Navigating healthcare costs can often be a challenge, as seen when engaging with practitioners. Typically, when a doctor prescribes drugs or recommends tests, they send their instructions to the pharmacy or laboratory, leaving both the patient and doctor unaware of the impending costs. Isn't it better if we could know the cost before it is incurred, taking advantage of various data sources at our disposal?

I experienced this issue firsthand when my wife and I were anticipating the arrival of our first child. The quotes for a simple imaging procedure varied widely among providers, with costs ranging from $100 to $800. As a professional in healthcare technology, I was equipped to untangle this ambiguity, yet it was clear the potential confusion it could cause for someone outside the field.

Experiences like these empower my profound desire to develop a healthcare system that stands not only for affordability but also for transparency and accessibility for all. Despite the geographic disparities, my unwavering vision of establishing advanced healthcare facilities in remote areas of the world holds steadfast. My aspiration is to create a system that capitalizes on data science, using historical data to mold a future where healthcare isn't a privilege but an inherent right for all. My steadfast mission is to guarantee that quality and economical healthcare services are available to every individual, regardless of their socio-economic status or geographic location.

Healthcare Challenges

The primary issues with healthcare cost predictability are rooted in the complexity of the healthcare system and the intricate nature of many contributing factors. These include:

• Lack of Transparency: Healthcare systems and billing can be very complex, making it difficult for patients to understand exact costs upfront. 
• Inconsistent Pricing: The prices of services can vary dramatically among different healthcare providers and even geographical locations, with the patient often unaware of the reason for this variation.
• Complex Billing: Medical bills can be incredibly complex and hard to decipher. They may include medical jargon, coding systems or abbreviations that a layman would not understand.
• Hidden Fees: Hidden, undisclosed or unexpected fees can be tacked onto the bill, such as facility fees or charges for additional procedures or tests, and patients aren't typically made aware of these costs up front.
• Insurance Complications: Insurance policies often involve complex terms and conditions and may not entirely cover certain services, leaving patients with unexpected out-of-pocket expenses.
• Unexpected Costs: There can be unexpected costs included in the final bill, for services like laboratory tests or additional procedures that were not initially accounted for.

See also: Using Data Science to End Surprise Billing

Technological Challenges

From a technical perspective, implementing a solution to predict healthcare costs brings a host of challenges:

• Data Integration: Integrating data from a multitude of sources, each with different data storage systems and formats, is a significant hurdle.
• Real-Time Processing: Given the dynamic nature of the healthcare industry, the system needs to process data in real time (or near real- time) to provide accurate estimates, which is technically demanding.
• Regulatory Compliance: Compliance with healthcare regulations, notably HIPAA in the U.S., is mandatory when handling patient data. Fulfilling these requirements while implementing advanced data analytics can be complex.
• Data Quality: Inconsistent, incomplete or erroneous data can impede the development of accurate predictive models. Ensuring high-quality data is challenging but essential.
• Security: Healthcare data is sensitive, making robust security measures a necessity to prevent data breaches.
• Resource -Intensive: Developing, implementing and maintaining a solution is resource-intensive, both in terms of cost and technical expertise.
• User Acceptance: The solution needs to be user-friendly and easily interpretable by non-tech users like patients and healthcare providers, which is an additional challenge in design and implementation.

See also: Insurance Models Driven by Hourly Wages

Comprehensive Solution:

To address the problem of unpredictability in healthcare costs, a comprehensive solution can be designed in the form of a Healthcare Cost Prediction Platform. This platform would integrate AI and machine learning algorithms to process and analyze huge datasets from various relevant sources. Here is a broad overview of the solution:

• Multi-Source Data Integration: The platform will integrate data from various healthcare providers, pharmacies, laboratories and insurance companies. It will use robust application programming interfaces (APIs) and data connectors to bring all this data from disparate sources into a unified environment.
• Data Standardization and Quality Control: After the data integration phase, the platform will standardize data to remove inconsistencies and attain uniformity. The integrity of the data would be ensured by regular quality checks to increase the reliability of the predictions.
• Predictive Analytics Tools: The core of the platform would consist of sophisticated AI-driven predictive analytics tools. These tools would analyze the historical data and extrapolate that into future costs, giving the patient and doctor a clear idea about the cost implications even before the treatments commence.
• Real-Time Updates: The platform would be designed to handle real-time data, allowing for cost updates as prices change at healthcare providers and insurance policies get updated.
• Security and Compliance: The entire solution would be designed with privacy and security at its core, maintaining strict compliance with regulations like HIPAA to safeguard sensitive patient information.
• User-Friendly Interface: The platform would be equipped with an easy-to-use interface, providing cost estimates and comparisons in a comprehensible format. An integrated dashboard could allow users to input their specific needs and get an accurate estimate of costs.
• Continuous Learning: The platform would be capable of learning from the previous data to improve the accuracy of its predictions over time, making it more reliable.

By implementing this Healthcare Cost Prediction Platform, we can tackle the challenge of unpredictability in healthcare costs, making healthcare more affordable and transparent for everyone.

Extreme weather across the globe—including heat, wildfires and floods—is escalating. Meanwhile, the East Coast is sinking, and only 14% of Americans have flood insurance, according to a survey commissioned by Selective and conducted by the Harris Poll. That same survey also found that the majority of Americans severely underestimate their own personal flooding risk while overestimating what their policies actually cover.

What gives?

For agents and consumers, the insurance landscape—which, by all indications, will only continue to be affected by extreme weather—is in complex, unprecedented territory. There’s no denying it: We’re all being forced to maneuver through turbulent headwinds, which is why it’s all the more important to examine the powerful forces at play. Doing so will ensure that insurance professionals and consumers alike are equipped and positioned to navigate the months and years ahead.

See also: How to Prepare for Extreme Weather

Examining the Insurance Landscape

The insurance industry remains in a hard market, and no one knows exactly when it will end. There are numerous contributing factors to the hard market—from lingering effects from the pandemic to increased interest rates and inflation, as well as broader economic uncertainty and extreme, volatile weather.

More frequent extreme weather and natural disasters inevitably lead to increased losses for insurance carriers, which compounds the challenging market. Meanwhile, late spring marks the beginning of hurricane and wildfire season, which creates problems in the short term and, depending on the severity of the season, could carry long-term implications, as well. 

In addition, many carriers are struggling to maintain adequate (and often mandated) reserve capacities. Rate increases and underwriting discipline will be at the core of insurers’ measures to carve a path forward. Until the landscape changes, these challenges will remain forces that insurers must contend with to remain competitive and profitable.

While the economy and hurricane season can’t be controlled by agents, what is within their control? What opportunities exist? 

As mentioned, only 14% of Americans have flood insurance—and, according to that same survey, two-thirds of Americans with homeowners or renters insurance incorrectly believe their current policy covers flood-related damage. Those statistics show that a laser-eyed focus on consumer awareness, education and engagement is crucial, and the key to how agents can successfully navigate the hard market and add value to their clients amid extreme weather.

Consumer Communications Amid Extreme Weather and the Hard Market

There are three key points that consumers need to know—and that insurance agents need to clearly communicate in their messaging to their customers, both current and prospective. Whether the communication is on social media, via email, over the phone or in person, these are the points to drive home with consumers: 

• Standard Policies Rarely Include Flood Protection: While millions of Americans assume that their homeowners or renters policy includes coverage for flood damage, the reality is that standard policies almost always omit flood protection. Flood insurance is typically a separate policy, obtainable through either the federally backed National Flood Insurance Program (NFIP) or the private market. 
• FEMA Flood Maps Are Not a Sufficient Guide: According to the National Association of Insurance Commissioners, approximately 25% of flood claims covered by insurance policies occur outside FEMA-designated hazard zones. While FEMA certainly serves an important role in providing resources and guidance, solely relying on FEMA flood maps will, for many homeowners and renters, pose the risk of being underinsured. And as extreme weather continues, this risk only escalates.
• Anywhere It Rains, Flood Damage Is a Threat: Flooding can occur due to various scenarios, including persistent rainfall, river and lake overflow, rapid snowmelt and even wildfires. It’s also essential for consumers to be aware that there is a 30-day waiting period for both purchasing and renewing flood insurance, and that flood protection policies can be purchased at any time—except during an actual flood. Considering the extent to which consumers are underestimating the threat of flood damage, it’s all the more important for insurance industry professionals to focus on communicating these basics, and doing so with clarity and empathy.

See also: Property Underwriting for Extreme Weather 

In addition, it’s crucial to be proactive about renewals and cultivating strong relationships with fellow industry professionals, including carriers and underwriters, who can be vital in securing that favorable policy and helping both the agent and policyholder maneuver through the hard market. For agents, that relationship-building ability combined with local expertise and access to multiple markets will go a long way to alleviate customers’ pain points. 

While the focus here has been mainly on extreme weather and flood protection specifically, much of this analysis also applies to the broader complex insurance market. Across the board, the story remains largely the same: Premiums are increasing, while many consumers remain unequipped with the knowledge and tools to adequately protect themselves, their assets and their families. 

What this all underscores: the critical and ever-increasing role of independent agents and industry professionals in helping consumers make wise decisions and successfully navigate this landscape. 

The good news, if you’re an insurance industry professional: today, is that your job is more important than ever—and as a consumer educator and advocate, you are primed to make a tangible, positive difference for policyholders, their loved ones and their financial futures.

The nation’s medical overbilling epidemic is literally sickening for businesses and individuals alike. In fact, many analysts lay the blame on egregious provider billing practices as a key contributor to: 1) participants with outstanding medical bills, 2) participants who forgo care due to anticipated out-of-pocket costs and 3) the exploding cost of health coverage, where participant contributions have a significant impact on take-home pay and where employer costs represent the largest P&L expense other than wages in many organizations. These issues spark runaway spending that erodes take-home pay, household wealth and corporate profits. 

Medical overbilling diminishes wages, lowers take-home pay, and increases cost sharing, causing scores of average working Americans to delay or forgo important medical care or ration medicine – damaging health. That undercuts the ability of households to save for emergency expenses and undermines productivity.

There is an urgent need for clear and accurate price transparency in healthcare to avoid medical overbilling. The task is twofold: securing the right administrative capabilities and plan design. 

Role of TPAs

Employers must be able to confirm a third-party administrator’s (TPA) process for ensuring that it receives accurate pricing where there is a preferred provider organization (PPO) network in place, as well as processes for identifying upcoding, billing errors or other inaccuracies. This is accomplished through auditing a sampling of claims from a third-party auditor that typically is performed annually. Many health plan sponsors also have long crafted performance-based TPA agreements where additional compensation may be earned.  

Reference-Based Pricing (RBP)

Reference-based pricing (RBP) is another key step to consider along the way to achieving accurate price transparency and avoiding egregious medical bills. Employers must confirm that where designs or provisions are in place, the processing to ensure accurate pricing may only require the TPA to confirm the accuracy of the coding and location of services. Once accuracy and location are confirmed, the TPA will reprice as necessary to the reference schedule adopted by the plan. 

See also: Using Data Science to End Surprise Billing

Plan Design

Plan design in and of itself is also critically important to remedying medical overbilling. Employers must consider that open negotiation and independent dispute resolution (IDR) procedures may trigger a new risk for health plans – even those that apply RBP to non-network providers or plans that directly contract with providers and facilities.

Adopting a “pure” RBP plan that does not contract with providers will generally avoid the IDR process. Because there are no out-of-network claims or direct-contracting fees, and becausee there is no need to determine a median in-network rate, these plans are generally not hurt by the No Surprises Act. 

Further, because in-network charges also tend to vary substantially, pure RBP ensures the suggested reference price (or billed amounts, where lower) applies in every situation. 

Other than determining the accuracy of pricing, price transparency is typically only a consideration when it is part of the purchase decision. So, the following points must be highlighted:  

• First, “accurate” suggests multiple prices for the same procedure, including variance among providers in the same PPO network, likely varying by contract provision. Individual providers may also vary their pricing for certain procedures. This is why it is so important to confirm that the patient received the correct price as stipulated in the contract. 
• Second, a price comparison is best accomplished prior to the provision of services. When done correctly, it would be an important component of an advanced explanation-of-benefit process.
• Third, the difference in price may not be as important to consumers as the difference in their out-of-pocket (OOP) expense. Therefore, side-by-side comparisons may have a more noteworthy impact on the cost to the plan. 

Experience has shown that when people are spending their own money, they’re more circumspect about those purchasing decisions. Therefore, the goal is to encourage wise consumer behavior. Health Savings Account (HSA)-capable coverage is one smart choice that often encourages consumer behavior in medical services decision making. By participating in an HSA-capable plan, consumers have a say in selecting medical services and incurring out-of-pocket (OOP) costs – where those OOP expenses can be paid with tax-preferred HSAs assets. 

HSA-capable coverage will generally lower the initial cost of coverage and help the participant prepare for years when they have out-of-pocket spending. The example below, involving a typical PPO with a $500 annual deductible and 80/20% coinsurance, shows what happens if the same service is priced at $1,000 and $2,000 under two different health plan models: 

As previously suggested, transparency in pricing is much more important to the consumer if they are actually spending their own dollars. So, when seen in the same example, a side-by-side comparison of a traditional PPO and an HSA-capable PPO identifies the incentive to check on the price. This recognizes that where a worker has a choice between the traditional and HSA-capable PPO, where the employer contribution is typically the same dollar amount (for coverage and employer contributions to the HSA), the worker and the plan both spend less – benefitting from consumerism.  

See also: The Need for Transparency in Underwriting

Empowering Consumers to Make Informed Decisions

Ensuring that health plan members have more of an ownership stake in their healthcare choices is a vital piece of the puzzle in combatting medical overbilling. Consider that just 43% of healthcare expenses have been traced to services that may have been shopped for by a motivated employee, according to the Health Care Cost Institute. 

Influencing consumer behavior is predicated on improving healthcare literacy through helpful educational materials, meaningful communication campaigns and decision-supporting tools. Arming healthcare consumers with the right knowledge will help them make healthier lifestyle choices, as well as select more appropriate coverage options and address cost concerns. By making more informed decisions about their healthcare, health plan members will improve their health outcomes and, by association, do their part to help remedy the nation’s medical-overbilling epidemic.

We've all seen the claim that "data is the new oil," and a recent global survey by Aon found that, in fact, information assets are 14% greater than property, plant and equipment assets (PP&E) at major organizations. But Aon also reports that organizations only insure about 19% of their information assets, vs. 60% of their physical assets -- despite believing that they have at least 2 1/2 times the likelihood of a loss on their information assets.

That sounds to me like a need for customers and an opportunity for insurers. 

So let's have a look at that report, along with some other items of interest that caught my eye over the holiday weekend:

• A pretty thorough argument that climate change is NOT increasing the number of Atlantic hurricanes (even though it appears to be raising their intensity and causing other sorts of storms).
• A move by Google that may radically change search and, thus, render obsolete many of the social marketing tactics used by agents and insurers.
• A really bad sign for commercial real estate, which insurers not only provide coverage for but invest in. 
• And, for fun, the latest high-profile glitches by generative AI. (Hint: Don't use Elmer's glue to keep the cheese from sliding off your pizza.) 

The Aon report says a major reason for the discrepancy between tangible and intangible assets is that intangible assets are too new and too volatile for insurers to be comfortable with them. 

"The insurance industry typically builds actuarial loss models based on decades of data," the report says. "However, due to the dynamic and fluid nature of intangible assets, we will never have decades worth of static intangible assets and risks data. Therefore, 'retain risk' versus 'transfer risk' decisions require fresh thinking."

How do we achieve that fresh thinking? The short answer in the report is: "Risk management typically considers frequency and severity of perils. With respect to intangible assets (especially artificial intelligence and cyber), we should add velocity of evolving risk profiles."

The long answer requires some serious engagement with the report. Here, I'll just cite a few more of the stats that show the serious underinsurance of intangible assets:

• "70 percent of respondents say their organizations are still not purchasing standalone cyber insurance coverage. The average limit for those organizations purchasing cyber insurance is $17 million." 
• "Only 35 percent of respondents say they have a trade secret theft insurance policy, and a similar percentage of respondents (34 percent) have an intellectual property liability policy."
• "Business disruption has a greater impact on information assets ($324 million) than on PP&E ($144 million)."

So, while the issue of information assets is truly tricky, the need is huge.

An article in Forbes, "Climate Change, Though Quite Real, Isn't Spawning More Hurricanes," says: "A search for answers about climate and hurricane connections reveals little or no evidence that major landfalling hurricanes in the Eastern United States have increased in frequency since data collection started around 1850."

The author says the data most commonly used suggest otherwise but says that we are simply better at detecting storms in the Atlantic and that they have become more memorable in the decades during which they've been named. He also acknowledges what is obvious to the insurance industry: that damages from hurricanes have soared, because at-risk areas are being built up and more people are moving into them. 

He adds that "there is some recent evidence that storms may be intensifying (i.e., increasing in severity) faster and traveling slower, which are subjects of active research."

The article challenged some of my assumptions and is an interesting read.

An article in Platformer describes the vast implications of an announcement Google made last week on providing more AI capabilities to search.  

"Google’s idea for the future of search," the articles says, "is to deliver ever more answers within its walled garden, collapsing projects that would once have required a host of visits to individual web pages into a single answer delivered within Google itself. The company’s AI-powered search results, which it calls Search Generative Experience, are coming to all users in the United States soon, Google announced.... By the end of 2024, they will appear at the top of results for 1 billion users." 

We've all seen this trend developing for some time. If you Google a matchup in the NBA playoffs, you get all the relevant information in a box: the time of the game, the win-loss record in the series, where it's broadcast, what the in-game score is if one is in progress and so on. No visit necessary to any other site. But Google is planning to go much further -- a slogan that appeared frequently at the announcement was, "Let Google do the Googling for you."  

That will be great for Google and often for the user, but all those sites that people used to click through to visit will be starved of traffic. Gartner Group predicts that traffic to the web from search engines will fall 25% by 2026.

That will mostly hit the publishing business, but it will also affect anyone -- including many carriers and agents -- that provide information online in the hope that people will click through to their sites to learn more. Why click through if Google's AI already tells you everything you want to know?

You've been warned.

An article in Bloomberg reports the sort of warning sign I've worried about and have been watching for in commercial real estate: 

"For the first time since the financial crisis, investors in top-rated bonds backed by commercial real estate debt are getting hit with losses. Buyers of the AAA portion of a $308 million note backed by the mortgage on a building in midtown Manhattan got back less than three-quarters of their original investment after the loan was sold at a steep discount. It’s the first such loss of the post-crisis era, says Barclays."

The five groups of lower-ranking creditors were wiped out, but what concerned Bloomberg most was that "the pain is reaching all the way up to top-ranked holders, overwhelming safeguards put in place to ensure their full repayment." Those losses are "a testament to how deeply distressed pockets of the US commercial real estate market have become. 'These losses,' warns Barclays strategist Lea Overby, 'may be a sign that the commercial real estate market is starting to hit rock bottom.'"

That is a concern for insurers on multiple levels. The most straightforward issue is for those that have invested in commercial real estate. But there will be ripple effects in other areas, too, for instance as workers' comp carriers have to adjust to the new world of hybrid work and as P&C carriers support construction companies as they turn many office buildings into apartments.

Finally, an article in the Washington Post documents a series of embarrassing errors by generative AI. The article says: 

"In search results, Google’s AI recently suggested mixing glue into pizza ingredients so the cheese doesn’t slide off. (Don’t do this.) It has previously said drinking plenty of urine can help you pass a kidney stone. (Don’t do this. And Google said it fixed this one.)

"Google’s AI said John F. Kennedy graduated from the University of Wisconsin at Madison in six different years, including 1993. It said no African countries start with the letter “K.” (Nope. Kenya.)"

The article explains at length where these stupid answers come from. For instance, the glue suggestion somehow came from a joking Reddit post from 11 years ago. Google's AI missed the joke part. 

But I mostly read the article to have a chuckle about that stupid AI... while it lets me.

Cheers,

Paul

It is no longer a matter of whether or not a business needs a customer portal. That question has been asked and answered with a resounding yes. And most businesses have conceded and developed one, though quality varies greatly. But the question remains, how good does your customer portal have to be?

When considering if a customer portal is good enough to satisfy customers, remember the competition is not only from other insurers. Rather, the portal has to stand up to scrutiny from consumers who are comparing it to other digital portals they use like Uber, Amazon, and Jet Blue— and they have high expectations. 68% of consumers surveyed say they wouldn’t use a company’s chatbot again if they had a poor experience and 32% of consumers agree they’d leave a brand they love after one bad experience, proving the criticality of getting digital portal services right the first time. 

Focus on the Right Parts of Your Digital Portal

With the seemingly endless customizations possible, insurers need to narrow their focus to the most critical components when it comes to designing a digital portal. Keeping customer data secure is non-negotiable. Other essential features customers expect from their portal include:

• Mobile web friendly 
• Easy, integrated payment capabilities
• Ability to submit and track a claim
• Data-driven product recommendations 
• Alerts and notifications for policy updates or severe weather warnings 

In addition to these top customer concerns, businesses should focus on these considerations when designing their portal:

Understanding Your Customer’s Needs

When developing a digital portal, consider the reasons why customers engage with companies, then use this information to prioritize the project. The top three reasons for customer inquiries are billing issues, support with a product or service, and order status. Start by adding or improving these aspects of the digital portal to add immediate value. 

Insurers can look at actual usage logs provided by most portals to determine what is most important to users and to gain insights into what may need to be corrected. Finally, insurers can also survey their customers to learn more about their needs and wants. 

By analyzing user interaction data within the portal, insurers can identify which capabilities are most used and valued by customers. This data-driven approach can lead to better decisions on where to invest future funds when refining the portal to offer more tangible user benefits. The balance between innovation and cost-efficiency helps to ensure strategic business goals are met while customers are satisfied.

With this knowledge, insurers can enhance their digital portal to meet these top needs first, optimizing the experiences customers use most often. By making these critical parts of the customer journey simple and intuitive, insurers will see more value than if they spent time improving parts of the portal that are rarely used. 

Flexibility

Flexibility is an important consideration when designing a portal. Consumers expect real-time experiences that provide value when they need it, so adapting to changing customer demands is critical. The ability to add new features or update existing ones very rapidly is an integral part of the flexibility customers expect. A configurable portal, along with regular vendor updates, allow an insurer to keep up with customer expectations. 

Research has shown 65% of customers expect the companies they do business with to adapt to their changing needs over time. Working with a vendor that offers continuous improvements through system upgrades can help ensure portals are flexible and adapt to changing consumer needs.

User Experience

Consumers expect a logical user experience. They are familiar with cool technology that is intuitive, easy, and functional — and they demand the same from their insurance portal experience. Any customer-facing portal must be easy to navigate and should match the look and feel of the insurer’s brand. 

Consumers demand mobile-friendly experiences and enjoy performing many different tasks on their smart phones, so any customer portal must be optimized for the mobile experience. Consumers pay bills, do research and chat with live agents and bots within other apps, so they expect this same functionality to work smoothly when logging into their insurer’s portal from their mobile device.

The hyper-personalization trend continues with a McKinsey study showing 71% of customers expect personalized interactions, like tailored content, customized recommendations, and personalized messages, and a full 76% are frustrated when that doesn’t happen. Configurable portal designs should allow insurers to personalize interactions for returning customers to enjoy. Insurers can accomplish this by knowing their customers’ wants and working with developers to include these personlizations. 

Single Interface 

Having an omnichannel experience means customers can decide how they want to interact with their insurer, having the freedom to choose different methods of communication at different times. But this experience should still be streamlined and optimized for the consumer, so even if an insurer operates on different core systems for different lines of business, the customer should see one integrated portal. They shouldn’t need to log out and back into different systems to accomplish their needs when a single interface provides a more streamlined customer experience. 

Balancing Cost and Capabilities

It never makes business sense to overspend on technology. However, insurers need to allocate a reasonable budget toward developing and maintaining their customer portal, and may need to overcome technical debt left from previous solutions. Some signs a business is grappling with technical debt include: 

• Slow release cycles, which may result from workarounds or complexities in the code that need to be managed each time a change is made. 
• Frequent outages or system crashes that may derive from shortcuts during development. 
• Challenges scaling the technology or integrating it with new tools as the original design did not account for growth. 
• Maintenance outweighs new development as IT resources are forced to spend more time fixing bugs than developing new features. 

Insurers with greater technical debt and those who have not kept up with digital trends will likely need to spend more to remain competitive. The trend toward digital self-service is only accelerating as consumers demand robust online capabilities. 

To calculate the return on investment for a digital portal, consider the increase in customer satisfaction and retention in ROI calculations. A good customer portal can significantly increase customer retention, with a recent survey showing customers who repeatedly use multiple self-service channels have a 25% higher retention rate. 

Balance the cost and the desire to add more features by prioritizing customers’ demands. With survey data and an understanding of what customers need, insurers can control costs by adding the right features and capabilities. And with a continuous feedback loop and regular vendor updates, the customer portal always remains current.

The Role of the Agent

The agent plays an important role in leveraging digital portals to help their clients through the purchase experience. Agents often help customers access the portal for the first time, helping them to set up and personalize the portal. Policyholders often need access to their ID cards or dec pages, and agents may help them access those documents. 

Policyholders often call their agent for help with filing a claim or inquiring about their claim status. Agents may also use digital portals to educate policyholders about their coverage, provide updated quotes, or offer recommendations based on their current coverage and personal needs. Agents may also help with basic updates for their clients, like adding an email address or updating employer information. 

Because the agent is often the first point of contact for policyholders when something goes wrong, insurers should invest in training agents on how to best use their portals. This best practice will help both the insurer and agent to sell more and spend less time with customer support. Providing incentives — for both insurers and policyholders —— will help encourage greater adoption. 

Portals can be valuable tools for agents to upsell policies and provide more personalized service to customers. Agents can add value by helping their policyholders navigate the portal to service their needs. 

How Good Does Your Customer Portal Have to Be?

In today's digital age, the quality of the customer portal can define a brand's success. To truly stand out, it must rival not only others in the insurance industry but also the best in any industry, as consumers compare their digital experiences universally. Staying ahead means embracing flexibility and continually refining the user experience based on actual customer feedback and emerging trends.

So how good does an insurer’s portal have to be? It must score well with consumers based on customer satisfaction surveys. Insurers should analyze how much the portal reduces their customer support costs, and decide if there is room for further improvements compared to industry benchmarks. Consider how the portal supports the agent network and whether it provides a positive experience that makes agents want to promote the insurer’s brand. Finally, benchmark how the portal stands up to competitors to be sure it compares favorably.

By investing in a customer portal that excels in these key areas, insurers can not only meet the high standards consumers now demand but also create lasting engagement that fosters consumer loyalty and drives growth.

Sponsored by: ITL Partner: insured.io

External Sources:

1. https://www.salesforce.com/content/dam/web/en_us/www/documents/research/State-of-the-Connected-Customer.pdf
2. https://www.pwc.com/us/en/advisory-services/publications/consumer-intelligence-series/pwc-consumer-intelligence-series-customer-experience.pdf 
3. https://www.forbes.com/sites/forbestechcouncil/2023/05/19/the-changing-face-of-customer-experience-in-the-self-service-economy/?sh=7bc6bc94545f
4. https://www.mckinsey.com/capabilities/growth-marketing-and-sales/our-insights/the-value-of-getting-personalization-right-or-wrong-is-multiplying

We’ve all read the headlines about major insurance carriers reducing their presence in certain markets. In California alone, 90% of companies either are not offering property insurance or have heavy restrictions, while 70% are not currently offering new plans. This trend raises important questions about how insurers can navigate profitability challenges without limiting customer options. The term double inflation is being heard, where not only is inflation causing continuing uncertainty, the industry’s pains have been exacerbated by social inflation.

Rising costs, unprecedented claims payouts, and consumer expectations are posing challenges for insurers. Many are struggling to navigate the combined pressures of  macroeconomic issues alongside escalating frequency and severity losses in personal lines. The situation demands P&C insurers adapt, focusing on profitability while delivering the relevant experiences consumers deserve and require.

One lever carriers have attempted to utilize in addressing profitability is filing for rate increases. However, there comes a point when requested rate increases are limited or denied by regulators, forcing carriers to make the difficult decision to stop offering policies. This leaves consumers with fewer choices, driving  premiums up for those that remain -  a death spiral by adverse selection.

Next Era Risk Identifier

A better approach is to leverage risk intelligence at an individual level, powered by behavioral deep learning. This type of predictive intelligence helps carriers prepare more effectively and avoid future profitability issues or adverse selection as more people shop for insurance. By incorporating individual-level risk selection insurers can identify consumers with the highest risk propensity before they even become policyholders.

In the latest report, AM Best projects a combined ratio of 100.7 for all P&C underwriting lines in 2024. With advanced intelligence available earlier in the buying process, insurers can guide consumers down different underwriting and pricing paths, evaluate critical financial implications and avoid the potential damage caused by the lack of early intelligence.

Enhancing Fairness Through Advanced Risk Selection

Fairness in insurance goes beyond industry standards to include a deeper understanding of the individual. Even if a customer is unbanked or has no credit history, carriers can still leverage behavioral data. Insuring people more appropriately, rather than exiting a market to alleviate profitability and rating constraints, is fairer and better serves all stakeholders, including customers.. 

A Better Approach for P&C Insurers in Tough Markets

Utilizing individualized predictive intelligence allows carriers to more precisely identify and quantify risks, placing policyholders into the appropriate tiers without the need for continuous premium increases or drastic market exits.

Furthermore, entering a market can also benefit from this cutting-edge individual-level intelligence. For example, a carrier entering a market like California, can use this approach to make informed decisions, identify customers who match their risk profile and gather better intelligence on potential agency partners for both the short and long term. 

Conclusion

Insurers have a responsibility to serve all stakeholders, even in volatile times. It’s our duty to keep the company sustainable, uphold promises to consumers, and deliver returns for investors or owners.

The challenges of achieving sustainable profitability amidst rising costs of claims, litigation, and social inflation require adapting to new or growing risks. By failing to utilize new technologies and intelligence, insurers miss the opportunity to build stronger companies and fulfill their obligations to stakeholders.. 

The key is more effective risk selection and assessment. Planning well and ensuring robust financial management are essential attributes for any company. The insurance industry, at its core, protects people and their dreams, providing peace of mind. By improving our practices and solidifying the industry, we leave a legacy we can all be proud of.

About Scott Ham

Scott Ham is the CEO of Pinpoint Predictive and was previously the President & CEO of Transamerica’s life, P&C and non-life business, where he provided strategic vision and leadership to global organization. At Transamerica he oversaw day-to-day operations and management of over 6,000 employees, $1.6 billion in new sales and over $6 billion in overall premium. Scott more recently was extensively involved with insurtech startups as a strategic advisor at McKinsey & Co, where he also led a Small Commercial Insurance SaaS platform that made possible real-time underwriting and pricing decisions through cutting-edge machine learning analytics and 3rd party data. Scott is joining Pinpoint to lead the company through a period of unprecedented growth.

Sponsored by ITL Partner: Pinpoint Predictive

No matter how much you say you protect yourself from fraud, you don’t know what server your last email came from and certainly don’t know where the next email you send goes.  

Trust is invisible yet somehow tangible in daily digital and electronic transactions.

This is not an insurance industry phenomenon, but because everyone has risk and almost everyone has insurance, yes, it is. In this respect, we insure tangible invisible transactions--sometimes our own operational work process, many times interactions with vendors, policyholders and claimants and other times actual named perils in a cyber policy. 

See also: How Technology Is Changing Fraud Detection

You can’t see a digital punch, but you can feel it

Trust issues can be like the wind. They can hit everywhere all at once at global scale, so digital identity is unworldly in every possible respect. That is a digital blind spot, and as we stumble toward modernization it is getting bigger.

The current digital, social, internet, connected, IoT-enabled world, and its surrounding cybersphere, is full of high-trust transactions as well as risky ones. The high-trust stuff is end-to-end encrypted with established security and verification protocols. The risky stuff is everything else to varying degrees.

Our legacy of paper and people process underpins our approach to technology adoption. And in a P&C world of people, places, vehicles, services and businesses, that means physical world thinking dominates our day-to-day practices. Digital is not that. 

Digital stands on trust alone. We won’t dive into AI fakes and deep cyber shenanigans here but focus on a more mundane topic -- identity capture.

The data we think of in the physical manner is usually captured in free form fields where data is simply entered as names, addresses, titles, numbers and such. Much is to establish identity and the ability to contact someone, which now may include digital labels like email or a website address.

While it is easy to assume a digital label relates to a physical presence, IT DOES NOT.

For example, one bad actor can have several variations of their legitimate name, address, phone number and email address. With a little effort, that same bad actor can create alternative additional addresses, business aliases, phone numbers and email addresses. Some are simple ways to hide their identity, others are fake data to make it impossible to contact them outside of their preferred channel. And each contributes to disaggregating the monetary impact you recognize at any level of perpetrator and their extended network of identities as well as those of their conspirators.

If you knew you were paying the same person multiple times for the same thing, or that a host of payments were all going to a fictitious identity, of course you would stop it. Because you don’t... you are fraud-friendly.  

Ghosts and mirages of every kind seem to exist in your data from marketing and advertising, to underwriting, pricing, schedules and claims. Some are data errors, others are intentional. Both contribute to doubt and mistrust, yet ennui and acceptance that the same data is in multiple systems yet inaccessible and unmatchable for most practical purposes.

If you fall in cyberspace, only headlines might catch you

Data, private information, system access, operation interruptions, trade secrets, ransom, reputation and other forms of value are also fungible, if perhaps latent, still a form of money. While there is a lot of non-financial motivation in some devious use cases, most people steal from insurance companies because they have money and don't protect it as well as a bank. Add to that all the manual processes and siloed data architectures, and we as an industry look like we deserve to be stolen from.

It's not like all the old fraud, waste and abuse menagerie of threats have gone away. And add to the list of “not to be trusted”: e-pickpockets, scammers, skimmers, online hackers, deceptive practices, fake claims, false identities, synthetic accounts, papermill billings, forgeries, data stealers, phishing, viruses, ransomware attacks, malicious actors, insider threats, corporate espionage, misinformation, malinformation, hostile governments in some cases or clever business email compromises and deepfakes of all varieties. All continue to make headlines.  

See also: Disaster Fraud — The Dark Side of Insurance Claims

Maintenance that matters

Without persisting entity resolution processes over your data, you make it easy for untrustworthy transactions to proliferate across your enterprise and throughout the insurance ecosystem.  

Savvy companies have multi-tiered supply chains of connectedness under persistent identification monitoring, as well as adding pre-fill and form flow application programming interfaces (APIs) to get the data right the first time while avoiding duplicate data entry everywhere. Ensemble data feeds augment analytic efforts while governance programs improve master data management.

It is a common issue everywhere as company after company is missing their digital transformation targets. It is as if we meant to take five years and do nothing more than move a few core applications to the cloud with little if any process change -- just a virtual mainframe lift & shift. Corporate-speak now calls that continuous modernization.

If you don’t know the businesses you do business with or underwrite, why not look them up using a digital entity resolution service? This outside-in master data management approach can then have all the digital attributes and technographic features and values kept current for your daily use.  

These data can also be historically accessible to show changes over time and monitor all sorts of necessary updates, changes and links. That last bit has added benefits of logged caching so you can forensically create feedback and plan to manage your relationships with digital entities based on their behavior and readiness to work with you over time -- at a renewal event or at a transaction event in real time.

If you don’t stay up to date on your vulnerabilities, how do you address them? Less obvious, yet equally on point, your connected partners and suppliers may not know their vulnerabilities (which are now yours, too). 

If you don’t know yourself, and you don’t know others, your “unknown unknowns” is a much larger window than you realize. No one can hear an AI scream in cyberspace -- but those voices all say, “send money.”

Catastrophic financial events and operational and reputational compromises occur with long lingering periods of latent system access to culprits. This will be easier than ever with newer AI capabilities for even the most novice of bad actors. 

Be savvy. Invest in a full-spectrum entity resolution service to power trust and to repel fraud. Don’t be fraud-friendly.

Florida is one of America’s most disaster-prone states, especially vulnerable to hurricanes due to its location between the Atlantic Ocean and the Gulf of Mexico, so it should come as no surprise that Florida ranks fifth in major disasters since 1953. 160 events have hit the Sunshine State in this 71-year period.

With the notable exception of 1992’s Category 5 Hurricane Andrew, the most destructive hurricane to ever hit Florida in terms of structures damaged or destroyed, the state was spared major hurricane-driven losses across several decades in the 20th century. This was even as it became the country’s third-most-populated state and exposure increased year-on-year as population centers expanded.

However, in 2004, what is remembered today as the “mean season,” four hurricanes – Charley, Frances, Ivan and Jeanne – struck the state in a single year, one after the other. 

This was the first such season in the U.S. since 1886. In just six weeks, those four hurricanes caused 125 deaths, damaged hundreds of thousands of properties, left millions without power for weeks and resulted in around $40 billion in property damages in Florida alone. 

While the sheer destruction of Hurricane Katrina might exert a stronger pull on our collective imaginations, given that it’s now 20 years since those terrible storms in Florida, it’s worth asking what the industry has learned since then.

See also: The Hurricane Forecast Keeps Getting Darker

The many challenges of natural catastrophe response

It’s important to recognize the increasing scale of the problem. Florida has suffered more hurricanes than any other U.S. state, and the U.S. Environmental Defense Fund says they are becoming more unpredictable and causing more flooding.

Policies can offer inadequate coverage. Insurers may refuse to cover many homes and businesses in particularly hard-hit areas. And, of course, claims can take months to settle, leading to bankruptcy for many businesses and great distress for domestic policyholders.   

Important lessons have been learned

But society is more prepared overall, and the insurance industry, in turn, has upped its game regarding hurricane event response. These changes include:

• Publicly underwritten property insurance. Some of the changes in Florida predate 2004. They came about in response to 1992’s Hurricane Andrew, which drove 16 insurance companies into insolvency and caused several others to leave the Florida home insurance market altogether. As a result, in the 1990s, the state of Florida created the Florida Windstorm Underwriting Association (FWUA), which provided coastal residents with wind-only coverage, along with the Florida Residential Property and Casualty Joint Underwriting Association (JUA). These two combined in 2002 to form the Citizens Property Insurance Corporation, a not-for-profit, tax-exempt government entity to provide property insurance to eligible Florida property owners unable to find insurance coverage in the private market. 
• Cat modeling. A key change since 2004 has been the industry’s approach to catastrophe (Cat) modeling. Once the preserve of reinsurance buyers, Cat modeling and analytics are now widely adopted across the industry. Virtually every risk with catastrophe exposure is now run through one or more models to consider potential loss scenarios, while commercial policyholders will often seek to understand their Cat exposures so they can negotiate with insurers, according to Marsh. 
• Increased focus on data quality. We’ve also seen a massively increased focus on data quality. For example, in the wake of Hurricane Katrina, the industry noticed a significant mismatch in modeled and unmodeled insurance losses because the Cat models of the time overestimated the impact of wind damage and underestimated the damage from flooding and storm surge. Initial damage estimates for Hurricane Katrina represented only about a quarter of the final tally. This issue remains to this day. In the 2000s, credit rating agencies also started looking at how insurers and reinsurers used Cat modeling in their capital management strategies. As Marsh puts it, credit ratings agencies’ attention “sharpened insurers’ focus on accurate risk modeling.”
• Better understanding of the scope of coverage. In the wake of 2004 and particularly 2005, many businesses were shocked to learn that they weren’t covered for storm surge. Yet storm surge was responsible for much of the damage post-Hurricane Katrina—even more so in New Orleans compared with Florida. Many disputes ended up in court, and insurers had to pay out for significant extra losses. Since then, many policyholders have become more careful about the coverage they purchase, while insurers have tightened their policy wordings. Even so, the possibility of misunderstanding, underinsurance and expensive litigation persists. 
• Business continuity and crisis management. The mid-2000s hurricanes also increase the industry’s – and policyholders’ – awareness of the need for business continuity, crisis management and mitigation. This is partly a response to the rising costs of coverage and advances in technologies that can sense and track storm damage and issue more timely warnings ahead of storms making landfall. 

Building on the lessons of the last 20 years

The history of the insurance industry’s hurricane modeling, mitigation and claims response shows an industry keen to learn and progress but also one that is still hindered by the scale of the issues and the limitations of technology. For example, a keen awareness of the value of accurate data is of little use if the data available is not accurate enough to deliver an actionable response.

Fortunately, developments in both new technologies and approaches are now available to address this and leverage the value of what’s been learned over the last 20 years. For instance, insurers are now ready to embrace a more data-driven approach to event response and claims. 

See also: Geomagnetic Storm for Insurance?

What’s new and making a difference?

Solutions now exist that empower insurers with timely and accurate data and intelligence to respond swiftly and effectively to hurricanes and other catastrophes. Using near real-time, multi-sourced data, such as satellite, aircraft, drone, IoT and on-the-ground vehicle-based imagery overlaid with human insights, now delivers actionable intelligence. 

With this data, loss-reserving teams gain a rapid quantification for events, at both individual and portfolio level. Exposure managers benefit from the ability to refine ultimate loss estimates to a finer degree, streamline processes and optimize resource allocation. 

Claims managers gain rapid on-site assessments immediately following catastrophic events, even in hard-to-reach areas. This expedites claims decisions and facilitates efficient on-ground resource management, including triage and oversight. 

Last but not least, underwriting teams gain a better understanding of the quantum of loss and a more accurate assessment of risk for future pricing or risk acceptance.

Of course, the speed and accuracy of this data mean that, in addition to getting a more accurate assessment of the damage as it happens and a faster claims response time, insurers can also get an accurate advanced picture of claims, even before first notice of loss, giving them a high level of reserving accuracy and oversight of how hurricanes are likely to affect their portfolio.

Many forward-thinking carriers, reinsurers and their clients already benefit from these advances, building on the lessons learned over the last 20 years of increasing storm damage. With solutions like these available, it will be fascinating to see what lessons the leading insurers of the next 20 years will learn from the hurricane seasons that lie in wait. 

Life insurance distributors are more important now than ever before! They play a pivotal role in the industry, acting as a bridge between carriers, clients and potential policyholders. However, despite technological advancements and an abundance of solutions, many distributors continue to grapple with outdated manual processes that impede efficiency and hinder growth. From commission calculation to policy submission tracking and sales follow-ups, these agency-critical tasks are often mired in ad hoc methods and manual, spreadsheet-based workflows.

Manual processes, a lack of centralized data and ineffective commissions processes are all challenges that not only consume valuable time and resources but also introduce a significant risk of human error, leading to dissatisfaction among advisers and clients alike. These challenges can affect an agency’s ability to function and can hinder industry-wide success.

In the following sections, we’ll take a closer look at all three of these critical life insurance agency management challenges and detail how they can be resolved. 

Challenge #1 – Manual processes degrade visibility into the policy approval process. 

Managing new business applications as they move from adviser to distributor to carrier is a process that still relies on too many manual steps. This ultimately delays the time to issuance and creates frustration among clients, a sentiment that then gets passed through the rest of the chain, with advisers flustered over being left in the dark about where an application is in the process and why it’s been held up. Manual workflows are more error-prone, not often well-documented or updated and filled with inefficiencies, which create an abundance of preventable frustration. 

This is an issue that can easily be addressed through technology. Many other industries have already digitized similar manual processes. It’s time for life insurance carriers and agencies to catch up by accelerating their adoption of integrated solutions that streamline the application process and increase policy status visibility. 

Challenge #2 – Lack of centralized data causes inefficiencies.

Unfortunately, many distributors still don’t have automated access to the carrier data that’s vital to their business. That lack damages their ability to track and manage policy submission status. And when manual processes must be used to move data where it needs to go, inefficiencies multiply.

For advisers, the lack of centralized client data from multiple carriers makes it difficult and time-consuming to get a full 360-degree picture of a client’s insurance products. Often, advisers need to log in to each carrier’s portal and flip back and forth to find the information they need, wasting time that could be spent on solving client challenges, acquiring new business or providing essential client consultation support. 

The clear solution to these challenges is to centralize all carrier data feeds in the agency management systems to provide an exhaustive view of a client’s insurance portfolio and build on the visibility created by automating manual agency processes. 

Challenge #3 – Commission frustrations erode financial adviser trust.

Commissions are a continuing sore spot for advisers. Quick and accurate payment isn’t as universal as one might think. When distributors and carriers don’t share commission feeds, and distributors lack robust commission management systems, significant obstacles can arise. 

According to Equisoft-commissioned Forrester research, one of the top four challenging aspects of a broker's relationship with a carrier is their inability to track compensation and performance in real time. Only 14% of broker respondents said digital commission accounting capabilities are fully integrated into their agency management systems, and 11% of carriers said it takes them more than 60 days to pay brokers. Additionally, brokers said that carriers’ compensation plans are overly complicated. 

Administering complex commission splits among all parties involved in a sale can be hard, and reconciling expected commissions with actual payouts is also challenging. But advisoers are just like everyone else. They expect to have transparency and visibility into their commissions and payments, and they’re frustrated by any errors, delays or complications. 

To win adviser trust, build stronger relationships and attract new advisers into the industry, distributors need to take back control of their commissions by implementing robust systems that automatically calculate and pay advisers — accurately and on time.

The solution: an effective agency management system, complete with a data management process.

Distributors’ unique position in the insurance ecosystem makes it essential for them to have a panoramic view of data from all sources. They need to be able to access, leverage and present a comprehensive data overview to give advisers and stakeholders transparency into every step of the policy lifecycle. To solve the issues detailed above and enable agency staff to focus on higher-value, customer-centric activities, life insurance distributors must tackle their challenges head on with an agency management system (AMS) and a strong data management strategy. 

Not only does an AMS provide a full scope of prospect and client data to help advisers streamline their process and manage the service aspect of their client interactions, but when leveraged properly, the system can provide updates on applications in underwriting, allowing advisers to manage client expectations. An AMS can also help open opportunities to cross-sell and up-sell and enhance compliance actions like client review meetings. 

See also: Predictions for Life Insurance in 2024

State-of-the-art agency management starts with centralized data feeds and good data management.

The data that distributors need to digitally transform their operations and increase efficiency and adviser effectiveness exists; the issue is consolidating it, getting it into the system and being able to share it with all the other necessary stakeholders. 

For some insurance distributors, their data’s true potential isn’t being harnessed because they’re continuing to operate with an outdated mindset. In some cases, even with an AMS in place, they’re still relying on the same types of manual processes they have always used, even though technology now makes it possible to automate and streamline many workflows. 

New business models and systems provide the opportunity for insurance distributors to re-think their approach to operations and optimize their organizations. That means leaving behind legacy thinking. Distributors should ask themselves how they can eliminate old processes, like data entry and manual review, and shift their resources to higher-value work within their organization.

Accessing a consolidated 360-degree view of clients’ data doesn’t need to be difficult. It just takes the adoption of an agency management system that has built in integrations to the relevant carrier feeds and rich data sources from all value chain stakeholders. 

See also: Revolutionizing Life Insurance Uptake in Younger Markets

A new approach to centralizing data and overseeing agency management is needed. 

To compete in the evolving independent channel and current digital era, distributors need to find AMS solutions that will speed the digitalization of their business. They need solutions that automate all core processes, enhance transparency and productivity among agents and staff, reduce errors and costs and create efficiencies. 

AMS solutions can be management workhorses that give distributors complete visibility into data and activity throughout the value chain. But this can only work when the AMS is coupled with a strong data management process. Implementing a comprehensive approach to centralizing, storing, and managing data will position distributors for success. 

Deterioration of accident year 2016-2019 reserves

The adequacy of reserves is a critical issue for the property and casualty (P&C) insurance industry, as it affects the profitability, solvency and reputation of insurers. Reserves are estimates of future liabilities based on past claim experience and actuarial assumptions. These estimates are subject to uncertainty and may change over time due to various factors, such as changes in claim frequency and severity, changes in legal environment, changes in social attitudes and changes in economic conditions. These factors may cause the actual payments to differ from the expected payments, resulting in reserve development, which can be either favorable or unfavorable.

One of the factors that has been widely discussed in recent years is social inflation, also called legal system abuse, which refers to the phenomenon of rising litigation costs, higher jury awards and broader contract interpretations that increase insurers' liabilities beyond their original expectations. Social inflation can have a significant impact on the reserve adequacy of P&C segments, especially in lines of business that involve long-tail claims, such as liability lines. In this article, we analyze the trends and patterns of reserve development in P&C segments, with a focus on the effects of social inflation and other factors that affect the adequacy of reserves. We will focus on the causes of adverse reserve development in the 2016-2019 accident years and what this means for future development in more recent accident years.

Adverse reserve development in the 2016-2019 accident years of liability segments could be a precursor to the deterioration of 2020 and subsequent. As can be seen in Figure 1, the booked net ultimate loss ratios in the Other Liability Occurrence line of business for the U.S. P&C industry for accident years 2016-2019 have developed adversely every calendar year since they were initially established (the initially established reserves are represented by the yellow bar at 12 months of development in Figures 1 to 3). The net ultimate loss and defense and cost containment expense (DCCE) ratios for the Other Liability Occurrence line of business have increased six to 10 loss ratio points depending on the accident year between the initial estimate after 12 months of development and the most recent estimate at year-end 2023. Other Liability Occurrence is not alone in experiencing development in accident years 2016 through 2019. Other Liability Claims Made has also seen almost universal adverse development in report years 2016 through 2019, with loss and DCCE ratios in report years 2018 and 2019 developing more than 13% and 8%, respectively. See Figure 2. The Commercial Auto Liability industry net loss and DCCE ratios for the 2016-2019 accident years have seen strengthening of over 10% since they were initially established. See Figure 3. Our analysis focused on industry aggregate net results, as net results are currently available. We suspect that direct results will display even more adverse development due to nuclear verdicts that would have a greater impact on the reinsurance layer. Direct results are not currently available but will be available in a month. 

See also: Insurers' Social Inflation Problem

Figure 1: Aggregated Other Liability Occurrence Industry Data From 2016-2023 Year-End Schedule Ps

Figure 2: Aggregated Other Liability Claims Made Industry Data From 2016-2023 Year-End Schedule Ps

Figure 3: Aggregated Commercial Auto Liability Industry Data From 2016-2023 Year-End Schedule Ps

Some insurers’ press releases include comments on social inflation increasing prior accident/report years’ reserves. When commenting on 2023 financial results, Vince Tizzio, president and CEO of AXIS Capital, said, “The decisive actions we are taking this quarter address reserve development that is predominantly related to 2019 and older accident years, as current economic and social inflation trends impact the overall U.S. casualty market. We undertook a rigorous review that included an examination of trend assumptions, emerging development patterns, new industry data and current legal trends.” AXIS Capital’s president is not the only one pointing to social inflation. Everest Re’s CEO, Juan Andrade, noted that Everest Re strengthened insurance segment reserves by $392 million for the impact of social inflation on long-tail lines with a focus on the 2016-2019 accident years. While not all point to social inflation as a root cause, companies are noting latent development in the 2016-2019 accident/report years in their press releases. 

See also: What to Do About Rising Inflation?

Social inflation – the driver of latent reserve development

The large development of more seasoned reserves stems at least in part from components of social inflation such as juror sentiments, nuclear verdicts, third-party litigation funding and evolving legal tactics.

Juror sentiments and nuclear verdicts

The 2007-2008 global financial crisis damaged people's trust in corporations, and many people now want to see big corporations pay more for their actions. This has led to higher-severity claims, especially in lines of business where lawsuits can be framed as a corporation against an individual. We are defining nuclear verdicts as those with a settlement over $10 million. Nearly two-thirds of the nuclear verdicts in personal injury and wrongful death cases studied by the U.S. Chamber of Commerce Institute for Legal Reform over a 10-year period came from product liability (24%), auto accidents (23%), and medical liability (21%) cases. Commercial Auto Liability has experienced nuclear verdicts for many years now; however, 2021 brought a new landmark, a $1 billion wrongful death verdict against two trucking companies found to be negligent. As nuclear verdicts become more and more prevalent, nuclear award amounts are reported by the media, making very large verdicts feel more mainstream to potential jurors regardless of whether the plaintiff is able to collect the full verdict amount. This rise of nuclear verdicts is contributing to rising social inflation. 

Third-party litigation funding

Jury attitudes are not the only factor in the increase in nuclear verdicts. Third-party litigation funding (TPLF) also continues to drive up the cost of claims. TPLF is when an external party invests capital in the litigation process in exchange for a portion of the settlement amount. The rise of TPLF has created larger verdicts as plaintiffs are able to pursue cases with stronger funding for longer periods. Just between 2019 and 2022, the TPLF market grew by 44% in the U.S. This market growth shows no signs of slowing, which will likely compound the upward pressure on liability severities. According to Swiss Re, TPLF-funded cases generated average internal rates of return of between 20% and 35% in 2019 and 2020. The rates of return on TPLF outperform those of risky asset classes such as venture capital and private equity. The TPLF market rose to $17 billion in 2021, with over 50% of that occurring in the U.S. Nine states have pending legislation regarding TPLF. The pending legislation in many states is aimed at requiring disclosure of TPLF to a jury as well as consumer protections. While this is a start, it may be quite some time before we see TPLF legislation soften the impact of TPLF on claim severity. TPLF thrives in environments where the plaintiff can be seen as the little guy against a big corporation, such as Commercial Auto and Professional Liability lines. 

Evolving legal tactics – a defense attorney’s perspective

Inflation—both social and economic—continues to drive settlements and judgments higher. Although inflation seems to have cooled from its 2022 high, it continues to take a toll on consumer sentiment and the cost of resolving claims. Law firms, experts and vendors are still increasing hourly rates to keep up with inflation, which serves to drive up the projected cost of defense beyond initially projected budgets. Social inflation is going hand in hand with that and also driving up costs. As nuclear verdicts desensitize potential jurors, we have seen plaintiffs’ firms acting more bullish about jury trials and the potential for excess of policy judgments. Plaintiffs also seem to be using inflation to increase their models of alleged damages to put pressure on pretrial settlements. These phenomena are part of the cause of a substantial increase in claim severity in professional liability lines.

In light of plaintiffs’ increased expectations, we are seeing evidence that it is harder to resolve professional liability claims, as plaintiffs seek larger monetary compensation than they have in the past. Mediators have reported that it is rare these days for complex professional liability cases to settle early, before considerable expense is incurred. Why there is a sudden divergence in case assessments is unclear, but what it means is that cases are dragging on for longer than they have in the past, especially large, eight- and nine-figure cases, where plaintiffs are refusing to settle early for fear of leaving any money on the table. This is especially in line with cases involving failed or bankrupt companies, as investor and creditor losses can be substantial and lawyers and accountants are viewed as ”insurance policies” when things go wrong. Investors who have lost money in bad deals often feel entitled to compensation from professional advisers, even when they struggle to link any acts by the professional advisors to the ultimate losses. Further, the judiciary seems disinclined to accept strong legal defenses such as in pari delicto and grant dispositive motions. What this means is that more cases are going all the way through discovery and into trial—or at least to the courthouse steps—substantially increasing the defense spending and ultimate cost of a claim.

Furthermore, regulators seem to be affecting claim inflation, as well. According to a recent Cornerstone Research article, the number of accounting and auditing enforcement actions increased 22% in fiscal year 2023 over 2022. This is affecting publicly traded companies as well as their professional service providers, and there has been a marked increase in claim notifications involving claims, subpoenas, inquiries or other actions by regulators against professionals. Although fines and penalties from such actions are not always covered by professional liability policies, the cost of investigating and defending these claims is, and that is also increasing the overall cost of liability claims. 

What does this mean for future reserves?

The adverse development trends in these liability lines lead us to question whether we will see similar deterioration in reserves for the 2020-2023 accident years. Unfortunately, the adverse reserve development may not be limited to the 2016-2019 accident/report years. Many actuarial methods rely on the loss ratios or ultimate losses from more mature accident/report years to predict the ultimate losses on recent accident/report years, where very little is known from actual claim data. Therefore, the deterioration of the 2016-2019 reserves could mean that more recent years might also undergo a similar period of adverse development, as pricing estimates in more recent years initially relied on the 2016-2019 years. The Other Liability Occurrence industry-weighted average booked loss and DCCE ratio at 12 months of development for the 2020 through 2023 accident years is 64%, which is slightly below where the weighted average 2016 through 2019 booked net ultimate loss and DCCE ratio started out at 12 months of development (65%) and significantly below where the 2016 through 2019 booked net ultimate loss and DCCE ratios were at year-end 2023 (72%). Likewise, Other Liability Claims Made and Commercial Auto Liability also have initially established weighted-average loss and DCCE ratios for the 2020-2023 period that are similar in magnitude to the initially established weighted-average loss and DCCE ratios from 2016-2019, which have developed significantly since their establishment. This is exhibited in Figure 4. There have been significant rate increases over the past few years, which might mean the 2020-2023 ultimate loss ratios are not overly optimistic. However, only time will tell where loss ratios will ultimately settle.

See also: A Tipping Point for P&C Litigation 

Figure 4: Net Ultimate Loss and DCCE Ratios by Accident/Report Year at 12 months of Development and at 12/31/2023 (from 2016-2023 year-end Schedule Ps)

As of year-end 2023, accident year 2020 for Other Liability Occurrence, Other Liability Claims Made, and Commercial Auto Liability have seen adverse development in the last 12 months. However, as of year-end 2023, the 2021 and subsequent net ultimate loss and DCCE ratios for Other Liability Occurrence and Other Liability Claims Made have experienced negligible adverse development. The same cannot be said of Commercial Auto Liability which has already seen its 2021 loss and DCCE ratios deteriorate from 69% to 71%, and its 2022 ultimate loss and DCCE ratios deteriorate from 70% to 72%. Figure 5 displays the development of the Other Liability Occurrence, Other Liability Claims Made, and Commercial Auto Liability net ultimate loss and DCCE ratios over the past 12 months.

Figure 5: Development of Net Ultimate Loss and DCCE Ratios by Accident/Report Year Between 12/31/2022 and 12/31/2023 (from 2022 and 2023 year-end Schedule Ps)

Juror sentiments, nuclear verdicts, TPLF and evolving legal tactics have given rise to social inflation. Social inflation’s influence has been prevalent in the Other Liability Occurrence, Other Liability Claims Made and Commercial Auto Liability lines of business. In recent years, these lines of business have seen a deterioration of the 2016-2019 net ultimate loss and DCCE ratios. Only time will confirm whether more recent accident/report years will deteriorate under the pressure of social inflation as the 2016-2019 accident/report years have deteriorated.