TRENDS IN SENIOR LIVING LITIGATION

Transcription

1 TRENDS IN SENIOR LIVING LITIGATION Insurance Underwriting October 26, Willis Towers Watson. All rights reserved.

2 Bruce W. Dmytrow, Vice President Aging Services CNA Healthcare Bruce is a Vice President at CNA and has been with the enterprise since He is responsible for developing the strategic and tactical direction for the growth and profitability of the CNA Aging Services business 2

3 Trends Contributing to Insurance Results in Senior Living Industry Insurance Industry New capacity Risk tolerance Top line growth versus profitability Pricing, terms and conditions Insurance program structures Influencing Factors Professional liability loss trends of 7% - 10% Limited return on investment Senior Living Industry Financial pressure change in reimbursement models Risk transfer versus risk sharing Increase in resident acuity levels and co-morbidities Increase in claim frequency Mergers/acquisitions and changes in ownership structures Increase in attorney specialization increase in litigation Large city urban creep 3

4 Using Evidence to Achieve Excellence Knowledge and experience to identify loss drivers Extensive databases Data analytics Pricing models Lessons Learned Underwriting discipline is paramount. Risk selection fosters profitability. Building and maintaining relationships are integral to managing market cycles. Utilization of client-specific data builds trust and supports underwriting determinations. Early discussions regarding renewal actions prepare all parties for mutually beneficial outcomes. Average Total Paid for Closed Claims by Bed Type BED TYPE AVERAGE TOTAL PAID Assisted Living $221,496 Skilled Nursing $212,766 Unknown $206,470 Independent Living $123,825 Overall Average Total Paid $211,709 Resource: CNA Aging Services 2016 Claim Report 4

5 Using Evidence to Achieve Excellence: Engage, Lead, Succeed Datasets and Methodology 2,617 aging services professional liability claims that closed between January 1, 2011 and December 31, 2015 Includes 1,387 professional liability claims that closed between January 1, 2014 and December 31, 2015 Excludes indemnity payment by CNA less than $10,000, home healthcare and adult day care claims Limited to CNA-insureds; monies paid by CNA; and closed date 5

6 Most Frequent Allegation in Closed Claims (Percentage of 2,617 Closed Claims) 4.2% 13.7% 6.1% 42.7% 14.7% 18.6% Resident fall Pressure ulcers Improper care Failure to monitor Resident abuse All other 6

7 Highest Average Total Paid Allegation in Closed Claims Elopement $325,561 Failure to follow physician order $323,325 Delay in seeking medical treatment $245,783 Pressure ulcers $232,398 Failure to inform physician $231,321 7

8 Resident Falls - Frequency by Allegation (Percentage of 1,117 Closed Claims) 8

9 Resident Falls Frequency by Outcome of Injury (Percentage 601 Closed Claims) Death is the most common outcome for fall-related claims. 9

10 Evaluating a Company s Risk Profile Venue Levels of care and services provided Total exposures (number of beds) Loss history Expiring insurance program Ownership structure and support Financial stability Stable and high performing leadership team Vision, mission and culture Retention of employees and staffing related to resident acuity Quality outcomes Litigation management strategies Risk, quality and compliance programs Reasons for marketing insurance program 10

11 Differentiators Submission Materials Quality of submission information Website consistent with submission information Quality outcomes Loss history Employee retention and staffing ratios Composition of leadership team Reputation in the community 11

12 Differentiators Meeting with Organization s Leadership Team and Frontline Staff Mission of organization Knowledge of senior living industry and operations Investment in well-being of the residents Understanding the importance of balancing operations with concern for residents and employees Transparency of successes and challenges Willingness to partner with CNA Risk Control and Claim Expectations of insurance company 12