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Is it over yet? (Perspectives on the Med Mal Crisis). Robert J. Walling III, FCAS, MAAA 2006 CAS Spring Meeting May 9, 2006. From Where’s Perspective. Historical, Cyclical Swings. Note 5 Year change!. Crisis Symptoms. Insurer adverse reserve developments Insurer operating losses

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is it over yet perspectives on the med mal crisis

Is it over yet?(Perspectives on the Med Mal Crisis)

Robert J. Walling III, FCAS, MAAA

2006 CAS Spring Meeting

May 9, 2006

historical cyclical swings
Historical, Cyclical Swings

Note 5 Year change!

crisis symptoms
Crisis Symptoms
  • Insurer adverse reserve developments
  • Insurer operating losses
  • Coverage availability problems
  • Coverage affordability problems
market concentrations
Market Concentrations
  • Measured using HHI (Herfindahl-Hirschman Index)
    • Sum the square of the market share of each firm in a market
    • The index can range from 0 to 10,000
    • 0 = Perfect competition
    • 10,000 = Perfect Monopoly
    • U.S. Department of Justice considers a result of
      • less than 1,000 to be a competitive marketplace
      • 1,000-1,800 to be a moderately concentrated marketplace
      • 1,800 or greater to be a highly concentrated marketplace
    • Used by some regulators to determine rate regulation
a call for greater efficiency
The

current

system is

woefully

inefficient

A Call for Greater Efficiency
tort reforms impact on efficiency
Tort Reforms Impact on Efficiency
  • Damage caps by themselves do not improve system efficiency
  • Other elements of MICRA should help
  • Some newer reforms may help too
  • Attorney fee caps
  • Birth Related Neurological Injury Funds (NICA)
  • Prelitigation screening
  • “I’m Sorry’ laws
i m sorry laws
I’m Sorry Laws
  • Physicians want more communication
  • Patients feel physicians are “hiding something”
  • In most states, expressions of regret or empathy are admissible as evidence
  • Lexington, KY VA Hospital
  • “I’m Sorry” laws,
    • Enacted in CA, CO, FL, MA, OR, TN, TX, WA
    • AZ, ME and others are considering
    • Providers/staff can say “I’m sorry this happened to you”
    • CO only, “I’m sorry I did this”

without admissibility

i m sorry laws19
I’m Sorry Laws
  • Insurers are:
    • Training providers on how to apologize (mandatory)
    • Coordinating with claims
  • Initial results are significant
    • Reduced severities
    • Reduced loss adjustment expense
    • Reduced attorney involvement

(CO: 2 lawsuits in 433 claims)

    • Improved patient satisfaction
    • In many cases, much improved efficiency
impact of i m sorry laws
Impact of “I’m Sorry” Laws
  • Focus on claims <$35,000
  • Company’s can match apology with aggressive claims settlement strategy (e.g. COPIC)
  • Increase efficiency at all costs (including higher pure loss severity)
  • Reduces ALAE on small claims 35-65% (3.5%-6.0% cost reduction overall)
  • Actually increases small claimant net damages