In a previous issue of Legal Brief, I discussed protecting yourself with adequate auto insurance. This is, perhaps, the insurance that is most commonly bought, because every driver is required to be covered by automobile liability insurance. But what about business owners? Should they buy insurance as well?
Employers generally realize that the initial premium they pay for Workers Compensation insurance isn't the final premium for that coverage-Workers Comp is normally subject to an audit after the policy ends, to adjust premium charges based on actual payroll amounts. When the policy starts, after all, payroll amounts can only be estimated for the coming year. So it's routine for employers of any size to undergo a Workers Compensation premium audit, and to receive an audit statement that often seeks some additional premium.
A growing trend for many businesses has been for their customers and prospects to use their experience modification factor as a safety benchmark, requiring a modifier of 1.00 or 1.05 for those bidding on projects. A higher modifier can disqualify a firm from bidding on many projects, particularly governmental projects.
Recently, a former Director of the Illinois Department of Insurance wrote an Op-Ed piece, decrying recently proposed legislation that would require insurers to file changes in Workers Compensation insurance rates with regulators before using those rates with insurers. The proposed legislation would also allow the Department of Insurance to disapprove rates if it was determined they were excessive.
Rarely are clients immediately aware of the wrongful or erroneous actions of the "professional" they trusted to perform specific duties or services; mainly because "professional" acts or errors do not or only seldom cause immediate injury. A "professional's" wrongful acts or errors may not manifest in client injury until long after the act is perpetrated or the error is committed.
Two mutually exclusive goals are beginning to result in apparently unintended results within the executive and professional liability markets. The quest for underwriting profits and the desire to develop clear (to whatever extent possible) coverage language have rapidly changed the coverage landscape within these two lines of coverage.
The 35-year history of the claims-made policy form has not brought it stability or standardization. In fact, claims-made forms have begun to incorporate with increasing frequency additional and exclusionary language that is unfavorable to the policyholder.
The claims audit is the anathema of day-to-day claim operations. Nothing is more disruptive. Yet, if properly defined, nothing is more informative and helpful in improving a claim management program. This article will examine the need for a regular auditing program and provide a recipe for a three-dimensional approach to the process in order to maximize the accuracy of the audit results.
Nationwide, water-loss claims continue to climb. In California alone, such claims have risen dramatically, with the percentage of homeowner claims growing from 24 percent in 1997 to 32 percent in 2001, costing insurers $1.7 billion. In a single year in California, between 2000 and 2001, claims rose $47 million. For some insurers, this meant that 40 percent of claim payments were for water losses.
Water damage is costly to both homeowners and insurance companies. It is estimated that the cost of household water damage in California, alone, exceeded $500 million for 2002. While the number of water-related claims varies year to year, the average amount paid for such claims increased steadily from $2,577 in 1988 to $3,646 in 2002.