July 18, 2024 by matray

AM Besthas affirmed the Financial Strength Rating of A++ (Superior) and the Long-Term Issuer Credit Ratings of “aa+” (Superior) of the members of MedPro Group (MedPro). These Credit Ratings (ratings) apply to The Medical Protective Company (Fort Wayne, IN) and its affiliates: Princeton Insurance Company (Princeton, NJ); PLICO, Inc. (Oklahoma City, OK); Wellfleet Insurance Company (Fort Wayne, IN); and Wellfleet New York Insurance Company (Flushing, NY); as well as MedPro’s two reinsured affiliates, MedPro RRG Risk Retention Group and AttPro RRG Reciprocal Risk Retention Group (both domiciled in the District of Columbia). The outlook of these ratings is stable.

The ratings reflect MedPro’s balance sheet strength, which AM Best assesses as strongest, as well as its strong operating performance, favorable business profile and appropriate enterprise risk management.

The ratings acknowledge MedPro’s risk-adjusted capitalization being at the strongest level, as measured by Best’s Capital Adequacy Ratio (BCAR), as well as the group’s long-term profitable operating performance and the leading market position it maintains in the medical professional liability (MPL) sector, proving the group’s ability to underwrite profitably through market cycles. Additionally, the ratings consider the group’s substantial distribution capabilities, prudent claims-handling philosophy and culture of holistic risk management. The group consistently outperforms peers by most metrics, illustrated by substantial historical returns on equity, low operating ratios and solid net underwriting income. Furthermore, the ratings benefit from the explicit and implicit financial support provided by its affiliate, National Indemnity Company, and MedPro’s ultimate parent, Berkshire Hathaway Inc. [NYSE: BRK A and BRK B], which includes reinsurance programs, investment opportunities and capital support.

Partially offsetting these positive rating factors are the inherent challenges associated with the MPL line of business, particularly as it relates to price competition, changing market dynamics, potential changes in legislation (i.e., tort reform), increasing loss cost trends and regulatory risk. At the same time, AM Best recognizes the organization’s strong management team, diversified premium base and jurisdictional diversity, which have contributed to MedPro outperforming its peers over the longer term.

The group’s large allocation to common stocks exposes it to significant volatility during periods when the equity markets experience sharp declines. The group has demonstrated its ability to absorb this volatility historically and maintain the strongest level of risk-adjusted capitalization, as measured by BCAR, due to its low underwriting leverage, driven by its affiliated reinsurance agreement with National Indemnity Company and MedPro’s substantial capital position, and the investment managers’ historical trend of success in turbulent markets.  

July 16, 2024 by matray

Fitch Ratings Affirms 'A' Ratings, 'Stable' Outlook for The Doctors Company.

Fitch Ratings affirmed its “A” (Strong) Insurer Financial Strength ratings for The Doctors Company. The outlook of these ratings is "Stable."

The ratings are based on Fitch's assessment of the company's very strong statutory capital position and sufficient loss reserve levels. Fitch recognized The Doctors Company's market position as the nation's number-two writer of medical professional liability insurance.

The "A" with "Stable Outlook" ratings include:

• The Doctors Company, an Interinsurance Exchange


• The Doctors Company Risk Retention Group, a Reciprocal Exchange


• TDC National Assurance Company


• TDC Specialty Insurance Company

July 11, 2024 by matray

Below are some headlines and article synopses from the July 2024 issue of Medical Liability Monitor. To read the articles in their entirety, please subscribe today.

Nuclear Jury Verdicts Have Surged During the Last Decade
Nuclear jury verdicts in personal injury and wrongful death cases have surged during the last decade, according to a new report from the U.S. Chamber of Commerce Institute for Legal Reform (ILR). The report’s authors define a nuclear verdict as a jury determination in favor of the plaintiff with a damage award that surpasses $10 million. Key findings from the report indicate that approximately half of the studied nuclear verdicts were between $10 million and $20 million, and more than a third were between $20 million and $50 million. The remaining 19% exceeded $50 million, including 115 “mega” nuclear verdicts of $100 million or more. The median nuclear verdict during the study period was $21 million, and the mean was substantially higher at $89 million. Medical liability verdicts had a $19.6 million median and a $33.6 million mean during the 10-year study period …

Number of Patient Harms rose 59% Globally Between 1990, 2019
The number of patient harms associated with medical treatment rose by 59% globally — from 11 million to 18 million — between 1990 and 2019, according to a new data analysis published online in the journal BMJ Quality & Safety. Patient harms outpaced the 45% increase in the world’s population during the same period. And older people bore the brunt of these adverse incidents, with the steepest rise among 65-69 year olds, the findings show …

Berkshire Hathaway Leads MPL in DPW
Berkshire Hathaway maintained its spot as the leading provider of medical professional liability insurance in the U.S. based on claims-made coverage with $1.3 billion in direct premiums written (DPW) in 2023. This figure represents a slight 0.2% decrease in annual premium for the company, according to a Best’s Rankings report released last month. The report evaluates the DPW for the top providers of claims-made medical professional liability insurance …

Colorado Supreme Court to Decide If Damages Cap Applies to Interest
The Colorado Supreme Court last month agreed to review whether a provision in state law that typically capped recoverable economic and noneconomic damages at $1 million also applies to the interest accrued from the time of the plaintiff’s injury. Colorado judges retain discretion to pierce the cap when there is a finding of good cause to believe that the cap is unfair and that economic damages alone would exceed the umbrella cap limit …

Inflation’s Double-Edged Sword Impacts First-Quarter 2024 Financial Results for MPL Specialty Writers
An analysis of first-quarter financial results for the MPL industry indicates elevated inflation resulted in higher-than-average underwriting expense growth in 2023 and 2024, but also helped investment yields achieve better returns than the five-year Treasury Bond would offer …

The AMA Adopts New Prior Authorization Reform Policies
Physician and medical student leaders at the Annual Meeting of the American Medical Association (AMA) House of Delegates last month approved two new policies aimed at fighting for greater health insurer accountability and transparency against the backdrop of proliferating, onerous prior authorization requirements that are delaying and denying necessary care for patients and adding administrative burdens for physicians. The House of Delegates is the AMA’s policymaking body …

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July 11, 2024 by matray

Coverys recently announced that Coverys Limited has received Prudential Regulatory Authority (PRA) and Financial Conduct Authority (FCA) approval to commence underwriting, effective June 26, 2024. This approval enables the organization to expand its offerings in the London market, supporting Coverys’ global growth and diversification strategy.

Coverys Limited has also been approved for admittance to the National Association of Insurance Commissioners (NAIC) Quarterly Listing of Alien Insurers, effective July 1, 2024. A company’s presence on the Quarterly Listing allows a non-U.S. insurer to write excess or surplus lines business in all states on a non-admitted basis. Regulatory approval comes on the heels of AM Best assigning an Excellent Financial Strength Rating (FSR) and a Long-Term Issuer Credit Rating (Long-Term ICR) of “A” (Excellent) to Coverys Limited.

Coverys Limited is part of Coverys’ dedicated London platform, which includes both an insurance company and MGA operations (collectively “Coverys London”). To lead the newly expanded London operation, Coverys has appointed Stef Raftopoulos as CEO of Coverys London, reporting to Coverys CEO Joseph Murphy. In addition, chief underwriting officer Chris Brooking and finance director Michael Bell, who together with Raftopoulos bring more than 85 years of combined global insurance experience to the team, will assist Raftopoulos in heading the Coverys London operation.

Mike Sibthorpe is stepping down as CEO of Coverys London following the completion of the goals set for his tenure. Sibthorpe joined Coverys with the task of leading the reorganization of the London office and the development of an alternative platform to replace Coverys’ Syndicate 1975.

Building on the organization’s commitment to the London market, Coverys London will write a balanced portfolio of both medical liability insurance and healthcare reinsurance across a broad range of specialty lines in which Coverys has well-established product offerings and risk mitigation services. This includes an expansion of the services and flexibility previously provided through Coverys’ Syndicate 1975.

Joseph G. Murphy, President and CEO of Coverys, said, “With the creation of the Coverys London platform and regulatory approval, Coverys can expand options for risk-taking through the London marketplace while also providing the level of service and expertise our long-standing clients and partners have come to expect,” Murpphy said. “The expansion of our London platform is just one of the ways we are evolving our offerings across the markets we serve to further our mission to protect and support healthcare professionals worldwide.”

July 9, 2024 by matray

Matthew Germak, MD, MPH, will be the new vice president for patient safety at CRICO, the medical professional liability insurance program serving the Harvard medical community and its affiliate organizations. He will assume this role beginning July 15, 2024.

As vice president, Germak will report to Luke Sato, MD, senior vice president and chief medical officer of CRICO. In this capacity, he will have oversight of strategic and operational patient safety solutions for all CRICO subscribers. His responsibilities will include advancing CRICO’s patient safety strategy, convening clinical leaders, overseeing protected discussions of the AMC PSO, designing CRICO’s educational programs and supporting advanced clinical data analytics.

“Matt is a respected leader in patient safety and highly regarded by our insured network. I expect him to bring a fresh perspective and insight to our team, allowing us to better address the quality and safety challenges faced by our community,” said Mark E. Reynolds, CRICO president and chief executive.

Germak joins CRICO with extensive experience in patient safety. During the last four years, he has been Beth Israel Lahey Health Primary Care’s (BILHPC) first chief quality and safety officer and has been a primary care physician for eight years at BILHPC – Wellesley Family Medicine. Matt also currently serves as BILH’s principal investigator in CRICO’s Ambulatory Safety Net Program.

“We are thrilled to have Matt join us as VP of Patient Safety, as he’s been working with CRICO as our Medical Director of Primary Care since 2022,” Sato said. “The combination of his experience as a clinician and achievements in healthcare quality and safety make him a perfect fit for our organization and our subscribers.”

June 20, 2024 by matray

AM Best has affirmed the Financial Strength Rating (FSR) of A (Excellent) and the Long-Term Issuer Credit Ratings (Long-Term ICR) of “a+” (Excellent) of the members of ProAssurance Group. Concurrently, AM Best has affirmed the Long-Term ICR of “bbb+” (Good) and the existing indicative Long-Term Issue Credit Ratings (Long-Term IR) of ProAssurance Corporation (PRA) (headquartered in Birmingham, AL). The outlook of the Credit Ratings (ratings) is stable. All companies are indirect subsidiaries of PRA. (See below for a detailed listing of subsidiaries and indicative Long-Term IRs.)

The ratings of ProAssurance Group reflect its balance sheet strength, which AM Best assesses as strongest, as well as its adequate operating performance, favorable business profile and appropriate enterprise risk management (ERM).

The group’s balance sheet strength assessment remains in the strongest range reflective of its strongest level of risk-adjusted capitalization, as measured by Best’s Capital Adequacy Ratio (BCAR), as well as quality of investments, adequate liquidity and strength of reserves. Loss reserve development trends over the prior 10 calendar and accident years have been mixed, driven in part by adverse development reported by the NORCAL subsidiaries, the development associated with a large national healthcare account and the emergence in 2023 of adverse development on the workers compensation line of business, reflecting the impact of rising medical severity.

The ratings also consider ProAssurance Group’s operating performance, which remains adequate, despite some deterioration over the past five-year period. The group’s operating results were impacted by the large national healthcare account’s non-renewal and the challenging loss environment in the specialty property/casualty segment’s healthcare professional liability and workers compensation segments, reflecting ongoing significant increases in average claim costs. Operating performance results and profitability in 2023 and through the first quarter of 2024 were bolstered by net investment income following the reallocation of investments and the continuation of higher yields. The ratings also consider the group’s national market position as one of the leading medical professional liability insurers in the United States with its breadth of product offerings across multiple disciplines, and geographic diversification. The ratings also recognize the group’s developed ERM framework and risk management capabilities across the organization.

The ratings also benefit from the financial flexibility afforded by PRA, the ultimate parent via access to the capital markets. PRA’s financial leverage is modest with adequate interest coverage, holding a significant amount of cash and short-term investments outside the insurance operations, which are available for use without regulatory approval or restriction. However, surplus growth has been limited over the most recent five-year period due to significant payments of dividends to PRA, which the parent has utilized for company stock repurchases and payment of shareholders’ dividends, and unrealized capital losses partially offsetting profitability. Management continues to remain committed to maintaining capital strength at its rated entities at levels commensurate with their ratings.

The stable outlooks reflect AM Best’s expectation that the group will maintain its strongest level of balance sheet strength assessment, supported by effective capital management, while ongoing initiatives implemented by management will maintain stable operating performance, supported by its favorable business profile.

Negative rating actions may occur if the group’s loss experience continues to impact underwriting profitability negatively and leads to further deterioration in operating performance trends. Negative rating action may also occur if the group's balance sheet strength weakens, which could result from deterioration of risk-adjusted capitalization or further adverse reserve development in its workers compensation or medical professional liability books from rising claims frequency or severity, or changes in regulatory, legislative and judicial actions. While unlikely in the near term, positive rating actions may occur following a positive trend in operating performance metrics that outpaces the group’s peers and materially contributes to surplus growth.

The FSR of A (Excellent) and the Long-Term ICRs of “a+” (Excellent) have been affirmed, with stable outlooks for the following members of ProAssurance Group:

• ProAssurance Indemnity Company, Inc.
• ProAssurance Specialty Insurance Company
• Medmarc Casualty Insurance Company
• ProAssurance Insurance Company of America
• ProAssurance American Mutual, A Risk Retention Group
• Allied Eastern Indemnity Company
• Eastern Advantage Assurance Company
• Eastern Alliance Insurance Company
• NORCAL Insurance Company
• NORCAL Specialty Insurance Company
• Medicus Insurance Company
• FD Insurance Company
• Preferred Physicians Medical Risk Retention Group, a Mutual Insurance Company

The following indicative Long-Term IRs under the shelf registration have been affirmed with stable outlooks:

ProAssurance Corporation— -- “bbb+” (Good) on senior unsecured debt -- “bbb” (Good) on senior subordinated debt -- “bbb-” (Good) on preferred stock

June 20, 2024 by matray

AM Best has affirmed the Financial Strength Rating (FSR) of A (Excellent) and the Long-Term Issuer Credit Ratings (Long-Term ICR) of “a+” (Excellent) of the members of ProAssurance Group. Concurrently, AM Best has affirmed the Long-Term ICR of “bbb+” (Good) and the existing indicative Long-Term Issue Credit Ratings (Long-Term IR) of ProAssurance Corporation (PRA) (headquartered in Birmingham, AL). The outlook of the Credit Ratings (ratings) is stable. All companies are indirect subsidiaries of PRA. (See below for a detailed listing of subsidiaries and indicative Long-Term IRs.)

The ratings of ProAssurance Group reflect its balance sheet strength, which AM Best assesses as strongest, as well as its adequate operating performance, favorable business profile and appropriate enterprise risk management (ERM).

The group’s balance sheet strength assessment remains in the strongest range reflective of its strongest level of risk-adjusted capitalization, as measured by Best’s Capital Adequacy Ratio (BCAR), as well as quality of investments, adequate liquidity and strength of reserves. Loss reserve development trends over the prior 10 calendar and accident years have been mixed, driven in part by adverse development reported by the NORCAL subsidiaries, the development associated with a large national healthcare account and the emergence in 2023 of adverse development on the workers compensation line of business, reflecting the impact of rising medical severity.

The ratings also consider ProAssurance Group’s operating performance, which remains adequate, despite some deterioration over the past five-year period. The group’s operating results were impacted by the large national healthcare account’s non-renewal and the challenging loss environment in the specialty property/casualty segment’s healthcare professional liability and workers compensation segments, reflecting ongoing significant increases in average claim costs. Operating performance results and profitability in 2023 and through the first quarter of 2024 were bolstered by net investment income following the reallocation of investments and the continuation of higher yields. The ratings also consider the group’s national market position as one of the leading medical professional liability insurers in the United States with its breadth of product offerings across multiple disciplines, and geographic diversification. The ratings also recognize the group’s developed ERM framework and risk management capabilities across the organization.

The ratings also benefit from the financial flexibility afforded by PRA, the ultimate parent via access to the capital markets. PRA’s financial leverage is modest with adequate interest coverage, holding a significant amount of cash and short-term investments outside the insurance operations, which are available for use without regulatory approval or restriction. However, surplus growth has been limited over the most recent five-year period due to significant payments of dividends to PRA, which the parent has utilized for company stock repurchases and payment of shareholders’ dividends, and unrealized capital losses partially offsetting profitability. Management continues to remain committed to maintaining capital strength at its rated entities at levels commensurate with their ratings.

The stable outlooks reflect AM Best’s expectation that the group will maintain its strongest level of balance sheet strength assessment, supported by effective capital management, while ongoing initiatives implemented by management will maintain stable operating performance, supported by its favorable business profile.

Negative rating actions may occur if the group’s loss experience continues to impact underwriting profitability negatively and leads to further deterioration in operating performance trends. Negative rating action may also occur if the group's balance sheet strength weakens, which could result from deterioration of risk-adjusted capitalization or further adverse reserve development in its workers compensation or medical professional liability books from rising claims frequency or severity, or changes in regulatory, legislative and judicial actions. While unlikely in the near term, positive rating actions may occur following a positive trend in operating performance metrics that outpaces the group’s peers and materially contributes to surplus growth.

The FSR of A (Excellent) and the Long-Term ICRs of “a+” (Excellent) have been affirmed, with stable outlooks for the following members of ProAssurance Group:

• ProAssurance Indemnity Company, Inc.
• ProAssurance Specialty Insurance Company
• Medmarc Casualty Insurance Company
• ProAssurance Insurance Company of America
• ProAssurance American Mutual, A Risk Retention Group
• Allied Eastern Indemnity Company
• Eastern Advantage Assurance Company
• Eastern Alliance Insurance Company
• NORCAL Insurance Company
• NORCAL Specialty Insurance Company
• Medicus Insurance Company
• FD Insurance Company
• Preferred Physicians Medical Risk Retention Group, a Mutual Insurance Company

The following indicative Long-Term IRs under the shelf registration have been affirmed with stable outlooks:

ProAssurance Corporation— -- “bbb+” (Good) on senior unsecured debt -- “bbb” (Good) on senior subordinated debt -- “bbb-” (Good) on preferred stock

June 11, 2024 by matray

Below are some headlines and article synopses from the June 2024 issue of Medical Liability Monitor. To read the articles in their entirety, please subscribe today.

MPLI Underwriting Loss Widens, Performance Uneven Among Carriers
The U.S. medical professional liability insurance (MPLI) market’s underwriting loss increased significantly in 2023. Pricing trends remain positive, but it remains uncertain whether MPLI specialists can move toward breakeven underwriting results and bolster returns on capital amid market competition and ongoing loss-cost volatility tied to litigation risks …

AM Best: MPL Segment Underwriting Slips, Profitability Buoyed by Net Investment Income
Premium growth for a composite of medical professional liability (MPL) insurance companies moderated to 3.6% in 2023, but overall financial results were bolstered by favorable net investment income, according to a new AM Best Market Segment Report. The initial premium growth was spurred by price firming after a prolonged period of soft market conditions and challenging industry dynamics that dampened demand …

Colorado Reaches Compromise to Preserve, Increase Damage Caps
Healthcare interests, trial attorneys and lawmakers hammered out compromise legislation last month that will raise Colorado’s cap on noneconomic damages for medical liability claims. As a result of the compromise bill, the Colorado Trial Lawyers Association will withdraw its pending 2024 ballot initiatives to completely eliminate the state’s caps on recoverable damages and pierce peer review confidentiality. Coloradans Protecting Patient Access — a coalition of hospitals, physician groups, liability insurance companies and business organizations — will also retract its ballot initiatives to limit the amount of money trial lawyers can make from medical liability lawsuits. Gov. Jared Polis signed the bill into law on June 3 …

NH Lawmakers Raise Caps on Wrongful Death Loss of Consortium
The New Hampshire Legislature last month sent a bill to Gov. Chris Sununu that would increase the state’s damage caps for wrongful death loss of consortium involving spouses, parents and children. Senate Bill 462 would raise the cap for the loss of “the comfort, society, and companionship of the deceased” for a spouse from $150,000 to $500,000, and for the loss of a parent or a child from $50,000 to $300,000. Gov. Sununu has not taken a public stance on the legislation but is expected to sign it …

MPL Insurance Professionals Convene in Washington, DC, to Collaborate, Solve Problems, Move Industry Forward
The Medical Professional Liability (MPL) Association hosted its Annual Conference in Washington, D.C., from May 8-10. More than 450 attendees assembled at the Omni Shoreham Hotel to hear from more than 25 speakers representing the MPL, healthcare and insurance industries. Following are some highlights from the educational sessions at this year’s MPL Association Annual Conference …

NY Gov. Rescues State Medical Indemnity Fund, Future Solvency in Doubt
New York Gov. Kathy Hochul last month earmarked an additional $58 million for the state’s Medical Indemnity Fund as part of her updated financial plan for this year. The MIF was created in 2011 to provide a funding source for the future healthcare costs of “qualified plaintiffs,” as defined by law, who suffered birth-related neurological injuries due to medical malpractice during a delivery admission. The additional money ensures the program will continue through the remainder of this year. It also allows the program to accept new enrollees in the short term …

Subscribe today to get this issue (as well as the 2023 and 2024 Annual Rate Survey at no additional cost).

June 11, 2024 by matray

DOXA Insurance today announces the acquisition of CPH Insurance, a Chicago-based specialty managing general agent (MGA) providing professional liability products for mental health, allied health and healthcare professionals.

“We are pleased to partner with CPH Insurance, an organization with vast specialized expertise in allied health. Everyone at DOXA looks forward to working with the team at CPH Insurance as they continue to grow and offer new solutions to allied health professionals,” said Matt Sackett, CEO and co-founder of DOXA.

Established in 2000 by founder and president Phil Hodson to specifically serve the mental health sector, CPH Insurance provides competitively priced, timely insurance products to over 250,000 insureds across the U.S.

DOXA will continue to support CPH Insurance as it continues to nurture its existing book of business and continues introducing new products targeted to suit the unique needs of the organization’s clientele.

The transaction closed on Jun 7, 2024.

June 6, 2024 by matray

Integris Group recently announced the promotion of Christina Canales-Perry, JD, to vice president of claims.

Canales-Perry joined Integris in 2023 as the director of claims. During her tenure, Canales-Perry implemented revised litigation guidelines, introduced a new process for legal bill review and has fostered a close partnership with the company’s defense panel.

“Through Christina’s leadership and collaboration, the company has benefited from significant improvements in our evaluation of claims and the strengthening of our defense strategies,” said Kirk Tweedy, Integris Group chief operating officer. “Providing our policyholders with exceptional protection and support is core to our company mission statement, and we look forward to Christina’s continued contributions in this new role.”

Before joining the Company, Canales-Perry was a partner at Morrison Mahoney LLP, specializing in the defense of medical professional liability claims. Prior to that, she served as a judicial clerk to the judges of the Connecticut Superior Court, as well as Judge Stuart Bear and Judge Thomas West of the Connecticut Appellate Court.

Canales-Perry earned her Juris Doctor at the University of Connecticut School of Law and completed her Bachelor of Arts degree at Boston University.