Issue Brief: Wyoming Medical Liability Insurance Company Summary

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1 04IB007 Issue Brief: Wyoming Medical Liability Insurance Company Summary June 2004 by: Matthew M. Sackett, Associate Research Analyst PURPOSE Provide a summary of the major insurance companies covering medical malpractice in the state of Wyoming, including a history of financial and settlement data. RESULTS IN BRIEF In the recent past, The Doctors Company (TDC) and OHIC Insurance Company (OHIC) have been the two major participants in the Wyoming medical malpractice market with a few other companies insuring a small number of physicians. OHIC's decision in March 2004 to no longer insure Wyoming physicians will change the overall structure of Wyoming's medical malpractice market. Utah Medical Insurance Association (UMIA), which has had a small presence in Wyoming since the late 90's, has been dramatically increasing its business in Wyoming over the last several months. Testimony from UMIA indicates continued expansion is expected in the future, although available capital may be a limiting factor. A few other companies also have a small share in the market and any interest in expanding presence in Wyoming is unknown. Overall, the net income of these companies has been relatively modest, and in fact, occasionally characterized by losses. For the most part, OHIC, TDC, and UMIA have had a net underwriting loss in the last 10 years, accounting for all business lines in all states. This means the premiums written have not covered the expenses during the year, which is regularly the case with insurance companies. Furthermore, TDC and OHIC have had a negative total net income over the last two years, which means underwriting income, when combined with other income sources, primarily investment income, have not sufficiently covered all expenses. UMIA has had positive net income over the last five years. The following information was taken from the three major insurance companies' audited annual reports over the last three years. LSO has not independently verified the accuracy of this data, and thus, the following conclusions are based solely on the information provided. THE DOCTORS COMPANY The Doctors Company (TDC) is owned by TDC Group. TDC Group wholly owns six other subsidiaries which include: The Doctors Management Company, Bernard Warschaw Insurance Sales Agency, Professional Underwriters Liability Insurance Company, The Doctors Company Insurance Services, The Doctors Life Insurance Company, and Underwriter for the Professions Insurance Company. TDC has written policies in every state plus Guam. In 2002, TDC insured percent of the Wyoming market. TDC's premium rates are comparably higher than OHIC's rates in Wyoming. OHIC OHIC Insurance Company is a subsidiary of Medical Liability Mutual Insurance Company (MLMIC). OHIC had the largest percent of Wyoming's market in 2002, providing insurance to percent of the Wyoming market. OHIC announced its intention to withdraw from the state in March 2004, leaving a large gap in coverage for other medical malpractice insurance companies to fill over the next several months. OHIC was insuring physicians in roughly 14 states but has WYOMING LEGISLATIVE SERVICE OFFICE 213 State Capitol Cheyenne, Wyoming TELEPHONE (307) FAX (307) WEBSITE

2 PAGE 2 OF 4 decided to withdraw from all but its home state of Ohio. UMIA Utah Medical Insurance Association, unlike TDC and OHIC, is a wholly owned company based in Salt Lake City, Utah. UMIA has historically written policies throughout the Rocky Mountain Region, including Idaho, Montana, Utah and Wyoming. They have had a relatively small presence in Wyoming's medical malpractice insurance market with only 1.23 percent of the market share in 2002, but UMIA has recently been increasing its presence substantially. This growth of new business is expected to continue given the departure of OHIC, according to several sources. Specifically, in discussions with several hospital personnel around the state, it appears that UMIA is providing more coverage and trying to increase its Wyoming market. FINANCIAL STATEMENTS Within the limits of our basis for analysis, in the last two years, TDC and OHIC have had negative net income (net loss). This is illustrated in Attachment A, which shows selected financial statistics over a 10-year history for each company. It should be noted that this is not Wyoming specific data, but it reflects the performance of the entire company, including all lines of insurance. It appears the net underwriting losses have been so large that the premium and investment income has not been able to cover those losses in all years. Over the 10-year history, TDC had an underwriting loss in all 10 years and OHIC had a loss in 8 of the last 10 years. TDC had a negative overall net income in two years and OHIC in three of those years. UMIA, whose five-year history is also provided in Attachment A, has had an overall positive net income every year, with a net underwriting loss in all five years. Over the last few years, there has been a drop in investment income for both TDC and OHIC. This could be a contributing factor to its overall loss in net income for the last two years. Knowledgeable parties indicate that the insurance industry is cyclical in nature, if one accepts this theory; peaks and valleys in investment income would be expected. UMIA's investment income has been relatively steady over the five-year history, considering the natural fluctuations in market returns. Determining the extent to which the attacks of September 11, 2001 impacted the investment performance of TDC, OHIC, or UMIA is difficult. There do not appear to be outstanding deviations from the investment income trend specifically identifiable in 2001 data. That is, there are no extraordinary dips in the trend data. The recent decline in investment income can most likely be attributed to the overall poorly performing financial markets and sluggish economy as a whole. It appears that TDC and OHIC have not been profitable over the last several years because of increased expenditures and overall declining investment income. On the other hand, UMIA has been profitable despite fluctuations in investment income. SETTLEMENTS, VERDICTS AND EXPENSES A summary of OHIC, UMIA and TDC's medical malpractice claim settlements and costs are shown in the following three tables. TDC and UMIA have provided very detailed information, while OHIC provided annual summaries. The settlement data in more recent years has an increasing chance of being adjusted upwards as new claims are filed. It should be noted that because UMIA has had a limited presence in Wyoming, it does not have a well-developed claims history. TDC settled all of its claims without going to trial for the data provided from January 1997 through December The average time from the reporting date to the closing date over those six years was 574 days. The average number of claims was 12.7 per year. During this period, TDC has incurred total settlement costs of $23,240,639 in Wyoming, which includes all settlement amounts and expenses used in defense against the claims, such as lawyer's fees. This amounts to an average cost per year of $3,320,091. The six-year average cost per claim is $261,131. These can be seen in Table 1. It should be noted that these numbers are subject to WYOMING LEGISLATIVE SERVICE OFFICE 213 State Capitol Cheyenne, Wyoming TELEPHONE (307) FAX (307) WEBSITE

3 PAGE 3 OF 4 change with the possibility of more claims being settled, cases being tried, and expenses being incurred, especially for the more recent years. (See Attachment B for the full detail of settlement data from TDC.) Table 1. The Doctors Company Historical Settlement Data TOTALS Average Cost Indemnity Amount $ 3,583,900 $ 5,723,726 $ 4,331,750 $ 2,196,500 $ 3,000,000 $ 409,000 $ 16,500 $ 19,244,876 $ 2,751,625 ALAE Paid $ 446,837 $ 1,220,411 $ 874,239 $ 831,297 $ 417,337 $ 178,724 $ 10,418 $ 3,968,845 $ 568,466 Total Settlement Costs $ 4,030,737 $ 6,944,137 $ 5,205,989 $ 3,027,797 $ 3,417,337 $ 587,724 $ 26,918 $ 23,240,639 $ 3,320, Average Average Cost Per Claim $ 251,921 $ 315,643 $ 325,374 $ 178,106 $ 262,872 $ 195,908 $ 13,459 $ 261,131 Average Days to Settle Number of Claims Source: TDC Documents, 6/18/2004. Notes: (1) Settlement data in more recent years are increasingly likely to be adjusted upward as new claims are filed. (2) ALAE is the allocated loss adjustment expense. In 1994, OHIC had $90,000 in verdict(s) charges; all other years included only settlements, which can be seen in Table 2. It is not known if the verdict amount shown in 1994 was for one claim or more than one claim. The total expense for OHIC from 1991 through 2002 was almost $24 million, with an average yearly expense of $1,983,505. There was no data provided regarding the number of claims this represented or how long it took to close each claim. Table 2. OHIC Historical Settlement & Claims Data Year Settlements Verdicts Legal Exp. Other Exp. Total by Year 1991 $ 9,034 $ - $ 142,963 $ 43,348 $ 195, $ 87,208 $ - $ 31,381 $ 9,986 $ 128, $ 360,000 $ - $ 70,296 $ 25,102 $ 455, $ 1,741,892 $ 90,000 $ 478,121 $ 199,525 $ 2,509, $ 288,420 $ - $ 181,072 $ 62,529 $ 532, $ 5,546,892 $ - $ 948,437 $ 604,762 $ 7,100, $ 2,501,109 $ - $ 836,942 $ 384,696 $ 3,722, $ 910,973 $ - $ 476,239 $ 183,891 $ 1,571, $ 2,233,946 $ - $ 1,145,831 $ 485,612 $ 3,865, $ 1,783,030 $ - $ 463,513 $ 190,782 $ 2,437, $ 311,176 $ - $ 338,534 $ 231,884 $ 881, $ 215,000 $ - $ 120,669 $ 67,267 $ 402,936 Total $ 15,988,680 $ 90,000 $ 5,233,998 $ 2,489,384 $ 23,802,062 Average of Total Yearly Expense $ 1,983,505 Source: OHIC Documents 1/16/2004 UMIA has very little claims data available because of its limited presence in Wyoming, with approximately one percent of the market in Table 3 shows the claims history from 2002 through There are only five total claims; one of which has been closed with no indemnity paid and $6,039 in expenses. The other claims have not been closed so the final expense values cannot be determined accurately. These details are reflected below in Table 3. Again, it should also be noted that the data in more recent years is more likely to be adjusted upwards as new claims are filed. Date Reported Table 3. UMIA Claims History Date Closed Indemnity Paid Indemnity Reserve Expense Paid Expense Reserve $ $ 11/18/ $ 10,000 $ 11,252 25,000 Total - $ 10,000 $ 11,252 25,000 1/2/2003 8/7/ $ - $ 6,039 $ 6,039 1/13/ $ 500,000 $ 155,001 $ 200,000 1/28/ $ 10,000 $ 11,373 $ 25,000 Total - $ 510,000 $ 172,413 $ 231,039 5/4/ $ 25,000 $ - $ 8,500 Total - $ 25,000 $ - $ 8,500 Grand Totals $ 545,000 $ 183,665 $ 264,539 Source: UMIA documents, Note: These claims are grouped by Date Reported. WYOMING LEGISLATIVE SERVICE OFFICE 213 State Capitol Cheyenne, Wyoming TELEPHONE (307) FAX (307) WEBSITE

4 PAGE 4 OF 4 GENERAL INSURANCE INFORMATION According the Nation Association of Insurance Commissioners (NAIC) Profitability by Line by State report for the year 2002, the medical malpractice insurance industry has not been profitable in the last two years countrywide. There has been a steady decline in the return on net worth over the last 10 years and a negative return on net worth for the last two years. This data is illustrated in Attachment C. According to the same report, last year medical malpractice was one of two lines of property and casualty insurance that had a negative return on net worth, the other line being "other liability". Attachment D shows the nationwide direct premiums earned for all lines of insurance and the different expenses and transactions incurred as a percent of those direct premiums. It also shows the overall return on net worth as a percentage of the direct premiums earned. This shows more specifically where the large expenses and overall losses come from, as well as the overall returns for the year Attachment E compares all 50 state's medical malpractice insurance and shows each state's expenses as a percent of direct premiums earned. Nineteen states had a positive return on net worth, while 32 had a negative return on net worth. (Note, these numbers include the District of Columbia.) Wyoming had a return on net worth of percent of the direct premiums earned in In terms of rank, there were 20 states that had a higher return on net worth than Wyoming, and all but one of those had a positive return. The state with the highest return on net worth was Minnesota, with a return on net worth of 20.6 percent. In contrast, 30 states had a negative return on net worth that was worse than Wyoming's. The average return on net worth was a percent, with the biggest loss being a percent in Arkansas. These are all presented as a percentage of direct premiums earned for all lines of insurance and all regulated companies. Comparing medical liability insurance to the other lines of property and casualty insurance may further inform the relative performance of this type of business. Over the last 10 years, "allied lines" accounted for the highest percent of direct premiums earned (highest loss incurred) at 79.9 percent. Next, "private passenger auto liability" earned 76.2 percent. The average losses incurred for medical malpractice were 72.7 percent of the direct premiums earned. The 10-year average for underwriting profit was a - 28 percent of direct premiums earned, which was the lowest average of all insurance lines. "Private passenger auto liability" was next with a percent. Overall, the return on net worth for the 10-year history was 0.1 percent, but there were only three years, which reflected a positive return on net worth. The lowest average return was "allied lines" with a percent. "Medical malpractice" had the second lowest average return at 0.1 percent. Over the last six years, Wyoming medical malpractice insurance companies have (collectively) experienced a negative return on net worth; the worst year was 1996 with a 16.4 percent return. While there is no information for the most recent two years, by looking at the individual companies data, it appears to uphold the earlier years of overall losses for the medical malpractice industry. CONTACTS FOR ADDITIONAL INFORMATION Ken Vines, Insurance Commissioner, phone: (307) Wyoming specific information for all lines of insurance can be seen in Attachment F. Starting in 1993, Attachment F illustrates Wyoming's annual losses incurred, underwriting profit, profit on insurance transactions, and return on net worth. WYOMING LEGISLATIVE SERVICE OFFICE 213 State Capitol Cheyenne, Wyoming TELEPHONE (307) FAX (307) WEBSITE

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