severity in workers comp. catlin, inc. 3 loss drivers of severity medical severity legal inflation...
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Severity in Workers Comp
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Catlin, Inc. 3
Loss Drivers of Severity
Medical severityLegal inflationCo-morbidity factorsHistory of drug dependencyHistory of depressionLack of family supportLegislative risk
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Catlin, Inc. 4
Loss Drivers of Severity
Medical severity Diagnostic expense Cost shifting on severe claims Prescription drugs
• Narcotics over prescribed
• Lack of generic alternatives on severe cases Technological advances
• Technology is keeping people alive longer and at greater expense
• $6M Dollar man a reality?
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Catlin, Inc.
$6 Million Dollar Man a Reality?
36 year old window cleaner, DOL- 2008
Accident Description: Lost his balance and fell into electrical power
lines touched lines with metal pole in his hands
Injury Details: burns to both arms – double amputation
Subrogation: third party claim against power company going to trial
Settlement: No settlement discussions to date – attorney waiting till
stable condition
Prognosis: 100% disabled, expected to live a full life. Claimant has steel
hook prosthesis, titanium hook prosthesis and being fitted for
myoelectric arm. May need revision surgery in future
5
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Catlin, Inc.
$6 Million Dollar Man a Reality?
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Paid to Date Incurred Total
Indemnity $58,380 $856,620 $915,000
Medical $966,069 $4,308,931 $5,275,000
Expense $40,780 $9,220 $50,000
$6,240,000 Average Cost projected to be
$2,041,640 for 2 arms plus maintenance (estimate only)
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Catlin, Inc. 7
Loss Drivers of Severity
Legal Inflation Jurisdiction and regional differences
Co-morbidity factors Diabetes High blood pressure Obesity
• Twice as many filed claims
• 13X more work days lost
• Claims open for 1 year: 3X as much
• Claims open for 5 years: 5X as much Cost Year 5
Cost Year 1
Work Days
Filed Claims
0 5 10 15 20 25 30
Normal
Obese
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Catlin, Inc.
Loss Drivers of Severity
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History of drug dependency Abusers have 300% higher medical costs Abusers account for over 38% of all W.C. claims Claimants prescribed narcotics have a greater chance of PTD
History of depression Longer disability periods High rate of co-morbid health disorders Average annual cost is 4.2 times greater than normal
Lack of Family Support Increased cost of attendant care Higher skilled nursing facility usage and costs
Legislative Risk Potential rollback of reforms
EX) California: Ogilvie, Almaraz and Guzman
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Catlin, Inc.
Dealing with Severity
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Underwriting Recognize: retrospective claims review
• Accident type• Class code• Diagnosis type
Identify
• Are supplemental questionnaires used? Heights Motor vehicle Subterranean Explosive Dust Exposure
• Tools to assist in identifying severity classes
• Pre binding audit
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Catlin, Inc.
Dealing with Severity
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Control
• Mitigate exposure with workplace safety programs?
Ex: Drug Free Workplace 60% of world’s illegal drugs are consumed in the US Nearly 70% of current users are employed 90% of large business have drug free workplace programs Only 5-10% of small-medium employers have similar programs 75% of employed Americans work for small to medium employers
• Use underwriting manual to restrict or exclude exposure
• Escalate review to more senior underwriter Price
• Comfort with R.I.C. dictates pricing flexibility
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Catlin, Inc.
Dealing with Severity
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Claims 24 hour reporting procedures On site loss investigation report
• Visit site within 48 hours• Standardize basics
Depositions Pictures Sequester broken equipment
Large Case Management• Already a focus with industry standards
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Catlin, Inc.
Dealing with Severity
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Surrounding Psych and social information• Co-morbidity, dependency, depression, family support• Gather information and escalate
Subrogation• Claims examiners – first line of defense• Better chance with timely loss site investigation
Settlement• Determine valid ultimate loss• Understand adverse development potential• Catlin provides reserve review to clients
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Catlin, Inc.
Interesting Comments that Reinsurers Hear
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“We have never had a loss excess $1 Million”
Different reserving methodology? Stair stepping Most favorable outcome At expected settlement value
We don’t write severity prone business
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Catlin, Inc.
Interesting Comments that Reinsurers Hear
14
If you are reserving to true ultimate, and still have not had a historic loss excess $1 Million…
You are LUCKY
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Catlin, Inc.
Can’t Underwrite Away from Severity
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38 year old cashier, DOL- 2001
Accident Description: Went to get coffee for manager. She was struck while crossing the road
Injury Details: Closed head brain injury that has affected ability to speak and retain information. Multiple fractures. Undergoing psych consultation for behavioral problems
Subrogation: Claimant ran out in front of car. $321,597 from drivers auto carrier
Settlement: Indemnity unlikely and cannot settle med in this state
Prognosis: Expected to live a full life. Claimant in 24hr skilled nursing facility. She is not expected to ever reach an independent state or able to reside in a home
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Catlin, Inc.
Can’t Underwrite Away from Severity
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Paid to Date Outstanding Incurred
Indemnity $62,579 $165,537 $228,116
Medical $2,982,680 $7,995,385 $10,978,065
Expense $52,557 $114,443 $167,000
$11,373,181
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Catlin, Inc.
Can’t Underwrite Away from Severity
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48 Year old Sales Person for Auto Dealer, DOL- 2007
Accident Description: Manager encouraged employee to demonstrate Martial Arts moves. Employee went to show a retreat move and apparently did not retreat fast enough. Co-worker was karate kicked in the head
Injury Details: TBI - vision problems, vertigo, headache pains, memory deficits and behavioral deficits. Judged to be totally disabled
Treatment: 24/7 attendant care, growth hormones to reduce headaches, TBI day program to help improve daily skills
Subrogation: No potential of subrogation
Settlement: No negotiations to date – attorney on claim
Prognosis: Normal Life expectancy
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Catlin, Inc.
Can’t Underwrite Away from Severity
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Paid to Date Incurred Total
Indemnity $104,081 $358,800 $462,881
Medical $883,995 $6,200,000 $7,083,995
Expense $17,560 $22,440 $40,000
$7,586,876
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Catlin, Inc.
Interesting Comments that Reinsurers Hear
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“We have strengthened our balance sheet, so we
don’t need reinsurance.”
Question: Penny Wise and Pound Foolish?
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Catlin, Inc.
Interesting Comments that Reinsurers Hear
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Where are we now? Competitive primary pricing Payroll deflation Rising medical severity Low investment returns Rising expense ratios
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Catlin, Inc.
Interesting Comments that Reinsurers Hear
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Where are we headed?• 2008/2009 combined ratios @ 100% and climbing• Reserve deterioration• Filed rates increasing
What are actual street rates? Are we any smarter?
There is lots of capital chasing same dollar• Rate of insolvency & acquisition
WATCH
WATCH
WATCH
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Catlin, Inc. 22
Variables and unknowns• Economic recession over?• Inflation or deflation?• Legislative reform erosion?• Impact of healthcare?
How are W.C. companies dealing with the market?• Growing outside traditional focus
Different policy sizes Expanded classes MGA/MGU New jurisdictions
• Reducing expense Consolidating operations Lay off’s Reign in spending (ex: reduce reinsurance spend)
Interesting Comments that Reinsurers Hear
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Catlin, Inc.
Interesting Comments that Reinsurers Hear
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If we are grappling with today and tomorrow…
How about trying to figure out the next 30 years?• Reinsurers are on the hook for the duration of the claim
We help absorb long tail variability Inflation/Deflation Legislative risk Economic cycles Market shifts
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Catlin, Inc.
Interesting Comments that Reinsurers Hear
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Management has a choice: Save money now, or Level long tail volatility through reinsurance
Given the current and future unknowns, is saving money now“Penny wise and pound foolish?”
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Catlin, Inc.
Using Reinsurance to mitigate Severity and Volatility