MEDICAL PROFESSIONAL LIABILITY

HEARING ON THE QUESTION OF COMPETITION IN THE PHYSICIAN, SURGEON AND HOSPITAL MARKET

October 31, 2019

SUBMITTED MATERIALS ACCOMPANYING NHID TESTMONY

CHRISTIAN CITARELLA CHIEF PROPERTY & CASUALTY ACTUARY NEW HAMPSHIRE INSURANCE DEPARTMENT Exhibit 1a NEW HAMPSHIRE INSURANCE DEPARTMENT Premium and Market Share in 2018 Medical Professional Liability HHI* Full Market 944 1,045 HHI for Regulated Companies only 2,665 2,551

2018 Direct 2017 Direct Group Type of Written 2018 Market Written 2017 Market Code Cocode Company Name State of Domicile Company Premiums Share Premiums Share 1154 10638 Proselect Ins Co Nebraska $10,604,389 23.5% $9,642,106 24.1% 4775 36277 Medical Mut Ins Co Of ME Maine $5,365,365 11.9% $6,114,123 15.3% 2698 10179 ProAssurance Specialty Ins Co Alabama S $3,641,812 8.1% $2,964,330 7.4% 3219 41718 Endurance Amer Specialty Ins Co Delaware S $3,362,968 7.5% $1,867,685 4.7% 10341 Controlled Risk Ins Co Of VT RRG Vermont RRG $2,408,511 5.3% $0 0.0% 31 11843 Medical Protective Co Indiana $2,365,596 5.3% $2,351,302 5.9% 31 20079 National Fire & Marine Ins Co Nebraska S $2,165,490 4.8% $2,901,168 7.3% 4770 13756 CMIC RRG District Of Columbia RRG $1,270,282 2.8% $1,587,172 4.0% 218 20427 American Cas Co Of Reading PA Pennsylvania $1,179,080 2.6% $1,117,014 2.8% 111 25445 Ironshore Specialty Ins Co Arizona S $1,046,328 2.3% $412,636 1.0% 2698 33391 ProAssurance Ind Co Inc Alabama $1,033,689 2.3% $1,179,535 3.0% 785 35378 Evanston Ins Co Illinois S $756,181 1.7% $1,473,799 3.7% 1279 21199 Arch Specialty Ins Co Missouri S $727,781 1.6% $537,298 1.3% 831 14347 The Doctors Co RRG a Recip Exch District Of Columbia RRG $643,443 1.4% $648,436 1.6% 831 34495 Doctors Co An Interins Exch California $625,876 1.4% $253,256 0.6% 212 26387 Steadfast Ins Co Illinois S $599,437 1.3% $532,806 1.3% 88 12833 AIX Specialty Ins Co Delaware S $587,579 1.3% $403,312 1.0% 508 44121 Oms Natl Ins Co Rrg Illinois RRG $548,684 1.2% $510,154 1.3% 218 31127 Columbia Cas Co Illinois S $503,474 1.1% $274,391 0.7% 4698 43460 Aspen Amer Ins Co Texas $500,607 1.1% $108,098 0.3% 111 19917 Liberty Ins Underwriters Inc Illinois $430,771 1.0% $428,006 1.1% 98 24856 Admiral Ins Co Delaware S $386,111 0.9% $111,906 0.3% 1282 44083 Preferred Physicians Medical RRG a M Missouri RRG $382,597 0.8% $490,100 1.2% 1154 15686 Coverys Specialty Ins Co New Jersey S $353,165 0.8% $85,000 0.2% 2638 15865 NCMIC Ins Co Iowa $350,653 0.8% $354,575 0.9% 626 22667 Ace Amer Ins Co Pennsylvania $259,099 0.6% $251,960 0.6% 44105 Ophthalmic Mut Ins Co RRG Vermont RRG $251,404 0.6% $242,040 0.6% 10115 Eastern Dentists Ins Co RRG Vermont RRG $238,507 0.5% $219,163 0.5% 12373 Caring Communities Recip RRG District Of Columbia RRG $188,052 0.4% $182,270 0.5% 244 10677 The Cincinnati Ins Co Ohio $170,317 0.4% $179,557 0.4% 35904 Health Care Ind Inc Colorado S $157,483 0.3% $130,689 0.3% 785 12537 United Specialty Ins Co Delaware S $154,348 0.3% $0 0.0% 4851 18767 Church Mut Ins Co Wisconsin $150,223 0.3% $52,109 0.1% 158 22730 Allied World Ins Co New Hampshire $144,889 0.3% $142,161 0.4% 181 25038 North Amer Capacity Ins Co New Hampshire $124,750 0.3% $120,750 0.3% 2698 14460 Podiatry Ins Co Of Amer Illinois $120,684 0.3% $125,734 0.3% 4904 34452 Homeland Ins Co of NY New York S $119,892 0.3% $135,532 0.3% 831 34487 TDC Specialty Ins Co District Of Columbia S $113,097 0.3% $83,385 0.2% 4776 15211 Lone Star Alliance RRG District Of Columbia RRG $105,147 0.2% $91,144 0.2% 111 10725 Liberty Surplus Ins Corp New Hampshire S $88,022 0.2% $72,240 0.2% 361 19720 American Alt Ins Corp Delaware $82,772 0.2% $63,336 0.2% 626 27960 Illinois Union Ins Co Illinois S $80,576 0.2% $167,232 0.4% 11710 Allied Professionals Ins Co RRG Arizona RRG $76,013 0.2% $86,920 0.2% 501 35157 Fair Amer Ins & Reins Co New York $64,123 0.1% $68,108 0.2% 501 10328 Capitol Specialty Ins Corp Wisconsin S $57,423 0.1% $34,784 0.1% 501 33138 Landmark Amer Ins Co New Hampshire S $55,063 0.1% $80,778 0.2% 31 37362 General Star Ind Co Delaware S $49,113 0.1% $18,600 0.0% 98 25224 Great Divide Ins Co North Dakota $47,598 0.1% $45,326 0.1% 10232 American Assoc Of Othodontists RRG Arizona RRG $40,526 0.1% $43,274 0.1% 4725 44776 StarStone Specialty Ins Co Delaware $39,029 0.1% $41,976 0.1% 464 15738 MedChoice RRG Inc Vermont RRG $27,906 0.1% $0 0.0% 508 10801 Fortress Ins Co Illinois $23,024 0.1% $17,271 0.0% 11846 Peace Church RRG Inc Vermont RRG $22,752 0.1% $22,752 0.1% 3478 26808 Hallmark Specialty Ins Co Oklahoma S $22,322 0.0% $21,781 0.1% 12 19445 National Union Fire Ins Co Of Pitts Pennsylvania $17,997 0.0% $109,391 0.3% 11941 Green Hills Ins Co RRG Vermont RRG $16,243 0.0% $15,358 0.0% 775 13714 Pharmacists Mut Ins Co Iowa $13,964 0.0% $15,386 0.0% 38920 Kinsale Ins Co Arkansas S $12,062 0.0% $14,617 0.0% 244 23280 The Cincinnati Ind Co Ohio $11,645 0.0% $12,377 0.0% 1154 36234 Preferred Professional Ins Co Nebraska $9,279 0.0% $10,488 0.0% 31 22276 Berkshire Hathaway Specialty Ins Co Nebraska S $7,803 0.0% $3,167 0.0% 176 25143 State Farm Fire & Cas Co Illinois $7,293 0.0% $8,002 0.0% 12 19380 American Home Assur Co New York $6,507 0.0% $5,907 0.0% 244 28665 The Cincinnati Cas Co Ohio $5,081 0.0% $0 0.0% 13677 Affiliates Ins Recip a RRG Vermont RRG $3,873 0.0% $3,945 0.0% 3494 12203 James River Ins Co Ohio S $3,638 0.0% $14,242 0.0% 12 37982 Tudor Ins Co New Hampshire $3,357 0.0% $7,690 0.0% 244 13037 The Cincinnati Specialty Underwriter Delaware S $2,921 0.0% $2,836 0.0% 98 39462 Berkley Assur Co Iowa S $2,893 0.0% $2,450 0.0% 4698 10717 Aspen Specialty Ins Co North Dakota S $2,500 0.0% $16,422 0.0% 4381 12936 Houston Specialty Ins Co Texas S $1,815 0.0% $0 0.0% 11598 Applied Medico Legal Solutions RRG Arizona RRG $1,622 0.0% ($12,609) 0.0% 218 20443 Continental Cas Co Illinois $1,534 0.0% $530,381 1.3% 12 23809 Granite State Ins Co Illinois $1,226 0.0% $2,403 0.0% 1282 35114 NORCAL Specialty Ins Co Texas S $1,000 0.0% $1,000 0.0% 184 33090 Medical Security Ins Co North Carolina S $667 0.0% $0 0.0% 12934 Academic Medical Professionals Ins E Vermont RRG $473 0.0% $541 0.0% 3416 26620 AXIS Surplus Ins Co Illinois S $0 0.0% $84,500 0.2% 783 37974 MT Hawley Ins Co Illinois $0 0.0% $9,693 0.0% 111 24732 General Ins Co Of Amer New Hampshire $0 0.0% $7,732 0.0% 968 36940 Indian Harbor Ins Co Delaware S $0 0.0% $4,250 0.0% 11714 Emergency Physicians Ins Exchange RR Vermont RRG $0 0.0% $242 0.0% 84 26344 Great Amer Assur Co Ohio $0 0.0% $90 0.0% 158 16624 Allied World Specialty Ins Co Delaware $0 0.0% ($554) 0.0%

Total Regulated Carrier $23,760,417 52.7% $23,375,289 58.5% Total Surplus Lines Carrier $15,062,964 33.4% $12,452,836 31.2% Total Risk Retention Group $6,226,035 13.8% $4,130,902 10.3% GRAND TOTAL $45,049,416 100.0% $39,959,027 100.0% * HHI: Herfindahl-Hirschman Index. An index from 1,500 to 2,500 indicates moderate market concentration and an index above 2,500 indicates high market concentration.

Source: NAIC Market Share Report NHID 10/30/2019 Exhibit 1b

NEW HAMPSHIRE INSURANCE DEPARTMENT

Regulated Insurers doing Business in New Hampshire in 2018 with more than $100,000 in Medical Professional Liability Written Premium

2018 MPL 2018 MPL NH MPL 2018 All Lines 2018 All Lines Written Premium Written Premium / Written Premium NH MPL / Written Premium NH MPL / Company Name NH Countrywide CW MPL NH NH All Lines Countrywide CW All Lines Market Commentary Proselect Ins Co 10,604,389 193,050,186 5.5% 10,839,962 97.8% 206,924,080 5.1% Regional, Parent is ProMutual - Northeast Focus Medical Mut Ins Co Of ME 5,365,365 41,245,473 13.0% 5,468,682 98.1% 42,049,315 12.8% Regional Medical Protective Co 2,365,596 570,364,100 0.4% 2,387,812 99.1% 581,888,016 0.4% National American Cas Co Of Reading PA 1,179,080 225,806,532 0.5% 2,020,722 58.3% 558,927,319 0.2% National ProAssurance Ind Co Inc 1,033,689 180,001,213 0.6% 1,033,689 100.0% 182,097,896 0.6% National Doctors Co An Interins Exch 625,876 624,446,621 0.1% 625,876 100.0% 635,036,620 0.1% National - Physician owned Aspen Amer Ins Co 500,607 44,874,315 1.1% 1,284,037 39.0% 456,806,746 0.1% National Liberty Ins Underwriters Inc 430,771 62,011,475 0.7% 18,115,503 2.4% 3,391,078,818 0.0% National NCMIC Ins Co 350,653 61,831,740 0.6% 350,653 100.0% 61,831,740 0.6% National - Chiropractors Ace Amer Ins Co 259,099 48,366,097 0.5% 11,487,765 2.3% 4,965,605,376 0.0% National The Cincinnati Ins Co 170,317 27,429,414 0.6% 13,763,862 1.2% 3,985,629,607 0.0% National Church Mut Ins Co 150,223 14,746,905 1.0% 2,903,084 5.2% 733,671,715 0.0% National Allied World Ins Co 144,889 19,124,466 0.8% 598,700 24.2% 186,345,226 0.1% National North Amer Capacity Ins Co 124,750 11,090,756 1.1% 544,695 22.9% 289,889,345 0.0% National Podiatry Ins Co Of Amer 120,684 65,885,057 0.2% 120,684 100.0% 65,896,878 0.2% National - Podiatrists

Source: NAIC Market Share Report NHID 10/30/2019 Exhibit 1c

NEW HAMPSHIRE INSURANCE DEPARTMENT Insurers Entering and Exiting the NH Market

1. Insurers entering the New Hampshire Medical Professional Liability Market after 2010

Company Name Type 2017 Premium 2018 Premium ProAssurance Specialty Ins Co (1) S $2,964,330 $3,641,812 Endurance Amer Specialty Ins Co S $1,867,685 $3,362,968 Controlled Risk Ins Co Of VT RRG RRG $0 $2,408,511 CMIC RRG RRG $1,587,172 $1,270,282 ProAssurance Ind Co Inc (1) $1,179,535 $1,033,689 Evanston Ins Co (2) S $1,473,799 $756,181 The Doctors Co RRG a Recip Exch (3) RRG $648,436 $643,443 AIX Specialty Ins Co S $403,312 $587,579 Aspen Amer Ins Co $108,098 $500,607 Coverys Specialty Ins Co S $85,000 $353,165 United Specialty Ins Co (2) S $0 $154,348 Allied World Ins Co $142,161 $144,889 North Amer Capacity Ins Co $120,750 $124,750 TDC Specialty Ins Co (3) S $83,385 $113,097 Lone Star Alliance RRG RRG $91,144 $105,147 7 Other Regulated (2018 premium < $100,000) $192,748 $193,857 11 Other Surplus (2018 premium < $100,000) S $169,297 $199,428 2 Other RRG (2018 premium < $100,000) RRG $541 $28,379

(1),(2),(3) These companies are part of the same insurance group.

2. Insurers exiting** the New Hampshire Medical Professional Liability Market between 2010 and 2018

Company Name Type 2010 Premium 2018 Premium Lexington Ins Co (1) S $4,613,302 $0 Darwin Select Ins Co (2) S $1,174,800 $0 Continental Cas Co $1,069,581 $1,534 Preferred Professional Ins Co $984,972 $9,279 Allied World Assur Co US Inc (2) S $983,972 $0 Illinois Union Ins Co S $907,783 $80,576 Homeland Ins Co of NY (3) S $616,449 $119,892 Catlin Specialty Ins Co S $573,000 $0 Ironshore Ind Inc $194,750 $0 Chicago Ins Co (4) $177,841 $0 National Union Fire Ins Co Of Pitts (1) $172,389 $17,997 Essex Ins Co S $100,050 $0 OneBeacon Ins Co (3) $90,641 $0 Empire Fire & Marine Ins Co $78,238 $0 Health Care Industry Liab Recip Ins $65,893 $0 Darwin Natl Assur Co (2) $65,351 $0 Nautilus Ins Co S $34,042 $0 Granite State Ins Co (1) $24,045 $1,226 Applied Medico Legal Solutions RRG RRG $21,893 $1,622 Continuing Care RRG Inc RRG $16,330 $0 Western World Ins Co S $11,919 $0 General Ins Co Of Amer $10,660 $0 Houston Cas Co S $7,884 $0 Interstate Fire & Cas Co (4) S $1,905 $0 Chartis Specialty Ins Co (1) S $221 $0

(1),(2),(3),(4) These companies are part of the same insurance group.

3. Insurers exiting** the New Hampshire Medical Professional Liability Market in 2018

Company Name Type 2017 Premium 2018 Premium National Union Fire Ins Co Of Pitts $109,391 $17,997 Aspen Specialty Ins Co S $16,422 $2,500 Continental Cas Co $530,381 $1,534 AXIS Surplus Ins Co S $84,500 $0 MT Hawley Ins Co $9,693 $0 General Ins Co Of Amer $7,732 $0 Indian Harbor Ins Co S $4,250 $0 Emergency Physicians Ins Exchange RR RRG $242 $0

** Includes Companies with substantially reduced writings (80% or more).

Source: NAIC Market Share Report NHID 10/30/2019 Exhibit 2a

PHYSICIANS AND SURGEONS MEDICAL PROFESSIONAL LIABILITY INSURANCE RATE COMPARISON CURRENT MARKET LEADERS IN NEW HAMPSHIRE Rates for $1 mil / $ 3 mil Limits: ISO Occurrence Premium Claims Made - 1 Claims Made - Mature Specialty Class MMICof ME ProSelect Med Pro MMICof ME ProSelect Med Pro MMICof ME ProSelect Med Pro

Family Practice - NS 80420 n/a 13,202 14,431 3,773 3,819 4,342 13,973 12,731 13,565 Radiology 80280 n/a 23,105 21,241 7,047 6,684 6,389 26,199 22,279 19,967 Cardiology - NS 80255 n/a 13,202 17,693 4,056 3,819 5,322 15,021 12,731 16,630 General Surgery 80143 n/a 52,499 54,427 14,525 15,187 16,371 53,796 50,623 51,161 Neurosurgery 80152 n/a 125,074 92,352 27,352 36,182 27,779 101,304 120,602 86,809 OB / GYN 80153 n/a 84,928 66,491 18,675 24,568 20,001 69,166 81,890 62,500

POTENTIAL ADJUSTMENTS TO REFLECT PRIOR CLAIMS ACTIVITY

MMIC of ME ProSelect Med Pro - Standard Program Premium Surcharges - Individual and Group Practice Schedule Rating plan - Premium credit for time without a claim - Chargeable claims - overall credit or debit of - 40% to +25% - in judgement of company underwriting committee - based on schedule of specific characteristics not - Claims for this purpose does not include negligence on the part of the physician is reasonably clear reflected in the experience for the class: instances of: - subject to a 10% surcharge for each chargeable claim for two - acceptance of risk management provisions - mistaken identity policy years - professional liability loss history - freq. or severity - blanket defendant listings - Hospital Disciplinary Action - unusual risk characteristics - improper inclusion - physicians under punitive or disciplinary observation, - office surgery inspection by an approved org. - non-meritorious or frivolous claims preceptorship or sponsorship in a hospital subject to - continuing education surcharge - amount determined by Underwriting Committee - for Group, schedule reflects: Years Credit - Other -qualification and experience of insured 3 0.05 - physician displays characteristics or patterns of practice - office appraisal 4 0.05 not reflective of established norms - adequacy of staffing, selection, supervision and 5 0.1 - surcharge ranges from 10 to 50% experience of staff 6 0.1 - past loss history 7 0.1 - Loss Free Discount - effective risk management 8 0.1 - loss = indemnity payment of $15 K or more 9 0.1 - 1% discount for each consecutive year a physician is - Claim-Free Program 10+ 0.2 insured with MMIC and loss free - minimum of 3 years claim free - maximum of 15% - "claim free" means no paid claims of more than $10,000 - 1% discount for each year up to 15 - Safe Care Hostipal 3% discount - Experience Rating Plan available to groups of 3 or more

RATE ACTIVITY - RECENT YEARS COMPANIES Most Recent 1st Prior 2nd Prior Company Date Amount Date Amount Date Amount

MMICof ME 9/1/2014 -5.1% 11/1/2011 -2.2% 10/1/2010 5.0% Medical Mutual Insurance Company of Maine ProSelect 10/1/2018 5.0% 10/1/2013 9.2% 10/1/2012 8.4% part of the ProMutual Group Med Pro 2/1/2019 5.0% 7/1/2011 -6.1% Medical Protective Company

Exhibit 2b

NEW HAMPSHIRE INSURANCE DEPARTMENT

MEDICAL PROFESSIONAL LIABILITY INSURANCE

RATE HISTORY BEGINNING 1/1/2009 Physicians and Surgeons

Medical Mutual Ins. Co. of ME Proselect Insurance Company Medical Protective Year Eff. Date Amt of Chg. Eff. Date Amt of Chg. Eff. Date Amt of Chg. 2009 10/1/2009 4.0% 9/1/2009 -5.9% 2010 10/1/2010 5.0% 2011 11/1/2011 -2.2% 10/1/2011 6.0% 7/1/2011 -6.1% 2012 10/1/2012 8.4% 2013 10/1/2013 9.2% 2014 9/1/2014 -5.1% 2015 2016 2017 2018 10/1/2018 5.0% 2019 2/1/2019 5.0%

Avg Annual Avg Annual Avg Annual Count Change Count Change Count Change All Years 3 -0.3% 5 3.2% 3 -0.7%

2009 to 2013 2 0.5% 4 5.5% 2 -2.4% 2014 to current 1 -1.0% 1 1.0% 1 1.0%

Total Chg Total Chg Total Chg over period over period over period 2009 to 2013 2.7% 30.5% -11.6% 2014 to current -5.1% 5.0% 5.0%

Cumulative Rate Change Summary -2.5% 37.0% -7.2%

Note: MMIC-ME, ProSelect and the Med Pro make up approximately 41% of the total MPL market in NH and 77% of the regulated market. Exhibit 3a

New Hampshire Medical Professional Liability Insurance Direct Underwriting Results 250 Loss Inc

200 LAE

Expense 150

100

50 Ratio as a Percentage of Premiumof Percentage a as Ratio

0 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 -50 All Yrs Calendar Year

* Data excludes the NH JUA

Source: NAIC Profitability Report by Line by State NHID 10/30/2019 Exhibit 3b

Countrywide Medical Professional Liability Insurance Direct Underwriting Results 250

Loss Inc

200 LAE

Expense

150

100

50 Ratio as a % of Earned Premium Earned of % a as Ratio

0 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 All Yrs Calendar Year * Data excludes the NH JUA

Source: NAIC Profitability Report by Line by State NHID 10/30/2019 Exhibit 3c

Medical Professional Liability Insurance Combined Ratios 5 Year Moving Average Direct Underwriting Results Countrywide, New Hampshire, Maine, Vermont 250 CW

200 NH

VT

150 ME

100

50

Ratio as a % of Earned Premium Earned of % a as Ratio 0 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 5 Calendar Years Ending

* Data excludes the NH JUA

Source: NAIC Profitability Report by Line by State NHID 10/30/2019 Exhibit 3d

MEDICAL PROFESSIONAL LIABILITY INSURANCE Profitability Results

Earned Premium Year ($000) Loss Ratio LAE Ratio Expense Ratio UW Profit

New Hampshire Results 1990 10,354 28.4 19.5 17.7 34.4 1991 10,253 51.0 31.8 20.1 -2.9 1992 10,536 8.2 12.3 21.9 57.6 1993 13,244 55.9 32.0 19.7 -7.6 1994 18,770 88.5 36.6 18.0 -43.1 1995 20,699 61.6 29.0 19.2 -9.8 1996 19,802 35.2 8.3 20.5 36.0 1997 19,769 49.6 25.5 21.5 3.4 1998 19,666 34.6 22.4 22.3 20.7 1999 18,499 67.2 33.4 28.9 -29.5 2000 17,333 143.6 37.7 22.0 -103.3 2001 19,296 90.8 20.8 25.8 -37.4 2002 31,792 56.1 21.5 19.2 3.2 2003 38,220 79.3 26.8 18.4 -24.5 2004 45,464 85.7 35.5 15.1 -36.3 2005 44,674 58.3 15.9 17.0 8.8 2006 43,470 44.8 22.1 17.7 15.4 2007 42,748 -5.3 5.7 20.2 79.4 2008 42,024 63.8 29.4 21.1 -14.3 2009 42,795 40.4 20.4 21.6 17.6 2010 42,796 11.3 7.4 22.1 59.2 2011 41,272 40.0 28.4 31.8 -0.2 2012 42,708 87.7 23.7 35.4 -46.8 2013 39,715 30.1 14.1 25.0 30.8 2014 39,598 49.2 28.6 14.8 7.3 2015 37,770 48.6 31.8 28.4 -8.8 2016 39,652 72.1 39.1 34.2 -45.4 2017 45,765 118.2 33.1 29.0 -80.3 2018 46,300 78.7 34.7 28.2 -41.5

All Yrs 904,985 58.2 24.9 23.1 -6.2 10 Year Total 414,095 56.8 25.5 26.4 -8.7

Comparing New Hampshire Results to Other States and Countrywide - 10 Year Total New Hampshire 414,095 56.8 25.5 26.4 -8.7 Maine 478,651 40.5 18.9 23.5 17.1 Vermont 201,047 35.2 15.1 25.8 23.8

Countrywide 94,871,180 39.6 25.7 23.4 11.3

* Data excludes the NH JUA

Source: NAIC Profitability Report by Line by State NHID 10/30/2019 Exhibit 4

NEW HAMPSHIRE INSURANCE DEPARTMENT

Direct Loss Experience for Calendar Year 2018* Leading Insurers in NH Compared to ME and VT

New Hampshire Premium Market Losses Company Earned Share** Incurred Loss Ratio

Proselect Ins Co 10,130,688 23.5% 6,763,866 66.8% Medical Mut Ins Co Of ME 5,752,560 11.9% 4,246,270 73.8% ProAssurance Specialty Ins Co 3,187,311 8.1% 2,405,209 75.5% Endurance Amer Specialty Ins Co 4,266,314 7.5% 3,008,962 70.5% Controlled Risk Ins Co Of VT RRG 2,408,511 5.3% 125,000 5.2% Subtotal 25,745,384 56.3% 16,549,307 64.3% All Companies 46,300,451 36,442,545 78.7%

Maine Premium Market Losses Company Earned Share** Incurred Loss Ratio

Medical Mut Ins Co Of ME 33,342,200 71.8% 22,837,868 68.5% Proselect Ins Co 4,386,098 6.7% 7,602,409 173.3% American Cas Co Of Reading PA 978,708 2.5% 285,523 29.2% Steadfast Ins Co 530,046 2.3% 524,946 99.0% Medical Protective Co 519,457 1.3% 81,870 15.8% Subtotal 39,756,509 84.6% 31,332,616 78.8% All Companies 45,831,622 34,205,003 74.6%

Vermont Premium Market Losses Company Earned Share** Incurred Loss Ratio

Medical Mut Ins Co Of ME 6,611,305 42.6% 5,014,330 75.8% Proselect Ins Co 5,526,656 27.1% 4,420,116 80.0% Columbia Cas Co 734,654 5.6% -609,161 -82.9% American Cas Co Of Reading PA 559,514 3.6% 52,609 9.4% Medical Protective Co 550,331 3.4% 477,311 86.7% Subtotal 13,982,460 82.3% 9,355,205 66.9% All Companies 17,103,044 10,344,723 60.5% * Loss Experience reflects loss only; ALAE and ULAE is not included; ** Market share is based on Direct Premium Written

Source: NAIC Market Share Report NHID 10/30/2019