Category Archives: Property/Casualty

NAMIC Nixes Car-Sharing

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While car-sharing has been given the green light in California, Oregon and Washington, some insurers are cautioning against it.

In the states that have passed laws, legislation prevents insurers from canceling the policy of an owner who rents a vehicle. Car-share programs are also required to provide liability insurance acceptable approved by the state.

Car-sharing services allow a car’s owner to turn a personal auto into a personal Zipcar and rent it out by the hour or the day. The owner sets a price, and an intermediary service lists the car online, connects the owner with people who want to it and takes a portion of the fee.

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According to CNBC, insurance companies worked with California’s legislature on the car-sharing law to make it work. Pete Moraga with the Insurance Information Network of California said, “We knew that this was a trend that was not going away, so our goal was to come up with a law that was advantageous to all parties.”

But the National Association of Mutual Insurance Companies (NAMIC) is opposed to New York’s proposed bill, A.8007B, which would regulate car-sharing programs.

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They claim it would likely result in lawsuits arising out of disputes over coverage.

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NAMIC pointed out that the rise of formal car-sharing programs throughout the United States has uncovered numerous insurance-related challenges, especially over the role of the car owner’s personal insurer and what exposure it may have.

“Unfortunately, the insurance provisions in this bill lack sufficient clarity and will likely result in unnecessary coverage disputes and consumer confusion,” said John Murphy, NAMIC’s state affairs director for the Northeast. “With a car-sharing program, an insurer lacks important information for gauging the risk. Car sharing is essentially a commercial enterprise, and the personal auto carrier should not be required to cover a risk that it never intended to cover.”

Murphy said that the insurer of any car involved in a car-sharing program needs to be free to decide whether it wants to underwrite the vehicle, exclude any damage resulting from such use, and cancel or not renew any vehicle participating in a car-sharing program. He also said that because New York has a competitive auto insurance marketplace, it is likely that some carriers will develop insurance products for the car-sharing market.

The 1,400 NAMIC member companies serve more than 135 million auto, home and business policyholders and write more than $196 billion in annual premiums, accounting for 50% of the automobile/homeowners market and 31% of the business insurance market.

Best of the Worst in Insurance Fraud

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The second most costly white collar crime in America behind tax evasion, insurance fraud costs an estimated $80 billion annually. Questionable claims rose 26.7% across the United States between 2010 and 2012, according to Mercury Insurance Company, whose Special Investigation Unit (SIU) of 50 investigators nationwide examines questionable claims. The team completed 1,476 investigations in California alone, exposing more than $24 million in attempted fraud, the company said.

“It’s amazing the things people will do to try and cheat the system, but they don’t know we’ve seen it all,” said Dan Bales, national director of special investigations for Mercury, which established one of the country’s first SIU’s in 1978. “Our SIU goal is to stay several steps ahead of these criminals and continue to uncover fraud, which can contribute to as much as 30% of customers’ premiums.”

Below are Mercury’s Top 3 “Best of the Worst Claims,” in 2013, highlighting some of the methods used to try and beat the system.

Claim #3: Bicycle Down

The claimant alleged he was struck as his bicycle passed behind a Mercury-insured vehicle that was backing up in a parking lot. He called the police, filed a report claiming injury and property damage, and was then transported by ambulance to a medical center to treat his alleged injuries.

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The real story was quite different, however, as this criminal didn’t know the entire incident was caught on video. The video clearly showed the claimant intentionally slapping the back of the insured vehicle with his hand and then guiding his bicycle to the ground to make it look like he’d been struck by the car.

The claimant retained an attorney to pursue an injury claim, which was denied by Mercury following the police report that included the security camera video taken at the scene. The claimant was ultimately arrested, convicted and sentenced to three months in jail with three years’ probation, and also had to pay a fine, restitution and his medical bills. Watch the video clip

Claim #2: Wrong Way Driver

The insured stopped at an intersection in front of a repair van. Suddenly, the two vehicles collided in what appeared to be a rear-end collision, which necessitated police being called to gather statements.

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The insured driver and passenger claimed the van driver had rear-ended the insured’s vehicle and both were allegedly injured. However, the van driver’s adamant contention that he hadn’t caused the accident led the investigating officer to seek surveillance video, which he found at a nearby gas station. Sure enough, the footage revealed that instead of proceeding through the intersection as expected, the insured driver threw her vehicle into reverse, slamming into the front of the van.

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The insured driver and her passenger were subsequently charged with insurance fraud and conspiracy, and the driver was also charged with assault with a deadly weapon … her car. And yes, the claim was denied. Watch the video clip

Claim #1: A Not-So-Merry Christmas

Looking to make some quick Christmas cash, the insured and two cohorts staged an accident and filed medical payment claims through Mercury, which were identified as questionable and assigned to the SIU for investigation.

A detailed claims history was compiled for the three individuals, who were then interviewed by SIU investigators. What the investigators found was that each claimant’s story was different, so they began to look deeper. That’s when they uncovered some very compelling evidence that suggested this accident was staged.

The SIU team discovered the insured’s prior claim history showed a loss at the same location with the same facts provided. A confession quickly followed about his latest claim, as well as a description of all the fraud he’d committed on each of his previous claims. All three claimants were convicted and given probation, community service and ordered to pay more than $26,000 in restitution to Mercury Insurance.

Suspicious activity can be reported to the National Insurance Crime Bureau.

RIMS Risk Maturity Model: Root Cause Discipline

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After the last article, which discussed the first two attributes of the RIMS Risk Maturity Model (RMM), ERM Based Approach and ERM Process Management; our focus here is on the third attribute, Root Cause Discipline.

Root Cause Approach

In Washington, D.C., officials tried, but were nearly helpless in stopping the deterioration of the Lincoln Memorial. Rather than address the damage with costly repairs, they instead traced the concern back to a root cause. Deterioration was caused by the high powered hoses needed to clean the building—which were necessary because the building was an attractive home for birds.

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Birds were drawn to a very dense population of insects, which were attracted to the bright lights of the memorial.

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So how do you stop the Lincoln Memorial from deteriorating? You dim the lights.

The root cause methodology provides clarity by identifying and evaluating the origin of the risk rather than the symptoms. Unveiling the triggers behind high level risk and loss events point to the foundation of where an organization is vulnerable.
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Uncovering, identifying and linking risk back to the root causes from which they stem allows organizations to gather meaningful feedback, and move forward with accurate, targeted mitigation plans.

To illustrate an example in a business environment, consider the risk of inadequate training. Within an organization, there may be multiple departments experiencing risk regarding their training policies, procedures and documentation, yet each area is likely to be recording and recognizing this risk in its own way. The result is an extensive amount of information recorded in spreadsheets that requires time and energy to sort and sift through. By identifying the root cause, a risk manager can expose the underlying commonality between departments and their concerns, allowing more effective identification and mitigation of systemic risk.

Applying root cause to your current approach

To integrate this type of approach to an enterprise risk management (ERM) program, you must first identify the root cause foundation of your organization. The RMM is built on five root cause categories which cover all enterprise risks:

  • External – risk caused by third-party, outside entities or people that cannot be controlled by the organization
  • People – risks involving employees, executives, board members and all those who work for the organization
  • Process – risks that stem from the organizations business operations including transactions, policies and procedures
  • Relationships – risks caused by the organization’s connections and interactions with customers, vendors, stakeholders, regulators  or third parties
  • Systems – risks due to theft, piracy, failure, breakdown, or other disruption in technology, plant, equipment, facility, data or information assets

Understanding which core area of the organization a risk stems from provides the ability to effectively understand and mitigate the risk. For instance, theft from an external third party is very different than theft from an internal employee, and will thus have a very different response and mitigation strategy.

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One strategy would require an investment in IT or infrastructure, while the latter would need an HR policy change or new ethics program.

Looking for an example of root cause? Download our complimentary Risk Assessment Template.

NOAA Releases 2014 Hurricane Season Outlook

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hurricane season

In a press conference this morning, the Climate Prediction Center of the National Oceanic and Atmospheric Administration (NOAA) released its official 2014 outlook for the Atlantic and Eastern Pacific hurricane seasons.

The East Coast may see below-average activity this year, thanks, in part, to the anticipated development of El Nino this summer. According to NOAA, “El Niño causes stronger wind shear, which reduces the number and intensity of tropical storms and hurricanes. El Niño can also strengthen the trade winds and increase the atmospheric stability across the tropical Atlantic, making it more difficult for cloud systems coming off of Africa to intensify into tropical storms.”

There is a 50% chance for a below-average season, a 40% chance of a near-normal season, and only a 10% chance of an above-average season, the center predicts. “For the six-month hurricane season, which begins June 1, NOAA predicts a 70 percent likelihood of 8 to 13 named storms (winds of 39 mph or higher), of which three to six could become hurricanes (winds of 74 mph or higher), including one to two major hurricanes (Category 3, 4 or 5; winds of 111 mph or higher),” they announced.

2014 Atlantic Hurricane OutlookBut the forecast is no reason to take preparations lightly. “Thanks to the environmental intelligence from NOAA’s network of earth observations, our scientists and meteorologists can provide life-saving products like our new storm surge threat map and our hurricane forecasts,” said Kathryn Sullivan, Ph.D., NOAA administrator. “And even though we expect El Niño to suppress the number of storms this season, it’s important to remember it takes only one land-falling storm to cause a disaster.”

On the West Coast, it may be a more tumultuous summer. The outlook calls for a 50% chance of an above-normal season, a 40% chance of a near-normal season, and a 10% chance of a below-normal season. The center predicts there is a 70% chance of 14 to 20 named storms, which includes 7 to 11 hurricanes, of which 3 to 6 are expected to become major hurricanes (Category 3, 4 or 5 on the Saffir-Simpson Hurricane Wind Scale).

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“The key climate factor behind the outlook is the likely development of El Niño this summer. El Niño decreases the vertical wind shear over the eastern tropical Pacific, favoring more and stronger tropical storms and hurricanes,” said Gerry Bell, Ph.

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D., lead seasonal hurricane forecaster with NOAA’s Climate Prediction Center. “The eastern Pacific has been in an era of low activity for hurricanes since 1995, but this pattern will be offset in 2014 by the impacts of El Niño.

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”

Next week (May 25-31) is National Hurricane Preparedness Week, and NOAA and FEMA will be offering additional tips and insight on their websites ahead of the official start of hurricane season on June 1.