Claims

Rapid growth. It's a "problem" most companies would welcome. Yet, along with accelerated growth comes a bevy of new challenges. At Geico and its affiliated companies, for example, when written premiums grew from $4.1 billion in 1998 to $4.9 billion in 1999, the company had to process twice as many agent licenses with state insurance departments-just to keep enough agents on the phones selling auto policies."In one year, we jumped from about 27,000 active licenses and 48,000 appointments to 55,000 licenses and 115,000 appointments," says Dan Corridon, director of licensing administration at Government Employees Insurance Co. (Geico), the Chevy Chase, Md.-based direct insurer. "We needed a system that was going to do more for us than what we were using."

Shortly after I returned from IsoTech last November, I received one of those forwarded "chain" e-mails. Unlike most chain e-mails I receive, I actually read this one, and, surprisingly, it pertained to a controversial topic that came up at ISOTech during the roundtable session, titled "The Next 'Killer Technology' in Insurance."Panelist Kevin Kelly, managing director, U.S. insurance industry, Microsoft Corp., said he thought sensing technologies were the next killer technology, and he described how radio frequency identification devices could be attached to people or assets to enable the industry to obtain a plethora of information about who or what it's insuring. "There's a privacy element," he admitted. "But people will give up some privacy for convenience."

The customer comes first. We've all heard that phrase, but many insurers would be hard-pressed to prove it's a strategic and tactical reality.Why? A number of carriers implementing customer relationship management (CRM) systems are hopeful that CRM's ability to provide profiling, micro-segmentation, and predictive analysis to reveal the preferences and proclivity of customers will help maintain their existing customer base and drive new business.

The insurance industry, long saddled with paperwork-intensive processes, has become prime turf for enterprise content management (ECM) solutions. ECM is the catchall phrase for what was originally a plethora of solutions, ranging from imaging systems to records management.To carriers seeking to expand their business lines and speed up processing at as little additional cost as possible, content management may be more than some glitzy new technology; it may fundamentally change the nature of the insurance business.

Segundo, Calif. - Two U.S. surveys of property/casualty insurance customers show a large, untapped opportunity for cost control through electronic billing.Conducted for Computer Sciences Corp. by MarketSearch Corp., a survey of car and homeowner insurance billing methods found 88% of auto insurance customers and 93% of homeowner insurance customers still receive bills by mail. Yet 73% of respondents surveyed indicated they would be willing to pay their insurance bills over the Internet. A second survey that asked approximately 350 P&C professionals at CSC's Connect 2005 conference about their own personal insurance experience confirmed these findings.

Schaumburg, Ill. - Expanding on its seminal 2002 study report, "A Comparative Analysis of Claims-based Methods of Health Risk Assessment for Commercial Populations," the Society of Actuaries (SOA) has appointed Milliman USA to produce an updated version of the study.The 2002 report, which evaluated the state of the art in predictive modeling software for health care claims at that time, provided an unbiased forum for comparing the technology and methodologies then available in the market. With the passage of three years and the continuous refinement of these methodologies and software, the SOA strongly felt a fresh look at the tools would provide immediate practical benefits to the health care community.

Novato, Calif. - Fireman's Fund Insurance Co. has named Oliver Bussman as its chief information officer, according to Charles (Chuck) Kavitsky, chief executive officer.Bussman has many years of IT leadership experience in the banking, insurance and asset management industries. He will lead the implementation and delivery of the significant IT investment Fireman's Fund has made to improve its customer and employee experience and to its operational effectiveness.

Des Moines - Many auto insurance companies ask customers to estimate their annual mileage when applying for a new policy, but these up-front estimates generally have a minimal influence on the overall premium. And, these companies don't ask for updated mileage readings over time.But what if an insurance company asked policyholders to report exact mileage readings over time and, by doing so, they could control how much they pay for car insurance by controlling the number of miles they drive?

Los Angeles - Farmers Insurance Exchange has begun serving civil summons and complaints upon Redding, Calif. auto glass company Onsight Auto Glass and its owner, accusing them of taking part in a scheme designed to defraud Farmers and its policyholders. The civil complaint, which is similar to prior successful lawsuits against auto glass businesses and body shops who submitted false insurance claims, seeks not only damages for the fraud allegedly committed, but seeks injunctive relief, where the courts are asked to order a halt to these deceptive practices.Outlining a highly unusual and aggressive billing scam, the lawsuit details how the alleged perpetrator deliberately over-billed Farmers for services on 455 occasions. As alleged in the civil complaint, the defendant created a sham office in a remote area, so it could manipulate its billing. In fact, the only things located where the shop is claimed to exist were abandoned mines and a shack. There was no electricity, no running water and certainly no auto glass business. Under national guidelines, automobile glass claims are paid at a premium if the shop is located in less densely populated areas. As explained in the complaint, defendant created documentation that the shop was located in a remote area, so it could charge Farmers significantly more.

Kansas City, Mo. - While increased frequency of hurricanes is nothing new in historical terms, the enormous growth in coastal population and development is dramatically increasing the potential for insured losses, according to a new paper from GE Insurance Solutions."Demographic trends in Florida and other coastal locations as well as the likelihood of increased frequency and severity of storms should remind the (insurance) industry of the growing exposures it will continue to face. The cost of hurricanes will rise--sooner or later surpassing even those of Hurricane Katrina," says the paper titled "Coastal Warning: The Rising Costs of Hurricane Frequency and Severity."

Chicago - Danish insurance company ALKA is fighting customer fraud and enhancing customer services with PredictiveClaims, an application developed by SPSS Inc. ALKA recently purchased and implemented the software in an effort to improve claims handling efficiency while reducing the cost of fraudulent claims.ALKA is one of the five leading insurance companies in Denmark. To differentiate itself in a highly competitive market, the company aimed to optimize its expensive claims handling processes and offer better service to customers. ALKA sought to enable "fast-track claim handling" while still sifting out the fraudulent cases from its high claim volumes. Industry experts estimate that on average 10% of all claims are fraudulent, whereas usually only 0.5% to 1% of fraud is actually being detected.

Seattle - Many companies advertise great service, but how many have been recognized for this by a non-partial third party such as J.D. Power and Associates? To receive recognition, companies must score higher than 730 out of a possible 1000 points. PEMCO received 911 points, a score that was noted as unusually high by J.D. Power and Associates."We come to work every day committed to giving our customers the absolute highest level of service and value," says Jon Osterberg, spokesperson for PEMCO, a provider of auto, home, boat, life, and umbrella insurance to Washington state residents. "This certification demonstrates that. Service is the bedrock of PEMCO's culture, and it's extremely gratifying to see our customers recognize that."

Hartford, Conn. - The Industrial Hygiene Laboratory of St. Paul Travelers has added a state-of-the-art instrument that helps customers address OSHA's proposed lowering of the Permissible Exposure Limit (PEL) for hexavalent chromium (CrVI). St. Paul Travelers purchased this instrument to help its customers better protect their employees and reduce workers compensation losses.Hexavalent chromium (CrVI) is a human carcinogen for which OSHA has proposed a 50x reduction in the PEL from the current standard. The new Inductively Coupled Plasma Mass Spectrometer (ICP-MS) has enabled the Industrial Hygiene Laboratory to develop a method for the analysis of CrVI below OSHA's proposed PEL.

San Diego - CareGroup Healthcare System has gone live at Beth Israel Deaconess Medical Center (BIDMC) with an application that delivers automatic healthcare information updates every 15 minutes to the Centers for Disease Control (CDC) in Atlanta. The bio-surveillance system, which feeds the CDC with information key to early identification of disease trends, is built on the CACHE post-relational database. InterSystems Corp., a health care database provider, spotlighted the bio-surveillance implementation at the HIMSS 2006 conference in San Diego, Calif.BIDMC is one of 10 U.S. hospitals that were approached by the CDC to provide medical data on an ongoing, around-the-clock basis. The initiative is part of a mandate by Health and Human Services (HHS) Secretary Michael Leavitt, who chairs the American Health Information Community (AHIC), a group charged with advising the federal government on standards for electronic health records (EHRs). Bio-surveillance and public health monitoring are among the first focus areas for AHIC and Leavitt has stated that he wants a system for streaming emergency department (ED) data to public health authorities in place by the end of 2006.

Washington, D.C. - Health insurance plans' cutting-edge information technology (IT) strategies are adding value to health care for employers, health care practitioners and most importantly, consumers, industry leaders said today on Capitol Hill.Participants in the briefing stressed that health insurance plans are using IT not only to process claims more efficiently, but also to promote evidence-based care, add value to health care services and empower consumers through access to better information and decision tools.

Chicago - The company stockholoders of CCC Information Services Group Inc., a supplier of software, communications systems, Internet and wireless-enabled technology solutions to the automotive claims and collision repair industries, voted to adopt a merger agreement with entities affiliated with Investcorp, a global investment group.

San Jose, Calif. - Business Objects S.A., a provider of business intelligence (BI) solutions, has entered into a definitive agreement to acquire privately held Firstlogic Inc., a La Crosse, Wis.-based global provider of enterprise data quality solutions and services.

Kansas City, Mo. - Vision may be the most important element required to underwrite liability risk, says Ajay Gupta, marketing leader of GE Insurance Solutions, a provider of reinsurance and commercial insurance and risk management services. Gupta says insurers tend to look backward at historical loss experience but not forward to factors that may impact future losses.Gupta's article, "Crisis or Opportunity: The Liability Dilemma", appears on GE Insurance Solutions' Web site at: www.geinsurancesolutions.com/erccorporate/theinstitute/pc/0601_cris.htm.

Yonkers N.Y., - An investigation in the March 2006 issue of Consumer Reports magazine contends that a national system of Electronic Health Records (EHRs) being developed by the federal government, states, HMOs, and PPOs to link the medical records of every American has potential for abuse. Consumer Reports claims that while such electronic medical records systems could save lives and billions of dollars in health-care spending, it may also jeopardize the security of personal health care information.The advantages of EHRs are many, according to Consumer Reports, include: more precise patient care from doctors, greater participation by patients, and an early-warning system for medical disasters such as the appearance of avian flu are among the hoped-for achievements for an electronic medical records network.

Needham, Mass. - In the next five years, analysts predict more than 77 million individuals in the U.S. will be of traditional retirement age, and this segment of the population is predicted to be the dominant demographic for a period of 20 years or more. TowerGroup, a Needham, Mass., research firm, expects that this explosion in the retired market will ultimately redefine the U.S. financial services industry, accelerating industry consolidation across banking, securities and investments, and insurance.