Tag Archives: policy

Is It Time to End the Annual Policy?

Is there anything more emblematic of the largely antediluvian state of the insurance market than the concept of the annual policy?

Admittedly, there is a certain convenience for the customer only having to worry about his or her insurance once a year and for the insurer only having to process the relevant paperwork every 12 months. And for years, of course, insurer returns were almost entirely built off the back of the profits to be gained from investing up-front premiums — as in, not on serving the customer.

But haven’t things moved on?

Certainly, today’s low interest-rate environment (nothing lasts forever, but it is hard to envision what might shift this dynamic in the short- to medium-term) means insurers have to focus far more on correctly pricing risk rather than on yield arbitrage. And our increasingly technically sophisticated and connected world surely raises questions regarding whether market practices essentially inherited from the 17th century are still appropriate.

See also: The Most Effective Insurance Policy  

Consider the humble motor policy.

At the risk of gross over-simplification, the market is currently centered on selling an annual policy with pricing essentially dictated by a number of important risk factors (such as the value of the vehicle, driver age, anticipated annual mileage, where the car is kept at night, previous convictions, etc.) But the price you pay reflects little about the environmental factors that really drive risk when you are behind — or not behind — the wheel. While the industry is far more sophisticated than it was 20 years ago, pricing is typically set according to statistical averages for whatever broad risk grouping you happen to fall into — with all the imperfections this implies — to the inevitable detriment of lower-risk drivers within each of those categories.

Today’s technology — of which telematics is a pretty rudimentary example — enables a different approach.

Rather than an annual policy, why not specify a daily standing charge that reflects the true risk to the insurer of the car sitting in your garage, say, where the risk of accident or personal injury or theft is extremely low? Think of it as a standing charge.

However, as soon as you take your car out of the garage, an additional cost would apply — think of the Uber surcharge — but this additional cost would vary depending on the time of day or the driving conditions. Taking the car out in the rain or when it is icy would be more expensive than when the sun is shining. Driving in the middle of the night when there is less traffic is inherently less risky than battling your way through rush hour. Far fewer accidents occur on the motorway per mile driven than on crowded urban streets. And geo-location software could confirm whether you are, in fact, parking your car at home at night as you have claimed or whether you have left it for a few nights at the airport while you fly off to Rome or Miami for the weekend.

This approach starts to suggest some interesting outcomes. First, it allows insurance companies to price far more accurately for the actual risk they face, based not on relatively blunt risk category averages but for each individual driver down to each specific trip. Second, it ensures that drivers pay the true costs of the risk they represent rather than subsidizing their higher-risk fellow drivers. For most drivers, this is likely to result in a lower price because the average is hugely skewed by the tail risk.

Perhaps most interestingly, the approach also enables the driver to better understand the relationship between how and when she drives and the cost of insurance; thus, it potentially acts as a spur for drivers to moderate or modulate their behaviors accordingly, which is where you start to drive some real alignment of interests and benefits for both drivers and insurers.

The good news is that the necessary technology essentially exists today in the mobile device you are probably reading this post on. The various data feeds — weather, time of day, geo-location, etc. — are already there. Even today, my iPhone varies the time at which I need to leave one meeting to make the next depending on traffic and weather.

Of course, as with any radical change to established operating models, there are some important practical issues to be overcome in terms of the customer interface, billing and mechanisms through which customers would physically agree to a surcharge before, during or after a journey, etc. Insurers would need to work through the change in their cash flow profile and may also feel that the complexity of some of the larger risk classes continues to favor an annual cycle. And the impenetrability of pricing in the mobile phone industry, which marches under the banner of increased customer transparency and choice, stands as a stark warning to how the best intentions can lead to utter confusion.

See also: Insurance Disruption? Evolution Is Better  

There are some broader potential social concerns, too, around third party tracking of your movements. There are also implications for higher-risk drivers who find themselves priced out of the market where, today, their costs are essentially subsidized by the rest (particularly in circumstances where the constraints of people’s day-to-day lives and jobs may not give them a huge amount of choice regarding the conditions under which they choose to drive), although that particular genie is probably halfway out of the bottle, anyway.

The question, as ever, is whether the inevitable change will come from the incumbents that are weighed down by their legacy positions or from some new entrant that has the freedom of movement but lacks the scale, brand and capital to compete in a meaningful way.

One thing is certain: In a world where one of the world’s largest hotel companies doesn’t own any rooms (Airbnb), one of the world’s largest car hire companies doesn’t own any cars (Uber) and one of the world’s largest retailers doesn’t own any merchandise (Ebay), the insurance industry’s continued attachment to the annual policy feels increasingly like a relic from a bygone age of quill and parchment.

penalty

When a Penalty Is Not a Penalty

The Affordable Care Act requires most Americans to buy qualifying health insurance coverage. Fail to comply with this mandate, and there’s a financial penalty waiting for you come tax time. But when is a penalty not a penalty? When is a mandate not a mandate? Hey, kids, let’s do some math.

The penalty for going uninsured in 2016 is $695 per adult and $347.50 per child, up to a maximum of $2,085 or 2.5% of household income, whichever is greater.

To determine the cost of coverage, we’ll use the second-lowest Silver plan available in a state. That’s the benchmark used to calculate ACA subsidies, and in 2015 Silver plans were roughly 68% of policies sold through an exchange. Even more important, I found a table showing the cost of the second-lowest cost Silver plan for 40-year-olds by state, but I couldn’t find a similar table for other levels.

The least our 40-year-old could spend on the second-lowest Silver plan this year is $2,196, in New Mexico; the highest premium is $8,628, in Alaska. The median is $3,336. Divide the penalty by the premium, and you get 32% of the cheapest premium and 21% of the median premium. Put another way, paying the penalty saves our 40-year-old  consumer $1,500 in New Mexico and more than $2,600 in the mythical state of median.

I did find a table showing the national average premium a 21-year-old would pay for a Bronze plan: $2,411.  In this situation, the $695 penalty amounts to just 29% of the policy’s cost, a savings of more than $1,700.

The purpose of this post is not to encourage people to go uninsured. I think that’s financially stupid given the cost of needing health insurance coverage and not having it. And, personally, I support the individual mandate. I also understand the political obstacles to establishing a real penalty for remaining uninsured.

However, I also believe the individual market in this country is in trouble. (More on this is a later post). Adverse selection is a contributing cause to this danger. The individual mandate is supposed to mitigate against adverse selection. The enforcement mechanism for that mandate, however, is a penalty that, for many people, is no penalty at all.

That’s not just my opinion. That’s the math.

A version of this article was originally posted on LinkedIn.

Jurors and Questions on Insurance Coverage

For most potential jurors, questions of insurance coverage do not usually arise in common conversation. Seldom cut and dried, usually subject to numerous definitions and intricacies, coverage issues can be boring and puzzling for even an experienced adjuster. Asking a lay person to try to classify an “occurrence” as defined by a policy, or whether a third party is covered as an additional insured, may prompt, at best, glazed-over eyes or, even worse, a negative commentary about insurance companies. While it may be best in some situations for a judge to determine the issue of insurance coverage, this is not always possible. Sometimes, coverage questions arise in litigation, and those interpreting policy language and determining the outcome are jurors. If jurors are deciding the issues, certain challenges then arise, such as how to clarify policy language, present a clear and concise argument and overcome negative preconceptions about the insurance industry.

Can the Judge Decide Coverage Issues?

In Louisiana, general rules regarding issues that are triable by a jury are set forth in Louisiana Code of Civil Procedure articles 1731 – 1736. These establish the general rule that a demand for a trial by jury will result in a trial by jury of all issues. However, exceptions to the general rule exist when: (a) the parties stipulate that the jury trial shall be as to certain issues only; (b) a party in his demand specifies the issues to be tried by a jury; or (c) the right to trial by jury as to certain issues does not exist. Where a jury trial has been demanded by one or both parties, the case must be tried by a jury unless both parties consent to trial without a jury or the trial court finds that a right to a trial by jury does not exist.

More particularly, La. C.C. P. art. 1562(D) specifically codified the general principle found in La. C.C. P. art. 1736 requiring a stipulation between or the consent of the parties before the trial judge can order that insurance coverage issues be tried separately, with the “court alone” deciding the issue of insurance coverage.

La. C.C.P. art. 1562(D) states:

“If it would simplify the proceedings or would permit a more orderly disposition of the case or otherwise would be in the interest of justice, at any time prior to trial on the merits, the court may order, with the consent of all parties, a separate trial on the issue of insurance coverage, unless a factual dispute that is material to the insurance coverage issue duplicates an issue relative to liability or damages. The issue of insurance coverage shall be decided by the court alone, whether or not there is to be a jury trial on the issue of liability or damages.”

The leading case on the subject is Citgo Petroleum Corp. v. Yeargin, Inc., 95-1574 (La. App. 3 Cir. 7/3/96), 678 So.2d 936, writ granted, remanded, 96-2000 (La. 11/15/96), 682 So.2d 746 and 96-2007 (La. 11/15/96), 682 So.2d 747. There, the court stated that La. C.C.P. art 1562(D) provided that, if principals of judicial efficiency or justice would be served then the court may order a separate trial on the issue of insurance coverage. However, the trial judge’s discretion is not unfettered. The judge’s ability to take the issue away from the jury is severely restricted because, under the article, all of the following conditions must exist: (1) it would simplify the proceedings, permit a more orderly disposition of the case, or be in the interest of justice; (2) the consent of all parties; (3) the non-existence of a factual dispute material to the coverage issue that duplicates an issue relative to liability or damages; and (4) the order must be rendered before trial on the merits.

Therefore, the requirements set forth in the article effectively leave the judge with no discretion, as it requires the consent of all parties. The court further noted that, while the issue of insurance coverage under an insurance policy is a narrow issue of the law between the alleged insured and the insurer, a jury is not prohibited, by statute or otherwise, from deciding this issue. Further, there is no exception to the right to trial by jury for issues that the trial judge may think are too technical or too complex for the jury to understand. Even if the trial judge believes that he is more capable than the jury of deciding the issue of coverage, he cannot take this issue away from the jury once the issue is included within the scope of issues for which a jury trial was requested, unless the conditions of La. C.C.P. art. 1562(D) are met.

As such, if a trial by jury has been requested, but an insurer is presenting technical questions of coverage and believes that a judge would be best suited to decide the coverage issue, a stipulation or the consent of all parties would be necessary before the judge could take the coverage issue away from the jury. Unfortunately, often the consent of all parties to separately try the coverage issue cannot be obtained, and the insurer is left with a jury to decide intricate and potentially costly coverage issues.

Selecting the Best Jury for Your Coverage Case

If coverage issues must be decided by a jury, the persons who make up that jury can make a difference in the outcome of the case. Questioning prospective jurors in voir dire about their current insurance policies and other contracts can provide some insight into how they view insurance companies and the potential for coverage. People often believe that they are “fully covered” under their insurance policies, and that insurers are large, prosperous companies that should be able to “help out” individuals. However, further questioning can reveal that potential jurors do understand that there are limitations as to what is covered under certain policies and what has been negotiated.

Questioning a potential juror about a policy he may currently have in place, whether that policy has a limit and if he understands that the insurance company would not be required to pay more than that limit, can show that the potential juror does understand some limitations to coverage. Additional questions may involve who the current policies provide coverage to and the limitations on that coverage. Even simple, and almost obvious, questions can help illustrate a potential juror’s understanding of coverage limitations. For example, discussing how an automobile policy might provide coverage for certain damage to an owned vehicle but would not cover general maintenance, oil changes or a monthly car payment can help provide insight into whether an individual may be able to understand the issues and be a constructive juror.

Additionally, general questions regarding the potential jurors’ opinion of insurance companies in general, personal claims experiences or inferences regarding insurers that the potential juror has taken from the media can provide insight into whether the potential juror might be favorable or undesirable from the insurer’s standpoint.

Presentation at Trial – Concise and Comprehensible

After a jury has been selected, helping jurors understand and follow the language and logic of the coverage argument is vital. The following tips may help simplify the coverage case and overcome obstacles when faced with presenting coverage issues to a jury.

1. Walk Jurors Through the Basics

Although often complex, insurance policies are simply contracts. They define a relationship between parties and outline who will do what, when and under what circumstances. Presenting the insurance policy as a simple contract, by identifying the promise between the parties and what each may receive in exchange for their promise, may help jurors be less apprehensive when approaching coverage issues.

A good place to start is with the basics of the policy and how it is structured. Discussing the declarations, insuring agreement, exclusions, definitions, conditions and endorsements allows jurors to get comfortable with the policy. After the policy and its purpose are explained, the specific provisions at issue can be addressed. An effective way to do this is by using demonstrative evidence, such as blowups of certain pages or Power Point presentations illustrating specific language and what it means. Presenting the policy through large exhibits helps break down the technicality for jurors and show that it is a logical and consistent contract.

Further, preparing an exhibit naming and listing the experience of all of the individuals who are involved in creating the policy, the claim investigation, adjustment and the coverage decision shows that time and thought of real individuals went into creating a well-organized document and making a well-thought-out coverage decision.

2. Humanize the Issues

Jurors often bring their own experiences to the courtroom and, sometimes, a bad impression of insurance companies. Further, oftentimes coverage disputes are coupled with bad faith claims, exacerbating the notion that insurance companies are malicious. To overcome these perceived notions and prejudices, it is key to humanize the insurer’s operations and show the jurors that real people have drafted the policies and handled the claims. Showing that the insurer is not just a large, faceless corporation, but individuals making decisions and doing their jobs, will help negate the insured’s presented image of an uncaring, profit-seeking business entity. While testimony from a vice president may be impressive, the agent who issued the policy or the adjuster who handled the claim may help put a more relatable face to the company.

Additionally, many insurers have adopted vision statements outlining a code of ethics or a commitment to the community. Using this at trial, and showing how the company is committed to its values or involved in the community, helps dispel negative ideas of an uncaring corporation.

Lastly, insurers should be careful about attacking the insured’s credibility or positions. While it may be necessary, the way this is presented to the jury can have a big impact and can erroneously further the negative ideas about the insurance company.

3. Show All Negotiations

Jurors will generally understand the concept of “you get what you pay for.” They know that if they contracted with their cable company and pay for only the basic channels, they do not get premium channels, such as HBO. It follows that jurors should understand that if underwriting documents or other evidence show what was discussed and understood between the parties, and this is reflected in the contract, this should be what governs. If evidence of negotiations is available, this should be presented to the jury. This concept may be particularly helpful in litigating commercial policies, where there is usually more negotiation, and in showing the application of policy exclusions.

4. Keep It Simple

As a general rule, the simpler the better. It is important to keep the insurance policy language from sounding too technical. Avoid overuse of legal terms and phrases, as this will only confuse jurors and may cause them to fall back on the generally accepted legal principle that “any ambiguity must be construed against the insurer.” A straightforward presentation, relying on only one or two strong coverage arguments, should be used. Presenting every argument possible is not always the best strategy, as this could bog down the jury and cause them to lose focus. When one or two key arguments are made, the case is tight and allows jurors to concentrate on the big picture, rather than trying to follow several moving parts.

Another tactic that may help bring the issues to a comfortable level is to compare the policy to other contracts jurors may have entered into. Outlining the limits and duties imposed by contracts that jurors may be more familiar with, such as a purchase agreement for a car, or a lease agreement for an apartment, may also help jurors realize that there are also limitations and duties imposed by insurance contracts, just like the contracts with which they are more familiar.

Additionally, working backward from the result being sought provides a road map for a streamlined argument and helps create a unifying theme throughout the litigation. Starting from the verdict form or jury instructions helps to keep concentration on the elements that need to be established or explained.

5. Apply Basic Jury Concepts

Basic concepts of persuasion, which apply to all jury litigation, can also be used effectively in a coverage case. Fairness must be stressed and run as a theme throughout the presentation of the coverage case. Jurors want to be fair and will try their best to do so. Additionally, any obvious weaknesses in the case should be addressed. Holes in the case, if not admitted to or explained, will create doubt.

Presenting a coverage case to a jury is sometimes unavoidable, but need not be too difficult or incomprehensible for jurors. Carefully questioning and selecting potential jurors, along with presenting a simple yet logical argument, while humanizing the insurance company, can help achieve a successful presentation of the case in the courtroom and, with that, a successful result.

Digital Insurance, Anyone?

The digital banking conversation is alive and kicking within the FinTech world, focused on discussing the merits, definitions and initiatives around what it means for a bank to become digital across its entire technology and business stacks. I have yet to find the same level of discourse and vibrancy within the insurance world.

Spurred by Yan Ranchere’s latest blog post, I am adding my own thoughts to the insurance narrative or, dare I coin it, the “digital insurance” narrative.

First, let’s frame the discussion by attempting to define the evolution of the insurance model from old to current and future or digital:

Old Insurance Model:  This model is mostly paper-based with an application collected from the customer by the agent and sent to the carrier. The agent quote is not binding and may indeed change once the carrier has reviewed the application. I would qualify this model as carrier-centric. The carrier does all the heavy lifting with data verification and underwriting, with little stimuli from external data feeds in real time; the agent merely serves as a conduit.  As result, underwriting and closing a policy may take several days or even several weeks.

Claims management and customer service are cumbersome. Arguably, this delivers poor service in today’s age of instantaneous expectations. Not only can the old model be considered carrier-centric, I would also venture it is product-centric (in the same way that the old banking model is product-centric). The implications from a technology point of view are the same as in the banking world: a thin front end, shaky middleware and a back end that is silo-driven and that makes it difficult to optimize underwriting or claims.

Current Insurance Model:  The current model optimized the old model and made the transition from carrier-centric to agent-centric, which means that things are less paper-based and more electronic and that there is more process pushed onto the agent to be closer to the customer. In this model, the agent is empowered to issue policies under certain limits and risk frameworks—the carrier is not the gating factor and central node anymore.

Instead of batch-processing policies at the carrier level, the system has moved to exception processing at the carrier level (when concerned with nonstandard data and policies), thereby leveraging the agent. The result is faster quotes and policies signed more quickly, with the time going from days and weeks to hours or just a day. Customer service will go the same route. Claims management will still remain the central concern of the carrier, though.

Digital Insurance Model:  This is the way of the future. It is neither carrier- nor agent-centric, and it certainly is not product-centric any more. This model is truly customer- and data-centric—very similar to what we witness in digital banking. The carrier reaches out to the customer in an omni-channel way. Third-party data sources are readily available, and the technology to process and digest the data is extremely effective and delivers fast and furiously. Machine learning allows for near-instantaneous underwriting at a carrier or agent level, any time, anywhere. The customer can now get a policy in minutes.

Processes after policy-signing follow a similar transformative route. The technology implications are material: new core systems of record, less silo effect, more integration, massive investments in data warehouses and in products and services that act as layers of connection between data repository centers, core systems, claims management platforms, underwriting platforms and omni-channel platforms.

Picture the carrier effectively plugged in to the external world via data sources, plugged in to the customer in myriad ways that were not possible in the past and plugged in to third-party providers, all of this in real (or near-real) time. That means no more of the old linear prosecution of the main insurance processes: customer acquisition, underwriting, claims management. Furthermore, with a fast-changing world and more complex customer needs, delivering a product is not the winning formula any more. Understanding the customer via data in a contextual manner is.

To be fair, insurance carriers have nearly completed massive upgrades to their database architecture and can claim the latest in data warehouse technology. Some carriers have gone the path of renovating their channels and going all-out digital. Others are refining the ways they engage new customers. Most are thinking of going mobile. Still, much remains to be done. These are exciting times.

Boiling down what a digital insurance model means, we can easily see the similarities with digital banking; digital insurance must be transparent, fast, ubiquitous and data-focused, and there must be an understanding that the customer is key and is not a product.

Once you digest this new model, it is easier to sift through the key trends that are reshaping and will reshape the industry. I am listing a few that we followed at R66.  By no means is this an exhaustive list, nor is it ordered by priority, impact or size of opportunity:

1) Distribution channel disruption: There are three sub trends here—a) the consolidation of brokers and agents, b) channels going all-out-digital and disrupting the brick and mortar and c) carriers continuing to go direct and competing with brokers.

2) Insuring the sharing/renting economy: Think about Uber, Airbnb and the many other start-ups that are building the sharing economy. All of them need to or already are creating different types of coverage through their ecosystems. Carriers that focus on the specific risks, navigate the use cases, gather the right data and are forward-thinking will win big. James River is an insurance carrier that comes to mind in this space.

3) Connected data analysis: I do not use the term “big data” any more. Real-time connected data analysis is the right focus. Think of the integration of a series of hardware devices, or think of n+1 data sources. These are powerful, mind-blowing and will affect the trifecta of insurance profits: underwriting, claims management and customer acquisition.

4) Technology stack upgrades:  This means middleware to complement data warehouse investments, new systems of record, software platforms for underwriting (or claims management) and API galore. It’s the same story with banking; there is just a different insurance flavor.

5) Technology externalities: GPS, telematics, AI, machine learning, drones, IoT, wearables, smart sensors, visualization and next-generation risk analysis tools—you name it, these will help insurance companies get better at what they do, if they adopt and understand.

6) Mobile delivery:  How could I not list mobile delivery? Whether it is to improve customer acquisition; policies or claims management; or customer service, we are going mobile, baby.

7) A la carte coverage: Younger generations are approaching ownership in different ways. As a result, a one-size-fits-all insurance policy will not work any more. We are already witnessing a la carte insurance based on car usage, homes or commercial real estate connected via sensors or IoT.

8) Speciality insurance products:  We live in a digital world, baby, which means cyber security, fraud and identity theft.

It should be noted that the above describes changes in the P&C industry and that the terms “carriers” and “reinsurers” can be used interchangeably. Furthermore, I have not focused on health insurance—I know next to nothing in that field.

Any insurance expert is welcome to reach out and educate me. Anyone as clueless as I am is welcome to add their thoughts, too!

This article first appeared on Pascal Bouvier’s blog, here.