Digital Platforms

Allstate Insurance Co., Northbrook, Ill., filed a half-million dollar lawsuit against a Philadelphia chiropractic clinic, All-Care Chiropractic, alleging fraudulent billing practices for insurance claims involving patients with personal injury lawsuits.The suit alleges that All-Care owners and operators Richard Walinsky, D.C. and Eileen Nelson Means, D.C. fraudulently billed Allstate for treatments that were never performed, over billed for services that were performed and used improperly licensed and unsupervised personnel for in-home patient visits.

Anthem Blue Cross and Blue Shield and Accenture are testing digital pen technology designed to help healthcare professionals capture and send medical claim information digitally. The solution, which is designed to complement physicians' hand-written claims process, was introduced in a two-phase pilot with Anthem plans in Indiana and Kentucky.In the first phase, health care professionals are using the pen to file claims electronically in conjunction with a desktop computer. Claims are written on specially designed digital paper forms that enable electronic data capture. The data is then uploaded electronically via a desktop computer to Anthem.

JUPITER, Fla.-- Property and casualty insurers more than doubled their profits during 2003, earning $32.3 billion compared to the $13.5 billion reported in 2002, according to Weiss Ratings, Inc., the nation's leading independent provider of ratings and analyses of financial services companies, mutual funds, and stocks.

As carriers "turn off" paper documentation and replace it with electronic information, agents and brokers are confronted with a new set of workflow challenges that can set back agency efficiency significantly unless carriers take specific steps with regard to the electronic information they provide to their sales forces.This is a conclusion of phase two of a report published by the Agents Council for Technology, a partnership of independent agents, companies and technology vendors, user groups and associations dedicated to enhancing the use of technology.

WHITE PLAINS, N.Y.--Cybersettle, the world's number one online settlement company, has been selected by CNA, the fourth largest U.S. commercial insurer, as its online settlement partner to assist with the quick resolution of commercial insurance claims.

SAN FRANCISCO--California State Compensation Insurance Fund's anti-fraud program has enabled statewide district attorneys to win more than $5 million in restitution orders. The restitution judgments are a direct result of 155 premium fraud convictions during the last six years.

HARTFORD, Conn.-- The Hartford Financial Services Group along with Ibbotson Associates, recently surveyed investors and found that eight out of 10 investors indicated that they are practicing asset allocation. However, when asked to describe what they believe asset allocation is, the majority describe simple "diversification" of assets rather than true asset allocation.

UnumProvident is now providing toll-free access for brokers to connect directly with individual disability income protection underwriters."We’re encouraging this dialogue so brokers can better understand the ‘whys’ of underwriting, and so we can better understand the individual customer," says Steve Joseph, vice president of individual disability underwriting at the Chattanooga, Tenn.-based insurance company.

NEEDHAM, MA--Until recently, regulatory compliance has been a relatively straightforward issue for U.S. insurance companies. Long deemed a service for the "public good," the insurance industry has been regulated by various entities for over 100 years - making compliance as commonplace as breathing for most insurers.

OMAHA, Neb., and HARRISBURG, Pa.-- Two leaders in the employee benefits arena -- Mutual of Omaha and United Concordia Companies, Inc. -- today announced a new line of dental insurance plans for employers of all sizes.

SAN FRANCISCO--Esurance, a direct-to-consumer personal auto insurance company, has selected ProcessClaims to provide a customized software management platform to support Esurance's expanding claims organization. Esurance believes that ProcessClaims' ClaimsPort material damage management system will increase claims handling efficiency, decrease cycle time costs, and scale with Esurance's rapid growth.

Forty-six percent of U.S. insurance organizations identified the lack of historical databases as a major cause of poor claims management, according to a recent customer poll conducted by Insurance Services Office Inc. (ISO), Jersey City, N.J. This follows an earlier ISO poll in which 78% of insurance organizations said reducing the rising cost of claims handling is their single most important goal for 2004.The poll asked insurance organizations to identify the most likely reason for paying injury claims incorrectly. Of the five options, just under half (46%) identified lack of historical databases as a major cause, and 20% cited lack of medical knowledge as the second most probable reason. Sixteen percent said inadequate negotiation skills, while 13% cited claims adjusters' inexperience.

Following the first quarter of integration activities, Prudential Retirement, a business of Prudential Financial, Newark, N.J. has moved out of the initial planning phase of integration and is now focused on the next phase, implementation of enhanced products and services for the retirement markets it serves."In just about 100 days, we've built the foundation for a new, stronger, and more dynamic Prudential Retirement," says John Y. Kim, president of Prudential Retirement. "In fact, strategic plans have been completed for all full-service retirement businesses, each of which is now working hard to enhance existing products and develop new ones," he adds.

Group Health Incorporated (GHI), a statewide not-for-profit health insurer in New York, has launched several new initiatives that improve customer service for its members, from 100% online plan enrollment to disseminating important coverage updates through brief automated phone calls.GHI has partnered with Sunnyvale, Calif.-based eHealthInsurance Inc. to enable individuals and small businesses to purchase health insurance coverage with GHI online, in real time and without any printing, signing or mailing of forms. Applicants simply log on to www.eHealthInsurance.com, submit the required data, credit-card information for the first month's payment and authorize the transaction with an "e-signature." Approved applicants are covered beginning on the first day of the next calendar month.

New York--The Catastrophe Risk Exchange International, Inc. (CATEX) announced today that it has completed delivery of a Web based Property Aggregate Monitoring System to facilitate the underwriting of facultative property business by the reinsurer QBE Reinsurance Corporation (QBE).

SOMERS, NY --IBM today unveiled new PartnerWorld Industry Networks for independent software vendors (ISVs) focused on the government and insurance industries. IBM also introduced new technical offerings and expanded initiatives that can help ISVs participating in the PartnerWorld Industry Networks speed solution development and ensure interoperability with IBM's middleware portfolio.

CHATTANOOGA, Tenn.-- UnumProvident has received a top ranking for the success of its individual income protection insurance sales, according to JHA's 2003 U.S. Individual Disability Market Survey.

NEW YORK-- Swiss Re's chief economist said today that strong economic growth, coupled with a slight uptick in inflation, will force the Federal Reserve to raise the federal funds rate to close to 2 percent by the end of 2004.

The Guardian Life Insurance Co, of America, New York, has selected iLinc Communications Inc. to provide Web conferencing for the insurers' 5,500 employees and 2,800 financial representatives in 94 agencies nationwide.Phoenix-based iLinc Communications offers integrated Web and audio conferencing solutions using a combination of Secure Sockets Layer (SSL) and Advanced Encryption Standard (AES) that can reside inside an organization's network. This combination provides end-to-end security for all data, video, and voice-over-IP exchanged within an online meeting, according to iLinc.

SPOKANE, Wash.-- Itronix Corp., a developer of wireless, rugged mobile computing solutions, announced today that its GoBook II wireless, rugged laptop has been certified by the insurance industry's top three software providers, including ADP Claims Services Group, a wholly owned subsidiary of Automatic Data Processing, Inc., CCC Information Services Inc., and Mitchell International Inc.

FORT WASHINGTON, Pa.-- Coventry First, the creator and leader of the secondary market for life insurance, today applauded the National Association of Insurance Commissioners for overwhelmingly approving a new Model Regulation which governs life settlements.

WELLESLEY HILLS, Mass. -- Sun Life Financial announced today that Sun Life Assurance Company of Canada (U.S.) a member of the Sun Life Financial group of companies, has launched Sun Life Financial Masters, a re-branding of its variable annuity line.

The Hartford Financial Services Group Inc., Hartford, Conn., has enhanced its small commercial automation to make quoting and submitting new business applications faster and easier for independent agents--whether they connect to the Internet from their office, their customer's place of business or on the road.According to The Hartford, its ICON 2.0 electronic quoting and submission system offers agents Web-based access, efficient navigation, and a host of integrated features that streamline the submission process for the company's key small business coverages. Those include Spectrum business owners' policy, workers' compensation and commercial auto. Similar support for The Hartford's new "Xpand" products is currently being piloted.

ATLANTA-- SellingLTC.com, LLC, the leader in providing long-term care sales and marketing solutions for insurance producers, today announced the release of its new LTCI Mobile Support feature which allows SellingLTC.com subscribers to download the best of SellingLTC.com's sales support modules to a laptop computer and access the information even when it's not possible to access the Internet.

NEW YORK -- Technology has become critically important to how insurers manage risk, share information with producers and support Internet sales and customer service, a panel of carrier CEOs said June 16 at Standard & Poor's 20th annual insurance seminar in New York City.

Worcester, Mass.-based Allmerica Financial has selected Clarity IT service configuration management software from Relicore Inc., Burlington, Mass., for enhanced change management capabilities for some of Allmerica's most mission-critical business applications.Allmerica is using Relicore Clarity to track operational changes in its point of sale and underwriting workflow systems used by its independent insurance agents to originate and change policies. Allmerica's initial implementation is focused on gaining better control of hardware and software configurations, with a future goal of ensuring that IT staff members are proactively notified of changes that happen outside of approved change windows, and that they fully understand the impact of proposed changes to this environment prior to implementation.

Add Hawaii and New Hampshire to the list of states enacting legislation to adopt the Interstate Insurance Product Regulation Compact. The Aloha and Granite states join Colorado, Iowa, Maine, Utah, Virginia and West Virginia in taking up the measure, which creates uniform national product standards and provides a central point of filing for insurers.Twenty-two more states currently are considering enactment of the Interstate Compact.

In their quest to expand their long-term care (LTC) products lines, many insurers have been challenged not only by the risk management and underwriting aspects of the coverage, but they've also struggled with finding the best agents tp market this coverage.

The quantity of filings submitted through the System for Electronic Rate and Form Filing (SERFF) continues to multiply as an increasing number of state regulators and insurers recognize the system as a much-needed solution to for addressing cost efficiency, accuracy, and ease of status tracking.As of May 31, 2004, over 50,000 filings had been submitted via SERFF, nearly twice the number of filings submitted during the first five months of 2003. It is anticipated that approximately 155,000 filings will be submitted by year-end 2004, according to the National Association of Insurance Commissioners (NAIC), Kansas City, Mo.

The National Association of Insurance Commissioners (NAIC), Kansas City, Mo., has submitted a detailed framework document to House Financial Services Chairman Michael Oxley, delineating several ongoing and proposed steps to create an effective, state-based national system of insurance regulation."We have been asked by Chairman Oxley to directly assist in the committee’s process of evaluating the modernization of state insurance regulation, and we have pledged our time and our full resources to move the regulatory process forward in a manner that benefits consumers and the industry," says Ernst Csiszar, NAIC president and South Carolina director of insurance.

MELVILLE, N.Y. -- AutoOne Insurance, a Limited Assignment Distribution (LAD) servicing carrier accepting assigned risks on behalf of client insurance companies, announced today that they are expanding their LAD services into other states and new markets. Assigned risks are those drivers who are unable to obtain automobile insurance in the voluntary market. AutoOne currently offers LAD services to automobile insurance companies in New York and New Jersey.

HARTFORD, Conn. --The Hartford Financial Services Group received a subpoena today from the Office of the Attorney General of the State of New York seeking information on compensation agreements between insurance brokers and the company. The Hartford intends to cooperate fully with the inquiry.

Seattle-based Safeco Corp. and Aon Risk Services have introduced an online interface designed to improve communications between the two companies, thereby improving service for risk managers and contractors.By making it easier to report new bonds, and eliminating errors in the renewal and billing of in-force bonds, Aon and Safeco will reduce the day-to-day involvement of risk managers and contractors without compromising their control.

Manulife Financial Corp., Toronto, has selected CGI Group Inc., Montreal, to create an information technology support centre in Halifax, Nova Scotia. The mission of this centre of expertise will be to provide systems development, maintenance and integration services to Manulife and other CGI clients in the U.S. and Europe.The memorandum of understanding, when finalized as a contract, would be valued at $120 million (Canadian) for a five-year agreement. As part of the agreement, 300 Halifax-based technology professionals will join CGI in September 2004. Over time, CGI expects to grow employment at the centre to 500 technology professionals.

EXTON, Pa. -- Guarantee Trust Life Insurance Company's (GTL) Impaired Risk Division has contracted with iPipeline to syndicate their insurance forms and product information to its distributors' Web sites. GTL Impaired Risk has also taken advantage of iPipeline's proprietary Web-based forms and database software, as well as their Web professional services to completely redesign its Web site, giving GTL's impaired risk producers greater access to the tools they need.

UnumProvident Corp, Chattanooga, Tenn., has selected customer data integration (CDI) software from Atlanta-based DWL Inc. The software, DWL Customer, will provide consolidated views of customer and producer information across UnumProvident's multiple lines of business.UnumProvident will be using DWL Customer, an enterprise customer hub to replace and enhance its existing customer index, providing increased availability to information currently contained in more than 30 business systems.

DriveCam Video Systems, a San Diego-based developer of fleet safety technology designed to improve driving behavior, reported a 120% increase in revenue for the first quarter 2004 over the same period in 2003 due to growing demand for its products and services.To support demand, the company has added new staff in safety services, sales, engineering, product management, customer service and administration while increasing its facilities. The new staff members will work with DriveCam fleet customers to maximize the results of the DriveCam Driving Feedback System in reducing collisions and lowering operating expenses.

To support insurers’ initiatives in the health savings account (HSA) market, Portland, Ore.-based MyHealthBank is collaborating with HSA Bank, Howards Grove, Wis., to provide insurers with a highly integrated banking and technology offering for health savings account-based plans.Through this relationship, MyHealthBank will integrate technology from HSA Bank for health savings account banking transactions with MyHealthBank’s Unify platform, a Web-based, self-service platform for broker quoting, member enrollment and benefits administration.

ViPS Inc., a Baltimore-based provider of business intelligence solutions for healthcare and life science companies, has signed a multi-year licensing agreement with Medical Mutual, a Cleveland-based health insurance company, for the ViPS anti-fraud software, STARSentinel.STARSentinel is an early-warning detection system that surveys health plan data and evaluates claims in the light of provider claims' histories, specialty profiles and the most common, documented fraud schemes. By calling questionable patterns to management's attention, STARSentinel helps prioritize cases so the plan's financial investigations department use its resources more productively.

ICICI Infotech Ltd., an Edison, N.J.-based IT solutions provider, has signed an agreement to implement its PREMIA 10.0 system for Comercial America Insurance Co. (CAIC).PREMIA 10.0, has been tailored for the U.S. insurance industry, and combines a modular application software solution with a single, integrated system. Beneath a consistent presentation layer, PREMIA 10.0 provides business functionality that supports rating, quoting, underwriting, binding, billing, endorsing (including out-of-sequence), claim administration, reinsurance management, and general ledger accounting. PREMIA 10.0 also delivers enhanced reporting and an improved capability to integrate with existing systems.

Computer Sciences Corp. (CSC), El Segundo, Calif., has signed a seven-year agreement with Trinity Universal Insurance Co., a subsidiary of Chicago-based Unitrin Inc. CSC will support Unitrin Multi Lines Insurance's commercial lines of insurance with business process outsourcing (BPO) and Internet-based services.A CSC client since 1982, Unitrin Multi Lines Insurance, which provides insurance products in 30 states, used CSC's technology to establish its X-Sell-A-Rate agent Web site two years ago. Under the new agreement, CSC will help Unitrin extend its Web capability to include a full range of commercial insurance services to more than 2,000 independent agents.

Answering the market's call for security, The Manufacturers Life Insurance Company of New York introduced Manulife New York Survivorship UL-G, the Company's first survivorship universal life insurance product to offer lifetime guaranteed coverage.

Madison, Wis.-based CUNA Mutual Group is using a high performance database engine from Objectivity Inc., Sunnyvale, Calif., for its credit union member database. The Objectivity-based service provides CUNA Mutual with an improved ability to track customer records and help its sales staff cross-sell financial services products.Called Objectivity/DB, the engine has enabled CUNA Mutual to build a scalable application that generates a unified, consolidated view for each individual credit union member. With Objectivity/DB, CUNA Mutual provides an integrated set of product offerings tailored for each individual. The system enables CUNA Mutual to access comprehensive credit union member histories as well as provide members with products and services customized for their individual circumstances.

Noodle Specialty Brokers (NSB), a new division of Chicago-based e-broker InsuranceNoodle Inc., has been created to offer professional liability and specialty small commercial property/ casualty insurance products nationwide using technology developed by InsuranceNoodle.Based on InsuranceNoodle's proprietary single entry (SEMCI) technology, Noodle Specialty Brokers provides retailers and wholesalers online access to specialty small commercial products not available from national standard lines small commercial P&C carriers. NSB will offer admitted and non-admitted products as a program manager for nationally recognized carriers.

AIG Technologies Inc. (AIGT), Livingston, N.J., has expanded its Web-based Automobile Liability Insurance Reporting (ALIR) system to support South Carolina's recently announced automobile liability reporting mandate.AIGT's ALIR system enables insurance carriers nationwide to electronically report personal and commercial automobile insurance verification and cancellations.

American United Life Insurance Co. (AUL) has licensed the Visual Product Modeling System (VP/MS) from Computer Sciences Corp., El Segundo, Calif. The Indianapolis-based financial services company will use VP/MS to simplify development of new life insurance products. More than 20 organizations in the United States and Canada have selected VP/MS."We expect VP/MS to transform not only how we design new products, but the products themselves," said Emet Talley, AUL vice president of information technology. "It will also give our actuaries more flexibility in designing life offerings, allowing us to add the bells and whistles that answer market needs."

Newark, Calif.--Prospects for an active hurricane season in 2004 reinforce the need for sophisticated storm tracking and modeling capabilities, Risk Management Solutions (RMS) said today.

A few years ago, when senior executives took to the podium to report their companies' earnings, no one really questioned if they were telling the truth. Today, because Enron, WorldCom and other companies have so blatantly duped investors, the federal government is hovering over them, saying "Prove it."With the threat of criminal penalties, the Sarbanes-Oxley Act of 2002 (SOX) holds senior executives personally accountable for the accuracy of their companies' financial statements. The law also requires publicly traded firms, including insurers, to document and test their internal financial controls, and report within 48 hours any "material" events or weaknesses that may affect their earnings.

For most insurers, there's a natural inclination to settle claims swiftly, particularly to satisfy customers who might take their business elsewhere. But as insurers improve claims processing time, ironically, many are paying a high price.To their chagrin, efficiencies surrounding claims settlement can actually produce negative results. Ultimately, many carriers find themselves dispersing dollars that shouldn't have been paid in the first place, due to claims fraud.

As insurance CEOs mull over their IT teams' plans to purchase new technologies, inevitably the decision boils down to this: What's the financial upside? It's an important question to ask, although a clear quantifiable answer is often hard to come by. However, two articles in this issue-fraud detection and financial reporting-offer clear-cut reasons for why insurers should consider implementing these business-supporting technologies.Fighting fraud is a multi-billion-dollar challenge for the insurance industry. Some estimates calculate the total annual cost of fraud across health, life and property/casualty lines is between $85 billion and $120 billion.

With public concern about credits scores far from extinguished, 11 state insurance departments-dubbed "the coalition of the willing"-are planning to conduct their own multi-state study of the effects of credit-based insurance scoring on consumers.The 11 states-Alabama, Indiana, Louisiana, Maryland, Michigan, Missouri, Montana, Nevada, Oregon, Washington and West Virginia-have issued calls to insurance companies for individual policyholder data in order to conduct their research on the effects of scores, which insurers use to price auto and homeowners policies.

Managed care companies across the United States continue to await a ruling on a series of class-action lawsuits alleging that the nation's largest managed care companies violated the Racketeer Influenced Corrupt Organ-izations Act (RICO).Filed in the U.S. District Court Southern District of Florida, the litigation claims that managed care companies violated the RICO Act by conspiring to reduce and delay claims payments to network physicians. One allegation lodged by a plaintiff physician, for instance, claims that managed care companies used billing software to automatically "bundle" several CPT (Current Procedural Terminology) codes and, in turn, failed to reimburse the physician for all services rendered.