PIA Summer 2017 by PIA of Tennessee

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Summer 2017 • Tennessee

Page 18

Rein in Claims Five ways to prevent a claim from escalating to the courtroom

The Claims issue 9

Coverage traps

Avoid cyberclaims

Reduce your clients’ risk

Stepping Forward to Serve Clients MidSouth Mutual has provided quality Workersâ&#x20AC;&#x2122; Compensation insurance and services to agents and their clients since 1995. Every step of the way, the company has moved forward to provide exceptional service and expanded coverage areas across the Southeast.

MidSouth Mutual provides strength, reliability and value to agents and their clients through quality products, forward-leaning loss control and superior claims services.

Examples of clients we serve include: HVAC Contractors

Bricklayers

Carpenters

Masonry

Building Suppliers

Electricians

Framers

Insulation

Dozing Services

Plumbers

Dry Wallers

Cabinetry

Road Contractors

Painters

Landscapers

Flooring

MidSouth Mutual provides insurance to customers in Tennessee, Georgia, Arkansas, Mississippi, Alabama, Kentucky and North Carolina.

Contact Tom Perez at tom.perez@bwood.com or 615-379-8245 www.midsouthmutual.com midsouthmutual.

Departments 04 In brief Summer 2017 • Tennessee

09 Tech 15 Connect 27 Sales 30 Readers’ service and advertising index 31

Officers and directors directory

Cover story 18 Rein in claims Five ways to prevent a claim from escalating to the courtroom

Feature 23 Reduce your clients’ risk How agents can help employers

Statements of fact and opinion in PIA magazine are the responsibility of the authors alone and do not imply an opinion on the part of the officers or the members of the Professional Insurance Agents. Participation in PIA events, activities, and/or publications is available on a nondiscriminatory basis and does not reflect PIA endorsement of the products and/or services. President and CEO of PIA Management Services Inc. Mark LaLonde, CPIA, CIC, AAI; Executive Director Kelly K. Norris, CAE; Communication Director Mary E. Christiano; Senior Magazine Designer Sue Jacobsen; Member Information Manager Jaye Czupryna. Postmaster: Send address changes to: Professional Insurance Agents of Tennessee, 504 Autumn Springs Court, Suite A-3, Franklin, TN 37067. “Professional Insurance Agents” is published quarterly by PIA Management Services Inc. PIA Management Services, 25 Chamberlain St., P.O. Box 997, Glenmont, NY 12077-0997; (518) 434-3111 or toll-free (800) 424-4244; email pia@pia.org. ©2016 Professional Insurance Agents. All rights reserved. No material within this publication may be reproduced—in whole or in part—without the express written consent of the publisher.

Cover design Roberta Lawrence

In brief

From the executive director

There is more to the PIA than meets the eye Research shows that some of the key benefits members seek from associations like the PIA include: advocacy, professional development and networking opportunities. Over the past several months and during the upcoming weeks, the PIA of Tennessee has set its focus on these key areas. Some of the efforts you may not have seen.

and preserving regulation of insurance on the state level. We also spoke about the importance of the crop insurance and flood insurance programs and preserving compensation for agents providing this vital professional advice. Of course, we could not visit D.C. without discussing the health-insurance bill, the dangers of the “Cadillac tax” and the need for tax reform that benefits small businesses.

Representatives from our association spent time working with legislators on You will see an increased focus on profesKristopher Mark Fisher, the state and national levels to advocate sional development at our upcoming CPIA, LUTCF for issues which impact our industry convention, as well as continuing-educaExecutive Director and the lives of our clients in March and tion credit from national instructors and PIATN Franklin, Tenn April. Our annual Day on the Hill was speakers. We want you to walk away from a huge success with great attendance our convention to be held June 22-23 and productive meetings. In fact, we are with renewed energy and valuable tools pleased to announce that the bill relating to insurance to help you be a more effective agent or staff member agents charging fees for health insurance passed both the in this new 21st century. If you have not registered for convention, please go to www.PIATNconvention.com to General Assembly and the Senate, and already has been at least attend with our single-day pass and trade show. It signed by Gov. Bill Haslam. That is a huge success for our will be well worth your time away from the office. industry and the professional guidance of our clients. In addition, our Federal Legislative Summit in Washington, Continue to watch for additional improvements and D.C., enabled us to meet with both our U.S. senators, efforts by the association. As always, the staff and I are several representatives and their staffs to discuss the here to hear your ideas, support you, and assist you and importance of eliminating the Federal Insurance Office your team. platinum partner profile

Markel Specialty Commercial 4600 Cox Road

History

Glen Allen, VA 23060

Tennessee staff Matt Valentine, Tennessee sales manager

Markel Specialty, one of Markel Corp.’s four insurance divisions, has over 70 years of experience in niche markets, with a product focus on commercial- and personal-lines insurance. Markel Specialty Commercial, the commercial-lines division of Markel Specialty, provides tailored commercial insurance solutions to small business and specialized niche industries, including general coverage in the areas of commercial package, monoline liability, workers’ compensation, accident and medical, commercial auto and business owner policies.

(615) 967-5515

(continued on page 5.)

mvalentine@markelcorp.com

Professional Insurance Agents magazine

platinum partner profile (continued from page 4.)

Appetite Markel Specialty’s product focus is on accidental and health; camps; child care; health clubs; human services; in-home child care; investment advisers; medical transportation; museums; pest control; sports and fitness; and workers’ compensation.

Working with retail agents across the U.S., our experienced underwriters know the risks your clients face and can craft coverage to meet their unique needs.

AMERISAFE DeRidder, LA www.amerisafe.com

AMERISAFE writes business in 27 states.

Senior executives Ed Ennis, VP of sales

Tennessee staff Hayley LeBlanc, Tennessee marketing associate Jarred Waters, territory sales manager

History AMERISAFE, which was established in DeRidder, La., in 1986, is a specialty provider of Workers’ Comp Insurance focused on small- to mid-sized employers in hazardous industries. AMERISAFE has grown to focus on a wide range of hazardous occupations in more than 27 states. The company has demonstrated expertise in underwriting the complex workers’ compensation exposures inherent in its targeted industries: construction, trucking, agriculture, logging and wood products, oil and gas, maritime, aggregates, and manufacturing.

Philosophy According to AMERISAFE: “We know that hazardous industry employers face unique challenges and tend to have less, but more severe, claims compared to employers in other industries. We employ a proactive, disciplined approach in underwriting our policies. Due to our specialization in hazardous industries, we understand the unique risks our clients face in the workplace. That understanding aids us in providing comprehensive services that lessen the overall incidence and cost of workplace injuries. “We provide safety services at employers’ workplaces as a vital component of our underwriting process. Our field safety professionals visit our clients’ work sites to offer assistance in making the workplace safer. As specialists in hazardous occupations, these safety professionals can offer unique insight into workplace safety that helps to lessen the overall incidence and cost of workplace injuries. Accidents occur in even the best-managed hazardous industry operation, and AMERISAFE is prepared for those circumstances. We utilize intensive claims management practices that we believe permit us to reduce the overall cost of workers’ compensation claims. Our field case managers carry low claims workloads to allow them to provide our insured employers and their injured workers with highly personalized service that facilitates prompt resolution of claims.”

www.pia.org

platinum partner profile

Cornerstone National Insurance Columbia, MO

Philosophy

(573) 817-2481

“The Cornerstone mission statement is, ‘Our foundation is you.’ As such, we pride ourselves on having a friendly and knowledgeable team that truly enjoys regularly finding increased efficiencies. When working with Cornerstone, expect a carrier that is continually becoming one of the strongest partners in your agency.

www.Cornerstonenational.com

Cornerstone National Insurance writes business in Missouri, Kansas, Oklahoma, Illinois, Indiana, Arkansas, Alabama, Tennessee, South Carolina and soon Virginia.

Senior executives William Wheeler, CEO Roger Walker, COO Sidney Neate, national sales director

“Cornerstone prides itself on offering wonderful incentive programs to agency partners, including profitability-based contingency bonuses; higher commission percentages; unparalleled claims service; a faster quoting and binding system with data prefill; and a supportive underwriting team. Agents interested in additional information or potential appointment should go to www.cornerstonenational.com. We look forward to your helping us drive insureds back to preferred today!”

Appetite

Tennessee staff Don Ellis, CPCU, CIC, West Tennessee VP agency relations DEllis@CornerstoneNational.com (501) 400-3570 Robert Ream, East Tennessee sales manager RReam@CornerstoneNational.com (864) 884-1277 Sidney Neate, national sales director (for central and northern Tennessee) Sidney.Neate@CornerstoneNational.com

History

Cornerstone National Insurance is a preferred auto insurance carrier for nonpreferred drivers. The Rate Recovery Plan drives insureds back to where they want to be. Cornerstone accepts drivers without prior insurance or those with slight motor-vehicle report issues by offering a monoline personal auto product that specializes in 25/50 or 50/100 limits. It guarantees a 6-8 percent discount upon every six-month renewal for three years to drivers who maintain favorable payment and claim activity. These discounts are accompanied by the opportunity for insureds to regain their coverage tier to the preferred status of 100/300 limits at their annual renewal. All Rate Recovery Plan policies include: roadside assistance, even for liability-only policies. With the Rate Recovery Plan, Cornerstone agents see 75-80 percent retention levels.

Cornerstone National Insurance, a Missouri-heaquartered personal auto company has been serving the independent agency network throughout the Midwest since 1997 and has an agency network of more than 800. Cornerstone expanded its Rate Recovery Plan to Tennessee during the fourth quarter of 2015.

Professional Insurance Agents magazine

The more coverage clients have with you, the less likely they are to switch agents. EMC National Life is committed to making life sales simple with easy-to-understand products and online services to speed up the sales process. It’s just one of the many reasons policyholders Count on EMC ®. LORA BUSKE Senior Life Sales Representative EMC National Life

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8/16/16 2:28 PM

It’s a trap! I’m treading on thin ice. I am daring to make a Star Wars reference in my article. Usually, those are reserved for my colleague, Brad Lachut. Hey, “damn the torpedoes, full speed ahead.” When I watch Star Wars with my kids, one of their favorite quotes is Admiral Akbar’s “It’s a trap!” (which he says during the rebels’ attack on the Death Star). Meanwhile, it makes me think of all the coverage traps found in insurance policies. I receive frequent calls from our members who ask me to review policies to confirm what they are seeing: hidden (or at least, we feel they are hidden) exclusions or coverage restrictions that one would not normally see or expect in these policies—coverage traps!

When reviewing a policy, one normally expects certain coverages and policy conditions to be evident. When reviewing an ISO policy, everyone who has been in the business long enough knows what is included or excluded in these policies. ISO policies are effortless to identify because the bottom of the form will state “© ISO Properties Inc., 20XX.” However, if the

Tech

jim pittz, cic, cpia Business issues director, PIA Management Services

Get to know M. J. Kelly, managing general agents and surplus lines brokers. We offer a national company’s purchasing power and a neighbor’s personal attention. When you partner with us, you get specialists with industry knowledge, superior products, easy applications, and personal service. We’re ready to write your risks and provide real solutions like in-house financing. Whether it’s special events, cyber liability, or artisan contractors, M. J. Kelly is here to help you write business. Our success is yours. Get to know M. J. Kelly Company.

M. J. Kelly Company-Arkansas 800.873.8374 www.mjkelly.com

www.pia.org

following appears on the bottom of the policy form: “Includes copyrighted material of Insurance Services Office, with its permission” this means that the policy is unique to that carrier and it may have alternative wording regarding coverages and exclusions. This makes it harder on the agents and makes it imperative that agents know and understand the policies of their represented carriers. No one wants to receive a call from a client with a claim and have to tell the insured there isn’t coverage (especially if there might have been coverage with another carrier). The damage may be compounded if the agent did not read the policy closely and did not understand what was included and excluded from it. Hello, errorand-omissions claim. Here are some coverage traps of which you should take note: Example 1: Personal Auto–Exclusion. No coverage for property owned by an “insured.” The first thing we notice is the use of insured. By definition: “Insured” as used in this Part means: 1. You or any “family member” for the ownership, maintenance or use of any auto or “trailer.” 2. Any person using “your covered auto.” I have seen this exclusion on multiple carriers’ policies. What does this mean in layman’s terms? Consider this scenario: Your client has multiple policies, in his or her household (Mom and Dad have policy A with carrier A; their child has policy B with carrier B) The child is backing out of the driveway, he

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or she accidentally backs into mom and dads’ vehicle. Under this policy exclusion, even though the child was at-fault when he or she backed up and hit the other car, there would be no coverage under the child’s policy. There is no coverage for property owned by an “insured.” Since the child lives with Mom and Dad, each is considered an insured on the their respective policies. Example 2: Personal Auto–StepDown Provision (not applicable in all states). Some states have this provision, in which the policy will only pay out state mandatory minimum limits, regardless of the limits that are carried on the policy/vehicle. This would affect the following scenarios: • when a personal auto is being used to carry persons or property for compensation or a fee,

including, but not limited to, pickup or delivery of magazines, newspapers, food, or any other products. • when any other person occupying a vehicle, even with permission from “you” or a “family member.” How many of your insureds have children away at college? Have these insureds asked their children if they have part-time jobs (e.g., as Uber drivers or pizza delivery drivers)? If they do, this could affect the coverage on the vehicle. Example 3: Homeowners–Where you reside definition (this is an ISO form change that has been adopted by some carriers, but not by all). On some policy forms, the definition of where you reside has been changed to identify that coverage begins on the effective date

of the policy if the insured is residing in the residence listed on the policy DEC page at that time. What happens when an insured purchases a new home and decides he or she wants to paint or complete a minor renovation and does not move in immediately, or delays the move-in date for two weeks? According to the policy, coverage would not exist since the insured is not residing in the dwelling on the effective date of the policy. Example 4: Personal Auto–Duty to report a new insured in the household. Some carriers now require that anyone new in the household must be reported to the carrier within a specific period. Failure to notify the carrier of this change could result in physical damage being excluded from coverage in the event of a loss. Example 5: Commercial Auto–Contract Liability Exclusion. Normally, there is always a form of a Contractual Exclusion: a. Assumed in a contract or agreement that is an “insured contract,” provided the “bodily injury” or “property damage” occurs subsequent to the execution of the contract or agreement; or b. That the “insured” would have in the absence of the contract or agreement. This tells you there must be a contract in place first, meaning you cannot have a loss, and then have a contract (after the loss) to take responsibility for that loss. What we are seeing in some policies is that there is absolute contract liability exclusion. No coverage for any contractual agreement, regardless of when the contract was executed. Many classes of business auto may have an

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exposure, it is important to check on this, as I said we are seeing this creep into policies with a greater frequency. Example 6: Homeowners–Vehicle parts. This one is a little bit different. Previously, vehicle parts were covered in the ISO homeowners policy, but they have disappeared. Motor vehicles always have been excluded under the homeowners policy. However, their accessories, equipment or parts were subject to the following: The exclusion of property described in (a) and (b) above applies only while such property is in or upon the “motor vehicle.”

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Professional Insurance Agents magazine

This means if accessories, equipment or parts (think snow tires) were laying around the garage they were covered. However, this has changed. The new wording states motor vehicles still are excluded, however, a motor vehicle’s equipment and parts (e.g., snow tires or any of the vehicle’s parts that have been removed or are being rebuilt) are now included in the exclusion. Now, the only items that are covered are portable electronic equipment that can be powered by other sources than the auto, or motor vehicles that are not subject to registration and are used solely to service a residence or are designed to assist a disabled individual. These are just a few of the coverage traps I have come across lately. It is incumbent upon you, the agent, to understand fully what is in your insureds’ policies and what is covering (or is some cases not covering) your insureds. Otherwise, the trap you could fall into could be your own E&O trap. Pittz is PIA Management Services’ business issues director.

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2017 PIA of Tennessee Convention Join us for the Annual Convention in Pigeon Forge,TN June 22nd-23rd. To make your stay memorable and beneficial there will be many fun activities, opportunities for professional development/CE, and networking. Register and reserve your hotel TODAY at http://piatn.com/2017-convention/

Ack! We’ve been hacked! Despite heightened awareness of cyberthreats and increased spending on technology-based solutions, businesses throughout the country continue to fall victim to a range of cyberattacks and data breaches. Many organizations—including insurance agencies—turn to cyberinsurance as a solution to cover both first-party loss and third-party liability. These insurance policies often have the added benefit of proactive cyberrisk management tools and offer access to the industry’s top-breach response vendors. Yet given the time-sensitive nature of cyberevents, it’s important to understand how the policies work and come up with a plan ahead of time. Consider the following three scenarios: • It’s 3 p.m. on a Friday and your human resources director receives an urgent email from the agency president requesting copies of each employee’s W-2 form to conduct a quick payroll review. While the request seems odd— especially since the president is on vacation—the HR director replies to the email, attaching the requested forms in a zip file. Only upon clicking “send” does he realize that the email recipient’s address differs slightly from the president’s. In fact, her email had been “spoofed” or forged to appear to come from her. At this point, the HR director realizes he has sent the confidential W-2 information for over 100 employees—including full names and Social Security numbers—to an unknown third party. • An account executive logs onto her computer to begin working on a client’s upcoming renewal. When she attempts to open the current policy and prior years’ applications, a message appears indicating that the file has been encrypted and the only way to obtain the encryption key (to unlock or decrypt the file) is to pay a ransom of 7 bitcoin (at the time of writing, equivalent to approximately $8,500). She calls the agency’s in-house IT manager who informs her that other users are experiencing the same issue. It seems that the entire internal agency management system has been infected with a new type of ransomware, most likely downloaded unknowingly by an employee clicking a malicious link in an email. Without access to critical client files, the agency’s operations come to a standstill. • While traveling to meet with a large client to discuss its group health insurance, your benefits specialist leaves his briefcase—containing his laptop—in the back seat of his car. When he returns, he finds that the briefcase is missing and realizes he forgot to lock the vehicle. Although his initial concern is the cost of the stolen laptop, he quickly remembers that he had downloaded files containing summary health information

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onto his desktop to easily share with the client, despite an agency policy mandating that such information only be accessed via a secure VPN. Although the laptop was password-protected, the IT department confirms that the hard disk is not encrypted— accordingly, this situation must be treated as a potential breach of protected health information. Although the fact patterns vary, these scenarios all point to the central role of data and information in the daily operations of the business. With your agency’s time, money and reputation on the line, you must act swiftly, but responsibly. In understanding the following three steps to cyberincident response, your agency will be better equipped to react and recover.

connect

evan fenaroli Product manager, Philadelphia Insurance Cos.

No. 1: Discovery This is the moment that an employee, manager or customer suspects that there has been some type of data breach, unauthorized access, or other cyberevent. Whether it’s a lost laptop or ransomware, all agency personnel should be instructed on how to report such incidents so they can be evaluated as quickly as possible. Ideally, your agency will have a predetermined incident response team that can be called upon when required. It also is recommended that you notify your cyberinsurance

Agency E&O

has a market for your agency and specific risk

carrier so it may guide you through the subsequent steps; advise you on what is and is not covered; or otherwise connect you with outside experts. Particularly, in cases when there is a suspected breach of sensitive client; customer or employee information; an experienced data and privacy attorney should be engaged to guide the subsequent investigation; preserve evidence; and coordinate notification.

Agency

E&O

No. 2: Investigation

Once an incident has been discovered, the incident response team, or other designated individual(s) can begin the investigation process. In the case of a data breach involving sensitive customer or employee information, you’ll want to determine how the information was accessed; the type of information compromised; and the number of affected individuals. In the W-2 fraud incident above, this information is obvious, but in other situations, you may need to engage computer forensic experts to conduct a thorough investigation; remove malware; and remediate vulnerabilities. For ransomware, your has a market hasdetermine a market which for your internal IT teamfor or your outside experts should files, applications agency and specific risk agency and specific risk and systems are affected and whether those assets can be restored from backups. In any event, it’s important to work with your insurer to confirm the available limits of coverage and seek the approval to use outside vendors.

No. 3: Response/remediation For breaches of personally identifiable information, your attorney—sometimes known as a breach coach—will evaluate your legal obligations under any applicable breach-notice laws. When necessary, specialized vendors are engaged to mail notification letters and set up a call center to answer questions from affected clients. The attorneys also provide legal representation in response to regulatory investigations or proceedings. In cases of ransomware (when you are unable to restore the data from backups), you may need to weigh the options of paying the ransom or finding another—possibly more expensive—means to restore or recreate your data. As mentioned above, you should coordinate with your carrier and seek approval for any such costs when necessary. While all cyberincidents are unique and require different responses and solutions, this basic three-step approach remains the same. Preparedness begins with understanding your exposure; identifying a team to respond to incidents; and having a process to follow in the event of a crisis. Through effective incident response planning, your agency can be better prepared to handle a breach with confidence and minimize monetary loss or business disruption. Fenaroli is a product manager with Philadelphia Insurance Cos.

Contact Kristopher Fisher 800-875-7428

Professional Insurance Agents magazine

Contact Kristopher Fisher 800-875-7428

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Tony SCiarrino, ESq. Director of claims litigation, Pennsylvania Lumbermens Mutual Insurance Co.

Rein in claims C

Five ways to prevent a claim from escalating to the courtroom onsumers and business owners buy insurance for peace of mind. They also buy it for the promise of a smooth claims process should disaster strike. As a result, the way agents, brokers and insurers handle claims for policyholders can make or break them. It’s important for agents, brokers and insurers to handle an insured’s insured’s claim as smoothly as possible so they maintain a healthy, positive relationship with the insured after the fact.

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However, poor claims handling doesn’t just affect the policyholder’s opinion of the agent, broker or company; it also can lead to drawn-out litigation. Actions taken by the agent or broker at binding, as well as timely careful action taken by the claims processor as soon as the claim comes in (among other things), can mean the difference between a smooth claims process and a lengthy battle in court. Superior claims service is a critical component to the commitment agents, brokers and insurers have to their policyholders. Managing common pitfalls in the claims process is key to not only ensuring a simple process for the policyholder, but also a no-surprises transaction for the agent, broker or insurer. In this article, we outline five actions that commonly lead to complications in the claims process for commercial lines—from producers neglecting to identify and bind the right coverages during the application process to allowing policyholders to share payout limits with a potential plaintiff. While our examples come from our experience in wood-related industries, these common mistakes can be made on a policy related to any industry.

Craft the right policy Let’s start with what might be the most important tip. If the agent or broker does not recommend and include the proper coverage in the initial application process, an array of problems can arise should the policyholder file a claim. Policyholders don’t always know the coverage they need for each of their facilities. A professional agent or broker will make sure everything is matched properly so the policyholder can make an informed decision. The producer or broker should ask the policyholder, “if this building burns down completely, will you have enough coverage to rebuild, and will you need business interruption coverage?” Producers and brokers have a responsibility to inform. Consider this: An insured has a facility comprised of multiple buildings, each housing a different component of the business. A warehouse, sales office, production facility and garage would all need to be examined separately as each would have different risk exposures. If the warehouse were to burn down, but the business interruption policy was only covering the sales office, problems could arise. Agents and brokers should also talk to their clients at binding and renewal time about emerging risks that could be facing their companies. For example, cyberthreats are a problem for any business that accepts credit cards or stores personally identifiable information. Agents and brokers also should discuss employment practices liability coverage, even if the client says he or she runs a small shop and doesn’t need it. The insured should understand that a standard commercial general liability policy does not cover employment claims, so if an employee is terminated and claims discrimination, or a host of other employment situations, the company would be on its own for legal costs and any settlement without EPLI. Underinsuring facilities also creates problems during the claims process. For example, suppose a policyholder has a building worth $6 million, but only has it insured for $3 million. If the building is partially damaged, or considered a total loss, the co-insurance provisions of the policy would apply. In that scenario, the policyholder would receive 50 percent of the actual 2

Professional Insurance Agents magazine

damages, less applicable deductibles. Therefore, in the event of a $1 million loss, the policyholder would receive less than $500,000. Typically, the co-insurance provisions of a policy only apply if the structure is insured at less than 80 percent or 90 percent of its actual value, depending upon the specific policy. Often insureds aren’t educated on this subject and believe that with a loss, they will get the full payout amount defined in their policies and then they consider filing lawsuits when they learn their coverage is far less. Insureds may not believe their entire building could be lost, but particularly in our industry, the wood business, this happens more than they realize. Finally, conflating entities is another topic brokers should address with their insureds at binding. For example, a business could be comprised of several different entities. One entity might own a parcel of land and another may own the building and have a long-term lease on the land. A third entity might own and operate a retail business in the building. If someone were to slip and fall at the retail store and suffer an injury, every one of those entities would be named in the suit. The role of each entity needs to be clearly defined and properly identified on the policy declaration page so that they are all covered.

Additional insured provisions For many commercial entities, the lifeblood of their business is providing goods and services to other businesses. Typically, those relationships are defined by a contract. Consider an insured that manufactures doors and has a contract with

a builder to supply doors. The manufacturer’s insurance policy will likely have a broad-form additional insured provision that provides additional insured status to the builder if the insured signs a contract that requires him or her to be added as such to the policy. However, too often, agents and brokers fail to explain that insureds need to read their vendor contracts carefully to understand what they are signing away. Some contracts contain indemnification clauses that would not only make the door manufacturer responsible for his or her negligent acts, but also for potential claims not related to his or her actions. For example, under certain contracts, the door manufacturer could be responsible for a roof leak in the building where his or her door

was installed. A good rule of thumb is for agents and brokers to encourage insureds to avoid clauses that pass liability on to them even if their own acts had nothing to do with the loss. This approach protects the insured’s loss experience, which over the long-term affects their pricing.

Report claims quickly, accurately Complications during the claims process also arise when the claim processor fails to report the claim quickly and accurately. The prompt and accurate reporting of a claim is critical. For example, if an insured files a claim with an agent or broker and the agent or broker doesn’t get the claim to the insurance company in a timely manner, it could lead to a default judgement, as the carrier would have never been made aware of the case. In some states, late reporting is a valid defense by the insurance carrier to deny a claim. This means that the insured becomes responsible for the verdict or judgement. To report a claim properly, the processor should file the claim that day or the next business day, and get all the material facts about the claim including: Who is the claimant? Where did it happen? How did it happen? It is important that the processor analyzes the loss and presents all potential claims. Finally, in the event of a lawsuit, the suit papers should be submitted immediately to the insurance company.

800-897-9719 www.amerisafe.com

Workers’ Workers’ Comp Comp for for Working Working People People

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Do not underestimate a claim’s severity “It was just a little fender bender.” Insurers hear this all the time and then somehow within a few weeks, the “little fender bender” escalates into a six-figure bodily injury claim. How does this happen? The insured underestimated the claim’s severity and the agent or broker who received the claim did not dig deeper. Report every third-party claim whether it is an injured party or damaged property. Consider this: An insured reports to his or her agent or broker that one of his delivery trucks was involved in a motor vehicle collision. The insured tells the agent or broker the victim didn’t appear to be injured and both parties walked away from the scene—though one complains of leg pain—and that is what is filed in that claim. Soon after, the person with leg pain has a more serious claim as his arthritis has been aggravated by the new injury and now a hip replacement is necessary. As a result, the insured is surprised and angry when he hears the claim has grown to six figures. To avoid this situation, brokers and agents need to help clients understand that claims evolve. They have to be careful that they don’t create any expectation that may not match the way their particular claim evolves.

Discourage oversharing Finally, agents and brokers also must be sure to share the importance of privacy with a client when it comes to claim reserves and policy limits. For example, suppose a customer who loads and unloads at an insured’s lumberyard falls on a faulty loading dock, breaks his leg and injures his shoulder. The claimant’s lawyer may be willing to settle the bodily injury case for $400,000. However, if the agent or broker shares with the insured that the carrier has a $500,000 reserve and the information is loosely discussed with other people,

somehow it always finds its way back to the claimant. Now, that same injury claim suddenly—coincidentally—comes in at exactly $500,000. Agents and brokers should be aware and careful when explaining policy limits and claim reserves to insureds so they know to keep that information close to the vest in the event of an accident.

Conclusion In the end, claims are unavoidable. However, there are measures everyone in the claims process can and should keep in mind to keep a claim from spiraling out of control. By getting the policy correct at signing; considering additional provisions; filing claims accurately and timely; understanding a claim’s severity; and discouraging insureds from oversharing information related to their policies, agents, brokers and insurers could keep claims from escalating. Insureds will receive better service and everyone can avoid costly claims that didn’t have to be.

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Sciarrino is the director of claims litigation for Pennsylvania Lumbermens Mutual Insurance Co. A graduate of the University of Pittsburgh School of Law, he spent 22 years as a civil litigator in Western Pennsylvania. His practice concentrated in insurance coverage, insurance bad faith and serious bodily injury claims. Sciarrino joined PLM in 2015 and his team supervises all of PLM’s claims litigation.

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susan toussaint Partner and co-founder, Oceanus Partners

Reduce your clients’ risk How agents can help employers

Often claims that spiral out of control do so based on circumstances that are unrelated to the accident or injury itself. Frequently, poor claims experience is the result of poor hiring practices; toxic supervisor and employee relationships; and a lack of oversight of medical treatment protocols. Asking an insurance claims adjuster to reduce reserves and close a claim with these mitigating factors is unreasonable, will leave employers and injured workers at risk and adjusters frustrated. Agents can play a pivotal role in reducing these risks and frustrations, first by helping employers to embed business practices that reduce the likelihood of claims from occurring or becoming adversarial and second by facilitating dialogue with adjusters to enable them to make more informed and appropriate case-management decisions. Agents’ understanding and use of primary prevention strategies that reduce the likelihood of workplace injuries and claims occurring and secondary prevention strategies that reduce the cost and duration of the claims that do occur can bring value to the agent-carrier-employer relationship. These primary and secondary prevention strate-

gies can have a positive impact on reducing the number, cost and duration of workers’ compensation claims.

Hiring practices According to the Bureau of Labor and Statistics, overexertion, sprains and strains of the back, neck and joints accounted for 31 percent of injuries in 2015.1 In addition, research from the Toronto-based Institute for Work and Health, shows that employees are three times more likely to be injured in the first month on the job.2 There are several hiring practices employers can implement that can have an impact on reducing new employee injuries—beginning with the use of detailed job descriptions. Usually, job descriptions focus on the role of the employee; who the employee reports to; as well as educational and work experience requirements. Typically, left out of job descriptions are the physical demands of the work to be performed. These demands include the description of the workplace environment as well as the work to be performed. For example, is the employee expected to lift, push, pull? If so, what is the www.pia.org

frequency and the weight involved? Including the physical demands in the job description provides applicants with the opportunity to assess their ability to perform the job and to determine for themselves if they can physically manage work expectations. It also serves a secondary purpose and strategy. When employers develop comprehensive job descriptions, they also can develop corresponding post-offer, pre-placement physical examinations. These physicals are given after the employee has been offered the job conditionally, ideally with the use of a conditional offer of employment, and before the employee begins the job. Developing a post-offer, pre-placement physical exam that mimics the work to be performed along with the use of a conditional offer of employment allows the employer to test the applicants’ ability to safely perform the work and to determine if they are likely to cause injury to themselves or others. Ideally, to maintain medical confidentiality and ensure proper administration, these physicals are developed and conducted by a third-party professional, such as a board-certified occupational physician. Once completed, the physician can share the exam results with the employer and provide a medical opinion as to whether the employee is at risk for injury or hurting others. Then the employer can make the decision to hire or rescind the job offer. Often, employers aren’t aware that hiring practices, such as including the physical demands of the job in a job description, or using a post-offer-preplacement physical can have an impact on claims reduction. Agents can play an important role by sharing these strategies and helping employers to develop relationships with medical providers who can assist with implementation. In addition, insurance carriers seek to better understand the culture of an employer and the steps it takes to reduce work-related injuries. Agents who effectively communicate a business’s proactive work and commitment to safety are more likely to positively influence pricing for their clients.

Return to work and modified duty In addition to being used in the hiring process, job descriptions can help medical providers and adjusters make informed return-to-work decisions. Job descriptions that outline the physical demands and the frequency of exposure to those demands provide the physician with greater insight into the environment to which they are discharging an injured worker. For example, let’s assume a physician is treating an injured employee, but isn’t familiar with the employer or the precise nature of the work the employee does and doesn’t have the benefit of a job description. How can he or she be expected to determine if a job can be modified, or if it is safe to return the injured employee back to work? On the other hand, if that same injured worker presents with a copy of his or her job description, the physician can assess the employee’s functional capabilities; have a better understanding of the work environment; and make a more informed decision about modifying the job duties for a limited duration of time. This can have a significant impact on the duration an employee is out of work, which ultimately affects the cost of the claim.

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Agents can encourage employers to engage proactively with both adjusters and physicians on returnto-work goals. When the employer, physician and adjuster work from the same information and communication is open, injured employees receive the same message, resulting in fewer lost workdays and a better recovery experience.

Engage supervisors Front-line supervisors are the forgotten treasures in the injury outcomes equation. Their firsthand knowledge of the injured employee; the work environment; and the opportunities available for either modified or transitional work assignments is priceless. Even more important are the tone and messaging that they send on behalf of the organization. Ideally, the message is: “You are valued, we want you to come back to work, and we are here to help.” Why are supervisors so important? A study by Liberty Mutual’s Center for Disability Research showed dramatic improvement in the reduction in new claims when supervisors were trained to communicate more effectively with employees.3 How can agents help drive improvements? Start by reviewing the type of supervisory training being offered at client worksites. Make sure supervisors are aware that they can positively improve the outcome of the claim by demonstrating empathy; encouraging the employee to recover at work when possible; and communicating the value the injured employee has within the organization. In addition, employers should assess how supervisors are compensated. Is it strictly on production, or are they also held accountable to injury

rates? Supervisor incentives can be misaligned, and employees inadvertently can receive the message that production is more important than a safe work environment.

Benchmarking Understanding what drives claims costs is essential to managing overall workers’ compensation costs. There are key metrics agents can help employers measure, and then improve upon to reduce injury costs. Legislative changes do not normally influence these metrics, nor are they controlled in full by insurance companies. By gaining control of these processes, employers can begin to impact costs. Claim lag times. The Hartford published a study that shows that one week’s delay in reporting an injury can increase claim costs by 10 percent. The study also found that claims filed a month or more after an injury costs 48 percent more to settle that those reported the first week. Disability duration and treatment. How long should a sprain take to heal? What is the appropriate treatment for a lumber strain? Understanding expected disability duration for an injury and benchmarking the physician’s treatment protocol to that duration is another way agents can assist employers in achieving the best results. Resources like the Reed Group’s MDGuidelines help employers and agents set recovery expectations and determine if physicians are using evidence-based treatment protocols. With these benchmarks, agents and employers can measure the actual versus expected disability duration for an employee based on the injury and determine whether the prescribed treatment matches established treatment guidelines. Agents

are uniquely positioned to help employers, injured workers and carriers achieve positive outcomes and reduce the cost and duration of employee injuries. These are just four areas in which agents can assist employers embed better business practices into their organization and help them reap rewards. While this work may seem onerous, it’s important to remember that absent these practices, employers face the chance of hiring employees who aren’t fit to perform the job safely and employees are at risk of becoming injured at work or not receiving the right medical treatment at the right time. Agents who embrace a consultative approach to their client and carrier relationships not only differentiate themselves, but they can have an impact in reducing the number, cost and duration of employee injuries. That’s a mission worth pursuing. Toussaint works with agents and brokers to improve sales, service and client retention. Her passion is helping agents engage with employers in well-defined processes that reduce employers’ risks and insurance costs and improve their outcomes. Before its evolution to Oceanus Partners, the WorkComp Advisory Group, founded by Toussaint and Frank Pennachio, guided insurance agencies in the process of leading with workers’ compensation to integrate technical knowledge with an effective sales process and implementation strategies. She can be reached at susan@oceanuspartners.com or (888) 496-1117. 1

https://www.bls.gov/news.release/pdf/osh2.pdf

https://www.iwh.on.ca/at-work/69/study-finds-persistence-of-higher-injury-riskfor-new-workers

https://www.libertymutualgroup.com/about-liberty-mutual-site/research-institute-site/Documents/SupervisorTraining.pdf 3

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Coverage features on a following-form basis ■ Full prior-acts coverage ■ Covers any person acting in a capacity as a real estate agent or notary. ■ Options unique to this program: • Personal coverage — broadened and excess personal protection for owners, partners and officers, including members of their families. (Submit ACORD Personal Umbrella Application.) • Employment practices liability — excess limits protection for liability incurred by named insured or employees for wrongful employment practices. Coverage can be written on a claims-made basis over a number of approved EPL carriers. Maximum available as a sub-limit is $2 million. (Submit a copy of underlying EPL application.)

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The ‘no-sale’ signals Salespeople pay attention to “buying signals,” those indications that a customer is ready to say, “Yes.” When this happens, the savvy salesperson knows it’s time to stop talking and ask for the order. However, salespeople often miss the warning signs that it is not going well. Mostly unspoken, these are the “no-sale signals” customers send when they’re dissatisfied with a salesperson. Here are 10 of them: No. 1: You don’t connect with me. You think you do with your small talk and feigned friendliness. It’s all an act, the same one you put on for every customer. Your efforts at manipulation are transparent and belittling. You don’t give even one good reason to buy from you. Take the time to discover what’s important to your customers; what they don’t like; how they make their decisions; and what bothers or worries them. If there’s one thing customers want from salespeople, it’s to be understood. No. 2: You’re only interested in making a sale. You may think that your job is to make a sale. It’s not. You haven’t figured out that your role as a salesperson is understanding what’s going on with your customers; what they’re thinking about; and what they want to accomplish. Do that, and the sale will take care of itself.

Try helping customers examine the possibilities so they can narrow the choices to the point that they will say, “This is what I want.”

No. 3: You decide what I should buy. Evidently, you don’t trust your customers to make their own buying decisions, so you do it for them. You don’t trust them enough to offer options. Do you think choices will confuse them—or worse, drive them away? Try helping your customers examine the possibilities so they can narrow the choices to the point that they will say, “This is what I want.” No. 4: You push me to make a decision. You and your customer aren’t on the same page when it comes to urgency. You prepare the proposal quickly; make

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the presentation; and get a positive response from the customer. You make constant attempts to motivate the customer, but nothing works. The customer procrastinates. Later, you find out they went to someone else. Pushing customers doesn’t work.

sales

john graham Principal, GrahamComm

No. 5: You don’t answer my questions. Some salespeople are so intent on what they want to get across, they don’t hear what the customers are saying or how they’re acting. Even so, salespeople come away pleased with their performance and pat themselves on the back for the great job they did on the presentation— but they don’t get the order. No. 6: You make me feel inadequate. You don’t do it deliberately, and you would be surprised and even shocked if customers told you how you made them feel. It’s easy to assume customers have a certain level of knowledge but many don’t—due to the rapid changes in every industry, including their own. It’s important to remember that you may be better informed than the customer, no matter what you are selling. This makes it easy for a customer to feel inadequate—and defensive. If the person is sensitive, this can harm your chances of moving forward.

No. 7: You don’t stay in touch after the sale. You make a point of telling customers that you will be checking in with them from time-to-time to see how they’re doing and to answer their questions. You know that’s what they want to hear from their salesperson. When you don’t do it, you let them down. They fell for your line, and you’ve played them for a sucker, or so they think— and that makes the bad juices flow. Then you wonder why you don’t get any more business or referrals from them. No. 8: You don’t follow through. You say you’ll get a customer the requested information. Three weeks later, you haven’t done it. Then, the customer reminds you, and you make up an excuse or throw a colleague under the bus. The customer concludes that he or she can’t count on you. It’s time to realize that such experiences are indelible. No. 9: You try to impress me rather than help me. All too often, some salespeople make themselves the “star” of the show. For some reason, perhaps it’s a lack of self-confidence, salespeople feel it necessary to “sell” themselves to a customer by peppering the conversation with success stories and name dropping. All the while, what customers are looking for is help, and you miss the opportunity to make a sale. No. 10: You offer solutions that don’t solve my problem. You do it deliberately, and you probably get away with it some of the time. However, when

customers figure out what you have done, your credibility is gone and so is the customer. There are easy sales, but they’re the exception. Selling requires patience and sensitivity. Most sales balance precariously between yes and no. Most sales are hard to win. It’s unfortunate when salespeople make it even tougher for themselves by undermining their own success. Graham of GrahamComm is a marketing and sales strategy consultant and business writer. He is the creator of “Magnet Marketing,” and publishes a free monthly eBulletin, “No Nonsense Marketing & Sales Ideas.” Contact him at jgraham@grahamcomm.com, (617) 774-9759 or johnrgraham.com.

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