Digital Platforms

Ask not for whom the bell tolls; it tolls for carriers' legacy systems. At least that's the conclusion of a survey conducted by Guidewire Software Inc., a San Mateo, Calif.-based Web-based claims system provider.Three-quarters of property/casualty and workers' compensation carriers are engaged in significant claims system projects, according to Guidewire (see chart). "Mid-sized carriers are really biting the bullet-looking at what's in front of them and starting to take steps," says James Kwak, vice president of marketing at Guidewire. "So we're seeing many of them looking at replacing their claims systems."

As insurance companies develop a blueprint for compliance to the Sarbanes-Oxley Act, an alarming number of U.S. corporations admit they are still uncertain about how they plan to adhere to the mandate.Moreover, industry experts believe that insurers who disregard the role of technology to comply with the Act might be in for a rude awakening.

In the past, insurers could write off fraud expenses with investment income and capital reserves. But those days are over. Reduced investment income and reserves have forced insurers to face such operational bugaboos as fraud and subrogation head on. Fortunately, insurers ahead of the curve have identified technology-based strategies to get to the heart of the matter.

The term "Web service" was coined only three years ago, according to Celent Communications Inc. And, already, U.S. insurers are spending roughly $78 million--or 5% of their integration dollars--on Web services-related initiatives (see "Web Services Spending By Insurers," page 14).What's more, by 2006, more than 40% of insurers' new systems integration spending will involve Web services, the Boston-based research and advisory firm predicts.

Rising somewhat like the Phoenix, an alternative bill that would provide compensation for workers injured by exposure to asbestos clawed its way through Congress in mid-October.Accepting a proposal drafted by Senate Majority Leader William Frist, R-Tenn., and his aides, insurers and defendants accepted a proposal on Oct. 16 to seed a trust fund projected to have enough capacity to settle $115 billion in claims over 27 years.

Forty years ago, mischievous adolescents got their kicks by calling people on the phone and asking them, "Do you have Prince Albert in a can?" Today, they concoct computer viruses and worms designed to knock out the networks of global corporations.

One of the core activities regularly performed by insurers-its telemarketing efforts is about to undergo modifications now that the federal Do Not Call (DNC) list has been given the green light for national enforcement.In October, a federal appeals court ruled that the Do Not Call registry-a list that currently includes about 50 million phone numbers-was within the legal boundaries of the Federal Trade Commission (FTC) and Federal Communications Commission (FCC).

After a prolonged lull in activity, consolidation in the insurance industry--marked by a new wave of proposed mergers and divestitures--appears to be gathering newfound momentum, with two major developments illustrating the potential changes that loom ahead.In late September, the board of directors of Boston-based John Hancock Financial Services Inc. and Manulife Financial Co., based in Toronto, unanimously approved a tax-free, stock-for-stock merger of the two financial services giants.

Information technology strategy plays a critical role in the success of American Modern Insurance Group Inc. (AMIG), a wholly owned subsidiary of The Midland Co., Amelia, Ohio.The provider of specialty personal lines insurance products has an average annual premium of just $450 across its book of business. So having information technology in place "so that the business can flow relatively untouched by human hands is critically important to us. There's not enough money in a $450 premium for us to have to fondle each file," says John Hayden, CEO and president of The Midland Co., and president, CEO and chairman of AMIG.

Never has the need for retirement planning been as great as it is today. Traditional sources of income such as Social Security and pensions will fail to meet the spending needs of future retirees.These factors portend a market of investors that will increasingly demand advice and guidance on the complexities inherent in retirement income planning.

In a California intellectual property lawsuit that could have sweeping implications over the way insurers and vendors approach software licensing agreements, a federal judge in late August granted a preliminary injunction barring San Diego-based Arrowhead General Insurance Agency from using insurance pricing software developed by a La Jolla, Calif.-based software solutions provider.In ruling against Arrowhead, a privately-held managing general agency, Chief Judge Marilyn Huff of the U.S. District Court for the Southern District of California prohibited Arrowhead's unlicensed use of the software in online insurance applications, including its Web-based distribution platforms, Arrowhead Exchange and YouZoom.com.

Privacy advocates will have to pin their hopes on Senate Banking Committee Chairman Richard Shelby, R-Ala., if they want to see national privacy standards enhanced through legislation extending provisions of the federal Fair Credit Reporting Act (FCRA) that expire at the end of this year.The House in September passed its version of FCRA legislation, via the Fair and Accurate Credit Transactions Act, using the measure more as a vehicle to provide citizens with increased protection from, and remediation for, identity theft.

Advocates of the use of credit scores in personal lines underwriting and rating could be excused if they are feeling a bit under siege lately.The industry has been generally pleased with the actions of state legislatures that have supported carriers' use of consumers' credit information for approving policies and setting policy rates.

Acordia Inc., the insurance agency arm of Wells Fargo & Co., sent a clear message in September that its integration with Wells Fargo is complete and it is once again an active buyer of agencies.Last month, Acordia announced three deals for agencies in Texas, Nebraska, and Pennsylvania. These purchases came on the heels of the purchase of a fourth agency, in Omaha, Neb., in August.

Insurers long ago developed tools to perform risk modeling for natural disasters such as floods, hurricanes and tornadoes. But Aon Corp. has launched a different kind of venture to help its clients reduce workplace violence.Realizing the great amount of pressure on its corporate clients to understand the dynamics that contribute to workplace aggression, Aon in July aligned itself with the Center for Aggression Management (CAM), a Winter Park, Fla.-based organization dedicated to identifying, measuring and preventing risks related to workplace aggression and violence.

Although the federal government granted the healthcare industry an extra year to comply with the transactions and code set rules mandated under the Health Insurance Portability and Accountability Act (HIPAA), experts say a procedural mess is set to occur on Oct. 16.That's the date for the HIPAA deadline-which originally was set for Oct. 16, 2002-for health plans, providers and clearinghouses to cease processing proprietary transactions and use only standardized transactions that comply with the 1996 law.

AnnuityNet Inc., the top-selling Web-based annuity distribution provider, has worked diligently over the past two years to distance itself from its nearest competitor-Info-One/VARDS.Deploying a dynamic front-end Internet distribution platform emphasizing "paperless accuracy," Herndon, Va.-based AnnuityNet has leveraged its technology to enable it to increase its sales of both fixed and variable annuities from 164,500 by the end of 2002 to 243,000 by the end of July.

Insurers are becoming insular with information technology maintenance and investment priorities. Referring to it as internal "housecleaning," Cary, N.C.-based Sapiens International Corp. states that U.S. insurers are shifting gears to emphasize internally-driven IT efficiencies as a better way to control costs.Findings from a recent survey conducted by Sapiens, a global IT solutions provider, reveal that externally focused activities, such as business process outsourcing (BPO), customer relationship management (CRM), and standards implementation-such as ACORD XML, now rank significantly lower on the IT priority scale than internal initiatives.

In today's tough economic climate, insurers are striving to increase productivity and efficiency while keeping expenses in check. And, due to escalating competition, they are also doing more to retain existing customers.As a result, many employees are overwhelmed by the challenges of finding and delivering the right information to customers when, where and how it is needed.

No one would argue against the fact that the insurance industry has been engulfed in a perfect storm over the past few years. Consolidations, monumental loss experiences, economic turmoil and investment declines have conspired together as never before.Faced with a hard market, staff and training reductions, and stagnant capital and IT budgets, insurers are under greater pressure than ever to work smarter, faster and more efficiently.

Most insurers rely on external guidance to help them map out information technology strategies. Over the years, they've derived such support from vendors, consultants, analysts and even state and national associations-all of whom possess a unique role in the grand scheme of IT strategizing.But a fledgling group that's touting itself as an "IT advisory and research firm" for property/casualty insurers is providing yet another alternative. The question is: Will P&C carriers embrace the concept widely enough to enable it to succeed?

The nation's largest insurers together received a mediocre score for online customer respect. But the good news is: The banking and securities sector, as well as Fortune 100 firms overall, didn't ace the test either.This assessment comes from The Customer Respect Group Inc., a Bellevue, Wash.-based research company that studies the Web sites of Fortune 100 and Fortune 1000 companies. The group gave insurers among the Fortune 1000 a 6.8 overall customer respect index (CRI) for their Web sites, while financial services firms scored 6.7 and Fortune 100 firms scored 7.0.

With trading volume reportedly far below management's expectations, Web-based reinsurance risk-trading hub inreon was terminated in early May, leaving two players to service the global online reinsurance risk-trading market.London-based inreon was launched in December 2000 as a partnership between global reinsurers Munich Re, its U.S. subsidiary American Re, and Swiss Re. But according to industry sources, the decision to close inreon down came when the reinsurance giants concluded that the service would have a difficult time turning a profit-both short- and long-term.

Although the Sarbanes-Oxley Act of 2002 is focused primarily on financial reporting and accounting processes, the law is forcing publicly traded companies to assess their IT systems too.Thanks to the transgressions at Enron, WorldCom and other now notorious corporations, all publicly traded companies in the United States-including insurers-are in the throes of trying to determine how to comply with the law that was passed to deter such corporate malfeasance in the future.

Rules-based underwriting systems are designed to reflect the logic of the best and most experienced underwriters. In this way, they can provide agents and customer service representatives with the appropriate questions to ask applicants, and enable the company to more accurately and efficiently assess risk. But what if the data the applicant provides is wrong?"The problem with technologies such as rules-based systems or efforts to streamline information flow to agents is the matter of the quality of the information," says Daniel Finnegan, Ph.D., and president and founder of Quality Planning Corp. (QPC), San Francisco. "You can make all the rules you want, but if you don't get the data right, the outcome is wrong."

If the laws of physics hold that for every action there is an equal and opposite reaction, then the laws of business hold that for every reaction, there can be unexpected consequences.An unexpected consequence of the recent spate of insurance company demutualizations is the renewed interest by state governments in newly revealed unclaimed property. At first blush, states would seem to have limited interest in how a mutual insurance company chooses to structure its capitalization.

Humana needed to replace its outdated billing system that relied mostly on paper and snail mail. Today Humana offers its employer-group customers an easy-to-use e-billing alternative that's available in real-time on the Internet.Back in 1999, Humana Inc. began to implement a wide-ranging e-business strategy that would include customer self-service features across its spectrum of business lines.

In an effort to become comprehensive financial service providers, some large insurers have taken an aggressive approach by forming their own banks.Banks, on the other hand, have carried out insurance expansion more conservatively-mainly through the acquisition of large agencies to drive insurance-product distribution through the bank branch.

At the recent ACORD technology conference, keynote speaker Larry Downes offered a theory that information technology spending shouldn't be curtailed just because operating conditions are poor.Downes, a technology strategist, noted that technology should not be perceived "as an obstacle within a business," adding that insurers "can't save their way to success" by scaling back on IT investments.

The mere mention of a data warehouse has often caused even the most unflappable insurance carrier executive to break out into a cold sweat.In recent years, the failure rate of data warehousing projects in the insurance industry has been a dubious distinction, owed in no small part to insurers' inability to effectively plan and execute such projects. Considered "data rich yet information poor," insurers have struggled to create data warehouses that can truly tap into the power of their customer data.

For years, Hispanic consumers have had to settle for "Americanized" versions of a wide variety of consumer goods-financial services products included. But as the Hispanic population in the U.S. rapidly ascends, industry experts insist that insurers must adopt new selling strategies to fully capitalize on a ripe opportunity.By the year 2025, Latinos are expected to represent the largest minority group in the United States. And, as this growth emerges, some insurers have begun to customize products to meet the needs of this burgeoning ethnic demographic group.

Using Global Positioning Satellite (GPS) and cellular communications technology to gather information about when and where a motorist is driving, United Kingdom-based insurer Norwich Union is launching a pilot study this summer that could play a role in transforming the way auto insurers underwrite policies.Called "Pay As You Drive," the two-year study will involve retrofitting the cars of 5,000 Norwich Union policyholders with a "black box" that will gather and transmit vehicle and driving data to the insurer's back-end systems. Norwich Union statisticians will then analyze the data to determine which variables affect risk and claims, and those results will be used to calculate usage-based premiums.

At this time of economic and operational uncertainty, many global insurers are scurrying to identify-and then rectify-vulnerable components of their operations.In April, executives at Boston-based John Hancock Financial Services Inc. believe they made a key decision to help restore stability to the operation when the carrier inked a multi-year agreement to implement IBM Corp.'s e-business on-demand solution.

Already on the defensive about the use of credit scores for underwriting, property/casualty insurers now face another assault on one of their prime data tools in the nation's largest market for homeowners insurance.In late April, California Insurance Commissioner John Garamendi all but banned carriers' use of the main data source to underwrite and rate homeowners insurance policy. For 11 years, the Comprehensive Loss Underwriting Exchange (CLUE) has tracked claims on properties and property owners supplied by carriers of the nation's homeowners insurance policies.

Last year, for the first time, more than 50% of banks in the United States produced some sort of insurance revenue.According to a "Bank Insurance Fee Income Report" from Michael White Associates, 4,359, or 52%, of all commercial banks or federally insured savings banks in the United States generated revenues through insurance sales.

We are living in interesting times. The U.S. insurance industry is in a state of transformation as the competitive landscape changes. This transformation presents a significant upside market opportunity for insurance companies.The industry is very mature, has rich customer information, established distribution channels, favorable product positioning, and years of sound business practices and solid investment reputation.

Let's face it. During an economic downturn, every dollar earned, spent or saved seems to carry more weight than it does when the economy is growing. With more financial pressure on carriers these days, IT departments are under more scrutiny to rationalize projects and expenditures.Rationalization translates into greater discipline in measuring and managing the costs of IT hardware, software and projects-and the desire to get a more comprehensive, enterprisewide picture of those assets.

In response to how Allstate Insurance Co. handled its employee-agents during its reorganization in 1999 and 2000-and to prevent other employers from repeating that action-the Employee Benefits Protection Act of 2003 was introduced in Congress in March.The Northbrook, Ill.-based carrier reorganized the company to reduce expenses by $600 million annually, to bring its agents under one program, and to integrate its agency force, direct response call centers, and the Internet. As part of that plan, Allstate terminated 6,400 employee-agents in June 2000, and offered them the option to convert to independent contractor status.

Most insurance e-business solutions providers have long considered investments in Web-based insurance distribution outlets as bold and risk-taking strategies to enhance their corporate fortunes.This belief didn't deter Brookfield, Wis.-based Fiserv Inc., an information management systems and services provider, from acquiring Falls Church, Va.-based ReliaQuote Inc., an Internet-based insurance agency and brokerage that dabbles in term insurance. Consummated in April, the terms of the deal were not disclosed.

Life insurers are seeking quick and painless solutions for compliance with the USA PATRIOT Act, which requires insurers to develop and implement anti-money laundering (AML) compliance programs intended to disrupt financial networks that support terrorist groups.How they plan to achieve it is the next hurdle: will life insurers decide that it's more prudent to develop a compliance program in-house or seek third-party support? A survey released in February by Gartner Inc., Stamford, Conn., focused on how enterprises choose their anti-money laundering software, whether they were pleased with their choices and whether they were able to remain within their budgets.

The insurance industry could learn as early as this week the broad outlines and ballpark costs of the so-called third wave of asbestos litigation.That's the timeline Sen. Orin Hatch, R-Utah, chairman of the Senate Judiciary Committee, has established for drafting proposed asbestos litigation legislation as he has woven his way between industry, insurer and labor interests in an effort to forge consensus legislation that will pass the Congress.

Facing a mandate to reduce their loss exposures for a variety of reasons-from the threat of terrorism to the need to secure better insurance coverage terms-risk managers are upping the ante on loss control spending.A survey of nearly 400 risk managers conducted by Warren, N.J.-based Chubb Group of Insurance Cos. revealed that nearly 50% of respondents increased their loss control spending over the past year; 34% held their budgets constant; and 5% decreased their loss control spending.

Before the passage of the landmark Gramm-Leach-Bliley legislation in 1999, several insurers received clearance from the federal government to operate online thrift institutions. Executives with Principal Bank of Des Moines, which opened for business in February 1998, say the brand-name backing of its parent and a growing acceptance of online banking will help it grow to $5 billion of assets by 2005.Principal Bank, owned by Des Moines, Iowa-based Principal Financial Group, had $1.5 billion of assets at the end 2002-compared with $100 million in January 2000. "We had expected, when the initial strategic plan was put together, to be about $100 million at year four," says Barrie Christman, Principal Bank's president and CEO.

Everyone knows the numbers by heart: Insurance fraud costs property/casualty carriers an estimated $27 billion each year, or roughly 10% of premiums collected.The tricky part is detecting fraud so that some of those losses can be redirected to the bottom line. In the world of auto repair, fraud rears its head higher during dicey economic times like now when folks are hurting for money.

Fraud can be subtle and complex. It can be hidden among voluminous amounts of data. New schemes are always emerging. Insurers understand the impact of fraud and consider it a serious problem.Fraud management technology that uses predictive modeling to identify suspicious claims can accurately cull out high-risk claims and label them at the earliest possible moment. It not only makes it practical for insurers to process and close the vast majority of claims faster, it focuses the adjusters review on claims that require the most attention. Lastly, it provides higher quality referrals to investigative units.

The quiet catastrophe of insurance fraud is gaining more attention as insurance executives continue to look to operational efficiencies-rather than investment income-to protect their bottom lines.With the Coalition Against Insurance Fraud (CAIF) estimating an annual fraud cost of $80 billion dollars, the industry has realized that the harmless fudging of a million here and a million there is adding up to real money.

In an effort to reduce internal IT costs, more insurers are considering buying packaged software-as opposed to building customized applications.However, many executives in the industry-those evaluating packaged software solutions-may not be familiar with vendors and products that are available. Therefore, they may have difficulty assessing them.

The typical profile of a perpetrator of fraud has been that of trained con artist who plans his or her scheme in a calculated fashion. But a new study depicts insurance fraud not only as a sophisticated ring carried out by professionals but as an act often executed by mainstream insurance customers.The study, by Bermuda-based consulting and technology solutions provider Accenture, found that nearly one in four U.S. adults say that overstating the value of claims to insurance companies is acceptable, and more than one in 10 say they approve of submitting insurance claims for items that were never lost or damaged or for treatments that were not provided.

As concerns over asbestos liability continue to mount, industry observers say carriers need to find solutions to manage the risk-other than just throwing money at it.Insurance Services Office Inc. (ISO) estimates that newly incurred asbestos loss and loss-adjustment expenses rose from $1.4 billion in 2000 to $3.7 billion in 2001. Based on partial data, Jersey City, N.J.-based ISO estimates newly incurred asbestos losses more than doubled in 2002, rising to about $8 billion.

With technology playing an increasingly important role in the modernization and standardization of the 50-state system of insurance regulation, officials from the National Association of Insurance Commissioners have decided the time is ripe for development of standards that can make the process more seamless.The National Technical Architecture working group started work early this year on standards that will be mandatory for information projects developed directly for the Kansas City, Mo.-based NAIC, and serve as a guide for state and industry efforts that target national regulatory interoperability.

The most important aspect of getting the back-office policy administration system up and running in eight months-without delays, excuses and empty promises-was a project protocol that Security Benefit Group followed."The piece that made it successful was project management guidelines that we followed," stresses David Keith, senior vice president and CIO for Security Benefit Group, Topeka, Kan.

A year ago, health insurers, health plans, providers, hospitals and clearinghouses collectively were heaving a sigh of relief.That's because they were granted the option of applying for a one-year extension to comply with the standardized transactions and code set rules of the Health Insurance Portability and Accountability Act (HIPAA).