Journal of Insurance Regulation最新文献

{"title":"Addressing low-value insurance products with improved consumer information: the case of ancillary health products","authors":"Jackson Williams","doi":"10.52227/26275.2022","DOIUrl":"https://doi.org/10.52227/26275.2022","url":null,"abstract":"The sale of financial services products is rife with information asymmetry favoring sellers and leads to the marketing of insurance products offering low value to consumers. Exemplifying this problem is the current market for ancillary health insurance products such as short-term health insurance and supplemental insurance. One policy option for state insurance regulators is to mandate a robust regime of disclosures and labeling, described here as comparative disclosures. This article reviews comparative disclosure regulations previously implemented in the U.S. and proposals for reforms. It then outlines a possible policy solution for the lack of value in ancillary health insurance products: expanding consumer information to facilitate shopping.","PeriodicalId":261634,"journal":{"name":"Journal of Insurance Regulation","volume":"28 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128954335","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Abstracts of significant cases bearing on the regulation of insurance","authors":"Olivea Myers","doi":"10.52227/25344.2021","DOIUrl":"https://doi.org/10.52227/25344.2021","url":null,"abstract":"This is a review of significant court cases of interest in 2021 concerning insurance regulation.","PeriodicalId":261634,"journal":{"name":"Journal of Insurance Regulation","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130727684","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"COVID-19 and CreditWatch list as an economic indicator","authors":"Joseph M. Goebel, K. Kemper, Kevin M. Gatzlaff","doi":"10.52227/26274.2022","DOIUrl":"https://doi.org/10.52227/26274.2022","url":null,"abstract":"The global pandemic attributable to COVID-19 interrupted a decade-long U.S. expansionary cycle. While governments intervened to manage the health crisis, the economy stalled, and equity markets crashed. However, equity markets quickly recovered and moved to positive territory a few months later. We examine the actions of credit rating agencies (CRAs) and the signals that are sent through S&P Global Ratings (S&P) Watch List activity. After creating a significant indicator based on CreditWatch activity reflecting private firm information, we find that the swift recovery may have been foreseeable for non-insurance firms. The indicator provides less potential predictive power for insurance firms, either because the greater regulatory activity surrounding insurance firms yields less private information to be discovered by CRAs or the insurance industry is more resilient to economic shock than other sectors of the economy.","PeriodicalId":261634,"journal":{"name":"Journal of Insurance Regulation","volume":"963 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123309594","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Feasibility questions about government-sponsored insurance for business interruption losses from pandemics","authors":"R. Klein, H. Weston","doi":"10.52227/22111.2020","DOIUrl":"https://doi.org/10.52227/22111.2020","url":null,"abstract":"Widespread economic losses to many businesses due to COVID-19 business\u0000closures have led many plaintiffs’ attorneys to assert in lawsuits that business\u0000interruption (BI) insurance policies cover these losses, while insurers generally\u0000contend that their BI policies exclude coverage for a variety of reasons. We explain\u0000the basic coverage contentions below. Additionally, several states are considering\u0000measures that would retroactively establish coverage for pandemic-caused losses\u0000under BI policies. While the resolution of coverage disputes and the legality of\u0000retroactive coverage expansions in the courts is uncertain, clearly there is strong\u0000interest in making BI pandemic insurance available going forward.\u0000\u0000While a few insurers have offered BI pandemic coverage, no firms have\u0000purchased it (Lerner, 2020). Further, many insurers are reluctant to expand their\u0000BI policies to cover pandemic losses. Hence, there is strong interest in creating a\u0000federal government insurance program that would provide BI pandemic coverage. \u0000\u0000Currently, there are at least two formal proposals to establish such a program.\u0000One proposal is the Pandemic Risk Insurance Act of 2020 (PRIA), which was\u0000introduced in the U.S. Congress as H.R. 7011; PRIA would establish a Pandemic\u0000Risk Reinsurance Program (PRRP) modeled after the Terrorism Risk Reinsurance\u0000Program (TRRP) established by the Terrorism Risk Insurance Act (TRIA). Three\u0000industry trade associations also have proposed a Business Continuity Protection\u0000Program (BCPP) as an alternative to PRIA that is similar in some regard to the\u0000National Flood Insurance Program (NFIP).\u0000\u0000PRIA intends to create a public and private insurance program that would\u0000provide BI insurance for pandemics, with participating private insurers retaining\u00005% of losses above a deductible. We critique the program contemplated by PRIA\u0000and discuss the BCPP. Additionally, we consider a program concept of our own\u0000design that would also borrow from the NFIP (but would differ somewhat from the\u0000BCPP), as well as a program similar to the federal crop insurance program. We\u0000conclude that frameworks based on the NFIP or the federal crop insurance program\u0000would have several advantages over PRIA, which has a number of problems, but\u0000even these alternative frameworks would face many challenges. This policy brief\u0000provides a preliminary review of the PRIA and BCPP drafts, as well as other\u0000alternative frameworks, and draws from a longer working paper by the authors\u0000(Klein and Weston, 2020)","PeriodicalId":261634,"journal":{"name":"Journal of Insurance Regulation","volume":"83 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122967701","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Flood insurance redesigned: Regulatory considerations for a viable and sustainable private market","authors":"Rebecca Williams, Lorilee A. Medders, David C. Marlett, Catherine Lattimore, D. Evans","doi":"10.52227/26443.2023","DOIUrl":"https://doi.org/10.52227/26443.2023","url":null,"abstract":"Several factors have converged in recent years, bringing the need for admitted-market, private flood insurance options in the U.S. to the fore. Meanwhile, other factors have coincided that make modeling and pricing large segments of the U.S. flood risk exposures more accessible and more accurate than was historically possible. The National Flood Insurance Program (NFIP), despite recent rating reforms, faces daunting financial and market challenges. The U.S. flood risk has increased: The risk of severe flooding and the cost of such events continues to grow. Flood loss models that can support granular pricing are now commercially available, outperforming the Federal Emergency Management Agency’s (FEMA’s) flood maps historically used for rating and loss mitigation purposes. Several states have begun encouraging admitted insurance markets to provide flood insurance in addition to the NFIP and the excess and surplus lines coverages already available. This paper examines the private market opportunity and challenges, highlights state-level strategies, and demonstrates the importance of flexibility in program legislation and regulation—with respect to both program design and implementation. Our work contributes to the literature by: 1)exploring the market challenges in the development of private flood insurance; 2)demonstrating the importance of local risk considerations and flexible program features for state-level, private strategies that provide a sustainable framework for insurers to consider; and 3) highlighting the alignment of recent model laws and several state programs with the recommended features.","PeriodicalId":261634,"journal":{"name":"Journal of Insurance Regulation","volume":"12 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133554317","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Denied and resisted life insurance claims: recommended changes to schedule f","authors":"Cassandra R. Cole, Jill Bisco","doi":"10.52227/23501.2017","DOIUrl":"https://doi.org/10.52227/23501.2017","url":null,"abstract":"Life insurance is generally purchased to protect against the economic consequences associated with premature death. Consumers and producers may assume that all life insurance companies settle death claims in one way—full payment of the life insurance proceeds. This is not always the case. Life insurers may deny or resist paying life insurance claims, and these claims are reported on the Schedule F of the statutory financial statement. This paper analyzes the claims that have been denied and resisted by life insurers and makes recommendations to modify the current Schedule F so that it is more informative to consumers, producers and state insurance regulators.","PeriodicalId":261634,"journal":{"name":"Journal of Insurance Regulation","volume":"48 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124866793","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Social media as a factor in personal injury underwriting: risk, rate and regulation","authors":"H. Weston, Brenda Wells","doi":"10.52227/22019.2020","DOIUrl":"https://doi.org/10.52227/22019.2020","url":null,"abstract":"In this study, the authors analyze the rise of social media claims and how such consumer usage of social media and other types of data might be analyzed to ascertain predictive and appropriate rate factors. Rates must be based on approved rate factors, which must correlate with the risk, be predictive of losses, and not be unfairly discriminatory.","PeriodicalId":261634,"journal":{"name":"Journal of Insurance Regulation","volume":"133 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122913454","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Do Health Insurers Manage Their Medical Loss Ratios? At What Cost?","authors":"Elizabeth Plummer, William F. Wempe","doi":"10.52227/23553.1.2021","DOIUrl":"https://doi.org/10.52227/23553.1.2021","url":null,"abstract":"We use plan-level data to examine a reporting incentive unique to health insurers—the federal Affordable Care Act’s (ACA’s) Medical Loss Ratio (MLR) provisions—which require that health plans spend a specified percentage of premiums on claims or else pay policyholder rebates. While there are no penalties for noncompliance with the MLR provisions, incentives for insurers to comply include avoiding political and reputation costs, reducing administrative burdens, and eliminating rebate payments. We find that health plans with pre-managed MLRs— i.e., the MLRs that would be reported without reporting discretion—below the required MLR overstate claims, thereby increasing their MLRs and reducing or eliminating rebate payments. Overall, results suggest that overstating claims reduced rebate payments by approximately $190 million to $325 million for 20112013; i.e., about 10–17% of total rebates actually paid. We also find that plans with pre-managed MLRs significantly greater than the minimum required MLR understate claims, thereby improving plan earnings while still complying with the MLR provisions. These understatements average between 14–34% of plans’ pre-tax earnings.","PeriodicalId":261634,"journal":{"name":"Journal of Insurance Regulation","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129333646","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An analysis of interpretation of insurance contracts: common law versus strict contra proferentem","authors":"Cassandra R. Cole, Randy Henry","doi":"10.52227/23499.2017","DOIUrl":"https://doi.org/10.52227/23499.2017","url":null,"abstract":"The majority of states recognize insurance policies as contracts of adhesion, in which the applicant must either accept the terms of the policy as written by the insurance company or reject the terms and accept similar terms from another insurance company (Plitt, 2010). As of June 2014, 44 states have adopted special rules interpreting insurance contracts to balance unequal bargaining power.1 One common alternative to traditional contract law is strict contra proferentem, which interprets ambiguous terms against the drafter without reviewing extrinsic or parol evidence. A second alternative, known as the reasonable expectations doctrine, interprets unambiguous policy language using the reasonable person standard. This article provides a discussion of the methods available to courts as it relates to interpreting ambiguous insurance contracts.","PeriodicalId":261634,"journal":{"name":"Journal of Insurance Regulation","volume":"9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130061613","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Material misrepresentations in insurance litigation: an analysis of insureds' arguments and court decisions","authors":"Kevin M. Gatzlaff, Stephen M. Avila, John R. FitzGerald","doi":"10.52227/25998.2015","DOIUrl":"https://doi.org/10.52227/25998.2015","url":null,"abstract":"The section presents abstracts of U.S. court cases bearing on the regulation of insurance during the 2012-2013 period, including Colby v. Union Security Insurance Co., UnitedHealth Group Inc. v. Columbia Casualty Co. and Bankers Life and Casualty Co. v. Superintendent of Insurance.","PeriodicalId":261634,"journal":{"name":"Journal of Insurance Regulation","volume":"37 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122021438","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}