the duty to indemnify. The duty to defend is typically triggered if there is some potential for coverage, and, in many jurisdictions, it is appropriate to look outside the facts pled in the underlying complaint to determine whether there is a duty to defend. Again, unfortunately, the court in the Travelers case took a narrow view of the insurer’s duty to defend. Even assuming for the sake of argument that the policy covered only negligence, the underlying complaint alleged, among other things, that Federal Recovery “retained possession of member accounts data, including the billing data, which was the property of Global Fitness ....” Allegations surrounding improper retention of data, even if that retention ultimately was wrongful or not legally justifiable, clearly may arise out of negligence as opposed to intentional conduct. Travelers Takeaways Putting aside the ultimate merits of the court’s ruling, and whether this case addresses any coverage issues that are appropriately characterized as “cyber” issues, Travelers offers at least five key takeaways: First, Travelers illustrates that decisions involving cyber insurance policies are coming and, considering all of the attention and buzz surrounding an otherwise seemingly mundane errors and omissions case, insureds and insurers alike are anxiously awaiting and anticipating the guidance those decisions may provide. Second, Travelers underscores that the types of coverage disputes that we will see arise out of cyber-related facts and, under cyber insurance policies, often will involve, or at least will intertwine with, the types of disputes that routinely arise in connection with traditional insurance coverages, including errors and omissions coverage and general liability coverage. This is useful for insureds to appreciate toward the goal of being prepared for future potential coverage disputes under cyber policies. Third, Travelers underscores the importance of securing a favorable choice of forum and choice of law in insurance coverage disputes. Until the governing law applicable to an insurance contract—cyber or otherwise—is established, the policy can be, in a figurative and yet a very real sense, a blank piece of paper. Fourth, although its label as a first cyber case is debatable, Travelers at a minimum has spotlighted the approaching disputes under cyber liability policies, which should remind insureds of the need to be prepared for, in addition to the traditional types of coverage issues and disputes that can arise under those policies, the potential cyber-specific coverage issues and disputes that may arise, such as the scope of coverage for “cloud”- related exposures. Fifth, Travelers illustrates the importance of obtaining the best possible policy cyber language at the initial coverage placement and renewal stage. Unlike some types of traditional insurance policies, cyber policies are extremely negotiable, and the insurer’s off-the-shelf language can often be significantly negotiated and improved—often for no increase in premium. It is important for the insured to understand its unique potential risk profile and exposure— and what to ask for from the insurer. Often in coverage disputes, the issue of coverage comes down to a few words, the sequence of a few words or even the position of a comma or other punctuation. It is important to get the policy language right before a dispute. And while the Travelers case addresses coverage issues that are not cyber-specific, the fundamentals of successfully pursuing coverage under traditional insurance coverage are important to keep in mind as we enter a time and space in which coverage disputes based on underlying cyber-related factual scenarios, and under specialized cyber insurance coverages, are poised to become commonplace.

Unstructured Data: New Cyber Worry

Many companies are just starting to come to grips with the challenge of how to categorize and manage the deluge of unstructured data.

Companies are generating mountains of unstructured data and, in doing so, unwittingly adding to their security exposure. Unstructured data is any piece of information that doesn’t get stored in a database or some other formal data management system. Some 80% of business data is said to be unstructured, and that percentage has to be rising. Think of it as employee-generated business information—the sum total of human ingenuity that we display in the workplace, typing away on productivity and collaboration software and dispersing our pearls of wisdom in digital communications. Free IDT911 white paper: Breach, Privacy, And Cyber Coverages: Fact And Fiction Unstructured data is all of the data that we are generating on our laptops and mobile devices, storing in cloud services, transferring in email and text messages and pitching into social media sites. Many companies are just starting to come to grips with the complex challenge of figuring out how to categorize and manage this deluge of unstructured data. Sensitive data at risk But what’s more concerning is the gaping security exposure. It was unstructured data—in the form of a text message transcript of employees conversing about deflating footballs—that blindsided the New England Patriots NFL team and its star quarterback, Tom Brady. Yet the full scope of risk created by unstructured data is much more profound. “The risk that unstructured data poses dwarfs that of any other type of data,” says Adam Laub, product management vice president at STEALTHbits Technologies. “It is the least understood form of data in terms of access, activity, ownership and content.” STEALTHbits helps companies that use Windows Active Directory identify and keep more detailed track of shared files that hold unstructured data. That may sound basic. Yet the fact that STEALTHbits is part of a thriving cottage industry of technology vendors helping organizations get a grip on unstructured data is truly a sign of the times. I met with Laub as he was pitching STEALTHbits’ technology at the recent RSA Conference in San Francisco. “Any single file can contain the data that puts an organization in the headlines, and turning a blind eye to the problem or claiming it’s too big to handle is not a valid excuse for why unstructured data hasn’t been secured properly,” Laub says. A decade and a half has elapsed since the Y2K scare. During that period, business networks have advanced and morphed and now tie extensively into the Internet cloud and mobile devices. Time to close loophole Along the way, no one had the foresight to champion a standard architecture to keep track of—much less manage and secure—unstructured data, which continues to grow by leaps and bounds. Criminals certainly recognize the opportunity for mischief that has resulted. It’s difficult to guard the cream when the cream can be accessed from endless digital paths. Just ask Morgan Stanley. Earlier this year, a low-ranking Morgan Stanley financial adviser pilfered, then posted for sale, account records, including passwords, for 6 million clients. The employee was fired and is being investigated by the FBI. But Morgan Stanley has to deal with the hit to its reputation. “The urgency is that your information is under attack today,” says Ronald Arden, vice president at Fasoo USA, a data management technology vendor. “Somebody is trying to steal your most important information, and it doesn’t matter if you’re a small company that makes widgets for the oil and gas industry or you’re Bank of America.” Fasoo’s technology encrypts any newly generated data that could be sensitive and fosters a process for classifying which types of unstructured data should routinely be locked down, Arden told me. Technology solutions, of course, are only as effective as the people and processes in place behind them. It is incumbent upon executives, managers and employees to help make security part and parcel of the core business mission. Those that don’t do this will continue to be easy targets. Steps forward Simple first steps include identifying where sensitive data exists. This should lead to clarity about data ownership and better choices about granting access to sensitive data, says STEALTHbits’ Laub. This can pave the way to more formal “Data Access Governance” programs, in which data access activities are monitored and user behaviors are baselined. “This will go a long way towards enabling security personnel to focus on the events and activities that matter most,” says Laub. Smaller organizations may have to move much more quickly and efficiently. Taking stock of the most sensitive information in a small or mid sized organization is doable, says Fasoo’s Arden. “If you are a manufacturing company, the intellectual property around your designs and processes are the most critical pieces of information in your business, if you are a financial company it’s your customer records,” Arden says. “Think about securing that information with layers of encryption and security policies to guarantee that that information cannot leave your company.” Some unstructured business data is benign and may not need to be locked down. “If I write you a memo that says, ‘We’re having a party tonight,’ that’s not a critical piece of information,” says Arden. “But a financial report or intellectual property or something related to healthcare or privacy, that’s probably something that you need to start thinking about locking down.”

100 Ideas That Changed Insurance

Because insurers constantly adapt to technology to preserve customers assets, there are dozens of ideas that changed insurance.

Recently, I bought a copy of Time magazine’s publication, TIME 100 Ideas That Changed the World: History’s Greatest Breakthroughs, Inventions and Theories, in an airport book store while on a business trip. It was certainly a compact and interesting read, highlighting amazing innovations that we now accept as the norm of human existence on Planet Earth, from the discovery of germs to the foundation of a seven-day week to the building of the World Wide Web. I was amazed as I read through it and was reminded of how human existence since the beginning of recorded history has been truly shaped through ideas turned into game changing innovation results. The purpose of this blog is not to get philosophical about our evolution as humans but, rather, to relate it to the world we live in every day: insurance. So of course, after I paged through the Time book, my wheels started spinning around the 100 ideas that have changed insurance – and I started to reflect on how we as an industry got to where we are today. The history of innovation in insurance has largely been shaped by advances made in technology external to the industry. As markets, businesses and consumers start to access better ways of doing business, insurance companies adjust to meet those demands. The same can be said for many other industries. But insurance is unique because its very core concept is to protect our customers’ assets from loss and mitigate risks. So, inherently, the insurance industry will always adapt in some form to technology changes to assist the customer. That is what we do every day – we adapt – though some days we don’t necessarily remind ourselves of the core mission. I started to ask myself, if we had to make a list, what would be the 100 ideas that changed insurance? I think it would be too hard to classify, in terms of the entire evolution of our ecosystem, because the last 100 years have changed so much. So let’s just focus on the last 40 years from a technology perspective: mainframes ... client servers ... personal computers ... development of core systems and automated business processes ... data processing to information systems ... typewriters to the fax machine, copiers, printers, scanners and even email ... our world on the World Wide Web ... mobile phones ... web applications ... smart phones ... big data ... telematics and even some of the emerging technologies like Internet of Things, wearable devices, artificial intelligence, semantic technologies and even drones and aerial imagery. The list of maturing and emerging technologies does just go on and on. It might be hard to pare it down to just 100 ideas, even by looking at just technology. The point is, when we talk of ideation and innovation, sometimes we forget to reflect on where we have been. Forty years ago, if someone described writing a blog for you that you could read on your mobile device, you may have seriously questioned their sanity. Today, it is commonplace. As we move rapidly through 2015 – look at plans; take the time to reflect on successes; take the time to reflect on where we truly have been. Sometimes these reflections are the seeds of new ideas, new ways of doing business and new ways to gain an edge. Just think, for every great solution out there, there is a better one possible. Innovation should be inspiring our work, and I am excited to see where it leads us.

Catastrophe Models Allow Breakthroughs

This article is the last in a series on how the evolution of catastrophe models provides a foundation for much-needed innovation in insurance.

“In business there are two ways to make money; you can bundle or you can unbundle.” –Jim Barksdale We have spent a series of articles introducing catastrophe models and describing the remarkable benefits they have provided the P&C industry since their introduction (article 1, article 2, article 3, article 4). CAT models have enabled the industry to pull the shroud off of quantifying catastrophic risk and finally given (re)insurers the ability to price and manage their exposure to the violent and unpredictable effects of large-scale natural and man-made events. In addition, while not a panacea, the models have leveled the playing field between insurers and reinsurers. Via the use of the models, insurers have more insight than even before into their exposures and the pricing mechanics behind catastrophic risk. As a result, they can now negotiate terms with confidence, whereas prior to the advent of the models and other similar tools, reinsurers had the upper hand with information and research. We also contend that CAT models are the predominant cause of the reinsurance soft market via the entry of alternative capital from the capital markets. And yet, with all the value that CAT models have unleashed, we still have a collective sour taste in our mouths as to how these invaluable tools have benefited consumers, the ones who ultimately make the purchasing decisions and, thus, justify the industry’s very existence. There are, in fact, now ways to benefit customers by, for instance, bundling earthquake coverage with homeowners insurance in California and helping companies deal with hidden volatility in their supply chains. First, some background: Bundling Risks Any definition of insurance usually addresses the concept of risk transfer: the mechanism that ensures full or partial financial compensation for the loss or damage caused by event(s) beyond the control of the insured. In addition, the law of large numbers applies: the principle that the average of a large number of independent identically distributed random variables tends to fall close to the expected value. This result can be used to show that the entry of additional risks to an insured pool tends to reduce the variation of the average loss per policyholder around the expected value. When each policyholder’s contribution to the pool’s resources exceeds the expected loss payment, the entry of additional policyholders reduces the probability that the pool’s resources will be insufficient to pay all claims. Thus, an increase in the number of policyholders strengthens the insurance by reducing the probability that the pool will fail. Our collective experiences in this world are risky, and we humans have consistently desired the ability to shed the financial consequences of risk to third parties. Insurance companies exist by using their large capital base, relying on the law of large numbers, but, perhaps most importantly, leveraging the concept of spread of risk, the selling of insurance in multiple areas to multiple policyholders to minimize the danger that all policyholders will experience losses simultaneously. Take the peril of earthquake. In California, 85% to 90% of all homeowners do NOT maintain earthquake coverage even though earthquake is the predominant peril in that state. (Traditional homeowners policies exclude earth movement as a covered peril). News articles point to the price of the coverage as the limiting factor, and that makes sense because of that peril’s natural volatility. Or does it make sense? Is the cost of losses from earthquakes in California considerably different than, say, losses from hurricanes in Florida, in which the wind peril is typically included in most homeowners insurance forms? Earthquakes are a lot more localized than hurricanes, but the loss severity can also be more pronounced in those localized regions. Hurricanes that strike Florida can be expected with higher frequency than large damage-causing earthquakes that shake California. In the final analysis, the average projected loss costs are similar between the two perils, but one has nearly a 100% take-up rate vs. the other at roughly 10%. But why is that so? The answer lies in the law of large numbers, or in this case the lack thereof. Rewind the clock to the 1940s. If you were a homeowner then, the property insurance world looked very different than it does today. As a homeowner back then, you would need to virtually purchase separate policies for each peril sought: a fire, theft and liability policy and then a windstorm policy to adequately cover your home. The thought of packaging those perils into one convenient, comprehensive policy was thought to be cost-prohibitive. History has proven otherwise. The bundling of perils creates a margin of safety from a P&C insurer’s perspective. Take two property insurers who offer fire coverage. Company A offers monoline fire, whereas Company B packages fire as part of a comprehensive homeowners policy. If both companies use identical pricing models, then Company B can actually charge less for fire protection than Company A simply because the additional premium from Company B affords peril diversification. Company B has the luxury of using premiums from other perils to help offset losses, whereas Company A is stuck with only its single-source fire premium and, thus, must make allowances in its pricing that it could be wrong. At the same time, Company B must also make allowances in the event its pricing is wrong, but can apply smaller allowances because of the built-in safety margin. This brings us back to the models. It is easy to see why earthquake and other perils, such as flood, was excluded from homeowners policies in the past. Without models, it was nearly impossible to estimate future losses with any sort of reliable precision, leaving insurers the inability to collect enough premium to compensate for the inevitable catastrophic event. Enter the National Flood Insurance Program (NFIP), which stepped in to offer flood coverage but never fundamentally approached it from a sound underwriting perspective. Instead, in an effort to make the coverage affordable to the masses, the NFIP severely underpriced its only product and is now tens of billions of dollars in the red. Other insurers bravely offered the earthquake peril via endorsement and were devastated after the Northridge earthquake in 1994. In both cases, various market circumstances, including the lack of adequate modeling capabilities, contributed to underpricing and adverse risk selection as the most risk-prone homeowners gobbled up the cheap coverage. Old legacies die hard, but models stand ready to help responsibly underwrite and manage catastrophic risk, even when the availability of windstorm, earthquake and flood insurance has been traditionally limited and expensive. The next wave of P&C industry innovation will come from imaginative and enterprising companies that use CAT models to economically bundle risks designed to lower the costs to consumers. We view a future where more CAT risk will be bundled into traditional products. As they continue to improve, CAT models will afford the industry the confidence needed to include earthquake and flood cover for all property lines at full limits and with flexible, lower deductibles. In the future, earthquake and flood hazards will be standard covered perils in traditional property forms, and the industry will one day look back from a product standpoint and wonder why it had not evolved sooner. Unbundling Risks Insurance policies as contracts can be clumsy in handling complicated exposures. For example, insurers have the hardest time handling supply chain and contingent business interruption exposures, and rightly so. Because of globalization and extreme competition, multinational companies are continuously seeking value in the inputs for their products. A widget in a product can be produced in China one year, the Philippines the next, Thailand the following year and so on. It is time-consuming and resource intensive to keep track of not only how much of a company’s widgets are manufactured, but also what risks exist surrounding the manufacturing plant that could interrupt production or delivery. We would be hard-pressed to blame underwriters for wanting to exclude or significantly sublimit exposures related to supply chain or business interruption; after all, underwriters have enough difficulty just to manage the actual property exposures inherent in these types of risks. It is precisely this type of opportunity that makes sense for the industry to create specialized programs. Unbundle the exposure from the remainder of the policy and treat it as a separate exposure with dedicated resources to analyze, price and manage the risk. Take a U.S. semiconductor manufacturer with supply exposure in Southeast Asia. As was the case with the 2011 Thailand floods or the 2011 Tohoku earthquake and tsunami, this hypothetical manufacturer is likely exposed to supply chain risks of which it is unaware. It is also likely that the property insurance policy meant to indemnify the manufacturer for covered losses in its supply chain will fall short of expectations. An enterprising underwriter could carve out this exposure and transfer it to a new form. In that form, the underwriter can work with the manufacturer to clarify policy wording, liberalize coverage, simplify claims adjusting and provide needed additional capacity. As a result, the manufacturer gets a risk transfer mechanism that more precisely aligns with the balance sheet affecting risks it is exposed to. The insurer gets a new line of business that can provide a significant source of new revenue using tools such as CAT models and other analytics to price and manage those specific risks. By applying some ingenuity, the situation can be a win/win all around. What if you are a manufacturer or importer and rely on the Port of Los Angeles or Miami International Airport (or any other major international port) to transport your goods in and out of markets? This is another area where commercial policies handle business exposure poorly, or not even at all. CAT models stand ready to provide the analytics required to transfer the risks of these choke points from business balance sheets to insurers. All that is required is vision to recognize the opportunity and the sense to use the toolsets now available to invent solutions rather than relying on legacy group think. At the end of the day, the next wave of innovation will not come directly from models or analytics. While the models and analytics will continue to improve, real innovation will come from creative individuals who recognize the risks that are causing market discomfort and then use these wonderful tools to build products and programs that effectively transfer those risks more effectively than ever. Those same individuals will understand that the insured comes first, and that rather than retrofitting dated products to suit a modern-day business problem, the advent of new products and services is an absolute necessity to maintain the industry’s relevance. The only limiting factor preventing true innovation in property insurance is imagination and a willingness to no longer cling to the past.