FULL SERVICES OVERVIEW

Transcription

1 FULL SERVICES OVERVIEW PREPARED FOR: MAY 2017

2 COMPANY OVERVIEW PROVIDING A COMPREHENSIVE RANGE OF INSURANCE, REINSURANCE, INVESTIGATIVE AND ACCOUNTING SERVICES FOR OVER 29 YEARS We are an international insurance and financial services firm, working with our clients to effectively address and resolve a wide range of operational and financial issues. We have a proven track record of providing consistently high levels of service that are tailored to meet the specific needs of our clients. EXPERTISE. INTEGRITY. RESULTS. 2

3 SERVICES AT A GLANCE CLAIMS Claims Auditing Claims Management Services Forensic Accounting, including Surety & Fidelity LEGAL SERVICES Legal Invoice Audits AI CD Analysis Internal Audits THIRD PARTY AUDITS Third Party Claims Management Coverholder/MGA Audits QUANTITATIVE SERVICES AND ANALYTICS Data Analysis and Claim Allocation Modeling Development of Decision Making Tools Actuarial REINSURANCE AND COLLECTIONS Reinsurance Arbitration & Reconciliation Premium, Loss Deductible & Reinsurance Collections Subrogation RISK MANAGEMENT Underwriting and Risk Management RUNOFF AND INSURANCE SERVICES Vanbridge Runoff Solutions STRATEGY AND TECHNOLOGY Enterprise Consulting Program and Financial Management Services Due Diligence 3

4 EXPERT TESTIMONY PROFESSIONALS AT ALAN GRAY LLC PROVIDE EXTENSIVE INSURANCE COMPANY OR LAW FIRM EXPERIENCE EXPERIENCE: The claim and accounting professionals at Alan Gray LLC average over 25 years of experience. We have been retained by many carriers in the following areas: Overall claim handling practices Evaluation of settlements Legal Bill Audit TPA management and claim handling practices Bad faith allegations against the carrier Allocation issues in mass tort or other multi-policy occurrences Determination of underlying exhaustion Evaluation of claimed damages/business Interruption matters Reinsurance disputes involving carrier claim handling, coverage analysis, accounting or allocation All of our senior staff has experience in giving testimony in deposition, litigation or arbitration forums. OUR SENIOR PERSONNEL HAVE HELD SIGNIFICANT POSITIONS AT PROPERTY & CASUALTY CARRIERS OR LAW FIRMS 4

5 REPRESENTATIVE CLIENTS THE SUCCESS OF OUR CLIENTS IS OUR HIGHEST PRIORITY. WE ARE FOCUSED ON IMPROVING THE BUSINESS CLIMATE, BOTTOM LINE AND FUTURE VISION OF OUR CLIENT PARTNERS. 5

6 CLAIMS AUDITING INVESTING IN CLAIM AUDITING SERVICES IS A PROACTIVE AND COST EFFECTIVE WAY TO IMPACT A CARRIER S BOTTOM LINE INDUSTRY LEADER We are one of the largest claims auditing firms in the country and widely recognized as the industry leader for the breadth of our experience and our proven results. CONFIRM PROPER EXHAUSTION Routinely conduct audits to support primary/underlying exhaustion for umbrella and excess clients and in support of litigation and settlement discussions. EXPERIENCED Our auditors average over 25 years of experience. This experience gives us a complete understanding of the issues and problems that our clients are faced with. We perform audits in all major lines of (re)insurance. OPERATIONAL REVIEW Operational reviews of entire claims departments including quality of staffing and overall claims handling. COMPLIANT Claims audits include compliance with Coverage in Place and Cost Share Agreements, reserve adequacy analysis, applicability of billed loss and expense to the policies at issue and analysis and breakdown of claim exposure and prior payments. PRE & POST SETTLEMENT AUDITS We conduct pre-settlement audits to validate claims history before settlement discussions as well as postsettlement audits to verify the terms and conditions are being adhered to. 6

7 CLAIMS AUDITING AUDIT IDENTIFIES SIGNIFICANT PERCENTAGE OF CLAIMS AS NON-PRODUCTS SAMPLE ENGAGEMENT A global insurer requested a comprehensive audit and analysis of claim files and related jobsites to develop a model for non-product allegations. The insured was a distributor/contractor but was billing all losses as products. The audit identified a significant percentage of claims as non-products. The client was able to utilize this information to negotiate a settlement that resulted in savings of over $10,000,000. 7

8 CLAIMS CLOSURE WITH A PROVEN WORK FLOW AND PROCESS, WE WORK WITH CLIENTS TO DECREASE CASE RESERVES, LOWERING IBNR AND SIGNIFICANTLY REDUCING THE AMOUNT OF CAPITAL COLLATERAL REQUIRED. STEP TWO Independent claim review by our experienced auditors. STEP FOUR Interface with Client s TPA and create a timely tracking and reporting schedule. STEP ONE Review, analysis and creation of a client strategy. STEP THREE Illustrated action plan detailing the breakdown of the claims closure strategy into four phases. STEP FIVE Organize Bi-Monthly meetings for status reports and provide statistics to client. 8

9 CLAIMS MANAGEMENT SERVICES PROGRAM DESIGN & ADMINISTRATION FULL SERVICE CLAIMS ORGANIZATION: Expert based team providing services to a broad spectrum of industries, with extensive experience in all facets of claims management and processing services, including: Program Design Program Administration Program Closure STRATEGIC PARTNERSHIPS: Provide significant experience in the claims processing segment, including: Optimized claims process to reach program targets, deadlines and reduce processing costs Large volume claims handling Call Center, Outreach & Notifications Claims review Award Determination Fraud Detection 9 9

10 CLAIMS MANAGEMENT SERVICES PROGRAM DESIGN & ADMINISTRATION PROGRAM DESIGN DEDICATED & EXPERIENCED SENIOR MANAGEMENT SME AND ANALYTICS BASED APPROACH PROCESSES AND PROCEDURES SPECIFICALLY DEVELOPED TO EACH CASE CLAIMS NOTICES CREATION OF SETTLEMENT APPLICATION FORMS DESIGN & DISTRIBUTION OF NOTICES TRACKING OF CLAIMANT RESPONSES CLAIMS SERVICES CALL CENTER / CUSTOMER COMMUNICATIONS & SERVICE BENEFIT DETERMINATION, PROCESSING & PAYMENT FORENSIC ACCOUNTING FRAUD DETECTION DESIGN GOALS PERFORMANCE BASED RISK REDUCTION SPEED OF DELIVERY EASE OF OBTAINING CLAIMANT DATA COST EFFECTIVENESS CLAIMS SYSTEMS RESPONSIVE WEBSITE, DATABASE & SYSTEM OF RECORD MASS MAILINGS, MAIL DISSEMINATION & INTAKE, OPT OUT PROCESS REPORTING TO PARTIES 10 10

11 FORENSIC ACCOUNTING & LITIGATION SUPPORT CPAs WITH YEARS EXPERIENCE PROVIDE FORENSIC ANALYSIS AND RECONCILIATION OF FINANCIAL DATA WITH A FOCUS ON RISK AND EXPOSURE EVALUATION FORENSIC ANALYTICS Procurement and analysis of electronic data to reconstruct, detect, or otherwise support a claim of financial fraud. Steps include; data collection, preparation, analysis and reporting. BUSINESS INTERRUPTION LOSSES Provide analysis and reporting on loss of business income, property claims and fidelity losses. Allows clients to maximize profitability by minimizing/reducing the submitted loss exposures. BUSINESS VALUATION SERVICES MGA/Coverholder Audits Policy/Data Archeology and Research LITIGATION SUPPORT Provide expert testimony, furnish discovery, trial and deposition assistance 11 11

12 FORENSIC ACCOUNTING SERVICES TECHNICAL KNOWLEDGE AND UNDERSTANDING OF BUSINESS OPERATIONS AUGMENT OUR ABILITY TO INVESTIGATE, SUMMARIZE AND REPORT OUR FINDINGS CLEARLY INTERNAL INVESTIGATIONS & FRAUD Investigative mindset has resulted in findings that have allowed our clients to recover substantial diverted funds resulting from transaction fraud and Ponzi schemes. Seasoned forensic professional staff are able to effectively identify relevant activity with precision leading to substantial recoveries. DAMAGES QUANTIFICATION & LOST PROFIT ANALYSIS Highly qualified and experienced forensic accountants have represented both plaintiffs and defendants in large and complex business dispute matters involving allegations of damages. Develop sound and defensible opinions based on a comprehensive analysis of the investigative and economic issues. Quantify business interruption damages in the form of lost profits. SURETY, FIDELITY AND CONSTRUCTION LITIGATION Our construction litigation practice is built around collaboration between our seasoned claims professionals and our forensic accountants with each applying their core competencies to effectively and efficiently mitigate potential losses. Experience in all phases of the litigation process including discovery, cost and damage analysis, expert testimony and dispute resolution. Quickly assemble the appropriate forensic accountant(s) and claims professional(s) having the experience and skills to focus on the assignment execution leading to timely and effective support to the claims handler and the attorneys

13 FINANCIAL TRANSACTION TRACKING AND ANALYSIS MISAPPROPRIATION SAMPLE ENGAGEMENT A major financial service company needed a forensic accounting review to quantify a misappropriation by a reinsurance broker. Over $100,000,000 in misappropriated funds was identified. Alan Gray's staff were instrumental in assembling the required support that led to a substantial recovery and prosecution

14 LEGAL INVOICE AUDITING SERVICES PERFORMED OBJECTIVELY BY OUR LICENSED ATTORNEYS REVIEW & ANALYZE Experienced legal analysts review and analyze data and results. ELECTRONIC LEGAL AUDIT SYSTEM Automated online system, designed by Alan Gray LLC was created specifically for the review of legal invoices. The dynamic web-based application, developed to accommodate LEDES formatted invoices, systemically reviews legal bills for adherence to pre-defined guidelines and rules. Hosted in a secure data center, ELAS offers faster results, greater accuracy and is a cost-effective solution. NEGOTIATE & TESTIFY Conduct negotiations with counsel on behalf of client. Available to testify as an expert at trials, mediations or arbitrations. COMPLIANCE Provide objective view of compliance with company guidelines. Assist with the development and management of litigation billing guidelines, as well as, provide recommendations on developing a national defense panel. 14

15 LEGAL INVOICE AUDITING SERVICES PROFESSIONAL REVIEW PROVIDES DETAILED, USEABLE DATA DELINEATING COMPLIANT, REIMBURSABLE FEES AND EXPENSES. WHAT WE DO: Unique analysis of a client s legal spend Capture and quantify billing activity via a proprietary web -based system to provide clients with valuable metrics Electronic and attorney review of invoices identifying unreasonable fees and expenses AG ADVANTAGE: Competitor's traditionally provide only e- billing capabilities; Alan Gray offers electronic review coupled with superior attorney analysis. Use of an ebilling system captures but a fraction of "unreasonable activity AG employs attorney auditors to examine the invoices "in context, identifying issues unnoticed by ebilling software. Use of attorney auditors correctly captures and quantifies non compliant practices. VALUE ADDED: Cost of service is guaranteed to be less than savings. Cost of 4% of invoice amount billed, realizes 10-25% savings. 15

16 LEGAL FEE AUDITING REVIEW OF DEFENSE INVOICES SAMPLE ENGAGEMENT An international property and casualty company needed a full review of all defense invoices on a rolling basis. By partnering to develop a comprehensive review system and overseeing the negotiation and appeals with the corresponding firms, Alan Gray LLC saved the client 10-15% on all their legal costs within one year. 16

17 TPA CLAIMS MANAGEMENT PROVIDING EXPERTISE IN THE TECHNICAL HANDLING, AUDITING AND ADMINISTRATIVE PROCESSING OF PROPERTY, CASUALTY, PROFESSIONAL LIABILITY AND MASS TORT CLAIMS THROUGHOUT THE UNITED STATES AND INTERNATIONALLY. Unlike many larger TPA companies, our service is highly personalized and dedicated to the individual client. In addition to mainstream lines of business, we specialize in high severity and complex accounts, including environmental and mass tort. We handle all aspects of claims management and processing including the tracking of financial information and the issuance of checks from a trust account. Our clients include major insurers, self insured corporations, hospitals and nursing homes.

18 TPA CLAIMS MANAGEMENT ASBESTOS RELATED EXPOSURES SAMPLE ENGAGEMENT Working for one insured, we were responsible for processing indemnity settlements and expense billings for 8-12 different insurers related to asbestos exposures. The processing consisted of correctly allocating the indemnity settlements and payments to various years of coverage; securing the funds from 12 carriers to pay the settlements and expenses; and issuing checks for payment. In addition, time-sensitive quarterly in-house audits of claims submissions from various plaintiff law firms were conducted under an administrative settlement agreement to ensure the submissions were in compliance with the agreement. Detailed and accurate results were delivered to coordinating counsel for the insurers, allowing them to promptly collect substantial money from their reinsurers. 18

19 INVESTIGATIVE SERVICES OUR LICENSED, EXPERIENCED AND QUALIFIED ADJUSTERS ARE CAPABLE OF INVESTIGATING THE MOST COMPLEX CASUALTY LOSSES WITH A FOCUS ON PROTECTING THE INTERESTS AND ASSETS OF OUR CLIENTS. INVESTIGATE Conduct investigations, interview relevant parties (insured, witnesses and claimants) and secure signed or recorded statements. OBTAIN AUTHORIZATIONS Obtain medical authorizations and/or reports and verification of lost wages on bodily injury claim. IMAGES Supply photography and prepare accident scene diagrams EVALUATE Evaluate scope and cost of property damage. 19

20 INVESTIGATIVE SERVICES LIQUOR LIABILITY SAMPLE ENGAGEMENT Example Exposures & Coverages Include: Private Passenger & Commercial Automobile General Liability including construction site accidents Professional/Healthcare liability with focus on nursing homes Products, liquor and amusement ride liability A liquor liability claim was brought against an insured restaurant after a motor vehicle accident occurred in which the driver was charged with operating under the influence of alcohol and seriously injuring the driver of another vehicle. The intoxicated driver pled guilty, stating that he consumed alcohol at the insured s restaurant. Our staff adjuster located and interviewed several witnesses who confirmed the guilty driver had not been at the insured restaurant on the night of the accident. The establishment where the driver had consumed alcohol was identified and placed on notice of their potential liability. The claim against the insured restaurant was successfully denied.

21 QUANTITATIVE SERVICES LOSS ALLOCATION AND DATA ANALYSIS ALLOCATION SERVICES Modeling to support settlement negotiations, cost-share agreements and post-settlement allocation in support of reinsurance recoveries. RECONCILIATIONS Account reconciliation services to quantify insurers payments and verify proper allocation to policies to support policy exhaustion and effectuate reinsurance recoveries. DATA ANALYSIS Detailed data analysis using complex queries to provide loss and exposure statistics and trending. 21

22 QUANTITATIVE SERVICES HAZARDOUS WASTE LITIGATION SAMPLE ENGAGEMENT Contracted to provide services in a complex hazardous waste litigation, the staff worked with the insured s counsel to develop and employ a decision tree analysis in conjunction with a number of standard allocation runs, to value their settlement options. After factoring in the appropriate coverage discounts, the client was supplied with a working model in which they were able to change the probabilities of success/failure at their discretion. The result was a favorable settlement where the insured paid approximately 10% of their exposed limits, 75% less than originally demanded. 22

23 QUANTITATIVE SERVICES CHEMICAL EXPOSURE CASE SAMPLE ENGAGEMENT An account reconciliation on payments made on a chemical exposure case resulted in the collection of $4,000,000 in deductibles from the insured. Our analysis determined that the insured s data reporting techniques aggregated losses rather than applying per claim deductibles, resulting in a lower assessment of deductible dollars. 23

24 QUANTITATIVE SERVICES DATA ANALYSIS AND EXPERT REPORTING SAMPLE ENGAGEMENT Counsel for a joint defense group requested data analysis and an expert report that resulted in a favorable summary judgement in an asbestos case where plaintiffs were seeking in excess of $100,000,000. We analyzed underlying claimant data, performed an audit of the underlying claims and calculated product exposure points corresponding to the insured s ownership of the asbestos product. 24

25 ACTUARIAL SERVICES TRADITIONAL AND ALTERNATIVE MARKET PROPERTY AND CASUALTY ACTUARIAL ANALYSES ACROSS A VARIETY OF SPECIALTY COVERAGE, EXPOSURE AND INDUSTRY SECTORS. Loss and Loss Adjustment Expense Reserve Reviews Pricing-Rating Analysis Modeling and Program Design Arbitration and Litigation Support including Expert Witness Testimony 25

26 ACTUARIAL SERVICES SAMPLE ENGAGEMENTS Habitational risk MGA with a contingent commission needed an actuary to provide an alternative IBNR study to their carrier in support of the contention that the reserves being set by the carrier were unreasonably high relative to specific policy language. Regional workers compensation carrier requested an actuarial review of the prospective loss and loss adjustment expense ratio of a proposed new book of business relative to the claims being made as to the books expected profitability. A self-insured not-for-profit organization needed an actuarial analysis to help set their reserve position and provide cash flow modeling for fiscal year budgetary planning. 26

27 REINSURANCE ARBITRATION & RECONCILIATION SERVICES PROVIDES A PROCESS TO U.S. PROPERTY AND CASUALTY CEDANTS AND REINSURERS THAT CREATES A STREAMLINED, FIXED FEE SOLUTION FOR DISPUTED ITEMS TO BE RESOLVED THROUGH ARBITRATION STREAMLINE ARBITRATION SERVICES INCLUDE: Document Analysis Pool of Arbitrators Single Arbitrators Three Panel Arbitration Flat Fee, Fixed Price and Turnaround Time Advantages 27

28 PREMIUM, LOSS DEDUCTIBLE AND REINSURANCE COLLECTION SERVICES Specializing in the collection of outstanding commercial insurance premiums, loss deductibles and reinsurance recoverables and striving to preserve the critical relationship between carrier, broker and insured. Our proactive approach to collections has enabled clients to improve cash flow, lower collection costs, and reduce over 90 day STAT penalities. In excess of $100M Receivables Under Management Reinsurance Audits and Collections Commutation support Accounts Reconstruction and Reconciliation Loss Deductible Collections Premium Collections 28

29 SUBROGATION COLLECTION SERVICES SPECIALIZES IN THE IDENTIFICATION AND COLLECTION OF OUTSTANDING MONIES OWED TO OUR CLIENTS BY A VIABLE THIRD PARTY. SERVICES INCLUDE: Comprehensive investigative techniques that quickly identify liability and possible subrogation sources Aggressive pursuit of all areas of recovery, whether it s subrogation, salvage or contribution 29 years of hands-on claims management experience in both personal and commercial lines Contingency based compensation no risk to client Benchmarking and closed file review for missed subrogation opportunities 29

30 UNDERWRITING AND RISK MANAGEMENT SERVICES PROVIDES OPERATIONAL AND FUNCTIONAL CONSULTING IN SUPPORT OF PROPERTY AND CASUALTY RISK-BEARING ACTIVITIES ACROSS A VARIETY OF SPECIALTY COVERAGE, EXPOSURE AND INDUSTRY SECTORS PROGRAM PLANNING Development or critique of insurance program deductibles/retentions, attachments, per occurrence and aggregate limits Block/book of business evaluation and structural retain versus (re)insure analyses POLICY LANGUAGE SUPPORT New policy design and wording including creation of tailored endorsements Analysis of underwriting intent versus claims and coverage Regulatory interface and rate filing assistance OPERATIONAL SERVICES Underwriting and compliance audits Individual account testing and reviews Strategic planning and operational consulting 30

31 VANBRIDGE RUNOFF AND INSURANCE SERVICES PROVIDES CAPITAL AND SERVICES IN THE LEGACY LIABILITY AND RUNOFF SECTOR WITH THE FLEXIBILITY TO HANDLE PORTFOLIOS OF ALL SIZES INCLUDING THOSE THAT ARE TOO SMALL FOR THE TRADITIONAL MARKET. Features & Benefits: De-risk balance sheet Removal of specific liabilities from the balance sheet to satisfy stakeholders Reduce in-house administration and management time/reporting Ring fence liabilities and transfer volatility to an insurer Release of collateral Release of surplus/capital Enable closure of duplicate vehicles following mergers and acquisitions activity De-risk old years to enable a captive to continue unencumbered by legacy liabilities We acquire property & casualty and life, health & annuity legacy liabilities from (re)insurers anywhere in the world. We have extensive experience in evaluating and administering runoff blocks, consistently delivering value and cost savings to our insurer clients. For over two decades, we have been involved in Loss Portfolio Transfers (LPT), working closely with insurers, reinsurers and corporate clients to evaluate liabilities, price covers, provide administrative services and mitigate claim and expense payments.

32 ENTERPRISE CONSULTING SERVICES CREATING THE ESSENTIAL LINK BETWEEN EMERGING TECHNOLOGIES AND BUSINESS OPPORTUNITY. STRATEGY, PLANNING, ASSESSMENT, SYSTEM SELECTION, DEVELOPMENT AND IMPLEMENTATION IS PERFORMED BY INDUSTRY AND TECHNOLOGY EXPERTS. FINANCIAL MANAGEMENT SERVICES TECHNOLOGY AND SYSTEM SERVICES Establish business entity strategy, budget and forecasting to support profit planning. Evaluate, select and implement systems and technology to support current and future business operations. OPERATIONS MANAGEMENT SERVICES Focus on process improvement by establishing process maps and applying best practices to identify inefficiencies, redundancies and processes that benefit from automation. PROGRAM MANAGEMENT (PM) SERVICES Enhance productivity, communication and control over mission critical projects. 32

33 DUE DILIGENCE SERVICES INCLUDE REVIEW OF: Our Buy-Side Due Diligence services practice offers an exhaustive review of all business documents and records in an effort to assess the health and viability of the business in question. Corporate Agreements and Documents Financial Information, Underwriting Practices and Loss Reserves Claim Payment Practices & Reinsurance Practices Information Technology and Internal Controls Employees and Human Resources Sales/Marketing Administration and Transition Services 33 33

34 STAY IN TOUCH WITH US ALAN GRAY LLC, A VANBRIDGE COMPANY BOSTON NEW YORK PHILADELPHIA/NJ LONDON Our Phone / Website 88 Broad Street Boston, MA Avenue of the Americas 32 nd Floor New York, NY Haddonfield-Berlin Road Cherry Hill, NJ Suite Minories London, England EC3N 1LS (617) (212) (800) MA NY UK PA/NJ 34