Tag Archives: government

Politics of Guns and Workplace Safety

The politics of guns in America are volatile, divisive and passionate, yet the risks that firearms present to organizations every day do not depend on the politics of the moment. Employers must deal with the reality of gun violence in America. A RIMS 2016 session discussed the legal aspects of what organizations can do and the practical implications of creating a firearms risk management program.

Speakers were:

  • Michael Lowry, attorney, Thorndal Armstrong Delk Balkenbush & Eisinger
  • Danielle Goodgion, director of human resources, Texas de Brazil

What Risks Do Firearms Pose?

OSHA states that an employer must provide “employment and a place of employment which are free from recognized hazards that are causing or are likely to cause death or serious physical harm to his employees.”

See Also: Active Shooter Scenarios

There are several risks to your organization, including:

  • Operations can halt in the case of a shooting. You have issues like police investigations and possibly injured employees.
  • Workers’ compensation will kick in if employees become injured.
  • General liability will be activated to cover injuries of non-employees.
  • Reputational risks are possibly the largest risks. You do not want your business associated with a violent act.

Most think that the Second Amendment bars private businesses from banning guns, but this is incorrect. The amendment applies to governments, not private homes and businesses.

Some employers react by posting signs banning all guns. This simple sign can be a recipe for disaster for several reasons:

  • Have you created a duty? If you post a sign, you have officially created a duty.
  • Why did you create this policy?
  • What are you doing to enforce this policy? Did you have a manual? Did you put up X-ray detectors? Probably not. You have to be able to prove you are enforcing the policy if you post a sign.
  • Did you train your employees to enforce this policy? If this policy is not enforced, a person might be injured by a firearm on your property.

“Bring Your Gun to Work” Laws

This is not a good idea. According to the law, business may not bar a person who is legally entitled to possess a firearm from possessing a firearm, part of a firearm, ammunition or ammunition component in a vehicle on the property.

In Kentucky, an employee may retrieve the firearm in the case of self-defense, defense of another, defense of property or as authorized by the owner, lessee or occupant of the property. In Florida, the employer has been held liable for civil damages if it takes action against an employee exercising this right.

Reputational risks also can apply. You could either get special interest groups protesting against your business or people who refuse to do business with you.

The Middle Ground

It is best to create a policy. Even if you support the right to bear arms, you can do it subtly. There are several provisions on what type of carry you allow and what signs are required. Business owners also do have the ability to allow no guns on the premises.

See Also: Broader Approach to Workplace Violence

Your policy should describe exactly how to approach a customer if an employee sees a weapon, including who should approach the customer, what to say and the steps to take to address the issue. Training is important.

Why Train?

  • Researchers from the Harvard School of Public Health and Northeastern University found the rate of mass shootings has tripled since 2011.
  • In 2014, an FBI study considered 160 events between 2000 and 2013. 70% occurred in business or educational setting.
  • In 2000-2006, the annual average rate was 6.4 shootings. That jumped to 16.4 in 2007-2014.

This is clearly a problem that is getting worse, so why is training rarely provided? Places of business are a target – especially retail, restaurants and businesses in the hospitality industry. The active shooter wants soft, easy targets in large, open, public and crowded areas, and the goal is to kill indiscriminately. If your business is doing well with large crowds, you are a soft target.

Active Shooter Resources

To learn how to manage this risk, you can find resources from:

  • Law enforcement
  • Insurance partners
  • Government
  • Outside experts
  • Legal
  • Human Resources

Online resources include:

How to Use All the New Data

Most people who purchase an insurance policy are faced with the daunting task of filling out an extensive application. The insurance company – either directly or through an intermediary – asks a myriad of questions about the “risk” for which insurance is being sought. The data requested includes information about the entity seeking to purchase insurance, the nature of the risk, prior loss experience and the amount of coverage requested. Insurers may supplement that information with a limited amount of external data such as motor vehicle records and credit scores. The majority of information used to inform the valuation process, however, has been provided by the applicant. This approach is much like turning off your satellite and data-driven GPS navigation system to ask a local for directions.

According to the EMC Digital Universe with research and analysis by IDC in 2014, the digital universe is “doubling in size every two years, and by 2020 the digital universe – the data we create and copy annually – will reach 44 zettabytes.” That explosion in the information ecosystem expands the data potentially available to insurers and the value they can provide to their clients. But it requires new analytical tools and approaches to unlock the value. The resulting benefits can be grouped generally into two categories:

  • Providing Risk Insights: Mining a wider variety of data sources yields valuable risk insights more quickly
  • Improving Customer Experience: Improving the origination policy service and claims processes through technology enhances client satisfaction

For each of these areas, I’ll highlight a vision for a better client value proposition, identify some of the foundational work that is used to deliver that value and flesh out some of the tools needed to realize this potential.

Risk Insights
Insurance professionals have expertise that gives them insight into the core drivers of risk. From there, they have the opportunity to identify existing data that will help them understand the evolving risk landscape or identify data that could be captured with today’s technology. One can see the potential value of coupling an insurer’s own data with that from various currently available sources:

  • Research findings from universities are almost universally available digitally, and these can provide deep insights into risk.
  • Publicly available data on marine vessel position can be used to provide valuable insights to shippers regarding potentially hazardous routes and ports, from both a hull and cargo perspective.
  • Satellite imagery can be used to assess everything from damage after a storm to proximity of other structures to the ground water levels, providing a wealth of insights into risk.

The list of potential sources is impressive, limited in some sense only by our imagination.

When using the broad digital landscape to understand risk — say, exposure to a potentially harmful chemical — we know that two important aspects to consider are scientific evidence and the legal landscape. Historically, insurers would have relied on expert judgment to assess these risks, but in a world where court proceedings and academic literature are both digitized, we can do better, using analytical approaches that move beyond those generally employed.

Praedicat is a company doing pioneering work in this field that is deriving deep insights by systematically and electronically evaluating evidence from various sources. According to the CEO Dr. Robert Reville, “Our success did not come solely from our ability to mine data bases and create meta data, which many companies today can do. While that work was complex, given the myriad of text-based data sources, others could have done that work. What we do that is unique is overlay an underlying model of the evolution of science, the legal process and the dynamics of litigation that we created from the domain expertise of our experts to provide context that allows us to create useful information from that data built to convert the metadata into quantitative risk metrics ready to guide decisions.”

The key point is that if the insurance industry wants to generate insights of value to clients, identifying or creating valuable data sources is necessary, but making sense of it all requires a mental model to provide relevance to the data. The work of Praedicat, and others like it, should not stop on the underwriter’s desktop. One underexploited value of the insurance industry is to provide insights into risk that gives clients the ability to fundamentally change their own destiny. Accordingly, advances in analytics enable a deeper value proposition for those insurers willing to take the leap.

Customer Experience
Requiring clients to provide copious amounts of application data in this information age is unnecessary and burdensome. I contrast the experience of many insurance purchasers with my own experience as a credit card customer. I, like thousands of other consumers, routinely receive “preapproved” offers in the mail from credit card companies soliciting my business. However appealing it may be to interpret this phenomenon as a benevolent gesture of trust, I know I have found myself on the receiving end of a lending process whereby banks efficiently employ available data ecosystems to gather insights that allow the assessment of risk without ever needing to ask me a single question before extending an offer. I contrast this with my experience as an insurance purchaser, where I fill out lengthy applications, providing information that could be gained from readily available government data, satellite imagery or a litany of other sources.

Imagine a time when much of the insurance buying process is inverted, beginning with an offer for coverage, rather than a lengthy application and quote request. In that future, an insurer provides both an assessment of the risks faced, mitigations that could be undertaken (and the savings associated), along with the price it would charge.

While no doubt more client-friendly, is such a structure possible? As Louis Bode, former senior enterprise architect and solution architect manager at Great American Insurance group and current CSO of a new startup in stealth-mode observes, “The insurance industry will be challenged to assimilate and digest the fire hose of big data needed to achieve ease of use and more powerful data analytics.”

According to Bode, “Two elements that will be most important for us as an industry will be to 1) ensure our data is good through a process of dynamic data scoring; and 2) utilize algorithmic risk determination to break down the large amounts of data into meaningful granular risk indexes.” Bode predicts “a future where insurers will be able to underwrite policies more easily, more quickly and with less human touch than ever imagined.”

The potential to use a broader array of data sources to improve customer experience extends well beyond the origination process. Imagine crowdsourcing in real time the analysis of images to an area affected by a natural disaster, getting real time insights into where to send adjusters before a claim is submitted. Tomnod is already crowdsourcing the kinds of analysis that would make this possible. Or imagine being able to settle an automobile claim by simply snapping a picture and getting an estimate in real time. Tractable is already enabling that enhanced level of customer experience.

The future for insurance clients is bright. Data and analytics will enable insurers to deliver more value to clients, not for additional fees, but as a fundamental part of the value they provide. Clients can, and should, demand more from their insurance experience. Current players will deliver or be replaced by those who can.

I’d like to finish with a brief, three-question poll to see how well readers think the industry is performing in its delivery of value through data and analytics to clients. Here is my google forms survey.

The Biggest Medicare Fraud Cases of 2015

Medicare does not keep records of how much it loses annually because of fraud, but the FBI, which oversees the investigation and prosecution of those alleged to have participated in fraud, estimates that 3% to 10% of all Medicare billings are fraudulent. The FBI task force believes that healthcare fraud costs taxpayers “tens of billions of dollars a year.”

Here is an overview of some of the biggest Medicare fraud cases of 2015:

  1. In June 2015, 243 healthcare providers across the country were charged individually with Medicare fraud. This was the largest-ever coordinated takedown in the history of the National Medicare Fraud Strike Force history. Doctors, nurses, pharmacists, home health workers and other healthcare professionals were all indicted for falsely billing Medicare for approximately $712 million in various fraudulent schemes. The healthcare providers allegedly:
  • Billed for services that were not rendered
  • Charged for equipment that was never delivered
  • Billed for care that was not needed

Specific criminal charges include:

  • Conspiracy to commit healthcare fraud
  • Violating anti-kickback statutes
  • Money laundering
  • Identity theft

Healthcare providers nationally were included in the sweep of the task force. Charges were brought in Texas, Louisiana, Florida, California, New York and elsewhere. The defendants face years in prison in addition to having their assets forfeited to the government and having to repay the amount of money they fraudulently obtained.

In a press release announcing the takedown, the attorney general for the U.S. expressed the commitment of the Department of Justice to continue its “focus on preventing wrongdoing and prosecuting those whose criminal activity drives up medical costs and jeopardizes a system that our citizens trust with their lives.”

  1. Also in June 2015, the former president of a Houston hospital was sentenced to more than 40 years in federal prison and ordered to pay $46.8 million in restitution to Medicare. His son and two other co-conspirators were also found guilty of receiving kickbacks, conspiracy to commit Medicare fraud and money laundering. The scheme involved billing Medicare for psychiatric services that were never provided to patients. The total amount of money fraudulently received by all participants was estimated to equal $158 million.
  1. In October 2015, Millennium Health in Boston, formerly Millennium Laboratories, admitted to billing Medicare and other governmental healthcare programs more than $256 million for laboratory tests that were either unnecessary or never actually performed. The lab also provided kickbacks to physicians for referring patients for testing. Millennium, with headquarters in San Diego, is one of the largest urine-testing laboratories in the U.S. According to the Massachusetts U.S. attorney, “Millennium promoted indiscriminate and unnecessary testing that increased medical costs without serving patients’ real medical needs. A laboratory which knowingly conducts medically unnecessary testing operates unlawfully and squanders our precious federal health care resources.”
  1. In August 2015, a New York man who operated several healthcare clinics for treating HIV/AIDS patients was sentenced to more than seven years in federal prison for defrauding Medicare out of more than $31 million. He billed for treatment that patients did not need and often were not given. Medicare was billed for infusion or IV treatment for many patients who never received treatment. Some patients who were provided infusion therapy were administered doses that were highly diluted.
  1. Two psychologists were recently added to an indictment to join two of their cohorts who had previously been charged with defrauding Medicare of more than $25 million. The psychologists are owners of two companies that provide psychological testing to nursing home patients in four Gulf Coast states: Alabama, Florida, Louisiana and Mississippi. The problem is that the psychologists allegedly billed Medicare for tests that were not medically necessary and, in many cases, were never performed. The case is pending, and the press release notes that the defendants are presumed innocent until proven guilty.

The Medicare Fraud Strike Force, since its formation in March 2007, has charged 2,300 defendants with fraudulently billing more than a total of $7 billion. The task force is committed to continuing its work to hold providers accountable so that the number of fraudulent providers will decrease.

A Word With Shefi: David Stegall

This is part of a series of interviews by Shefi Ben Hutta with insurance practitioners who bring an interesting perspective to their work and to the industry as a whole. Here, she speaks with David Stegall, principal consultant with Risk Consulting & Expert Services, who often serves as an expert witness in insurance litigation.

To see more of the “A Word With Shefi” series, visit her thought leader profile. To subscribe to her free newsletter, Insurance Entertainment, click here.

Describe what you do in 50 words or less:

Risk Consulting & Expert Services is an insurance and risk management consulting firm providing services and counsel to commerce, industry and government on insurance, reinsurance and alternative risk transfer matters. I have more than 37 years of experience and often act as an expert witness in litigation.

What made you decide to start Risk Consulting & Expert Services?

After 30 years, I no longer had an interest in continuing to work within the industry as a purveyor of insurance.

And if it weren’t for the appeal of working in insurance, what profession would you be in today?

Film and/or music production. I like the creative process.

Describe your typical client:

A litigation attorney with the need for an insurance or risk management professional who can offer a professional opinion on the usual and customary practices of the insurance industry or the required standard of care used within the industry and can explain that opinion to a judge and jury in plain, simple English.

Memorable court trial:

Very few cases go to trial, yet I recall the irony of testifying on a case regarding flood insurance at the Cameron Parish Court House in Louisiana, which is about a stone’s throw away from the Gulf of Mexico.

Is there a carrier you would love to testify in court against?

I cannot answer that because I do not think of insurance companies as being either good or bad. They are only as good (or bad) as those individuals who are making decisions for them in a given instance, and even then the good (or bad) decision may be specific to that instant.

You have a talent for explaining complicated risk terms. In your experience, which P&C coverage is most baffling to consumers?

Water damage and flood. Flood is excluded in practically every insurance policy (except flood policies), and water damage may or may not be covered. Most people think of the terms synonymously, but they aren’t. The simplest way to think of it is: If the water comes from above (without hitting the ground) it is covered (note that pipes are considered as being above). If the water comes from below (lake, river, stream, ocean), it is not covered. But please read your policy and ask questions of your insurance representative or call a consultant!

You have more than a few designations, one of which is the Chartered Property & Casualty Underwriter. Has the role of underwriting changed much from when you last practiced it?

There are fewer underwriters now, but they are extending specific yet limited underwriting authority to more general agents (or some form or position of limited underwriting authority) that specialize in a particular industry or product offering.

What emerging technology keeps you up at night from a litigation standpoint?

The same as everybody else: cyber risk. The risks are emerging at the same rate as the technologies.

Speaking of cyber, you recently published a whitepaper on “Cyber Risk & Insurance.” The Ashley Madison hack is now correlated to at least two suicides; where do you think insurers should draw the line?

The same place they draw the line with the idea that, if you attend a baseball game, you might get hit by a foul ball. A person does take some risk by subscribing to any service or website – yes, there is an implicit, if not explicit, responsibility (in the form of statutes) to protect people’s privacy but some activities carry innate risk that insurance can only partially address.

Favorite quote/s:

“Everything’s Gonna Be Alright” (Muddy Waters and others) and “It is always getting too late and then it is.” I hope I made that one up, but I’m sure I’ve heard it somewhere, and it resonated.

When you are not working, you are most likely…

Playing with my seven grandchildren or playing the harmonica.

What are you most excited about at the moment?

That I feel happy, healthy and terrific! A phrase made famous by a former insurance professional and fellow lover of Chicago, W. Clement Stone.

No Vaccine for Social Media Theft

Whether you are new to college, single and dating or newly divorced (because you panicked and confessed when news of the Ashley Madison hack hit the media), I’ll bet there is at least one socially transmitted disease you haven’t started worrying about: identity theft.

If you use Facebook, you’re making easy work for identity thieves. The same goes for the whole cosmos of social media whether you favor Twitter, Instagram, Reddit, Pinterest, YouTube or LinkedIn or prefer to Tumblr your thoughts, preferences and predilections to anyone who cares to know what they are. The more you put out there in publicly viewable spaces, the more your personal identity mosaic is exposed. An identity thief’s day job is piecing together that mosaic into a passable, or usable, version of you: one that will get through the authentication process of financial, medical or governmental organizations.

The echo of another kind of disease here is intentional. Like the more widely known kind of STD, the socially transmitted diseases that fall under the rubric of identity-related crimes are contracted by unsafe personal information practices. Unlike the more familiar variety, where safety is taught in high school, tacked to college community boards and heralded by countless other media new and old, not as many people these days know how to stay as safe as possible from the threat of identity theft, especially online.

How to practice “safe social”:

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

There is no immunization

Unlike the other kind of STD, the socially transmitted disease of identity theft is not avoidable. There is no immunization, no safe way to avoid it—not even complete abstinence. There have been too many breaches with too much data for anyone but those living entirely off the grid to be completely safe. (And even still you can’t be sure.)

Your best bet, in my opinion, is a system detailed in my book (forthcoming in November). A key element to that approach is acceptance. Specifically, you need to come to terms with the fact that it’s no longer a question of “if” but “when” you will become a victim of at least one type, if not multiple types, of identity theft. Anyone who tells you that they can keep you from getting got is selling snake oil. In fact, they are running afoul of the Federal Trade Commission. There is no guarantee. There are, however, best practices.

THE THREE M’S

If you accept the basic premise that you are at risk for identity theft no matter what you do, here are some thoughts as to how you might stay as safe as possible. The good news may actually be that you are a seasoned and intelligent user of social media, because that means you already have several of the habits in place that you will need.

Minimize your exposure

The same strategies you can adopt to make yourself a harder-to-hit target on social media go for the rest of your life. Whether that means saying “no” when asked for your Social Security number, limiting the amount of sensitive personal information you provide to anyone who contacts you, making sure all your accounts (email, social networking, financial or retail) have different user names paired with unique, long and strong passwords, properly securing your computers and mobile devices or freezing your credit—there are a variety of things you can do to make your attackable surface smaller.

Monitor your accounts

If you use social media regularly, you are used to checking in on a regular basis—the Pew Research Center found that 70% of Facebook users check in daily, as did about half of Instagram users, and nearly 40% of Tweeps. The same behavior, applied to your financial life, may keep you from getting got … or help you undo or minimize the damage in case you do. Check your bank and credit card accounts daily. Other things you can do include signing up for free transactional monitoring alerts at your bank, credit union or credit card provider, or purchasing more sophisticated credit and noncredit monitoring programs.

Manage the damage

When the dark day comes that your daily practice of monitoring your credit or financial life yields a compromise, you need to get on it immediately by informing the institution of the account that is involved, as well as law enforcement and the fraud department of at least one credit reporting agency. Because many insurance companies, a number of financial services organizations and the human resources departments at a number of companies offer complimentary or low-cost identity theft assistance as a perk of your relationship with the institution, check to see if you are covered or, if not, how you can get covered. Resolution experts can greatly help you speed your way back to normalcy.

Identity theft is a permanent threat. The best way to stay safe is to change your behavior. The above tips are only some of the ways to do that. In the age of universal data vulnerability, practicing safe information hygiene is a must—lest you contract the one STD that may haunt you for the rest of your life.