MLMIC Announces the Passing of Its Founder, Donald J. Fager

March 10, 2023 by matray

It is with great sadness that MLMIC Insurance Co. reports the passing of its founder, friend and colleague, Donald J. Fager, Esq. (11/9/1930 - 3/6/2023).

An attorney with 48 years of experience in the healthcare professional liability field, Mr. Fager was a noted authority on the subject. He was called upon to provide testimony on medical liability before committees of the U.S. House of Representatives, as well as state legislative committees in states as diverse as New York, Ohio, and Iowa. He was also a member of the Liability and Quality Committee of Governor Mario Cuomo’s Health Care Advisory Board. Mr. Fager was frequently invited to speak on the subject of medical liability by various state and county medical societies, national and state specialty societies, medical schools, hospitals, law schools, Joint Medical Society and Bar Association meetings, American Medical Association programs, and American Bar Association programs.

For 17 years, beginning in 1956, Mr. Fager was a trial attorney for Martin Clearwater & Bell, specializing in the defense of physicians, dentists, and hospitals in medical malpractice cases in New York State. He managed the firm’s Syracuse office from 1964 until 1973. In 1973, he became the indemnity representative of the Medical Society of the State of New York, and in 1975, he assisted the Medical Society in the formation of MLMIC Insurance Company. Today, MLMIC is one of the largest writers of medical liability insurance in the country and a member of the Berkshire Hathaway family of companies.

Mr. Fager was also a founding board member of the Medical Professional Liability Association and a member of the board of trustees from inception until 1991 (the last two years as emeritus). Within MPL Association, he also served as the chairman of the Membership and By-Laws Committee; chairman of the Neurologic Deficit Study Committee; chairman of the Legislative Oversight Committee; and president (1986 and 1987).

A founding member of the National Patient Safety Foundation, Mr. Fager was a member of its board of directors since 1997. He served as a member of the foundation’s executive committee from 2000 through 2003 and the chair of the By-Laws Committee. He was also a member of the board of trustees of the Medical and Health Research Association of New York City, the board of directors of the Physicians’ Home, the board of trustees of the New York State Dental Foundation, and the board of directors of the New York State Dental Association Support Services, Inc.

Mr. Fager served as a member of the American Bar Association, the New York State Bar Association, the International Association of Defense Counsel (and a member of its Medical Defense Committee), and the Defense Research Institute, and an arbitrator for the American Arbitration Association.

He was the recipient of several awards, including MPL’s prestigious Peter Sweetland Award of Excellence; the Professional Liability Underwriting Society (PLUS) Foundation’s Award for Outstanding Leadership in Healthcare Professional Liability; and the Onondaga County Medical Society’s Award for Service to Physicians of New York State.

Born in Brooklyn, N.Y., Donald Fager received his Bachelor of Arts cum laude from the University of Notre Dame and his Juris Doctor from New York University School of Law, where he was an editor of the Law Review. In 1956, Mr. Fager was admitted to practice law in New York State and is admitted in U.S. District Courts for the Southern, Northern, and Western Districts of New York. He is survived by his wife, Geraldine, their three grown children – two daughters and a son – and their three grandchildren.

For those who would like to make a donation in Mr. Fager’s name, the family has designated two charities for consideration:

The Bridgeport Rescue Mission https://bridgeportrescuemission.org

Covenant House New York https://www.covenanthouse.org.

Pinnacle Actuarial Resources Announces New Senior Consulting Actuaries, Consulting Actuaries

March 10, 2023 by matray

Pinnacle Actuarial Resources announced several consultant appointments. Hongmei Li and Darcie Truttmann were named the firm’s newest senior consulting actuaries and Brittany Henrich, Andrew Krieger and Nicole McArdle were named consulting actuaries.

“We couldn’t be more pleased about these talented individuals joining our consulting team,” Pinnacle managing principal Joe Herbers said. “These are accomplished actuaries with years of experience in multiple lines of business and in different industry sectors including predictive analytics and captive insurance. They broaden and deepen the range of expertise we can bring to bear for our clients, and help those clients make Better Business Decisions.”

Li and Krieger join Pinnacle from a large consulting firm and a large personal lines insurer, respectively. Truttmann has been with Pinnacle since 2005, most recently in a consulting actuary role. Henrich and McArdle have been promoted from the position of associate actuary and both have been with Pinnacle since 2016.

Truttmann and Krieger are fellows of the Casualty Actuarial Society (FCAS). Li, Henrich and McArdle are associates of the Casualty Actuarial Society (ACAS). All are members of the American Academy of Actuaries (MAAA).

“We are particularly excited that four of five of these appointments are women leaders, each with a track record of stewardship, both inside and outside our firm. Pinnacle is committed to diversity, equity and inclusion and the addition of such outstanding consultants strengthens the work we do and the solutions we develop for our clients,” Herbers added.

Medical Liability Monitor March 2023 issue highlights

March 7, 2023 by matray

Below are some headlines and article synopses from the March 2023 issue of Medical Liability Monitor. To read the articles in entirety, please subscribe today.

Curi, Constellation to Merge into Organization with National Scope
Curi Holdings and Constellation Inc. last month announced the signing of a merger agreement. Combined, the two organizations intend to build on their legacies of mutual ownership, client service and innovation, while creating a national brand that delivers the products, services and advice that healthcare providers need to thrive in a rapidly evolving healthcare landscape. With more than $2 billion of consolidated assets and generating nearly $400 million in annual revenue, the merged companies will serve more than 50,000 physicians, healthcare providers and organizations across the United States. With minimal geographic overlap between the two companies, the merger positions the combined organization to continue meeting its member-owners wherever they are in their own evolutionary journey …

Iowa Enacts Hard Cap on Medical Liability Noneconomic Damages
Iowa Gov. Kim Reynolds last month signed a bill into law that limits noneconomic damages to $2 million for medical liability verdicts involving permanent impairment, disfigurement or death against hospitals and $1 million for those types of verdicts against clinics and individual doctors. The state had already capped most medical malpractice awards at $250,000, but had included an exception for those involving permanent impairment, disfigurement or death, for which there was no cap …

Arkansas Weaponizing Medical Malpractice Law to Restrict Transgender Youth Care
An Arkansas Senate panel advanced a bill last month that would make it easier to file medical liability lawsuits against doctors who provide gender-affirming care to minors. The proposed Protecting Minors from Medical Malpractice Act of 2023 would create civil liability for any doctor who “performs a gender transition procedure on a minor … if the minor is injured, including without limitation any physical, psychological, emotional, or physiological injury, by the gender transition procedure, related treatment, or the after effects.” The bill would also grant potential plaintiffs an up-to-30-year statute of limitations for filing a medical liability claim against a doctor who provided them with gender-affirming care as a minor. All other medical liability claims are subject to a two-year statute of limitations under Arkansas law …

Prior Paid Claims Are Predictive of Future Malpractice Claims
Physicians often view malpractice claims as mostly random events that reflect bad luck, rather than a lack of clinical skill. But a paper published Feb. 13 in JAMA Health Forum that examined all paid medical liability claims against U.S. physicians between 2004 and 2018 uncovered strong evidence that paid claims are far from random. Rather, physicians with even a single paid claim are far more likely than those with no paid claims to pay additional claims in the future. The effect held regardless of specialization or whether a doctor’s prior malpractice claims had been disclosed publicly, which suggests that in an average case, patients and attorneys who sued were unlikely to be acting on the belief that they could win a case in a risky subfield or against a vulnerable doctor ...

Nearly a Quarter of Inpatient Visits Had an Adverse Patient Safety Event
Almost a quarter (23.6%) of the inpatient hospital visits in Massachusetts during 2018 had at least one adverse patient safety event, and almost a quarter (22.7%) of those patient safety issues were preventable, according to a new study from Mass General Brigham and CRICO, the medical professional liability insurer for the Harvard medical community and its affiliated organizations ...

Medical Liability Tort Fix Blocked by New Mexico House Panel
The Health & Human Services Committee of the New Mexico House of Representatives last month blocked a bill that would have capped recoverable damages at $750,000 for medical malpractice claims against outpatient facilities not owned or controlled by a hospital. Those facilities otherwise face a $5 million cap set to go into effect Jan. 1, 2024, as part of the state’s 2021 overhaul of its Medical Malpractice Act …

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The Doctors Company Granted ANCC Accreditation

February 21, 2023 by matray

The Doctors Company was granted accreditation for nursing continuing professional development (NCPD) from the American Nurses Credentialing Center (ANCC). According to the company, its accreditation demonstrates a commitment to using evidence-based criteria when developing high-quality educational activities that promote the professional growth of nurses and advanced practice clinicians (APCs). TDC Group recently launched top-tier malpractice coverage tailored for APCs in a variety of practice settings.

With this accreditation, The Doctors Company joins a global community of accredited organizations. The accreditation was for the company’s continuing education courses for physicians, dentists, APCs, nurses, practice managers and other clinical staff across a broad range of subjects. Nurses and APCs are now awarded NCPD credits for participating in accredited education provided by The Doctors Company and can apply these credits toward their board certification licensure requirements.

Over the next decade, as predicted in TDC Group’s white paper What U.S. Healthcare Will Look Like in 2032, physician shortages, combined with recognition of the competencies of APCs, will drive more widespread independence in practice for APCs. In a time of rapid changes, nurses and APCs are vital to improving patients’ quality of care and access to care. Insights from TDC Group’s newly formed APC Advisory Board will assist in helping members and clients navigate this change in healthcare delivery with confidence.

“ANCC accreditation marks the achievement of an important milestone for The Doctors Company; our continuing education courses incorporate malpractice claims data, analysis of actual malpractice claims, and risk reduction strategies,” said Kim Hathaway, MSN, RN, CPHRM, CPHQ, director of Patient Safety Healthcare Quality & Risk Management at The Doctors Company. “Nurses and APCs play a prominent role in our evolving healthcare environment, and this accreditation recognizes our commitment to delivering the best imaginable service to those who provide care.”

NCPD accreditation from ANCC elevates educational offerings that benefit nurses, patients, and the communities we serve by:

• Promoting the highest professional standards to sustain effective strategies that improve professional nursing practice.


• Improving curricula for nurses to provide evidence-based education that strengthens professional development programs.


• Increasing credibility by adhering to evidence-based, global standards that deliver quality professional education.


• Expanding visibility via inclusion among other accredited organizations that are listed in a nationwide, searchable directory.


• Increasing demand to offer continuing professional development contact hours, which are essential to building professional portfolios and maintaining certification and accreditation from ANCC and other licensing boards and regulatory bodies.

The ANCC Accreditation Model is based on the original Donabedian framework of structure, process, and outcome measures to evaluate quality. The ANCC standards provide organizations with a structured, evidence-based framework to design and implement NCPD activities. The development of quality outcomes ensures that accredited organizations continuously evaluate processes and their impact on the professional development of nurses.

For more information on the ANCC NCPD Accreditation Program, visit nursingworld.org/ncpd.

Medical Liability Monitor February 2023 issue highlights

February 7, 2023 by matray

Below are some headlines and article synopses from the February 2023 issue of Medical Liability Monitor. To read the articles in entirety, please subscribe today.

NY Governor Vetoes Bill Expanding Wrongful Death Damages, Legislature Rejects Medical Liability Compromise
After much speculation and delay, Gov. Kathy Hochul vetoed a bill expanding recoverable damages in wrongful death claims. She first asked legislators to amend the bill to exempt medical liability claims from the changes that would be made to New York’s 176-year-old wrongful death statute. Hochul had until Jan. 30 to sign, veto or let the measure expire due to inaction …

Social Inflation Adds As Much As 11% to Malpractice Losses
Social inflation accounted for somewhere between $2.4 and $3.5 billion, or 8% and 11%, of all medical liability losses incurred by a composite of physician-focused medical liability insurers between 2011 and 2021, according to new research from The Doctors Company and Moore Actuarial Consulting …

Private Equity Changes Workforce Stability in Physician-Owned Medical Practices
New research reveals private equity firms that acquire physician-owned medical practices experience greater replacement of the workforce and rely more heavily on advanced practice providers — such as physician assistants and nurse practitioners — than physicians. The study is the first to characterize the shift in workforce composition following private equity acquisition …

Iowa Political Leaders Signal Intent to Enact Hard Cap
In her annual Condition of State address on Jan. 10, Iowa Gov. Kim Reynolds signaled that enacting a hard cap on medical liability damages would be one of her priorities during the next legislative session. The state already caps noneconomic damages at $250,000 for most medical malpractice cases. There is an exception for those involving permanent impairment, disfigurement or death, for which there is currently no cap ...

Nearly a Quarter of Inpatient Visits Had an Adverse Patient Safety Event
Almost a quarter (23.6%) of the inpatient hospital visits in Massachusetts during 2018 had at least one adverse patient safety event, and almost a quarter (22.7%) of those patient safety issues were preventable, according to a new study from Mass General Brigham and CRICO, the medical professional liability insurer for the Harvard medical community and its affiliated organizations ...

Emergency Medicine Organizations Take Issue with AHRQ Report On Misdiagnosis Rate in the Emergency Department
Nine organizations representing the specialty of emergency medicine (EM) sent a letter last month to leadership at the Agency for Healthcare Research & Quality (AHRQ) expressing concerns about of a report it had published, entitled Diagnostic Errors in the Emergency Department: A Systematic Revie. According to the organizations, “the report makes misleading, incomplete and erroneous conclusions from the literature reviewed and conveys a tone that inaccurately characterizes and unnecessarily disparages the practice of emergency medicine in the United States ...”

Subscribe today to get this issue (as well as the 2022 Annual Rate Survey at no additional cost).

A.M. Best Affirms A+ (Superior) Rating of the Cooperative of American Physicians’ Mutual Protection Trust for 16th Consecutive Year

February 3, 2023 by matray

The Cooperative of American Physicians, Inc. (CAP) announced that its medical professional liability coverage product, the Mutual Protection Trust (MPT), has earned a Financial Strength Rating of A+ (Superior) from A.M. Best for the 16^th consecutive year.

Among several notable acknowledgments, A.M. Best recognized MPT’s “cost-effective medical professional liability services,” with a “favorable market position in California as the second-largest provider of physician professional liability coverage in the state.”

The rating reflects MPT’s ability to meet ongoing coverage and contract obligations for more than 12,500 of CAP’s physician members. MPT’s outlook was reaffirmed as stable and its strong financial flexibility, capital strength, and sound invested asset base were highlighted as part of the rating.

“Since 2006, MPT has received an A+ rating from A.M. Best, a demonstration of our ongoing prudent financial oversight and strength on behalf of our physician members and their practices,” said CAP CEO Sarah E. Scher. “As so many California physicians recognize and rely upon MPT’s protection, CAP continues to experience significant growth.”

A.M. Best also acknowledged the financial strength of the Cooperative of American Physicians Insurance Company, Inc. (CAPIC), which earned a rating of A- (Excellent). CAPIC is a wholly owned subsidiary of CAP and provides reinsurance and other benefits to its physician members.

Claims Consultants: Why, When and How to Refer a Physician to Litigation Stress Coaching

February 3, 2023 by matray

by Gail Fiore MA, MSW

Every Claims Consultant will recognize this: as much as 80% of attorney-client communication is consumed with emotional and psychological issues – often fruitlessly.

Lawyers may be very skillful at practicing law, but they’re not trained to deal with the kinds of stress-related issues many of their clients are facing. Ninety-five percent of doctors in medical malpractice litigation report having symptoms of emotional disequilibrium such as anxiety and PTSD. Of the remaining 5%, most are in denial.

Regardless of the intensity of the case, the client is going to feel stressed – apprehensive, wondering if you really understand their situation, questioning if you are doing all that can be done, wondering if they can trust you. The high level of stress may also interfere with the client’s professional judgement and patient relationships, possibly increasing their risk for an additional medical error.

How should a Claims Consultant deal with issues related to Litigation Stress?

The first step requires recognition that Litigation Stress or Med Mal Litigation Stress Syndrome is a common occurrence that can be very effectively addressed through Litigation Stress Coaching – designed to help an emotionally overwhelmed physician-defendant become a more effective witness, cooperative collaborator in the case and a more competent practitioner.

What’s the best way of approaching the subject with a reluctant or emotional client?

Experience shows that the physician-defendant is typically more amenable to Litigation Stress Coaching when it’s presented as a tool for building a "stronger case.”

When approaching the physician-defendant it is key to do so with a respectful attitude and empathetic understanding, seeing them as healthy, strong and resourceful; they are not weak or lacking in some way. Having litigation stress is a normal response to an abnormal situation.

Also, it’s important to approach the person with genuine concern and authenticity – be as real as possible in the moment – genuine empathy is more valuable than any brilliant insight or psychological acumen.

Try to put yourself in their shoes, attempt to view events from their frame of reference, and avoid comments that may be perceived as judgmental; for example, don’t try to address whatever impact the stress may be having on their job performance.

Make them aware that there is a very good resource for emotional support – called Litigation Stress Coaching – that’s non-reportable, totally confidential, and covered by their liability insurance. Remind them that this is coaching, which is a short-term process that’s specifically focused on the issues unique to litigation. It’s not psychotherapy.

Point out that, since this is a common occurrence, a lot of people have had experience with it and have gotten good results in a relatively short amount of time.

If they are open to it, you may want to initiate a referral and offer to follow up with them.

Be prepared to hear resistance, ranging from: “I don’t have time,” to “how will it look if anyone finds out,” from “there’s nothing wrong with me” to “the situation is hopeless.”

The most important part of a response is to be supportive and not challenging or judgmental. They are facing litigation and litigation stress coaching will make them a stronger defendant. It’s helped many other physicians in the same situation.

With all the time and energy they’re already spending with lawyers and litigation prep, this could actually save time, helping them focus and deal with the issues more efficiently.

When someone expresses hopelessness, it may be cause for greater concern. It might be helpful to mention that many physicians enmeshed in nasty malpractice litigation feel suicidal and ask if they ever feel that way. Ask them to bring a family member or significant other – someone they trust – into the conversation. It may be necessary for you to notify someone and make sure that they are getting help.

Claims consultants are in a unique position – and can serve as a valued counselor to physicians at a time when they need it most, rather than being viewed merely as a point of contact. Sometimes physician-defendants need more than just a lawyer and claims consultants can steer them in a more productive direction that produces better outcomes.

Gail Fiore is president of The Winning Focus, LLC, which works with physicians and other professionals coping with stress, anxiety and other emotional issues during litigation. She can be reached via www.thewinningfocus.com.

MagMutual Announces 6.5% Dividend

January 31, 2023 by matray

MagMutual Insurance Co. announced it will return a 6.5% dividend to its policyholders this year.

According to the Atlanta-headquartered insurer of medical liability, the payment marks 24 years of dividends and more than $370 million in financial rewards MagMutual has returned to policyholders since its inception — with more than half of those rewards being paid in the past six years.

“Paying dividends reflects our commitment to our PolicyOwners, who we put first in everything we do,” said William S. Kanich, MD, JD, MagMutual executive chairperson. “We are proud of our record of consistent payments to them, which is an important part of the overall support we offer as a mutual insurer of long standing.”

“The fact that we have increased dividends while most companies are taking them away is a sign of our ongoing financial strength, which our team has worked hard to achieve,” said Neil Morrell, MagMutual CEO. “The successful management of our company means we can support policyholders both financially and with innovative insurance products for years to come.”  

AM Best Assigns “A” Credit Ratings to MMIC Risk Retention Group, Inc.

January 25, 2023 by matray

AM Best has assigned a Financial Strength Rating of A (Excellent) and the Long-Term Issuer Credit Rating of “a” to MMIC Risk Retention Group, Inc. (MMIC RRG). The outlook assigned to these Credit Ratings is stable. MMIC RRG is a sponsored risk retention group of Constellation, Inc., the parent company of MMIC Insurance, Inc., which is the lead member of Constellation Insurance Group.

The ratings of MMIC RRG reflect the consolidated balance sheet strength of Constellation, which AM Best categorizes as strongest, as well as its adequate operating performance, neutral business profile and appropriate enterprise risk management.

The rating assignment level reflects MMIC RRG’s role as a member of Constellation. Explicit support is provided to MMIC RRG through participation in a quota share reinsurance program with MMIC Insurance, Inc. In addition, MMIC RRG is fully integrated into Constellation’s operations and strategic plans, including a centralized management structure.

Constellation sponsored the formation of MMIC RRG in 2011 to meet the geographic expansions needs beyond its licensed territories. Constellation specializes in providing medical professional liability insurance to physicians, clinics, hospitals and other healthcare facilities, ancillary healthcare providers, long term care facilities and also offers self-insured retention options.

AM Best Removes From Under Review with Positive Implications, Upgrades Credit Ratings of MDAdvantage Insurance Co. of New Jersey

January 24, 2023 by matray

AM Best has removed from under review with positive implications and upgraded the Financial Strength Rating to A (Excellent) from A- (Excellent) and the Long-Term Issuer Credit Rating to “a+” (Excellent) from “a-” (Excellent) of MDAdvantage Insurance Co. of New Jersey (MDAdvantage) (Lawrenceville, NJ).

The outlook assigned to these Credit Ratings is stable.

The ratings of MDAdvantage were previously placed under review with positive implications in August 2022, following the announcement that it had entered into a definitive agreement to be acquired by MAG Mutual Insurance Co. The ratings action reflects the completed acquisition effective Jan. 1, 2023, and MDAdvantage’s inclusion as a member company under the MAG Mutual Holding Co. rating unit, which has a consolidated balance sheet strength level of strongest, as well as adequate operating performance, a neutral business profile and appropriate enterprise risk management.

MDAdvantage is considered part of the MAG Mutual rating unit based on operational support, strategic importance to the group’s strategy and explicit support provided through an intercompany reinsurance pooling agreement. MDAdvantage is fully owned by MAG Mutual and the parent maintains full management control for the company.