Claims‐Made and Reported Policies and Insurer Profitability in Medical Malpractice

The liability crisis of the 1970s led to the introduction of a new type of insurance policy designed to reduce the undiversifiable uncertainty associated with writing long‐tail liability lines. These new claims‐made and reported policies gained favor in place of the traditional occurrence coverage in the early 1980s not only in medical malpractice but also in the general liability arena. The main question we want to address in this article is why two types of contracts that cover the same risk exposure exist in the medical malpractice insurance industry whereas only one exists primarily in other insurance lines.     

Pricing and Capital Allocation for Multiline Insurance Firms

We study multiline insurance companies with limited liability. Insurance premiums are determined by no‐arbitrage principles. The results are developed under the realistic assumption that the losses created by insurer default are allocated among policyholders following an ex post, pro rata, sharing rule. In general, the ratio of default costs to expected claims, and thus the ratio of premiums to expected claims, vary across insurance lines. Moreover, capital and related costs are allocated across lines in proportion to each line's share of a digital default option on the insurer. Our results expand and generalize those derived elsewhere in the literature.     

Externalities From Driving Luxury Cars

Driving luxury cars creates negative externalities. Driving a luxury car increases property damage liability insurance costs for all drivers due to the striking differences in repair costs of luxury cars and nonluxury cars in Korea. In this study, we estimate the externalities related to auto accidents involving luxury cars by running a two‐part model using unbalanced individual‐level panel data on insurance claims and characteristics of the insured party. We find evidence of negative externalities in all of our results. To be specific, a 1 percent increase in luxury cars raises the property damage liability costs by 1.9–2.6 percent per claim. The estimated nationwide increase in the cost of liability due to driving of luxury cars in Korea is USD 139–196 million per year. This cost is shared by all drivers nationwide.     

Deterring Fraud: The Role of General Damage Awards in Automobile Insurance Settlements

Awards for pain and suffering and other noneconomic losses account for over half of all damages awarded under third‐party auto insurance bodily injury settlements. This article hypothesizes that third‐party insurers use general damage awards to reduce the incentive to submit exaggerated claims for specific damages for injuries and lost wages. Consistent with this hypothesis, the article finds evidence using data on over 17,000 closed bodily injury claims that special damage claims that exceed their expected value receive proportionally lower general damage awards than claims that do not. Among the implications of this research is the possibility that insurers will be less zealous in challenging fraudulent special damage claims under a third‐party insurance regime than they will be under a first‐party insurance regime in which access to general damages is limited.     

Die Haftpflichtversicherung nach der VVG-Reform

The reform of the German Insurance Contract Act (Versicherungsvertragsgesetz, ?VVG“) also targets key aspects of third-party liability insurance. The changes go beyond the findings made by both the courts and legal authorities to date.Compulsory insurance aside, the law still provides that an injured third party has no standing to assert a claim directly against the tortfeasor’s liability insurer. The tortfeasor may assign its indemnity claim against the insurer solely to the injured third party and may no longer be precluded from doing so under the General Insurance Conditions (AVB). Consequently, the tortfeasor’s indemnity claim against the insurer effectively becomes a pecuniary claim. This is criticised by the insurance industry particularly with regard to eliminating the prohibition against acknowledgment and satisfaction of claims.In the future, third parties will be able to assert claims directly against the tortfeasor’s insurer and this will be the case for compulsory insurance across the board. Provisions currently in effect in the motor vehicle liability insurance industry will be carried over to the entire compulsory insurance sector. Compulsory insurance does permit agreements involving self-deductibles. However, such agreements are generally effective only as between the insurer and the tortfeasor inter se, i.e. they are not effective as against third parties — in contrast to valid disclaimers of risk.Another change in compulsory insurance is the hierarchy of claims for compensatory damages and relief in the event the insured amount is inadequate. Specifically, the hierarchy gives preference to individual claims of injured parties which are not otherwise covered, such as claims for pain and suffering.The prohibition against the retroactive loss of provisional coverage for failure to pay the first premium, which had been criticised primarily by motor vehicle liability insurers, has been omitted in the Government bill.     

Consumer Response to a National Marketplace for Individual Health Insurance

The objective of this analysis is to simulate the difference between national and state‐specific individual insurance markets on take‐up of individual health insurance. This simulation analysis was completed in three steps. First, we reviewed the literature to characterize the state‐specific individual insurance markets with respect to state regulations and to identify the effect of those regulations on health insurance premiums. Second, we used empirical data to develop premium estimates for the simulation that reflect case‐mix as well as state‐specific differences in health care markets. Third, we used a revised version of the 2005 Medical Expenditure Panel Survey (MEPS) to complete a set of simulations to identify the impact of three different scenarios for national market development. (National market estimates are based on the simulation model with competition among all 50 states and moderate impact assumptions.) We find evidence of a significant opportunity to reduce the number of uninsured under a proposal to allow the purchase of health insurance across state lines. The best scenario to reduce the uninsured, numerically, is competition among all 50 states with one clear winner. The most pragmatic scenario, with a good impact, is one winner in each regional market.     

The Impact of Rate Regulation on Claims: Evidence From Massachusetts Automobile Insurance

The article tests the hypothesis that insurance price subsidies created by rate regulation lead to higher insurance cost growth. The article makes use of data from the Massachusetts private passenger automobile insurance market, where cross‐subsidies were explicitly built into the rate structure through rules that limit rate differentials and differences in rate increases across driver rating categories. Two approaches are taken to study the potential loss cost reaction to the Massachusetts cross‐subsidies. The first approach compares Massachusetts with all other states while controlling for demographic, regulatory, and liability coverage levels. Loss cost levels that were about 29 percent above the expected level are found for Massachusetts during years 1978–1998, when premiums charged were those fixed by the state and included explicit subsidies for high‐risk drivers. A second approach considers changing cost levels across Massachusetts by studying loss cost changes by town and relating those changes to subsidy providers and subsidy receivers. Subsidy data based on accident year data for 1993–2004 show a significant and positive (relative) growth in loss costs and an increasing proportion of high‐risk drivers for towns that were subsidy receivers, in line with the theory of underlying incentives for adverse selection and moral hazard.     

Incentives for Managing Accounting Information: Property-Liability Insurer Stock-Charter Conversions

Incentives to manage accounting information are examined within 63 property‐liability insurance company conversions from mutual ownership to common stock charter. In the conversion process, policyholders' embedded equity claims must be valued. Since mutuals have no separately traded equity, accounting numbers are a critical input in this valuation. Incentives for surplus management vary across firms; the strongest evidence of surplus management is observed among firms where the mutual's executives become the firm's principal stockholders following conversion. The evidence suggests that converting firms manage accounting information primarily by adjusting liabilities and selectively establishing investment losses—not by altering claims settlement policy.     

Funding conditions and insurance stock returns: Do insurance stocks really benefit from rising interest rate regimes?

We examine funding conditions and U.S. insurance company stock returns. Although constrained funding conditions, signaled by restrictive Federal Reserve monetary policy, correspond with increases in the future payouts of fixed‐income securities held by insurance firms and potentially provide value through the liability side of insurer balance sheets, they also decrease the values of securities currently held in insurer portfolios. Prior research finds that restrictive policy has a negative effect on equity returns in general. Our results suggest the negative impacts of constrained funding environments outweigh the potential positives, as insurance company stock returns are significantly lower during periods of constrained funding. This effect varies within a given funding state and also across insurer type. The effect is strongest during the first 3 months of a constrained funding environment and for life and health insurers—insurer types with longer portfolio durations. For property and liability (P&L) insurers, lower stock return performance only exists in the first 3 months of a constrained funding environment. In the subsequent months, P&L insurers actually have higher stock returns during constrained periods, consistent with their typically shorter duration asset portfolios, which are more quickly rolled over into new higher‐yielding securities.     

索赔特征对保险理赔(诉讼)额影响的实证分析——基于交强险人身伤害判决数据

面对日益增多的保险理赔(诉讼),亟需加强索赔原因及索赔特征对法院判决结果的影响研究.本文通过对北京市大兴区人民法院2007年1月至2010年8月涉及人身伤害的交强险判决案例进行回归分析,发现:索赔原因与索赔人损失大小、就业状况、法律规定的赔偿上限有关;索赔人在交通事故中承担的过错责任与其性别、医疗费支出状况、是否死亡有...     

“The Future of Risk Classification in the Age of Predictive DNA-Based Testing”, Donald C. Chambers,January 1999

Abstract

The correlation among multiple lines of business plays an important role in quantifying the uncertainty of loss reserves for insurance portfolios. To accommodate correlation, most multivariate loss-reserving methods focus on the pairwise association between corresponding cells in multiple run-off triangles. However, such practice usually relies on the independence assumption across accident years and ignores the calendar year effects that could affect all open claims simultaneously and induce dependencies among loss triangles. To address this issue, we study a Bayesian log-normal model in the prediction of outstanding claims for dependent lines of business. In addition to the pairwise correlation, our method allows for an explicit examination of the correlation due to common calendar year effects. Further, different specifications of the calendar year trend are considered to reflect valuation actuaries’ prior knowledge of claim development. In a case study, we analyze an insurance portfolio of personal and commercial auto lines from a major U.S. property-casualty insurer. It is shown that the incorporation of calendar year effects improves model fit significantly, though it contributes substantively to the predictive variability. The availability of the realizations of predicted claims permits us to perform a retrospective test, which suggests that extra prediction uncertainty is indispensable in modern risk management practices.     

Estimating the Cost of Equity Capital for Property-Liability Insurers

This article presents new evidence on the cost of equity capital by line of insurance for the property‐liability insurance industry. To do so we obtain firm beta estimates and then use the full‐information industry beta (FIB) methodology to decompose the cost of capital by line. We obtain full‐information beta estimates using the standard one‐factor capital asset pricing model and extend the FIB methodology to incorporate the Fama–French three‐factor cost of capital model. The analysis suggests the cost of capital for insurers using the Fama–French model is significantly higher than the estimates based upon the CAPM. In addition, we find evidence of significant differences in the cost of equity capital across lines.     

The Economic Effects of Road Safety Improvements: An Insurance Claims Analysis

This article demonstrates the feasibility of exploiting insurance claims data to estimate the marginal benefits to society of highway infrastructure improvements. We construct a unique database linking claims expenditures for a major auto insurer in Michigan to infrastructure investments at 62 intersections in the City of Detroit, and conclude that the addition of a left‐turn lane, or left‐turn phase in the signal, decreases the insurer's average monthly claims costs at a representative intersection by $944 or $1,062, respectively. The evidence also indicates that these cost savings are a result of reductions in accident severity, rather than being a consequence of fewer accidents.     

Rainfall or Rainmaking? Lawyers,Courts, and the Price of Mold Insurance in Texas

In well‐functioning property‐‐liability insurance markets, the price of coverage reflects the impact of the legal environment on the frequency and severity of claims. This article presents a case study of the Texas mold insurance crisis of 2001–2002. We provide a narrative of the controversy in Texas over insurance coverage for household mold and use county‐level data from a single Texas insurer to assess the determinants of postcrisis prices for supplemental mold, slab, and extended water loss coverages. We find that more attorneys per capita and more heavily Democratic courts were both associated with higher prices for mold and slab coverage.     

Sarmanov Family of Bivariate Distributions for Multivariate Loss Reserving Analysis

The correlation among multiple lines of business plays a critical role in aggregating claims and thus determining loss reserves for an insurance portfolio. We show that the Sarmanov family of bivariate distributions is a convenient choice to capture the dependencies introduced by various sources, including the common calendar year, accident year, and development period effects. The density of the bivariate Sarmanov distributions with different marginals can be expressed as a linear combination of products of independent marginal densities. This pseudo-conjugate property greatly reduces the complexity of posterior computations. In a case study, we analyze an insurance portfolio of personal and commercial auto lines from a major U.S. property-casualty insurer.     

Examining the Marginal Access Value of Private Health Insurance

According to a new theory advanced by Nyman (1999, 2003) , an important access motivation underlies the demand for health insurance. However, little empirical research has attempted to quantify and explain changes in the access value of health insurance. By assuming the demand for health insurance is derived from the demand for good health, this article shows mathematically that the marginal access value of private health insurance can be reasonably indexed by dividing the price of health insurance by a composite measure of medical prices. For the period from 1960 through 2002, national data for the United States suggests that the marginal access value of private health insurance has tended to increase over time. Based upon multiple regression analysis, marginal access value is shown to have increased over time in response to rising income, more generous benefit coverage, new medical technologies, and, in recent years, the backlash against health maintenance organizations (HMOs). In addition, expansions in the Medicaid program are shown to have slowed the growth of the marginal access value of private health insurance.     

The Cost of Pension Insurance

This article estimates the cost of the federal pension insurance program. Pension insurance claims have an important market‐risk component, which means that the cost of the exposure cannot be estimated by discounting future claims by the risk‐free rate. Moreover, owing to the complexity of the insurance contract, its price cannot be estimated with known options formulas without introducing an error of nonquantifiable magnitude. To circumvent these problems, we model the insurance program in its full complexity and use a Monte Carlo method. By hedging the exposure with a dynamic premium policy that offloads the market risk to the insureds, one can calculate the risk‐free, or actuarial, cost of that policy. One can also characterize the nature of the subsidy and its structure across insured plans. Finally, we provide an estimate of the implicit cost of the hedge function that taxpayers currently are providing for zero remuneration. The model shows that simple contingent claims models of pension insurance result in a price that is about triple the true market cost of the insurance, and that pension insurance models that ignore market risk understate the cost by half. The solution demonstrates the broad characteristics that might characterize a credible private‐sector version of pension insurance.     

Nonlinearity and Low Deterministic Chaotic Behavior in Insurance Portfolio Stock Returns

This article presents new empirical evidence indicating a deterministic component in the portfolio return dynamics of life‐health and property‐liability insurance company stocks. Our research is motivated by the fact that nonlinearities are a fact of economic life for many financial applications the source of which is logically apparent, yet empirical evidence of their existence is at best weak. The primary reason attributed to the weak findings of nonlinearities reported in previous research is the use of aggregate data that can hide nonlinearities at the micro level. Insurance sector stock returns are analyzed because unique institutional characteristics indicate the possibility of identifying nonlinear dynamics. Tests based on the correlation dimension partially confirm the presence of nonlinearity. However, the more powerful Brock, Dechert, and Scheinkman (BDS) statistic strongly suggests the presence of nonlinearities in the insurance stock portfolio data. The BDS statistic applied to the standardized residuals of exponential generalized auto regressive conditional heteroskedasticity (EGARCH) models strongly rejects the null of independent and identically distributed, indicating that conditional heteroskedasticity is not responsible for the presence of the nonlinear structures in the data. In addition, tests for chaos based on locally weighted regressions indicate that insurance stock portfolio returns indicate low‐complexity chaotic behavior. This is an important result since most previous research has failed to report evidence of chaotic behavior in the time series of stock returns. Important contributions of this article are the application of tests of nonlinearities and chaos to more desegregated data sets and the findings of statistically significant evidence indicating nonlinearities and low‐deterministic chaotic behavior in insurance stock portfolio returns.     

现阶段商业银行汽车贷款保证保险问题分析--兼评保监会《关于规范汽车消费贷款保证保险业务有关问题的通知》

保监会《关于规范汽车消费贷款保证保险业务有关问题的通知》在贷款流程、除外责任、索赔顺序、承保期限等方面对银行汽车贷款产生了较大的影响。该《通知》将被保险人(银行)的实质性审查义务作为保证保险合同生效的要件值得商榷,也没有合理、公平地划分保险公司和银行之间的风险。对此,作者认为,商业银行在汽车消费贷款中不能过分依赖保证保险,积极探索汽车贷款风险防范的其他途径,巧妙利用保险公司的先索抗辩权并不包括汽车的其他财产险、偷盗险等险种的有利条件,注意区分汽车贷款诈骗的情况,严防保险公司对诈骗做扩大解释,从而有效防范和化解汽车贷款义务中存在的风险。     

医疗保险、健康异质性与精准脱贫——基于贫困脆弱性的分析

医疗保险能否有效减少贫困,尚未达成共识。本文利用CHARLS全国调查数据,基于资产度量个体的贫困脆弱性(即陷贫概率),实证分析医疗保险参保行为及其保障水平对贫困脆弱性的影响。研究表明,参与医疗保险和提高医疗保险保障水平的减贫效果都存在健康异质性,对健康状况差的群体有显著的减贫效果,而对健康状况好的群体减贫效果不显著。此外,本文证实了改善劳动供给是医疗保险减贫的重要中介渠道之一。