December 16, 2021 by matray

The Cooperative of American Physicians, Inc. (CAP) announced today that the Mutual Protection Trust (MPT), its medical malpractice/professional liability coverage product for California physicians, again earned an A+ (Superior) rating from A.M. Best. This marks the 15^th-consecutive year MPT achieved this rating.

As part of its grading report, A.M. Best praised MPT for its financial flexibility and capital strength, sound invested asset base and ability to access capital. The report also highlights CAP’s “strongest level of risk-adjusted capitalization and favorable market position in California as the second-largest provider of MPL coverage in the state.” It further cited CAP’s company culture that is focused on enterprise risk management and strong internal controls.

“For 15 years now, our MPT product has earned an A+ Rating from A.M. Best, a testament to the collective efforts of a team that is committed to supporting its physician members and their financial health in the most effective way possible,” said Sarah Scher, CAP chief executive officer.

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 CAP and its primary medical professional liability partner, MPT.

December 15, 2021 by matray

LAMMICO was named one of the Best and Brightest Companies to Work For in the Nation for fall 2021 by the National Association for Business Resources. The 2021 Fall National winners were assessed by an independent research firm that reviewed a number of key measures relative to other nationally recognized winners, based on categories such as communication, work-life balance, employee education, diversity, recognition, retention and more.

The Best and Brightest Companies to Work For in the Nation offers different timelines of applications throughout the year: spring, summer, fall and winter. The fall Best and Brightest National winners honored 167 organizations from across the country out of 1,500 nominations.

According to LAMMICO, its commitment to work-life balance and flexibility to the recognition. LAMMICO employees report valuing the benefits of flexible work hours, compressed workweeks, remote work and telecommuting.

The Best and Brightest Companies to Work For in the Nation winners will be honored at the virtual Illuminate Business Summit week in January 2022. During the Illuminate Business Summit, LAMMICO and the other winning companies will be celebrated for demonstrating exceptional innovative human resource practices and setting high standards for all businesses.

“This honor reflects the heart of LAMMICO and its people, who are among the best and brightest I know,” said J. Michael Conerly, MD, LAMMICO president and chief executive officer. “I am grateful for — and proud of — the LAMMICO staff who successfully worked during the pandemic and hurricane recoveries to best serve the needs of our insured healthcare providers.”

LAMMICO is headquartered in Metairie, Louisiana, and has offices in Baton Rouge and Shreveport.

December 15, 2021 by matray

AM Best has assigned a Financial Strength Rating of A- (Excellent) and a Long-Term Issuer Credit Rating of “a-” (Excellent) to Applied Medico-Legal Solutions Risk Retention Group, Inc. (AMS RRG) (Phoenix, AZ). The outlook assigned to these Credit Ratings (ratings) is stable.

The ratings reflect AMS RRG’s balance sheet strength, which AM Best assesses as very strong, as well as its adequate operating performance, limited business profile and appropriate enterprise risk management.

AMS RRG’s balance sheet assessment is supported by risk-adjusted capitalization, as measured by Best’s Capital Adequacy Ratio (BCAR), at the strongest level. The assessment also considers the company’s consistent surplus growth through earnings and required capital contributions from policyholders. In order to be an insured, members are required to contribute 30% of their mature claims-made premium as capital. These member contributions are paid over a three-year period, which results in a significant portion of capital being receivable from policyholders. The balance sheet is further solidified by an adverse development cover, which insulates the company from any future reserve development on business written in 2020 and prior. The very strong balance sheet strength assessment also considers enhancements to the company’s reinsurance program and planned capital contributions totaling $35 million in the form of surplus notes and equity, which are expected to be implemented in the fourth quarter of 2021.

While the company’s reported results have been subpar, more recent accident-year results have been on par with its peers when adjusted for swing-rated reinsurance. This assessment also considers management’s recent reinsurance initiatives, which are expected to insulate the company from much of its legacy business written prior to 2021. These initiatives include the elimination of swing-rated reinsurance with more traditional reinsurance going forward, the purchase of an adverse development cover, and the purchase of a swing premium protection cover – all of which are expected to reduce volatility of underwriting results and earnings drag going forward. The overall operating performance assessment of adequate places considerable weight on management’s projections and the company’s expected return to underwriting profitability in 2022.

AMS RRG provides medical professional liability (MPL) coverage to over 3,000 individual physician and small physician group members. The limited business profile assessment primarily reflects product and geographic concentration risks as a monoline MPL writer, with approximately 70% of premium volume in its top five states of operation, which exposes the group to risks associated with changes in underwriting cycles, loss cost trends, health care delivery and the legal, economic and regulatory environment.

The company benefits from an appropriate ERM program that promotes clear communication throughout the organization. A formally defined risk appetite and tolerance have been established as foundational elements of the framework. AMS RRG also maintains an appropriate fixed-rate reinsurance program in excess of its $500,000 net retention per claim and per clash. Furthermore, awards-made coverage of $10 million provides additional protection.

The stable outlooks reflect AM Best's expectation that the company will maintain its overall balance sheet assessment, supported by risk-adjusted capitalization at the strongest level, and restored level of underwriting results and operating profitability that are generally in line with management's projections.

Negative rating action could occur following a weakening of overall balance sheet strength, a considerable decline in risk-adjusted capitalization or other quantitative and/or qualitative balance sheet metrics. Negative rating action may also occur if operating and underwriting results differ materially from management's projections as a result of unfavorable shifts in claim frequency or severity, changes in market dynamics or the emergence of adverse loss reserve development on prospective accident years not covered by the adverse development cover.

December 6, 2021 by matray

The December 2021 issue of Medical Liability Monitor features the following articles and more. Click here to subscribe today:

Federal Appeals Court Narrows PREP Act Liability Protections
Almost two years after the U.S. government declared COVID-19 a public health emergency, federal courts are beginning to narrow the application of the Public Readiness & Emergency Preparedness (PREP) Act, a law invoked via emergency declaration in early 2020 to shield providers of pandemic countermeasures from civil liability. A recent, precedent-setting federal appeals court decision raises concern over the scope of protections for hospitals, nursing homes and healthcare providers …

Milliman Inc. Analysis of Third-Quarter Financial Results for MPL Specialty Writers
Milliman actuaries note continued premium growth continued for medical professional liability specialty writers in the third quarter, although it was driven more by non-MPL premiums — which have been increasing by more than 30% per annum — than earlier this year ...

California Hospitalist Wants Federal Court to Declare Disciplinary Hearings Unconstitutional
A California hospitalist who had his hospital privileges rescinded in 2015 for substandard performance and inadequate record keeping filed a civil action last month asking a federal court to reinstate those privileges, alleging a lack of due process during medical disciplinary hearings violates the Fourteenth Amendment of U.S. Constitution …

ProAssurance Q3 Results Benefit from NORCAL Acquisition
Last month, ProAssurance Corp. reported a net income of $12.2 million for the quarter ended Sept. 30, 2021. The company posted a third-quarter current-accident-year loss ratio of 85.2%, net-loss ratio of 82.1%, underwriting-expense ratio of 24.5%, combined ratio of 106.6% and operating ratio of 99.5%. ProAssurance also boasted a $34.5 million net investment result, an increase of 58.5% over the same period in 2020. ProAssurance’s Specialty P&C Segment reported $235 million in gross premiums written for the third-quarter 2021, up from $158.3 million for the same period in 2020. The Specialty P&C Segment’s increase in gross premiums written is primarily attributed to ProAssurance’s acquisition of NORCAL Group, which was finalized on May 5, 2021 …

AMA Adopts Policy to Combat Disinformation by Healthcare Professionals
Acknowledging the dangerous spread of public health disinformation during the COVID-19 pandemic, physician, resident and medical student members of the American Medical Association (AMA) House of Delegates adopted policy last month aimed at combatting public health disinformation disseminated by healthcare professionals …

Subscribe today to get this issue (as well as the 2021 Annual Rate Survey at no additional cost).

November 30, 2021 by matray

AM Best has affirmed the Financial Strength Rating (FSR) of A+ (Superior) and the Long-Term Issuer Credit Ratings (Long-Term ICR) of “aa-” (Superior) of MLMIC Insurance Company (MLMIC) (New York, NY). The outlook of these Credit Ratings (ratings) is stable.

The ratings reflect MLMIC’s balance sheet strength, which AM Best assesses as strongest, as well as its adequate operating performance, limited business profile and appropriate enterprise risk management. The ratings also benefit from the financial support provided by MLMIC’s direct parent company, National Indemnity Company, which is ultimately owned by Berkshire Hathaway Inc.

MLMIC has a long track record of favorable reserve development and adequate underwriting returns. In recent years, net operating results have been somewhat skewed by a 100% loss portfolio transfer (LPT) and an 85% quota share agreement with National Indemnity Company, which were executed in 2018. As a result, favorable reserve development related to accident years covered by the LPT (for all business written prior to the acquisition by National Indemnity Company in 2018) no longer benefits MLMIC’s underwriting results. The pace of favorable reserve development was likely further slowed by the impact of the COVID-19 pandemic on the New York court system, which reduced the speed with which claims were closed and delayed the recognition of possible favorable reserve development on more recent accident years that are not covered under the LPT. As such, the company’s net underwriting results in the most recent years have not yet benefited from the same degree of reserve releases seen in previous years. The direct underwriting results remain in line with historical trends, however, and further support the current operating performance assessment.

MLMIC’s insurance portfolio is concentrated in the medical malpractice line of business. The company underwrites risks only within New York state, which is one of the nation’s most challenging markets for medical professional liability. However, management has been able to operate successfully through underwriting cycles while maintaining MLMIC’s leading market position within New York. In addition, risk management capabilities have proven appropriate for the risk profile of the company.

November 16, 2021 by matray

As specialist insurer Beazley moves to expand its Hospital Professional Liability portfolio in the United States, Joseph Washington has been appointed its underwriter for U.S. Healthcare, beginning his role on Monday, November 15, 2021.

With more than 25 years of medical professional liability experience, gained at Berkshire Hathaway and Zurich, Joseph has specialized in providing this type of coverage for hospitals throughout his career and brings with him a wealth of expert knowledge and experience in the field.

“With Beazley's reputation for working with organizations that manage their own risk effectively, they're a well-respected player in this market,” Washington said. “Naturally, I am very much looking forward to working with them to open distribution for Hospital Professional Liability here in the states.”

“This is an exciting hire for us, as we continue to target double-digit growth into 2022,” said Matt McCullaugh, focus group lead for US Hospitals at Beazley. “While the London distribution remains core to Beazley’s US Hospitals offering, there is a real opportunity to access more middle market US hospital business, by opening up distribution locally. With his vast experience in this area, Joseph is the ideal candidate to help us achieve this.”

Washington will be based in Atlanta.

November 15, 2021 by matray

A jury in Vermilion County, Illinois, reached a verdict of more than $14.75 million today in a medical malpractice action brought against Presence Hospitals, PRV, the former operator of the Presence United Samaritans Medical Center in Danville, Ill. The lawsuit was brought on behalf of L.B., a disabled person, through her guardian CIBC Bank USA.

The lawsuit alleged that Presence, individually and through its agents, was negligent in the medical care and treatment provided to L.B. while she was an inpatient at Presence United Samaritans Medical Center on April 22, 2014. L.B. was pregnant with twins and underwent a cesarean section procedure by the obstetrician on call, Mohannad Rajjoub, MD. Following the delivery of the twins, Rajjoub attempted to remove L.B.'s placenta when she had a condition known as placenta accreta, in which the placenta attaches deeply into the uterine wall. As a result, plaintiff presented evidence that the placenta was torn, and L.B. suffered massive hemorrhaging resulting in hypoxic brain injury and seizure like activity.

The plaintiff further alleged that negligent conduct of the anesthesiologist, Damon Green, MD, contributed to L.B.'s injuries. Plaintiff presented evidence that following the massive hemorrhage, L.B. did not receive proper resuscitative care which contributed to the hypoxia. This evidence included that no blood was available in the operating room for transfusion and that more than 30 minutes elapsed before the first transfusion was begun.

Plaintiff's medical expert in rehabilitation testified that L.B. sustained a severe and diffuse brain injury with global consequences, and that her intellectual age is 3 years, 3 months with an estimated IQ less than 34. L.B. is virtually totally dependent on all aspects of daily life and will require 24-hour, life-long care.

Presence Hospitals denied that Rajjoub and Green were its agents. It further maintained at trial that L.B. was not stable for transfer to a different hospital and required an emergency c-section during which the doctors and the hospital each acted within the standard of care.

The jury awarded the plaintiff a total of $14,756,744.03 consisting of $3 million each for loss of a normal life and pain and suffering, $7.4 million for future medical and caretaking expenses and $1,356,744.03 for past medical expenses.

   

November 15, 2021 by matray

The Cooperative of American Physicians (CAP) today announced the upcoming retirement of CAP Physicians Insurance Agency president and chief executive officer Deidri (Dee) Hoppe. After 10 years of service to CAP members, Hoppe will retire at the end of December 2021. She will be succeeded by Michael Dyse, who is currently CAP Agency vice president.

Hoppe joined CAP in 2011 and previously held the position of vice president, where she oversaw the property casualty insurance division. She was promoted to president and CEO of CAP Agency in 2016.

“Dee has been a strong and effective leader, instrumental in the growth of all lines of the CAP Agency,” said Sarah Scher, CAP chief executive officer. “Her use of technology to build the agency and the fact that she delivered almost $3 million in dividends to the CAP enterprise from the agency are particularly noteworthy. We will miss her and wish her much happiness in her retirement.”

Michael Dyse will take the reins as CAP Agency president, effective Jan. 1, 2022. He has worked at CAP since 2014. According to CAP, before moving to the Agency as vice president earlier this year, Dyse served as assistant vice president, CAP Membership Services, where he managed the largest groups and accounts across the CAP enterprise.

“With Michael’s extensive background, strong work ethic and excellent interpersonal skills, he is sure to build upon the success of an already thriving agency,” Scher said. “Michael has been working with the agency as he transitions into his new position, and we are excited about the innovative thinking he has already demonstrated.”    

November 15, 2021 by matray

Positive Physicians Insurance Co. announced today that Michael G. Roque has joined the medical professional liability insurer as its new president.

Bringing more than 25 years’ experience in medical professional liability on both the broker and carrier sides of the industry, Roque most recently served as chief operating officer at Integris Group. He specializes in strategic planning, operations management and market growth.

“We are very pleased to have Michael join our team,” Lewis Sharps MD, Positive Physicians chief executive officer. “His knowledge and experience within the MPL industry will be a tremendous asset for PPIC. We look forward to his leadership and insight as we continue to expand and change the landscape of the MPL industry.”

November 8, 2021 by matray

AM Best has revised the outlook of the Long-Term Issuer Credit Ratings (Long-Term ICR) to stable from negative and affirmed the Financial Strength Rating of B++ (Good) and the Long-Term ICRs of “bbb+” (Good) of Kansas Medical Mutual Insurance Company, and its subsidiary, KAMMCO Casualty Company, Inc. These companies are referred to collectively as Kansas Medical Mutual Group. The outlook of the FSR is stable. Both companies are domiciled in Topeka, KS.

The ratings reflect Kansas Medical Mutual Group’s balance sheet strength, which AM Best assesses as very strong, as well as its marginal operating performance, limited business profile and appropriate enterprise risk management (ERM).

The revised Long-Term ICR outlook to stable reflects actions taken by the group to stabilize operating performance and capital levels in recent years. These actions have demonstrated the effectiveness of the group’s risk management capabilities through improvements in operational efficiencies, adaptation to recent tort reform events and executing its strategy to refocus on its core medical professional liability (MPL) business. AM Best considers the group’s ERM framework appropriate with a defined risk appetite and tolerances as well as stress test scenarios for critical risks that could impact the group.

The group’s balance sheet strength is supported by the strongest level of risk-adjusted capitalization, as measured by Best’s Capital Adequacy Ratio (BCAR), partially offset by declining level of policyholders’ surplus and other balance sheet metrics over the prior five-year period. During the earlier portion of the prior five-year period, the group reported significant weakening of earnings and reduced surplus due to higher-than-expected underwriting losses and diminished investment returns. These factors, along with several one-off charges, including the write-off of its KAMMCO Health Solutions subsidiary, which had generated significant operating losses and strained liquidity, culminated in a significant loss in 2019.

Performance improved in 2020 and through the first six months of 2021, with the group reporting modest organic surplus growth, due to the impacts of expense reductions, modest annual rate actions and reduced frequency.

The group’s limited business profile reflects its monoline concentration of risk in the MPL sector and heavy geographic concentration in Kansas. A 2019 judicial ruling resulted in the removal of noneconomic damage caps on personal injury cases in Kansas; however, uncertainty remains as to whether this applies to medical malpractice actions until further clarification from the Kansas Supreme Court. The group has taken proactive measures by modifying its reserving procedures for noneconomic damages, and reviewed all outstanding cases and increased reserves accordingly.