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John Ballinger is a co-founder of Ballinger and Associates, an enterprise risk management firm, and 10XB Captives, a captive management company. He has over 25 years of experience in the insurance industry, conducted over 1,000 risk assessments, and managed over 5,000 claims. He has started six captives across the logistics, DoD, and heavy-civil construction space.…
Mitchell L. Lathrop has been handling insurance and reinsurance cases for over 50 years. He is a former trial lawyer licensed in California, New York and the District of Columbia. After over 40 years in trial courts throughout the United States, he today restricts his practice to arbitration, mediation, and expert consulting and testimony in…
In the past two decades, nearly 200 rural hospitals across the United States shuttered their doors, leaving millions of residents without local access to essential healthcare services. Hospital closures not only impact injured workers, but they also place additional pressure on rural industries. Farms, ranches, factories and energy producers rely on a healthy and stable workforce to attract talent and maintain productivity.
Asperta, Ltd. is a unique independent consulting practice coaching risk managers and brokers on critical issues with property insurance underwriting submission format, data quality, and valuation, including optimization for leading CAT models. Insureds with large, complex property schedules need to attract capacity at best available terms. We offer an objective and credible insiders’ perspective on…
The insurance industry has always been cyclical, going through periods of “soft” and “hard” market conditions that can last several years. Today’s agents have been thrust into what the insurance industry has historically called a “hard market.” However, this market cycle seems a bit different than those in the past and perhaps may not soften as quickly as we’ve seen in some cycles.
Andrew Sall The Business Interruption Guy Episode 709 This week we welcomed Andy Sall of Complex Claims Resolution, LLC for a show on Business Interruption. What would happen to your business if there was a fire, flood or cyber attack that wiped out your income overnight? Would your insurance cover you? Are you confident that…
“By investigating a case aggressively at the outset, it was often possible to have a developed factual matter for analysis within 90 days, maybe as long as 6 months, depending on the cooperation of any third‑party claimant and other sources of information. By having that development, one could set accurate reserves earlier. The insurer would know where it stood, and actuaries could also have access to that data and reassess a particular book of business or a particular program to see how profitable it may be over time and make adjustments, rather than canceling a program as unprofitable, should development and accurate reserve setting take longer, such as years versus months.
Another important function was the interaction between claims handlers and underwriters. The two go hand in hand. Underwriters have a certain view of the world and ways they want to approach coverage, but it’s the claims people who must handle the result and keep up to date with the latest case law affecting liability and/or coverage. Such teamwork results in tighter and more successful programs including decisions as to whether or not policy language needs to be changed or the need to add additional exclusions based on developing appellate decisions that might create new perils. That level of communication was important, especially for innovative insurance companies. Where the intent is to cover something as communicated to the applicant, the claim department might not be aware of it, resulting in a claim denial.”
I am an unique risk management and insurance professional, having worked in all three main sectors of the industry, insurer, broker, and risk management. More particularly, I have been a risk manager for a Fortune 50 company, an insurance broker, twice albeit in different roles in addition to being a wholesale insurance broker, and a…
“This number (224) likely represents just a small fraction of the notice-based denials that never
make their way to a courtroom. More must bedone to educate policyholders on how to comply with their policies’ claims-made reporting requirements. How did notice-based denials under claimsmade forms become so common? To understand how the industry has arrived at this
point, it is important to explore the history and evolution of the claims-made form.
There are six main reasons for these denials.
1.Late reporting of a claim after policy expiration
2.Failure to disclose known claims or potential facts and circumstances that could
give rise to claims later on an application (and not reporting same under the notice
of potential claim provisions)
3.Failure to identify that the current claim being reported is related to a prior claim reported to a previous insurer or previous policy with the same insurer
4.Failure to disclose prior-pending claims made on an insurance application
5.Reporting the claim in a manner that is not as directed by the policy language itself
6.Claims denied for not reporting “as soon as practicable”
The main driver of denials is that the policyholder reported the claim after the policy expired, as represented by 101 denials upheld by the courts. Not too far behind that category is
the situation where the insured knew of a claim or wrongful act before the inception of a policy.
Here is a breakdown of the six categories. … “
