DOCSLIB.ORG

The Changing Regulatory Landscape for Stop Loss Insurance by Fred E

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
The Changing Regulatory Landscape for Stop Loss Insurance by Fred E The Changing Regulatory Landscape for Stop Loss Insurance by Fred E. Karlinsky, Richard J. Fidei and Erin T. Siska EDITORIAL NOTE: Commentary Background offered by the authors does not Although stop loss insurance is not addressed in the Patient Protection and necessarily represent the views of SIIA. Affordable Care Act of 2010 (the “Affordable Care Act or “ACA”), the National Association of Insurance Commissioners (“NAIC”) recently reviewed proposed ecent developments at the action with regard to the regulation of stop loss insurance. The NAIC adopted federal and state levels of a Stop Loss Insurance Model Act (#92) (the “Model Act”) in 1995, which was government, taken together, amended in 1999 to clarify that the law applied only to insurers and did not impose portend changes in the obligations on employer benefit plans directly. In essence, the Model Act provides Rregulation of stop loss insurance, which could lead more and more small and certain minimum standards for stop loss insurance coverage. Specifically, it prohibits mid-size firms to self-insure than ever an insurer from issuing a stop loss insurance policy that has an annual attachment before. Although neither state nor point for claims incurred per individual which is lower than $20,000; has an annual federal officials keep comprehensive aggregate attachment point (for groups of fifty or fewer) that is lower than the statistics on self-insurance, it appears to greater of: be growing in popularity as a feasible 1. $4,000 times the number of group members option. A recent study by the Employee 2. 120 percent of expected claims or Benefits Research institute indicates that nearly 60% of private sector 3. $20,000; workers were in self-insured health has an annual aggregate attachment point for groups of fifty or more that is lower plans in 2011, up from approximately than 120 percent of expected claims; or provides direct coverage of health care 40% in 1998 and 1999. expenses for an individual. These minimum standards ensure that the plan sponsor 42 June 2013 | The Self-Insurer © Self-Insurers’ Publishing Corp. All rights reserved. retains some of the risk in providing plans from state regulation, the Developments at the health benefits to its employees, rather Affordable Care Act does not define State Level than transferring all or most of the risk what a self-insured plan is. Absent a In July 2012, the NAIC’s ERISA (B) to a stop loss insurer. definition, there is no clear legislative Working Group circulated a set of draft The Model Act was only adopted in guidance in ACA as to what a self- guideline amendments to the Model its entirety by three states (Minnesota, insured plan is. More clear, however, is Act, as amended, which would have New Hampshire, and Vermont). Other which parts of ACA do not apply to essentially tripled the recommended states have adopted certain parts of self-insured plans. stop loss insurance attachment the Model Law only, or have chosen to First and foremost, self-insured minimums adopted in 1995. The new regulate stop loss insurance through plans are not subject to ACA’s essential standards had been developed by the other ways. For example, New York benefit requirement, otherwise known NAIC’s Health Actuarial Task Force and and Oregon have banned stop-loss as the “employer mandate,” which were intended to update the 1995 insurance for any firms with fewer than requires employers to provide certain standards to reflect today’s fifty workers. Many other states have essential health insurance coverages economic realities. standards similar to those in the to their employees. These essential Those speaking in favor of the Model Act, but allow attachment points benefits include health services such updated standards at the NAIC’s below $20,000. as maternity, mental health, and Fall 2012 meeting argued that they So much time has passed since prescription drug benefits. would maintain a level playing field and 1995 that the intended effect of the In addition, self-insured plans are establish reasonable expectations on standards in the original Model Act not subject to ACA’s risk adjustment or stop loss insurance attachment points. has been minimized in today’s medical risk pooling requirements. Accordingly, They also said the updated standards care environment. The obsolescence a self-insured plan can price its small would be important because they of the 1995 NAIC standards means, provide an alternative path for state- group coverage to reflect the group’s as a practical matter, that self-insured based regulation of health insurance, claims history or medical status or by plans bear less relative risk, even in the most of which is preempted by age, gender, or other factors. In contrast, few states where the Model Act was ERISA. They asserted that if stop loss fully-insured plans, under ACA, can adopted. Accordingly, today, self-insured attachment points are unregulated, a only vary premiums by the average age products with stop loss insurance high percentage of small groups are of the employees, the presence of a or reinsurance that are marketed to likely to self-insure, which would raise wellness program, and tobacco use. small firms closely resemble high- premiums noticeably in the small group Additionally, self-insured plans are deductible fully-insured plans, but are market. On the other hand, if the not required to pay the annual fee that not subject to many state insurance recommended higher attachment points regulations applicable to fully-insured insurers are required to pay on fully- were to be adopted, that risk disappears. plans pursuant to the federal Employee insured products pursuant to Section Opponents argued that the Model Retirement Income Security Act of 1343 of ACA. However, self-insured Law is largely irrelevant since it has 1974 (“erISA”). ERISA states that plans are required to contribute to the been adopted in so few states. They multistate employers that offer a self- transitional reinsurance program from also opposed the updated standards on insured plan are not required to cover 2014 through 2016 created by Section the basis that they would close doors health care services for state-mandated 1341 of ACA, and confirmed in Final to options for small employers who benefits, as fully-insured plans are. Rules promulgated by the Department are already facing tough choices; that Additionally, certain provisions of the of Health and Human Services in the new standards were not actuarially Affordable Care Act are also presumably March 2013. sound; that they were unnecessary; incentivizing small employers to self- It bears noting that ACA only and that an increase in self-insurance insure rather than to participate in the applies to employers with 50 or more by small groups would not result in state-based insurance exchanges. employees. Smaller organizations, with adverse selection against fully-insured 49 or fewer employees, do not need plans or the insurance exchanges. Federal Developments to comply with these new Affordable Rather, it was suggested that self- While it is well settled that ERISA Care Act requirements, regardless of insured plans were meant to operate insulates multistate employee benefit whether they are self-insured or not. alongside fully-insured plans. © Self-Insurers’ Publishing Corp. All rights reserved. The Self-Insurer | June 2013 43 The adverse selection argument advanced by supporters of, higher self insurance currently set forth in California law for attachment points is based on the projection that if the current attachment points all stop loss insurance policies issued remain at their existing levels, employers with young and healthy employees will self- on or after January 1, 2014. It would insure until they encounter unexpected losses, at which time they will quickly switch change the individual attachment to a public insurance exchange. However, others argue that even though young point from $95,000 to $65,000. The people do not usually have some of the health conditions that older populations aggregate attachment point would have, young people still have family medical histories, pre-existing conditions, and are need to be the greater of one of the more prone to accidents and to take maternity leave. In addition, some advocate following: that there are substantial administrative costs associated with switching from one 1. $13,000 times the total number type of health plan to another, making it less likely for all but the smallest employers of covered employees (down to switch back and forth from one plan to another. from $19,000 times the total Ultimately, the NAIC’s proposed updates narrowly failed to pass at the NAIC’s number of covered employees) November 2012 meeting. At the NAIC’s Spring 2013 meeting, the ERISA Working 2. One hundred twenty percent of Group announced that it is working on a white paper to further explore the expected claims; or potential impact of regulation of small employer self-insurance on the small group 3. $65,000 (down from $95,000). market beginning in 2014. This bill was still making its way In addition to the NAIC Model Act activity on stop loss insurance, there has through the legislative process as of been a recent flurry of proposed state legislation designed to regulate stop-loss press time. insurance. A bill passed in Colorado would In California, Senate Bill 161, if it passes, will lower the attachment points require stop loss insurers to make 44 June 2013 | The Self-Insurer © Self-Insurers’ Publishing Corp. All rights reserved. annual filings with the Colorado The Colorado Commissioner would bill has passed in the Colorado House Commissioner of Insurance with collect such data for the year s2013- of Representatives and the Colorado information including the following: 2018 and make the information publicly Senate but has not yet been signed into 1.
Load more

Recommended publications
  • Program Sponsored By: TABLE of CONTENTS
    Program sponsored by: TABLE OF CONTENTS Welcome .......................................................................................... 3 Thank You to Our Partners ......................................................... 5 Thank You to Our Sponsors ........................................................ 7 WIFI Instructions ............................................................................ 7 HCAA Mission, Vision and Values Statement .................... 10 Antitrust Policy/Ethics Policy/Anti-Harassment Policy .... 11 Schedule-At-A-Glance ................................................................ 13 Speakers ................................................................................ 17 - 23 Schedule of Events .............................................................. 27 - 29 HCAA Management Staff / Past Presidents ........................ 33 2019 – 2020 Officers and Board of Directors ..................... 35 HCAA Committees & Task Forces ......................................... 37 Member Companies ............................................................ 40 - 41 CSFS® Information .............................................................. 44 - 46 Notes ........................................................................................ 51 - 53 Hotel Map ................................................................................ 54 - 55 Sponsor/Partner Materials ............................. Throughout Program Notice: Videotaping and/or Photography in Progress Today’s event will be videotaped
    [Show full text]
  • President's Message
    PRESIDENT’S MESSAGE It’s been a busy and exciting time for IAIR! At the NAIC Fall National Meeting in Miami, several committees met and furthered their work, the Receivers and Guaranty Fund Relations committee meeting was well attended (See Donna Wilson –CIR-MIL Lynda Loomis’ wrap up later in this issue), Kathleen McCain conducted an educational and thought provoking Issues Forum, the Annual Meeting resulted in four directors continuing on the Board and the election of Don Roof to his first term. The IAIR’s committees have begun 2017 with very full Annual Meeting was capped off with a great celebration of agendas. Thank you to all the committee chairs and the IAIR’s 25th Anniversary where Joe DeVito captivated us with a committee members. Without you, the Board would not rendition of Unchained Melody. be able to fulfill our obligations. James Kennedy and Pat Hughes successfully co-chaired The Audit, Finance, Governance, and Membership & the 2017 Insurance Resolution Workshop February 1-3 (See Promotions Committees are working to improve our Summary in this issue). With over 160 attendees, excellent organizational processes and fulfill our duties to the topics and panels, warm Austin weather and great food and association and to you. locale, it was an event that will not soon be forgotten. Great The Ethics Committee has worked diligently to develop work gentlemen! outlines and processes to improve our professional During the Workshop, James Mills was awarded the Accredited designation program. The development, review and Insurance Receiver (AIR) designation for legal experience and discussions have been thorough and collaborative.
    [Show full text]
  • Insurance Law
    SMU Law Review Volume 51 Issue 4 Annual Survey of Texas Law Article 18 1998 Insurance Law Michael Sean Quinn Pamela D. Nielson Follow this and additional works at: https://scholar.smu.edu/smulr Recommended Citation Michael Sean Quinn & Pamela D. Nielson, Insurance Law, 51 SMU L. REV. 1131 (1998) https://scholar.smu.edu/smulr/vol51/iss4/18 This Article is brought to you for free and open access by the Law Journals at SMU Scholar. It has been accepted for inclusion in SMU Law Review by an authorized administrator of SMU Scholar. For more information, please visit http://digitalrepository.smu.edu. INSURANCE LAW Michael Sean Quinn* Pamela D. Nielson** TABLE OF CONTENTS I. INTRODUCTION ..................................... 1132 II. INSURER BAD FAITH ............................... 1133 A. COMMON LAW INSURER BAD FAITH ............... 1134 B. SCOPE LIMITED .................................... 1135 C. ELEMENTS OF COMMON LAW INSURER BAD F A ITH ............................................. 1138 1. Universe Life Insurance Co. v. Giles ............ 1138 2. State Farm Lloyds v. Nicolau ................... 1145 3. United States Fire Insurance Co. v. Williams .... 1150 D. STATUTORY BAD FAITH ........................... 1153 1. A rticle 21.21 .................................... 1153 2. D TPA .......................................... 1155 3. A rticle 21.55 .................................... 1156 III. PROPERTY INSURANCE ............................ 1157 A . A RSON ............................................. 1158 B. PLUMBING RELATED FOUNDATION DAMAGE
    [Show full text]
  • Squire Patton Boggs Reinsurance Newsletter, March 2016
    Reinsurance Newsletter March 2016 In this Issue Maine Federal Court Finds That Parties Had Contractually Agreed to Submit to Arbitration the • Recent Case Summaries Question of the Enforceability of an Arbitration Agreement • A Brief Review of Reinsurance Trends Mt. Valley Prop., Inc. v. Applied Risk Servs., Inc., No. 1:15-cv-00187- in 2015 DBH, 2015 U.S. Dist. LEXIS 171799 (D. Me. Dec. 22, 2015). • Recent Speeches and Publications A Maine federal court sent to arbitration a dispute between a property management company and a group of affiliated insurers and Recent Case Summaries administration companies, finding that the parties had contractually agreed to submit the question of arbitrability to arbitrators, and not to Wisconsin Federal Court Compels Arbitration a court of law. Over Question of Effect of Prior Arbitration Award The management company participated in an insurance program that Emplrs Ins. of Wausau v. Cont’l Cas. Co., No. 15-cv-22-wme, 2016 was marketed and sold by the defendant companies as an insurance U.S. Dist. LEXIS 18850 (W.D. Wisc. Feb. 17, 2016). alternative that integrated multiple lines of insurance and also provided A Wisconsin federal court granted a cedent’s application to compel certain payroll and tax services. The program was governed by a series arbitration and dismissed, without prejudice, a complaint by the of related agreements, one of which – a Reinsurance Participation reinsurer seeking a declaration and injunction seeking to preclude Agreement – contained an arbitration clause. None of the other the cedent from allegedly re-arbitrating the final decision of a prior transaction agreements did.
    [Show full text]
  • The Insurance Receiver”, Financially Troubled and in Need of Has Been Reimagined
    “To establish a professional organization comprised of individuals who provide services associated with the affairs of insurers that are in receivership or otherwise financially troubled and in need of restructuring; Donna Wilson –CIR-MIL “To develop educational and training PRESIDENT’S MESSAGE programs to enhance the qualifications Throughout its 25 years, IAIR has been faithful to its of professionals working in the field of mission. Our educational programs are well respected insurance company receiverships and and provide opportunities to discuss a variety of restructurings and to provide a forum subjects both during the presentations and more informally with each other, our standards are high for discussion of ideas, experiences and and our members strive to serve with expertise and subjects of common interest to them; proficiency. Where is IAIR going from here? “To establish ethical and professional IAIR will continue to uphold our mission but it must standards for professionals retained to consider new ways to do so. conduct or advise in the affairs of insurers As you know by the fact you are reading this that are in receivership or otherwise newsletter, IAIR’s publication “The Insurance Receiver”, financially troubled and in need of has been reimagined. The newsletter is an important part of fulfilling our mission to educate, to train and restructuring; and share ideas and experiences. It reaches the entire membership even when members are unable to attend “To recognize, through accreditation, the live events. The digital format allows IAIR to publish the attainment by its members of expertise and newsletter economically but also in a format that better proficiency in such pursuits.” meets the needs and expectations of our membership.
    [Show full text]
  • Understanding the Lack of Transparency in Insurance Consumer Protection
    Scholarship Repository University of Minnesota Law School Articles Faculty Scholarship 2014 Transparently Opaque: Understanding the Lack of Transparency in Insurance Consumer Protection Daniel Schwarcz University of Minnesota Law School, [email protected] Follow this and additional works at: https://scholarship.law.umn.edu/faculty_articles Part of the Law Commons Recommended Citation Daniel Schwarcz, Transparently Opaque: Understanding the Lack of Transparency in Insurance Consumer Protection, 61 UCLA L. REV. 394 (2014), available at https://scholarship.law.umn.edu/faculty_articles/572. This Article is brought to you for free and open access by the University of Minnesota Law School. It has been accepted for inclusion in the Faculty Scholarship collection by an authorized administrator of the Scholarship Repository. For more information, please contact [email protected]. Transparently Opaque: Understanding the Lack of Transparency in Insurance EVIEW R Consumer Protection Daniel Schwarcz ABSTRact UCLA LAW UCLA LAW Consumer protection in most domains of financial regulation centers on transparency. Broadly construed, transparency involves making relevant information available to consumers as well as others who might act on their behalf, such as academics, journalists, newspapers, consumer organizations, or other market watchdogs. By contrast, command-and-control regulation that affirmatively limits financial firms’ products or pricing is relatively uncommon. This Article describes an anomalous inversion of this pattern: While state insurance regulation frequently employs aggressive command- and-control consumer protection regulation, it typically does little or nothing to promote transparent markets. Rather, state lawmakers routinely either completely ignore transparency-oriented reforms or implement them in a flawed manner. While acknowledging the limits of transparency-oriented consumer protection regulation, this Article argues that the lack of transparent insurance markets reflects a pervasive and unappreciated flaw in state insurance regulation.
    [Show full text]
  • Considering Insurance Billing for College Health and Counseling Services
    January, 2013 CONSIDERING INSURANCE BILLING FOR COLLEGE HEALTH AND COUNSELING SERVICES By Stephen L. Beckley, Doreen Hodgkins, and Marc M. Tract Considering Insurance Billing for College Health and Counseling Services 1 ABLE F Abstract . T O Historical Values for Pre-Funding of College Health and CONTENTS Counseling Services . 2 The Shift Away from Pre-Paid Funding for College Health Services . 2-3 Increased Utilization of College Health and Counseling Services . 3 The ACA and Full Coverage for Preventive Care Services . 3 Increased Enrollment in Student Health Insurance/Benefit Programs . 4 Variable Success for Developing Insurance Billing Revenue . 4-5 Waiving Insurance Copayments, Deductibles, and Coinsurance Charges . 5-6 Understanding Coordination of Benefits . 6 Secondary Payor Status for Health Fees and Institutional Funding . 7 Common Components for a Secondary Payor System . 8-9 Secondary Payor System Example Charges and Out-of-Pocket Expenses . 9-10 Stephen L. Beckley, CEBS Secondary Payor System Example Communications . 10 Hodgkins Beckley Consulting, LLC Concerns for Adopting a Secondary Payor System . 11-13 3500 Carlton Avenue, #0-45 Fort Collins, CO 80525 Typical Steps for Considering a Secondary Payor System . 13-15 877-559-9800 toll free [email protected] Summary . 16 Doreen Hodgkins, MBA Appendix A . N/A Hodgkins Beckley Consulting, LLC 5435 Klipsun Lane, SW Minnesota Medical Association – Waiving Copays and Reducing Fees Olympia, WA 98512 877-559-9800 toll free Appendix B . 21-22 [email protected] Excerpts from Coordination of Benefits Model Regulation, #120 Marc M. Tract, JD Appendix C . 21-23 Katten Muchin Rosenman, LLP Credentials for Authors 575 Madison Avenue New York, NY 10022-2585 212-940-8800 Endnotes .
    [Show full text]
  • Understanding Insurance Regulation
    UNDERSTANDINGMove Over ILS? INSURANCE REGULATIONThe Rise and Rise of PriDe And Its Many Forms January 2020 @assetcohen @cohen-and-company-asset-management cohenandcompany.com TABLE OF CONTENTS 1 Introduction 2 2 Insurance - Why Does it Need Regulation? 3 3 A Deeper Dive 5 3(i) Solvency II SCR 6 3(ii) NAIC’s Risk Based Capital (RBC) 8 3(iii) Bermuda Solvency Capital Requirment (BSCR) 12 3(iv) AM Best’s Capital Adequacy Ratio 15 4 Insurance Failure 17 5 Insurance Industry Performance: An Investment Perspective 18 6 Cohen & Company 19 1 INTRODUCTION When ancient Egyptian, Indian, Greek, Roman and other civi- lizations existed, so too did a form of regulation of business- es. To an extent, standardized weights and measures existed in the ancient world in the form of business norms and customs. Insurance, in some form, dates back to ancient times, too. Chi- nese and Babylonian traders had methods to distribute risk in the second and third millen- nia B.C., with the first known written insurance policy carved in the Babylonian obelisk mon- ument known as the Code of King Hammurabi. The ancient law states that in the event of some impossible personal circumstance, such as a flood or a disability, a debtor did not have to pay back his loan. In today’s modern world there is an ever-increasing number of complex regulations that vary by jurisdiction. This paper does not explore whether regulation helps or hinders business but instead focuses on some of the insurance industry’s regulato- ry bodies, its dedicated rating agency and the differing ap- proaches to capital adequacy.
    [Show full text]
  • The Impact of the Affordable Care Act on the Content of Insurance Coverage for Persons with Disabilities, 25 Notre Dame J.L
    Notre Dame Journal of Law, Ethics & Public Policy Volume 25 Issue 2 Symposium On Health Care: Health, Ethics, & Article 16 the Law January 2014 Crossing the Rubicon: The mpI act of the Affordable Care Act on the Content of Insurance Coverage for Persons with Disabilities Sara Rosenbaum Joel B. Teitelbaum Katherine Hayes Follow this and additional works at: http://scholarship.law.nd.edu/ndjlepp Recommended Citation Sara Rosenbaum, J. B. Teitelbaum & Katherine Hayes, Crossing the Rubicon: The Impact of the Affordable Care Act on the Content of Insurance Coverage for Persons with Disabilities, 25 Notre Dame J.L. Ethics & Pub. Pol'y 527 (2012). Available at: http://scholarship.law.nd.edu/ndjlepp/vol25/iss2/16 This Article is brought to you for free and open access by the Notre Dame Journal of Law, Ethics & Public Policy at NDLScholarship. It has been accepted for inclusion in Notre Dame Journal of Law, Ethics & Public Policy by an authorized administrator of NDLScholarship. For more information, please contact [email protected]. CROSSING THE RUBICON: THE IMPACT OF THE AFFORDABLE CARE ACT ON THE CONTENT OF INSURANCE COVERAGE FOR PERSONS WITH DISABILITIES SARA ROSENBAUM* JOEL B. TEITELBAUMt KATHERINE HAYEST I. INTRODUCTION The Patient Protection and Affordable Care Act,' as amended by the Health Care and Education Reconciliation Act' (hereinafter referred to collectively as the "Affordable Care Act" or "PPACA"), has been heralded' as the most important set of changes to American health insurance since the 1965 enactment of Medicare' and Medicaid.5 Building on the public and private health insurance coverage systems in existence at the time of pas- * Harold and Jane Hirsh Professor of Health Law and Policy and Chair, Department of Health Policy, The George Washington University School of Public Health and Health Services.
    [Show full text]
  • Delta Dental ID Cards  Member Handbook  Evidence of Coverage
    Member Welcome Kit Your Delta Dental ID Cards Member Handbook Evidence of Coverage VPC BENFFITS CONSORTIUM-HIGH PLAN PREVENTION FIRST Group Number: 000700100 Delta Dental of Virginia 4818 Starkey Road MEMBER WELCOME KIT Roanoke, Virginia 24018-8510 MH_EOC#01.2019 This page intentionally left blank. TABLE OF CONTENTS I INTRODUCTION HOW TO DELTA DENTAL 1 HOW TO USE YOUR BENEFITS 2 ELIGIBLE DEPENDENTS 2 CHOOSING YOUR DENTIST 2 HOW TO ESTIMATE YOUR COST 3 PREDETERMINATION OF BENEFITS 6 FILING CLAIMS 6 COMPLAINT AND APPEALS PROCEDURES 7 COORDINATION OF BENEFITS 7 COMMON DENTAL TERMINOLOGY 7 II EVIDENCE OF COVERAGE (EOC) PLAN PROVISIONS SCHEDULE OF BENEFITS LIMITATIONS 1.0 HOW DELTA DENTAL PAYS FOR COVERED BENEFITS 2.0 ELIGIBILITY AND ENROLLMENT 3.0 COVERED BENEFITS, DEDUCTIBLE AND BENEFIT WAITING PERIOD 4.0 EXCLUSIONS 5.0 OTHER PAYMENT RULES THAT AFFECT MY COVERAGE 6.0 WHEN COVERAGE ENDS 7.0 CLAIMS, APPEALS AND GRIEVANCES 8.0 NONDISCRIMINATION NOTICE 9.0 NONDISCRIMINATION GRIEVANCE POLICY 10.0 COORDINATION OF BENEFITS (COB) WITH OTHER PLANS 11.0 ORAL HEALTH INFORMATION 12.0 MEMBER RIGHTS AND RESPONSIBILITIES 13.0 DEFINITIONS 14.0 ADDITIONAL BENEFITS IN HEALTHY SMILE, HEALTHY YOU® PROGRAM 16.0 PROTECTING YOUR PRIVACY 16.0 IMPORTANT INFORMATION REGARDING YOUR INSURANCE 17.0 LANGUAGE ASSISTANCE SERVICES This page intentionally left blank Introduction The Virginia Private Colleges Benefits Consortium, Inc. dental plan (the “dental plan”) shall be effective January 1, 2012. The dental plan may be amended at any time, in whole or in part, by the Board of Directors. The dental plan has been approved by the Board of Directors of the Virginia Private Colleges Benefits Consortium, Inc.
    [Show full text]
  • Full Briefing Book
    CENTER FOR JUSTICE & DEMOCRACY 185 WEST BROADWAY NEW YORK, NY 10013 TEL: 212.431.2882 [email protected] http://centerjd.org BRIEFING BOOK MEDICAL MALPRACTICE: BY THE NUMBERS Emily Gottlieb, Deputy Director for Law and Policy Joanne Doroshow, Executive Director March 2021 Update ii CENTER FOR JUSTICE & DEMOCRACY 185 WEST BROADWAY NEW YORK, NY 10013 TEL: 212.431.2882 [email protected] http://centerjd.org BRIEFING BOOK MEDICAL MALPRACTICE: BY THE NUMBERS Table of Contents PART 1: MEDICAL MALPRACTICE LITIGATION 1 Experts agree that when cases are filed, they are not “frivolous”; few injured patients file claims or lawsuits. 1 The number (“frequency”) and size (“severity”) of medical malpractice claims, lawsuits and payouts are low. 3 A small number of doctors are responsible for most malpractice payouts; incompetent physicians are rarely held accountable by state medical boards or the federal government. 7 Sexual abuse of patients goes largely unpunished. 15 Medical malpractice payments are not arbitrary; they reveal negligence and fortell future claims. 19 "Tort reforms” keep legitimate cases from being filed. 21 Physicians greatly misperceive the risk and consequences of being sued; personal assets not at risk. 22 Compensation is for serious injuries or death; high verdicts are almost always slashed; and punitive damages are extremely rare. 24 Medical malpractice cases are not clogging the courts; juries resolve few cases and strong cases settle. 29 iii Lawsuits filed for medical negligence are not frivolous yet it is still difficult for patients to prevail. 30 Experts say and data show that, even with its problems, the current medical malpractice system works.
    [Show full text]
  • Insurance Law Law School Career Services Office What Is Insurance Law?
    University of Memphis Insurance Law Law School Career Services Office What is insurance law? The practice of insurance law focuses on the various legal issues related to insurance policies. Insurance polices are purchased contracts that provide for protection from pecuniary liability that may result as a legal consequence from mistakes, misjudgments, physical accidents, and disasters. Medical insurance po- lices are designed to protect someone when they incur large medical bills. Corporations frequently seek insurance counseling to determine how much insurance to purchase for a business and its employees. Some insurance polices are designed as benefit meant to retain talented em- ployment. Insurance attorneys can work as the defense counsel for professionals and lay people alike. Some insur- ance attorneys represent doctors and specialize in medical malpractice defense. Insurance lawyers may also defend claims for personal injury, Some attorneys who defend these claims work as in-house counsel and litigate for large insurance companies. Insurance attorneys advise their clients about insurance coverage, dealing with disputes between policy- holders and insurance companies over whether a contract provides for recovery after a particular incident or accident. Even though an insurance policy is a private contract, the business of insurance is a highly regulated in- dustry. Insurance regulatory law seeks to protect the public as consumers and policyholders. Both feder- al and state laws regulate insurance practices. Where do insurance attorneys work? What other areas of the law are related to insurance? Insurance companies: Insurance companies Lawyers working with insurance law may also practice law in employ in-house counsel to litigate their dis- the areas of corporate transactions and litigation, health care putes, as well as to draft insurance policies law, and personal injury law.
    [Show full text]