2023 March PIA Vermont

Navigating claims today

A modern approach provides specific industry advantages

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A modern approach provides specific industry advantages

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President and CEO Jeff Parmenter, CPCU, ARM; Executive Director Kelly K. Norris, CAE; Communications Director Katherine Morra; Editor-In-Chief Jaye Czupryna; Advertising Sales Executive Calley Rupp; Senior Magazine Designer Sue Jacobsen; Communications Department contributors: Athena Cancio, David Cayole, Patricia Corlett, Darel Cramer, Anne Dolfi, Maura Rosner and Lily Scoville. Postmaster: Send address changes to: Professional Insurance Agents Magazine, 25 Chamberlain St., Glenmont, NY 12077-0997.

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J.D. Power: Claims Processes Suffer Digital

Growing Pains

The ongoing digital transformation of the property/casualty insurance industry has hit some speedbumps when it comes to customer satisfaction among those who use insurers’ digital channels to manage their claims.

According to the J.D. Power 2022 U.S. Claims Digital Experience Study, SM released at the end of 2022, overall satisfaction with the digital claims process declined for a second consecutive year as insurers struggle to manage longer cycle times via digital channels.

Some key findings of the 2022 study:

Customer satisfaction declines again. Overall customer satisfaction with the digital claims experience declines 7 points year over year to 857 (on a 1,000-point scale). This is the second consecutive year that overall satisfaction has declined.

Digital first notice of loss shows promise, but low adoption. Overall satisfaction with the claims process is higher among customers who use digital first-noticeof-loss tools—whereby they notify their insurer of a claim via the insurer’s website or mobile app—compared with satisfaction among customers who report a claim via an insurer’s call center. Satisfaction is notably higher when services such as the estimate being scheduled, shop being notified, or rental car confirmed are provided. However, among digitally engaged customers, only 41% are using the website or app to initially report a claim.

Digital estimation creates challenges. Customer experience with the estimation process is the most notable driver of digital satisfaction, adding a significant 66 points to overall satisfaction scores when it is done well. However, insurers are meeting customer expectations just 34% of the time. Submitting photos is a key task performed with mobile apps, but the ease of the process takes a big hit when customers still need to arrange for an in-person estimate. Electronic communications with an estimator result in the highest satisfaction scores, with video chat scoring particularly high—but just 15% of customers are using this technology.

Managing expectations

via digital is

critical. Customers are three times more likely to say the claims process was slower than expected when regular updates are not provided via digital channels. Conversely, they are nearly two times more likely to say the process was quicker than expected when they are provided with regular status updates through insurer websites or mobile apps.

Water-damage claims can happen anywhere at any time; education & tech can mitigate damage

Year in and year out, clients experience water damage from a variety of causes, from the washer leaking, to a toilet or dishwasher malfunctioning, or when the water line disconnects from the refrigerator. InsurTech does have its place in the insurance industry—especially to prevent possible waterrelated claims. Water-leak detector systems can detect leaks, and close the valve attached to the main water line to the house. These systems can be installed for less than $1,000.

Wacky claim, the importance of travel insurance

A man filed an insurance claim against his travel insurance for his lost dentures. While he was vacationing on a cruise, his false teeth fell out of his mouth while he was vomiting over the side of the ship. His insurer paid the claim.

Fraud hurts everyone

According to the Coalition Against Insurance Fraud: Fraud costs businesses and consumers $308.6 billion a year. Additionally, the FBI estimates fraud costs the average family between $400 and $700 a year in insurance premiums.

According to the Insurance Information Institute, in terms of frequency, water damage and freezing ranks second for claims; its falls behind top-ranked wind and hail.

Water damage also ranks second for average claim payout at $11,098 its payout average amount is only beaten by fire and lighting claims.

(A brief) insurance timeline …

There would be no opportunities to file an insurance claim if there wasn’t an insurance industry …

1347: The first insurance contract was signed.

1752: The first mutual insurance company was founded in the U.S.— with the help of Benjamin Franklin.

1849: New York state passed the first general insurance law in the U.S.

1851: New Hampshire created the first formal agency to regulate insurance in the U.S.

1898: The first automobile insurance policy is issued in the U.S.

1902: Car theft insurance was first introduced.

1925: Connecticut passed the first financial responsibility law for motorists.

1939: The New Jersey Association of Mutual Insurance Agents, which would become PIA Northeast was founded.

1968: The federal flood insurance program was established with the passage of the National Flood Insurance Act

Claim scenario: Websites and ADA compliance

Helping your clients through the claims process is a part of your job description. You’ve made a promise to help your clients through their worst day.

However, sometimes the best offense is a good defense. That’s why you often share your claims stories with your colleagues and takeaway best practices from their experiences.

What follows is an actual scenario from PIANJ Vice President Andrew Harris Jr., CIC, AAI, CISR, who experienced a claim that has the potential to affect many of your business clients. He also outlines how his agency is working to mitigate this potential claim going forward.

Our agency writes a fair number of insurance policies for marinas and boat dealers. Generally, there are some specialty coverages associated with the class of business (e.g., protection and indemnity, “bumbershoot,” marine operators legal liability, and dock coverage).

Believe it or not, this claim stemmed from a boat dealer’s website—and for a reason no one foresaw.

At first review, the boat dealer’s website was generic. Usually, when we review a client’s website, we scan for content that embellishes areas of practice that could be troublesome in the underwriting process. This site was about what you’d expect from a boat dealer—it included the dealer’s inventory, the business’s branding, etc.

There wasn’t anything about shipping space shuttles or shooting fireworks from a barge, so we were good, right? Wrong.

Americans with Disabilities Act

Our client received a demand letter from a plaintiff, a blind man, who alleged that the boat dealer’s website wasn’t compatible with the software he uses to read websites. Further, the letter stated that the defendant (our client) had violated the Americans with Disabilities Act by not making the site accessible for the blind.

As I’m sure all agents have experienced, the take-up rate for cyber liability policies is lower than it should be— particularly with clients who don’t have a large amount of computer-centric workflow.

However, even if the client had purchased a generic cyber insurance policy, we learned that this type of claim is a media-liability related claim, so that policy would have had to cover that exposure.

As it was, the plaintiff’s attorney told our client if it settled for $5,000, the lawsuit would be withdrawn.

Compliance

It’s important to remember, that every website should be compatible with text-to-speech software. The ADA doesn’t delineate which industries do or do not have to comply with the law.

We later learned that the plaintiff’s attorney had filed dozens of these lawsuits across the state, mostly with the same plaintiff, but some with other individuals with a similar disability.

While these lawsuits are necessary to raise awareness and to ensure that everyone has equal access to information on the internet—they also can be an easy way for lawyers and their clients to make some money. Whatever the rationale, the client paid the attorney $5,000 and it received a release letter.

Best practices

In response to the lawsuit, we sent correspondence to our entire commercial-customer base, explaining the claim scenario, and advising them to direct their website vendor to review the ADA website, and its checklist for ADA website compliance.

The list of things to be on the lookout for helping a business with risk management is seemingly infinite. Our internal checklists already are cumbersome, and we seem to be adding to them regularly. However, it’s a best practice that can help our clients in the long run, and it helps to highlight the value we offer those who choose to work with an independent insurance agent.

Andrew Harris Jr., CIC, AAI, CISR, is president of Liberty Insurance Associates Inc., in Millstone Township, N.J. Active in PIANJ, he has served as an officer since 2019, and as a director for several years. Currently, he is vice president of the association.

Looking for more information on how to make websites ADA compliant? See the article BeyoncADA , written by PIA Northeast Director of Government & Industry Affairs Bradford J. Lachut, Esq. It can be found on PIA Northeast News & Media (blog.pia.org).

Do you have an interesting claims story and lessons learned from it that you’d like to share? PIA Northeast is interested in hearing it. You can email your story to PIA Magazine’s Editor-in-Chief Jaye Czupryna at jczupryna@pia.org. Your story may be featured on PIA Northeast News & Media.

BRADFORD J. LACHUT, ESQ. Director of government & industry affairs, PIA Northeast

Premiums on the rise: What to do about it

I’m not sure if you noticed, but prices went up in 2022. After decades of low inflation, the dams burst last year—and the United States experienced the highest inflation since the Carter Administration. In order to combat this historic inflation, the U.S. Federal Reserve increased interest rates from near zero in early 2022 to over 4% by year end. The combination of inflation and increasing interest rates have caused a shift in the insurance marketplace. The soft market that had existed for a decade appears to be over—at least temporarily. In its place are the telltale signs of a hard market: reduction in capacity and increasing premiums.

Get ahead of client questions

With insurance premiums on the rise, policyholders may question why they are paying more in premium for the same coverage. It’s a natural reaction: Just

like I don’t like paying $5 for a dozen eggs when I used to pay $2. Policyholders don’t like to pay more for the same. When faced with premium increases, it is likely that policyholder behavior will change.

Policyholders may look to lower the cost of their insurance through reducing or removing coverage altogether. This isn’t just hypothetical. PIA has received numerous questions over the past year from

By phone … PIA serves members. Online …

PIA members on the best practices for handling client requests to reduce or remove coverages.

Anytime a policyholder decides to reduce or drop coverage, agents should be nervous for what will happen if, and when, a loss occurs. Reducing coverage to save money may seem like a sound idea to the policyholders at the time they are paying the premium, but they will be sure to regret the decision when a loss occurs. If there is a shortfall in the insurance payout, policyholders may explore other avenues for additional funds—including looking for coverage from their agent’s errors-and-omissions policy.

So, what should an agent do in these situations? If there is one universal piece of guidance that I could give to you, it would be to make sure you have the capabilities and procedures in place to document interactions accurately and effectively with clients and potential clients.

Documentation, while boring, is the first and best line of defense for agents against E&O claims. I would suggest at least two pieces of documentation when a client decides to reduce or remove coverage.

One, there should be some record of the conversation between the agent and the client concerning the change in coverage. A frequent question PIA receives is how thorough the documentation should be, and when should information be recorded. The answer to this question involves a balancing act between timeliness and completeness. In a perfect world, agents would record their conversations with clients verbatim and in real time. Of course, that is not realistic. Most agencies don’t record conversations and storing that amount of data could be costly, not to mention time consuming to sort through. When balancing between timeliness and completeness, I veer toward timeliness.

[EDITOR’S NOTE: This does not apply to article due dates.]

The biggest mistake an agent can make is to fail to document a client interaction properly and then have an issue arise. Once a potential E&O claim is on the horizon, it’s too late to start the documentation process. That is why timeliness is so important. The further you get from a client conversation, the fuzzier your memory is, and the less likely it is that the conversation gets documented. Jotting down a quick note in your agency management system or in a client file as to the who, what, where, when and why of the conversation is preferable to pages of detailed notes, days later. Here is an example:

John Doe called to discuss reducing his auto limits due to the premium increase. I advised that reducing coverage is not advisable, as it would leave John and his family underinsured in the case of a claim and with a gap in coverage between the auto policy and the umbrella policy. John said he understood and asked for quotes with reduced coverage.

Date and time stamp that note, and you have yourself some good documentation. Hopefully, the client takes the agent’s advice and does not reduce coverage.

Two, should the client reduce or remove coverage, make sure you obtain a signed statement from the client acknowledging that he or she is purchasing a policy with less coverage than in the prior policy period and that the client has been advised of the risks of doing so.

Related to this, whenever a client decides to reduce coverage, agents are advised to check to see if there is an umbrella policy in place. If so, make sure the policyholder is advised of the impact a reduction or removal of coverage will have on the umbrella coverage. It is almost certain that a reduction in coverage will create a gap in coverage between the base liability policy and the umbrella policy.

When there is an umbrella policy in place, the signed statement should include language indicating that the policyholder has been advised of the impact that reducing coverage will have on the umbrella policy. Have the policyholder sign and date the statement and keep it in the client’s file. In many cases the conversation about reducing coverage and the decision to do so will happen within minutes of each other. Even in those situations, it still is advisable to record a note about the conversation and have the signed statement.

As I write this article, inflation and the price of eggs are decreasing. Yet, with interest rates still climbing, it looks like agents should be getting used to the hard market and increasing premiums.

This will undoubtable lead to difficult conversations with clients and even more difficult decisions. Just make sure these conversations are documented.

Lachut is PIA Northeast’s director of government & industry affairs.

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JULIE CIRILLO, ESQ. Chief risk officer, Engage PEO

Should we glide or drive claim mitigation efforts?

The workers’ compensation line of insurance has experienced over eight years of strong underwriting profitability with the industry combined ratio consistently below 90%.1 Will 2023 continue to be profitable? Will frequency rates continue to remain low? Will the labor market tighten, and losses increase—as they have done historically during recessionary times?

More than 100 experienced industry leaders rate: adequacy, medical inflations, the economy, and the shifting workplace as their top concerns for 2023.2 With our industry leaders singing the same tune, and the past few years running so well, can those of us who consult clients on claims and loss control glide into the new year? Or should we be driving clients to achieve better results?

We should be driving. Why?

For small- to mid-size businesses, we see different trends. As a consultant and claims-management organization for over 40,000 employees across a myriad of industries, the risk team at Engage PEO is monitoring three trends that are driving workers’ compensation claims costs in 2023:

1. A labor shortage with employees who are either overworked or undertrained sustaining injuries

2. Medical inflation outpacing wage inflation and premium growth for lower-skilled workers

3. After several years in which older workers stayed out of the workforce due to the pandemic, many are returning, and ultimately, are having more expensive, and longer-tenured claims

These trends will lead to higher losses and higher premiums for small- to midsize businesses. Employers cannot afford to take their foot off the accelerator and stop driving claim mitigation.

Overwork and undertraining

While big tech may be laying off people, local hotels, restaurants, and other small businesses are dealing with a labor shortage. These industries are feeling the crunch of employee losses that have not fully recovered from the pandemic. With wage inflation and stronger competition for hiring lower-skilled employees, these businesses—which are injury prone—are overworking their

staff, which is leading to more jobrelated injuries.

These employers also are seeing another contributing factor in that those employees who have returned have a reduced physical capacity. Employees who aren’t physically conditioned to work long shifts, carry heavy food trays, or perform repetitive housekeeping duties are prime reasons we will continue to see an increase in claims for repetitivetype injuries.

Sprain-and-strain type injuries jumped 23% over pre-pandemic levels.3 These injuries occur due to a lack of physical conditioning, repetitively performing the task, or simply performing the task in an inappropriate manner. It is important for employers to hire employees who can perform the positions needed, train them on proper techniques for performing the job, and stop overworking employees beyond the point of exhaustion.

Think about a nursing assistant who helps patients in-and-out of bed. While this nurse is comfortable doing these tasks for her eight-hour shift, by the end of a double shift (16 hours), she is too tired, bends and twists the wrong way, and herniates a disc in her back resulting in a surgery that was preventable.

Workers’ compensation is not resistant to inflation

While most people can agree that higher wages mean higher premiums, and thus the workers’ compensation system receives the benefit of inflation with higher premiums, these higher premiums are not offsetting higher loss costs. The problem is that medical inflation is outpacing premium levels on lowerskilled employees. Without rate increases, we will see higher loss ratios.

For example, consider a veterinary technician—who is not vaccinated for rabies, and who is not wearing protective gloves—who was exposed to an

animal positive for the virus. The cost of the series of shots that are required after a rabies exposure is $80,000. The premium received for this technician working 40 hours a week, at $20/hour is around $5,000. Whereas the gloves would have cost the veterinary clinic between $10-$30. Employers cannot allow employees to take shortcuts, they must continue to train employees and drive safety best practices to prevent these types of claims.

More expensive claims and longer claim tenures are on the horizon

Older workers are returning to the workplace and are bringing with them more comorbidities that lead to higher claims costs. Prior to the pandemic, the un-retirement rate for those employees who are older than 65, who decided to return to the workforce after retiring, averaged 3%, then dipped to 2% during the pandemic and rebounded to 3.3% by April 2022,4 but inflationary pressures of everyday life are leading more older workers back to the workplace to supplement their incomes. With labor shortages in some industries, this is a welcome return. While it is great to have more employees working, older workers have more comorbidities that lead to more expensive claims and longer claim tenures.

Take for example a 60-year-old salesperson who jumped down from her pick-up truck and fractured her heel in multiple places. Over the years prior to her injury, she developed diabetes, and she is a smoker, so what could have been a simpler recovery 20 years ago, has led to multiple surgeries and a bone-growth stim-

ulator. This claim amounts to over $180,000. Had the employee climbed down from the truck maintaining three-point contact with the vehicle, it is less likely that she would have sustained this injury. Employers must continue to train and reinforce best practices to mitigate and prevent these claims from happening. Small- to mid-size employers cannot continue to glide on the notion that workers’ compensation costs will continue to decline. The high cost of claims that have the potential to arise out of three trends—the labor shortage, medical inflation, and return of older workers—may make workers’ compensation costs unaffordable for small- and mid-size businesses in the future.

It is not time to glide, but to continue to drive best practices in hiring, training, and conditioning

our employees regardless of their age to maintain a healthy and safe work environment.

Cirillo is the chief risk officer for Engage PEO. She is a seasoned veteran in the workers’ compensation industry, with more than 20 years of experience in workers’ compensation litigation, claims management and risk management. She is a former workers’ compensation defense attorney and has held multiple senior roles in management, claims, loss prevention, risk management and sales. Cirillo earned a Bachelor of Arts degree from the University of South CarolinaColumbia and a Juris Doctor degree from the University of Pittsburgh School of Law.

1 NCCI, 2022 (bit.ly/3wacfzJ)

2 NCCI Insights , 2022 (bit.ly/3kmzELE)

3 Amtrust, 2022 (bit.ly/3WkOhMF)

4 NewsNation, 2022 (bit.ly/3QQ9MUg)

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Navigating claims today

A modern approach provides specific industry advantages

ecently, claims management has had a hard and unmissable shove into the future. With the growing emphasis on digital transformation and the rise of InsurTechs, it’s nearly impossible to manage claims—or even exist—in the property/casualty insurance industry without having at least a base understanding of the technological evolution growing within it. Or coming face-to-face with it in a realistic capacity.

The technological era of claims management is no longer on the horizon. It’s here. Innovate. Integrate. Modernize. That’s the mandate. The future is now, and it waits for no one.

Yet still, studies have shown that some p/c insurers have been measurably and noticeably slow to adapt to the newest technological advancements, invest in Insurtechs, update their legacy systems—rife with neglected IT infrastructure—and generally display a reluctance to fully modernize.

So, it’s worth diving into the specific modern factors that the digitization and technological upgrading of claims management solves in the first part of 2023. New wrinkles—some which we never could have been predicted would impact the claims space until they landed at its door—are addressed by a modernization of the process that’s crucial as we approach the mid-2020s. Let’s look at the claims-management issues digitization specifically tailors and helps solve today, and why this modern approach provides advantages for insurers, and by extension their agents, that can no longer be missed.

An unheard of complexity

According to global reinsurer Munich Re, the insurance industry currently is experiencing a period of “virtually unprecedented levels of complexity.” In relation to other tricky historical periods insurers have faced, and there have been many, how can that be?

Well, even a terse examination of the factors in today’s industry and world reveals it’s nearly impossible not to reach that conclusion, without going far beneath the surface.

At the heart of the claims-management process is the collection of data to gain a comprehensive understanding and details of a claim (e.g., angles, influences, evidence, background, faults, and information) ideally from end-toend. Unsurprisingly in 2023, the amount of data available has exploded exponentially. Literal terabytes of information exist, and it may need to be culled, applied and made sense of, from a number of sources, which impacts a spectrum of new types of claims that pop up daily.

The interconnectivity of the digital age has made unlimited knowledge accessible at our fingertips. However, it also has created an infinite haystack of information to be interpreted, adjusted and categorized. The world is smaller, but the mountain of information grows every day. Compared with even 20 years ago, the sheer magnitude pales by comparison. Digitization is crucial to manage this vast breadth of data.

With this boundless and unavoidable data-heavy world now required to be navigated and interacted within, cyberrisks have become more prevalent, complicated and dangerous. Collecting the necessary information to compete in the p/c industry means wading deeper into the digital waters, and that means opening insurers and their agents to greater risks.

A 2022 report by third-party cyber risk intelligence provider Black Kite found that of the top 99 U.S. insurance carriers examined, only roughly 26% were graded “A” for their cyberposture, while the approximately 73% remaining were more vulnerable to cyberattack.

Reluctant to update, insurers often employ outdated and neglected IT infrastructure as a remnant of old industry standards. Yet, when examining solutions to these problems that often require full-system overhauls to solve (i.e., updating entire legacy systems in one fell swoop to keep up with times) their solution frequently has been to pile newer technology fixes atop their legacy systems. Yes, it may save on budget now, but it also opens firms to greater cyber risk vulnerabilities, which could be catastrophic and cost more down the line. The modernization of core systems to keep up with the digital age is no longer an option, it’s a requirement for insurers today.

Coinciding with these complexities are the geopolitical impacts of the world (more on these later in this article). Inflation, banks changing interest rates, values of fixed-interest securities, international conflicts, the supply-chain crisis and fallout from a post-pandemic world all impact balance sheets, rates and a near-infinite amount of additional data points for insurers to analyze actionably. It’s far too much to risk with anything resembling analog. In short, the most advanced technological solutions are needed as more data needs to be collected. How these factors impact the claims-administration process—even for smaller insurers—goes beyond the global scale and borders on galactic. Technological modernization to account for it in the claims process is integral.

The other side of the pandemic

As we emerge from the COVID-19 crisis and into post-pandemic life, the world we find ourselves in is undoubtedly full of more open-air

experiences than our cave-like prior surroundings. That is positive. But of course, the issues lingering from it will have reverberations for a while, in many avenues and industries, insurance included. One of the most prominent and chronic has been the supply-chain crisis.

This ongoing turmoil has wreaked havoc for three years now, impacting supply and demand, shippers and shoppers, wallets, and everyday life. The situation has been stubborn and catastrophic. But finally, there is cause for positive expectation. As experts have examined the situation from all angles, conclusions have emerged that the solution lies in rapid digitalization and wholistic and real-time data analytics. As evidence, in a 2021 McKinsey report—over a year ago now and at the heart of the onset of the crisis— 93% of companies surveyed across various industries already had stated that they “intended to make their supply chains far more flexible, agile, and resilient.”

The ripple effect this has on the insurance industry and claims management can’t be overstated. With the evolving digitization of the supply chain and transportation ecosystem, the result is real-time data capture, analysis, insight and most importantly, reaction. Real-time operational risk management is moving as close to financial risk transfer as it’s ever been.

That means if insurance companies can’t keep up with this new warp speed of analysis and insight, they won’t survive.

All of this points to loss control, underwriting and real-time operational risk and claims management as solutions to this rapid financial risk transfer. Looking to the future, it is clear signs point to this connec-

tion between real-time data and insight, loss control and underwriting as the next horizon insurers must have on their technological to-do list. That’s not all. Additionally, fallout from the pandemic has left the economy— and all unfortunate suffering parties—with losses on such a grand scale that the holes will need digging out still for the foreseeable future. That leaves the insurance industry with a need to manage and process claims with as much speed and accuracy as possible, as claims continue to mount. Digitization and technology solutions to the process are the best ways to ensure both are accomplished as efficiently as possible.

Hurricanes and climate change

Climate change has had an expansive and magnifying effect on the p/c industry. It has resulted in not only a larger volume of disaster-related claims corresponding with these events, but also events that have higher impacts on economies and claims processes as well. With these higher impact events— and increased frequency—comes an increased scale in complexity of claims. These rising trends across the board have made ensuring state-of-the-art capabilities and utilizing digital solutions for insurers a necessity, not an option. Unfortunately, these trends are growing, not declining. McKinsey research shows that the value at stake from climate-induced hazards could, conservatively, increase from about 2% of global GDP to more than 4% of global GDP in 2050. With this climate risk escalation comes the predicted (and evidenced) occurrence of more floods, wildfires, hurricanes, and other catastrophic events. It’s a surge that p/c insurers must prepare for with every tool at their disposal to account for a steadily increasing amount, and diversity, of claims to be managed.

Tragically, hurricanes have come to the forefront recently, and they are their own specific category of claim-impacting disaster. In 2022, Hurricane Ian became Florida’s costliest storm since Hurricane Andrew in 1992. Its tragic devastation resulted in estimated losses between $28-$47 billion. While total losses still are being assessed—that would make it one of the 10 costliest storms in U.S. history (six of which will have come since 2012).

Hurricane disasters of that magnitude bring widespread flooding, wind damage, and varied property insurance claims resulting in exposure estimates. Not to mention the monumental task of simply calculating the damage in total. All of which falls on insurers.

As insurance companies are inundated with record numbers of claims filed after an event (like Ian) from claimholders picking up the pieces of their lives, the claims are unpredictably complex and diverse. The risk is bottlenecked and overloaded with large-volume claim management such as this. Accomplishing it alone is an impractical task. To do it without the most modern and up-todate tools is impossible.

Of course, not every insurer will face claims management on an event to the magnitude of Hurricane Ian—which could take multiple years to settle the resultant personal property and commercial claims. However, in looking at the frequency, the recent multiplying amount, and the severity of these events—plus the calculable effects from climate change—disasters on some level likely will present themselves. Digitization, scalable technology, and opti-

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mized infrastructure is required to handle the complexity of claims management resulting from disaster.

Inflation

Inflation was one of the most dominant stories of the past year. It was impossible not to feel its impact in nearly every facet of everyday life, every industry, and every news report. As inflation rates reached their highest levels in many markets in 50 years, 2022 saw the U.S. Federal Reserve raise interest rates seven times by the end of 2022, and the U.S. braced for a recession.

The insurance industry wasn’t immune. As central banks hiked rates to counterbalance inflation, insurer and reinsurer balance sheets were impacted. Additionally, inflation rates for key loss components for insurers (e.g., construction costs) often have higher rates than standard inflation. This can make the effects especially hard to handle.

Insurers and agents have been forced to examine the most cost-effective ways to operate business as a targeted solution. The priority has been efficiency and financial optimization. Digitally managing claims is proven and by far the most efficient method. It saves money in the long run through process, and measurably saves resources on process administration through streamlining. In short, digital optimization is optimal.

Inflation also has caused an increase in premium costs, which has led to more shopping amidst policyholders who prioritize lower costs. Insurers and their agents have had to react accordingly to keep pace and stay competitive within the industry. Utilizing tech solutions to reduce their own in-house claim management costs, enabling lower price points to keep with market competition, is a premium that digital solutions afford.

That being said …

The modernization of claims management is immensely important. It provides process advantages and benefits—both fiscally and efficiently—that cannot be ignored by those in the insurance industry. Yet, there are some traditional claims-management processes that still belong in the industry in a crucial way and remain presently effective.

Software advancements are not a catchall. Some traditional services can help bring the job home in ways that digitization—at least today—can’t fully accomplish solely. In those ways, general knowhow, decades of industry expertise, and classic methods will never go out of style.

There is value in finding a merging balance between legacy core systems and newer technologies working hand-in-hand. That could make business processoutsourcing critical to managing a high volume of claims, underwriting, or commercial distribution. In policy administration and claims management, the right combination of both is what gives insurers and agents a true best

In any case, it’s best to have all bases covered.

Barrett launched National Flood Services, working with the Federal Insurance Administration and the National Flood Insurance Program. He later joined Bankers Insurance Group as executive vice president of sales before founding

Almost every day, mental health is in the news. Increasingly employers are understanding that they must be part of the solution to improve mental health for millions of Americans.

In my decades of experience in the insurance industry and the behavioral health field, I have not experienced the focus and prioritization of mental health that I see today. As an experienced licensed clinician, I am advocating for our industry and the business community at large to capitalize on this unique opportunity in time.

There are a couple ways in which agencies can support mental health in the workplace—as business partners for employers, as well as businesses hiring and retaining important employees in the insurance industry.

A workplace issue

Today, mental health is not simply a public health issue. It is a workplace issue that businesses cannot ignore because employee well-being—including mental health— profoundly influences a company’s bottom line.

Depression and anxiety disorders cost the global economy an estimated $1 trillion each year in lost productivity.1

In 2022, 71% of U.S. employers said the deteriorating mental health of their workforce negatively impacted their company.2

Mental health conditions are among the top five reasons for U.S. workers to file a short-term disability claim.3 A person diagnosed with a primary injury or illness—along with the presence of psychological factors, such as anxiety or depression—takes two to three times longer to recover than someone with similar injuries or illness and no additional psychological factors.4

Agents who help employers better support their employees’ mental health can be considered innovative and empathetic business partners who understand how to advance companies’ goals, and who help boost their bottom line. Agents who support the mental health of their own workforce can differentiate themselves in the employment marketplace, which ultimately can help achieve better business outcomes.

Empathetic leadership

Although employers may believe they are fostering a supportive workplace, research shows U.S. workers feel

ADELE SPALLONE

Head of clinical operations, Workers’ Compensation and Group Benefits, The Hartford

Make mental health a priority

Anxiety. Burnout. Depression.

their companies are falling short on access, flexibility, and resources.5 That gap between employers and employees about psychological safety can be shrunk by exhibiting empathetic leadership, adapting to the needs of a multigenerational and diverse workforce, and providing flexibility and mental health resources that meet each employee population’s needs.

To be inclusive of what isn’t readily seen—such as mental health conditions— requires a companywide commitment to education and empathy to remove stigma as a barrier to employees asking for help. Building trust throughout an organization requires leaders to listen to and implement feedback, use inclusive language, prioritize confidentiality, and model behaviors.

Nothing can be more discouraging to an employee than a manager or employer writing off his or her needs or concerns. In a time of escalated uncertainty and anxiety, it is crucial for leaders and managers to acknowledge the increase in stressors for their employees, and that each individual employee faces a unique set of challenges.

Leaders can promote the use of respectful, person-first language when talking about mental health conditions. Leaders also can establish mental health training for managers so that they are given the education and resources to effectively support employee mental health. Managers need to validate their employees’ experiences and express that what they are going through is common, the stress in today’s world is real, and they don’t have to do it alone. Some employees may feel hesitant to discuss their concerns or situations at home. This could be for a variety of reasons, such as embarrassment, fear of losing their job, or a cultural custom. Companies can offer an outlet, such as an anonymous survey or the opportunity for an employee to write responses privately to some of these more delicate questions, as an excellent way to gather employee feedback on mental health.

Flexibility

Leaders can establish policies and practices that demonstrate to employees that mental health is a priority for the organization (e.g., flexibility). Flexible work has been a staple of return-to-work arrangements for employees who are recovering from a disabling illness or injury. Flexible work arrangements include remote work, a compressed work week, and flex time.

The pandemic elevated the importance of workplace flexibility, and now flexibility is more important than ever to all employees. Employers who offer flexible work arrangements will have an advantage in recruiting and retention—and help with supporting mental wellbeing in the workplace. Research shows employers think they are offering flexibility, but many U.S. workers disagree. Agents can take the opportunity to review company procedures and policies about flexible work and consider discussing those with their employer clients.

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Researchers and, in turn, employers are understanding the tangible and powerful connection between mental health and diversity, equity and inclusion in the workplace. Microaggressions, code-switching, and imposter syndrome are behaviors understood in the context of racism and discrimination. They also can affect the mental health of many working Americans. If employees feel like they cannot bring their whole selves to work or feel like they don’t belong, that’s an impact to their well-being—and in turn to a business’s bottom line.

Increasing the feelings of inclusiveness, empathy, and flexibility for

workers can help remove the stigma that blocks care. Employers can promote racial equity by identifying problems, giving an equal voice to employees of all backgrounds and cultures, and educating the workforce on racial equity.6

Employee resource groups can offer peer-to-peer support, particularly for those whose race, culture or identity affects their individual decisions about mental health. ERGs can help establish a safe place for conversation and learning as part of a companywide approach to mental well-being. Gen Z workers—those in their 20s and younger—have made mental health a central part of their job search. Agents who take key steps within their own workforce to offer mental health resources that Gen Z desires, can leverage this as a differentiator in the job market.

Now is not the time for employers to scale back on DEI or mental health initiatives, especially when recruitment challenges make it difficult for some companies to achieve the employee mix that they want. Now is an ideal time to embed inclusive mental health initiatives into your agency’s DEI strategies.

By normalizing mental health as part of total health, employees have the potential to feel more comfortable in seeking mental health care in the workplace.

In a crisis?

Call or text 9-8-8 to reach the suicide and crisis lifeline, which is a national network of local crisis centers that provides free and confidential emotional support to people in suicidal crisis or emotional distress 24 hours a day, 7 days a week in the United States.

Benefits

Agents can help their employer clients create benefits packages with tailored insurance coverage offerings that support mental health in the workplace and beyond. Employers can think beyond the traditional Employee Assistance Program, and they can consider adding digital apps and wellness programs to their benefits packages. Employers should keep in mind that wellness programs designed for specific issues, such as insomnia, have added mental health advantages. For example, researchers have found sleep problems can both contribute to—or exacerbate—mental health conditions. Benefits must be easy to understand and accessible, without stigma, for them to be most useful for employees. That means now, with the current focus on mental health, is a great opportunity to communicate widely to employees about a company’s benefit programs.

There are a host of free mental health and wellness applications and telehealth resources that can supplement resources offered in the workplace. Employers can help make employees aware of mental health and emergency crisis hotlines—such as the helpline by the National Alliance on Mental Illness, the nation’s largest grassroots mental health organization. It can be reached by phone call or text at (800) 950-6264, Monday through Friday, from 10 a.m.-10 p.m. (EST).

Mental health movement

I am grateful and encouraged by the progress made to support employees’ mental health to-date. I will continue to advocate for more—because the need is great and the time for action is now.

I hope more agents and their employer clients will join the mental health movement. Making mental health and employee well-being a top workplace priority will not only benefit your agency—it will make our industry and society a better place as well.

Spallone is the head of The Hartford’s clinical operations for Workers’ Compensation and Group Benefits. Reach her at adele.spallone@thehartford.com.

1 World Health Organization, 2022 (bit.ly/3WlOzmg)

2 The Hartford’s Future of Benefits Study, 2022 (bit.ly/3XErgFz)

3 Top five reasons for short-term disability claims for last four years, excluding pregnancy, were musculoskeletal injury, cancers and other neoplasms, digestive conditions, and mental health conditions

4 Analysis of four years (2014-18) of The Hartford’s workers’ compensation and disability claims data

5 The Hartford’s Future of Benefits Study, 2022 (bit.ly/3XErgFz)

6 Arlene S. Hirsch, “Advancing Racial Equity in the Workplace,” Society for Human Resource Management, July 15, 2021 (bit.ly/3iLrhZs)

Common causes for E&O claims: Policies and claims

Common causes for errors-and-omissions claims occur when clients perceive that their insurance agents fail to notify them of the cancellation of coverage, or they fail to replace canceled coverage. Problems also can occur during the reporting of claims. Let’s examine these issues.

Failure to notify of cancellation/replacing canceled coverage

Some clients are not good at paying their premiums on time. Chasing bad-pay clients creates an exposure for your agency if a client has a claim post-cancellation and you did not provide additional notification. Best practices include the following:

• Do not set the precedent of notifying clients of pending cancellations.

• Do not make payments on behalf of clients to avoid their policy being canceled.

• Do not advise that you will be able to cure a gap in coverage due to a cancellation.

• Do offer to obtain replacement coverage as soon as possible once coverage is canceled—and let the insured know as soon as possible if you may not be able to provide an acceptable replacement.

Reporting of claims

Educate your staff members on what they should and shouldn’t say when they receive a notice of claim from a client. Create a clear process with an emphasis on documentation to help you avoid E&O claims.

• Do have a process to ensure that any claims notice received from an insured is forwarded to the carrier within 24 hours.

• Do confirm receipt of the claim with the carrier.

• Do ensure you report the claim to all policies that may have coverage, being particularly aware of excess or umbrella coverage in place—this often is overlooked.

• Do communicate in writing to your clients if you do not accept notices of claim, with details on where they should report the claim. If this is discussed verbally, back it up with a written communication.

• Do not advise a client that “you will be covered” or “there is not coverage.” The carrier should determine claims coverage.

Important: If you believe there is a potential E&O claim against your agency, report it to the carrier immediately and do not admit liability.

Could this happen to your agency?

Scenario No. 1: An agent made a habit of making premium payments on behalf of a client and then billing the client for those payments. The agent later stopped fronting payments for the client and one of the client’s policies was canceled for nonpayment. A loss occurred that would have been covered under the canceled policy, and an E&O claim was pursued against the agent. The case went to trial and the jury ruled in favor of the plaintiff on the theory that the agent created a duty by paying the client’s premium, creating an ongoing duty to continue paying the premium on behalf of the client. This claim paid over $500,000.

Lesson: Do not accommodate bad-pay clients by fronting their premiums or chasing them to make a premium payment.

Scenario No. 2: An agent received a notice of potential claim from a client, and the agency has a policy of not

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accepting notices of claim. The agent advised the client that the client would need to submit the claim directly to the carrier, supplying the client with the claim-reporting details. The client did not report the claim to the carrier at that time. A few months later, the client contacted the agent further with a notice of summons and he was again advised to report the claim to the carrier. Again, the client did not report the notice to the carrier. Subsequently, a default judgement was made, and the claim was then reported to the carrier by the agent. There was no documentation of the instruction from the agent to the client regarding reporting the claim. This E&O claim resulted in a payout to the client exceeding $100,000.

Lesson: Document in writing if you advise a client to report a claim directly to a carrier.

Utica National Insurance Group and Utica National are trade names for Utica Mutual Insurance Company, its affiliates and subsidiaries. Home Office: New Hartford, NY 13413. This information is provided solely as an insurance risk management tool. Utica Mutual Insurance Company and the other member insurance companies of the Utica National Insurance Group (“Utica National”) are not providing legal advice, or any other professional services. Utica National shall have no liability to any person or entity with respect to any loss or damages alleged to have been caused, directly or indirectly, by the use of the information provided. You are encouraged to consult an attorney or other professional for advice on these issues. © 2023 Utica Mutual Insurance Company

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Floor-plan coverage, power surges and more

Backing into a garage door

Q. While backing up his car, my client ran into the garage door he had just installed. Does he need to submit the claim to his auto or homeowners insurance carrier?

A. Since it appears that your client owns the garage, damage to the door will not be covered by his personal auto policy. The Insurance Services Office Inc., form reads:

EXCLUSIONS

A. We do not provide Liability Coverage for any “insured”:

2. for “property damage” to property owned or being transported by that “insured.” [emphasis added]

However, your client’s homeowners policy will cover this damage—although it will be subject to the policy deductible.—Dan Corbin, CPCU, CIC, LUTC

Umbrella policy–obligation to give notice of a claim

Q. Someone was injured on my client’s property. Initially, the incident resulted in a $1,500 reserve being placed on my client’s commercial general liability policy. Since it was such a small amount, my client chose not to report it to his umbrella insurer. However, when the reserve subsequently was increased to $75,000, I persuaded the client to give notice on the umbrella policy. Then, the umbrella insurer declined coverage due to late notice. Should my client have given notice on the umbrella policy, even though the claim appeared to lack severity in the beginning?

A. In most jurisdictions, the insurer would be required to show prejudice in its ability to adequately defend the claim before such denial could be enforced. If there is no prejudice, it will not matter that the insured’s notice was late.

To determine the insured’s obligation to give notice of claim, the policy conditions will need to be examined. While there are some standard forms available, most umbrella policies are filed by commercial insurers independently.

The ISO CU 00 01 form requires the named insured “to see to it that we are notified as soon as practicable of an ‘occurrence’ or an offense, regardless of the amount, which may result in a claim.” By stating “regardless of amount,” the ISO conditions make notice on this policy imperative at the same time

notice is given to the primary underlying insurer.

Some policies may not require notice until the occurrence is likely to exceed the primary policy limits. Other policies could have specific thresholds that trigger the notice requirement; such as, when the claim exceeds a percentage of the primary limits. The insured must be careful to consider all factors pertaining to the litigation that may indicate the claim could exceed the primary limits or the percentage threshold. When in doubt, PIA recommends giving immediate notice on all policies that could possibly provide coverage.—Dan Corbin, CPCU, CIC, LUTC

Floor-plan coverage

Q. What can you tell me about floor-plan insurance?

A. Floor-plan coverage protects merchants of high-valued articles, such as automobiles or large appliances. Often, such merchants finance their stock while it is on the showroom floor, awaiting sale. The stock is the collateral for the loan. Insurance taken out to protect the merchant and/or the finance company from loss to this collateral is floor-plan insurance.

ISO’s Floor Plan (CM 00 52) Form provides all risk coverage for merchandise for sale that has been

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financed. This form covers the single interest of the dealer or lending institution for its dual interest.

The insured needs to keep accurate records on covered inventories, retaining such records for three years.—Dan Corbin, CPCU, CIC, LUTC

Power-surge exclusion

Q. A gas station with a package policy sustained a loss when a power surge shorted its computer equipment. It turned out that a tree limb on the premises was rubbing on the wires, creating power surges. The insurance company is denying coverage. Is it correct?

A. You would have a difficult time arguing for coverage under the package policy language. The ISO Cause of Loss–Special Form Exclusion B.2.a. removes coverage, “for loss or damage caused by or resulting from artificially generated electric current, including electric arcing, that disturbs electrical devices, appliances or wires.”

The phrase “caused by or resulting from” could be interpreted to be the proximate cause that sets the damaging chain of events into motion. If the proximate cause triggering the artificial electric current is not excluded, an argument could be made for coverage. For example, you might argue the proximate cause was the nonexcluded event of the branch rubbing the wire due to a windstorm. However, if the branch rubbed the wire over a long period of time, the insurer might invoke the “wear and tear” exclusion [2.d.(1)].

Unfortunately, many courts rule that only the most direct and obvious (i.e., efficient) cause should be looked to for purposes of applying an exclusion. In this case, the efficient cause of loss would be the artificially generated electric current. For instance, in describing this damage, the claimant would not likely refer to the loss as “wind” damage to my computer, but rather “electrical” damage to my computer.—Dan Corbin, CPCU, CIC, LUTC

Transportation expenses

Q. Does a personal auto policy provide expenses for airfare if our insured is on vacation and his vehicle is stolen?

A. The 2018 ISO Personal Auto Policy has a limited benefit for “transportation expenses” and has been adopted by New Hampshire, Vermont, Connecticut, New Jersey and New York.

This coverage is limited to $30 per day, up to a maximum of $900, so it would not cover a typical airline fare.— Helen K. Horn, CIC, CPIA, CISR

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