3109CorneliusDrive Bloomington,IL61704 309.807.2300 pinnacleactuaries.com RooseveltC.Mosley,FCAS,MAAA Principal&ConsultingActuary rmosley@pinnacleactuaries.com June8,2015 Mr.CharlesRaimi DeputyCorporationCounsel CityofDetroitLawDepartment 2WoodwardAvenue,Suite500 Detroit,Michigan48226 [deliveredviaemailtoraimic@detrotitmi.gov] DearChuck: AttachedisthereportdetailingtheestimatedsavingsbasedontheproposedPIPreforms.Ithasbeena pleasureworkingwithyouinthedevelopmentofthisreport. Pinnacleremainsavailabletoansweranyquestionsorprovideanyclarificationsasneeded. ThankYou, Roosevelt RooseveltC.Mosley,FCAS,MAAA PrincipalandConsultingActuary CommitmentBeyondNumbers
June8,2015 RooseveltC.Mosley,Jr,FCAS,MAAA rmosley@pinnacleactuaries.com 309.807.2330 3109CorneliusDrive Bloomington,IL61704 309.807.2300 pinnacleactuaries.com CommitmentBeyondNumbers
3109CorneliusDrive Bloomington,IL61704 309.807.2300 pinnacleactuaries.com June8,2015 TableofContents Contents TableofContents...1 Scope...2 ReliancesandLimitations...2 DistributionandUse...2 Data...3 ProjectBackground...4 ReformProposal#1:PIPBenefitLimitsandPreferredProviderAgreements...5 IntroducePIPBenefitLimits...5 PreferredProviderAgreement...5 ReformProposal#2:HighDeductibleOption...7 TotalEstimatedSavings ReformOption#1...7 TotalEstimatedSavings ReformOption#2...8 MoreRecentData...9 Conclusion...10 IndexofAttachments...12 CommitmentBeyondNumbers
Scope TheCityofDetroit(TheCity)engagedPinnacleActuarialResources,Inc.(Pinnacle)toperforma feasibilitystudyforaproposedcitysponsoredinsurancecompany(dinsurance)thatwillsellnofault insurancetovehicleownersindetroit.theinitialphaseoftheprojectwasforpinnacletoreview availableinsurancedataandproposedlegislativechangestothemichigannofaultlawthatwould applytotheproposednewinsurer,andtoestimatethepremiumsavingsthatcouldbeachievedbased onthelawchanges. Basedonthefindingsintheinitialphaseandtheoutcomeoftheproposedlegislativechanges, PinnaclewouldthenassistTheCitywithdevelopmentoftheratingandunderwritingplanforD Insuranceaswellasprojectedfinancialresultsandcapitalrequirements. Thisreportoutlinesthecalculationoftheestimatedsavings. ReliancesandLimitations Indevelopingthisreport,PinnaclehasreliedprimarilyupondataandinformationsuppliedbyTheCity andtheinsuranceresearchcouncil(irc).werelieduponthegeneralaccuracyofthisdataand informationwithoutindependentverification.however,wedidreviewcertainelementsofthisdata andinformationforreasonablenessandconsistencywithourknowledgeoftheinsuranceindustryand theclaimsprocess.wealsovalidatedthatthedataprovidedwasconsistentwithothersourcesof publiclyavailableinformation.anyerrorsoromissionsinthedataprovidedcouldhaveamaterial effectonouranalysisoftheprojectedsavings. TheanalysisoftheIRCclaimexperiencewasforclaimsthatoccurredin2012.Assuch,anyprojection oftheresultsofthisdataintothecurrentclaimsenvironmentinvolvesestimatesoftheimpactof differencesinthelegalandmedicalenvironmentnowasopposedto2012.therefore,anysuch projectionsaresubjecttoeconomicandstatisticalvariation.noassurancescanbeofferedthatthe resultsofthisclaimstudywillberepresentativeoftoday sconditions. Otherreliancesandlimitationsandspecificassumptionsanddataadjustmentsarecitedinthisreport andintheattachedexhibitsthatareanintegralpartofthisreport. DistributionandUse ThisreportandtheopinionsexpressedhereinhavebeenpreparedforTheCity sinternaluseandfor thesupportofthecity slegislativeeffortstoauthorizeinsurerstoselladinsuranceproductonly. FurtherdistributionofthisreportisnotallowedwithouttheexpresswrittenconsentofPinnacle. Upongrantingofsuchrequest,thereportmustbereleasedinitsentirety,andallrecipientsmustbe madeawarethatpinnacleistheauthorofthisreportandisavailabletoansweranyquestions. 2 P age PinnacleActuarialResources,Inc.
Pinnacledoesnotassumeanyliabilityforthereliancesofthirdpartiesontheconclusionsofthis report. Anythirdpartiesreceivingthereportshouldrecognizethatthefurnishingofthisreportisnota substitutefortheirownduediligenceandshouldplacenorelianceonthisreportorthedatacontained hereinthatwouldresultinthecreationofanydutyorliabilitybypinnacletothethirdparty. AnyreferencetoPinnacleinrelationtothisreportinanyaccountsorotherpublicdocumentsorany verbalreferenceissuedbythecityisnotauthorizedwithoutourpriorconsent. Data Duringthecourseofthisreview,Pinnaclehasreliedonthefollowingdataandinformationreceived fromthecityandtheirc: 1. DraftDInsurancelegislationdatedMay20,2015 2. AutoInjuryInsuranceClaims:CountrywidePatternsinTreatment,CostandCompensation, 2014Edition PersonalInjuryProtection(PIP)andBodilyInjury(BI)InformationforMichigan, NewYork,Florida,NewJerseyandMassachusettsforclaimsthatwereclosedin2012 3. CitizensResearchCouncilofMichigan,October2013report MedicalCostsofNoFault Insurance. 4. MichiganChamberofCommerce,April2011studytitled"TheHighCostsofMichigan'sNoFault AutoInsuranceCausesandImplicationsforReform." 5. MichiganAutomobileInsurancePlacementFacilityBaseRateseffectiveJanuary1,2015 6. IndependentStatisticalServicesAutomobileExperiencePremiumData,calendaryear2013 TheIRCdataincluded5,095claims.Theclaimsbreakdownbystateisshownbelow. NumberofClaims State BI PIP GrandTotal Florida 1,025 780 1,805 Massachusetts 421 159 580 Michigan 139 557 696 NewJersey 310 632 942 NewYork 317 755 1,072 GrandTotal 2,212 2,883 5,095 FromthisIRCdatabase36BIclaimsand55PIPclaimsoccurredinDetroit.Duetothelimitednumberof PIPclaimsintheIRCdatabase,reformsavingsestimateswerecalculatedforallIRCPIPclaimsin MichiganaswellasseparatelyforclaimsthatoccurredintheCityofDetroitonlyasareasonability checkforsavingsestimates. 3 P age PinnacleActuarialResources,Inc.
ProjectBackground Bylaw,Michigandriversmustbuyfirstpartymedicalinsurance(alsoreferredtoasPersonalInjury ProtectionorPIP)andresidualliabilitycoverage(BodilyInjuryandPropertyDamage,BIPD).Drivers arenotlegallyrequiredtobuycollisionandcomprehensivecoverage,butthesecoveragesarerequired bylienholdersifadriverhasacarloan. StatisticaldatafiledwiththeMichiganDepartmentofInsuranceandFinancialServices(DIFS)through theindependentstatisticalservice(iss)bysomeofthelargestcarinsurancewritersinmichigan, includingallstate,autoclub,andstatefarm,showsthatin2013,theaverageannualpolicypremium forpip,bipd,andcollisionandcomprehensivecoverageindowntowndetroitwas$2,249.70.thiswas doubletheaverageannualpremiuminwesternoaklandcounty.itshouldbenotedthatthisaggregate dataisnotadjustedtoreflectthedifferenceinthespecificcoveragespurchasedbetweenthetwo areas.issdataalsoshowsthatabout2/3ofpolicyholdersindetroitpurchasefullcoverage,while almost100%ofpolicyholdersinthedetroitsuburbspurchasefullcoverage. TosupportinitiativesoftheMayor soffice,thecitywouldliketoenactlegislationauthorizingthecity tocontractwithinsurancecarrierstoofferdinsurancecoverage.thiscoveragewouldbeofferedata lowerratethancurrentlyavailableinthemarketplace.thiswouldbeaccomplishedbyintroducing reformstothemichiganinsurancelawsthatwouldbeapplicableonlytothecityownedinsurance company.theproposedreformshavebeendevelopedbythemayor sofficeandareasfollows: 1. ReformProposal#1:Thefirstreformproposalconsistsoftwoelements. a. Introducea$25,000/$250,000limit:Currently,PIPbenefitsareunlimited.Thischange tothelawwouldallowinsuredstopurchasepipbenefitswithaspecifiedlimitof $25,000,exceptincasesofnecessarycriticalcare,whichwouldbeadditionalcoverage withalimitof$250,000peroccurrence. b. Allowinsurerstonegotiatepreferredproviderarrangementsandpreauthorization:This wouldallowdinsurancetocreatealimitedprovidernetwork.exceptforemergency services,theinsurermayrequireaclaimanttoobtainproducts,treatment,services, accommodations,orrehabilitativeoroccupationaltherapyortrainingprovidedfor underthisactfromaproviderorsupplierthatispartofthelimitedprovidernetwork. Theclaimantmayalsoneedtoobtainpreauthorization. 2. ReformProposal#2 HighDeductibleOption:Thisoptionwouldincorporateahighdeductible optionintothecurrentunlimitedpipbenefitprogram. Theattachedexhibitsanddiscussionbelowshowtheexpectedimpactoninsurancelossesifthese reformsareimplemented. 4 P age PinnacleActuarialResources,Inc.
ReformProposal#1:PIPBenefitLimitsandPreferredProviderAgreements IntroducePIPBenefitLimits Currently,PIPbenefitsinMichiganareunlimited.Oneofthereformsbeingproposedisthe introductionofpipbenefitlimits.specifically,thelegislativechangesbeingproposedare: 1. $25,000limitperpersonforbenefitspayableformedicalexpenses,worklossandreplacement services. 2. Anadditionalamountnottoexceed$250,000intheaggregate,onlyforcriticalcareforthe personnamedinthequalifyingnofaultpolicy,theperson'sspouse,andarelativeofeither domiciledinthesamehousehold,whoareinjuredinasinglemotorvehicleaccidentduringthe policyterm.criticalcaremeanstreatmentrenderedatanacutecarehospitalortraumacenter immediatelyfollowingthemotorvehicleaccident,necessarytosavethepatient slifeortreat lifethreateningorpermanentlydisablinginjuries,untilthepatientisstabilized.apatientis stabilizedwhenthepatientcansafelybedischargedortransferredtoanotheracutecare hospitalortraumacenter,rehabilitationorotherfacility,regardlessofwhetherthepatientis, infact,dischargedortransferredatthattime.aqualifyinginsurershallhavetherightto contestthechargesofanacutecarefacilityunderthissectiontotheextenttheinsurercan presentcompetentevidenceshowingthatthefacility schargesrelatetopoststabilization services. Toestimatethesavingsforthisreform,Pinnacleappliedthe$25,000benefitlimittotheindividualPIP claimsprovidedintheircdatabase.priortotheapplicationofthelimit,themedicalnoncriticalcare paidclaimamountsweredecreasedbytheestimatedsavingsfromthepreferredprovideragreement reform(discussedbelow).aftertheapplicationofthe$25,000limit,iftherewerepaidlossespresent ontheclaimforemergencyroomdoctorsorambulancecare,theseamountswereaddedtothe lossesthatwouldbepaidunderthereformsubjecttothe$250,000limit. TheestimatedsavingstotheoverallPIPcostssolelyfromtheapplicationofthebenefitlimitsis62.1% fordetroit. PreferredProviderAgreement Thisproposedchangewouldallowaninsurertocreatealimitedprovidernetwork.Exceptfor emergencyservices,theinsurermayrequireaclaimanttoobtainproducts,treatment,services, accommodations,orrehabilitativeoroccupationaltherapyortrainingprovidedforunderthisactfrom aproviderorsupplierthatispartofthelimitedprovidernetwork.theclaimantmayalsoneedto obtainpreauthorizationfornonemergencyservices. 5 P age PinnacleActuarialResources,Inc.
ThelimitedprovidernetworkandpreauthorizationwouldaddresstwosignificantissuesrelatedtoPIP coverageindetroit.thefirstisthatthechargeformedicalprocedurespaidunderpipissignificantly higherthanthechargeformedicalprocedurespaidunderworker scompensationormedicare.the secondrelatestooveruseandpotentialabuseofpipcoverage. Formanycommonmedicalprocedures,Michiganmedicalproviderschargenofaultinsurerstwoto fivetimesmorethanrateschargedforthesameprocedurebymedicare. 1 Atableofmedical proceduresandassociatedreimbursementsundernofault,medicareandworker scompensationis showninattachment1. Inaddition,nofaultpremiumsinMichiganmayalsobeinflatedbyoveruseofbenefits,thefilingof fraudulentorexcessiveclaims,andlegalfeesgeneratedbyexcessivelitigation.typicalpatternsof fraudoroveruseinvolvehardtoverifyinjuriesandlargenumbersofvisitstoprovidersofalternative medicaltherapies. 2 TheproblemofoveruseisparticularlyacuteinDetroit,where 1. theaveragefrequencyofpipclaimsindetroitistwicethefrequencyinthesuburbs(12per 1,000exposuresvs.6per1,000exposures), 2. averageseverityofpipclaimsindetroitisroughlytwicetheaverageseverityinthesuburbs ($59,000vs$30,000),and ThecreationofaclosednetworkwithpreauthorizationwillprovidetheDInsurancecarrierwiththe abilitytonegotiaterateswithmedicalproviders,tolimitexcessiveorunnecessarytreatmentandavoid litigation.therefore,webelievethattheultimateratesnegotiatedwouldmoveinthedirectionofthe Worker scompensationschedule.ascanbeseeninattachment1,worker scompensationmedical providerreimbursementsare11%77%lowerthanreimbursementsunderpipbasedonthetypeof medicalprocedure. PinnaclealsoperformedasearchforstudiesthatestimatedthecostsavingsassociatedwithPreferred Providersystems.ThoughmanyofthestudiesaresomewhatdatedbecausePreferredProvideroptions wereintroducedroughly15 20yearsago,PinnacledidfindastudybyTheRobertWoodJohnson Foundation 3 thatprovidedsavingsestimatesfromintroducingappo.theestimatedsavingsfromthis studywere12 14%. 1 CitizensResearchCouncilofMichigan,October2013report"MedicalCostsofNoFaultAutomobileInsurance,"p.7. 2 MichiganChamberofCommerce,April2011studytitled"TheHighCostsofMichigan'sNoFaultAutoInsuranceCauses andimplicationsforreform,"p.17. 3 RobertWoodJohnsonFoundation. PreferredProviderOrganizations AreTheyBetteratKeepingHealthCostsDown? January1,2001. 6 P age PinnacleActuarialResources,Inc.
Tounderstandthepotentialsavingsbasedonimplementationofpreauthorization,thusdecreasing fraudandoverutilization,pinnaclereviewedthestatisticsrelatedtopipfraudinotherstates.inthe IRCdata,therearedatafieldsthatindicatewhetheraclaimwasreferredtoanotheragencyforfurther investigation.foraspecificclaim,thisfieldindicateswhetherornotaclaimwasreferredtothe insurancecompany sspecialinvestigativeunit(siu),lawenforcement,prosecutorsorthenational InsuranceCrimeBureau(NICB).Inaddition,Pinnaclereviewedtheseverityofclaimsthatwerereferred forfurtherinvestigationversusthosethatwerenotreferred. Attachment2showstheclaimreferralratesbyNoFaultstateandtheseverityofnonreferredvs. referredclaims.forpip,thereferralratesformichiganwere5.4%andfordetroitwere20%.theother statesrangedinreferralrateswere1.9%10.6%.theseverityfornonreferredclaimsformichigan wasabout62%lowerthantheseverityforreferredclaims.fordetroit,thenonreferredseveritywas 71%lowerthantheseverityforreferredclaims.Fortheotherstates,thedifferenceinseverities rangedfrom8.4%35%lowerfornonreferredclaims.asaresult,forpipwecanseethatthereis potentialforsavingsbasedontheseveritydifferencesofreferredvs.nonreferredclaims.assumingan estimated25%decreaseinseverity,forexample,translatesintoestimatedsavingsforpipof10.5%,as showninattachment3. Basedonthiscombinationofpotentialsavings,weareestimatinga20%losscostsavingsfrom implementingalimitedprovidernetworkandpreauthorization.thisestimatedsavingsappliedonlyto themedicalportionofthelossespaidandassumingnootherchangeswouldresultina13.9% estimateddecreaseinoverallpiplosscosts.seeattachment4formoredetails. ReformProposal#2:HighDeductibleOption ThisoptionwouldallowinsuredstopurchasePIPbenefitssubjecttoadeductible.Pinnacleestimated thesavingsfromseveraldeductibleoptions$1,000,$2,500and$5,000.forthisoption,theinsured wouldberesponsibleformedicalcostsuptheamountofthedeductible. Toestimatethesavingsfromtheseoptions,Pinnacleappliedthedeductibletoeachoftheindividual claimsintheircdata.ascanbeseeninattachment5,savingsforthecityofdetroitrangedfrom3% to13%baseduponthedeductibleselected. TotalEstimatedSavings ReformOption#1 AscanbeseeninAttachment6,thecombinedestimatedlosssavingsforthelimitedprovidernetwork andthepipbenefitlimitforthecityofdetroitisestimatedtobe64.5%ofpipclaimcosts.thereason thetotalsavingsdoesnotequaltheproductoftheindividualsavingsestimatesisduetothe overlappingimpact.becauseofthe$25,000pipbenefitlimit,theimpactofthelimitedprovider networkisdampenedsignificantly. 7 P age PinnacleActuarialResources,Inc.
ThetotalestimatedpremiumsavingsforthePIPreformsisshowninAttachment7A. Toestimatethesavings,Pinnaclebeganwiththe2013averagepremiumbycoverageinDetroit MetropolitanInner(Territory36)ascalculatedfromtheAutomobileExperienceDatafromISS.We thenappliedtheestimatedlosssavingspercentages(adjustedasdescribedbelow)basedonthe reformsdiscussed.theoverallestimatedpremiumsavingsforafullcoveragepolicywouldbe25.8%, whiletheestimatedsavingsforaliabilityonlypolicywouldbeabout45.9%. Thecostestimatesinthisreportaregenerallystatedintermsoftheimpactonclaimlosses.Theimpact onclaimlossescannotbeusedinterchangeablywithpremiumsavings.thisisbecauseaportionofthe insurancecompanies expensesisforgeneraloverhead(rent,utilities,etc.)andwouldnotdecrease proportionatelytothelosscosts.basedonthe2013bestsaggregatesandaveragespublication, PrivatePassengerAutomobileLiabilitygeneralandotheracquisitionexpensesrepresent14.2%ofthe industrywidewrittenpremium(this14.2%doesnotincludeagents commissions,premiumtaxesand otherpremiumrelatedexpenses).toestimatethepremiumsavingscorrespondingtothecostsavings showninthisreport,itisnecessarytoreducethelosssavingsbyafactorof.858.thusa64.5%cost savingsequatestoanapproximate55.3%premiumsavings. Thesavingscalculatedassumethatcurrentratesareadequate.TotheextentthatcurrentPIPratesare inadequate,itislikelythatthepremiumsavingscouldbelower.wewouldalsoemphasizethatthe abovepercentagesavingsareaveragesforpipcoverageonly.itispossiblethatactualsavingscould varybyareaofdetroit,andalsobytheageandotherratingcharacteristicsofthecovereddrivers(s), drivingrecords,typeandageofcar,levelandtypeofcoverageandotherfactors. Inaddition,thesesavingsestimatesassumenochangetothetortthresholdinMichiganandthusno associatedincreaseinliabilitycosts.totheextentthattheliabilitythresholdchangesasaresultofthe PIPbenefitlimitsandmoreliabilityclaimsarefiled,thiswouldleadtoanincreaseinliabilityclaim costs. TotalEstimatedSavings ReformOption#2 AscanbeseeninAttachment5,theestimatedlosssavingsforthehighdeductibleoptionfortheCity ofdetroitisestimatedtobe313%ofpipclaimcostsdependingonthelimitchosen.theestimated savingsgeneratedbyapplyingthebenefitlimitstoallclaimsinmichiganare518%ofpipclaimcosts. ThetotalestimatedpremiumsavingsforthePIPreformsisshowninAttachment8Aand8C.The overallestimatedpremiumsavingsforafullcoveragepolicyfora$1,000deductiblewouldbe1.2%, whiletheestimatedsavingsforaliabilityonlypolicywouldbeabout2.2%.forthe$5,000deductible, theestimatedfullcoveragesavingsare5.1%,andtheliabilityonlyestimatedsavingsare9.1%. 8 P age PinnacleActuarialResources,Inc.
MoreRecentData Asdiscussedabove,Pinnacle sanalysisfocuseson2013isspremiumdatathatsuggestsan average Detroitautoinsurancevehiclepremiumin2013was$2,250.Thatinformationexcludestheeffectsof citizensofdetroitwhodrivewithoutinsurance.thecityhasprovidedanecdotalevidencethatin2015, manycitizensofdetroit,includingthosewithgooddrivingrecords,paypremiumsmuchhigherthan $2,250. PinnaclehasobtainedrecentinformationfromtheMichiganAutomobileInsurancePlacementFacility (Facility).TheFacilityactsasaninsureroflastresortforindividualswhocannotsecurenofault coverageintheopenmarket.thefacilitysetsits baserate premiumsastheaverageofthetopfive insurancecarriersinthestate.baseratesrepresentthepremiumschargedpriortotheapplicationof anydiscountsorsurcharges.mostdriversseekingcoveragefromthefacilitywillpaypremiumshigher thanthebaseratesasaresultofunderwritingfactorssuchasage,drivingrecord,mileage,etc. TheFacility smostrecentannualbaserateaveragepremiumdatafordetroitisasfollows: Coverage BodilyInjuryLiability $468 PropertyDamageLiability 48 PropertyProtection 142 PersonalInjuryProtection 4,134 Collision($100Deductible) 1,126 Comprehensive($100Deductible) 310 Total $6,228 PremiumsPerYear Usingthisdata,andassuminga55.3%savingsonthePIPpremium(basedonReformOption1PIP limitoption),theownerwouldsaveapproximately$2,286bringingthepremiumdownfrom$6,228to $3,940 anallcoveragesavingsonthepolicyof37%. Dependingontheageandvalueofthevehicle,itmightbeeconomicallywiseforanownertoselecta largerdeductibleforcollisionandcomprehensivecoverageorelectnottoobtaincollisionand comprehensivecoverage.ifcollisionandcomprehensivecoverageiseliminated,theannualpremium underthecurrentnofaultlawwouldbe$4,792.a55.3%savingsonpipwoulddecreasethepriceof thepolicydownto$2,504,oradecreaseof48%.thedetailsareshowninattachment7b. TheestimatedsavingsforReformOption2basedontheMAIPFbaseratesareshownin8Band8D.For the$1,000deductibleoption,thefullcoveragesavingsare1.8%andtheliabilityonlysavingsare2.3%. 9 P age PinnacleActuarialResources,Inc.
Usingthe$5,000deductibleoption,thefullcoveragesavingsare7.3%andtheliabilityonlysavingsare 9.5%. TheCityhasalsoprovidedtoPinnaclethefollowing2015hypotheticalrateexampleasanexampleof thetypesofsavingsthatcanbeachieved.thehypotheticalcasestudycomesfromamajorauto insurerthatoffersinsurancepremiumquotationsonline.arepresentativeofthecityenteredthe followingdetails: AnaddressinnortheastDetroitinthe48225zipcode 2005ChevyMalibu 10,000milesdriverperyear Vehicleusedtocommutetoworkandforpleasure Basiccoverageincludingthemandatorynofaultinsurancecoveragestogetherwith comprehensive(theft)andcollisioncoveragewith$1,000deductibles. Thefollowingquotationwasprovidedforaoneyearpolicy: Coverage BodilyInjuryLiability $260 PropertyDamageLiability 24 PropertyProtection 60 PersonalInjuryProtection 3,332 Collision 1,042 Comprehensive 234 Total $4,952 PremiumPerYear Usingthisexample,andassuminga55.3%costsavingsonthePIPpremium,theownerwouldsave approximately$1,844reducingthepremiumfrom$4,952to$3,108. Iftheownerinthisexampleelectednottoobtaincollisionandcomprehensivecoverage,theannual premiumundercurrentnofaultlawwouldbe$3,676.a55.3%savingsonpipwouldproduceasavings of$1,844,decreasingthepriceofthepolicyto$1,832.detailsareshowninattachment7c. Conclusion Asshownabove,implementingreformthatlimitsPIPbenefitswillprovidesignificantpremiumsavings tothecitizensofdetroit.themostsignificantchangeswouldbeachievedwiththeimplementationof 10 P age PinnacleActuarialResources,Inc.
ReformOption#1.Whiletheactualsavingswouldvarydependingonthespecificpolicycircumstances, theestimatedaveragesavingsfromthisoptionwouldadecreaseinpremiumsof25.8%forafull coveragepolicy,and45.9%foraliabilityonlypolicy. 11 P age PinnacleActuarialResources,Inc.
IndexofAttachments 1. LimitedProviderNetworkSavingsEstimate 2. PIPFraudReferralRates 3. PotentialSavingsfromFraudMitigation 4. PreferredProviderCostSavingsEstimate 5. HighDeductibleOptionSavingsEstimate 6. PIPLimitandLimitedProviderNetworkSavingsEstimate 7. PremiumSavingsCalculation PIPLimitandLimitedProviderNetworkOption a. SavingsEstimatesBasedon2013ISSAveragePremiums b. SavingsEstimatesBasedon2015MAIPFBaseRates c. SavingsEstimatesBasedonHypotheticalQuoteExample 8. PremiumSavingsCalculation HighDeductibleOption a. SavingsEstimatesBasedon2013ISSAveragePremiums,$1,000DeductibleOption b. SavingsEstimatesBasedon2015MAIPFBaseRates,$1,000DeductibleOption c. SavingsEstimatesBasedon2013ISSAveragePremiums,$5,000DeductibleOption d. SavingsEstimatesBasedon2015MAIPFBaseRates,$5,000DeductibleOption 12 P age PinnacleActuarialResources,Inc.
Attachment1 CityofDetroit InsuranceReformPricing MedicalProcedureReimbursementAmounts Procedure Code NoFault Reimbursement Detroit Medicare Reimbursement PotentialSavings Medicare Reimbursement Description WorkComp Therapeuticexercisesforstrength(each15minutes);usuallychargedby PhysicalTherapist 79.38 30.66 41.57 61.4% 47.6% 97110 98941 Chiropracticmanipulativetreatment,spinal,34regions 72.60 36.43 48.67 49.8% 33.0% 97140 Manualtherapy(each15minutes)physicaltherapy 60.80 28.91 38.03 52.5% 37.5% 97014 Electricalstimulationphysicaltherapy 56.05 13.20 19.27 76.4% 65.6% 97124 Massage(each15minutes)physicaltherapy 52.36 25.07 32.96 52.1% 37.1% 99284 Emergencydepartmentvisit;severemedicalcomplexity 443.68 124.98 170.35 71.8% 61.6% 99283 Emergencydepartmentvisit;moderatemedicalcomplexity 297.04 65.70 90.75 77.9% 69.4% 98940 Chiropracticmanipulativetreatment,spinal,12regions 56.47 25.94 34.98 54.1% 38.1% 99213 Officevisit,establishedpatient;typically15minutes 104.40 72.84 89.23 30.2% 14.5% 97012 Mechanicaltractionphysicaltherapy 56.94 15.99 20.79 71.9% 63.5% 97035 Ultrasound(each15minutes)physicaltherapy 66.26 12.50 16.73 81.1% 74.8% 99214 Officevisit,establishedpatient;typically25minutes 151.30 107.90 133.85 28.7% 11.5% 97530 Therapeuticactivities,improvefunctionalperformance(each15minutes); generallychargedbyoccupationaltherapists 53.72 33.44 43.10 37.8% 19.8% 97112 Neuromuscularreeducation(each15minutes)physicaltherapy 77.69 32.05 42.08 58.7% 45.8% 72040 Xray,spine,cervical;2or3views 161.96 41.59 54.76 74.3% 66.2% 72125 CTScanNeck 1,820.09 261.50 418.78 85.6% 77.0% 72141 MRINeck 3,258.68 483.98 769.63 85.1% 76.4% 72148 MRILowBack 3,278.55 484.31 765.57 85.2% 76.6% 72193 CTScanPelvis 1,828.04 305.65 477.59 83.3% 73.9% 72050 XRaySpine 227.55 55.89 77.06 75.4% 66.1% 29826 SurgeryShoulder 2,806.13 730.70 939.98 74.0% 66.5% Work Comp Source:MitchellDecisionPoint;CRCCalculations
Attachment2 CityofDetroit InsuranceReformPricing PreferredProviderOrganization PersonalInjuryProtection ClaimReferralRate State Total SIU Other Company NICB State Fraud Local Police Prosecutor Other Non Referred Severity Referred Severity Florida 3.8% 3.2% 0.0% 0.4% 0.0% 0.0% 0.0% 0.3% 7,330 8,001 Massachusetts 1.9% 1.9% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 3,608 5,547 Michigan 5.4% 4.1% 0.9% 0.0% 0.0% 0.0% 0.0% 0.4% 14,121 36,844 NewJersey 10.6% 10.4% 0.2% 0.0% 0.0% 0.0% 0.0% 0.0% 16,000 20,655 NewYork 7.0% 6.1% 0.9% 0.0% 0.0% 0.0% 0.0% 0.0% 8,743 12,827 Detroit 20.0% 18.2% 1.8% 0.0% 0.0% 0.0% 0.0% 0.0% 17,880 61,477 Difference 8.4% 35.0% 61.7% 22.5% 31.8% 70.9%
Attachment3 CityofDetroit InsuranceReformPricing FraudInvestigation PersonalInjury Protection Stateof Michigan Cityof Detroit (1) EstimatedIncreaseinClaimReferralRate 0.0% 0.0% (2) EstimatedDecreaseinSeverityforReferredClaims 25.0% 25.0% (3) IRCTotalPaidLossesforReferredClaims 1,105,306 676,247 (4) IRCTotalPaidLosses 7,969,097 1,613,067 (5) SavingsasaPercentageofTotalLosses 3.5% 10.5% Notes (1) EstimateBasedonIRCFraudAnalysisExhibit (2) EstimateBasedonIRCFraudAnalysisExhibit (3) IRC:AutoInjuryInsuranceClaims:CountrywidePatternsinTreatment,Costs,andCompensation,2014Edition (4) IRC:AutoInjuryInsuranceClaims:CountrywidePatternsinTreatment,Costs,andCompensation,2014Edition (5) [[(2)*(3)]/(4)]+(1)
Attachment4 CityofDetroit InsuranceReformPricing PreferredProvider Stateof Michigan Cityof Detroit (1) PPOSavingsEstimate 20.0% (2) TotalPIPMedicalPaid 4,559,642 1,120,411 (3) IRCTotalPaidLosses 7,969,097 1,613,067 (4) PIPSavingsasaPercentageofTotalLosses 11.4% 13.9% Notes (1) EstimatedImpactofPreferredProviderandPreauthorization (2) IRC:AutoInjuryInsuranceClaims:CountrywidePatternsinTreatment,Costs,andCompensation,2014Edition (3) IRC:AutoInjuryInsuranceClaims:CountrywidePatternsinTreatment,Costs,andCompensation,2014Edition (4) [(1)*(2)]/(3)
Attachment5 CityofDetroit InsuranceReformPricing HighDeductibleOption DeductibleImpact Deductible Stateof Michigan Cityof Detroit 1,000 5.1% 3.1% 2,500 10.6% 7.1% 5,000 17.5% 12.8%
Attachment6 CityofDetroit InsuranceReformPricing Impactof25,000PIPLimit/$250,000EmergencyCareLimitandLimitedProviderNetwork StateofMichigan (1) OriginalPaidLosses 7,969,097 (2) RevisedPaidLosses 3,646,820 (3) SavingsEstimate 54.2% CityofDetroit (4) OriginalPaidLosses 1,613,067 (5) RevisedPaidLosses 572,548 (6) SavingsEstimate 64.5% (1) IRC:AutoInjuryInsurancePIPClaimsData (2) EstimatedRevisedLossesAssuming$25,000PIPLimit/$250,000LimitforEmergencyCareandLimitedProviderNetwork (3) (2)/(1)1 (4) IRC:AutoInjuryInsurancePIPClaimsData (5) EstimatedRevisedLossesAssuming$25,000PIPLimit/$250,000LimitforEmergencyCareandLimitedProviderNetwork (6) (5)/(4)1
Attachment7A CityofDetroit InsuranceReformPricing EstimatedSavings$25,000/$250,000LimitOptionUsing2013ISSAveragePremiums (1) (2) (3) (4) (5) 2013ISSAverage TotalLoss Estimated Premium EstimatedNew Coverage Premium Savings Savings Premium BI $163.08 0.0% 0.0% 163.08 PD $19.24 0.0% 0.0% 19.24 PIP $1,105.55 64.5% 55.3% 493.67 PPI $44.20 0.0% 0.0% 44.20 Collision $664.79 0.0% 0.0% 664.79 Comprehensive $374.43 0.0% 0.0% 374.43 Estimated Overall Percentage Savings FullCoverage $2,371.28 $1,759.41 25.8% LiabilityOnly $1,332.07 $720.19 45.9% (1) IndependentStatisticalService,Inc,AutomobileExperience,AveragePremiumsforDetroitMetropolitanInner(Territory36) (2) Attachment5 (3) (3)*0.858(PortionofPremiumsthatareVariable) (4) (1)*[1+(3)] (5) [(4)Total/(1)Total]1
Attachment7B CityofDetroit InsuranceReformPricing EstimatedSavings$25,000/$250,000LimitOptionUsing2015MAIPFBaseRates (1) (2) (3) (4) (5) 2015MAIPFBase TotalLoss Estimated Premium EstimatedNew Coverage Rates Savings Savings Premium BI $468.00 0.0% 0.0% 468.00 PD $48.00 0.0% 0.0% 48.00 PIP $4,134.00 64.5% 55.3% 1846.00 PPI $142.00 0.0% 0.0% 142.00 Collision $1,126.00 0.0% 0.0% 1126.00 Comprehensive $310.00 0.0% 0.0% 310.00 Estimated Overall Percentage Savings FullCoverage $6,228.00 $3,940.00 36.7% LiabilityOnly $4,792.00 $2,504.00 47.7% (1) MichiganAutoInsurancePlacementFacilityBaseRates,010115,Territory3637 (2) Attachment5 (3) (3)*0.858(PortionofPremiumsthatareVariable) (4) (1)*[1+(3)] (5) [(4)Total/(1)Total]1
Attachment7C CityofDetroit InsuranceReformPricing EstimatedSavings$25,000/$250,000LimitOptionUsingHypotheticalRateQuote (1) (2) (3) (4) (5) HypotheticalQuote TotalLoss Estimated Premium EstimatedNew Coverage AnnualPremium Savings Savings Premium BI $260.00 0.0% 0.0% $260.00 PD $24.00 0.0% 0.0% $24.00 PIP $3,332.00 64.5% 55.3% $1,487.88 PPI $60.00 0.0% 0.0% $60.00 Collision $1,042.00 0.0% 0.0% $1,042.00 Comprehensive $234.00 0.0% 0.0% $234.00 Estimated Overall Percentage Savings FullCoverage $4,952.00 $3,107.88 37.2% LiabilityOnly $3,676.00 $1,831.88 50.2% $1,844.12 (1) MichiganAutoInsurancePlacementFacilityBaseRates,010115,Territory3637 (2) Attachment5 (3) (3)*0.858(PortionofPremiumsthatareVariable) (4) (1)*[1+(3)] (5) [(4)Total/(1)Total]1
Attachment8A CityofDetroit InsuranceReformPricing EstimatedSavingsHighDeductibleOptionUsing2013ISSAveragePremiums $1,000DeductibleOption (1) (2) (3) (4) (5) 2013ISSAverage TotalLoss Estimated Premium EstimatedNew Coverage Premium Savings Savings Premium BI $163.08 0.0% 0.0% $163.08 PD $19.24 0.0% 0.0% $19.24 PIP $1,105.55 3.1% 2.7% $1,076.19 PPI $44.20 0.0% 0.0% $44.20 Collision $664.79 0.0% 0.0% $664.79 Comprehensive $374.43 0.0% 0.0% $374.43 Estimated Overall Percentage Savings FullCoverage $2,371.28 $2,341.92 1.2% LiabilityOnly $1,332.07 $1,302.71 2.2% (1) IndependentStatisticalService,Inc,AutomobileExperience,AveragePremiumsforDetroitMetropolitanInner(Territory36) (2) Attachment4($1,000DeductibleOptionSavings) (3) (3)*0.858(PortionofPremiumsthatareVariable) (4) (1)*[1+(3)] (5) [(4)Total/(1)Total]1
Attachment8B CityofDetroit InsuranceReformPricing EstimatedSavingsHighDeductibleOptionUsing2015MAIPFBaseRates $1,000DeductibleOption (1) (2) (3) (4) (5) 2015MAIPFBase TotalLoss Estimated Premium EstimatedNew Coverage Rates Savings Savings Premium BI $468.00 0.0% 0.0% $468.00 PD $48.00 0.0% 0.0% $48.00 PIP $4,134.00 3.1% 2.7% $4,024.22 PPI $142.00 0.0% 0.0% $142.00 Collision $1,126.00 0.0% 0.0% $1,126.00 Comprehensive $310.00 0.0% 0.0% $310.00 Estimated Overall Percentage Savings FullCoverage $6,228.00 $6,118.22 1.8% LiabilityOnly $4,792.00 $4,682.22 2.3% (1) IndependentStatisticalService,Inc,AutomobileExperience,AveragePremiumsforDetroitMetropolitanInner(Territory36) (2) Attachment4($1,000DeductibleOptionSavings) (3) (3)*0.858(PortionofPremiumsthatareVariable) (4) (1)*[1+(3)] (5) [(4)Total/(1)Total]1