Claims

  • Toronto, Ontario - Pink Elephant, provider of IT management best practices, plans to launch ISO/IEC 20000 Essentials, a new course that will help organizations understand the benefits of adopting a quality approach to IT, as defined by the first global standard for IT Service Management, ISO/IEC 20000. Published by the International Organization for Standardization (ISO) in 2005, ISO/IEC 20000 is directly linked to the IT Infrastructure Library (ITIL), the best practices framework that focuses on aligning IT with the business, resulting in greater productivity and reduced costs. Despite the many strategic advantages, implementing ITIL has also been met with several challenges; primarily, gaining both management and staff support for a process improvement project. "By demonstrating a commitment to quality IT service provision, organizations can gain a competitive edge through ISO/IEC 20000 registration. We're seeing more RFPs that include this standard as a prerequisite," says Pink Elephant president David Ratcliffe. "ISO/IEC 20000 also plays an important role in preparing organizations for audits. With these two benefits alone, the executive team and IT staff can make a clearer connection between ITIL and how it addresses actual business pressures and concerns." The new ISO standard also allows the organization at large to receive recognition for following ITIL best practices, whereas before only individual ITIL certification existed; therefore, ISO/IEC 20000 represents a level of excellence that can be felt across all departments and is not limited to IT or its ITIL-certified practitioners. Pink Elephant's ISO/IEC 20000 Essentials is aimed at: * IT department staff of an organization that is considering or is already ISO/IEC20000 certified, so as to understand the breadth, depth and integration between the processes; * Contracts managers looking to construct RFPs to include ISO/IEC20000; the course will help explain what is involved in the standard; * Senior IT Managers, who will understand the importance of adopting a quality approach to Service Management and understand the value of ISO/IEC20000 accreditation; * Anyone involved in service provision; this course will show how ISO/IEC20000 will enable you to transform the service provision using best practice from ITIL and ISO9000. More information about course dates and locations, and in-house deliveries, will be available soon. Please visit www.pinkelephant.com for the latest updates or call 1-888-273-7465. For more information about ISO/IEC 20000, please visit www.iso.org. Source: Pink Elephant

    April 26
  • Schaumburg, Ill. - Zurich announced the debut of eZ Transition, an online tool that bolsters the effectiveness of Zurich's return to work (RTW) program and supports a wide range of employers' RTW practices. According to a company statement, employers can use eZ Transition to generate customized RTW policies and procedures, create job description profiles with physical job demands, develop temporary transitional work assignments, develop RTW implementation and training materials, and access Americans With Disabilities Act information and state-specific Family and Medical Leave Act data. "Effective RTW programs like Zurich's can save 10-40% of workers' compensation medical costs and 14-25% of wage replacement costs," said John Kelm, President, Zurich Corporate Customer, North America. "With disability costs projected to increase 37% this decade due to the growing number of workers aged 45 to 64, an effective RTW program and tools like eZ Transition are now more important than ever to a company's bottom line. " The tool's design reflects the input from Zurich specialists in many facets of its operations, including claims, managed care, risk engineering and underwriting. It enables the creation of a customer-specific RTW profile and the implementation of preventative loss controls that will help reduce lost workday cases. The eZ Transition tool is available 24 hours a day, seven days a week to Zurich's workers' compensation customers through www.zurichna.com. Armand Fernandez, Risk Engineering Field Operations executive for Zurich, added that eZ Transition is flexible enough to adapt to employers of all sizes and program complexity, and complements Zurich's Absence Management consulting services. "Smaller employers are often unprepared for workers' compensation claims and even larger employers, with established RTW programs, frequently need assistance with physical job demands and transitional work assignments," Fernandez said. "Zurich's overall RTW program adapts to employers of all sizes, and provides the tools and directions they need to develop a comprehensive RTW solution for their specific needs, helping return their operations to normal as soon as possible." Source: Zurich, Schaumburg, Ill.

    April 26
  • Chicago - Multinational corporations are facing increasingly diverse, complex and exotic risks, and may not have all the resources in place to manage them effectively, according to a global risk management survey conducted by Aon, a Chicago provider of risk management services, insurance and reinsurance brokerage, human capital and management consulting, and specialty insurance underwriting. More than half of the survey's respondents said they weren't prepared for the risk they rated as most worrisome -- damage to reputation. "Executives now see reputation as a major source of competitive advantage," said Ruth Joplin, Aon Global Risk Consulting managing director. "While intangible, reputation is one of the most important corporate assets and one of the hardest to protect," she added. "The lack of preparedness reported for this and other key risks is both surprising and somewhat worrying." Joplin says it should come as no surprise that business interruption was cited as the second key risk. "Preserving earnings power is clearly one of the top priorities of senior management," she said, "and there is a growing realization that the resulting loss of income following an event could pose a greater threat than the physical damage itself. While 70% of respondents reported being prepared, it is perhaps even more telling that 30% are not." Survey responses suggest that third party liability risk concerns have arisen as a result of the encroachment of U.S.-style litigiousness into other geographies. "The 'compensation culture' is gaining a stronger global foothold," Joplin said. Rounding out the top five risk concerns, based on the survey's results, is distribution or supply chain failure, and market environment. Lack of preparedness for these risks is reported at 37% and 65%, respectively. What does this mean? "There is clearly more work to be done," said Joplin. "Dealing with these and future risk trends will require innovative, forward-looking solutions." Other top ten risk concerns rated by survey respondents are, in order, regulatory changes, failure to attract or retain staff, financial risk, physical damage and mergers and acquisitions and disaster recovery plan failure are tied for tenth place. Ranking Risk/description 1 - Damage to reputation 2 - Business interruption 3 - Third party liability 4 - Distribution or supply chain failure 5 - Market environment 6 - Regulatory/legislative changes 7 - Failure to attract or retain staff 8 - Market risk (financial) 9 - Physical damage 10 - Merger/acquisition/restructing 11 - Failure of disaster recovery plan Joplin says that that Americas is the only region where technology failure and loss of data are cited as a major risk concern, while Europe uniquely cites mergers/acquisitions/restructuring and Asia/Pacific is highly concerned with weather/natural disasters. Risk managers in the Americas tend to rely heavily on senior management intuition and experience to identify major risks as compared to other regions that rely more on business unit registers. The survey also indicates that corporate boards recognize the criticality of risk management and are engaged in the review of risk issues. Respondents reported identifying and understanding their risks is a top priority and many planned to take a more enterprise-wide approach to risk within the next two years. "By taking a more integrated, systematic approach to managing risk," Joplin said, "organizations can begin to actively start turning risk into opportunity." Aon's Global Risk Management Survey 2007 was conducted in late 2006 and early 2007 by Aon Global Risk Consulting, and is based on responses from 320 organizations in 29 countries. The Web-based survey, aimed at risk managers, CFOs, treasurers and others responsible for risk, addressed both qualitative and quantitative risk issues. Insight is provided by region, revenue and industry. Source: AON Corp.

    April 25
  • Pearl River, N.Y. - China Life Insurance Co. Ltd. became the first Chinese domestic insurance company to join the Association for Cooperative Operations Research and Development (ACORD) as a member.ACORD members participate directly with their peers and partners in the standards process regarding development, maintenance and management of ACORD standards. Members participate in working groups and committees, which manage and develop, and then vote on new standards specifications and maintenance requests to support both international and local business requirements.

    April 20
  • Charlottesville, Va. - SNL Financial LC, a Charlottesville, Va.-based business intelligence provider, reached an agreement with the National Association of Insurance Commissioners (NAIC), Kansas City, Mo., to acquire and publish statutory insurance data through SNL's database products.Statutory insurance data consists of detailed financial and operating data filed quarterly for more than 5,000 public and private insurance companies, including: line-of-business results, market share and geographic exposure, relevant calculated ratios, investment portfolio statistics, loss triangles, reinsurance relationships and more.

    April 19
  • Indianapolis and Washington - During the past few months, legislation has been introduced in the U.S. Congress to repeal or alter the existing limited antitrust exemptions afforded under the McCarran-Ferguson Act.Many associations and organizations have publicly opposed the repeal. Among those are the National Association of Mutual Insurance Companies (NAMIC) and the Independent Insurance Agents & Brokers of America (IIABA).

    April 18
  • Stamford, Conn. - Public and private companies—more than 66% of respondents—have received a record number of inquiries from potential board members who are concerned about their current directors and officers (D&O) liability insurance, an increase of 16% from 2005, according to the D&O Liability 2006 Survey on Insurance Purchasing and Claims Trends conducted by Towers Perrin. Nonprofit respondents received similar D&O inquiries from approximately 32% of their boards, up slightly (3%) from 2005.At the same time, the survey, which included 2,875 participants, shows that companies are responding to these inquiries by providing broader personal liability protection for directors and officers. In fact, 14% of those surveyed purchased Side A-only coverage in the past year. Side-A coverage provides D&O coverage for personal liability when they are not indemnified by the organization.

    April 17
  • Hartford, Conn. - With the recent sale of a small business policy to Creative Music Adventures of Seattle, Wash., The Hartford Financial Services Group Inc. now maintains one million small-business policies in force across the country."This is an outstanding achievement for The Hartford," says Jim Ruel, senior vice president of small business insurance at The Hartford. "For years, we've been listening to what small business owners want, and then developing the right products and services to help our agents meet their clients' needs. Reaching this milestone in such a competitive market is a testament to our company's leadership and expertise in this field. As the number of small businesses in this country continues to increase, The Hartford will continue to find new ways to serve them."

    April 16
  • Reston, Va. - The year 2006 represented the tipping point for using the Internet to buy auto insurance, says comScore, Inc., a Reston, Va., company that measures commerce in the digital world.

    April 13
  • Criminals can imitate public or private Wi-Fi services to lure unsuspecting consumers and businesses into an ID theft nightmare, says TraceSecurity, a Baton Rouge, La., provider of security compliance management.

    April 13
  • Atlanta - A disk containing the personal information of 2.9 million Georgia residents has gone missing, state health officials say.

    April 11
  • New York - Parents can track the whereabouts of teenage drivers with the help of a global positioning system about to undergo testing by New York-based AIG Auto Insurance.

    April 10
  • New York - Senior insurance executives are concerned about governing and managing the crushing volume of data their companies maintain these days, especially in light of stricter reporting requirements.

    April 9
  • Edwardsville, Ill - Florists' Mutual Insurance Company (Hortica) has announced the loss of a locked shipping case containing backup computer tapes with personal information.

    April 9
  • Denver - Despite some challenges, the health insurance industry continues to focus forward on initiatives that will enable patient-related data sharing in order to help eliminate errors and reduce overall costs. Anthem Blue Cross and Blue Shield in Colorado announced its participation in a voluntary data-sharing program developed by the Council for Affordable Quality Healthcare (CAQH), the company reports. The program, based on rules drafted by CAQH's Committee on Operating Rules for Information Exchange (CORE), is designed to link the data collected by health plans, providers, and vendors so that doctors can electronically verify their patients' insurance information in twenty seconds or less, significantly improving communications between providers and insurers. A report issued in February 2006 by Dublin, Ireland-based Research and Markets notes that insurers will benefit from a trend in widespread adoption of electronic capture of patient data. With solid benefits predicted, there still remain challenges, however. Alluding to the routine capture of documents and data for both regulatory and business intelligence purposes, the Research and Markets holds that "health care in the clinical setting has resisted this industry-transforming technology for nearly 20 years. The reasons: the lack of user-friendly interfaces for busy health care providers, lack of workflow understanding on the part of vendors, the expense and complexity of implementation and maintenance solutions, and the lack of transparent ROI for providers." Empirical data on long-term benefits for a program such as this may not be available yet, but carriers such as anthem BCBS nevertheless have high hopes for initiatives designed to create incentives for providers that will help improve communications between parties and create a "healthier" patient base in the process. The fact that the CORE program is a voluntary, industry-wide collaboration facilitated by Washington-based CAQH, may help the cause. Anthem has been certified as a CAQH CORE health plan and has already completed the Phase I implementation of the CORE rules, which allows for standardized data transfer and quicker response times. Physicians who link to the health plan through electronic data interchange (EDI) will be able to use EDI for this quick verification. EDI is a method for two organizations to confidentially exchange data from one computer to another using standard formats that are HIPAA compliant. Currently, Anthem's EDI is used for claims filing, claims status checks, eligibility verification, electronic remittance advices, and electronic fund transfers back to health care providers. "Anthem is committed to employing the most advanced information technology solutions available to improve both our members' experience and their interactions with physicians," said John Martie, president, Anthem Blue Cross and Blue Shield in Colorado, a subsidiary of WellPoint, Inc. "CAQH has developed an excellent framework for simplifying the administrative side of the health care system, and Anthem has worked diligently to ensure that we are capable of bringing the benefits of CAQH's efforts to our members." "These programs have the potential to transform the way that health care providers and health plans communicate," continued Martie. "But most importantly, they will take much of the confusion out of the health care system for our members." Sources: Anthem Blue Cross and Blue Shield, INN Archives

    April 6
  • Washington - A new report calling for a review of the McCarran-Ferguson Act is troubling, said the National Association of Mutual Insurance Companies (NAMIC), Indianapolis. While the report - created by the Antitrust Modernization Commission - does not recommend repealing the antitrust exemption provided to insurance companies under the Act, its suggestion for Congress to carefully review it and other exemptions could ultimately lead to higher costs for consumers. "Many of the statements in the report indicate a lack of understanding of the business of insurance," said Carl Parks, NAMIC's senior vice president for federal affairs. "There are several statements that incorrectly characterize the McCarran-Ferguson antitrust exemption." For example, the commissioners contend that McCarran-Ferguson and other exemptions lead to higher prices, reduced output, lower quality, reduced innovation, and less competition. They also argue that a decision to provide an exemption is a decision to sacrifice competition and consumer welfare. "The exact opposite is true in the case of the nation's 5,000 insurers," Parks said. "It is the presence of the exemption that has fostered a vibrant and competitive marketplace affording consumers greater choice, lower prices, higher quality and more varied products and increased innovation, while ensuring a sound and stable marketplace." The report incorrectly contends that immunities and exemptions benefit relatively small special interest groups and spread their costs to the broad consuming public. Actually, McCarran-Ferguson benefits all insurance consumers and serves to safeguard consumer welfare, Parks said. NAMIC found other problems with the report. The commissioners state that solvency should not serve as justification for antitrust exemptions. In fact, solvency is an integral component of consumer welfare and protection in the property/casualty context, Parks explained. The report also discounts fears of litigation and legal uncertainty. "Essentially, the report says that insurers have nothing to fear from being subject to the antitrust laws as long as the cooperative behavior in which they're engaged has pro-competitive effects," said Robert Detlefsen, NAMIC's vice president of public policy. "The report is unduly confident that courts with little or no experience adjudicating insurance issues would be able to distinguish clearly between pro-competitive and anti-competitive practices. We are not nearly as optimistic about this prospect as is the commission." Detlefsen further said the report does not address the negative consequences for insurers and consumers that would result from the legal uncertainty and expense of private antitrust litigation to settle such questions if the exemption were to be repealed. "The main problem with the report is that (a) it assumes that courts applying a rule of reason analysis to alleged antitrust violations by insurers will actually make reasonable decisions; (b) it discounts the impact that costly and protracted antitrust litigation would have on companies and consumers; and (c) it ignores the extent to which the threat of litigation would inhibit insurers from acting cooperatively even if they thought that eventually their actions would survive antitrust scrutiny by the courts," Detlefsen continued. Ironically, Commissioner Jonathan M. Jacobson, who wrote a separate statement calling for the repeal of the insurance antitrust exemption as well as exemptions applying to three other industries, also opined that "the Commission would have better served the country through a more focused review of these four [exemptions] than by relying purely on the generalist overview reflected in our official recommendations." "We couldn't agree more," said Detlefsen. "Had the Commission more carefully examined the implications of repealing the limited insurance antitrust exemption, it's likely that Commissioner Jacobson would have reached a different conclusion." NAMIC, which today announced its membership in the Insurance Research Council, a public policy research organization providing objective analysis on a broad range of issues of vital interest to insurers, consumers, and public policymakers, opposes any changes to the McCarran-Ferguson Act. The organization reports that it will continue to work with members of Congress to inform them on the effects of the limited antitrust exemption on the insurance industry and America's insurance consumers. Antitrust Division's Statement The Antitrust Division of the U.S. Department of Justice made the following statement regarding the release of the Antitrust Modernization Commission Report. "The AMC has made many specific recommendations in its report, and the Division is in the process of reviewing all of them. The Division commends the AMC for its three primary conclusions: * Free-market competition should remain the touchstone of United States' economic policy. The Commission's conclusion in this regard is a fundamental starting point for policy makers. Over a century of experience has shown that robust competition among businesses, each striving to be increasingly successful, leads to better quality products and services, lower prices, and higher levels of innovation; * The core antitrust laws -- Sherman Act sections 1 and 2 and Clayton Act section 7 - and their application by the courts and federal enforcement agencies are sound and appropriately safeguard the competitiveness of the U.S. economy; * New or different rules are not needed for industries in which innovation, intellectual property, and technological innovation are central features. Unlike some other areas of the law, the core antitrust laws are general in nature and have been applied to many different industries to protect free-market competition successfully over a long period of time despite changes in the economy and the increasing pace of technological advancement. One of the great benefits of the Sherman and Clayton Acts is their adaptability to new economic conditions without sacrificing their ability to protect competition." To view the complete report visit www.amc.gov. Sources: PRNewswire/USNewswire, NAMIC, U.S. Department of Justice

    April 5
  • Needham, Mass. - The time is right for U.S. property and casualty claims insurers to aggressively exploit the business benefits of an enterprise mobility strategy, according to new research from research and advisory services firm TowerGroup. TowerGroup's report, "Mobile Solutions for US Property & Casualty Claims: Life in the Fast Lane," maintains that while using mobile solutions for settling claims is not new to the U.S. insurance industry, adoption for claims processing has been haphazard at best. Insurance carriers have been slowly bringing on mobile technology solutions to assist field workers with claims operations, yet the process has lacked focus and forward momentum. Given the strides made by mobile technology vendors in functionality, bandwidth and devices, mobility solutions for the insurance industry are increasingly reliable - and can yield significant value if developed within a coordinated strategic initiative, says the report. "Customers are increasingly expecting real-time, any-time service from their insurance carriers," said Karen Pauli, senior analyst in the TowerGroup insurance research practice in Needham, Mass., and author of the research. "While many insurers have various mobility irons in the fire, catastrophes like Hurricane Katrina quickly exposed the limits of the haphazard solutions that are in place. It's time for carriers to step back and create an enterprise strategy for mobility that encompasses all aspects of the claims process." Highlights of the research include: * Mobile initiatives will yield significant value for carriers when the implementation directly impacts the most critical business issues facing carriers today, including: disaster response; business continuity; and meeting regulatory and compliance mandates. The report also highlights the key actions carriers must take in order to create an effective mobile strategy. * Carriers can improve day-to-day claims operations, gaining competitive advantage and saving costs, by using predictive analytics to direct activities in a mobile environment. * Before carriers jump into an enterprise mobility plan, they must carefully review the needs and workflow of their claims personnel. "Today, few carriers leverage the breadth of available mobile technologies that could contribute to claims process efficiency," continued Pauli. "Instead, it's more common to see stand-alone applications that have little to no integration with other claims applications or services. Stand-alones don't scale well, usually lack extensibility and cost too much. Carriers must develop a more holistic approach to claims mobility, one that arms the adjuster with the key devices and applications necessary to get the job done in the most efficient and effective way possible." Source: TowerGroup

    April 3
  • Fayetteville, Ark. - Blue Cross Blue Shield will partner with the University of Arkansas and Wal-Mart Stores Inc. to create a research center that will focus on using information technology to improve the health care delivery system, the companies report. The center's creation was announced today during a health information technology meeting -- hosted by Wal-Mart -- of business, IT and health care leaders held in Rogers, Ark. The Center for Innovation in Health Care Logistics will conduct research designed to identify and address gaps and obstacles in the application and delivery of health information technology. The center will also serve to highlight and replicate proven applications that are working to benefit patients and providers. The goal of the center's work is to put the right materials in the hands of doctors and nurses where and when they need them; it also aims to eliminate the threat of medical errors arising from wasteful and unreliable practices in health care supply networks. The Center's initial work will address information technology-based innovations for bringing visibility and tracking to every level of health care procurement and distribution processes. Experience shows that such transparency leads to significant cost savings by eliminating duplication and confusion, enhancing collaboration among participating organizations and avoiding mistakes that can lead to dangerous errors. "Blue Cross Blue Shield is proud to join Wal-Mart and the University of Arkansas in this worthy venture," said Bob Shoptaw, CEO, Blue Cross Blue Shield Arkansas, Fayetteville. "We look forward to contributing to the advancement of health care technology through the creation of this research center." In making the announcement, Wal-Mart Vice Chairman John Menzer said the center's work will help fill a large information gap in the health care system. "The best example of this need was Hurricane Katrina. Medical records, property records, court records were lost. Entire family histories -- medical, cultural and otherwise -- were gone in an instant, and the entire region is still recovering from this massive loss of information," Menzer said. "The University of Arkansas has a strong track record of success with industry-university research collaborations in the ever-changing realms of information technology and logistics," said University Chancellor John White from the University's Fayetteville campus. "A fundamental purpose of any flagship university is to stimulate economic success and enhance quality of life. We are well positioned to leverage our logistics center experience to ensure success in identifying real solutions for transforming health care processes, which holds benefits for the State of Arkansas and the entire nation." Professor Ron Rardin will be the center's executive director. Before joining the University of Arkansas, Dr. Rardin led the National Science Foundation's efforts to foster research in health care delivery and later played a key leadership role in Purdue University's Regenstrief Center for Health Care Engineering. Wal-Mart, Bentonville, Ark., will pledge $1 million over five years to fund the center. Blue Cross Blue Shield of Arkansas, Alabama and Illinois have joined Wal-Mart as partners. The Center will also raise money from other private sector companies, government agencies and foundations to help conduct its research and demonstration projects. Source: PRNewswire

    April 2
  • It may not have started with the vehement criticism logged by Sen. Trent Lott, R-Miss., and Rep. Gene Taylor, D-Miss., against Bloomington, Ill.-based State Farm over hurricane damages to their respective homes, but the negative press that's ensued in Katrina's aftermath is still haunting the insurance industry.Shortly after Lott's brother-in-law, high-profile plaintiff attorney Richard "Dickie" Scruggs, filed a federal lawsuit, however, a flurry of additional actions, some of which are being played out by state and federal regulators, thrust the P&C insurance industry into defense mode.

    April 1
  • The insurance industry can't agree on a definition of the phrase "enterprise content management." Whatever it means, though, there's a consensus that it's improving.Many think of it as combining absolutely every kind of documented information the company owns and putting it into a paperless electronic central repository that imposes business rules, manages distribution and affords virtually unlimited access. That master file would house everything from this morning's jpegs to digitized versions of yellowing old paper-and-ink policies.

    April 1