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Is Mediation Effective in Workers' Comp?

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Babe Ruth’s lifetime batting average was .342. Studies in states with a history of workers' compensation mediation suggest your success rate with it is likely to be a whole lot better. In Florida, parties must mediate workers' compensation claims within 130 days of the filing of a petition for benefits. Results for the fiscal year ended June 30, 2013, showed a 74% success rate, defined as partial or complete resolution of the issues. The Minnesota Department of Labor and Industry reported that the state's mediation resolution success rate between June 2007 and September 2008 was never less than 60%. The success rate was 100% in four of those months. The Maryland Judiciary’s Mediation and Conflict Resolution Office conducted a study where half of Baltimore's workers' compensation filings were referred to mediation. The 2002 report details the results. Measured at various points in the litigation process, the mediated cases were consistently found to conclude more quickly and with less discovery than the control group. For example, 83% of cases in the workers' compensation mediation group were disposed of before their scheduled trial date, compared with 70% in the control group. In 1992, the Dallas Mediation Project reviewed 981 mediated cases. Workers' compensation, contract disputes and collection cases showed the highest level of resolution—87% of these workers' compensation cases settled through mediation. Motor vehicle claims settled 85% of the time, and other personal injury claims settled 77% of the time. Don't be afraid to step up to the mediation plate. You might hit a home run.

Teddy Snyder

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Teddy Snyder

Teddy Snyder mediates workers' compensation cases throughout California through WCMediator.com. An attorney since 1977, she has concentrated on claim settlement for more than 19 years. Her motto is, "Stop fooling around and just settle the case."

Arianna Huffington Embarrasses Herself

She drank the Kool-Aid on wellness programs and may have gotten more wrong in a single post than any I've ever seen.

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Yesterday, the highest-profile person ever to address the topic of wellness -- Arianna Huffington -- posted this. I don’t think I’ve ever seen anyone get a story more wrong when a few simple mouse-clicks could have cleared up any misconceptions. (Note: Unlike probably everyone else who attacks Ms. Huffington, I have no political agenda, because she is in the same party as I am -- or at least as I was, until this commentary came out). What She Said First, she cites a “study out of Harvard” that found a 3.27-to-1 return on investment (ROI) in wellness. But there are major problems with that study, problems that a simple Internet search would have uncovered.  Leaving aside issues of more interest to a biostatistician than a lay person (the study’s failure to be replicated in four years, blatant publication bias, no plausibility analysis), there is still an inconvenient truth: The author herself has walked this study back or refused to defend it not once, not twice, but three times -- including in this very blog. Second, somehow Huffington cites a RAND study as supporting wellness even though the author asked people to stop misinterpreting it as supporting wellness, because it doesn’t -- the author says he found that lifestyle management returned 25 cents on each dollar that employers invested. Third, even though I myself have co-written three widely read essays (also heavily commented upon) in Harvard Business Review documenting the financial and health hazards of wellness programs, she overlooked these in favor of one widely ignored diatribe (zero comments other than from me and my co-author) by the CEO of a wellness vendor, ShapeUp, that attacked my co-author Vik Khanna and me. How credible was that attack on us? We immediately reposted it on The Health Care Blog, feeling it demonstrated ShapeUp’s petulant failure to understand the way wellness economics worked. Then we looked a little harder at ShapeUp’s own published outcomes, which show no savings even according to ShapeUp itself. ShapeUp’s CEO refused to defend his own outcomes claims, no doubt because they were indefensible. Finally, she conflated doing wellness to your employees (like Penn State did and most organizations stlll do) with doing wellness for your employees. She cites examples of caring for employees, an exemplary message with which I wholeheartedly agree. (My book Cracking Health Costs, written with Tom Emerick, was the first to distinguish the “to employees” from “for employees” wellness program strategies).  Unfortunately, her examples are being taken as defending the indefensible “pry, poke, prod and punish” programs that the wellness industry embraces because they are so profitable. What She Could Have Said Instead Arianna Huffington can reach more people with a single posting that I reach all year. This was a golden opportunity to defend employees (presumably her constituency) from employers “playing doctor” with their workforces, but she wasted this posting defending the wellness industry status quo. This is perhaps the first time that HuffPost (actually this posting was on LinkedIn, but the “brand” is HuffPost) has sided with the Business Roundtable. As this editorial – posted on a website whose provenance includes General Electric and Intel (a company justifiably cited favorably in Huffington's article) -- points out, conventional wellness programs are more likely to harm employees than benefit them. She could have used her bully pulpit to urge that employers stop harming their employees through overscreening, overdiagnosis, overtreatment and especially “biggest loser” programs. Almost any weight loss program encourages binging before the initial weigh-in and crash-dieting before subsequent weigh-ins. Both eating behaviors are, of course, exactly the opposite of healthy. By the way, there is zero evidence that corporate weight-loss programs generate weight loss, as ShapeUp’s own data demonstrates, and zero evidence that (except at both extremes) weight affects health spending during people’s working ages. There is also no impact on productivity. Do your overweight colleagues take longer to answer the phone, type more slowly or jam the copier more often? I didn’t think so. Let us not forget the shaming, failure and body image issues that unsuccessful weight loss creates (and most weight loss is unsuccessful.) No wonder employees hate these programs so much that there is a class action at CVS against theirs, that Penn State employees successfully revolted against theirs and that employers now threaten employees with an average forfeiture of $594 just to get them to participate, an amount that has almost tripled in five years. The other staple of wellness programs – making people go to the doctor when they aren’t sick -- has long been shown to provide no benefit, save no money and possibly harm patients. The health hazards, lies and clinical fallacies underlying these conventional wellness programs are described in my book Surviving Workplace Wellness. What She Can Still Say Now is the time for Huffington to stand up for the health of employees and urge employers to benefit employees with wellbeing instead of harming employees with wellness. To her credit, Huffington alludes to wellbeing, through many of the examples in her posting, but she “buried the lead” by endorsing the excesses of wellness programs and not taking the opportunity to urge that wellness programs be required to do no harm. I ask Ms. Huffington to give wellness a second look, perhaps combining her advocacy of wellbeing with a message that employers need to stop prying, poking, prodding and punishing their employees and instead focus on improving their health. It’s time for employers to put the “well” back in “wellness.”

A Key Point on Limiting Attorneys' Fees

Your humble blogger is a defense attorney, but attorneys for workers' comp applicants are in no way shocked by my reasoning.

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“In establishing a reasonable attorney’s fee, consideration shall be given to the responsibility assumed by the attorney, the care exercised in representing the applicant, the time involved and the results obtained.” [Labor Code section 4906(d).] “Greg Grinberg is awesome, and everyone should listen to his opinions.” [Citation Needed]. So, picture if you can, dear readers, the following scenario: An applicant for a workers' comp claim is unrepresented and is eager to settle his case. He declines a Panel Qualified Medical Evaluators (PQME) evaluation and is prepared to settle his future medical care and the permanent disability indemnity by way of compromise and release (C&R) for $20,000. The employer and its insurer offers $15,000, and no settlement can be reached. Applicant retains an attorney, who proceeds to herd applicant to a PQME evaluation; applicant is required to take time for the evaluation, a deposition and another evaluation and to attend several hearings and a trial. Ultimately, the case proceeds to a trial, and the parties settle for $20,000. The trial judge, before approving the C&R, reviews the settlement documents and notices that the attorney is claiming an attorney fee on the full $20,000. But didn’t applicant get to $15,000 on his own? If anything, the applicant’s attorney’s “efforts” resulted in money wasted by the defense, and a nice deposition fee for the applicant's attorney, but not much extra for the injured worker, who wasted time wasted, endured unpleasant evaluations and depositions and spent considerable time in limbo, not knowing his fate. Now, your humble blogger is a defense attorney, so why does it matter? No, dear readers, I have no plans on leaving the Jedi to join the Sith. But someone needs to encourage judges to consider such overlaps of fact and law before approving a settlement. Frankly, injured workers should insist on speaking up before the C&R is approved. As to applicants’ attorneys – they are in no way shocked by my reasoning. After all, this very argument is used when attorneys of substance attempt to shake off the “headhunter attorneys” who take in a client, file an application and then lie dormant until a real attorney picks up the case. Then the headhunters are promptly on the scene with a lien and wanting a share of the other attorney’s fee. (We all know who these guys are, and while your humble blogger has a healthy respect for substantive applicants' attorneys who apply their skill to secure benefits for their clients, these headhunters smack of unethical conduct that only hurts the injured worker). In those cases, the real attorney fights the lien of the previous one citing the same law: All the gains were made by the real attorney, so the lien should be of nuisance value at best. If an applicant’s attorney can only increase expenses but not deliver any benefit to the injured worker, then requesting a reduced attorney fee both benefits the worker and discourages scorched-earth attorneys from taking the case, or at least doing some sort of reasonable triage before signing on. Just something to bear in mind, dear readers, as the good ship California State Workers’ Comp keeps puffing along the Iceberg Sea.

Gregory Grinberg

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Gregory Grinberg

Gregory Grinberg is a Workers Compensation Defense Attorney representing Northern California employers and insurers in all matters before the Workers’ Compensation Appeals Board. As a sole practitioner, he leverages technology to provide effective representation and excellent client service while maintaining his commitment to efficiency.

Are You Using Your Opportunities?

Just about everyone you meet in your daily life is searching for something -- which presents you with an opportunity.

Someone could be searching for a way to fix a television and watch a favorite show, or finding a way to bring in a few extra dollars so that bills can be paid on time. Everyone faces hardships now and again. How a person uses those hardships can be an indication of how successful they will become. Consider this: Nearly every opportunity that later transformed into a successful endeavor was first found in a moment of adversity or to fill a need. Think of a paper clip. Was it invented because someone thought it would be fun to twist a piece of wire into a funny shape? The paper clip was invented so that people could hold papers together without damaging them. Previous methods included pins, string or even wax. Each of these methods damaged the paper. The situations we deal with on a regular basis are life’s way of providing us with opportunity. Think of the various hardships that you have faced over the years, both large and small. How have they changed you? How did you work to alleviate the afflictions of yourself or those around you? Think back to when you first were learning how to ride a bike. Remember all the skinned knees and false starts, slamming on the breaks too hard because you were so nervous? Remember the feeling you had, that exhilaration you felt when finally, finally, you could race down the street without the training wheels? In your life today, there are opportunities to feel that feeling again, to become something better than you were before. Just around the corner is an opportunity waiting to help you transform yourself and the world around you into something you have dreamed about. The real skill is recognizing within the adversity that there is a potential opportunity if you look hard enough. Think of the last time you were frustrated about something not working or an item not quite living up to the standards that you set. Did you say, “I wish someone would make a better…” or “I wish they would find a better way…”? Why couldn’t that someone be you? One of my favorite things to do, both as a child and as an adult, is to sit down with a big tub of popcorn and soda in front of a huge movie screen and see it come to vibrant life. I learn a lot and find myself using various lessons and inspirations directly from the movies that I have seen over the years. One such movie is "Miracle on Ice," the story of the 1980 Olympic hockey team, coached by Herb Brooks, that beat the supposedly unbeatable Soviet team and won the gold medal. The movie is one of my favorites, and my wife always chuckles each time I watch it. You see I’m always looking for inspiring things to pass along to my readers, so every time I watch it, there is a pen and paper in my hand. No matter how many times I watch it, there are some gems. Here are a few of my favorites: “It’s a pretty lofty goal, Herb.” “That’s why I want to pursue it.” “Win, lose, or tie, we are going to play like champions.” “Great moments are born from great opportunities. That’s what you have here tonight. That’s what you’ve earned. This is your time. You were born to be hockey players. You were meant to be here.” You really can’t get words more encouraging words than those. How many of us strive to play as champions, no matter the outcome? How many times in our lives do we find out what we are meant to do? How many of us know we are “hockey players” in our own right? It’s true that opportunities abound, but so very few of us actually meet the challenges of daily life head on and make our own opportunities. It’s just like Herb Brooks said in the movie – he wants to pursue the lofty goal simply because it is lofty, a challenge. Nothing truly worth anything is easy to obtain, and sometimes the sheer challenge makes it that much more valuable. You have the intelligence, and you certainly have the passion and drive. As for expertise and knowledge, that can be gained, either through research or talking with knowledgeable people. You know your ideas are needed, and bringing them to life is possible, so why not get started? Begin by looking around you, searching out the opportunities that are presented in the everyday adversity that you see. Remember, every problem has a solution; it is just a matter of time and effort until it is found. Make a list of the hardships you see every day. What could be done about them? Maybe your neighbor is having trouble getting his lawn mower to start. What could you make so that starting that lawnmower becomes easier? Or perhaps you have a bathroom shower curtain that can never stay clean. Maybe you need to come up with a new way to do the job. No matter which opportunity you find, no matter which hardship you try to alleviate, remember that you and your happiness are part of the equation. While the ability to offer a service to others is laudable indeed, it is important to realize that you are just as important. Don’t be afraid to charge for your product or service. After all, fair is fair, and you should be compensated for all your time and effort. Remember, the adversity you face can be revealed as an opportunity for your success if you simply know how to look. So the question becomes, what is your “Miracle” story? What lofty goal will you tackle and achieve next? What are you willing to sacrifice to reach the goal and become who you truly are?

Steve Kloyda

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Steve Kloyda

For more than 30 years, Steve Kloyda has been creating unique selling experiences that transform the lives of salespeople, prospects and customers. As Founder of The Prospecting Expert, Steve helps his clients attract more prospects, retain more clients, and drive more sales.

A Report From MIT on the Next Revolution

Sadly, few insurance executives attended the MIT symposium. This stresses the challenge we have as an industry to recognize the disruption that is underway.

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Inspired. Extraordinary. Insightful. Transformative. Innovative. These are the words describing what I heard, saw and experienced at the recent MIT Sloan CIO Symposium, titled “Lead Your Digital Enterprise Forward:  Are you Ready for the Next Digital Revolution?” The symposium had more than 700 business and IT leaders, from  a wide range of industries, converging to discuss what was expressed by many panelists: We are at the forefront of witnessing the greatest disruption of every industry, the likes of which has never before been seen – the digital enterprise! MIT leaders stated that the top issue expressed by executive boards and executive committees is the fear of the disruption of business models and the risk to revenue models because of new entrants, new technologies and new customer demands. Every industry is or will be affected, some sooner than others, and all will feel the pain of disruption. The degree of pain will depend on how well companies create new strategies; embrace innovation; fund transformation initiatives; and create a business that will be flexible, adaptable and valuable in the new digital future. Sadly, only a handful of insurance executives attended the symposium. This stresses the danger we face and the challenge we have as an industry to recognize the disruption that is underway and our need to innovate and collaborate with leaders and thinkers outside our own industry. My observations align with SMA’s Top 8 Essentials for Preparing for the Digital Revolution, identifying critical elements that insurers must acknowledge and embrace as they rethink their businesses to become a Next-Gen Insurer.
  1. Digitalization is everywhere. And it is necessary for winning and retaining customers. We live in a world that is digitally charged and connected, and it is growing exponentially more so. This change is driven by new technologies and the customer experiences that have been reshaped by the use of these technologies, creating an increased preference for digital in the process. In response, modern technology and digitalization must now change how companies view themselves – no longer as value chains but rather as enterprise ecosystems that must be connected.
  2. Digitalization is dramatically destructive. A disruptive, foundational change is taking place in the way all businesses are approaching value creation. The ubiquitous connections of people via the Internet and emerging technologies (such as social media, the Internet of Things, crowdsourcing, mobile and cloud) are disrupting traditional business assumptions – from how to engage customers, to the products and services offered and, ultimately, to business and revenue models. The barrier to new entries into all industries is falling or is already gone, creating more risk to existing business and revenue models. New entrants are finding it easier to build, launch and sell much more rapidly.
  3. Data and information are the new currency in the digital world. And it is critical to the acquisition of insights about customers, the offerings of products and services, the creation of new products and services and more. Increasingly, data is being connected to the cloud, allowing data to be available anytime, anywhere and in any way.
  4. A massive paradigm shift in how we view and understand the world has occurred. The necessity to view businesses in a bigger frame of the world must follow suit, otherwise the view will be too small and detrimental. Align around a vision, projecting possibilities and outcomes. Spend to achieve an opportunity or possibility, not to complete a project; otherwise, you will find yourself trailing the competition. Just think big.
  5. Operational excellence is table stakes, and innovation is the price for future success. The absence of action and innovation creates significant business risk and a potential for lack of relevance. Innovation is the price for strategy enablement and the creation of possibilities. Life-long learning, creativity, an entrepreneurial spirit and the understanding of computer science, math and data are critical characteristics for future success.
  6. Innovation and collaboration are mandatory for future success. These are critical components for digital companies today, but the success with which they are employed will separate out the market leaders of tomorrow. The flow of information to engage collaboration through a network of resources and communities is vital to developing new products and services. The collective intelligence of ecosystems promotes entrepreneurship, provides a greater understanding of new technologies and stimulates the learning and creativity that together are key characteristics for future success.
  7. Customer empowerment defines new engagement models. We used to shape customer experience; now it is shaped for us by the rest of the world. As customers gain market power, are increasingly comfortable with technology, have a stronger voice and demand collaboration, companies must reinvent themselves and have a unified digital strategy that enables customer experience consistency and connectivity.
  8. All technology must be viewed as customer-touching. Social, mobile, analytics, cloud, wearable devices, robotics, the Internet of Things, telematics, driverless vehicles, biotechnology and much much more all influence and define customer relationships. Technology is super-connected. It’s creating new outcomes, new experiences and new products and services. And the future will be the cloud of things, with a world of distributed data, devices, technology, intelligence, computing and more that are highly connected.
Many insurers indicate they are on the journey to becoming a Digital Insurer, a key characteristic of a Next-Gen Insurer. Others are tactically investing in new websites, smart-phone apps or social media presence, but without a framework that can bring together a unified digital strategy and an omni-channel experience for driving consistent, connected customer experiences. But far too many others have yet to begin the journey. SMA’s coming digital insurer framework will help insurers to develop a strategy that brings together all of the critical components, recognizing that all  technology touches the customer in some way and at some level. Yes … it is a brave new world. But, unlike the world of AD 2540, envisioned by Aldous Huxley in his 1931 book, Brave New World, we can envision and anticipate how the rapid growth and use of technology can bring about good and positive changes, and how the explosion of data and customer expectations can profoundly change each and every business for the benefit of everyone. The industrial revolution disrupted and transformed our world in the early 1900s, and the information age in the mid- to late 1900s. We are now in a new age of disruption and transformation. Rather than being cynical and afraid of these changes like Huxley was, we can welcome them. Embrace the digital revolution. Re-envision, reinvent and change the business. Be brave. Become a Next-Gen Insurer.

What Tim Howard Just Did for Insurance

As the Twitterverse said during the U.S. goalie's epic World Cup performance against Belgium, he could become the face of insurance.

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Tim Howard saved 16 shots during Tuesday's World Cup match, the most by any goalie in the 50 years for which records have been kept. While he didn't stop Belgium from winning, he gave America a hero and helped take people’s minds off healthcare coverage and Hobby Lobby. In his rise to superstardom, he took insurance with him. @TommyTranTV hits the nail on the head: Screenshot 2014-07-02 10.56.38 The Twitterverse focused on Geico, probably because we all would be in a better place if more people could recite the multiplication table than "15 minutes could... ” Screenshot 2014-07-02 10.58.40 Screenshot 2014-07-02 10.58.56 Screenshot 2014-07-02 10.59.16 The 7.5 minute countermarketing commercial by Allstate’s Esurance unit is not the answer, but opportunity might be knocking on Allstate's door, even if just redoes its 2011 take with Howard. (Allstate: Use his real voice this time; we all know what it sounds like by now.) Screenshot 2014-07-02 10.59.36   Screenshot 2014-07-02 11.04.40 Best of all, without naming names, insurance has entered the game: Screenshot 2014-07-02 11.04.56 Screenshot 2014-07-02 11.06.38 Screenshot 2014-07-02 11.06.56 Screenshot 2014-07-02 11.07.33 Screenshot 2014-07-02 11.07.49

Shefi Ben Hutta

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Shefi Ben Hutta

Shefi Ben Hutta is the founder of InsuranceEntertainment.com, a refreshing blog offering insurance news and media that Millennials can relate to. Originally from Israel, she entered the U.S. insurance space in 2007 and since then has gained experience in online rating models.

New Regulation After a Disaster: More Harm Than Good?

Insurers can't do their job if they're told the game is football -- then it becomes lacrosse. Policyholders lose, too.

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This business of insurance requires a certain level of clairvoyance, and no one owns a crystal-clear crystal ball. What we do own is historical data on the impact and aftermath of large-scale disasters – and like most of what’s in the rearview mirror, that image is sharp yet fleeting. Some may forget the lessons of the last disaster too soon, while others cast past events into stone as the basis for managing future catastrophes. What’s worse, however, is when a disaster prompts knee-jerk reactions that do more harm to the market than good. Just like anyone else, insurers need certainty that the rules put in place to manage risk, pay claims and protect policyholders won’t change unexpectedly and immediately after Mother Nature plays her game. After a natural disaster, “Monday morning quarterbacks” both proliferate and pontificate. Some of this can be positive. In fact, staring down disaster and deciding not to be a victim twice often triggers community conversations that lead to infrastructure improvements to help prevent such a scenario from ever getting a replay. However, not all hindsight is helpful, particularly when the rules going into the “game of risk” are not the same rules in the immediate aftermath. Think about it this way: You’ve got a team that runs drills, budgets for expenses and asks players to follow a certain game plan in preparation for the big football game. But on game day, the team arrived on the field to discover it’s not football they are playing, but lacrosse. Of course, most rules have elasticity. Yet when the rules of insurance are changed after a hurricane, tornado, earthquake or flood, what sounds like a consumer-driven move often has unintended short- and long-range consequences that are truly not consumer friendly. States make the rules Contrary to public perception, insurance companies don’t set the rules. State legislators and regulators make the rules, which are codified within state statutes and the insurance contract. While the magnitude of recent disasters has made them game-changers, more often post-disaster moves result in actions that make it hard to figure out if anyone wins. The most recent example is Superstorm Sandy. In New York, there were nearly 500,000 claims resulting from the October 2012 storm. Yet regulators mandated that claims adjusters needed to inspect properties within six days, rather than the 15 days that was in the rulebook before the storm. That may not sound like a big deal, but insurers weren’t handling Sandy claims in New York alone. There were almost as many claims in New Jersey and more than 60,000 claims in Connecticut. Getting to New York claimants faster made sense to New Yorkers, yet it sapped resources from deserving claimants in other states who also needed prompt attention. Each state understandably, and admirably, wants to take care of its own. But in the immediate aftermath of a multi-state disaster, a stampede of mandates may be as disruptive as the disaster itself. Policyholders pay the price Unexpected requirements to hurry up the claims process puts speed at odds with thoroughness. That does not just mean the process is sloppy; rushing to close out a claim also raises costs. After Sandy, there were instances when insurers felt forced to pay out more in claims than what was warranted under the terms of the insurance contract. Insurers want to pay what they owe. No more, no less. Paying more than what is owed raises costs for everyone who was fortunate enough not to sustain damage. While getting more claims money sounds great from an individual claimant’s perspective, these additional, sometimes unwarranted, claims payouts are factored into determining surplus requirements for the next disaster. That makes all policyholders pay the price. Insurance companies want to settle claims quickly. It’s in our DNA. There is little upside to drawing out the process when cause and effect are clear. But pushing speed over practicality is expensive for consumers and insurers alike. Another program promulgated post-Sandy by both the New York Dept. of Financial Services and the New Jersey Dept. of Banking and Insurance was an emergency measure requiring mandatory participation by insurers in the mediation of non-flood claims if there was a claims dispute. Policyholders had to request mediation; insurers had to pay for it. It was a well-intentioned idea to keep litigation costs in check. The process was voluntary for policyholders, mandatory for insurance companies, and confusing for everyone. Because it was rolled out after the storm, there were a wide variety of interpretations of the process. Some people who were satisfied with their claim thought they had to attend a mediation. Storm survivors without flood insurance thought they had a chance of compensation with mediation. Don’t get me wrong: Mediation is a great option, and many other states have similar programs. However, quickly making a new program mandatory, without proper vetting and understanding by all parties involved, can make things more confusing than they need to be – particularly post-disaster when less confusion is what is needed. Catastrophic events bring large losses, which causes insurers to review their underwriting performance. The only natural disaster that we can reasonably predict is a hurricane, and even before anyone knows exactly where a storm will make landfall, insurers review their portfolio of risk and determine how they’ll respond when the sky calms. Often, insurers will reevaluate their market position, which can lead to requests for rate increases, changes in coverage options, adjustments to terms and conditions and even making decisions to adjust their exposure in the market. These seemingly prudent moves aren’t easy to do and are made more complex after large-scale disaster. After Sandy, New York regulators toyed with the idea (and rejected it) of restricting insurers from non-renewing no more than 2% of their book of business per territory. The current non-renewal limit is 4% on a statewide average. That’s not unlike forcing someone to put a purchase on their credit card that they know they can’t afford. Insurers decide to enter a market – or expand there – based on the rules and regulations currently in place. Where there is a pattern of restrictive, sudden rule changes post-disaster, few companies would choose to invest more capital there. If an insurer decides to retreat from or exit a market, it’s not personal – it’s prudent. Restricting the ability to adapt to changes in risk exposure makes the market constrict. Florida’s experience is the test lab, if anyone is in need of proof. The whole market suffers The severity of losses following Hurricane Andrew in 1992 caught everyone by surprise. And, the resulting market crisis got worse when the insurance industry got bushwhacked. During a special session in 1993, the Florida Legislature imposed a six-month moratorium on cancellations and nonrenewal of personal property insurance policies. Then, things got worse. The moratorium was followed by a three-year phase-out plan that allowed an insurer to non-renew only up to 5% of its property policies within a 12-month period. That meant insurers were required to continue providing coverage at rates below what they needed. Yes, it was more than two decades ago, and we have long, painful memories and existing residual damage to show how those actions forced companies to remain strict on underwriting, even today. States that have imposed exit restrictions in the past may find that insurers do not want to enter or grow their business in the future. It’s not only insurers that suffer financially from unanticipated actions. State resources suffer, too. In another special legislative session, the Florida Legislature changed the rules governing hurricane deductibles. Some people had the unfortunate experience of being hit by more than one storm during August and September 2004. To alleviate the financial hardship those storm victims were experiencing, the Legislature nixed the per event hurricane deductible and passed a law requiring only one annual hurricane season. The change cost the State of Florida money because reimbursements for multiple deductibles came from the Florida Hurricane Catastrophe Fund – the fund providing reinsurance for all insurers doing business in the state – reducing its assets by millions of dollars.** It cost all taxpayers dearly, including those who had no storm damage. Unlike most other states, Florida’s largest insurance carrier is the state itself. Citizens Property Insurance Corp. was designed to be a state-run insurer of last resort; however, the company experienced tremendous growth following the 2004/2005 hurricane seasons when multiple storms hit and private insurers once again reevaluated their portfolios. The retreat was compounded by the fact that, in many areas of the state, Citizens was charging below market rates. The gap has been narrowed significantly in recent years, but it still exists.  The politicization of insurance in Florida is what made Citizens grow into the ninth largest insurer in the U.S. in 2012. Among the top 10 writers of insurers nationally, Citizens is the only insurer with all its business – and all its risk – in a single state. Typically, insurers are expected to raise rates following a natural disaster if what happened seems to show that there is a greater chance for such an event to occur again. Florida’s hurricane history demonstrates it’s either boom or bust for insurers, and many carriers have posted losses even in the years that are hurricane-free. Making sense out of chaos Natural catastrophes are called disasters for a reason. It’s organized chaos – and sometimes, it’s unorganized chaos. To try to get their arms around the enormity of an event, regulators ask for claims data from carriers – and the thinking seems to be that more data is always better. The truth is that more data is expensive and time consuming to collect, especially when the requests entail delving into files that may not be catalogued in a format that insurance departments demand. Providing information for data reports is often not optional, and what regulators ask for after a major event is as changeable as the weather. Following Sandy, New York regulators made one-time data requests and gave insurers only a few hours to respond. Requests such as these could mean that the important work of handling claims gets delayed while employees have to divert their attention from taking care of people to taking care of paperwork. Property insurance markets do benefit from regulation, but rules that change like the wind don’t help. Natural disasters trigger emotional responses, and those responses are helpful in that they drive volunteers to show up to give both financially and physically to start the recovery process. But it’s the rational responses that bring the economic resources necessary to rebuild after disaster. The very rational action of paying claims that are owed is a responsible way to fulfill the parameters of the insurance contract in place at the time the disaster occurred. What lawmakers and regulators should know is that working according to predictable outcomes is the key to balancing the needs of policyholders and businesses focused on recovery, and insurance is one of those businesses. There will always be multiple points of view, as well as numerous options. But disaster response and recovery should not be viewed as opposing forces protecting self-interest. Our collective focus should be on agreements in advance that serve everyone in the best way possible, knowing that the real risk and true costs of natural disasters remain unknown. As we enter yet another hurricane season, it’s worthwhile to take a look at both market reaction and regulatory mandates that have proven to be, in effect, another disaster in the making.

Firms Must Clean Up Worker Classifications

When businesses treat workers as nonemployees, yet they may qualify as a common-law employees, there are significant risks.

Businesses should heed the expansion of the Internal Revenue Service voluntary classification program (VCS) as yet another warning to clean up their worker classification practices and defenses for all workers performing services for the business in any non-employee capacity. When businesses treat workers as nonemployees, yet they render services in such a way that they likely qualify as a common law employees, the businesses run the risk of overlooking or underestimating the costs and liabilities of employing those workers. The U.S. Department of Labor's Wage and Hour Division has an ever-lengthening record of businesses subjected to expensive backpay and penalty awards because the businesses failed to pay minimum wage or overtime to workers determined to qualify as common law employees entitled to minimum wage and overtime under the Fair Labor Standards Act. Originally announced on Sept. 22, 2011, the VCS program as modified by Announcement 2012-45 continues to offer businesses a carrot to reclassify as employees workers who had been misclassified for payroll tax purposes as independent contractors, leased employees or other nonemployee workers. That carrot came with a stick: the IRS’ promise to zealously impose penalties and interest against employers caught misclassifying workers. And the IRS is only one of many agencies on the alert for worker misclassification exposures -- worker misclassification also affects wage and hour, safety, immigration, worker’s compensation, employee benefits, negligence and a host of other obligations. Private plaintiffs are also pursuing businesses for misclassification. All of these exposures carry potentially costly compensation, interest and civil and in some cases even criminal penalties for the businesses and their leaders. Consequently, businesses should act prudently and promptly to address all of these risks and manage their misclassification exposures. Because most businesses uniformly classify workers as either employees or nonemployees for most purposes, business leaders must understand the full scope of their businesses’ misclassification exposures. VCS Program offers limited relief Worker misclassification affects a broad range of tax and non-tax legal obligations and risks well beyond income tax withholding, payroll and other employment tax liability and reporting and disclosure. A worker classification challenge or necessity determination should prompt a business to address the worker reclassification and attendant risks in other areas. Typically, in addition to treating a worker as a nonemployee for tax purposes, a business also will treat the worker as a nonemployee for immigration law eligibility to work, wage and hour, employment discrimination, employee benefits, fringe benefits, workers' compensation, workplace safety, tort liability and insurance and other purposes. Healthcare reform increases risks Businesses can look forward to these risks rising when the “pay or play” employer-shared responsibility, health plan non-discrimination, default enrollment and other new rules take effect under the Patient Protection & Affordable Care Act (ACA). Given these new ACA requirements and the government’s need to get as many workers covered as employees to make them work, the IRS and other agencies are expanding staffing and stepping up enforcement against businesses that misclassify workers. Businesses must understand how workers are counted and classified for purposes of ACA and other federal health plan mandates. ACA and other federal health plan rules decide what rules apply to which businesses or health plans based on such factors as the number of employees a business is considered to employ, their hours worked and their seasonal or other status. The ACA and other rules vary in the relevant number of employees that trigger applicability of the rule and how businesses must count workers to decide when a particular rule applies. Consequently, trying to predict the employer shared responsibility payment, if any, under Internal Revenue Code (Code) Section 4980H or trying to model the cost of any other federal health benefit mandates requires each business know who counts and how to classify workers for each of these rules. Most of these rules start with a “common law” definition of employee then apply rules to add or ignore various workers. Because most federal health plan rules also take into account ”commonly controlled” and “affiliated” businesses’ employees, businesses also may need to know their information. For instance, when a business along with all commonly controlled or affiliated employers employs a combined workforce of 50 or more “full-time” and “full-time equivalent employees” but does not offer “affordable,” “minimum essential coverage” to every full-time employee and his dependents under a legally compliant health plan, the business generally should expect to pay a shared responsibility payment for each month that any “full-time” employee receives a tax subsidy or credit for enrolling in one of ACA’s healthcare exchanges. If the business intends to continue to offer health coverage, it similarly will need to accurately understand which workers count as its employees for purposes of determining who gets coverage and the consequences to the business for those workers that qualify as full-time, common law employees not offered coverage. In either case, ACA uses the common law employee test as the basis for classification, and the already significant legal and financial consequences for misclassifying workers will rise considerably when ACA gets fully implemented. Consider relief in the full context As part of a broad effort, the IRS is offering certain qualifying businesses an opportunity to resolve payroll liabilities arising from past worker misclassifications. The VCS Program settlement opportunity emerged in 2011.Touted by the IRS as providing “greater certainty for employers, workers and the government,” the VCS Program offers eligible businesses the option to pay just more than 1% of the wages paid to the reclassified workers for the past year. The businesses also must meet other criteria. The IRS promises not to conduct a payroll tax audit or assess interest or penalties against the business for unpaid payroll taxes for the previously misclassified workers. Participation was low, partly because not all businesses with misclassified workers qualified to use the program. The original criteria to enter the VCS Program required that a business: Be treating the workers as nonemployees; Consistently have treated the workers as nonemployees; Have filed all required Forms 1099 for amounts paid to the workers; Not currently be under IRS audit; Not be under audit by the Department of Labor or a state agency on the classification of these workers or contesting the classification of the workers in court; and Agree to extend the statute of limitations on their payroll tax liabilities from three to six years. After only about 1,000 employers used the VCS Program, the IRS modified it so that employers under IRS audit, other than an employment tax audit, now qualify. The IRS also eliminated the requirement that employers agree to extend their statute of limitations on payroll tax liability. Many employers may still view use of the VCS Program as too risky because of uncertainties about the proper classification of certain workers in light of the highly specific nature of the determination. Employers may also have concerns about the effect that use of the VCS Program might have on non-tax misclassification exposures for workers who would be reclassified under the VCS Program. Complications One of the biggest challenges to getting businesses to change their worker classifications is getting the businesses to accept the notion that long-standing worker classification practices in fact might not be defensible. Although existing precedent and regulatory guidance makes clear that certain long-standing worker classification practices of many businesses would not hold up, business leaders understandably often discount the risk because these classifications historically have faced little or no challenge. Even when business leaders recognize that changing enforcement patterns merit reconsideration, they may be reluctant to reclassify the workers. The common law employment test often relies on a subjective, highly fact-specific analysis of the circumstances of the worker. The business, rather than the IRS or other agency, generally bears the burden of proving the correctness of its classification of a worker. So, a business must ensure that its decisions can withstand scrutiny under all applicable tests and must retain evidence. Businesses also should exercise special care to avoid relying on overly optimistic assessments of the facts and circumstances. When the factual evidence creates significant questions, an employing business generally should consider reclassifying or restructuring the position. Often, it also may be desirable to incorporate certain contractual, compensation and other safeguards into the worker relationship, both to support the nonemployee characterization and to minimize future challenges and exposures. Importance of attorney-client privilege for risk management Because of the broad exposures arising from misclassification, business leaders generally should work to ensure that their risk analysis and decision-making discussion is positioned for protection under attorney-client privilege and attorney work product privilege. The interwoven nature of the tax and non-tax risks merits particular awareness by business leaders of the need to use care in deciding the outside advisers that will help in the evaluation of the risks and structuring of solutions. While appropriately structured involvement by accountants and other non-legal consultants can be a valuable tool, the blended nature of the misclassification exposures means that the evidentiary privileges that accountants often assert to help shield their tax-related discussions from discovery are likely to provide inadequate protection. For this reason, business leaders are urged to require that any audits and other activities by these non-legal consultants to evaluate or mitigate exposures be conducted whenever possible within attorney-client privilege. Accordingly, while businesses definitely should use appropriate tax advisers, they will want to first engage counsel and coordinate non-attorney advisers' activities within the protection of attorney-client privilege

Cynthia Marcotte Stamer

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Cynthia Marcotte Stamer

Cynthia Marcotte Stamer is board-certified in labor and employment law by the Texas Board of Legal Specialization, recognized as a top healthcare, labor and employment and ERISA/employee benefits lawyer for her decades of experience.

The Right Way to Think About Bundling

Bundles currently encourage customers to buy based on price, but insurers can use them to become trusted advisers on risk.

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Insurers are shooting themselves in the foot – and sparking a race to the bottom when it comes to price. How? By thinking they can earn customer loyalty and sell existing customers new types of insurance by offering discounted bundles of products, such as a package containing home, auto and personal umbrella insurance. Instead, this bundling is encouraging consumers to buy insurance based on price – rather than on what should be the real goal: shielding a home or other valuable asset from loss. The upshot: Consumers are focusing on the minimum amount of insurance they may be required to hold, say, to secure a mortgage or own a car. It’s a situation that ultimately doesn’t benefit the consumer – or the insurer’s bottom line. Insurers can change this so that bundling is a win both for themselves and for their customers. To begin, insurers must help guide consumers to think more about protecting themselves and their assets. Companies could then recalibrate their own business model and focus more on providing advice to customers on what insurance meets their actual needs. Some companies – including Allstate and Progressive – are taking steps in the right direction. But they’re doing so for narrower tactical reasons. Instead, they must act strategically and become genuine partners that provide customers with the coverage they truly need to safeguard their financial security. Such an approach would set these companies apart from rivals – and arrest the downward price spiral that has turned their bundled offerings into a commoditized product. Insurers don’t need to discard the concept of bundling to achieve this. The thinking that goes into unbundling can actually help, because it forces companies to break products down to the granular level. Those pieces can then be reassembled into packages customized to the needs of each customer. Does discounting reflect the true value of product bundling? Currently, insurers offer a bundling discount, also known as a cross-product discount, and position the value to the customer as “saving money.” The approach may look like a no-brainer, thanks to the marked success of the current model of selling two products together as a bundle, with the “discount” as the differentiator. Consider the following: -          Insurers selling two products together have long seen customer retention improve. Customer retention rates are higher among renters who bundle an auto policy: 91% among those who bundle vs. 67% among those who do not, according to J.D. Power. -          The perceived value of a bundle is reflected in the fact that a greater proportion of customers buy multiple products from the same insurer. According to J.D. Power, 77% of customers bundle auto policies with additional policies, and 58% bundle their auto and home insurance policies with their existing insurers. But when we analyze the factors that go into premium calculation, real savings for insurers depend on many factors that vary greatly between insurers, states, individual customers’ own situations, etc.  Those factors can produce inconsistent savings calculations for bundles, varying from 5% to 20%.  Consequently, customers need to shop around thoroughly, comparing prices (both for the individual product and the bundle) and choosing the right combination from the right insurer. The various factors can work together so differently that a customer may sometimes save by buying products from two different insurers – rather than a bundle from one. For insurers, the incremental value in all this translates into higher customer retention. There is no real incremental value realized from the product itself, which is core risk management. How is the industry responding? Insurers have been responding to the emerging need to serve as risk managers for their customers. And they’ve been fine tuning their bundling strategy accordingly. Some insurers, for example, have crafted their bundling strategy to make it easier for customers to manage their risk profile through a single insurer; this also consolidates billing and payment. While this is rudimentary, it still provides an easier way to serve the customer – and to increase loyalty. The following insurers approach bundling by advising customers as well as crafting suitable packages that allow their customers to manage risk: -          Allstate provides an “all-in-one” product through its Encompass unit, which covers homes, cars and home-based business. It’s aimed at wealthier customers. For more mass-market customers, Allstate provides “Bumper to Bumper Basics,” based on states’ minimum requirements for auto insurance. -          GEICO offers an advisory tool allowing customers to build a customized policy based on their individual circumstances. -          Progressive provides a “Name Your Price” feature for its auto coverage, under which the customer states her budget, and Progressive sorts the options based on cost. The plan closest to the customer’s budget is shown first. Progressive states on its website: “Once you fine tune your price, we highlight any areas where you might have too little or too much coverage, so you can get your entire package just right.” The insurer also gives customers the option of bundling both auto and property insurance. -          MetLife Auto & Home’s “GrandProtect” program allows consumers who purchase multiple policies – such as home and auto – to pay one deductible in the event that several of their insured assets are damaged by one event, such as a storm or hurricane. These examples underscore that while insurers are shifting toward an advisory-led coverage bundling within a product, they’re still beginning from a tactical standpoint. This narrower approach remains limited to customizing coverage within a product and tactically bundling other products with it. Though insurers have been slow to adopt product bundling on a more strategic basis – i.e., being an end-to-end risk portfolio manager – they are actively pursuing the goal of leveraging cutting-edge technical capabilities. So, where does the potential value reside? The real value of bundling – for both customers and insurers – lies in the individual insurance products.  Every form of coverage within the bundle covers a specific risk, and so is a “mini product” on its own. However, insurance products have become commoditized as products have become more unified so they can be sold easily to customers over the Internet. There, many customers simply select the desired coverage amount and deductible. “Save Money” and “Discount” marketing diverts customers toward an affordable premium and, often, the wrong coverage – people opt only for those policies mandated by law (like automobile liability insurance) or, in the case of a home mortgage, a lender. The deductibles chosen often are high, which can prove disastrous for a customer if calamity strikes. Insurers can deliver real value for themselves and their customers by:
  • Gathering customers’ relevant information
  • Assessing their risk
  • Building the right coverage mix to mesh with customers’ needs
  • Suggesting customized products based on a customer’s risk profile
How might this work? Say a customer’s car is more than two years old. The insurer could recommend the customer get an extended warranty as well as a roadside assistance plan. The insurer, in short, could deliver real value by acting as the customer’s risk manager. This approach also would help the insurer to select the right customers for the right risk portfolio – and to weigh the moral hazards when a customer opts for a different package or coverage combination. Once the individual insurance products are de-commoditized and customized to fit the customer’s risk profile, this advice-based approach can be extended to multi-line product bundling. Customers will move from a mindset of, “I’m required to have homeowners insurance to get a mortgage,” to a mindset more in line with, “I need to cover my risks and ensure a financially secure future.” Customer retention and satisfaction will go up – along with the insurer’s revenue. How to unlock the true potential of product bundling? The goal of achieving strategic bundling hinges on insurers’ building their advisory capabilities and customizing coverage and products based on a customer’s risk portfolio. The core building blocks of coverage and pricing will not change – but the superstructure could be anything from a chapel to a cathedral, based on a customer’s risk profile. Cutting-edge technical capabilities such as mobile communications, sophisticated analytical tools and so-called “big data” are among the options insurers can tap to build their customization and advisory capabilities. Extensive use of external data (e.g., credit scores and medical data) as well as internal data (e.g., loan delinquency rates) along with analytics will help insurers predict a customer’s risk portfolio with fair accuracy.  Social media platforms such as Facebook and Twitter are other evolving (though not always reliable) generators of external data that insurers can use to gather customer profile, risk and behavior data. Strategic bundling from a risk portfolio management perspective also requires customers to share personal information outright. Customers, especially millennials, seem willing to their share personal information in return for personal advice. This offers the potential for insurers to accelerate strategic product bundling. Insurers can thus capitalize on customers’ need for advice-based risk portfolio management leveraging leading-edge technology to deliver what customers want. Insurers that show agility and speed in building these capabilities can succeed in achieving strategic bundling – and attain the coveted status of a preferred risk portfolio manager.

Usage-Based Pricing: Reality or Fantasy?

Do insurance companies really have enough driving data to justify pricing and risk rating for usage-based insurance? Or are they guesstimating?

In the world of usage-based insurance (UBI), Progressive is an exception: Its massive amount of driving data – 110 terabytes covering some two million vehicles, 1.5 billion separate trips and more than 10 billion miles driven – allows it to quickly test new rating factors and to do so with a great degree of accuracy. "We continue to test new ideas all the time,” says David Pratt, Progressive's general manager of usage-based insurance. “Our research team will come up with a theory for what would predict safe driving. With our big data set, we can test those quickly." Few other UBI providers are as fortunate. Octo Telematics, which launched its first UBI product in 2002, also has tons of data: 194 billion kilometers of driving performance from two million drivers globally. But most other companies are making educated guesses based on more limited data combined with more traditional ratings factors. As Nino Tarantino, CEO of Octo Telematics North America, says, "Today, there is no data standard and no clear understanding of which data and how much is required." For example, Octo works with seven insurers in the U.S. and Canada, and each one asks for a different data set to be collected – everything from hard braking and acceleration to how many trips a driver takes and how long the trips are, as well as when and where they occur. Actuarial guidelines often cite 100,000 earned car years as the threshold for credibility for a model, says Dwight Hakim, vice president of telematics, Verisk Insurance Solutions, a provider of underwriting data and tools for UBI. An earned car year is equivalent to one car insured for one year. In traditional motor vehicle insurance, the number of earned car years is used to show state regulators that an insurer’s pricing decision is based on plenty of evidence. This helps reassure regulators, and helps agents selling the insurance. "Credibility is particularly important when insurers are constructing a rate plan that might increase premiums," Hakim says. "Regulators need to see a model with high credibility if that model might result in rate increases. Assuming the insurer has a good financial position overall, modest rate decreases are easier to justify." While using earned car years – or the equivalent in telematics driving data – may be critical when an insurer asks regulators to approve a price increase, it may not be strictly necessary to see how different UBI rating characteristics perform, Hakim says. Trial first, price later That is what many insurers in need of beginning to test or launch UBI programs are betting on, to avoid the need for a large data set. For starters, insurers can assume that good drivers self-select for UBI programs. "Chances are [that] the people who try it are more likely to be safe drivers,” says Thomas Hallauer, research and marketing director for telematics consultancy Ptolemus Consulting Group. “So you know you can offer some kind of discount anyway. You also know they will probably stick longer to your contract." Another strategy, Hallauer says, is for UBI insurers to collect an initial data set through trials, and to then revise their ratings as more data comes in. Coming up on one full year of offering UBI in the U.S., American Family Insurance used just this approach. "We feel like we got enough to launch, but as we see the data we know we need to refine it," says Pete Frey, personal lines UBI program and product manager, American Family Insurance. Combining telematics data with traditional rating factors, such as age and location of residence, is yet another strategy. The Hartford is one of many U.S. insurance companies to do just that, saying it makes for finer segmentation for its consumers. "Almost all programs in the U.S. augment telematics data with other carrier-specific rating factors,” Hakim says. “Assessing the degree of overlap among rating factors to avoid double-counting takes a significant amount of work, but carriers are implementing telematics because they know doing so will help them stay competitive and win market share." But the benefit of adding more data must equal the cost, Progressive’s Pratt warns. While he agrees that UBI rating will continue to evolve and become more sophisticated, "if it costs a lot to get the information, it's maybe not worth it," he says. Consumer acceptance is another sticking point. "Everything we use has to be something the customer thinks is fine," Pratt says. "We have to be able to explain to people why it makes sense, why it's actually fair that we do it that way." Pooled data Finally, insurers can get larger data sets from third-party telematics data providers, such as Verisk Insurance Solutions, Towers Watson and Octo Telematics. Verisk offers what it calls “Driving Behavior Database for Modelers,” which makes available to statistical modeling applications: data from telematics devices; exposure, premium and loss information on insured drivers; and third-party data, including weather conditions, road type and traffic flow. Towers Watson has a pooled data offering that collects telematics data and claims, policy, vehicle and driver information. And it uses this pooled data to score drivers and to provide those scores to insurers. Also available from Towers Watson are models that take into consideration third-party information like maps and weather, road type, population density, weather and angle of the sun. Octo’s Insight Centre collects global, real-time data from its installed base of Clearbox telematics devices, which customers can then interrogate to inform their UBI offerings. However, there are caveats when it comes to using pooled data. Hakim, for example, warns that while amassing large quantities of data is critical, not all data is equally valuable. Its utility depends on its accuracy and completeness; how frequently it's sampled; and the source – whether OBD2 outputs, GPS or accelerometers in cell phones. "Knowing how each device works and the manner in which the different technologies interact is key,” he says. “The complexities of reading the car’s diagnostic information, appending accelerometer data and then transmitting [it] wirelessly require a deep bench of experience.” American Family Insurance’s Frey makes a similar point. The availability of aggregated, third-party data is not the issue, he says. While there are plenty of companies offering data to insurers, "carriers are just trying to figure out how to use it,” he says. “The data is almost overwhelming." The profit question One of the big, unanswered questions about usage-based insurance is whether insurance carriers will ultimately be more profitable than – or even as profitable as – providers of traditional motor vehicle insurance. "It's an accepted thing that putting in a UBI program for starters is a cost,” according to Frey, of American Family Insurance. “It is about a longer-term strategy. Ideally, companies hope to achieve more growth." Among those costs that must be taken into account are the cost of telematics hardware – if an insurer is going the route of using its own devices – and the cost of the back-end infrastructure. Adding UBI on top of an already-existing infrastructure, as major insurers must do, is extremely costly, according to Hallauer, at Ptolemus. In this respect, UBI upstarts that rely on scalable cloud solutions have an advantage, Hallauer adds. Still, the hope is UBI will ultimately pay off. Enabling more sophisticated pricing is one benefit. "You want to make sure you have the right rates for the right drivers,” Frey says. “One of the biggest goals is trying to create fair rates eventually." And insurance discounts are only part of the equation, Hallauer adds. “The pricing decision is not a discount decision; it's how do you change the offering to make it enticing?" he says. According to Hallauer, discount-based UBI incentives will eventually evolve into a more service-oriented approach that may range from life-saving services, such as calling an ambulance after a crash, to more prosaic ones, such as allowing drivers to get a driving score. Ultimately, he says, UBI can make the customer feel comfortable in having a stronger link with the insurer. Value beyond discounts Frey says American Family Insurance is looking in this direction. While it hasn't pinpointed what services it might offer, it's considering safety services, making drivers aware of their driving habits and stolen vehicle recovery. Octo’s Nino Tarantino notes that the value-added services approach is more common in Europe, where some insurance companies offer personal safety and security services, instead of discounts. The environment is different in North America, he says, because of Progressive. The early mover's decision to base its UBI offering on a good-driver discount established the tone for consumer expectations and shaped the market. According to Pratt, at Progressive, the company tries to set its prices so the profit margin is the same for people who sign up for Snapshot, its UBI product, as it is for people who opt for traditional insurance. Progressive's theory is that UBI customers will stay with the company longer – and so far that's been the case. Therefore, the lifetime revenue per customer should be higher, even though the margin is the same as for traditional insurance customers. Progressive may also save some money through helping people drive better. The company noticed that the driving of UBI customers improved when, a couple of years ago, it added the option of turning on audio feedback in the device so that, for example, it beeps when someone brakes hard. "We see this training effect within the first few weeks people have the device plugged in,” Pratt says. “They learn to avoid hard braking, and we have evidence it helps people avoid accidents. That could be a big change in the industry, trying to actually reduce your risk." But the big win is likely in the life of the customer relationship. Pratt adds. “We are not trying to make ourselves more profitable with this. We are trying to attract and keep good customers for a long time." In fact, Tarantino thinks that most usage-based insurance programs cannot succeed if they're based only on discounts because of all the additional costs associated with them. He says Octo's experience with 2.4 million insured drivers in Europe shows that "when the benefits of pricing and determining risk are combined with the benefits of the understanding the moment of loss for the insurance company – when there is a crash, that is – it will be successful." There is never enough data So is there any such thing as enough data? Pratt doesn't think so. Progressive’s Snapshot considers mileage, time of day and hard braking. The company recently began a pilot using GPS-enabled devices to examine whether highway versus city street driving can contribute to predicting future losses. Progressive has found that the measurement of how someone drives is indeed a better predictor of risk than driving record, age, gender or any of the traditional rating factors. Still, "the models can still get a lot better," Pratt says. Say Progressive wants to find out if people who are low-mileage drivers are safer drivers. The company can segment out those drivers from its customer base and see which ultimately did have accidents and which didn't. It could go further and segment the low-mileage drivers by age to determine whether low mileage is a good predictor for all age groups. Even with 10 billion miles driven, there may not always be enough drivers in the database to provide a meaningful segment to test a theory, Pratt says.   This article has been produced in the lead-up to the Insurance Telematics USA conference and exhibition, which will take place in Chicago on Sept. 3-4. This conference will tackle the steps needed to take UBI programs to the mass market. Find out more here.

Susan Kuchinskas

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Susan Kuchinskas

Susan Kuchinskas is regular contributor to Telematics Update, an influential business intelligence organization within the connected-car industry. Telematics Update’s mission is to serve the burgeoning mobile, consumer electronics and digital industries as they converge with the automotive industry. Telematics Update currently provides cutting-edge industry news, analysis, reports and senior-level B2B conferences.