Insurance Online
When Risk & Insurance last visited Zurich U.S.’s Web site in March 1999, the Schaumburg, Ill.-based property and casualty insurer had just introduced RiskIntelligence, its fee-based Internet service that allows current or former insureds to access up-to-date claim, claimant, and payment reports for all lines of insurance (www.zuricbus.com, click on “RiskIntelligence”).
Now, users will have access to information from Zurich and other past or present carriers, so that they can compare data from different companies, years, etc. Zurich officials say the upgrade will give users, especially those who have more than one carrier, more comprehensive loss analysis reports on which to base critical decisions. Zurich officials say that the company is planning another release of the product during the first quarter of 2001. The new release of RiskIdntelligence will include user-friendly upgrades, including: a streamlined log-in process, improved response time, increased user capacity, and increased organization of reports for easier access. The site is secure.
Zurich-based Swiss Re has also upgraded its Web cap abilities. Among the company’s new products is CatNet, a new service offered on ELRiX (www.elrix.com), a B2B exchange that is designed to provide risk management tools for Swiss Re reinsurance clients.
CatNet is an Internet-based information service for assessing risks posed by natural hazards.
The product offers an interactive atlas that provides an overview of the hazard exposure and the insurance solution, as well as actual losses and potential losses from individual countries.
The company has also made available The Swiss Re Portal, which offers insurance and reinsurance data from the company’s sigma research that are downloadable as Excel sheets; access to more than 50 industry-specific news topics from more than 300 sources; and a library of insurance and reinsurance Internet links.
Swiss Life shuts up shop in UK with loss of 200 jobs
SWISS LIFE, Switzerland’s largest life insurer, said yesterday it would stop writing new individual life insurance policies in Britain, leading to 200 job losses.
The move came after the beleaguered Zurich-based insurer was unable to find a buyer for all of its UK business as a going concern, which specialises in writing critical illness cover and income protection for companies and for individuals.
Swiss Life said it would now put the part of the business which sells policies to individuals into run-off. The decision is likely to lead to about 200 job losses around the UK out of its total workforce in the country of 700. A spokesperson for Swiss Life said it had decided to put the individual insurance division into run-off because “there was no attractive price for the whole business”.
There was speculation that Swiss Re, the mammoth reinsurance company, was preparing to snap up Swiss Life’s business in Britain. Swiss Re is thought still to be interested in buying the company’s business which caters for companies, and may also want to pick up the individual arm once it is in run-off.
Swiss Life, which plunged to a record loss in 2002, had made it clear it wanted at least the equivalent of the net asset value for the two businesses, which at the end of last year was pounds 230m.
It signalled yesterday it would want a potential bidder to offer an additional pounds 30m or pounds 40m, because Swiss Life itself will bear the redundancy and other costs associated with putting a business into run-off. The group, which was forced to raise 1.2bn Swiss francs in a rescue rights issue last year, put its UK insurance arm up for sale in September. It has been in the UK since 1967 and has its UK headquarters in Sevenoaks, Kent.
Swiss Life is increasingly aggressively paring its business portfolio, having sold trust company and asset manager STG and minority stakes in Credit Agricole and Swiss investment firm Tuxedo so far this year. The insurer is also expected to sell its Spanish operations as well as its Swiss unit La Suisse later in 2003, in addition to ending its presence in the Italian market.
Judge boosts State Farm verdict
MARION, Ill. — A damage award to State Farm auto insurance customers swelled to nearly $1.2 billion Friday after a judge ruled the nation’s largest auto insurer committed fraud by its use of generic replacement parts in auto-body repairs.
Friday’s $730 million award of actual and punitive damages came on top of a jury’s $456 million verdict Monday in the same class-action lawsuit. The initial award already was believed to be the largest ever against an insurer.
At issue is the use of “aftermarket” auto parts — modeled on those made by the manufacturer but made without access to factory specifications — to repair the cars of State Critics say aftermarket parts aren’t as good as those made for automakers. The lawsuit accused State Farm executives of concealing that information while flooding customers with brochures promoting the parts as a high-quality, low-cost alternative.
The jury’s award to 4.7 million State Farm policyholders was based on a claim the insurer breached its contract with customers by failing to restore their cars to their pre-accident condition
Commentary: Raising the Bar - Reforming and revitalizing the jury
Many aspects of the American legal system are under assault, but the right to a trial by jury suffers from some of the harshest criticism.
Juries are blamed for increasing the costs of insurance; for being arbitrary and capricious; for being biased against greedy plaintiffs and overpaid corporate executives. They are accused of being ill- equipped to understand complicated cases, and of being unrepresentative of their communities.
Likewise, judges are criticized for not taking the jury trial seriously; unfairly limiting voir dire so as to prevent the selection of unbiased jurors; and too aggressively discouraging parties from invoking their right to civil jury trial.
The great institution of trial by jury continues to suffer from the litigation explosion and many litigants’ need for fast, inexpensive and risk-averse approaches to dispute resolution. A recent study of the American Bar Association presents statistics reflecting that the frequency of trial by jury is waning in both the federal and state courts. A survey by Decision Quest and Reuters reveals the analogous fact that 61 percent of Americans have lost trust in their leaders, institutions and lawyers. Civil litigators may opt for a bench trial, or for non-binding mediation or binding arbitration, all of which are less expensive and faster than a trial by jury.
Yet the jury trial is one of the pillars of our society, and its continued erosion would be a loss to the country. We should keep in mind that the jury trial has evolved over centuries. It should continue to be developed - without the sacrifice of core principles that have been bestowed to us by history.
The trial by jury is ancient, dating as far back as early Egypt and Greece, and extending to the Roman Empire up through the ages to the Franks and Normans, who brought it with them to England in 1066. By the time of Magna Charta in 1215, the right to a trial by jury was firmly acknowledged and fundamental. In the United States, that entitlement - both in criminal and civil trials - is secured in the Bill of Rights.
Trial by jury in civil cases in our country is properly recognized as a unique method of dispute resolution. That is because no other country’s judicial system provides for trial by jury in civil cases to the full extent that we do. Until relatively recently, all sectors of our society have regarded the right to jury trial in a civil case as a precious aspect of our free society and as a safeguard against tyranny and corruption.
It was a generally accepted principle that in a disputed matter a jury of one’s peers, fairly and impartially selected from the community at large, would find the truth and render a just result. Putting one’s case to a panel of citizens whose possible individual biases would be subordinated to the collective, rather than to a single judge whose possible bias could control the outcome, intuitively and empirically comported with the highest values in American society - freedom, fairness and equality before the law. H.L. Mencken is said to have remarked that nowhere else but in a courtroom in the United States would Judas Iscariot and Jesus Christ be on equal footing.
Today, the question arises: What is the future of civil trial by jury in the United States? Will it have an integral role in promoting fair resolution of disputes in an economic fashion such that it should be preserved?
We believe the trial by jury should not cease to be the main method of civil dispute resolution, but should undergo specific improvements to assure that its purposes are fulfilled.
The ABA’s Section of Litigation has set forth standards designed to improve the jury trial system and encourage its usage. These standards call for, among other improvements, limiting the length of jury trials; encouraging the court and the parties to promote juror understanding of the facts and the law; and ensuring that the process used to empanel jurors serves the goal of assembling a fair and impartial jury.
We second these general recommendations, and set forth below some of our own.
*Limit discovery and schedule cases promptly. Reducing the burdens of discovery affiliated with the jury trial, such as the number of depositions, would also remove some of the burdens imposed on the parties. While the Federal Rules of Civil Procedure do impose some restrictions, many jurisdictions allow for exceptions.
*Allow for a meaningful voir dire. Permitting a robust voir dire would go a long way to proving that the term jury of one’s peers has meaning. Today voir dire is virtually non existent in many courts. Judges pride themselves on putting the jury in the box by noon. Often the process of jury selection becomes a challenge of eliminating one or two jurors whom the judge did not excuse for cause. Frequently, the parties feel dissatisfied that their jury is not composed of their peers.
Commentary: Raising the Bar - Reforming and revitalizing the jury
This article originally ran in The Daily Record, Baltimore, MD, another Dolan Media publication).
Many aspects of the American legal system are under assault, but the right to a trial by jury suffers from some of the harshest criticism.
Juries are blamed for increasing the costs of insurance; for being arbitrary and capricious; for being biased against greedy plaintiffs and overpaid corporate executives. They are accused of being ill- equipped to understand complicated cases, and of being unrepresentative of their communities.
Likewise, judges are criticized for not taking the jury trial seriously; unfairly limiting voir dire so as to prevent the selection of unbiased jurors; and too aggressively discouraging parties from invoking their right to civil jury trial.
The great institution of trial by jury continues to suffer from the litigation explosion and many litigants’ need for fast, inexpensive and risk-averse approaches to dispute resolution. A recent study of the American Bar Association presents statistics reflecting that the frequency of trial by jury is waning in both the federal and state courts. A survey by Decision Quest and Reuters reveals the analogous fact that 61 percent of Americans have lost trust in their leaders, institutions and lawyers. Civil litigators may opt for a bench trial, or for non-binding mediation or binding arbitration, all of which are less expensive and faster than a trial by jury.
Yet the jury trial is one of the pillars of our society, and its continued erosion would be a loss to the country. We should keep in mind that the jury trial has evolved over centuries. It should continue to be developed - without the sacrifice of core principles that have been bestowed to us by history.
The trial by jury is ancient, dating as far back as early Egypt and Greece, and extending to the Roman Empire up through the ages to the Franks and Normans, who brought it with them to England in 1066. By the time of Magna Charta in 1215, the right to a trial by jury was firmly acknowledged and fundamental. In the United States, that entitlement - both in criminal and civil trials - is secured in the Bill of Rights.
Trial by jury in civil cases in our country is properly recognized as a unique method of dispute resolution. That is because no other country’s judicial system provides for trial by jury in civil cases to the full extent that we do. Until relatively recently, all sectors of our society have regarded the right to jury trial in a civil case as a precious aspect of our free society and as a safeguard against tyranny and corruption.
It was a generally accepted principle that in a disputed matter a jury of one’s peers, fairly and impartially selected from the community at large, would find the truth and render a just result. Putting one’s case to a panel of citizens whose possible individual biases would be subordinated to the collective, rather than to a single judge whose possible bias could control the outcome, intuitively and empirically comported with the highest values in American society - freedom, fairness and equality before the law. H.L. Mencken is said to have remarked that nowhere else but in a courtroom in the United States would Judas Iscariot and Jesus Christ be on equal footing.
Today, the question arises: What is the future of civil trial by jury in the United States? Will it have an integral role in promoting fair resolution of disputes in an economic fashion such that it should be preserved?
We believe the trial by jury should not cease to be the main method of civil dispute resolution, but should undergo specific improvements to assure that its purposes are fulfilled.
The ABA’s Section of Litigation has set forth standards designed to improve the jury trial system and encourage its usage. These standards call for, among other improvements, limiting the length of jury trials; encouraging the court and the parties to promote juror understanding of the facts and the law; and ensuring that the process used to empanel jurors serves the goal of assembling a fair and impartial jury.
We second these general recommendations, and set forth below some of our own.
* Limit discovery and schedule cases promptly. Reducing the burdens of discovery affiliated with the jury trial, such as the number of depositions, would also remove some of the burdens imposed on the parties. While the Federal Rules of Civil Procedure do impose some restrictions, many jurisdictions allow for exceptions.
* Allow for a meaningful voir dire. Permitting a robust voir dire would go a long way to proving that the term jury of one’s peers has meaning. Today voir dire is virtually non existent in many courts. Judges pride themselves on putting the jury in the box by noon. Often the process of jury selection becomes a challenge of eliminating one or two jurors whom the judge did not excuse for cause. Frequently, the parties feel dissatisfied that their jury is not composed of their peers.
Critical illness policy with a hidden trap
A critical illness claim may go before the European Court of Human Rights because good faith was not enough for a policyholder to win pounds 28,000 she felt she was entitled to. Alison Ridgway decided to buy a house in 1999, four years after a divorce and once she had finally saved enough by living with her parents to put down a deposit.
The 40-year-old planning officer from Fareham, Hampshire, was advised, like most people, that it was a good idea to take out insurance to cover her mortgage. She chose a critical illness policy from Friends Provident. The policy undertook to pay off her mortgage in the event that she contracted one of a number of serious illnesses which could have meant she was unable to work to make repayments.
The house buying went smoothly, and Ms Ridgway moved into her one- bedroom maisonette in February 2000. When most people would have been settling in, Ms Ridgway was given sad news. At a hospital appointment two days after moving house, she was told test results from a biopsy of a lump on her breast showed she had breast cancer, and not just the benign lump she had hoped for.
Ms Ridgway, who was only 38 when diagnosed, said: “I was gobsmacked when they found something was wrong. I was not in a high- risk category. There is no history of breast cancer in my family.”
She had an operation at once to remove the lump and, as soon as she returned from hospital, contacted Friends Provident so that she could claim on her policy for a sum in the region of pounds 28,000. After initially sounding positive about paying out, Friends Provident changed its mind and told Ms Ridgway that the company would not be able to honour the agreement because she had not kept them fully informed about the state of her health. Ms Ridgway recalls her reaction was “extreme shock, not a good reaction”.
The problem, Friends Provident explained, was that between taking out the critical illness policy in November 1999 and making it active when she actually moved in February 2000, their customer had gone to the doctor and not informed them about it. Ms Ridgway went because of a cold, but in a routine check her doctor found a lump which she said should be checked in hospital. She had the lump tested in hospital in January 2000 and had her diagnosis on 21 February, just after her critical illness policy came live with the move to the new home.
Ms Ridgway says she did not inform Friends Provident of the trip to her doctor or hospital test because she was given the impression that it was very unlikely that there was something wrong. She says of her doctor, who supports her dispute with the insurance company: “When I went to see her she assured me she was convinced it was nothing but she was referring me to hospital as a matter of course.”
Friends Provident takes a very different view. Graham Aslet, Friends Provident’s appointed actuary, says: “We ask for full information from a customer which is up to date until the point we go on risk [when the policy comes into force]. The onus is on the customer to tell us everything.”
Ms Ridgway says - and Friends Provident accepts this - that she did not deliberately try to mislead the company. She says: “I don’t think people inform their insurer every time they go to the doctor for a cough or cold.” She also points out that her policy says customers should inform the company when they have been diagnosed with an illness. Ms Ridgway feels she did this because, while the tests took place before she moved, the diagnosis came after the policy was in force. Friends Provident disagrees, and says application forms and letters remind customers that they must tell the company about a change in their health.
Mr Aslet says this is sometimes overlooked. “Our policy is to put customers back in the position they would have been in if they had got it absolutely right. So if they haven’t told us about a trivial thing, it is not a problem. In some cases the new information would have made the policy more loaded, so we recalculate the claim.”
Unfortunately, in Ms Ridgway’s case, Friends Provident says it would not have been able to continue with its promise to offer her critical illness cover until it knew the outcome of her breast cancer tests.
Ms Ridgway describes the last two years, when she has had to deal with chemotherapy and frequent checks for fresh signs of cancer as well as battles with Friends Provident, as “absolute hell”. After being off work for six months she felt she could not afford to live on half-pay and, because she was also unable to claim critical illness compensation, she had to return to work.
Ms Ridgway’s MP, Sir Peter Lloyd, and the broker who arranged her cover support her argument that she acted in good faith and is entitled to her claim. Sandy Dawson, from the broker Roy Sansom, says that if Ms Ridgway had suspected she had breast cancer, she could have brought her move forward so her visit to the doctor came after the policy went live.
Off-Label Prescribing of Erythropoiesis-Stimulating Proteins in US Hospitals
This study quantifies and describes off-label prescribing of currently marketed erythropoiesis-stimulating proteins(ESP): epoetin alfa and darbepoetin alfa. Methods: A retrospective database study examined on-label, off-label supported, and off-label unsupported ESP treatment of anemia in 464,834 inpatients. Findings: Epoetin was used in 97% of the patients studied from January 2002 to June 2004. ESPs were prescribed on-label in 48% of patients primarily for chronic kidney disease and nonmyeloid cancers. Off-label supported use was seen in 38% of patients mainly for unlabeled chronic kidney disease indications and anemia associated with critical illness. Off-label unsupported use occurred in 14% of prescriptions for cardiovascular, pulmonary, pediatrics, and other conditions. Differences in prescribing were associated with hospital, physician, patient, clinical, and drug variables. Conclusions: Off-label ESP drug use appears to be widespread and associated with many factors. It may be evidence based, since most is associated with conditions supported by the medical literature.
Learning Objectives :
Upon completion of this article, participants should be able to
* Describe the prescribing of erythropoiesis-stimulating proteins in on-label, off label, and off-label unsupported treatment settings
* Discuss the impact of these uses on the patient population
Target Audience
This article is designed for physicians, pharmacists, nurses, other health care professionals, journalists, researchers, health care insurers, and policy makers.
In the past decade, innovations in biotechnology have lead to breakthrough therapies for numerous medical conditions. Biotechnology drugs are created using cellular attributes such as DNA and proteins from yeast, bacteria, and mammals to develop and manufacture new therapies. Biotech drugs have been used successfully to treat millions of patients for uses approved by the Food and Drug Administration (FDA), including cancer, osteoporosis, hepatitis C, and multiple sclerosis. At the same time, advances in medical knowledge and practice associated with biotech drugs have resulted in extensive off-label use.
Off-label medication use occurs when physicians prescribe drugs for indications not approved by the FDA. Off-label prescribing occurs whenever drugs are used at different doses, via different routes of administration, or in patient populations other than those specified by FDA-approved labeling. Off-label prescribing of any FDA-approved drug is considered acceptable practice as long as physicians deem it medically appropriate.
Response to health insurance by previously uninsured rural children
Concerns over the large number of children without health insurance led Congress to expand Medicaid coverage to children in poverty through the Omnibus Reconciliation Act of 1990. An estimated 10 million children, however, remained uninsured in 1996. A majority of these children have parents who work but who do not have employer-sponsored health insurance coverage . Because children without health insurance coverage have reduced access to necessary health services, many health care reform proposals have focused on providing universal, comprehensive insurance benefits for all children.
Under the Balanced Budget Act of 1997, Congress created a new program and funding source that allows states to implement health insurance expansions to low-income, uninsured children. The State Children’s Health Insurance Program (S-CHIP) provides states with considerable flexibility in their design of individual programs. States were given the option of expanding Medicaid or creating new programs. The development of new programs requires a fundamental choice between whether to build on the existing Medicaid infrastructure or to enter into contracts with private insurers . A potential source of debate related to this choice is the uncertainty over benefit costs and administration fees - especially in states that are considering using private insurers. Proposals involving private insurers under the failed Health Security Act often ignored both the risks associated with covering previously uninsured persons and the potential for significant increases in premiums.
A critical assumption in estimating the cost of providing health insurance to previously uninsured children concerns the behavior of the children upon obtaining insurance. Most studies assume that uninsured persons, after they receive insurance, behave like people who are insured. It is possible, however, that individuals who are uninsured may behave differently from those who are insured because of differences in observed and unobserved characteristics. Two different behaviors are suggested. First, it is possible that uninsured persons, after they receive health insurance, will use healthcare in much greater proportions than will persons who have consistently been insured. Under this possibility, uninsured individuals are viewed as having accumulated, by their underuse of healthcare, more need for services than the need shown by their insured counterparts. If this accumulated need results in greater than expected healthcare utilization in response to health insurance, these uninsured people can be described as having a pent-up demand for healthcare. Over time, their use of healthcare is expected to fall back in line with that of persons who are insured and who share the same economic and demographic characteristics.
These two possibilities suggest that the actual cost of providing health insurance will differ from estimates based on the assumption of similar behavior by the insured and the uninsured cohorts. Frank and McGuire recently reviewed estimates of the cost of mental health benefits in the Health Security Act. One estimate assumed that previously uninsured mental health patients would require 1.98 times more services than those currently insured because of differences between the two groups in “severity.” No data were presented to justify the assumption. The assumption most likely resulted in an overstatement of the cost of providing mental health benefits to previously uninsured persons.
The purpose of this study is to determine how previously uninsured rural children respond to insurance. The study uses four years of claims data by children enrolled in the Get Smart Delta Health Insurance Initiative.
MAKE BIG SAVINGS ON INSURANCE TOO
DON’T forget that becoming a nonsmoker can nearly halve your premiums for life, critical illness and income protection insurance because of medical evidence that smoking increases the risk of serious illness.
For example, a male smoker aged 30 would have to pay pounds 11.95 a month for pounds 100,000 of life cover with Legal & General, according to LifeSearch.
But, if he kicks the habit, the same cover costs just pounds 7.38 a month with Royal Liver, representing a saving of pounds 1,371 over the 25-year term of the policy.
Insurance companies consider ex-smokers to be “non-smokers” a year after they give up.
Tiny solution, big problem: mini-med plans provide a solution to the premium increases that all businesses have experienced, are experiencing and will continue to experience
With business comes the opportunity to hire more people. Good news for a company, right? The answer is yes, until employers look at the price of benefits and the reality of what those employees truly cost the company, over and above typical compensation numbers. This reality can lead many small businesses to cut out health coverage altogether, and larger companies to push the costs on to employees who can’t handle them.
How can you find a health-care solution that will satisfy the needs of both the employer and employee? The answer may be a limited-benefit medical plan, also known as a “mini-med plan.”
According to the National Survey of Employer-Sponsored Health Plans, the average total cost of health benefits rose from $6,215 per employee in 2003 to $6,679 in 2004.
SurePayroll, a Chicago-based online payroll service, reported that among small-business customers, as many as 350,000 companies may be priced out of the health insurance market in 2007–forced to drop benefits altogether.
Small businesses are not the only ones affected by rising costs. High insurance premiums are also having an impact on large companies. They could see double-digit increases in their health-care costs, as shown in the Towers Perrin’s Health Care Cost Survey released in October of last year. That would make the fourth year in a row they have had to endure these increases.
Medical insurance premiums are rising so quickly that employers providing insurance are facing little choice but to pass these costs on to their employees. In a worst-case scenario, employees would be responsible for 50 percent of their health-care costs and up to 100 percent of their family coverage. Can employees afford to take over these costs? The real median U.S. household income is only $44,389, according to the Census Bureau. At this income level typically, families are living paycheck to paycheck and are closely watching their spending.
Employees then opt out of health insurance because they often can’t afford the rising premiums. Roughly 46 million people in the United States do not have health insurance, again going by Census Bureau figures. Don’t be mislead into thinking the working uninsured are mostly young and healthy individuals. An increasing number of Americans age 50 and older also do not have health-care coverage.
The time is right for mini-med plans. A recent study by Aflac found that nearly half of all business owners believe that they can’t attract and retain quality employees without offering competitive health benefits. That realization, coupled with the consumer appeal of mini-meds’ cost-controlled price, explains why more carriers–Symetra and, more recently, Aetna and Cigna, for example–have jumped on the mini-med bandwagon.
BETTER BENEFITS, LONG-TERM EMPLOYEES
Kevin Brown, an employee benefits planner for Laurel, Md.-based Professional Benefits Solutions, said mini-meds are a viable option for employers of all sizes who find themselves unable to afford major medical coverage due to rising costs. It is not a matter of saying that companies should abandon major medical insurance, but there is a segment of each company population that could benefit from these plans. The challenge is understanding the financial and insurance needs of employees.
These highly customizable plans include everything from doctor visits and prescription-drug coverage to accidental medical coverage, hospital stays and surgical procedures. Plus, these plans can include nurse hotlines, flexible coverage for spouse and children, and additional riders for dental, vision and critical illness.
Unlike many “off-the-shell” medical plans, mini-meds can be tailored to meet a company’s specific needs. Plans are custom designed to offer the most coverage for basic medical services, excluding rare illnesses or catastrophic injuries. The plans also give employees control over their medical options and access to medical coverage by taking advantage of PPO networks to reduce out-of-pocket costs.
Mini-med premiums typically range from $50 to $150 per month for single health-care coverage, which can be much more financially manageable for employees compared with $308, the 2006 average national monthly premium for employer-sponsored coverage, as calculated by America’s Health Insurance Plans.
Mini-reed plans give employees the ability to get out of the county hospitals, walk-in clinics and emergency rooms and back to the primary-care physician of their choice. They earl now have the care that major medical plans offer, with options that meet their financial needs.
The Society for Human Resource Management estimated that it costs $3,500 to replace one $8-per-hour employee when all costs–recruiting, interviewing, hiring, training and reduced productivity–are considered. With full-time salaried employees, that number goes up even higher.
For companies large, medium and small, providing a mini-med plan offers an extra advantage when it comes to recruiting and retaining top talent, considering that other companies are dropping health-care coverage completely. Because quality employees are attracted to companies with health-care benefits, a limited-benefit plan can demonstrate the value a company places on its people and can be very attractive to job candidates.