RECORDS OF MEETING CLAIMS ADVISORY PERFORMANCE STANDARDS SUBCOMMITTEE

Transcription

1 RECORDS OF MEETING CLAIMS ADVISORY PERFORMANCE STANDARDS SUBCOMMITTEE A meeting of the was held at the offices of Commonwealth Automobile Reinsurers, 100 Summer Street, Boston on WEDNESDAY, MARCH 10, 2004 AT 1:30 P.M. Members present - Mr. Francis N. Delage Chairman The Hanover Insurance Company Mr. Michael J. Cesinger Ms. Kathleen H. Devericks Mr. David E. Krupa* Arbella Mutual Insurance Company The Premier Insurance Company of Mass. Safety Insurance Company Substituting for Mr. Robert J. Kerton* Commonwealth Automobile Reinsurers present - Mr. Ralph A. Iannaco Ms. Valerie B. Gedziun Mr. Robert W. Bell Ms. Suzanne M. Riddle President Vice President Claims Senior Claims Manager Claims Analyst

2 Records of Meeting -2- March 10, 2004 Chairman Mr. Francis Delage, called the meeting to order at 1:30 p.m Performance Standards Mr. Francis Delage opened the meeting by advising the Subcommittee members that they were here to review the draft copy of the 2003 Annual Report of Compliance with the Performance Standards to explore the reasons behind the results and recommend actions to be taken to improve industry performance and bring more companies into compliance. Ms. Valerie Gedziun advised that the compliance data this year was inconsistent with other years. While the industry as a whole met the Performance Standards, 20 companies received a warning in one or more areas of the standards. In the 2004 rate decision, the Commissioner of Insurance speculated that the warnings and compliance rates of the 2002 Annual Report indicated that the companies might be relaxing their use of cost containment methods. In that year, only seven warnings were issued. Additionally, the Subcommittee was reconvened because Section 41, Chapter 273, requires a review of the standards every two years. The last review took place in 2002, so this year would be the target year. Mr. Robert Bell reviewed the summary of warnings with the Subcommittee. He mentioned that the auto body payments, fraud bodily injury claims, and no-fault personal injury protection benefits handling were the most problematic standards. The breakdown by standard is: I. Auto Body Payments PS I A 3 Appraisal Assignment 1 PS I A 4 Appraisal Transmittal 6 PS I A 5 Payment Time 2 PS I F 3 Storage 1 PS I G 4&5 Reinspections 5 Total Warnings for PS I 15 II. Fraud Bodily Injury Claims PS IV A 4 a, b, c Unwarranted BI Settlements 2 PS IV B 2c Report of PIP and BI to DCD 1 Total Warnings for PS IV 3 V. No-Fault Personal Injury Protection Benefits Handling PS V B 1 Injured Party Contact 8 PS V B 2&3 Uninjured Party Contact 2 PS V B 4 PIP Form Mailing 8 PS V C 1&2 Medical Management 2 PS V D 2 Tort Carrier Notification 2 Total Warnings for PS V 22 Number of standards in non-compliance per company: 16 companies in non-compliance with 1 Standard 3 companies in non-compliance with 2 Standards 1 company in non-compliance with 3 Standards

3 Records of Meeting -3- March 10, 2004 Mr. Delage asked Ms. Gedziun if the results indicated deterioration in company performance or was it reflective of CAR getting more stringent on the audit. Ms. Gedziun advised that nothing had changed in the review process. Prior to any warning being issued, the company is sent the results of the review and is asked to respond within 30 days. If the company disagrees with any of the non-compliance numbers, CAR s Claims Examiners review the supporting documentation and make changes if warranted. Meetings were held with several of the companies this year to discuss the results prior to issuing warnings. Training sessions have also been conducted for Servicing Carriers claim staff by CAR. Mr. Robert Bell discussed with the Subcommittee some of the reasons for non-compliance. Many companies split the handling of the file to multiple adjusters. As a result time lags can occur and the time frames may not be accomplished. The standards measure the contact time from the notice of injury to the company, not to the individual adjuster. Turnover and lack of training of staff on the Performance Standards can also lead to non-compliance. A company may have decided that being warned or even fined is more economical than meeting compliance. In attempting to limit expenses, some companies may have cut back on medical bill reviews and independent medical exams. Finally, implementing new systems at companies such as imaging could lead to delays. The Subcommittee members agreed that companies are in various stages of implementing systems and that this impacts workflow. Mr. Michael Cesinger asked if the distribution of the sample could have some effect. If more files were from the winter quarter of a particularly bad year and the volumes of claims were higher that could impact compliance. Staff said they would research the distribution over the past few years and report their findings to the Claims Advisory Committee at its March 24 th meeting. Mr. Delage asked if there were any differences in the handling of voluntary and ceded claims. Mr. Bell mentioned that this is reviewed every year but CAR has always found that this is not an issue. Mr. Delage asked how CAR selects the sample of files. Mr. Bell explained that they select from 50 to 120 files depending on the size of the company. The sample includes both ceded and voluntary losses with an approximately equal representation of Bodily Injury, PIP, and Physical Damage claims. If the company writes commercial business, they will take a sample of personal and commercial lines. This allows CAR to take a snapshot of each company's claim handling practice. The Subcommittee agreed that they were comfortable with the sample size, and did not feel it needed to be increased. Mr. Cesinger asked about the date parameters for the sample set. Mr. Bell answered that CAR tries to keep it as current as possible without interfering with claim handling. The Subcommittee discussed various suggestions for ways to address the results that would improve compliance. The consensus was that the industry should take the necessary steps to regulate itself. Ms. Kathleen Devericks suggested that the companies who are warned and fined should have mandatory training. CAR staff advised that they do conduct training sessions for claims personnel when requested by the companies. Mr. Krupa stated that it should be the responsibility of the company to train their staff. Mr. Cesinger stated that an appropriate place to provide training on the Performance Standards would be at the Cost Containment Seminars.

4 Records of Meeting -4- March 10, 2004 In response to a question regarding who the Claims Report is sent to at the companies, and whether the names of the companies that are in non-compliance were ever included in the Annual Report or published on CAR s website, Ms. Gedziun stated that the report is sent to the Senior Claims Officer and that it has been the practice not to publish the names of the companies that are in non-compliance. The rationale has been that a warning was issued to give the company an opportunity to correct the deficient area. Other departments at CAR do publish penalty program results. Mr. Delage suggested that the report should be signed off by the CEO of the company in the case of a warning or fine. Mr. Cesinger disagreed, as the Senior Claims Officer is responsible for the operation of the claims department but felt that publishing the results on CAR s website would be acceptable. Following discussion, the other members agreed that the results should be published on CAR s website. The Subcommittee then reviewed the Schedule of Penalties section of the Performance Standards. They considered eliminating the warnings and raising the compliance rates to 85% or 90% but felt that would necessitate increasing the sample size. It was agreed that it would be more effective to adjust the penalties. The Performance Standards currently allow for two levels of penalties, Type I and Type II, and three ranges of fines based on the market share of the company. Following discussion, it was agreed that the two types and the three carrier levels were not necessary and one penalty should be used for all carriers. The penalty range that should be used is the current highest level of $30,000 to $150,000. It was also felt that if a company received a fine, the next claim review should be done in six months and the penalty accelerated if still in non-compliance. At Mr. Delage s request, Ms. Gedziun recapped the recommendations: 1. Publish the results of the Annual Report on CAR s website and a list of the companies with their compliance status as follows: Companies in compliance Companies in non-compliance with 1 standard Companies in non-compliance with 2 standards, etc. Companies with fines 2. Put the Performance Standards permanently on the Cost Containment Seminar agenda. Staff could do a short presentation each year as training on various sections. 3. Have CAR offer training assistance to companies in non-compliance. 4. Eliminate Type I and Type II penalty levels, and the three ranges of fines based on market share. Use the current highest level ($30,000 - $150,000) as the penalty range amount. 5. If a company is in a fine situation, have a supplemental review done in six months and accelerate the penalty if not in compliance. A motion was made by Ms. Kathleen Devericks and seconded by Mr. David Krupa to recommend these changes to the Claims Advisory Committee. The motion passed on a unanimous vote.

5 Records of Meeting -5- March 10, 2004 Ms. Gedziun advised that the first three recommendations could be implemented if approved by the Claims Advisory Committee and the Governing Committee, but that the last two would have to be submitted to the Commissioner of Insurance for her approval. The Subcommittee felt that they should meet after the March 24 th Claims Advisory Committee meeting to review the remaining text of the Performance Standards and determine if they need to propose any other changes. Mr. Krupa expressed a concern he had with the paperless subrogation program. He had observed that some companies were submitting unallocated expenses as allocated in their request for subrogation recovery. The question was raised if CAR looks for situation as part of their review and Mr. Bell advised that the submissions were examined in the course of the Claim Reviews. Mr. Krupa felt that the Subcommittee may want to strengthen the subrogation section of the standards. Mr. Delage said the members should review the standards and bring their suggestions to the next meeting. Other Business There being no further business, a motion was made by Mr. David Krupa and seconded by Ms. Kathleen Devericks to adjourn the meeting. The motion passed on a unanimous vote. The meeting adjourned at 3:10 p.m. Boston, Massachusetts April 19, 2004 VALERIE B. GEDZIUN Vice President, Claims Note: These Records have not been approved. They will be considered for approval at the next Claims Advisory Performance Standards Subcommittee meeting.