Comparing expiring vs proposed

For many years, E&O carriers have expressed significant concerns over the issue of what many call “The Mirror Test”. Essentially, this is the need for a process within agencies to compare coverages when they are moving an account from one carrier to another.

Oftentimes, agencies will look to move an account to a new carrier when there is a need for some premium relief. However, inherent in this process is the realization that when an account is moved to a new carrier, there is definitely the potential for there to be some coverages that were part of the expiring but not of the proposed. The following is an actual E&O claim to illustrate the point:

An E&O claim was filed against the agency for failing to procure professional liability coverage on the business owner’s policy. The agency client owned a hair salon. A Professional services endorsement was on the prior policy per the request of the agency client. However, it was inadvertently left off when the agent moved the coverage to a new carrier.   

The underlying loss was a scalp burn to a client. The “new” carrier denied the claim based on the professional liability exclusion on the CGL policy. There was clear liability on the part of the agency and this matter was resolved with the agency paying the policy deductible and E&O carrier paying the remainder of the underlying damages.

How many times does your agency move a client to a new carrier at renewal time? It probably happens many times a week, if not daily; in both personal lines and commercial lines. 

Agencies should have a process to compare the coverages of the expiring and the proposed to determine any areas where coverage is being reduced. These reductions should be brought to the client’s attention and their sign off secured.  

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Documenting discussions you have with your markets

When the subject of documentation comes up, typically the mindset involves documentation of discussions with your prospects / clients, etc. A good documentation policy in an agency would certainly address these circumstances. However, for some reason, documentation of discussions with your carriers / wholesalers, etc. is often not perceived to be of the same level of importance. It appears that the thinking is that if there is a problem, the carrier will back you up. While one would hope that this occurs, it is definitely not a given.

During a normal business day, there are a host of situations where the agency is going to be contacting the carrier. They include:

-     An exception to the underwriting guideline. Agents are provided underwriting guidelines on risk that you have the authority to bind. If the risk is not a perfect fit, typically the agent will contact the carrier underwriter and ask for an exception. If the exception is granted, this should be documented not only on the agency system but also with an e-mail back to the carrier underwriter memorializing the conversation. At the time of a problem, this level of documentation is going to be critical. There is the definite possibility that the carrier underwriter that you spoke with is now no longer with the carrier.

-     Questions on how coverage would apply. For as long as I can remember, agents have relied upon the carriers for assistance in understanding how certain coverage would apply (whether that is a good thing to do is debatable). What if the carrier underwriter provided you with an incorrect explanation of a specific coverage and you relied on that underwriter’s assessment and a problem developed? In my expert witness work, I have seen situations where the agent required the underwriter to provide the explanation in writing and even though the assessment was incorrect, the carrier stood behind their underwriter and honored the situation. If the carrier underwriter does not put their explanation in writing then you, as the agent, should. Once again, sending that to the underwriter with a statement that if your understanding is not correct, for the underwriter to please let you know as soon as possible.

As with any type of documentation, the documentation should be handled promptly and accurately. The documentation should not only reside in the agent system but should also include some form of written communication to the carrier.

 

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Did the carrier quote all of the coverages you requested?

In the preparation of the application for submission to the marketplace, agents will typically include coverages they are looking for the carrier to include in the proposal. As the producer, you are expecting that the markets you are working with will provide the coverages requested.

The carrier proposals begin to arrive. For many producers, unfortunately, the natural approach is to look at the premiums being quoted. It is probably assumed that the carrier proposals provide all of the coverages requested. But do they?

It is definitely incumbent upon the agency to review the proposal to determine if all of the coverages have been quoted. In addition, the proposal should be reviewed to determine if there are any exclusions or limitations that are being included. While this is especially a key issue when dealing with the E&S marketplace, there is also the potential for the standard markets to include some limitations / exclusions such as a Protective Safeguards endorsement or an exclusion for professional services.

If the agency staff are of the belief that the carrier will advise them of those coverages not quoted, think again. While some carriers may do that, it is not the norm and at the end of the day, it is the agents responsibility to do this “application vs. proposal” comparison.

If the coverage is not what was quoted, a follow up contact to the underwriter will probably be the next step. I have one client that recently found that when they received the proposal, there were over 30 items (including various manuscript wording) that were not provided in the proposal.

Another key issue involves the development of the agency proposal. As your agency looks to develop your own proposal for presentation to the prospect, is your proposal being generated based on the coverages you believed to be part of the carrier proposal or is it based on the coverages actually proposed?

Bottom line, it is probably the best practice to presume that the carrier proposal does not exactly match the coverages requested on the application. For this reason, every agency should have a detailed process (maybe including more than one set of eyes) to review the proposal to verify what was / was not provided in the carrier proposal. The producer’s “eyes” should definitely be part of the process. If this type of review is not done, there is certainly significant potential for some problems to occur.

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Agency Loses in Huge Workers Comp E&O Claim

For most E&O carriers, the workers compensation line of business accounts for 8-10% of all E&O claims. Definitely not a small number.

As noted by the attached which appeared on AgencyEquity.com on April 11, 2017, claims involving workers compensation can also be significant when they happen.

Continue Reading: Agency Loses in Huge Workers Comp E&O Claim

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“I told you I wanted the coverage”

When explaining the need for prompt and accurate documentation, it is important to understand the “why” behind the issue. For many folks, this is when they are able to truly “buy-in” and do what is needed.

A big reason behind the documentation “why” is that after an agency client suffers a loss only to find out that there was no coverage in place, it is truly amazing what type of response they will come out with. Here is a real-life E&O claim example:

The agency client called the agency to place a secondary home policy. Unfortunately, the client was not sure of the closing date and told the agency they would let them know. The agency account exec quoted the policy and sent it electronically to the client. Then unknown to the agency, the client purchased the home and claimed that they called the agency to place the policy. However, the agency had no record of such a phone call. When the closing took place, the client showed the quote to the bank and the bank allowed the mortgage to close without a true verification the coverage had been placed. A loss occurs and there is now a dispute as to whether coverage was technically in place. Since there was no way to verify whether a phone call had been made, this case was settled prior to trial.

What could the agency had done different?

Probably when the agency provided the quote, there should have been some stipulations noted on the quote on what would be required to bind coverage. Issues such as a signature on the application or a payment of some amount. Also, a statement such as “coverage is not bound until verified in writing by a licensed agency staff member”.

To me, this is clearly a case where the client forgot to call the agency to place the coverage. If the bank would have held fast and required a policy / binder / evidence of coverage, the client would have been forced to call the agency. But that did not happen. So, it sounds like the client took the position that when they (allegedly) called the agency, they told the account exec “I said I wanted the coverage”.

You never know what the agency client is going to state after they have suffered an uninsured loss but unfortunately, very rarely will they take the position that “yes, I screwed up, I forgot to call the agency to bind the coverage”. So, when interacting with your customers, it is probably best to assume that they are not going to take any responsibility for the error and then take some steps to protect the agency should a problem develop.

 

 

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The latest in Dog Bites statistics

As noted in the attached excellent article published by the Insurance Information Institute (www.iii.org), dog bites and other dog-related injuries accounted for more than one-third of all homeowners liability claim dollars paid out in 2016, costing in excess of $600 million.

The key issue from an E&O perspective involves the inconsistent manner in which insurance carriers are dealing with this issue. This speaks to the need to identify any “dog” exposure especially when writing new business and also the need to manage this issue when moving your homeowners clients (that own a dog) to a new carrier.

Continue Reading Dog Bites statistics

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Top 10 Causes of Liability Losses Include Bedbugs, Crashes and Defective Products

Many E&O carriers report that E&O frequency is in very good shape but continue to express concerns on the severity of the E&O claims being reported. Quite possibly, one of the reasons why E&O claims are rising in size is due to the increasing size of the underlying claims.

The following is from a claimsjournal.com article that appeared on March 31 and speaks to the top causes of liability claims and the increase in size of those claims.

“Not only are liability losses increasing but they are getting more expensive, particularly in relation to global product recalls, corporate liability, cyber and environmental incidents, according to a new report by Allianz Global Corporate & Specialty (AGCS). Global Claims Review: Liability in Focus identifies defective product or work, crash and human error incidents as the largest causes of liability loss for businesses, based on analysis of insurance claims.”

Continue Reading: Top 10 Causes of Liability Losses Include Bedbugs, Crashes and Defective Products

 

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A key issue when using a carrier proposal

Over the last couple of years, the agency’s use of carrier proposals is becoming much more common. This is especially true with small commercial accounts or accounts in the personal lines division. Using the carrier proposal actually has several advantages including:

-     A gain in efficiency. To retype the carrier proposal onto the agency letterhead takes time and effort. Every agency is looking for some gains in efficiency and this approach is a plus.

-     Accuracy is enhanced. If an agency were to retype the carrier proposal onto the agency letterhead, there is certainly a greater possibility that an error is made in the transfer of the information. 

-     Support from the carrier. If there was an error in the carrier proposal and the agency used that document, I would have to believe that the carrier would agree to providing the coverage created by the error.

-     Greater depth of information. There is a good chance that the carrier proposal has greater depth to the information provided which should enable the client to more clearly understand the proposal.

Unfortunately, there is also a disadvantage to using a carrier proposal. This disadvantage, however, is easily addressed.

Typically, the carrier proposals do not include any of the common disclaimer language. This disclaimer language can play a key role in the defense of the agency should a problem develop.

Thus, if the agency is sending the client / prospect the carrier proposal, it is highly suggested the agency include some of this disclaimer language in a document commonly referred to as a “wraparound” because it envelops the carrier’s materials with protections for the agency.  

What are some of the disclaimers that should be included?

-     “This is a convenient coverage summary, not a legal contract. The actual policies should be reviewed for specific terms, conditions, limitations, and exclusions that will govern in the event of loss.”

-     “Higher liability limits may be available. Please let us know if you would like a quote for increased limits.”

-     If the carrier is non-admitted, that fact should be stated with the additional statement regarding the absence of guaranty fund protection.

-     Since it is common for agencies to include on the proposals other coverages for the client to consider, the “wraparound document” should include a statement of “other coverages to consider include but are not limited to the following”.

Proper use of the carrier proposal can lead to some positive gains and with the inclusion of a “wraparound” document, it can also aid in the defense of the agency in an E&O matter.

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Can a “bad” audit score actually be a good thing? Can a “good” audit score be a bad thing?

Two very interesting questions.

Without a doubt, Internal auditing within an agency is one of the best initiatives an agency can have in the establishment of a healthy E&O culture. Auditing serves a very vital role to evaluate to what degree the agency staff are performing their responsibilities based on the expectations of the agency. Typically, the issues that are key to minimizing the potential for E&O claims are reviewed. Issues such as the performance of an exposure analysis checklist (both for new and renewal business), confirmation of client buying decisions, certificates and policy checking. Missteps in these areas certainly heightens the E&O claims potential.   

There is a key element inherent in the auditing process. That element is HONESTY. It is vital that for audits to have the necessary value, the answers to the questions need to be accurate and honest.

So can a “bad” audit score actually be a good thing? It can be a very good thing. Obviously, a poor score is not desirable but it can have a benefit. The results of the audit need to be evaluated to determine the issue. Is it a situation where the employee did not understand the procedure and performed the responsibilities based on an incorrect understanding? This will provide the opportunity for training of the employee and a reinforcement of the expected procedures. Discussion on the audit score might reveal an imbalance in workloads which make it very difficult for the employee to meet the expectations. Also, the individual audit scores will identify areas that need a greater degree of attention and focus.

It might also identify an employee that is just not the right fit for the job that is expected of them.

Hopefully a “bad” audit score also translates into the fact that at least the audit was honestly handled.

Is a “good” audit score always a good thing? A “good” audit score is desirable provided it is achieved through hard work and adherence to the agency expectations. If the “good” score does not accurately demonstrate good results, the positive score could be very bad as it is deceiving what truly is happening on the floor. It could be misleading management on what the real issues are.

Bottom line – performing internal auditing requires the highest level of honesty and objectiveness. If this is a potential concern in your shop, consider “auditing the auditors”. Pull some files that were audited and re-audit the accounts to determine if the scores accurately convey reality.

Auditing is a great initiative provided it is handled with honesty and integrity.

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