Category Archives: Claims Management

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Texas Cold Crisis: Insurance Options for Severe Weather Disruption

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On February 15, a massive and unseasonal storm with frigid temperatures spiked the demand for power and outpaced the supply, severing power to 26 million Texans. Unpredictable weather patterns present risks for business owners, but also create an opportunity to improve their risk mitigation strategies to address future uncertainties. 

Power outages are not caused by storms alone. Heat waves, hurricanes and wildfires can also create power outages—and outages are more common than business leaders may think. S&C’s 2018 Commercial and Industrial Power Reliability Report found that one in four businesses experience at least one power outage per month. The Department of Energy estimates that these outages cost companies $150 million per year. Although companies may face spoilage-related losses, data centers often experience the most severe consequences. When a data center goes down, it can impact a business’s most vital proprietary assets. According to a Ponemon Institute study, the cost of an unplanned data center outage is $5,600 per minute with an average recovery time of 119 minutes resulting in a loss over $690,000.

The cost for businesses goes beyond damage. Litigation tends to run rampant, and with the recent Texas power outages, businesses are already facing lawsuits. The family of an 11-year-old boy who died of hypothermia is suing energy company Entergy and grid operator Electric Reliability Company of Texas. Multiple wrongful death lawsuits are predicted from incidents including carbon monoxide poisonings, house fires and shelter closings.

A range of insurance options can help businesses protect themselves from complex, evolving and completely unpredictable risks such as natural disasters and climate change.

Property insurance protects the building and physical assets like equipment, supplies, inventory, fixtures and computers. However, property insurance may not provide all the coverage needed. Exclusions like floods, sink holes, earthquakes, terror incidents, and chemical, nuclear, biological and environmental events are likely not covered. An unexpected policy exclusion can be devastating and result in a claim being denied, leaving business owners and leaders feeling helpless and infuriated.

Business interruption insurance is helpful but may not be enough. Typically, when damage obstructs business operations, it is covered by property insurance, and business interruption insurance covers losses from interruption. However, a natural disaster can create a perfect storm, so to speak. For example, if an establishment is forced to close due to lack of power, there can be a denial of claims. Business owners may be able to have property repaired, but cannot recoup the lost revenue through insurance.

Another option for businesses is to choose captive insurance and own their own insurance company. This establishes a more robust approach to risk management, and enables the business or business owner to own a profitable second business. This can help lower commercial insurance costs, build up assets and loss reserves, enhance critically needed cash flow and liquidity, and help prevent losses from hollowing out the total business entity. Importantly, successful captive insurance companies are filled with liquid assets that back the reserves for potential future losses, owned by the business or business owner. Liquid assets are often more desirable than durable assets that depreciate and may be difficult to sell. Finally, a captive insurance company is a regulated entity.

A captive primarily insures its parent company or related companies, so the parent company can purchase insurance from its wholly owned captive. Such purchases may replace all, or a portion, of its commercial insurance. Additionally, risks that are unable to be insured, are cost prohibitive, or are underinsured in the commercial insurance market can be placed in the captive insurance company. The captive can also insure gaps in third-party commercial insurance policies.

Benefits of Captives in Natural Disasters

While businesses with claims for property insurance or business interruption coverage are denied, a business with a captive insurance company would not face exclusions that leave them vulnerable. Since a captive insurance policy can be written to be broad and robust, it has more triggers than third-party commercial insurance, sos an event may covered where business interruption might not provide coverage.

Captive insurance also serves as a valuable financial strategy. When captives build up loss reserves, backed by corresponding assets, those assets are available for dealing with a catastrophic event. When a business has to restart or relocate their operations, assets are readily available to help it navigate the challenges and pursue big changes. The business owner can use the asset buildup in successfully managed captive insurance companies to help grow the business by funding acquisitions, growth strategies and enhanced risk mitigation strategies via a dividend from the captive insurance company to the business owner.

Before another crisis strikes, businesses should review insurance policies, determine whether current policies offer adequate coverage, and determine if a captive will help them face the next worst-case scenario.

PAID Act Becomes Law, Fixing Medicare Secondary Payer Flaw

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On December 11, the Provide Accurate Information Directly (PAID) Act was signed into law as a part of the funding bill to keep the government running. A top priority of RIMS Advocacy since it was introduced in 2019, the PAID Act will fix a current flaw in Medicare Secondary Payer (MSP) compliance. Specifically, the PAID Act amends 42 U.S.C. § 1395y(b)(8)(G) to require that the Centers for Medicare and Medicaid Services (CMS) expand its Section 111 Query Process to identify whether a claimant is currently entitled to, or during the preceding 3-year period has been entitled to, Medicare Part C (Medicare Advantage) and/or Medicare Part D (prescription drug) benefits. If so, CMS is then required to provide the names and addresses of any such Medicare plans through the Section 111 Query Process. Included in the bill is a one-year implementation provision that requires the fix to go live by December 11, 2021.

The bipartisan bill was introduced in 2019 by Republican Senator Tim Scott of South Carolina and Democratic Congressman Ron Kind of Missouri in the House of Representatives. “Today, the PAID Act has taken a pivotal step closer to becoming law, filling in Medicare-related potholes that have cost seniors, Main Street job creators, and the American taxpayer millions of dollars over the years,” Sen. Scott said when the bill passed. “Decades-old regulations and bureaucratic red tape have caused confusion and avoidable litigation in the MSP for far too long, and by eliminating those problems we can help seniors and families across the country.”

The fix in the PAID Act will essentially settle the increased number of lawsuits that have been filed by Medicare Advantage Plans asserting recovery rights against insurers, including claims for “double damages” under Medicare’s private cause of action provision. If CMS provides settling parties with the name and identity of the plan and the dates of coverage, they can better resolve and repay MSP liabilities associated with settlements, judgments or awards. With these changes, there will be a more efficient solution for beneficiaries, taxpayers and employers.

Proponents of the PAID Act assert, in part, that this legislation will now help insurers better identify and address potential Part C and/or Part D recovery claims by allowing them to obtain entitlement and plan information in a more programmatic manner using Section 111’s Query Process.

Currently, there is no such centralized process or system for insurers to obtain this information. When an applicable plan submits the required query process data elements to CMS, if the queried individual is identified as a Medicare beneficiary, the query response only confirms that they are enrolled in Medicare. It does not provide any information as to the “type” of Medicare program in which the individual is enrolled. The PAID Act will change this to better identify whether a claimant is enrolled in Medicare Advantage and/or Part D.

The text of the PAID Act states that CMS must provide the following information to the applicable plan through the Section 111 Query Process:

    (I) whether a claimant subject to the query is, or during the preceding 3-year period has been, entitled to benefits under the program under this title on any basis; and (II) to the extent applicable, the plan name and address of any Medicare Advantage plan under part C and any prescription drug plan under part D in which the claimant is enrolled or has been enrolled during such period.

With the PAID Act now law, RIMS will monitor the CMS implementation process and provide feedback as needed. RIMS worked closely with the Medicare Advocacy Recovery Coalition (MARC) to support their efforts to get this bill passed. Check out their infographic on the Medicare issue the PAID Act should fix:

Mitigating Construction Risks with Advanced Training Techniques

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Construction is consistently ranked as one of the riskiest jobs in the United States. Fluid workforces, high-risk scenarios and a communication disconnect between home office and front-line workers all result in the very real possibility of serious injury or even death.

One of the major challenges in the construction industry is getting information and training to the front-line workers who face the most risk, but are often the least informed. Company emails and company-issued phones go as far as the foremen but do not always make it down to the crew themselves. Training is not always readily available or is more compliance-based than it is practical for the day’s work. This creates major risks for front-line workers, contractors, insurers and anyone involved with ensuring construction projects are safely and accurately completed. As a result, the construction industry is increasingly turning to new virtual and mobile technology tools. In an effort to improve its communication and training practices and provide critical information to its workers.

Visualizing High-Risk Scenarios

New, interactive modules are allowing safety teams to offer more effective and engaging job-site training in the form of videos, quizzes, virtual reality and 3D simulators. Exposure-based training platforms can also provide a “hands-on” experience, giving front-line workers the opportunity to encounter different situations while in a safe environment.

For example, a 3D simulation of a “hazard hunt” tests workers by having them identify all of the potential hazards on a building such as tilt, unsafe conditions and proximity to power lines and how to mitigate those risks. Fire safety prevention can be made into an immersive experience to help a worker identify the proper fire extinguisher based on the simulated fire, increasing the likelihood that they will make the right choice in the event of an emergency.

Simulations can also take tradesmen step-by-step through the process of working on specific tasks, allowing them to learn the process from start to finish and monitoring for the most common risk exposures. To become a signalman when working with cranes, the current process is to watch videos and memorize the hand motions. With simulators, workers can now be put into specific scenarios and learn how to proceed in the safest way and without endangering the person or equipment. Ultimately, new exposure-based training helps workers overcome any natural inclinations that put them in harm’s way and increases their awareness of all the risks of a specific task or job site.

Facilitating Effective Communication

Construction workers may be on a site for three months, or they might work on a job for one day. In both cases, contractors take on the same level of risk when it comes to ensuring each employee is appropriately trained. And with a workforce that is constantly in motion, construction managers face the challenge of tracking who has been trained on what. Paper filing systems and limited access to the training records while onsite can lead to oversights when it comes to identifying improperly trained workers.

Virtual training allows contractors to more easily track exactly who is trained on what, and store the important documents in a digital archive. By keeping critical information readily available digitally, onsite managers can more quickly confirm and step in if someone is not properly trained and manage overall communication for the duration of the project even as the job site’s workforce changes.    

Builders are also using digital communication platforms to address the communication disconnect between the home office and the front-line workforce, and in order to reduce the risk of miscommunication. These apps allow teams to send messages, emergency alerts and even just-in-time training videos that can highlight safety hazards specific to the job site to individuals or entire crews in an instant, helping to reduce unnecessary work stoppages and operational friction. They can also deliver micro-training refresher courses so that workers can better retain and implement the new knowledge and skills they have learned.

By deploying new types of digital training techniques, companies can improve communication and provide the front-line workforce with the right information to make safe decisions on a job site, reducing overall risk and most importantly, ensuring that their workers get home safely.

Hurricane Preparation and Recovery Tips for Businesses

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hurricane dorian disaster preparation

The first Atlantic hurricane of the season is rapidly approaching the mainland United States, with experts currently expecting Hurricane Dorian to make landfall in Florida on Sunday. For businesses both in the storm’s path and beyond, it is important to take the opportunity to consider how to protect property from hurricane damage before and after storms. The Congressional Budget Office estimates that, on average, hurricane damage costs $54 billion annually, and even at this late date, there is always more businesses can do to try to mitigate such losses and damage to their property and operations.

One of the simplest steps is having an accurate replacement cost and business income valuation. If valuations were conducted previously, consider how long it has been and any significant changes, such as assets or location. It is also important to document the property before a storm arrives, including taking photos and videos, or even using 3D-mapping technology to record a detailed account of an entire space, building or structure. Most importantly, confirm with the insurer that the policy is current and that the terms, conditions, and limits are all well understood.

Creating and practicing a detailed disaster plan is another important step. Business owners can use risk modeling programs, which run a range of potential scenarios digitally to flag issues and create a more holistic plan. If digital modeling is unavailable, walking through or rehearsing plans can help identify potential issues. For example, built-in hurricane shutters are great, but if they are not tested ahead of time and then malfunction in the hours before a storm, it may be too late to find an adequate solution. When tailoring the disaster response plan, also consider the available coverage to limit out-of-pocket expenses after a storm. Coordinating with your insurance professional is the best way to minimize uninsured expenses.

One critical factor for any business disaster plan is how to protect data, including business data as well as plans and building layouts. House these valuable documents in a secure location in case of physical damage to the main data storage unit or computer drives. Insurance companies will likely request very specific information to process any claim, so speak with an insurance company adjuster in advance to determine what types of documents they need for filing a claim, then store those in an easily accessible online portal.

Create a business continuity plan that addresses how to expedite recovery or avoid interruption, potentially including employing an off-site workforce, creating an alternative workspace, and locating backup suppliers.

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It should also always include a communication plan so that key players remain connected. Business owners should engage with critical vendors and emergency responders in advance to assist with loss mitigation, temporary repairs, and restoration. Following a wide-spread catastrophe, these vendors are in high demand and having a preexisting relationship will help.

Once the storm passes, the first step must be communication: contact everyone to address safety concerns and identify their needs. Phone lines and internet service are often unreliable following a storm, and business owners should be prepared to use multiple forms of communication, from texts to emails and applications that use Wi-Fi.

After reestablishing contact, quickly document the damage (ideally in both photos and videos) since demonstrating the extent and cause of loss becomes increasingly difficult over time. Policyholders should notify their broker and insurance company of the loss immediately, and once damage is documented, policyholders must reasonably and with due diligence preserve and protect property and commence restoration while mitigating future risk. For example, if a structure suffers roof damage, but no action is taken to “reasonably and quickly” provide temporary cover, rain damage following the storm may not be covered as part of the storm’s damage.

Finally, it is critical to log all logistical and monetary details.

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After a hurricane, there may be challenges accessing damaged areas, so retain all notices, civil orders or police mandates concerning any access limitations to later provide the insurance company. An insurance company cannot expect a policyholder to put a tarp on a roof if access was prohibited. Likewise, policyholders should track all expenditures. After a disaster, the price of restoration services can increase dramatically, so acquire and keep multiple estimates of any cleanup, construction, or emergency service needed. Having these estimates will allow policyholders to assert the cost was both reasonable and necessary and receive reimbursement.

Hurricane season is already here but it is not too late to take preparative steps to help protect your business from the often unpredictable effects of storms. The only things business owners can control are the steps to help prevent and recover from damages.