Many life insurance executives with whom we have spoken say that their business needs to fundamentally change to be relevant in today’s market. Life insurance does face formidable challenges. First, let’s take a hard look at some statistics. In 1950, there were approximately 23 million life policies in the U.S., covering a population of 156 million. In 2010, there were approximately 29 million policies covering a population of 311 million. The percentage of families owning life insurance assets has decreased from more than a third in 1992 to less than a quarter in 2007. By contrast, while less than  a third of the population owned mutual funds in 1990, more than two-fifths (or 51 million households and 88 million investors) did by 2009. A number of socio-demographic, behavioral economic, competitive and technological changes explain the trends -- and the need for reinventing life insurance:

• Changing demography: Around 12% of men and an equal number of women were between the ages of 25 and 40 in 1950. However, only 10% of males and 9.9% of females were in that age cohort in 2010, and the percentage is set to drop to 9.6% and 9.1%, respectively, by 2050. This hurts life insurance in two main ways. First, the segment of the overall population that is in the typical age bracket for purchasing life insurance decreases. Second, as people see their parents and grandparents live longer, they tend to de-value the death benefits associated with life insurance.

• Increasingly complex products: The life insurance industry initially offered simple products with easily understood death benefits. Over the past 30 years, the advent of universal and variable universal life, the proliferation of various riders to existing products and new types of annuities that highlight living benefits significantly increased product diversity but often have been difficult for customers to understand. Moreover, in the wake of the financial crisis, some complex products had both surprising and unwelcome effects on insurers themselves.

• Individual decision-making takes the place of institutional decision-making: From the 1930s to the 1980s, the government and employers were providing many people life insurance, disability coverage and pensions. However, since then, individuals increasingly have had to make protection/investment decisions on their own. Unfortunately for insurers, many people have eschewed life insurance and spent their money elsewhere. If they have elected to invest, they often have chosen mutual funds, which often featured high returns from the mid-1980s to early 2000s.

• Growth of intermediated distribution: The above factors and the need to explain complex new products led to the growth of intermediated distribution. Many insurers now distribute their products through independent brokers, captive agents, broker-dealers, bank channels and aggregators and also directly. It is expensive and difficult to effectively recruit, train and retain such a diffuse workforce, which has led to problems catering to existing customers.

• Increasingly unfavorable distribution economics: Insurance agents are paid front-loaded commissions, some of which can be as high as the entire first-year premiums, with a small recurring percentage of the premium thereafter. Moreover, each layer adds a percentage commission to the premiums. All of this increases costs for both insurers and consumers. In contrast, mutual fund management fees are only 0.25% for passive funds and 1% to 2% for actively managed funds. In addition, while it is difficult to compare insurance agency fees, it is relatively easy to do so with mutual fund management fees.

• New and changing customer preferences and expectations: Unlike their more patient forebears, Gens X and Y – who have increasing economic clout – demand simple products, transparent pricing and relationships, quick delivery and the convenience of dealing with insurers when and where they want. Insurers have been slower than other financial service providers in recognizing and reacting to this need.

A vicious cycle has begun (see graphic below). Insurers claim that, in large part because of product complexity, life insurance is “sold and not bought,” which justifies expensive, intermediated distribution. For many customers, product complexity, the need to deal with an agent, the lack of perceived need for death benefits and cost-of-living benefits make life products unappealing. In contrast, the mutual fund industry has grown tremendously by exploiting a more virtuous cycle: It offers many fairly simple products that often are available for direct purchase at a nominal fee. Reasons for optimism Despite the bleak picture we have painted so far, we believe that reinventing life insurance and redesigning its business model are possible. This will require fundamental rethinking of value propositions, product design, distribution and delivery mechanisms and economics. Some of the most prescient insurers are already doing this and focusing on the following to become more attractive to consumers:

• From living benefits to well-being benefits: There is no incentive built into life policy calculations for better living habits because there traditionally has been very little data for determining the correlation between these behaviors and life expectancy. However, the advent of wearable devices, real-time monitoring of exercise and activity levels and advances in medical sciences have resulted in a large body of behavioral data and some preliminary results. There are now websites that can help people determine their medical age based on their physical, psychological and physiological behaviors and conditions. We refer to all these factors collectively as “well-being behaviors.” Using the notion of a medical age or similar test as part of the life underwriting process, insurers can create an explicit link between “well-being behaviors” and expected mortality. This link can fundamentally alter the relevance and utility of life insurance by helping policyholders live longer and more healthily and by helping insurers understand and price risk better.

• From death benefits to quality of life: Well-being benefits promise to create a more meaningful connection between insurers and policyholders. Rather than just offering benefits when a policyholder dies, insurers can play a more active role in changing policyholder behaviors to delay or help prevent the onset of certain health conditions, promote a better quality of life and even extend insureds’ life spans. This would give insurers the opportunity to engage with policyholders on a daily (or even more frequent) basis to collect behavioral data on their behalf and educate them on more healthy behaviors and lifestyle changes. To encourage sharing of such personal information, insurers could provide policyholders financial (e.g., lower premiums) and non-financial (e.g., health) benefits.

• From limited to broad appeal: Life insurance purchases are increasingly limited to the risk-averse, young couples and families with children. Well-being benefits are likely to appeal to additional, typically affluent segments that tend to focus on staying fit and healthy, including both younger and active older customers. For a sector that has had significant challenges attracting young, single, healthy individuals, this represents a great opportunity to expand the life market, as well as attract older customers who may think it is too late to purchase life products.

• From long-term to short-term renewable contracts: Typical life insurance contracts are for the long term. However, this is a deterrent to most customers today. Moreover, behavioral economics shows us that individuals are not particularly good at making long-term saving decisions, especially when there may be a high cost (i.e., surrender charges) to recover from a mistake. Therefore, individuals tend to delay purchasing or rationalize not having life insurance at all. With well-being benefits, contract durations can be much shorter -- even only one year.

• Toward a disintermediated direct model: Prevailing industry sentiment is that “life insurance is sold, not bought,” and by advisers who can educate and advise customers on complex products. However, well-being benefits offer a value proposition that customers can easily understand (e.g., consuming X calories per day and exercising Y hours a day can lead to a decrease in medical age by Z months), as well as much shorter contract durations. Because of their transparency, these products can be sold to the consumer without intermediaries. More health-conscious segments (e.g., the young, professional and wealthy) also are likely to be more technologically savvy and hence prefer direct online/call center distribution. Over time, this model could bring down distribution costs because there will be fewer commissions for intermediaries and fixed costs that can be amortized over a large group of early adopters.

We realize that life insurers tend to be very conservative and skeptical about wholesale re-engineering. They often demand proof that new value propositions can be successful over the long term. However, there are markets in which life insurers have successfully deployed the well-being value proposition and have consistently demonstrated superior performance over the past decade. Moreover, there are clear similarities to what has happened in the U.S. auto insurance market over the last 20 years. Auto insurance has progressively moved from a face-to-face, agency-driven sale to a real-time, telematics-supported, transparent and direct or multi-channel distribution model. As a result, price transparency has increased, products are more standardized, customer switching has increased and real-time information is increasingly informing product pricing and servicing. Implications Significantly changing products and redesigning a long-established business model is no easy task. The company will have to redefine its value proposition, target individuals through different messages and channels, simplify product design, re-engineer distribution and product economics, change the underwriting process to take into account real-time sensor information and make the intake and policy administration process more straight-through and real-time. So, where should life insurers start? We propose a four step “LITE” (Learn-Insight-Test-Enhance) approach:

• Learn your target segments’ needs. Life insurers should partner with health insurers, wellness companies and manufacturers of wearable sensors to collect data and understand the exercise and dietary behaviors of different customer segments. Some leading health and life insurers have started doing this with group plans, where employers have an incentive to encourage healthy lifestyles among their employees and therefore reduce claims and premiums.
• Build the models that can provide insight. Building simulation models of exercise and dietary behavior and their impact on medical age is critical. Collecting data from sensors to calibrate these models and ascertain the efficacy of these models will help insurers determine appropriate underwriting factors.
• Test initial hypotheses with behavioral pilots. Building and calibrating simulation models will provide insights into the behavioral interventions that need field testing. Running pilots with target individuals or specific employer groups in a group plan will help test concepts and refine the value proposition.
• Enhance and roll out the new value proposition. Based on the results of pilot programs, insurers can refine and enhance the value proposition for specific segments. Then, redesign of the marketing, distribution, product design, new business, operations and servicing can occur with these changes in mind.

Even as economies recover, the insurance sector continues to face many competitive pressures and regulatory challenges. Yet a new drive for growth is emerging. The 2014 EY Global Insurance CFO Survey captures the priorities and challenges for finance and actuarial teams as they seek to support business growth strategies while addressing regulatory and cost pressures. Delivering more value to the business through performance measurement and improved decision support is the top priority for the finance function through 2020. Among senior finance professionals participating in the survey, 71% indicated that “being a better business partner” ranked among their top three priorities, with 35% placing this as number one. Other Key Findings

• Top three business drivers: #1 growth, #2 managing costs and #3 regulatory changes
• Two-thirds of respondents rank data and technology issues among the top three challenges facing finance and actuarial functions; participants on average score data as their least developed capability
• By 2020, the most significant shifts in maturity levels by operating model will be in data management and technology capabilities
• Respondents expect onshore shared services to support transaction processing functions, with outsourcing selectively used for payroll and internal audits
• Decision support and controls are expected to account for a larger share of finance and actuarial headcount by 2020

What insurers must do We see three key areas where insurers can take action:

• Modify current reporting processes by developing an efficient reporting solution architecture.
• Deliver timely and relevant management information and link strategic objectives to performance indicators.
• Improve finance and actuarial operational performance by using the right skills and processes to strike a balance between effectiveness and efficiency.

For the full survey from which this excerpt was taken, click here.

Everyone is talking about the war for talent. Must there be a war? Or can your organization accomplish what it wants to (needs to) by fighting the battle for retention quietly, within its own borders?

There's only so much a company can manufacture with its brand to catch the attention of top talent. Smart candidates understand that the truth about you is displayed by your existing employment base. Your employment brand is much less the result of intentional messages created for an external audience than it is the result of the vibe your existing employee base creates in the marketplace. Social media has increased the volume of this voice exponentially.

To retain the talent you have and to make that social voice work for you, you should:

1. Make sure existing talent knows it's being treated fairly in terms of pay and recognition.
2. Make sure each employee leaves work for the day, week, month with a sense of achievement.
3. Make sure your processes continue to improve. Smart people don't like working with dumb processes.
4. Make sure each employee has at least a small sense of camaraderie.
5. Relate all work to the customer experience. Most employees would rather work for customers than bosses!

Brilliant people or brilliant processes?

In some cases, employers believe they need brilliant employees because they are the only ones who have been proven to find their way through the maze of terrible processes. Often, employers don't even realize this is the reason they're looking for talent. A well-known Japanese company's leader once said, "In America, you have brilliant people working with average processes; in Japan, we have average people working with brilliant processes." Something to think about.

Lets face it. There are only so many brilliant people to go around. Most of us are closer to average. Given this, is it really smart to fight a war for talent? Or would it be smarter to work on processes -- remove waste (things customers wouldn't pay for), minimize the things customers do have to pay for but would rather not (things normally required by law) and spend time working on processes that create value? It's about the customer.

The focus of everyone's work must be on creating value for customers. The message should be, "Shoot for referrals, settle for retention." The entire workforce should be motivated by this. Common purpose builds workplaces worth working for.

Unfortunately, it has been my experience that it is easier to convince a janitor of this than it is most executives. Executives make a lot of money. There's a lot of temptation to protect their domains, their technical areas of work, their lines of business, their territories, etc. What these executives need to understand is that customers flow horizontally through the spectrum of work performed by each executive's area of influence. The thicker the borders between those areas of influence, the harder it is for employees who want to satisfy customers to get their jobs de. These employees, especially the smart ones, eventually leave the organization. They definitely don't recommend their own workplace to people they care about.

What if you actually won the war?

So before you begin to fight a war for talent, my recommendation is to think internally. If you did win the war for talented people, what kind of environment would they be working in? What kinds of processes would they be forced to work with? Are your best employees already recommending others to work at your company? If not, why not?

Don't just sit there, ask them!

The obesity rate in the U.S. has doubled in the past 15 years. More than 50% of the population is overweight, with a BMI (body mass index) between 25 and 30, and 30% have a BMI greater than 30 and are considered obese. Less than 20% of the population is at a healthy weight, with a BMI less than 25.

On June 16, 2013, the American Medical Association voted to declare obesity a disease rather than a comorbidity factor, a decision that will affect 78 million adults. The U.S. Department of Health and Human Services said the costs to U.S. businesses related to obesity exceed $13 billion each year. With the pending implementation of ICD (International Classification of Diseases) 10 codes, the reclassification of obesity is is fast becoming a reality and will dramatically affect workers' compensation and cases related to the American Disability Act and amendments.

Before the AMA's obesity reclassification, ICD-9 code 278 related to obesity-related medical complications rather than to obesity. The new ICD-10 coding system now identifies obesity as a disease, which needs to be addressed medically. Obesity can now become a secondary claim, and injured workers will be considered obese if they gain weight because of medications, cannot maintain a level of fitness because of a work-related injury or if their BMI exceeds 30. The conditions are all now considered work-related and must be treated as such.

The problem of obesity for employers is not confined to workers' compensation. The Americans with Disability Act Amendment of 2008 allows for a broader scope of protection for disabilities. The classification of obesity as a disease now places an injured worker in a protected class pursuant to the ADA amendment. In fact, litigation in this area has already started. A federal district court ruled in April 2014 that obesity itself may be a disability and will be allowed to move forward under the ADA (Joseph Whittaker v. America's Car-Mart, Eastern District of Missouri).

Obesity as an impairment

Severe obesity is a physical impairment. A sales manager of a used car dealership was terminated for requesting accommodation and won $128,000. He was considered disabled, and the essential function of the job was walking, so he was terminated without reasonable accommodation.

The judge ruled that obesity is an accepted disability and allowed him to pursue his claim against his employer. This could have substantial impact for employers as injured workers could more easily argue that their obesity is a permanent condition that impedes their ability to return to work, as opposed to a temporary life choice that can be reversed.

The Equal Employment Opportunities Commission (EEOC) has recently chimed in on obesity. According to the EEOC, severe [or morbid] obesity body weight, of more than 100% over the norm, qualifies as impairment under the ADA without proof of an underlying physiological disorder. In the last year, we have seen an increasing number of EEOC-driven obesity-related lawsuits. Federal district courts support the EEOC's position that an employee does not have to prove an underlying condition, especially in cases where there is evidence that the employer perceived the employee's obesity as a disability or otherwise expressed prejudice against the employee for being obese.

Workers' compensation claims are automatically reported to CMS Medicare with a diagnosis. When the new ICD-10 codes take effect, an obesity diagnosis will be included in the claim and will require co-digital payments, future medical care or continued treatment by Medicare.

There is good news on the horizon. Reporting of a claim only happens if there is a change in condition not primarily for obesity. It is recommended that baseline testing for musculoskeletal conditions be conducted at the time of hiring and on the existing workforce. In the event of a work-related injury, if a second test is conducted that reveals no change in condition, it results in no reportable claim and no obesity issue. In the event of ADA issues, the baseline can serve to determine pre-injury condition or the need for accommodations.

What does this mean to employers?

Obesity is now considered a physical impairment that may affect an employees' ability to perform their jobs and receive special accommodations pursuant to the ADA.

An increasingly unhealthy workforce will pose many challenges for employers in the next few years. Those that can effectively improve the health and well-being of their employee population will have a significant advantage in reducing work comp claim costs, health and welfare benefits and retaining skilled workers.

Recent studies

In a four-year study conducted by Johns Hopkins with an N value of 7,690, 85% of the injured workers studied were classified as obese. In a Duke University study involving 11,728 participants, researchers revealed that employees with a BMI greater than 40 had 11.65 claims per 100 workers, and the average claim costs were $51,010. Employees with a BMI less than 25 had 5.8 claims per 100 workers, with average claim costs of $7,503. This study found that disability costs associated with obesity are seven times higher than for those with a BMI less than 30.

A National Institute of Health study with 42,000 participants found that work-related injuries for employees with a BMI between 25 and 30 had a 15% increase in injuries, and those with a BMI higher than 30 had an increase in work-related injuries of 48%.

The connection between obesity and on the job injuries is clear and extremely costly for employers. Many employers have struggled with justifying the cost of instituting wellness programs just on the basic ROI calculations. They were limiting the potential return on investment solely to the reduction in health insurance costs rather than including the costs on the workers' comp side of the equation and the potential for lost business opportunities because of injury rates that do not meet customer performance expectations. Another key point is that many wellness programs do not include a focus on treating chronic disease that may cause workers to be more likely to be injured and prolong the recovery period.

Customer-driven safety expectations

There are many potential customers (governments, military, energy, construction) who require that their service providers, contractors and business partners meet specific safety performance requirements as measured by OSHA statistics (recordable incident rates) and National Council on Compensation Insurance (NCCI) rating (experience modifiers) and, in some cases, a full review by 3^rd party organizations such as ISNet World.

Working for the best customers often requires that your company's safety record be in the top 25^th percentile to even qualify to bid. To be a world-class company with a world-class safety record requires an integrated approach to accident and injury prevention.

Challenges of an aging workforce

The Bureau of Labor Statistics projects that the labor force will increase by 12.8 million by 2020. The number of workers between ages 16 and 24 will decline 14%, and the number of workers ages 25 to 54 will increase by only 1.9%. The overall share of the labor force for 25- to 54-year-olds will decline from 68% to 65%. The number of workers 55 and older is projected to grow by 28%, or 5.5 times the rate of growth in the overall labor force.

Employers must recognize the challenge that an aging workforce will bring and begin to prepare their workforce for longer careers. A healthy and physically fit 55-year-old worker is more capable and less likely to be injured than a 35-year-old worker who is considered obese.

Treating chronic disease

Employers who want a healthy work force must recognize and treat chronic disease. Many companies have biometric testing programs (health risk assessments) and track healthcare expenditures through their various providers (brokers and insurance carriers).

The results are quite disappointing. On average, only 39% of employees participate in biometric screenings even when they are provided free of charge. For those employees who do participate and who are identified with high biometric risk (blood pressure, glucose, BMI, cholesterol), fewer than 20% treat or even manage these diseases.

This makes these employees much more susceptible to injury and significantly lengthens the disability period. The resulting financial impact on employers can be devastating.

Conclusion

Best-in-class safety results will require a combined approach to reduce injuries and to accommodate new classes of disability such as obesity. It is important that employers focus on improving the health and well-being of their workforce while creating well-developed job descriptions, identifying the essential functions, assessing physical assessments and designing job demands to fall within the declining capabilities of the American workers. It is important for an employer to only accept claims that arise out of the course and scope of employment. This is especially true with the reclassification of obesity as a disease. Baseline testing will play an essential role in separating work-related injuries from pre-existing conditions in this changing environment.

No insurance executive in touch with the marketplace would deny that traditional distribution is no longer a reliable way to deliver dependable sales and enduring customer relationships. The adviser-based model is under threat in most sector categories. Why? There are many reasons, but two at the top of the list are:

1. Customers are changing – the Millennial generation shops and buys differently than their Boomer parents, and even Boomer habits and expectations are changing in the digital world.

2. Technology has disrupted the distribution model, as it has disrupted everything else in its wake – the experiences, access, transparency, ability to compare and socialize at any moment from any location – dislodging practices that were deeply rooted for decades.

As a result, carriers are being forced to recast not only distribution itself, but also the entire ecosystem that enables distribution to do its job:

• Product – must be simpler, understandable to the average person and offering a real benefit worth the price
• Service – must be always available, accurate and helpful
• Channels – must be consistent on all dimensions – as a client, I want to feel I am dealing with the same company wherever I go looking for you, whether online, on the phone or in person
• Underwriting – must use data in ways that are respectful and pass the test of being reasonable in the client’s eyes

Perhaps most of all, insurers must put aside marketing myths and see marketing as more than an optional cost center that puts sponsorships in place, designs product brochures, supports trade show presence and runs advertising campaigns. Marketing done right can become the function that unifies your business around the client, and fuels answers to these critical questions:

• Whom do you really want to have as your customers?
• What are their needs, both emotional and rational?
• What are the ways you can meet those needs?
• And how can you do so better than competition, within a good economic and risk structure?

The insurance industry seems to live by a series of unfortunate beliefs about what marketing is and what it is not. These marketing myths stand in the way of putting the huge potential of this function to work to meet your business goals. To enable marketing to have the impact on your business that it can have, put these myths aside and empower a capable team to help drive growth.

Marketing Myths	Marketing Truths
“Brand” and “advertising” are synonymous.	Brand defines what your company stands for and connects people in ways that help them see you as relevant in their lives … leading to purchase and loyalty. Everything you do is a manifestation of your brand, whether or not you advertise.
Marketing is a cost center.	Marketing is an investment. Marketing is a leader in creating profitable and persistent revenue growth, by helping to identify the right customers, gather their needs and provide direction to the organization on how to fulfill those needs.
Marketing people are creative types, not business people.	Yes, as in every business function, creativity is demanded. But marketing today is a technology-driven function and drives P&L, so a close partnership between internal tech professionals and external providers is a must.
Product builds, distribution sells, marketing supports.	Insurance is an experience business. It’s not just about policy bells and whistles, it’s about the end-to-end experience of engaging with your brand from pre-sale to post-sale to continuing servicing and claims. This means internal silos must be eradicated and collaboration must be a defining attribute of your culture, or your customer will feel the negative effects of self-imposed internal barriers.
Marketing decisions are made on gut.	Marketing is a data-driven discipline, requiring a special mix of talent and skills to get the right data and use it to create customer experiences that will drive business results.

Workers' compensation is a no-fault form of insurance that an employer is legally obligated to secure, providing wage replacement as well as medical, rehabilitation and death (survivor) benefits to employees injured in the course of employment. Workers' comp is in exchange for mandatory relinquishment of the employee's right to sue his or her employer for the tort of negligence. The lack of recourse outside the workers' compensation system is sometimes referred to as "the compensation bargain." This compromise system also establishes limits on the obligations of employers for these workplace exposures, so that the costs are supposedly more predictable and affordable.

The system is always evolving, and there are key choices in workers' comp, which I will cover here -- and update as the system continues to evolve.

First, some background:

Where did workers' comp come from?

Workers' compensation has roots all the way to 2050 B.C., where ancient Sumerian law outlined compensation for injury or impairment involving loss of a worker’s specific body parts. Beginning in the 17^th century, most pirate crews, including the one led by English privateer Capt. Henry Morgan, organized fairly sophisticated and favorable benefits for injured crew members. Injured pirates were treated on board and fitted for prosthetics - as popularized in literature and film. Furthermore, they were compensated in pieces of eight depending upon the type and severity of injury. As for modified duty, crew members were oftentimes offered non-physically demanding work on the ship. Such work could include cleaning cannons, cooking meals and washing the ship decks.

In modern times, workers' comp as we know it today was first modeled in Germany and Prussia in the late 19^th century, then adopted in the U.S. in 1908 by the federal government, then in 1911 by Wisconsin. Workers' comp spread to all states and the District of Columbia by 1948, with Mississippi as the last state to adopt the model.

Why is workers' comp coverage mandated?

At first, participation in U.S. workers' compensation programs was voluntary. In 1917, however, after the Supreme Court upheld the constitutionality of compulsory workers' comp laws, the majority of states then passed legislation that required employers to purchase workers' compensation coverage for their employees. Requirements varied -- and still vary -- from state to state. Currently, Texas and Oklahoma have voluntary "opt-out" or "non-subscription" provisions, which allow employers to provide their own formal injury benefit plan options.

How is workers' comp different from other insurance?

Workers' comp is intended to eliminate tort liability litigation arising from employee injuries or work-related diseases by providing wage replacement, vocational rehabilitation and medical benefits to employee injured in the course and scope of their employment. This is intended to minimize worker conflicts and to avoid costly lawsuits. The standard workers' compensation insurance policy is a unique insurance contract in many respects. Unlike other liability insurance policies, it doesn't have a dollar amount limit to its primary coverage. The coverage is considered "exclusive remedy," to deny employees the opportunity to sue their employee. In general, an employee with a work-related illness or injury can get workers' compensation benefits regardless of who was at fault -- the employee, the employer, a coworker, a customer or some other third party.

Why does a workers' comp policy have two parts?

Part One is the standard workers' compensation insurance policy (formerly known as Coverage A) that transfers liability for statutory workers' compensation benefits of an employer to the insurance company. If a state increases benefit levels during the term of the policy, the employer doesn't have to make any adjustments to the policy. Instead, the policy automatically makes it the responsibility of the insurance company to pay all claims due for workers' compensation insurance for the named employer in the particular states covered by the policy.

Part Two (formerly known as Coverage B) addresses employers' liability coverage. This coverage protects the employer against lawsuits brought by the injured employee or the survivor. If an employer is thought to be grossly negligent, the employer runs the risk of being sued for that negligence. Under Part Two of the workers' comp policy, the employer would be defended in such a suit. If a judgment were rendered against the employer, that judgment would be paid by the workers' comp coverage, but no more than the limits provide for in the policy. Part Two also insures an employer in cases such as third-party "over suits," where an injured worker sues a third party and that third party seeks to hold the employer responsible.

How states differ

Examine your company's possible exposures to workers' compensation claims from different states. If you have employees who live and work in or who travel to other states, you need to make sure you are properly covered in each state. In most jurisdictions, employers can meet their workers' compensation obligations by purchasing an insurance policy.

Five states and two U.S. territories (North Dakota, Ohio, Puerto Rico, the U.S. Virgin Islands, Washington, West Virginia and Wyoming) require employers to get coverage exclusively through state-operated ("monopolistic") funds. If you're an employer doing business in any of these jurisdictions, you need to obtain coverage from the specified government-run fund unless you’re legally self-insured. A business cannot meet its workers' compensation obligations in these jurisdictions with private insurance.

Thirteen other states also maintain a state compensation insurance fund, but their state funds compete with private insurance. In these states, an employer has the option (at least theoretically) to use either the state fund or private insurance. Those states that offer employers this option are Arizona, California, Colorado, Idaho, Maryland, Michigan, Minnesota, Montana, New York, Oklahoma, Oregon, Pennsylvania and Utah.

FORMS OF FINANCING WORKERS' COMP

1. Fully Insured

There are more than 300 workers' comp insurers writing policies in the U.S., although many will only provide coverage with a high deductible. Most states have a State Fund Insurance Carrier that is the insurer of last resort and provides fully insured (no deductible) workers' comp coverage to entities operating in their state. State fund programs are also referred to as the residual markets. They are more commonly known as state insurance funds, assigned risk plans or workers' compensation pool policies. Generally speaking, state insurance funds are non-profit entities that cost more than private companies (10% to 40% higher premiums) but that guarantee availability of coverage as a "last resort" carrier.

Some common reasons that employers fail to obtain competitive quotes from private carriers include: 1) a high frequency of claims or a high cost of claims; (2) the dangerous nature of the risk or industry (based on codes from the National Council on Compensation Insurance, or NCCI); 3) prior bankruptcies or poor financial status of the business; and 4) prior cancellations because of nonpayment of workers' compensation premiums.

2. Group or Association Coverage Plans

In various states, there are options for small to medium-sized companies to obtain group coverage through their industry associations. These options include Self-Insured Groups (SIGs), which provide a true self-insured option. Group members make contributions to the self-insured group, and the self-insured group pays expenses and claims for injured workers.

SIGs directly contract for services normally performed by an insurance company. Services secured on behalf of members include: elected Board of trustees, program administration, safety and loss-control services, third-party administration (TPA), independent accountants and actuaries and excess insurance carrier.

Companies must apply for membership and generally indicate adherence to effective risk management and loss control programs.

3. Large-Deductible Plans

This is a form of self-insurance where the employer is responsible for reimbursing the insurer for claims up to a certain dollar amount and the insurer is responsible for paying claims in excess of that deductible. The insured funds an account (loss fund) to pay losses, and the insured reimburses the fund as losses are paid. The insured must collateralize, usually by letter of credit, an amount approximately equal to the difference between paid and ultimate losses. The actuary is typically one assigned by the carrier.

With the advent of the high-deductible program in the early ‘9Os, actuarial efforts focused principally on pricing issues. Employers are able to save significant premium expenses if they manage their loss-control and return-to-work programs effectively. The "deductible" is a sum that is subtracted from the insurer’s indemnity or defense obligation under the policy. Importantly, the responsibility for the defense and settlement of each claim rests almost entirely with the insurer, and the insurer typically maintains control over the entire claim process.

Large-deductible programs were slow to find favor in the U.S. In 1990, only six states approved of such deductibles. Currently, at least 45 states utilize large-deductible programs for workers’ compensation.

Deductibles are based on a per claim or per occurrence basis, with self-insured retentions of $100,000 to $1 million. The insurer sets the minimum deductible allowed. Insurers initially developed this program to provide both themselves and insureds certain advantages, including:

• price flexibility, by passing risk back to the insured
• reduced residual market charges and premium taxes in some states
• better cash flow
• coverage options for aggregate limits
• broadest choice of insurance carriers
• the possibility that a separate TPA may be allowed as an option to the carrier
• that certificates of insurance issued to the employer’s key business partners show full coverage and policy limits

With a well-designed and -managed, loss-sensitive product, companies can potentially lower costs by assuming a greater proportion of their risk. You get increased cash flow and lower costs and improve claims outcomes for the business and its employees. What’s important with a loss-sensitive program is that the organization is committed to fully leveraging the insurer’s loss control, claims, medical and pharmacy management programs.

Additionally, it is critical to choose the right risk-financing structure. That involves having the business itself, you, the agent and the carrier carefully examining the organization’s current financial situation and short- and long-term goals.

Because the carrier is legally responsible for the employer’s claims, the carrier will require collateralization of existing and future claims covered by the policy period. Collateral is usually a letter of credit, surety bond or cash.

Keep in mind, however, that choosing a high retention is all about the frequency and severity of your workers' comp claims as well as the responsiveness and quality of your claims administrator. In essence, the employer is giving the insurance company an open checkbook with respect to the handling and disposition of claims.

4. Retrospective (Deferred) Premium Options

Retro programs are written through an endorsement on your large-deductible workers' comp policy. It is the ultimate amount of money you will owe your carrier for the contract period. It can be broken down into installment payments. It consists of basic premium and converted losses, both of which get adjusted by the tax multiplier, which are the taxes and assessments due to the state. The insurer provides you a written agreement that defines the terms of your contract. It will show the basic and maximum and minimum premium, how the premium will be paid during the policy year, how the retrospective premium will be calculated and, most importantly, when you will be eligible for a premium refund. The agreement also defines any penalties associated with a midterm cancellation of the contract.

The two major retro payment plan options:

A.   Incurred Loss Retro:

You’ll pay the same up front as with a guaranteed-cost program, but you’ll be refunded money if your loss experience is favorable. The risk, however, is having to pay additional premium if your loss experience is unfavorable. The cost of the insurance program is determined by the actual incurred loss experience for a specific policy period. Incurred costs include paid costs as well as future expected costs (reserves). The premium is adjusted annually until all claims are paid and closed.

B.     Paid Loss Retro:

Premiums are determined using paid only loss amounts rather than incurred (reserved amounts). Timing of premium and loss payments are negotiated before inception, and disbursements are made as costs are realized and billed. Because this option is typically the favorite of insureds, this option is typically only offered to large entities paying in excess of $1 million in premium.

How is the basic premium determined?

Basic premium is basically the insurer’s cost of doing business plus expected profitability. The amount is determined by multiplying the standard premium by a percentage called the basic premium factor. This factor varies based on your actual premium size and the amount of risk you are assuming. In general, if you take on more risk for your claims, the amount you will pay for the basic premium decreases.

What are converted losses?

 Converted losses are the total claims, also called incurred losses, adjusted by the tax multiplier (see below) and multiplied by the loss conversion factor (LCF), which is negotiated with you prior to the inception of the coverage. As the loss conversion factor increases, you assume more risk, so the basic premium decreases.

What is the tax multiplier?

This is a factor that is applied to the basic premium and converted losses to cover state taxes and assessments that must be paid by your insurance carrier.

What is the maximum premium?

Maximum premium is the most you will have to pay under a retro plan. It helps protect you by placing a limit on the impact of any substantial losses you could have. It can range from 100% up to 150% of audited standard premium. For example, if the audited standard premium was $100,000, and you selected a 125% max, the most you could pay for the total of all retro charges under the specific contract period is $125,000.

When will my money be returned if losses are low?

After completing the full contract period, the first adjustment for a possible refund is usually calculated six months after the policy expiration date. The premium is adjusted according to the retro formula, using the basic premium, converted incurred losses and taxes. If your claim losses are better than expected, you will get as much as 50% of the total estimated refund. Another adjustment is usually made in 12 months, with as much as 25% of the total estimated refund. The final adjustment is at least 12 months after that, with the final 25%. If, however, you have complex indemnity (lost-time) claims that are unresolved, the adjustments may drag out for years.

5. Captive Insurance

A captive insurance company is an insurance company formed by a business owner to insure the risks of related or affiliated businesses. A captive permits a business to manage its risks while potentially providing substantial benefits to that related business. More than 75% of the Fortune 500 now utilize some form of captive insurance, but captives are usually not a viable alternative for most small to medium-sized companies.

Is a captive still a viable alternative?

The number of captive insurance entities is growing worldwide. Today, nearly 10,000 businesses in the world employ some form of captive insurance coverage. Those totals are expected to triple over the next 10 years as more companies further examine comprehensive and well-targeted risk-management plans. More than 5,750 large companies have their wholly owned captive insurance entities that were formed to insure the risks of the parent company and its subsidiaries.

What risks does a captive typically underwrite?

Captives are formed in 30 domestic locations (state) or in foreign ("off-shore") domiciles like Bermuda and the Cayman Islands. Vermont is the most popular state. Each domicile has its own set of laws and regulations. To be successful, captives usually cover disparate types of risk, with a good geographical or industry spread. Captives are intended to build financial strength over time and help insulate the parent company from price fluctuations in the traditional insurance market. Increasingly, captives' owners are also looking to their captive to provide broader coverage, including unusual or emerging risks, where risk transfer is either expensive or unavailable.

The type of risks that captives cover is expanding rapidly, from the more common property damage and casualty coverage, to employee benefits, environmental, cyber, business interruption and other non-traditional covers like operational risk and supply chain. Captives typically provide large companies an opportunity to insure against risks that are generally uninsurable or exotic.

Are there different types of captives?

There are at least 10 types of legal insurance captives, including:

• Pure captives (single parent)
• Industry group captives
• Agency captives
• Association captives
• Risk-retention groups (RRGs)
• Rent-a-Captives
• Segregated and protected cell captives
• Special-purpose reinsurance captives
• Series LLC captives
• Internal Revenue Code 831b captives.

How is workers' comp coverage provided in each state?

A commercial insurance company ("fronting company"), licensed in the state where a risk to be insured is located, issues its policy to the insured. That risk is then fully transferred from the fronting company back to the captive insurance company through a reinsurance agreement, known as a fronting agreement. Thus, the insured obtains a policy issued on the paper of the commercial insurance company.

The cost varies for a fronting carrier, which legally assumes the workers' comp risk it fronts, in the event of default by the captive. The fronting company will almost always require collateral to secure the captive's obligations to the fronting company under the fronting agreement, in addition to a 4% to 10% fee.

Is there a tax advantage to using captives?

While the tax advantages from captive arrangements should never be at the top of any company’s list, captives can offer accelerated premium deductions, unlike most self-insurance programs. However, if the IRS believes that a captive has been established purely for tax purposes, the agency may challenge the captive status of the company. Comprehensive documentation of the objectives of the captive structure is important.

6. Self- Insurance

A self-insured workers' comp program is one where the employer sets aside an amount to provide for any workers' comp claims and associated expenses—losses that could ordinarily be covered under an insurance program. Self-insurance is a means of capturing the cash flow benefits of unpaid loss reserves and offers the possibility of reducing expenses typically incorporated within a traditional insurance program. It involves a formal decision to retain risk rather than transfer (insure) and allows the employer to pay workers' comp associated expenses as incurred.

A self-insured workers' comp plan is one in which the employer has legal approval from the one or more states to assume the financial risk for providing workers' comp benefits to its employees. In practical terms, self-insured employers pay the cost of each claim "out of pocket" as necessary. The employer maintains its ability to settle or adjudicate each claim within its self-insured retention – assuming it has excess insurance.

Importantly, key decisions, including which vendors to use to treat injured workers and to administer claims, remain with the employer and not an insurer.

How many employers currently operate a self-insured workers' comp program?  It is estimated that more than 6,000 corporations and their subsidiaries nationwide operate self-insured workers' comp programs. Many other smaller employers participate in Self-Insured Groups (SIGs), where they pool their risks with other companies.

How large do you have to be to self-insure?

Each state sets its own minimum standards for eligibility. For example, in California, you only need to have at least $5 million in shareholder equity and a net profit of $500,000 per year for the last five years. Eligibility is not based on the number of claims.

Keep in mind that each state is a distinct entity, so a company might be self-insured in one state where it has a high concentration of employees and have a large-deductible policy in another state with fewer employees.

Does the state require collateralization?

Every state, except California and North Carolina, has mandatory minimum security deposits that consist of: letters of credit, surety bonds, securities or cash. In many states, the amount posted by the self-insured is less that that required by an insurer or captive.

Can self-insured employers protect themselves against unpredicted or catastrophic claims?

Most states, except California, require self-insureds to purchase statutory (no limit) excess insurance from a state-licensed workers' comp insurer. Where available, a negotiated, aggregate stop-loss ("attachment point") endorsement protects an employer to a specific policy period dollar cap regardless of the per-claim self-insured retention or number of claims incurred.

Is self-insurance typically only used by large entities?

No. Employers of all sizes typically choose to self-insure because it gives them the greatest opportunity of any workers' comp funding alternative to manage their own destiny. A self-insured can control its costs by choosing and managing various program vendors and by implementing a wide variety of loss-prevention and return-to-work programs that serve to greatly reduce workers' comp claims. Self-insureds choose program components that they feel are the most cost-effective and responsive.

Who administers claims for self-insured workers' compensation programs?

Self-insured employers can either administer the claims in-house (if allowed by the state) or subcontract to a TPA. Other medical treatment or claim-related services can be "unbundled," or obtained through TPA contractual services.

7. Opting Out of Workers Comp

The opt-out concept is appealing to those who believe that statutory workers' comp systems are hopelessly complicated, burdensome to both employers and their injured employees and out of touch. Privatized opt-out programs are intended to better integrate into the matrix of existing employee health plans and benefits.

Just two states have laws that allow employers to opt out of the state-regulated system: Texas and Oklahoma.  Texas has always had this law, with 114,000 employers (about 1/3 of the total employers) choosing to forgo workers' comp coverage. Oklahoma recently adopted a variation where employers can choose an alternative to workers' comp coverage.

Practically speaking, "Opt-Out" ("non-subscription") gives employers enormous discretion to decide under what circumstances to compensate an injured worker under the employer’s own benefit plan. To protect the employer from most negligence lawsuits, as a condition of employment the employer can force the employee to sign a contract so all cases are resolved through an employer-designed, secret arbitration system rather than in court.

One crucial aspect is the adoption of federal standards under the Employee Retirement Income Security Act of 1974 (ERISA) for administering work-injury benefits. A state insurance or self-insured guarantee fund would not back up an opt-out employer that defaults.

With continuing legal challenges to workers' compensation, including recent lawsuits against Uber and Lyft seeking court approval to mandate workers' compensation benefits for "app assigned" work, traditional workers' comp may give way to modern versions of the opt-out programs. The goal would be to create a more seamless benefit program that participants hope will take out the litigation components that have haunted the "no-fault compensation bargain" that began just more than 100 years ago.

As an engineer (at least that's what my university degree says), I must say I like to solve problems. Big, ugly, complex problems can a great challenge.

We all know what has been happening with insurers' core systems over the past several years. To respond to the challenging needs for product agility, customer-centricity and operational effectiveness, insurance companies are moving toward new core systems and away from the constraints of their legacy systems. And there are oodles of problems to be solved. Product modeling and patterns, configurability and customization options, integration and connectivity, external data sources, testing automation…it's a tasty list, my friend.

And yet…and yet.

Even if these complex problems are nicely solved, many insurance companies fail to achieve the anticipated returns with their new core systems.

Over the past years of these types of projects, when we at Wipfli analyze the root causes, we find that the following risks have not been properly managed or mitigated:

1. Expectation risk – Are we all looking for the same things? 2. Acceptance risk – What could prevent us from leveraging this investment? 3. Alignment risk – What could prevent us from achieving the value we expect? 4. Execution risk – Are we getting things done effectively and efficiently? 5. Solution risk – Will this solution deliver on its potential? 6. Resource risk – Have we accounted for the total investment required for success?

What's most enlightening about these risks is that five of them are about people and not technology. Only solution risk encompasses technology. As the engineer once said, "This project would have been a roaring success except for the people!" Don’t be that guy….

The desired future state following an implementation is only achieved when individual contributors do their jobs differently.

So, yes, systems projects are about the people.

Many C-suite insurance executives complain about how difficult it is to find leaders in their organization. Many people believe leadership can't be taught. "You know it when you see it" is a common observation. Finding a consistent definition for leadership is difficult. How do you develop/teach/articulate a core set of traits of great leaders if it is so difficult to even define leadership? After leading various organizations ranging in size from several people to several thousand, I realize that there are fundamental core requirements needed to be an effective leader. Whether you are an entry-level employee or the chief executive of a large organization, you need these characteristics to lead. Leadership doesn't come from your title. It comes from how you act. People follow leaders; they don't follow titles. As technology allows companies to be leaner, and as Millennials become a bigger part of the work force, we live in a less hierarchical and more collaborative work environment. Leadership no longer comes with a title. Today, companies need leaders at every level. You don't need to be outgoing or have the loudest voice in the room. People with low-key personalities can also be outstanding leaders. Personal leadership is not about self-promotion; leadership is the ability to get others to follow what you are advocating. To trust you. To respect you. To feel that your direction and requests are in everyone's best interests, not just your own. So what are the traits of great leaders? Here are five core personal leadership competencies that anyone must practice to be an effective leader. 1.         Integrity: Make sure you do the right thing for all the right reasons. In any leadership role, you will be called on to make difficult decisions. If you act with integrity, you will be respected. People might disagree with your decision, but they will accept your direction. One of my mentors told me, "People can spot someone who takes moral shortcuts." Never forget: A reputation lost is a career destroyed. 2.         Courage: All leaders have courage. The courage to ask why. To challenge the status quo. To go out on a limb. To do what others are afraid to say and do. Many years ago, when  eight bottles of Tylenol were found to have been tampered with, leading to seven deaths from cyanide poisoning in the Chicago area, the CEO of Johnson & Johnson, which produced Tylenol, immediately directed that all bottles of the pain reliever be removed from every shelf in every store. He vowed that Tylenol wouldn't be back on store shelves until the company knew that every bottle was safe. It was a bold move with a large negative impact on the company’s short-term sales. But when Tylenol did return to the counters and shelves, so did their customers. 3.         Lead by example: Don't ask anyone to do something you wouldn't do yourself. If you are asking others to stay late, you had better, too. When I ran a new business unit, our initial office space couldn't accommodate an office for everyone. So I sat down with my senior team, and we defined objective criteria for an office. I didn't qualify, and, much to everyone's surprise, I sat in a cubicle alongside the other employees. It made a statement -- I play by the same rules as everyone else. Likewise, any rule or policy we adopt, I make sure I also abide by. You can't act one way and expect others to act differently. You have to be a role model. 4.         Be a great listener: You can't understand what's going on around you unless you listen to others. Listening is how you learn. Listening is how you gain perspective. Listening is how you understand what's important and what's not. Listening is how you discover opportunities. A good listener sends a strong message to others: “I respect and care about what you say. I'm not a tyrant.” Throughout my career, the best ideas always came from people closest to the core operations I was looking to improve. You can't find those answers unless you ask a lot of questions and listen carefully to the answers. 5.         Be a great communicator: Leaders learn to master the form and substance of communication. Let's start with the form of communication: the way you communicate. You can't lead unless people understand you. Language, tone, facial and other physical expressions all send messages that affect what you are saying. (This also applies to listening. If you look away while people are talking they know you are not listening.) Here are a few tips to master good communication form:

• Keep your message clear and concise. We live in a world of short attention spans. People get drawn away quickly. Spend time thinking about what you want to say and how best to communicate it quickly. I like to pretend I only have 30 to 60 seconds to talk. That forces me to get right to the point.
• Use examples. They reinforce your points by tying them to real life instead of dry theories.
• Think like a teacher. Great communicators understand that, when they are speaking to someone or to a group, they are in effect teaching others what they want them to understand.

Mastering the substance of communication means the ability to move people to react to what you are saying in the way you want. In other words, you want your words to motivate, educate and inspire.  By motivate, I mean the ability to get people to want to do something as a result of what you say. Your words ignite your listener to want to react in the way you desire. Educate means you explain why you are asking them to do something. People will follow direction -- but only grudgingly if they don't understand why they are being asked to do something. Good leaders know how to get people to understand why they should take a specific action. Inspire means the ability to touch someone with your words. Engender a positive emotion that enables them to do something they otherwise might not have done.   Inspirational leaders provide the fuel to allow others to find success. Today's ever-changing work environment is creating opportunities for people at all levels of an organization to lead. Those who master the personal leadership competencies that I've described will enrich their work experience and create wonderful opportunities for themselves and others. Enjoy the journey.

Your clients and prospects are inundated with information online to help them solve their problems. Some of the information is genuinely educational; most of it, though, is self-promotional or generic. How do you stand out and get noticed as the one they should turn to for help? One way to break through the clutter is to focus on thought leadership.

What is a thought leader, and why do you want to be one? There are lots of definitions, but I like this one from Forbes:

"A thought leader is an individual or firm that prospects, clients, referral sources, intermediaries and even competitors recognize as one of the foremost authorities in selected areas of specialization, resulting in its being the go-to individual or organization for said expertise … [and thereby] significantly profit[ing] from being recognized as such. "

As the go-to expert, you’re likely to profit in many ways. Regardless of whether it directly brings in new business, thought leadership helps to differentiate you from competitors, expand your reach and build relationships and trust with your audience. You’re also educating people and promoting deeper and more informative discussions, which is a public service.

That all sounds great, but how can you be a thought leader?

1. Understand your sweet spot. In his book, Epic Content Marketing, Joe Pulizzi defines the sweet spot as “the intersection between your customers’ pain points and where you have the most authority with your stories.” Take the time to really research your audience’s needs and concerns. Then consider what expertise and insights you can offer to help them. Don’t spend time talking about areas where you are not well-informed and don’t have much value to add. Focus on what you know best that can assist your clients.

2. Differentiate your message. Your strongest competitors will be trying to do the same thing you are doing – providing valuable content. Know what they are saying and doing and look for ways to be even better or different. For example, focus on a narrow niche, survey the industry and share research, have an opinion, identify trends and provide insights. Give specific and actionable strategies taking into account whatever new developments are occurring. The point is to go beyond sending out a typical client alert that sounds just like the ones from every other firm. The Forbes article provides a great example, but we’ve all seen examples of thought leadership. We know who is going above and beyond.

3. Have a strategy and goals and align the two. Being a thought leader is a lot of work, and you want to be clear about what you’re doing, why you’re doing it and what you hope to get out of it. Seems pretty obvious, but the reality is that too many firms start down a path without thinking it through. For example, you have an attorney who happens to be a prolific writer and speaker in a specific area of the law. The problem is that area is not very profitable or high-priority for the law firm. How much effort do you want to put behind promoting expertise that isn’t a good fit for the firm? Or maybe the thought leadership is great and would be good for the firm, but it’s not being seen by the right niche audiences. Sometimes, firms focus on getting the content piece right but spend less time making sure the promotion and distribution is getting to their target market. You need to bring both parts together in a strategic way; otherwise, how are you going to profit from being a thought leader?

4. Write, speak and share information consistently. You can’t be a thought leader if you don’t put your thoughts out there. Write articles, blog posts, whitepapers and books. Curate and comment on other people’s content. Speak at online and live events. Create video. Use social media. You don’t have to do them all, but put out content in different formats to maximize your reach and appeal to different audiences. And do this regularly. Thought leadership is a long-term strategy. People have to hear from you on a consistent basis. An occasional article or speech isn’t enough, even if it’s really great. Of course, there are lots of ways to repackage that great content to get more life out of it, but make sure you’re doing that. You must be visible on a regular basis.

5. Cultivate relationships with other experts, influencers, industry professionals and media. As you develop your thought leadership, reach out to other authorities. Gather and share their insights with your audience, make introductions and give referrals and offer to help them with their content. By assisting others, you’re getting your name out to key contacts in your field and developing deeper relationships, and it’s likely at least some people will reciprocate by helping you. It will also make your thought leadership better-informed because you’re incorporating insights from others.

Becoming a thought leader is a long-term commitment and a lot of work. However, successful firms know the investment is worth it, to not only survive but thrive against the competition.