Category Archives: Insurance

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The Impact of Collaboration in Cyber Risk Insurance

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Former FBI Director Robert Mueller once said, “There are only two types of companies: those that have been hacked and those that will be. Even that is merging into one category: those that have been hacked and will be again.” This is the environment in which risk managers must protect their businesses, and it isn’t easy.

Cyber risk is not an IT issue; it’s a business problem. As such, risk management strategies must include cyber risk insurance protection. Until recently, cyber insurance was considered a nice-to-have supplement to existing insurance coverage. However, following in the wake of numerous, high-profile data breaches, cyber coverage is fast becoming a must-have. In fact, new data from The Ponemon Institute indicates that policy purchases have more than doubled in the past year, and insiders estimate U.S. premiums at around $1 billion today and rising.

But is a cyber policy really necessary? In short, yes. As P.F. Chang’s China Bistro recently discovered, commercial general liability (CGL) policies generally do not include liability coverage to protect against cyber-related losses. CGL policies are intended to provide broad coverage, not necessarily deep coverage. Considering the complexity of cyber risks, there is a real and legitimate need for specialized policies that indemnify the insured against cyber-related loss and liability.

The fact is, cyber risk is a problem all its own.

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The cyber threat is pervasive, and attacks are increasing exponentially. Cyberattack trends are also shifting constantly. An attack can come from multiple directions and in multiple forms, targeting different information and outcomes: an attack launched by a hacker group intent on making a political statement, malware that enters the network through a third-party service provider to steal credit card information, or a data breach perpetrated by a trusted insider seeking competitive intellectual property (IP).

In this complex, dynamic threat landscape, the ability to accurately assess risk becomes a monumental undertaking. If we accept that every organization has been hacked or will be again, it’s clear that prior incidents are no longer relevant or legitimate indicators of a company’s risk. Similarly, stagnant security checklists required by many insurers are hardly representative of actual, ever-changing cyber risk. Traditional risk assessment methodologies that rely on these elements to determine pre-binding risk simply have no place in today’s world.

Risk Assessment for the Cyber Era

The industry needs assessment methods consistent with the changing threat landscape. That means real-time, active assessment of an entity’s entire business ecosystem including upstream and downstream threats, as well as the often overlooked insider threat. What this provides is a holistic understanding of an entity’s vulnerabilities, high priority risks and security maturity.

In the current cyber environment, it’s implicit that every organization will be the victim of a cyberattack and that there will be some cyber loss as a result. Thus, savvy underwriters are looking beyond mere ticks on a checklist to determine insurability; rather, they’re looking for security maturity and cyber resilience.

The more cyber resilient an organization, the faster it can identify a cyberattack, stop it and recover from the impact. Data loss is expected. It’s the severity of the data loss that will impact the company’s business, damage its brand and customer loyalty and erode investor confidence.

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Those organizations that can quickly and effectively minimize the risk and get back to business are generally considered a safer bet.

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This is where organizations can realize the benefits of holistic cyber insurance assessment. All too often, critical data is uncovered after a breach occurs. By implementing a proactive risk assessment before an attack occurs, the organization can gain in-depth intelligence about its highest priority risks before an incident, not years later when it’s too late to do anything about it. A pre-binding assessment provides the right data at the right time to inform risk management decisions and align resources with an organization’s highest priority risks.

Additionally, organizations that adopt continuous proactive assessment and ongoing risk mitigation demonstrate mature security practices, which indicate an organization’s ability to return to regular operations faster following a cyber incident.

Partners Against Cybercrime

Historically, there has been an antagonistic relationship between the insurer and client, but in the wake of catastrophic data breaches, these two sides are now finding common ground. For instance, several insurance brokers today are requiring a holistic, pre-binding risk assessment before a company can receive a policy. This benefits both the insurer and the pre-insured by providing invaluable insights about the company’s security, often revealing unexpected weaknesses and new priorities. Some policies also tie risk assessment to financial incentive to encourage ongoing risk mitigation. This becomes a virtuous circle situation for the insured, as it gets the benefit of reduced premiums after risk maturity has been measured, which allows the company greater insight and the ability to be proactive about reducing security risks.

For decades, the bargaining power has been with the insurer. With a revised approach, and in keeping with the demands of today’s cyber landscape, the relationship between insurer and insured has become collaborative as both sides work together to identify and mitigate risk. In this way, cyber insurance becomes an avenue for companies to improve cybersecurity, not to simply offset risk.

The Cost of Savings: Checking Medical Bill Review Charges

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Here’s a provocative question for all the risk managers out there: what did you pay last year in workers compensation medical bill review charges?

Stumped? The answer may be more elusive, and more expensive, than it would initially appear.

Medical bill review is an essential service typically performed by an insurer, claims administrator, or outside vendor. The service provider reviews medical bills related to claims and audits the bills for accuracy, duplication of charges, and reasonableness. The costs for these services are allocated claim expenses, meaning they get charged directly to the claim file. This makes figuring out what you’re paying more difficult, as bill review charges tend to blend in with other expenses and bills.

Bill review charges are typically calculated in two ways. First, for each bill, there is a standard review charge. This could be a flat rate or calculated by the number of lines. Second, for bills that are outside of medical provider networks and are negotiated, a percentage of the savings are charged.

This last piece is critical, because it means that charges for a single bill review can be thousands and sometimes even tens of thousands of dollars.

Here’s an example. Suppose an employee injures his back and is forced to have surgery, but does so at an out-of-network facility. The hospital bills $200,000, an amount it has no illusions of receiving. As part of the medical bill review process, the bill is negotiated down to $50,000, netting a savings of $150,000. The charge for the bill review is a percentage of the savings, typically between 20-30%. If we assume conservatively that the rate is 20%, in this example, the charge for the bill review service would be $30,000. For self-insureds and those with large retentions, this a cost paid directly out of pocket.

This example highlights two important facts. The first is that network penetration is of prime importance—when a patient is treated at an in-network facility, the bill is generally reduced to the pre-negotiated rate at no cost to you. Second, the medical billing process in this country has created an immensely profitable enterprise for skilled medical bill reviewers.

This is not to say that paying a percentage of negotiated savings is unfavorable to a risk manager. This system aligns the interests of the bill reviewer and the party paying the bill. The more the bill reviewer can lower a bill, the more you save, even if you are ceding a percentage of that savings to claim handling expenses.

And to be fair, the above scenario is more of an anomaly than the norm—in most cases both the savings and fees are much lower.

Still, the entire medical billing strategy employed by hospitals is rather discomforting. In what other industry are bills sent out and routinely negotiated down by 50, 60, or even 75%? Certainly, there are financial motives for hospitals, many of which are owned by private equity firms, to bill higher amounts than they ever expect to receive. Not only will the unsuspecting recipient occasionally unwittingly pay the full amount, higher bills allow hospitals increased write-offs for charity care and other unpaid services. And while fee schedules in some states have attempted to address this problem, this has further contributed to hospitals and insurers, each employing competing billing experts with the respective goals of maximizing and minimizing amounts paid for the same services.

The net result is higher processing expenses for everyone.

Accepting the fact that the medical billing system in this country is the way it is, let’s return to the ,000 medical bill review charge.

As risk managers, we need to continuously be concerned with our expenses. At the same time, these fees represent only a percentage of savings, and theoretically, the higher the bill review charge, the higher the savings. But the knowledge of that fact may not be enough to eliminate the sticker shock. Because medical bill review services are so essential, the only recourse is a better negotiation of fees—paying a lower percentage of savings is a good start, and a hard cap on the maximum charge for a single bill is even better. Of course, the first step is sitting down with the data and figuring out how much you’re actually paying.

That way, when someone asks you the question about how much you’re paying, you’ll not only have the answer, you’ll also have a plan to make it less.

Lloyd’s Underwrites Ebola Indemnity Coverage

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A new class of insurance is now being offered to address the occupational hazards faced by healthcare workers and first responders who are in jeopardy of contracting blood-borne pathogens such as Ebola, HIV, Hepatitis B and Hepatitis C.

Underwritten by Lloyd’s of London and distributed by Specialty Insurance Advisors, Essential Professional Insurance Coverage (EPIC) is the first such indemnity coverage available to individuals, including administrators who check in patients, doctors and nurses treating patients and patrolmen and women responding to 911 calls. The coverage goes beyond workers compensation and disability insurance to protect these individuals, EPIC said.

According to the Occupational Safety and Hazards Association (OSHA), up to 800,000 needle sticks occur each year, of which 16,000 are likely to be contaminated with HIV. The risk of acquiring Hepatitis B or C from a needle stick is even higher than HIV.

EPIC President Richard Kosinski said in an online interview with Fox Business, “We provide the ability for a health care worker or law enforcement professional to buy very inexpensive coverage in the event they get infected with Ebola, HIV or Hepatitis B or C.

For a nominal amount of 9 per year they can get 0,000 of coverage if the worst case happens and they get infected with Ebola or some other type of blood pathogen.

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”

While the coverage has been available for more than a year, primarily through unions, to large health care hospitals and other institutions, “We have just announced the ability for an individual to buy a policy,” Kosinski said. Centinela Hospital Medical Center in Inglewood, California was one of the first hospitals in the United States to offer EPIC to its healthcare workers, and the first to add Ebola infection coverage, according to EPIC.

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The plan provides a safety net that can help defray some of the costs, Kosinski explained, adding that otherwise, “No one is going to pay the cost for the average health care worker to be flown by a private jet to a specific CDC facility to get Ebola care.”

How is it possible to write this coverage? “Because this is Lloyd’s of London, which has a 500 year history of writing specialty risks,” Kosinski said.

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“We understand the risk, how to price it correctly and how the claims will be paid out.”

Handling the Pain: Getting People Back to Work

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Employers nationwide are always concerned about absenteeism. When a worker doesn’t show up, the loss of productivity and profits can be staggering, making the worker’s problems a serious issue for the employer.

If the employee doesn’t stay home, the result doesn’t fall under ‘absenteeism’ but it still creates a negative impact.

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Productivity loss due to poorly performing employees who try to “work through” recurrent pain places employers in a difficult situation. Lost productivity—like time itself—is a non-renewable resource. No one wins when employees are unable to work.

The reverberations are felt on many levels. The worker may continue to feel pain. The employer must deal with the issue. Colleagues and associates often need to pick up the slack. Customers may be affected.

Who else? The employee benefits managers and the company’s workers compensation claims statistics. The higher the number and value of claims, the greater the drag on the company’s fiscal performance.

Pain emanating from chronic or lingering injuries needs professional involvement. The good news is that by treating the pain comprehensively or applying interventional pain techniques, nagging injuries or pain can be remedied or reduced sufficiently to increase the productivity of suffering employees.

On the Job

For many sufferers, relief through medication, physical therapy or other ‘traditional’ remedies is temporary, but pain and lost productivity continue.

Interventional pain care and management is a specialty where the physician diagnoses and treats pain at the source. According to the American Society of Interventional Pain Physicians (ASIPP), “Interventional pain management is defined as the discipline of medicine devoted to the diagnosis and treatment of pain-related disorders, principally with the application of interventional techniques in managing subacute, chronic, persistent, and intractable pain, independently or in conjunction with other modalities of treatment.” Employers should encourage workers to learn more on how interventional pain management can reduce the duration and severity of pain, help them return to work faster and enjoy an overall improved quality of life.

Interventional pain physicians employ a number of techniques and procedures. Among the many successful solutions are epidural steroid, trigger point and botox injections; sympathetic plexus blocks; spinal cord stimulation; radiofrequency ablation, percutaneous intradiscal procedures, and implantable intrathecal drug delivery systems.

Pain reduction or eradication is the desired outcome, but diagnosis plots the path to potential recovery. Procedures like fluoroscopically-guided injections using local anesthetic can provide both relief and diagnostic value. Fluoroscopy is an imaging technique that incorporates X-rays to produce real time images of the internal anatomy. This diagnostic tool provides more accurate delivery of medication and important information to the physician on the origination of the pain, and thus the doctor can offer more effective treatment. In a healthcare climate that seeks to reduce unnecessary expenditures, like tests or procedures, such interventional techniques can reduce or eliminate ineffective, unnecessary or even more invasive options, up to and including surgery.

Injuries, chronic pain and absenteeism, plus the urgency to get employees back to work affect more than the bottom line. From on-the-job injuries, like lifting, strains and slip-and-fall injuries, to the resulting drain on human capital and performance, organizations are in need of solutions.

The Call of the Benefits Manager

The appropriate first call made by a human resources director or employee benefits manager is to the general practitioner or claims adjuster to document the mishap. Yet, if pain persists and lengthens an employee’s out-of-work status, quite possibly exacerbating a deteriorating psychological status, resolution may be difficult to achieve.

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The advice and services of an interventional pain management specialist are beneficial and can often be even more effective when combined with physical therapy or other home programs. A patient treated early often begins to experience expedient and lasting relief. The employee is not only more comfortable, but also returns to work sooner. This increases organizational productivity and, equally as important, reduces the time of a workers compensation claim.

Interventional pain care and management is growing in favor and its beneficiaries run the demographic gamut. Depending on the injury or source of lingering pain, employees from millennials to baby boomers approaching retirement are ideal candidates for many procedures.

This is especially important as many workers are putting off retirement into their late 60s and 70s. As those older patients more frequently suffer degenerative problems that may create or complicate injuries, interventional treatments deliver an ideal remedy, especially when performed in concert with physical or occupational therapy.

Using an Interventional Pain Specialist

The engagement of an interventional pain specialist presents a unique scenario. Benefit managers, human resource professionals and case workers have become more aware of interventional pain care over time.

Who should get the referral? The American Board of Anesthesiology has a certification process for interventionalists, as well as an additional sub-specialty certification in pain management. The American Board of Pain Medicine (ABPM) also certifies qualifying members. A Fellow of Interventional Pain Practice (FIPP) has earned certification by the World Institute of Pain, and the American Board of Interventional Pain Physicians (ABIPP) has a certification process as well.

The American economy loses upward of billion annually, due to lost productivity stemming from health issues and missed work, according to a 2013 report from Gallup-Healthways.

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Issues include chronic health problems such as pain, obesity, high cholesterol, blood pressure, cancer, asthma and depression. Even issues like poorly designed ergonomics in the workplace can result in significant pain and absenteeism. About one in three (34%) of all work missed stems from ergonomic-related issues, according to the U.S. Bureau of Labor Statistics.

For employee benefits managers who know how to help employees tackle pain and return to work, absenteeism and lost productivity can be reduced and billions of dollars can be saved all year long.