Medical Professional Liability Outlook and Economic Impacts of the Changing Healthcare Environment
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Transcript of Medical Professional Liability Outlook and Economic Impacts of the Changing Healthcare Environment
Medical Professional Liability Outlook and Economic Impacts
of the Changing Healthcare Environment
Willis Re Annual Healthcare Reinsurance ForumScottsdale, AZMarch 18, 2014
Download at www.iii.org/presentationsRobert P. Hartwig, Ph.D., CPCU, President & Economist
Insurance Information Institute 110 William Street New York, NY 10038Tel: 212.346.5520 Cell: 917.453.1885 [email protected] www.iii.org
2
Presentation Outline
The US Healthcare System & the Economy
Employment/Professional Trends in Healthcare
Medical Professional Liability: Performance Overview & Outlook
The Affordable Care Act: Potential Impacts on MPL
Overall P/C Insurance Industry Performance
Investment Overview & Outlook
Tort Trends
Cyber Risk and the Healthcare Industry
Q&A
U.S. Health Care Expenditures,1965–2022F
65 67 69 71 73 75 77 79 81 83 85 87 89 91 93 95 97 99 01 03 05 07 09 11 13 15 17 19 21
$0
$1,000
$2,000
$3,000
$4,000
$5,000
$6,000
$42.
0$4
6.3
$51.
8$5
8.8
$66.
2$7
4.9
$83.
2$9
3.1
$103
.4$1
17.2
$133
.6$1
53.0
$174
.0$1
95.5
$221
.7$2
55.8
$296
.7$3
34.7
$369
.0$4
06.5
$444
.6$4
76.9
$519
.1$5
81.7
$647
.5$7
24.3
$791
.5$8
57.9
$921
.5$9
72.7
$1,0
27.4
$1,0
81.8
$1,1
42.6
$1,2
08.9
$1,2
86.5
$1,3
77.2
$1,4
93.3
$1,6
38.0
$1,7
75.4
$1,9
01.6
$2,0
30.5
$2,1
63.3
$2,2
98.3
$2,4
06.6
$2,5
01.2
$2,6
00.0
$2,7
00.7
$2,8
06.6
$2,9
14.7
$3,0
93.2
$3,2
73.4
$3,4
58.3
$3,6
60.4
$3,8
89.1
$4,1
42.4
$4,4
16.2
$4,7
02.0
$5,0
08.8
U.S. health care expenditures have been on a relentless climb for most of the past half century, far outstripping population growth,
inflation of GDP growth
3
From 1965 through 2013, US health care expenditures had
increased by 69 fold. Population growth over the same period increased by a factor of just 1.6. By 2022, health spending will have
increased 119 fold.
$ Billions
Sources: Centers for Medicare & Medicaid Services, Office of the Actuary at http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NationalHealthAccountsProjected.html accessed 3/14/14; Insurance Information Institute.
0%
2%
4%
6%
8%
10%
12%
14%
16%
18%
20%
65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22
National Health Care Expenditures as a Share of GDP, 1965 – 2022F*
Sources: Centers for Medicare & Medicaid Services, Office of the Actuary at http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NationalHealthAccountsProjected.html accessed 3/14/14; Insurance Information Institute.
1965 5.8%
Health care expenditures as a share of GDP rose from 5.8% in 1965 to 18.0% in 2013 and are expected to
reach 19.9% of GDP by 2022
% of GDP
2022 19.9%
1980: 9.2%
1990: 12.5%
2000: 13.8%
2010: 17.9%
Since 2009, heath expenditures as a %
of GDP have flattened out at about 18%--the
question is why and will it last?
-1%
0%
1%
2%
3%
4%
5%
95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10 11 12 13
Change in Medical CPI CPI-All Items
Medical Cost Inflation vs. Overall CPI, 1995 - 2013
Sources: Med CPI from US Bureau of Labor Statistics, WC med severity from NCCI based on NCCI states.
Average Annual Growth AverageHealthcare: 3.8%
Total Nonfarm: 2.4%
Though moderating, medical inflation will continue to exceed inflation in the overall economy
6
63.1%650.7%
2235.9%
6839.8%
0%
1000%
2000%
3000%
4000%
5000%
6000%
7000%
8000%
Population CPI GDP Health CareExpenditures
Rate of Health Care Expenditure Increase Compared to Population, CPI and GDP
Accelerating business investment will be a potent driver of
commercial property and liability insurance exposures and should drive employment and WC payroll
exposures as well (with a lag)
Source: Insurance Information Institute research.
1965: 194.3 Mill2013: 317.0 Mill
1965: $719.1 Bill2013: $16,797.5 Bill
1965: $42.0 Bill2013: $2,914.7 Bill
Employment Trends in the Healthcare Industry
7
Employment Will Grow but Skills, Responsibilities and Risks Will
Evolve
7
8
Growth in Health Professions,1991-2013
Sources: Bureau of Labor Statistics, Insurance Information Institute.
-5.0
-3.0
-1.0
1.0
3.0
5.0
7.0
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
Health care
Total nonfarm
(Percent Annual Change)
Healthcare employment has continued to grow in good times and bad - including the Great Recession.
Average Annual Growth AverageHealthcare: 2.5%
Total Nonfarm: 1.0%
The U.S. economy lost more than 8 million jobs during the Great Recession, but health sector
employment expanded
Healthcare SupportHealthcare Practitioners
ConstructionPersonal Care and Service
Computer and MathSocial Service
Business & FinancialGroundskeeping/Janitorial
EducationAll Occupations
LegalLife, Phys and Social Science
RepairFood Preparation
TransportationFire, Police, Etc.
Architects and EngineersSales
ManagementArts and Media
Administrative SupportProduction
Farming
28.121.521.4
20.918
17.212.512.5
11.110.810.7
10.19.69.4
8.67.9
7.37.37.276.8
0.8-3.4
Source: Bureau of Labor Statistics, Insurance Information Institute.
Occupations Ranked by Projected Percentage Growth, 2012-2022F
9
Healthcare professions are expected to grow at 2 to
nearly 3 times employment growth overall
10
Growth in Healthcare Profession by Skill Level, 2012 – 2022F
Source: Bureau of Labor Statistics, Insurance Information Institute.
5,00
5
2,89
3
2,49
2
1,77
1
6,02
0
3,59
0
3,24
2
2,19
6
0
1,000
2,000
3,000
4,000
5,000
6,000
7,000
Practitioners, includingRNs
Technicians, includingLPNs
Aides Other
2012 2022
(Thousands of Jobs)
+1.015 Mill +20.3%
+697,000 +24.1% +750,000
+30.1% +425,000 +24.0%
Projected Physician Supply and Demand, 2008–2020
Source: American Association of Medical Colleges https://www.aamc.org/advocacy/campaigns_and_coalitions/fixdocshortage/; Insurance Information Institute. 12
851,300
759,800
A potential large and growing shortage of physicians
looms. Estimates suggest a shortage of 91,500 physicians
by 2020—a gap 12% gap.Will this be a negative for
MPL?
Physician Supply and Demand, 2008–2020
Source: American Association of Medical Colleges https://www.aamc.org/advocacy/campaigns_and_coalitions/fixdocshortage/; Insurance Information Institute. 13
A potential large and growing physician gap looms over the next decade, with potential negative impacts on MPL
14
12 Industries for the Next 10 Years: Insurance Solutions Needed
Export-Oriented Industries
Health Sciences
Health Care
Energy (Traditional)
Alternative Energy
Petrochemical
Agriculture
Natural Resources
Technology (incl. Biotechnology)
Light Manufacturing
Insourced Manufacturing
Many industries are
poised for growth, though
insurers’ ability to
capitalize on these
industries varies widely
Shipping (Rail, Marine, Trucking, Pipelines)
Medical Professional Liability
15
Performance Overview
15
16
Medical Professional Liability:4 Major Challenges Increasing Competition
Price (rate) competition is intensifying Physicians: More employed by hospitals, large inst. hurts exposure Self-insurance by hospitals adds to downward pressure
Falling Investment Income Despite Fed “tapering,” rates remain low More complete “normalization” will not occur until 2015
Rising Number of Self-Insured Exposures Hospitals increasingly self-insure More use of captives
Legal & Legislative Reform Tort reform law changes (caps) Affordable Care Act (“ObamaCare”) Impacts on practice of defensive medicine
Other: Reserves, Loss Frequency & Severity Trends
17
Medical Errors: Rate of Lethal and Serious Adverse Events
Source: “A New, Evidence-Based Estimate of Patient Harms Associated with Hospital Care, Journal of Patient Safety, Volume 9, Issue 3 (Sept. 2013) by John T. James, Ph.D. accessed at: http://journals.lww.com/journalpatientsafety/Fulltext/2013/09000/A_New,_Evidence_based_Estimate_of_Patient_Harms.2.aspx
1.1% 1.4%
1.1%
0.6%
15%
15%
21%
14%
0%
5%
10%
15%
20%
25%
OIG (2008) OIG (2010) Classen, et al (2011) Landrigan, et al (2011)Lethal Events Serious Adverse Events
Error Rate New study reviewed 4
studies authored
since 2008
Sept. 2013 study in the Journal of Patient Health suggests that 210,000
– 400,000+ die each year from preventable medical errors (implies
3rd leading cause of death in US)
19
$2,229 $2,343
$1,944$1,744
$2,228
$2,884
$2,303$2,161
$2,896
$2,521
$0
$500
$1,000
$1,500
$2,000
$2,500
$3,000
$3,500
2006 2007 2008 2009 2010 2011 2012 2013E 2014F 2015F
($ Millions)
MPL profits peaked in 2010. Falling rates and exposures and lower investment earnings are impacting the bottom line.
MPL Statutory Net Income After Tax,2006 – 2015F
Source: Conning.
Rates and yields will need to improve to reverse the drop in
profits+29.4%
-20.1%-6.2%
+34.0%
-12.9%-11.6% +5.1%
-17.0%-10.3%
103.
7
108.
0
96.4 99
.8 106.
6
107.
9 115.
7
130.
4 136.
0
154.
7
142.
3
137.
3
110.
9
100.
9
91
84.3
77.4
85
82.0 87
.9 92.9
93.5 96
.5 101.
0
127.
9
70
80
90
100
110
120
130
140
150
160
170
91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10 11 12 13E
14F
15F
Medical Malpractice Combined Ratio vs. All Lines Combined Ratio, 1991-2015F
Source: AM Best (1991-2014F); Conning (2015F) Insurance Information Institute.
MPL insurers in 2013 paid out an estimated $0.96 in loss and expense for every $1 they earned in premiums
In 2001, med mal insurers paid out $1.55 for every dollar earned
The dramatic improvement over the past decade has restored med
mal’s viability, though some deterioration has occurred and is
expected to continue
20
21
RNW: MPL vs. All P/C Lines, 2003-2012
Sources: NAIC.
-2%
0%
2%
4%
6%
8%
10%
12%
14%
16%
18%
03 04 05 06 07 08 09 10 11 12
US All Lines MPL
(Percent)
Average 2003-2012All P/C Lines: 7.9%
MPL: 12.3%
Since 2005, MPL has outperformed the p/c
insurance industry overall by a wide margin
MPL Combined Ratio and ROE,2006 - 2015FCombined Ratio / GAAP ROE
Source: Conning; Insurance Information Institute.
90.0
83.3
76.7
83.580.0
92.9 93.596.5
101.0
87.2
15.6%
10.0%
13.7%
11.3%
7.1%6.1%9.2%
11.9%13.5%
9.1%
70
75
80
85
90
95
100
105
110
06 07 08 09 10 11 12 13 14 150%
3%
6%
9%
12%
15%
18%
Combined Ratio GAAP ROE
As underwriting results deteriorate, ROEs are have begib to decline
e improved ROEs in 2013
23
$24,895$26,841
$28,075 $29,116
$14,162
$17,290 $16,502$19,421
$23,013 $23,052
$0
$5,000
$10,000
$15,000
$20,000
$25,000
$30,000
$35,000
2006 2007 2008 2009 2010 2011 2012 2013E 2014F 2015F
($ Millions)
Capital and surplus growth in the MPL shows steady growth growth mirroring the overall P/C insurance industry
MPL Statutory Capital & Surplus,2006 – 2015F
Source: Conning.
Capital is increasing even as premium growth has been
negative
+22.1% -4.6%+17.7%
+18.5% +0.2%+8.0%
+7.8%+4.6% +3.7%
24
15.1%
22.1%
-4.6%
17.7% 18.5%
0.2%
8.0%
14.2%
6.5%
-11.7%
11.8%9.3%
-1.6%
6.6%7.8%
6.4%
-15%
-10%
-5%
0%
5%
10%
15%
20%
25%
06 07 08 09 10 11 12 13E
MPL All P/C Lines
Since 2006, MPL capital and surplus has grown at twice the pace of the p/c
insurance industry overall
Source: Insurance Information Institute from A.M. Best and Conning data.
Change in MPL vs. All Lines P/C Capital & Surplus, 2006-2013E
% ChangeAverage 2006-2013EAll P/C Lines: 5.2%
MPL: 10.6%
P/C Estimated Loss Reserve Deficiency/ (Redundancy), Excl. Statutory Discount
Line of Business 2012Personal Auto Liability -$3.9BHomeowners -$0.4Other Liab (incl. Prod Liab) $7.5Workers Compensation $11.1Commercial Multi Peril $1.9Commercial Auto Liability $0.7Medical Malpractice -$3.5Reinsurance—Nonprop Assumed $1.0All Other Lines* -$4.6 Total Core Reserves $9.8Asbestos & Environmental $11.2Total P/C Industry $21.0B
Source: A.M. Best, P/C Review/Preview 2014; Insurance Information Institute. *Excluding mortgage and financial guaranty segments.
25
27
-0.8%
3.0%
8.1%
-6.2%
-2.9%-4.3%
-2.4%
1.0%
-6.8%
-3.2%
2.1%
-1.8%
-8%
-6%
-4%
-2%
0%
2%
4%
6%
8%
10%
04 05 06 07 08 09 10 11 12 13E 14F 15F
Competition and an increasing number of
self-insured exposures are weighing on MPL
premium growth
Source: Conning.
Annual Change in Medical Professional Liability DPW, 2004-2015F
% Change
28
-7.1%
-15.6%-11.8%
3.5%
-10.4%
5.9%7.9%
-3.0%
0.1%
7.1%
-20%
-15%
-10%
-5%
0%
5%
10%
06 07 08 09 10 11 12 13E 14F 15F
Incurred losses have been generally increasing since 2011
after years of sharp declines
Source: Conning.
Annual Change in Medical Professional Liability Incurred Losses, 2004-2015F
% Change
29
8.1%
-6.2%
-2.9%-4.3%
-2.4%
1.0%
-6.8%
-1.8%
2.1%
-7.1%
-15.6%
-11.8%
3.5%
-10.4%
5.9%7.9%
0.1%
7.1%
-3.2%-3.0%
-20%
-15%
-10%
-5%
0%
5%
10%
06 07 08 09 10 11 12 13E 14F 15F
MPL DPW Growth Change in Incurred Losses
Mid-2000s: Favorable loss
trends precipitated lower prices and falling premium
Source: Insurance Information Institute from A.M. Best and Conning data.
Medical Professional Liability: Change inPremium and Incurred Losses, 2006-2015F
% Change
Today: Premium seems to be lagging an
increase in losses
30
Medical Professional Liability, RNWBy State, Average 2003-2012
35.4
24.9
22.5
21.9
20.6
20.1
19.4
19.0
19.0
18.7
18.0
17.6
17.3
17.3
17.2
17.1
16.6
16.3
16.0
16.0
15.9
15.4
15.4
15.0
14.6
0
5
10
1520
25
30
35
40
OH AL
ND TX MI
KS
NC AK
WV
NV
MS CA LA NE VA ID WA
CO IA W
I
MO
MN
OR GA
ME
Source: NAIC; Insurance Information Institute.
Top 25 States and DC
31
Medical Professional Liability RNWBy State, Average 2003-2012
13.8
13.7
13.4
13.0
12.6
12.5
12.3
12.2
12.1
11.6
11.3
11.3
11.2
11.2
11.0
10.6
10.1
5.9
5.3
3.5
3.4
-1.7
7.1
9.19.310
.0
-0.4
-4-202468
10121416
TN UT
DC AZ
FL CT
SD KY
US HI
IN MA
MT NJ
VT AR
WY
NH PA IL RI
MD
NM NY
SC DE
OK
Source: NAIC; Insurance Information Institute
Bottom 25 States
32
Medical Professional Liability, RNWBy State, 2012
53.1
31.8
28.2
27.7
26.6
25.4
23.8
23.2
21.6
21.2
20.3
19.9
19.9
19.4
19.0
18.7
18.6
17.9
17.8
17.6
17.6
15.7
15.4
15.3
15.2
15.0
0
10
20
30
40
50
60
OH NV WI
OK
ND AL
MT
WV
KS
MN
MS
UT VT HI
SD CT TX MO MI
ID NE AK IL CO NC
DC
Source: NAIC; Insurance Information Institute.
Top 25 States and DC
33
Medical Professional Liability RNWBy State, 2012
14.5
14.3
13.0
12.7
12.2
11.6
11.3
11.3
11.0
10.8
10.7
10.4
10.3
10.0
8.8
8.8
7.6
-9.8
-3.6-2.0
-0.9
0.5
5.66.
27.1
-51.
4
-60
-50
-40
-30-20
-10
0
10
20
LA GA
WA
PA VA AZ
ME
US
MA NJ FL IN CA IA KY
OR SC AR
WY
NY
TN NM R
I
MD
NH DE
Source: NAIC; Insurance Information Institute
Bottom 25 States
34
Medical Professional Liability, RNWBy State, 2003
32.4
22.8
19.2
15.5
12.9
12.0
11.3
11.1
11.1
9.7
8.8
8.1
7.3
6.7
6.6
6.6
6.5
5.7
5.5
4.5
3.6
3.5
3.3
2.4
2.0
0.3
0.2
-0.1
-0.1
4.9
9.9
14.9
19.9
24.9
29.9
34.9
AL
MN
ND HI
MI
CA
WA
CT
WV
MA
NV LA NC UT
ME WI
TN NE
KS ID CO NJ VA N
M AZ
GA
DE
US
Source: NAIC; Insurance Information Institute.
Top 27 States and US
35
Medical Professional Liability RNWBy State, 2003
-1.4
-1.8
-2.6
-2.9
-3.1
-3.2
-4.4
-4.5
-4.5
-5.3
-5.3
-5.6
-6.0
-6.3
-7.2
-7.8
-7.8
-9.0
-11.
8
-13.
7
-29.
5
-30.
2
-51.
9
-75
-65
-55
-45
-35
-25
-15
-5
OR IN NH NY KY TX RI AK DC MD VT SD FL IL AR IA PA MO MT MS SC OH WY OK
Source: NAIC; Insurance Information Institute OK -202.5
Bottom 24 States and DC
The Affordable Care Act and Medical Professional Liability
52
A Summary of Potential Impacts
52
Issue Concern Contravening Argument
Surge in People Covered by Health Insurance
• System is overwhelmed
• Doctors spend less time on patients
• Patient care adversely impacted
• Over time, people will have access to preventative care, improving the general health of the population
• People are receiving care already via suboptimal channels
• Less use of ERs
Electronic Health Records
• Digitization could create a treasure trove of data for plaintiff attorneys
• Computerization of patient data could help flag issues and improve risk management and improve patient outcomes
MPL Claim Severity• More large verdicts
will • ACA will help contain system
costs
Source: Insurance Information Institute research. 53
Potential Impacts of the ACA on Medical Professional Liability
Number of People Signed Up for Health Care Under the ACA, Oct. 1 – March 1
54
759,800
Source: Centers for Medicare and Medicaid as of March 7, 2014: http://aspe.hhs.gov/health/reports/2014/MarketPlaceEnrollment/Mar2014/ib_2014mar_enrollment.pdf
As of March 1, 4.2 million people have signed up for coverage under the ACA
since enrollment opened on Oct. 1, 2013
UPDATEHHS
announced that
enrollment as of 3/16 now exceeds 5
million
55
Projected Number of People with No Health Insurance, 2013—2022*
31
55
4437
30
5
15
25
35
45
55
65
2013E 2014F 2015F 2018F 2022F
Millions
The projected decline in the uninsured population is very sensitive to the enrollment rate under the Affordable Care Act
By 2018 the number of people under age 65 without
insurance is expected to drop by 25 million (~45%)
55
*Under age 65.Sources: Centers for Medicare & Medicaid Services, Office of the Actuary at http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NationalHealthAccountsProjected.html accessed 3/14/14; Insurance Information Institute.
56
P/C Insurance Industry Financial Overview
2013: Best Year in the Post-Crisis Era
56
P/C Net Income After Taxes1991–2013:Q3 ($ Millions)
2005 ROE*= 9.6% 2006 ROE = 12.7% 2007 ROE = 10.9% 2008 ROE = 0.1% 2009 ROE = 5.0% 2010 ROE = 6.6% 2011 ROAS1 = 3.5% 2012 ROAS1 = 5.9% 2013:9M ROAS1 = 9.5%
• ROE figures are GAAP; 1Return on avg. surplus. Excluding Mortgage & Financial Guaranty insurers yields a 8.9% ROAS through 2013:Q3, 6.2% ROAS in 2012, 4.7% ROAS for 2011, 7.6% for 2010 and 7.4% for 2009.
Sources: A.M. Best, ISO, Insurance Information Institute
$14,
178
$5,8
40
$19,
316
$10,
870
$20,
598
$24,
404 $3
6,81
9
$30,
773
$21,
865
$3,0
46
$30,
029
$62,
496
$3,0
43
$35,
204
$19,
456 $3
3,52
2
$43,
029
$28,
672
-$6,970
$65,
777
$44,
155
$20,
559
$38,
501
-$10,000
$0
$10,000
$20,000
$30,000
$40,000
$50,000
$60,000
$70,000
$80,000
91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10 11 12 13:9M
2013:9M ROAS
was 9.5%
Net income is up substantially
(+54.7%) from 2012:Q3 $27.8B
58
-5%
0%
5%
10%
15%
20%
25%
71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10 11 1213
:9M
Net Premium Growth: Annual Change, 1971—2013:Q3(Percent)
1975-78 1984-87 2000-03
Shaded areas denote “hard market” periodsSources: A.M. Best (historical and forecast), ISO, Insurance Information Institute.
Net Written Premiums Fell 0.7% in 2007 (First Decline
Since 1943) by 2.0% in 2008, and 4.2% in 2009, the First 3-Year Decline Since 1930-33.
2013:9M = 4.2%
2012 growth was +4.3%
-5%
0%
5%
10%
15%
20%
25%
75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10 11 1213
:Q3
Profitability Peaks & Troughs in the P/C Insurance Industry, 1975 – 2013:Q3*
*Profitability = P/C insurer ROEs. 2011-13 figures are estimates based on ROAS data. Note: Data for 2008-2013 exclude mortgage and financial guaranty insurers.Source: Insurance Information Institute; NAIC, ISO, A.M. Best.
1977:19.0% 1987:17.3%
1997:11.6%2006:12.7%
1984: 1.8% 1992: 4.5% 2001: -1.2%
10 Years
10 Years9 Years
2011: 4.7%
History suggests next ROE peak will be in 2016-2017
ROE
1975: 2.4%
2013:Q3 8.9%
A 100 Combined Ratio Isn’t What ItOnce Was: Investment Impact on ROEsCombined Ratio / ROE
* 2008 -2013 figures are return on average surplus and exclude mortgage and financial guaranty insurers. 2013:9M combined ratio including M&FG insurers is 95.8; 2012 =103.2, 2011 = 108.1, ROAS = 3.5%. Source: Insurance Information Institute from A.M. Best and ISO Verisk Analytics data.
97.5100.6 100.1 100.8
92.7
101.299.5
101.0
96.6
102.4
106.5
95.7
14.3%15.9%
12.7%10.9%
7.4% 7.9%
4.7%6.2%9.6%8.8%
4.3%
8.9%
80
85
90
95
100
105
110
1978 1979 2003 2005 2006 2007 2008 2009 2010 2011 2012 2013:9M0%
3%
6%
9%
12%
15%
18%
Combined Ratio ROE*
Combined Ratios Must Be Lower in Today’s DepressedInvestment Environment to Generate Risk Appropriate ROEs
A combined ratio of about 100 generates an ROE of ~7.0% in 2012, ~7.5% ROE in 2009/10,
10% in 2005 and 16% in 1979
Lower CATs are improved ROEs
in 2013
61
P/C Insurance Industry Combined Ratio, 2001–2013:Q3*
* Excludes Mortgage & Financial Guaranty insurers 2008--2012. Including M&FG, 2008=105.1, 2009=100.7, 2010=102.4, 2011=108.1; 2012:=103.2; 2013:Q3 = 95.8. Sources: A.M. Best, ISO.
95.799.3
100.8
106.3
102.4
96.6
101.0
92.6
100.898.4
100.1
107.5
115.8
90
100
110
120Best
Combined Ratio Since 1949 (87.6)
As Recently as 2001, Insurers Paid Out
Nearly $1.16 for Every $1 in Earned
Premiums
Relatively Low CAT Losses, Reserve Releases
Heavy Use of Reinsurance Lowered Net
Losses
Relatively Low CAT Losses, Reserve Releases
Avg. CAT Losses,
More Reserve Releases
Higher CAT
Losses, Shrinking Reserve
Releases, Toll of Soft
Market
Cyclical Deterioration
Sandy Impacts
Lower CAT
Losses
62
2
(2)
(8)
(3)(7)
(10)(10)
(4)(0)
11
24
1411 9
(5)(9)
(13)(12)(10)(14)
(12)(10)
(7) (7)
-$20
-$15
-$10
-$5
$0
$5
$10
$15
$20
$25
$3092 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10 11 12
13E
14E
15E
Prio
r Yr.
Res
erve
Rel
ease
($B
)
-6
-4
-2
0
2
4
6
8 Impact on C
ombined R
atio (Points)
Prior Yr. ReserveDevelopment ($B)
Impact onCombined Ratio(Points)
P/C Reserve Development, 1992–2015E
Note: 2005 reserve development excludes a $6 billion loss portfolio transfer between American Re and Munich Re. Including this transaction, total prior year adverse development in 2005 was $7 billion. The data from 2000 and subsequent years excludes development from financial guaranty and mortgage insurance. Sources: A.M. Best, ISO, Barclays Research (estimates).
63
Policyholder Surplus, 2006:Q4–2013:Q3
Sources: ISO, A.M .Best.
($ Billions)
$487.1$496.6
$512.8$521.8
$478.5
$455.6
$437.1
$463.0
$490.8
$511.5
$540.7$530.5
$544.8$559.2 $559.1
$538.6$550.3
$567.8$583.5$586.9
$607.7$614.0$624.4
$570.7$566.5
$505.0$515.6$517.9
$400
$450
$500
$550
$600
$650
06:Q
4
07:Q
1
07:Q
2
07:Q
3
07:Q
4
08:Q
1
08:Q
2
08:Q
3
08:Q
4
09:Q
1
09:Q
2
09:Q
3
09:Q
4
10:Q
1
10:Q
2
10:Q
3
10:Q
4
11:Q
1
11:Q
2
11:Q
3
11:Q
4
12:Q
1
12:Q
2
12:Q
3
12:Q
4
13:Q
1
13:Q
2
13:Q
3
2007:Q3Pre-Crisis Peak
Surplus as of 9/30/13 stood at a record high $624.4B
2010:Q1 data includes $22.5B of paid-in capital from a holding company parent for one insurer’s investment in a non-insurance business .
The industry now has $1 of surplus for every $0.78 of NPW,close to the strongest claims-paying status in its history.
Drop due to near-record 2011 CAT losses
The P/C insurance industry entered 2014in very strong financial condition.
Financial Strength & Underwriting
64
History Suggests that MPL, Like Other Long-Tailed Lines Is Much
More Difficult to Underwrite
64
P/C Insurer Impairments, 1969–201269 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10 11 12
0
10
20
30
40
50
60
70
815
127
11 934
913 12
199
16 14 1336
4931
3450 48
5560 58
4129
1612
3118 19
49 5047
3518
14 155
1619 21
3421
Source: A.M. Best Special Report “Pace of P/C Impairments Slowed in 2012; Auto Writers, RRGs Continued to Struggle,” June 2013; Insurance Information Institute.
The Number of Impairments Varies Significantly Over the P/C Insurance Cycle, With Peaks Occurring Well into Hard Markets
65
Impairments among P/C insurers remain infrequent
66
P/C Insurer Impairment Frequency vs. Combined Ratio, 1969-2012
90
95
100
105
110
115
12069 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10 11 12
Com
bine
d R
atio
0.0
0.2
0.4
0.6
0.8
1.0
1.2
1.4
1.6
1.8
2.0
Impairm
ent Rate
Combined Ratio after Div P/C Impairment Frequency
Source: A.M. Best; Insurance Information Institute
2012 impairment rate was 0.69%, down from 1.11% in 2011; the rate is lower than the 0.82% average since 1969
Impairment Rates Are Highly Correlated With Underwriting Performance and Reached Record Lows in 2007; Recent Increase Was Associated
Primarily With Mortgage and Financial Guaranty Insurers and Not Representative of the Industry Overall
67
Reasons for US P/C Insurer Impairments, 1969–2012
43.4%
12.6%
7.2%
7.1%
8.0%
6.6%
8.4%
3.5% 3.1%
Source: A.M. Best Special Report “Pace of P/C Impairments Slowed in 2012; Auto Writers, RRGs Continued to Struggle,” June 2013; Insurance Information Institute.
Historically, Deficient Loss Reserves and Inadequate Pricing AreBy Far the Leading Cause of P-C Insurer Impairments.
Investment and Catastrophe Losses Play a Much Smaller Role
Deficient Loss Reserves/Inadequate Pricing
Reinsurance Failure
Rapid GrowthAlleged Fraud
Catastrophe Losses
Affiliate Impairment
Investment Problems (Overstatement of Assets)
Misc.
Sig. Change in Business
68
Top 10 Lines of Business for US P/C Impaired Insurers, 2000–2012
19.7%
22.2%
9.2%8.8%
7.3%
8.6%
6.7%
4.8%
4.0%
8.6%
Source: A.M. Best Special Report “Pace of P/C Impairments Slowed in 2012; Auto Writers, RRGs Continued to Struggle,” June 2013; Insurance Information Institute..
Medical Professional Liability Accounts for Only About 2% of Industry DPW but 6.7% of Insurer Impairments
Workers Comp
Other
Pvt. Passenger Auto
HomeownersCommercial Multiperil
Commercial Auto Liability
Other Liability
Med Mal
Surety
Title
INVESTMENTS: THE NEW REALITY
69
The Challenge of Low Investment Yields Is a Critical Issue for MPL
Insurers Is Relief in Sight?
69
Property/Casualty Insurance Industry Investment Income: 2000–2013*1
$38.9$37.1 $36.7
$38.7
$54.6
$51.2
$47.1 $47.6$49.2
$47.7$45.8
$39.6
$49.5$52.3
$30
$40
$50
$60
00 01 02 03 04 05 06 07 08 09 10 11 12 13*
Investment Income Fell in 2012 and is Falling in 2013 Due to Persistently Low Interest Rates, Putting Additional Pressure on (Re) Insurance Pricing
1 Investment gains consist primarily of interest and stock dividends..*Estimate based on annualized actual 9M:2013 investment income of $34.338B.Sources: ISO; Insurance Information Institute.
($ Billions)
Investment earnings are running below their 2007
pre-crisis peak
71
P/C Insurer Net Realized Capital Gains/Losses, 1990-2013:Q3
Sources: A.M. Best, ISO, Insurance Information Institute.
$2.8
8
$4.8
1 $9.8
9
$9.8
2
$10.
81 $18.
02
$13.
02
$16.
21
$6.6
3
-$1.
21
$6.6
1
$9.1
3
$9.7
0
$3.5
2 $8.9
2
-$7.
90
$5.8
5
$7.0
4
$6.2
1
$6.0
4
-$19
.81
$9.2
4
$6.0
0
$1.6
6
-$25-$20-$15-$10
-$5$0$5
$10$15$20
90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10 11 1213:9M
Insurers Posted Net Realized Capital Gains in 2010, 2011 and 2012 Following Two Years of Realized Losses During the Financial Crisis. Realized Capital
Losses Were the Primary Cause of 2008/2009’s Large Drop in Profits and ROE
($ Billions) Realized capital gains in 2013 will eclipse 2012 gains
Property/Casualty Insurance Industry Investment Gain: 1994–2013:Q31
$35.4
$42.8$47.2
$52.3
$44.4
$36.0
$45.3$48.9
$59.4$55.7
$64.0
$31.7
$39.2
$53.4$56.2$53.9
$40.4
$58.0$51.9
$56.9
$0
$10
$20
$30
$40
$50
$60
$70
94 95 96 97 98 99 00 01 02 03 04 05* 06 07 08 09 10 11 12 13:9M
Investment Income Continued to Fall in 2013 Due to Low Interest Rates but Realized Investment Gains Were Up Sharply; The Financial Crisis
Caused Investment Gains to Fall by 50% in 20081 Investment gains consist primarily of interest, stock dividends and realized capital gains and losses.* 2005 figure includes special one-time dividend of $3.2B; Sources: ISO; Insurance Information Institute.
($ Billions)
Investment gains through 2013:Q3 were approximately
double those through 2012:Q3
73
-1.8
%
-1.8
%
-2.0
%
-3.6
%
-3.3
%
-3.3
%
-3.7
%
-4.3
%
-5.2
%
-5.7
%
-7.3%
-1.9
%
-2.1
%
-3.1
%
-8%-7%-6%-5%-4%-3%-2%-1%0%
Person
al Lines
Pvt Pass
Auto
Pers P
rop
Commerc
ial
Comml A
uto
Credit
Comm P
rop
Comm C
as
Fidelity
/Surety
Warra
nty
Surplus
Line
s
Med M
al
WC
Reinsu
rance
**
In order to offset a 1% decline in investment yield, an MPL insurer needs to reduce its combined ratio by
about 5.2 points to maintain the same ROE*Based on 2008 Invested Assets and Earned Premiums**US domestic reinsurance onlySource: A.M. Best; Insurance Information Institute.
Reduction in Combined Ratio Necessary to Offset 1% Decline in Investment Yield to Maintain Constant ROE, by Line*
73
74
$57,079$58,085 $58,559 $58,900
$47,944
$50,648
$48,261
$50,340
$54,112 $54,511
$40,000
$42,000
$44,000
$46,000
$48,000
$50,000
$52,000
$54,000
$56,000
$58,000
$60,000
2006 2007 2008 2009 2010 2011 2012 2013E 2014F 2015F
($ Millions)
MPL invested assets continue to grow despite declining profits
MPL Cash and Invested Assets,2006 – 2015F
Source: Conning.
Growth in invested assets has been strong since the
recession, mirroring the p/c insurance industry overall
75
U.S. 10-Year Treasury Note Yields:A Long Downward Trend, 1990–2014*
*Monthly, through February 2014. Note: Recessions indicated by gray shaded columns.Sources: Federal Reserve Bank at http://www.federalreserve.gov/releases/h15/data.htm. National Bureau of Economic Research (recession dates); Insurance Information Institutes.
1%
2%
3%
4%
5%
6%
7%
8%
9%
'90 '91 '92 '93 '94 '95 '96 '97 '98 '99 '00 '01 '02 '03 '04 '05 '06 '07 '08 '09 '10 '11 '12 '13 '14
Yields on 10-Year U.S. Treasury Notes have been essentially below 5% for a full decade.
Since roughly 80% of P/C bond/cash investments are in 10-year or shorter durations, most P/C insurer portfolios will have low-yielding bonds for years to come.
Yields on 10-Year U.S. Treasury Notes recently plunged to record modern-era lows in early 2013 but have since risen as the Fed begins “tapering” its
QE program in 2014
75
76
U.S. Treasury Security Yields:A Long Downward Trend, 1990–2014*
*Monthly, constant maturity, nominal rates, through February 2014.Sources: Federal Reserve Bank at http://www.federalreserve.gov/releases/h15/data.htm. National Bureau of Economic Research (recession dates); Insurance Information Institute.
0%
1%
2%
3%
4%
5%
6%
7%
8%
9%
'90 '91 '92 '93 '94 '95 '96 '97 '98 '99 '00 '01 '02 '03 '04 '05 '06 '07 '08 '09 '10 '11 '12 '13 '14
Recession2-Yr Yield10-Yr Yield
Yields on 10-Year U.S. Treasury Notes have been essentially below 5% for a full decade.
Since roughly 80% of P/C bond/cash investments are in 10-year or shorter durations, most P/C insurer portfolios will have low-yielding bonds for years to come.
U.S. Treasury yields plunged to historic lows in
2013. Only longer-term yields have rebounded.
76
77
Treasury Yield Curves: Pre-Crisis (July 2007) vs. Feb. 2014
0.05% 0.05% 0.08% 0.12% 0.33%
2.15%
2.71%
4.82% 4.96% 5.04% 4.96% 4.82% 4.82% 4.88% 5.00% 4.93% 5.00% 5.19%
1.40%
0.69%
3.66%3.38%
0%
1%
2%
3%
4%
5%
6%
1M 3M 6M 1Y 2Y 3Y 5Y 7Y 10Y 20Y 30Y
Feb. 2014 Yield CurvePre-Crisis (July 2007)
Treasury yield curve remains near its most depressed level in
at least 45 years. Investment income is falling as a result.
Even as the Fed “tapers” rates are unlikely to return to pre-crisis
levels anytime soon
The Fed Is Actively Signaling that it Is Determined to Keep Rates Low Until Unemployment Drops Below 6.5% or Until Inflation Expectations
Exceed 2.5%; Low Rates Add to Pricing Pressure for Insurers.Source: Federal Reserve Board of Governors; Insurance Information Institute.
79
Outlook for U.S. Treasury Bond Yields Through 2015
0.761.17
1.802.30
1.802.35
3.50
4.20
1.40
0.100.090.060.00.51.01.52.02.53.03.54.04.5
2012 2013 2014F 2015F
3-Month 5-Year 10-Year
% Yield
Longer-tail lines like MPL and workers comp will benefit the most from the normalization of yields
Long-term yields should begin to normalize in 2014 but short-term yields will
remain very low until 2015
79Source: Federal Reserve Board of Governors (2012-2013), Swiss Re (2014-2015); Insurance Information Institute.
81
Distribution of Bond Maturities,P/C Insurance Industry, 2003-2012
16.0%
15.2%
15.7%
16.2%
16.3%
29.8%
29.2%
28.8%
29.5%
30.0%
32.4%
36.2%
39.5%
41.4%
40.4%
31.3%
32.5%
34.1%
34.1%
33.8%
31.2%
28.7%
26.7%
26.8%
27.6%
15.4%
15.4%
13.6%
13.1%
12.9%
12.7%
11.7%
11.1%
10.3%
9.8%
9.2%
7.6%
7.6%
7.4%
8.1%
8.1%
7.3%
6.4%
6.3%
5.7%16.5%
15.2%
14.4%
16.0%
15.4%
0% 20% 40% 60% 80% 100%
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
Under 1 year1-5 years5-10 years10-20 yearsover 20 years
Sources: SNL Financial; Insurance Information Institute.
The main shift over these years has been from bonds with longer maturities to bonds with shorter maturities. The industry first trimmed its holdings of over-10-year bonds
(from 24.6% in 2003 to 15.5% in 2012) and then trimmed bonds in the 5-10-year category (from 31.3% in 2003 to 27.6% in 2012) . Falling average maturity of the P/C industry’s bond portfolio is contributing to a drop in investment income along with lower yields.
Bonds Rated NAIC Quality Category 3-6 as a Percent of Total Bonds, 2003–2012
2.69%
2.10% 2.17%1.98%
3.07% 3.10%
4.07%
2.04%2.27%
2.58%
1.5%
2.0%
2.5%
3.0%
3.5%
4.0%
4.5%
2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
There are many ways to capture higher yields on bond portfolios.One is to accept greater risk, as measured by NAIC bond ratings.
The ratings range from 1 to 6, with the highest quality rated 1.Even in 2012, over 95% of the industry’s bonds were rated 1 or 2.
Sources: SNL Financial; Insurance Information Institute.
From 2006-07 to year-end 2012, the percentage of lower-quality
bonds in P/C industry portfolios more than doubled
Shifting Legal Liability & Tort Environment
83
Is the Tort PendulumSwinging Against Insurers?
83
84
Over the Last Three Decades, Total Tort Costs as a % of GDP Appear Somewhat Cyclical, 1980-2013E
$0
$50
$100
$150
$200
$250
$300
80 82 84 86 88 90 92 94 96 98 00 02 04 06 08 10 12E
Tort
Syst
em C
osts
1.50%
1.75%
2.00%
2.25%
2.50%
Tort Costs as %
of GD
P
Tort Sytem Costs Tort Costs as % of GDP
($ Billions)
Sources: Towers Watson, 2011 Update on US Tort Cost Trends, Appendix 1A
Tort costs in dollar terms have remained high but relatively stable
since the mid-2000s., but are down substantially as a share of GDP
Deepwater Horizon Spike
in 2010
1.68% of GDP in 2013
2.21% of GDP in 2003
= pre-tort reform peak
85
Commercial Lines Tort Costs: Insured vs. Self-(Un)Insured Shares, 1973-2010
Billions of Dollars
$0
$20
$40
$60
$80
$100
$120
$140
$160
73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10
Self (Un) Insured ShareInsurer Share
Tort Costs and the Share Retained by Risks Both Grew Rapidly from the mid-1970s to mid-2000s, When Tort Costs Began to Fall But Self-
Insurance Shares Continued to Rise
$9.5
$15.0
$6.0
1973: Commercial Tort Costs
Totaled $6.49B, 94% was insured,
6% self-(un)insured
1985: $46.6B 74.5% insured,
25.5% self-(un)insured
1995: $83.6B 69.5% insured,
30.5% self-(un)insured
2005: $143.5B 66.4% insured,
33.6% self-(un)insured
2009: $126.5B 64.4% insured,
35.6% self-(un)insured
Sources: Towers Watson, 2011 Update on US Tort Cost Trends, III Calculations based on data from Appendix 4. 85
86
Commercial Lines Tort Costs: Insured vs. Self-(Un)Insured Shares, 1973-2010
Percent
0%10%20%30%40%50%60%70%80%90%
100%
73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10
Self (Un) Insured ShareInsurer Share
The Share of Tort Costs Retained by Risks Has Been Steadily Increasing for Nearly 40 Years. This Trend Contributes Has Left
Insurers With Less Control Over Pricing.
1973: 94% was insured,
6% self-(un)insured
1985:74.5% insured,
25.5% self-(un)insured
1995: 69.5% insured,
30.5% self-(un)insured
2005: 66.4% insured,
33.6% self-(un)insured
2010: $138.1B 56.6% insured, 44.4% self-(un)insured
(distorted by Deepwater Horizon event with most losses retained by BP)
Sources: Towers Watson, 2011 Update on US Tort Cost Trends, III Calculations based on data from Appendix 4. 86
Business Leaders Ranking of Liability Systems in 2012
Best States1. Delaware
2. Nebraska
3. Wyoming
4. Minnesota
5. Kansas
6. Idaho
7. Virginia
8. North Dakota
9. Utah
10. Iowa
Worst States41. Florida
42. Oklahoma
43. Alabama
44. New Mexico
45. Montana
46. Illinois
47. California
48. Mississippi
49. Louisiana
50. West Virginia
Source: US Chamber of Commerce 2012 State Liability Systems Ranking Study; Insurance Info. Institute.
New in 2012 Wyoming Minnesota Kansas Idaho
Drop-offs
Indiana Colorado Massachusetts South Dakota
Newly Notorious
Oklahoma
Rising Above
Arkansas
87
88
The Nation’s Judicial Hellholes: 2012/2013
Source: American Tort Reform Association; Insurance Information Institute
West VirginiaIllinoisMadison County
New YorkAlbany and
NYC
Watch List Philadelphia,
Pennsylvania South Florida Cook County, Illinois New Jersey Nevada Louisiana
Dishonorable Mention
MO Supreme Court WA Supreme Court
California
MarylandBaltimore
CYBER RISK
89
Cyber Risk is a Rapidly Emerging Exposure for Businesses Large
and Small in Every IndustryNEW III White Paper:
http://www.iii.org/assets/docs/pdf/paper_CyberRisk_2013.pdf
89
Data Breaches 2005-2013, by Number of Breaches and Records Exposed# Data Breaches/Millions of Records Exposed
* 2013 figures as of Jan. 1, 2014 from the ITRC updated to an additional 30 million records breached (Target) as disclosed in Jan. 2014.Source: Identity Theft Resource Center.
157
321
446
656
498
419447
619662
87.9
17.322.9
35.7
19.1
66.9
222.5
16.2
127.7
100
200
300
400
500
600
700
2005 2006 2007 2008 2009 2010 2011 2012 2013*020406080100120140160180200220
# Data Breaches # Records Exposed (Millions)
The Total Number of Data Breaches (+38%) and Number of Records Exposed (+408%) in 2013 Soared
Millions
91
2012 Data Breaches By Business Category, By Number of Breaches
3.8%11.2%
13.6%
34.5%
36.9%
Source: Identity Theft Resource Center, http://www.idtheftcenter.org/ITRC%20Breach%20Report%202012.pdf.
The majority of the 447 data breaches in 2012 affected business and medical/healthcare organizations, according to the Identity Theft Resource Center.
Business, 165 (36.9%)Govt/Military, 50 (11.2%)
Banking/Credit/Financial, 17 (3.8%)
Educational, 61 (13.6%)
Medical/Healthcare, 154 (34.5%)
Medical/Health organizations accounted for
more than 1/3 of all cyber breaches in
2012
92
2012 Data Breaches By Category, By Number of Records Exposed
2.7%12.9%
13.3%
26.7%
44.4%
Source: Identity Theft Resource Center, http://www.idtheftcenter.org/ITRC%20Breach%20Report%202012.pdf.
Government/Military and Business organizations accounted for the majority of records exposed by data breaches during 2012.
Govt/Military, 7.7 million (44.4%)
Medical/Healthcare, 2.2 million (12.9%)
Banking/Credit/Financial, 470,048 (2.7%)
Educational, 2.3 million (13.3%)
Business, 4.6 million (26.7%)
Medical/Health organizations accounted for
12.9% of records exposed in 2012
95
External Cyber Crime Costs: Fiscal Year 2012
2%5%
19%
30%
44%
* Other costs include direct and indirect costs that could not be allocated to a main external cost categorySource: 2012 Cost of Cyber Crime: United States, Ponemon Institute.
Information loss (44%) and business disruption or lost productivity (30%) account for the majority of external costs due to cyber crime.
Information loss
Equipment damagesOther costs*
Revenue loss
Business disruption
Information loss is the major concern,
business interruption could
cause serious issues for health
institutions as well
www.iii.org
Thank you for your timeand your attention!
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