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.  

May 30, 2024 by matray

The Doctors Company, part of TDC Group, announced today that it has now distributed more than $175 million in Tribute Plan awards to almost 14,000  members. Created in 2007, the Tribute Plan rewards retiring doctors for their loyalty and dedication to superior patient care. The highest individual award to date is $264,808.

"The Tribute Plan is tangible proof of our mission to advance, protect and reward the practice of good medicine," said Richard E. Anderson, MD, FACP, chairman and CEO of The Doctors Company and TDC Group. "I'm pleased that in our recent survey of members, 90% recognized the importance of Tribute and 90% expressed satisfaction with our unmatched benefits."

Backed by the financial strength of $7.3 billion in assets and $2.8 billion in member surplus, the millions of dollars that are in Tribute accounts today come from the capital of the company, not from premiums, and Tribute payments do not affect The Doctors Company's ongoing dividend program.

May 24, 2024 by matray

ProAssurance Corp. announced at its annual meeting of shareholders on May 22 that shareholders had elected new directors Richard J. Bielen, CPA, and Staci M. Pierce, JD, and re-elected directors Bruce D. Angiolillo, J.D. (chairman), and Samuel A. Di Piazza, Jr., CPA, to serve three year terms expiring at the company's 2027 annual meeting. The company's board of directors now consists of 10 members, down from the previous 12.

Shareholders also approved the ProAssurance Corp. 2024 Equity Incentive Plan and ratified the selection of Ernst & Young, LLP as the independent auditing firm for the fiscal year ending Dec. 31, 2024. Acting on matters related to compensation, shareholders approved, on an advisory basis, the compensation of named executive officers. According to ProAssurance, all proposals on the ballot were approved by a substantial supermajority of votes cast.

Bielen is the president and chief executive officer of Protective Life Corp. He brings more than 35 years of experience in various executive roles in the financial services industry.

Pierce is the chief executive officer at Action Resources, a transportation and environmental services company headquartered in Birmingham, Ala. She brings more than eight years of executive and leadership experience in the transportation and environmental services industries. She also spent five years as a practicing attorney.

"ProAssurance looks to its board of directors for a diversity of viewpoints, backgrounds, and experience, among other skills," said Ned Rand, ProAssurance Corp. president and chief executive officer. "With the addition of Rich and Staci, our board is even better positioned as a resource as we work to achieve our objectives in our core lines of insurance - medical professional liability and workers’ compensation.”    

May 22, 2024 by matray

Matthew L. Perkins, MD, of Smyrna, Tenn., became the chair of the State Volunteer Mutual Insurance Company (SVMIC) Board of Directors on May 14, 2024. An internal medicine physician and pediatrician, Perkins has spent 16 years on the SVMIC Board, having previously served as treasurer and vice chair.

“I am honored to lead the board of SVMIC,” Perkins said. “I look forward to working with my fellow board members and management to continue building on the strong foundation laid by Dr. Francis serving the physicians of the southeast.”

Perkins replaces outgoing board chair, Hugh Francis III, MD, of Memphis, who held the role since 2015 and will remain as chair emeritus. Francis has served SVMIC in various leadership positions since 1994, including 27 years on the board.

Katrina M. Hood, MD, of Lexington, Ky., is the new vice chair of the SVMIC Board of Directors. A pediatrician who has been on SVMIC's board since 2009 and previously held the position of secretary; Hood has served on various committees of the board since 2006.

Craig A. Myers, MD, of Knoxville, Tenn., is the new secretary of the SVMIC Board of Directors. Myers is an obstetrician-gynecologist who has served on SVMIC's board since 2021 and has held positions on SVMIC committees since 2007.

Chad T. Couch, MD, MBA, of Bristol, Tenn., continues as the treasurer of the SVMIC Board of Directors, a role he has held since 2022. Couch has been on SVMIC's board since 2008 and has served on its committees since 2006.

“We are thrilled to welcome the new leadership of our board of directors,” said John H. Mize, FCAS, MAAA, SVMIC chief executive officer.  “Their impressive backgrounds, innovative approaches, and experience with SVMIC's leadership align perfectly with our vision and mission. We also extend our heartfelt gratitude to Dr. Hugh Francis III for his unwavering commitment and leadership as chair and are grateful that he will continue to serve SVMIC on the board of directors."    

May 20, 2024 by matray

Christine M. Tomkins, MBChB(Hons), FRCS, FRCOphth, FRCP, MBA, BSc(Hons), DO, strategic advisor to the Medical Defence Union, has been selected to serve as the chair of the Medical Professional Liability (MPL) Association.

“It’s a privilege to continue my service to the MPL Association in the role of Chair,” Tomkins said. “There are challenges for the MPL industry, but there are also many great opportunities. I look forward to working with the board members and staff and to engage our members as we continue to implement the Association’s strategic plan and deliver what our members want and need from their MPL Association.”

Tomkins serves as the Strategic Advisor to the Medical Defence Union (MDU), a company run by doctors for doctors and one of the UK's leading medical defense organizations. Tomkins was in clinical practice as an ophthalmologist before joining the MDU. She served as a medicolegal adviser, head of claims, and director of professional pervices prior to her appointment as chief executive in 2009 and moved from CEO to strategic advisor in 2021.

In addition to naming Dr. Tomkins its chair, the MPL Association elected two new board members to three-year terms:

Cheryl F. Matricciani is president and chief executive officer of Medical Mutual Liability Insurance Society of Maryland and has been with the company since 2005, previously serving as executive vice president and chief operating officer and in other roles. Prior to joining Medical Mutual, Matricciani was employed by the Maryland Department of Legislative Services as a senior staff attorney for the Senate Finance Committee of the Maryland General Assembly. She received her Juris Doctor from the University of Baltimore School of Law and a Bachelor of Science degree in business from the University of Baltimore. Matricciani is a Certified Public Accountant and a member of the Maryland Association of CPAs and the Maryland State Bar Association.

LaDona M. Schmidt, MD is vice chair of Kansas Medical Mutual Company (KAMMCO). She began her career in nursing, then went on to receive her doctor of medicine from American University of the Caribbean School of Medicine. She began residency at Trinity Lutheran Hospital in Kansas City and completed it at the University of Kansas School of Medicine/Smoky Hill Campus in Salina, Kansas. Schmidt has been active in organized medicine for many years, having served on the KAMMCO Board of Directors since 2015, as president of the Kansas Medical Society from 2019-2022, as delegate to the American Medical Association, and as former International Medical Graduate representative to the AAFP. She works in a critical access rural hospital covering inpatient, outpatient and emergency medicine.

The MPL Association Board of Directors also appointed J. Michael Conerly, MD, president & CEO, LAMMICO, to serve as vice chair, Edward L. Rand, Jr., president and chief executive officer, ProAssurance Corporation, to serve as Secretary, and Joseph G. Murphy, president and CEO, Coverys, to serve as Treasurer.

Also at the meeting, MPL Association members approved Michele J. Johns, Cleveland Clinic, Agustin L. Montalvo, SIMED, and Mark E. Reynolds, CRICO, to additional three-year terms on the Board.

“We are pleased to welcome Dr. Tomkins to the helm of the Board,” said MPL Association interim president and CEO Eric R. Anderson. “She has an extensive and distinguished career in the healthcare and medical professional liability fields, and we will benefit greatly from her guidance and expertise.”

“We are also extremely appreciative of the commitments of our other new Board officers and directors,” he continued. “All of these leaders bring tremendous expertise and knowledge to the MPL Association, and we look forward to working with them as we strive to advance the interests of the MPL industry and deliver on the mission of the organization.”  

May 7, 2024 by matray

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

Colorado Considers Raising Noneconomic Damage Cap To Save It
The Colorado Senate Judiciary Committee last month approved by a four-to-one vote Senate Bill 24-130 (SB-130), legislation that would incrementally increase the state’s $300,000 cap on noneconomic damages to $500,000 over the course of five years. The bill must now clear the full Senate and the House before the legislative session concludes on May 8. Supported by the Colorado Medical Society, the state’s largest insurer of physician liability COPIC Insurance Co., and other key physician and patient advocates, SB-130 is similar to the approach taken by California in 2022 when an initiative to remove the state’s medical liability noneconomic damage cap qualified for the electoral ballot. In response, legislators brokered a compromise between healthcare, legal and consumer advocates to increase the state’s noneconomic damage cap legislatively and incrementally from $250,000 to $500,000 …

Congress Likely to Kick the Can on Covid-Era Telehealth Policies
Federal lawmakers face a year-end deadline to solidify or scuttle an array of COVID-era payment changes for telehealth services that include allowing people to stay in their homes to see a doctor or therapist. Most of the proposals focus on how Medicare covers telehealth services. But the rules affect patients on all types of insurance plans because typically private insurers and some government programs follow Medicare’s example. Without congressional action, virtual healthcare services like audio-only calls or online meetings with specialty doctors — such as an occupational therapist — could end. The bills would also continue to allow rural health clinics and other health centers to offer telehealth services while waiving a requirement for in-person mental health visits …

New Kentucky law Protects Healthcare Workers from Criminal Prosecution of Medical Mistakes
Kentucky recently passed a law shielding healthcare providers from criminal liability for any “harm or damages” alleged to have occurred from “an act or omission relating to the provision of health services.” House Bill (HB) 159 — which received unanimous support from the commonwealth’s House and Senate — protects physicians, nurses and other medical staff from criminal prosecution for medical mistakes made in good faith as they navigate patient care situations. The bill was signed by Gov. Andy Beshear on March 26 …

Physicians Fight to Keep Practices Afloat After ‘Change’ Cyberattack
The American Medical Association (AMA) last month published results from an informal survey that illuminates the ongoing, devastating impact of the February 21 cyberattack against Change Healthcare — a unit of UnitedHealthcare Group (UHG) — on physician practices across the country. And according to survey respondents, the fallout has serious implications for the survival of independent medical practices and patient care …

Study Challenges Common Assumption on Rising Maternal Mortality, AMA Lobbies for Changes
The U.S. maternal mortality rate is accelerating at an alarming rate, according to a new study from Northwestern Medicine. And it’s not because Americans are getting pregnant at older ages. The study discovered that maternal mortality increased among every age group — with the greatest relative increases among pregnant people aged 25-29 and 30-34 years old …

Senate Investigating Whether Emergency Care Harmed by Private Equity
U.S. Senator Gary Peters, chairman of the Homeland Security & Governmental Affairs Committee, last month requested information from four emergency department staffing firms — and the three private equity companies that own them — about their business practices and how those practices impact patient care. In letters to Blackstone, KKR and Apollo Global Management and their respective staffing firms TeamHealth, Envision Healthcare, US Acute Care Solutions and Lifepoint Health, Peters requested information about business operations, staffing decisions, and patient care and safety at several emergency departments across the country …

Patients’ Health at Risk as Insurers Deny, Delay Vital Treatments
To curb healthcare costs and block unnecessary services, insurers have long required doctors to obtain their approval before they’ll pay for certain drugs, treatments and procedures. But in recent years, insurers have ratcheted up their use of prior authorization, causing delays and denials of care that are harming or even killing people, many doctors and patients say …

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

April 26, 2024 by matray

The Medical Professional Liability (MPL) Association has announced that the Federation of State Physician Health Programs, Inc. (FSPHP) will receive the 2024 Award of Excellence in Physician Wellness. FSPHP is being honored for its role as a leader in the medical community, specifically to improve the health and well-being of medical professionals. The MPL Association is the leading international organization representing the medical professional liability insurance community.

FSPHP is a national association of Physician and Health Professional Programs (PHPs). The programs provide confidential assessment, referral to treatment, resources, and monitoring for physicians and healthcare professionals, and those in training who may be at risk of impairment from mental illness, substance use disorders, and other health conditions. In addition to working with participants, PHPs provide education, outreach, and advocacy to their medical communities in support of physician health and well-being.

“Physician health programs provide hope for physicians and other healthcare providers suffering with substance use disorders, mental health conditions, and suicide. They also protect the public by ensuring healthcare providers under their charge are safe to practice by providing personalized, tailored support, treatment, monitoring, and accountability,” said Michael J. Baron, MD, MPD, DFASAM, president of the Federation of State Physician Health Programs and medical director of the Tennessee Physician Health Program. “PHPs facilitate the return of healers to practice with outcome data that far surpasses that for the general population facing similar disorders. Embracing these programs isn't just about healing individuals; it's about reducing professional liability risk, ensuring patient safety, and advancing a culture of empathy, accountability, and excellence in patient care.”

“We applaud the Federation of State Physician Health Programs and stand with them in the mission to support physician health programs to improve the health of medical professionals, thereby contributing to quality patient care,” said MPL Association Board Chair John H. Mize, president & CEO, SVMIC. “On behalf of the MPL Association Board and its members, I am pleased to honor FSPHP with this award.”

The MPL Association Award of Excellence in Physician Wellness will be presented at the 2024 MPL Association Conference on May 9 in Washington, D.C.