Insurance Contracts for 831(b) Enterprise Risk Captives Policies and Pooling Agreements Jeffrey K. Simpson John R. Capasso Brian Johnson Gordon, Fournaris & Mammarella, P.A. Captive Planning Associates, LLC Bartlett Actuarial Group, Ltd. Director President & CEO Managing Principal Phone: (302) 652-2900 Phone: (888) 305-8889 Phone: (843) 377-0993 jsimpson@gfmlaw.com jcapasso@captiveplanning.com brianj@bartlettactuarialgroup.com Tuesday, March 10, 2015 11:15 a.m.
Introduction What will we discuss and why? 2
Overview Evolution of Enterprise Risk - Coverages - Pricing Policy Agreements Pooling Arrangements 3
ENTERPRISE RISK 4
What is Enterprise Risk Management? Enterprise Risk Management ( ERM ) enables management to effectively deal with uncertainty and associated risk and opportunity, enhancing the capacity to build value. Value is maximized when management sets strategy to strike an optimal balance between growth and return goals and related risks, and efficiently and effectively deploys resources in pursuit of the entity s objectives. According to the Casualty Actuarial Society ( CAS ), ERM is defined as: The process by which organizations in all industries assess, control, exploit, finance and monitor risks from all sources for the purposes of increasing the organization s short and long term value to its stakeholders. All entities face uncertainty. The challenge for management is to determine how much uncertainty to accept. Uncertainty presents both risk and opportunity, with the potential to erode or enhance value. 5
Enterprise Risk Management Furthermore, CAS has enumerated the types of risk subject to ERM as Hazard, Financial, Operational and Strategic. Hazard risks are those risks that have traditionally been addressed by insurers, including fire, theft, tornado, earthquake, windstorm, general liability, business interruption, pollution and health. Financial risks cover potential losses due to changes in financial markets, including interest rates, foreign exchange rates, commodity prices, liquidity risks and credit risk. Operational risks cover a wide variety of situations, including customer satisfaction, product development, product failure, trademark/copyright protection, corporate leadership, information technology, management fraud and information risk. Strategic risks include such factors as completion, customer preferences, technological innovation and regulatory or political impediments. 6
Enterprise Risk Management ERM helps management ensure effective reporting and compliance with laws and regulations, and helps avoid damage to the entity s reputation and associated consequences. The following capabilities inherent in ERM help management achieve the entity s performance and profitability targets and prevent loss of resources: Aligning risk appetite and strategy Management considers the entity s risk appetite in evaluating strategic alternatives, setting related objectives, and developing mechanisms to manage related risks. Enhancing risk response decisions ERM provides the objectivity to identify and select among alternative risk responses from; risk avoidance, reduction, sharing and acceptance. Reducing operational surprises and losses Entities gain enhanced capability to identify potential events and establish responses, reducing surprises and associated costs or losses. Identifying and managing multiple and cross-enterprise risks Every enterprise faces a myriad of risks affecting different parts of the organization, and ERM facilitates effective response to the interrelated impacts, and integrated responses to multiple risks. Seizing opportunities By considering a full range of potential events, management is positioned to identify and proactively realize opportunities. Improving deployment of capital Obtaining thorough risk information allows management to effectively assess overall capital needs and enhance capital allocation In summary, ERM helps management get to where it wants to go and avoid pitfalls and surprises along the way. 7
Property Risks: Wind Flood Earthquake Cyber Risk Environmental / Pollution Workers Compensation Reputational / Brand Risk Representations & Warranties Supply Chain Interruption Intellectual Property Pandemic Risk Employee Benefits Current Trends in ART Coverage Considerations Gain immediate control over a substantial business expense, which is designed to increase exponentially, with access to the reinsurance market Ability to segregate funds and build surplus to stabilize annual cost incurred Create a new corporate profit center and increase rate of return Establish and benefit from best practice risk management procedures Reduce current business costs over a predictable term of years and avoid artificial market adjustments Create flexible claims payment structure Provides coverage for uninsured or hard-to-insure risks Create an insurance infrastructure that provides flexibility for unknown market changes (whether politically or financially mandated) Potential to build up underwriting profits of the captive exempt from federal income tax when premiums are less than $1.2 million 8
Enterprise Risk Management Risk Evaluation and Transfer Understand the organizations risk exposures Know the organizations risk tolerance Be aware of loss history Know the insurance marketplace Understand the organizations risk requirements and how they may change, and Determine the organizations corporate risk limits and expectations 9
Risk Management and Underwriting Reducing the Net Cost of Risk Almost any form of self-insurance can be less expensive than risk transferred to the commercial marketplace (due to adverse selection to support external losses) Carefully analyze risk exposure (strategic underwriting) Transfer unacceptable levels of risk to others (commercial insurers, reinsurers) Best-in-class claims administration Proactive risk mitigation program (employee education/training) Expert captive management 10
PRICING 11
Measures the following: Total Cost of Risk (TCOR) Total cost of insurance premiums, Self-insured or retained losses, and Risk management administration costs Direct loss costs: Losses retained by the company Losses beneath the deductible Losses above the limit of insurance Losses completely uninsured Indirect loss costs: Diminished profits and productivity Costs paid to third parties who were affected by your loss 12
How Do You Measure TCOR? Insurance premiums Commercial market premiums Captive insurance premiums Direct loss costs First part of the What if? scenario Indirect loss costs Second part of What if? scenario Can be substantial many times the direct loss itself Can be difficult to quantify 13 Must get a sense of the sources and magnitude of indirect losses
Keys to Pricing Understand the actual captive insurance policy What s covered? What s excluded? How claims are triggered? Potential overlap among coverages (i.e. could a claim be submitted under multiple coverages) Potential correlation among coverages 14
Examine the potential losses Keys to Pricing How likely is it to happen? If it happens, how bad is it likely to be? Modeling can be extremely useful Lack of documented loss experience Enables exploration of various deductibles and/or limits Allows sensitivity testing of assumptions Can give a very good sense of the worse case scenarios Capitalization recommendations Appropriate risk load in the premium 15
POLICY AGREEMENTS 16
Advantages & Benefits to Control Control over policy drafting and administration is one of the key advantages of a captive Opportunity to tailor coverage to insured s unique exposures Address specific gaps in insured s commercial insurance program Flexibility in interpreting policy provisions Ability to endorse after the fact to confirm intentions 17
Administrative/Practical Concerns Captive plays a dual role insurer of related party risks and reinsurer of pooled, unrelated party risks Customized and / or diverse policies create uncertainty for the insurer Also less efficient for the captive manager to administer claims, since every policy can have different definitions / claim triggers / methods of valuation / exclusions 18
Administrative/Practical Concerns Presence of unrelated exposures can lead to tensions between captives in the pool Captives may not want their manager to interpret policies liberally Because pooling arrangements can put as much as 75% of a claim into the pool, an insured has an incentive to aggressively contest a denied claim. 19
Administrative/Practical Concerns There are also external pressures from the desire to have the captive be treated as an insurance company for tax purposes. Case law emphasizes the need for reasonable pricing that is actuarially determined This necessarily requires some level of coordination between policy terms and premium pricing analysis Vague policy language could arguably expand coverage beyond what the actuary contemplated, perhaps even into business risks, as opposed to insurable risks 20
Goals of Policy Drafting Establish and meet the expectations of the insured with respect to scope of coverage, the responsibilities of the insurer and insured. Coordinate with feasibility study and business plan Prevent claim disputes 21
Policy Forms, Limits, and Exclusions Master Policy vs. Individual policies Master policy can be unwieldy Difficult to make master policy internally coherent 22
Policy Forms, Limits, and Exclusions Claims made or occurrence based? The term Claims made is ubiquitous not always applicable What event creates liability for the insurer: The event itself? A Claim against the insured from an injured thirdparty? Loss (e.g. expense) actually incurred by the insured? 23
Policy Forms, Limits, and Exclusions Policy Limits Do you permit or prohibit stacking (e.g. an occurrence triggers liability under multiple captive policies)? 24
Policy Forms, Limits, and Exclusions Policy Exclusions: Making sure that the exclusions are applicable to the types of coverage Balance between providing DIC coverage and permitting policy to cover moral hazards, uninsurable risks 25
Adjudication of Claims Exhaustion of Liability for the Insurer Must the bad act or property damage occur during the policy period or can it occur prior? 26
Adjudication of Claims Dealing with spill-over claims What happens if liability is triggered during the policy period but losses continue into future periods? ~ Only reimburse for expenses incurred during the period? ~ Reimburse for expense incurred during the period and allow insured to renew? o How does the pricing account for the known claim? 27
Adjudication of Claims Reimburse for expenses until the claim is done or policy limits reached? ~ How does this affect the ability to close the pool? ~ Use a period of restoration to cut off liability after a certain time? 28
Adjudication of Claims Valuation of Claims How are business interruption losses calculated? Projection income that would have been earned but for the event Meaningful comparison of pre-loss and post-loss experience Valuing the loss of a contract or a key employee 29
POOLING ARRANGEMENTS 30
Key Features Layer vs. First Dollar Layer: Protects Against Abusive & Nuisance Claims Participants Feel Less Vulnerable Very Few Shared Claims First Dollar: Every Claim is Shared Increases Loss Frequency Easier to Defend? Struggle for Balance 31
Key Features Front or Reinsurance Pool as Direct Writer: Facilitates High Volume Programs Easier to Standardize and Issue Policies Beware of Multi-State Issues Pool as Reinsurer: Easier for Pool (Simple Reinsurance) May Add a Transaction (Reinsurance and Retrocession) 32
Key Features Entity or Contract Entity: Direct regulation and frictional costs May give participants more comfort May be necessary if pool intends to retain risk Contract: Ease of entry and documentation Can reduce administrative expenses Who holds the money? How do you pay claims? 33
Key Features Term Retrospective or Prospective Several Pool Philosophies: Fixed start date for current year Rolling admission Fixed future start date Retrospective: Mid or late year entry can force retrospective policy issuance Might not be insurance 34
Key Features Premium Allocation Consider how much premium is being pooled (typically in %): Safe Harbor Greater than 50% But what if your quota share of pool includes your own risk? 35
Key Features Premium Allocation Consider how the % is determined: Often arbitrary or little actuarial support for reasonableness Easier to get comfortable in first dollar? More difficult in layered or hybrid designs 36
Key Features Maximum Exposure (Stop Loss) Always get asked: Some pools have stop loss provisions Some pools buy stop loss coverage Some pools ignore or don t think they need stop loss May be important in open pools or pools with high limit exposures Carefully circumscribed pools may not need it Participant program or policy aggregates can operate as a virtual stop loss provision 37
Natural Tension: Key Features Collateral Captive owner wants his money in the captive Pool needs to know the funds are available to pay claims Common Methods: Funds withheld Pledged account Controlled operating account or other set aside Can be very messy if pool must collect from each participant to pay claims 38
Practical Considerations Open or Closed Open: Can increase participants quickly Broad diversity (risk, industry, geography) Helpful in extraordinary situations Closed: More certainty regarding risks and vetting of participants Enough participants? Easier in and out 39
Practical Considerations Claims Magnitude and Frequency: Pool s history? Never had a claim! How much is enough? Management: Who adjusts claims and how? What if there is a committee of participants? Written record important 40
Practical Considerations Transparency How much do you need or want? All participants known to one another? All claims and claimants identified? Should it work like a member-owned group? 41
Practical Considerations Standardization Underwriting/Rating Several different pool underwriting approaches? All participants must be underwritten through pool s program Pool must review and approve underwriting Pool doesn t consider underwriting 42
Practical Considerations Standardization Underwriting/Rating Does it matter for participant: Subjectivity in rates Not reviewing at all could be too laissez-faire? Otherwise, maybe more about confidence of the pool provider 43
Practical Considerations Standardization Coverages Coverage selections may be more important than rating method because: Affect frequency and severity Different appetites for different exposures First party vs third party control Homogeneity: What does it mean? Is it required? 44
Practical Considerations Reaction to Experience The most important factor of all? How do you act like an insurance company? What happens at renewal time? Is there annual re-rating of underlying coverage? Is there annual re-consideration of reasonableness of premium allocation? 45
QUESTIONS AND ANSWERS 46