TRENDS IN SENIOR LIVING LITIGATION · willistowerswatson.com Insurance Underwriting 2,617 aging...
Transcript of TRENDS IN SENIOR LIVING LITIGATION · willistowerswatson.com Insurance Underwriting 2,617 aging...
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TRENDS IN SENIOR LIVING LITIGATION
October 26, 2017
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Insurance Underwriting
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Bruce W. Dmytrow, Vice President Aging ServicesCNA Healthcare
Bruce is a Vice President at CNA and has been with the enterprise since 1995. He is responsible for developing the strategic and tactical direction for the growth and profitability of the CNA Aging Services business
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Insurance UnderwritingTrends Contributing to Insurance Results in Senior Living Industry
Insurance Industry New capacity Risk tolerance Top line growth versus profitability Pricing, terms and conditions Insurance program structures
Senior Living Industry Financial pressure – change in reimbursement models Risk transfer versus risk sharing Increase in resident acuity levels and co-morbidities Increase in claim frequency Mergers/acquisitions and changes in ownership structures Increase in attorney specialization – increase in litigation Large city urban “creep”
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Influencing Factors Professional liability loss trends of 7% - 10% Limited return on investment
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Insurance UnderwritingUsing Evidence to Achieve Excellence
Knowledge and experience toidentify loss drivers
Extensive databases Data analytics Pricing models
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BED TYPEAVERAGE
TOTAL PAID
Assisted Living $221,496
Skilled Nursing $212,766
Unknown $206,470
Independent Living $123,825
Overall AverageTotal Paid
$211,709
Average Total Paid forClosed Claims by Bed Type
Lessons Learned
Underwriting discipline is paramount. Risk selection fosters profitability. Building and maintaining relationships are
integral to managing market cycles. Utilization of client-specific data builds trust
and supports underwriting determinations. Early discussions regarding renewal actions
prepare all parties for mutually beneficial outcomes.
Resource: CNA Aging Services 2016 Claim Report
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Insurance Underwriting
2,617 aging services professional liability claims that closed between January 1, 2011 and December 31, 2015
Includes 1,387 professional liability claims that closed between January 1, 2014 and December 31, 2015
Excludes indemnity payment by CNA less than $10,000, home healthcare and adult day care claims
Limited to CNA-insureds; monies paid by CNA; and closed date
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Using Evidence to Achieve Excellence: Engage, Lead, Succeed – Datasets and Methodology
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Insurance Underwriting
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Most Frequent Allegation in Closed Claims(Percentage of 2,617 Closed Claims)
42.7%
18.6%
14.7%
6.1%
4.2%
13.7%
Resident fall Pressure ulcers Improper careFailure to monitor Resident abuse All other
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Insurance UnderwritingHighest Average Total Paid Allegation in Closed Claims
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$231,321
$232,398
$245,783
$323,325
$325,561
Failure to inform physician
Pressure ulcers
Delay in seeking medicaltreatment
Failure to follow physicianorder
Elopement
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Insurance Underwriting
Resident Falls - Frequency by Allegation(Percentage of 1,117 Closed Claims)
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Insurance Underwriting
Resident Falls – Frequency by Outcome of Injury (Percentage 601 Closed Claims)
Death is the most common outcome for fall-related claims.
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Insurance UnderwritingEvaluating a Company’s Risk Profile
Venue Levels of care and services provided Total exposures (number of beds) Loss history Expiring insurance program Ownership structure and support Financial stability Stable and high performing leadership team Vision, mission and culture Retention of employees and staffing related to resident acuity Quality outcomes Litigation management strategies Risk, quality and compliance programs Reasons for marketing insurance program
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Insurance UnderwritingDifferentiators
Submission Materials Quality of submission information Website consistent with submission information Quality outcomes Loss history Employee retention and staffing ratios Composition of leadership team Reputation in the community
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Insurance UnderwritingDifferentiators
Meeting with Organization’s Leadership Team and Frontline Staff Mission of organization Knowledge of senior living industry and operations Investment in well-being of the residents Understanding the importance of balancing operations with concern
for residents and employees Transparency of successes and challenges Willingness to partner with CNA Risk Control and Claim Expectations of insurance company
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