Placing You First Insurance Podcast by CRC Group
The Placing You First Podcast spans a diverse spectrum of insurance industry issues to keep you and your clients informed.
Placing You First Insurance Podcast by CRC Group
What 2024 is Teaching Us About the Human Services Market
Summary: Join hosts Amanda Knight and Scott Gordon as they engage with industry specialists Tyler O'Connor, Josh Anderson, and Michelle Earle to dissect the seismic shift from admitted carriers to the thriving Excess and Surplus (E&S) market. You’ll learn precisely why high-severity claims and social inflation are pushing human services organizations toward E&S solutions, especially during a mental health crisis. The conversation doesn’t shy away from the tough topics, particularly the thorny issue of underwriting abuse claims in the wake of reviver statutes. This episode also offers vital insights into how limited excess coverage options can be navigated, emphasizing the crucial role of collaboration between agents and brokers in constructing robust liability programs. Tune in to equip yourself with the knowledge and strategies needed to manage intricate human services market challenges effectively.
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Welcome back to the CRC podcast, where we bring you the latest insights and trends from the world of insurance. I'm Amanda Knight, and today we're diving deep into the evolving human services marketplace. It's a sector that has faced big shifts in 2024, especially as retail insurance agents navigate new challenges and opportunities. New challenges and opportunities. It's a critical moment for agents to understand the nuances of this market, and we have an all-star panel of guests to share their expertise with us today. Joining us in the studio is Tyler O'Connor, senior Vice President with CRC Birmingham. We also have Josh Anderson, a healthcare broker from our Chicago team, and finally, we're joined by Michelle Earle, the CEO of Omnishore Consulting Group, a specialist in healthcare risk management and a leader in supporting human services organizations. This is the Placing you First podcast from CRC Group.
Josh Anderson:This podcast features news and insights from a vast knowledge base of over 5,100 associates who write more than $35 billion in premium annually.
Amanda Knight:Plus, we give you the latest information on what's happening at CRC this, this, this is the. Placing you. First podcast and now the hosts of the podcast, Amanda Knight and Scott Gordon, Tyler, Josh and Michelle. Welcome to the podcast, Thanks.
Tyler O'Connor:Thank you, yeah, thank you Great to be here.
Amanda Knight:Well, let's get right into it, Tyler. Let's start with you. 2024 has marked a noticeable shift in the human services market. You know, historically it's been dominated by admitted carriers, but we're seeing a strong pivot toward E&S. Can you sort of talk us through what's driving that shift?
Tyler O'Connor:Sure, I mean there's a major shift, is a good word.
Tyler O'Connor:The admitted marketplace, which is for decades really controlled human and social service risk placement, largely on a current professional liability basis, largely on a package basis.
Tyler O'Connor:It's really driving a migration, kind of a forced migration, of business into the E&S marketplace.
Tyler O'Connor:So these admitted markets, which continue to be strong but are really making corrective measures on their books, which means that they're refining their books based on appetites, venues, profitability, class selection and they are becoming a great deal more selected, which means that the ENS marketplace, which in a lot of people's minds has been a place of last resort, has now become the strategic place to be to find coverage and try to replicate coverage.
Tyler O'Connor:So the ENS platforms and wholesale brokers really have a tremendous opportunity right now to step in and assist at this stage of the marketplace. So the flexibility of the E&S marketplace, while it's not always perfect and it can be hard to find solutions, is really equipped to address some of these unique high risk profiles that you see within critical, what we think are critical community organizations you know, human services organizations being organizations that are delivering some type of care, and social service organizations which are not necessarily delivering care but are really contributing to the community through programs like YMCA, boy Scouts, girl Scouts, youth sports and things like that. So the marketplace on the ENS side, where we live, is fielding a lot of this risk for the first time in a long time, and so we look forward to talking about it, because each risk is unique and each risk right now is unfortunately encountering its own challenges in the marketplace.
Amanda Knight:That makes sense, Michelle. What are you seeing on your end with Omnishore as this shift toward E&S happens?
Michelle Earle:Word on the street is that a lot of this is being driven by severity, high severity claims, and this is a class of business that is very sensitive to social inflation. And when I say the high severity claims and losses, it's not all PL. Some of it is abuse and some of it is hired and non-owned auto. A lot of the admitted carriers have those packages, and so the class of business gets blown up by one of the coverages.
Michelle Earle:But from our perspective, the pivot to E&S is crucial, especially in a marketplace that's grappling with the US mental health crisis. So mental health is a type of care being provided at every point of the patient experience, and so, because of the growth in mental health and behavioral health needs, it's led to more facilities and services to address the demand, and that presents our marketplace with new and complex risks. At OmniSure, we help facilities navigate these shifts by developing really strong protocols to address specific clinical risks and patient safety concerns, while also navigating the changing standards of care, especially those related to emerging therapies. So ENS gives insurers a great flexibility to support these new and unique needs.
Amanda Knight:Josh, with this shift toward ENS, I know you're also, you know, like Tyler a health care broker. How is that shift impacting what you just see sort of on a daily basis?
Josh Anderson:Yeah, so the push from the admitted marketplace into the ENS marketplace has basically encouraged us as brokers to communicate more effectively with our clients. So that can look a few different ways. You know, kind of setting up in advance, talking with our agents about deals that are on their desk that aren't in the ENS space right now and they may not be in the ENS space in the next year or two years. But it's critical that they have those conversations with their human services, social services, behavioral health, having conversations with those clients in advance to set realistic expectations.
Josh Anderson:The changes to the marketplace and the admitted space at least look a few different ways. You know you have higher rates or you're doing sublimits or you're doing exclusions to some of your major exposures as well as just cutting capacity overall. You know we're seeing when. You know when the admitted carriers are staying in. In most cases we're seeing a 30 plus percent increase which really changes the way that the package looks, you know, which then ends up making ENS options the most viable pathway to Tyler's point truly getting into the ENS space with strategic placements, and we're seeing a lot of it.
Amanda Knight:All right, you guys have mentioned that you know a lot of business is moving toward ENS from the admitted marketplace. Are there any that come to mind that are particularly substantial, that you're seeing come in right now or particularly tough?
Josh Anderson:Yeah, absolutely so. Tyler mentioned a couple earlier and kind of distinguished between human and social services, having, you know, the human care aspect versus more of like an oversight aspect for the social services. One of the big ones that we're seeing come to our desk is the foster care space Traditionally has been a non-admitted market like the rest, and this has, you know, severely been pushed to us as, again, capacity being cut, non-renewing, and it's a very venue-driven. On this one there's several very difficult venues where a lot of carriers are just an absolute no-go and a lot of that is due to legal and judicial decisions in those venues. You know the Northeast and the West Coast in particular have been very challenging in this space.
Tyler O'Connor:Yeah, foster care is a risk that is coming in very, very often. We anticipate that it will come even more in 2025. We expect continued, possibly worsened, disruption in that space, depending on the state. For instance, there are a couple of states where a few MGU carrier outfits are probably going to make significant maneuvers on their foster care book. Already, for us in the ENS space there's a limited amount of capacity for placing 100% foster care risk.
Tyler O'Connor:Oftentimes it's a vicarious risk, mainly for the placement of the child into a home where any type of bodily injury or emotional distress may occur. Abuse is a massive concern for underwriters in that way. A massive concern for underwriters in that way. It's not invisible to them, it is in their losses and it is showing up more and more in their losses and the carriers that are really shouldering most of that risk in the marketplace. We've got to do a good job of helping them remain healthy and viable in doing that. So expectation setting in foster care, with foster care submissions, is critical and those organizations are near and dear to everyone's heart. I am a foster parent. You know those organizations have got to continue. They provide just tremendous goodwill to communities. But it's unfortunate that the claims that come out of those are severe enough to really restrict and change care appetite.
Amanda Knight:And shifting gears a little bit. Michelle and you all three kind of just touched on this. Actually, we talked about, you know, social inflation, how mental health is now sort of built into a lot of different aspects of health care and with that comes some emerging therapy modalities right, new therapies that maybe we didn't see before or aren't as regulated, like ketamine or psychedelics. In the written companion piece that goes with this podcast, we talked about how use of those is on the rise. What sort of unique risks do those new emerging therapies present for this sector?
Michelle Earle:Well, it's a great question because these new therapies are expanding and there are a number of new treatments that hold a lot of promise and are yet still being studied in many ways, and because in healthcare and in human services, we're all about helping others, we'll pull out, you know, everything we can to meet the needs of somebody with a difficult to treat condition like PTSD or treatment resistant depression, but they bring risks that insurers are just really now beginning to understand. For instance, the ketamine clinics can present regulatory and safety challenges. There's so many different ways ketamine is prescribed or taken, and with psychedelics it's the same. Sometimes it's microdosing, sometimes it's in treatment sessions, and there's just even more ambiguity and complexity with each turn. So add to that the fact that tech giants are joining the healthcare ecosystem and there's still a staffing crisis out there and private equity is targeting healthcare.
Michelle Earle:All these things are kind of converging. So it's important, and we are advising all of our clients to adopt some really robust risk management frameworks early on and make sure that they have access to sound clinical risk management advice and not just one time advice, but on demand. You need the answers when you need them, and so for insurers, it's about keeping up with the ever changing landscape and the ever changing standards, thoroughly evaluating how each of the emerging therapies are administered and then focusing on a big piece of that, which is patient selection criteria and then also ensuring that they have the right professionals with the right training and credentialing handling these treatments. We get a number of calls on our helpline related to scope of practice and the lines are just so blurry because of the new treatments that are out there that not everybody understands.
Amanda Knight:Tyler, are these risks that, michelle, you know, just talked about, something that you're starting to see reflected in claims in this sector?
Tyler O'Connor:Yes, unfortunately, the claims really come in pretty much all of these sectors, really the human services so I kind of want to focus there for a second where care is being delivered as opposed to really where oversight is being delivered in a social service setting. So in a human services setting we're talking about behavioral health, mental health, substance and addiction treatment centers, youth centers, developmentally disabled, organizations that care for various aspects of intellectual or developmental disability, various aspects of intellectual or developmental disability, whether they are inpatient risk, where people come and stay or reside for a short time, business in certain settings. You can imagine where it's very close contact with people, particularly youth, and that leads to some pretty severe claims. We do see a balance of severity and frequency, unfortunately, across the human services sector. But the business is all coming in from years of being placed in a very administratively easy way, meaning on a packaged basis with an admitted carrier, often, again on that occurrence, pl, professional liability coverage form, which allows you to report claims to your carrier in perpetuity. And if you think about abuse being a loss driver and a real area of sensitivity for underwriters and for their reinsurers, truly a lot of it has to do with the fact that these abuse claims are rearing their head across the board, the industry, no matter the sector, no matter whether it's a youth organization or an adult organization. And we've seen things like revivership statutes put in place which if you're not aware of those, it's something to look into where revivership abuse claims are essentially civil lawsuits that can be brought by adult survivors of childhood sexual abuse after the statute of limitations has expired. So states have allowed these what's called revival statutes which allow these survivors to file claims after the statute of limitations has expired.
Tyler O'Connor:So when a piece of business comes in, when an organization comes in and say they have a have had coverage in place since 1995, for instance, and the ens market is trying to honor a retroactive date, you know, or place new retro inception coverage maybe the carrier is, the occurrence market is still in business, but maybe not. They could be on the hook for a claim that is filed well beyond the statute of limitations. So it becomes much harder for an underwriter to properly underwrite to abuse, which is a very tricky and kind of invisible thing to do on the front side and Michelle could weigh in on this in terms of how people think about underwriting to abuse, because organizations naturally are screening people, they conduct training of people, they trust their people. Otherwise the people would be fired or relocated into settings that would not create certain circumstances, and so an organization can do everything that they can possibly do to follow the rules, and an underwriter can check all the they can possibly do to follow the rules, and an underwriter can check all the boxes in their underwriting file and an abuse claim can still come in, and when it comes in, it is not a low settlement figure, it's a high defense dollar. It's often a very high settlement dollar often triggers punitive damages. Depending on the state. They may be insurable, in which case your entire umbrella tower, your entire liability program is at risk, and so abuse truly is a massive thing.
Tyler O'Connor:That is arguably one of the hardest things to underwrite to, and these reviver statutes in certain states you can imagine that New York, new Jersey, california have made some of the most significant changes in this way, but with that type of opportunity for abuse to be a real issue way down the road past the statute of limitations is one of the things that is restricting that coverage, which is one of the first things that agents call to discuss with a wholesale broker, because they'll walk a piece of business in and they'll call a wholesaler once they realize what's happening with their direct market and the direct market is going to not renew the business or they're going to dramatically reduce the amount of excess that they're going to give them this year, namely in the way of abuse. They call up a wholesale broker and they say can you please help us replenish the excess limit this year? And so most often you please help us replenish the excess limit this year. And so most often they're asking to replenish the abuse limit which is in the marketplace. There's very few carriers you can actually go to and say, hey, can you please give me just excess for abuse, monoline abuse, we call it, and you can go do that.
Tyler O'Connor:But it makes it very hard when there's only a few people doing it. So then you try to build out the entire tower, or what's happening is you're coming back saying, look, the ens market could actually provide an entire solution here for the liability line. So what if we, what if we showed you what a brand new professional and general liability with abuse program looked like from the ground up? And if you just say at that point you're going to kind of dismantle what was prior a package, and so the agent will be working to place the auto in the property and the wholesale broker will be working with them to provide solutions for the PLGO and the abuse. But across the way claims have come in. Addiction treatment presents some really unfortunate and gnarly claim scenarios, but abuse is the first thing people want to talk about because it really is a major pain point for both underwriters and for clients.
Michelle Earle:I just have to add you know Tyler's spot on when it comes to the abuse. We've had to develop some really extensive guidelines to implement in the human services sector because of these claims. And one of the things that makes it so difficult with these revival statutes is that the longer it's been since the actual event occurred, the more likely there are multiple victims. If it got swept under the rug and it's not been addressed for that many years, that's when multiple victims start coming out of the woodworks. And sadly, some of these human services organizations don't have good records. They may not know if the carrier is still in business. They may not have a copy of their policy. Things may have changed a lot in that many years. We now have much better record keeping than we did 20, 30, 40, 50 years ago. So yeah, tyler's spot on and part of the checklist for the retail brokers should be to look and see do they have a good history of their coverage? Do they have somewhere that they can show? In this year I had this policy with this carrier.
Tyler O'Connor:Just so people understand how that coverage is designed to work, is that while a perpetrator may be named in the lawsuit, you would like to have a policy that is going to obviously defend and provide vicarious liability to the insured organization itself. The perpetrator, under a good policy, should be defended until the matter is finally adjudicated, until that person is proven to have committed what is, at that point, a criminal act. At that point that perpetrator is not insurable because of the criminal act. So a good policy would provide defense for that perpetrator is not insurable because of the criminal act. So a good policy would provide defense for the perpetrator up until final adjudication but would absolutely provide vicarious liability for the insured organization, like we said, so long as they were not complicit and knew that this person had a history or knew that there were rumors of something going on or something like that. So as long as they were not complicit, the insured organization I can't speak to every policy, but a good policy would provide defense and vicarious liability for that organization.
Amanda Knight:So that's all fantastic insight. Let's boil it down a little bit for our retail agent partners, Josh. What are maybe a few key things that you really want them to either understand or know or be able to provide to you to be able to help them as their wholesale partner?
Josh Anderson:Yeah, absolutely so. We definitely want them to know that it's a changing marketplace, as we've discussed for the last several minutes, you know, but also that it's fluid, you know. I think here at CRC we've done a very good job with our carriers at getting them to kind of go where the business leads us. So some of these difficult classes of business, historically, you know, there's only a few markets. We're starting to get more and more markets on board, which is important. However, they're only going to look at these deals for us if we have good, comprehensive submissions that are complete and full up front so that they can fully review and have time to work on them. You know some of the things that we really need right off the bat. You know we can't work off of accords. We need true applications that are driven towards this class of business. So behavioral health, human services type applications.
Josh Anderson:We're going to want to see the expiring policies. We're not trying to compete or compare premiums here. We're looking to, you know, maintain coverages, maintain retro dates, make sure that our policies match up to the expiring out of the admitted market to the best of our ability. No policy is the same, but a lot of those things we're looking to match as best as possible. We're going to need loss runs and we can't just take two, three years typically. It's a tough class of business. The tail on these is very long. The maturation I know we talked about it a lot. Tyler did with the abuse it can be years and years and years later, tens of years later. So any loss runs at least five to seven years. We prefer as far back as the retro at a minimum Narratives on any significant loss.
Josh Anderson:Tell us a story. We need to have that story up front. If there's a six-figure loss on there, give us the story. Tell us what happened. Tell us what they've done since that loss to make sure that that doesn't happen again. These losses can get very difficult, very high in cost. But if we have a good narrative, a good story to tell, our carriers are open to listening. If they just see several six figure losses they're going to decline it. We need to be able to tell the story.
Josh Anderson:Any sort of you know roster of providers that's always important because you kind of have that social human services mixed in with a medical malpractice exposure. It's going to be important that we know you know the providers, the specialty. All of that you know. We need to know the difference in inpatient and outpatient. We have a lot of carriers that'll do outpatient all day. Inpatient gets a little bit more difficult typically. Inversely, we have some that'll do outpatient but not inpatient, and inpatient and not outpatient. So you know there's a mix, but we need to know that breakout up front to where we can prepare our underwriters appropriately. You know.
Josh Anderson:Lastly, on kind of, you know the list that I that I use as a guideline is financials. Some carriers really won't go too far without them. I'm not saying that it's something that we must have up front, but it's something that we'll typically ask for during it. Ultimately, the more transparent that we can be with a deal to our carriers, the better response time that we're going to get out of them and the better, or the more likely, that they're going to be willing to work on these difficult deals. For us, we're almost calling in favors, you know, whenever we work on these, every time that we call an underwriter. So we need to do our best to help them as well, to make the process as easy as possible, as streamlined as possible. So ultimately, we need from our retailers just to be upfront. Give us all the information upfront as much as possible and then just work through it with us.
Tyler O'Connor:I totally agree. I think the way to think about human services risk in this marketplace is it's a team sport, so there's going to be a lot of work that goes into renewing even a small account. Here you might have a local risk that the agency has been proud to insure for a number of years. It may be far from your biggest revenue driving risk, but it may be one of the flagship accounts in the entire agency and it might be a small package policy that going into this marketplace is going to require a tremendous amount of work and so it's a team sport. To Josh's point, and just knowing, okay, we are going to most likely need to break the property and the auto from the liability lines here we're going to need to be flexible and we're going to need to be well in advance and advising expectations and getting a sense and being in sync with our client and with the wholesale are two very different ends of the spectrum often, but have got to be managed through conversation. So it's a team sport in that sense.
Tyler O'Connor:Oftentimes, when an account, a submission, shows up on a wholesaler's desk, one of the first things that we do like to do is say thank you very much for the submission. Can you please tell us your thinking and expectations this year, but also what's happened? Why is it coming into the marketplace and who have you spoken to? And oftentimes we'll say, okay, well, here are our thoughts in terms of strategic marketing here. Why don't you go approach some additional markets? Why don't you go approach and we'll suggest a couple other direct or admitted players?
Tyler O'Connor:We're going to go to all of these places so that the direct admitted marketplace if that's where it's coming from then that's a great first place to just make sure you exhaust that it can't be moved inside of that marketplace and we'll help you understand or advise you some other places to try. So, inside of that marketplace, and we'll help you understand or advise you some other places to try so that when that is exhausted we have together exhausted that option. It helps in the context of the end result because in the end result, what we do want to always be able to deliver is that you are hopefully getting the most comprehensive coverage, whether it's same or better, for the most competitive price on this day. Josh is absolutely right. All of the quality submission and a quality backstory on what's driving the risk into the E&S market this year from its incumbent carrier is critical and just to work in tandem. It's a team sport.
Michelle Earle:I like that A team sport. Tyler and Josh are exactly right it is a team sport and my advice is to be proactive with the risk management as well. Don't wait for a claim to happen. Engage with risk management support early and ensure that your clients are putting strong protocols in place that will open doors for you. Omnisure. Here. We don't just assess a risk at a single point in time. We stay engaged throughout the policy period to help clients identify and prevent or mitigate risks early, before there's a claim. So, for instance, we support facilities with policy and procedure reviews, documentation, audits and guidance on everything from safety protocols to employee competency and training, and this ongoing support can make a substantial difference in securing better coverage terms. Since the underwriters, they often look more favorably on clients who take advantage of all the resources and support at their disposal to actively manage the risk and prevent the losses.
Amanda Knight:So, josh Tyler, michelle, if I'm a retail agent and I've got an account that I need someone like you to look at, how do they get to Michelle Tyler and Josh?
Tyler O'Connor:So Michelle's done a great job and has earned a tremendous amount of respect in the marketplace with insurers, and so oftentimes insurers will bring Michelle and OmniSure and her team in or a similar risk management company. Oftentimes a carrier will try to provide some type of assistance or support without getting in the way of doing business, but be there to lend best practice advice. Omnishare, for instance, has a tremendous 24-7 call hotline that a lot of our clients utilize to run things past them, so you can reach out to them directly. But oftentimes, through their reputation in the marketplace, insurers will bring them in as well.
Michelle Earle:Oftentimes, through their reputation in the marketplace, insurers will bring them in as well. We often have retail brokers and wholesale brokers reach out to us on behalf of the policyholders. So we got a call from a retail broker who we didn't know, we'd never run into in the market, but he was big in the human services space and he just lost his biggest account. And he lost that big account because the his competitor brought OmniShore to the deal. We don't have a contract with any retail brokers, so their competitor brought the deal to the table by using an ENS market that we work with, which may have been how they went through CRC.
Michelle Earle:But my advice is if the carrier that they're with has risk management services available, they should use them and then show that they've used them, and if they don't, then they should talk. The retail broker should talk with their wholesale broker and say can we build risk management into this deal for my client? You know I can be reached or our whole. We have a nationwide network of consultants, all with different skill sets. Some of them are experts in suicide prevention, some of them are experts in addiction treatment. Some of them are experts in psychiatric inpatient care. So when they reach out to our helpline via helpline at omnisurecom or on the website or our 800 number, which is on the website. They will get an immediate response.
Amanda Knight:Great advice all around. And now that you've made it through the tough stuff, we've got one last fun thing we like to call rapid fire. Nothing hard, nothing scary, just a couple of fun questions to close out the show. So just answer with whatever comes to mind. First, you know, halloween was not long ago. The holidays are near, if not already here by the time you're, or past by the time you're listening to this. But with the holidays comes candy. So what's your favorite holiday candy and what do you feel is trash candy that no one should be forced to eat? I know, for me trash candy is candy corn. No one will eat that at my house.
Michelle Earle:Well, I'm going to say anything with crunch. I love a good Butterfinger or a Kit Kat and I think crunch should be its own food group. I really do Agree 100%. Trash candy would be marshmallow, anything with marshmallow in it.
Amanda Knight:All right, Josh Tyler, hit me with it.
Josh Anderson:Yeah, I like more just traditional chocolate. So, whether that's milk chocolate or dark chocolate, I'm pretty simple when it comes to that. And then I agree, candy corn is not good, and neither is anything that's just a heavy marshmallow with more sugar added to a marshmallow. Those are two things that I'm not interested in.
Tyler O'Connor:You know it's funny, my kids eat all of the candy except their. Trash candy is my candy and maybe it's become that, but I just crush it on all of the Almond Joys Because people somehow still give Almond Joys I think they still come in those big bags that you buy and no kid eats it for whatever reason and they're completely missing out. So their trash candy is the one I want and I freeze them.
Amanda Knight:Yep. At my house the kids want all the fruity candy and don't care about the chocolate, which is great for me. So I hear that All right. One more fun question before we wrap up the podcast. Today you can watch one holiday movie. Do you pick Home Alone, elf or A Christmas Story?
Michelle Earle:Well, definitely not Home Alone. Home Alone is traumatizing for parents. I actually did lose sight of my five-year-old in New York City, and so I will never watch that movie again. I love A Christmas Story.
Tyler O'Connor:I'll watch all three of those, whatever's on it, doesn't matter where it is when it shows up on. You know, whatever you can just parachute into all three of those movies and, for whatever reason, just be hypnotized, all three of them. I'll just stop, just be like hypnotized all three of them.
Josh Anderson:I'll just stop and watch. They're all great movies. I would go home alone as number one and elf is number two, that's if I'm ranking them and I'm the decision maker. That's, those are the first two there are no wrong answers here.
Amanda Knight:Well, thank you tyler, josh and michelle for sharing your insights today and for being good sports here at the end. This is a valuable conversation, especially for those navigating the complex human services market, and and we appreciate you being here. And to our listeners thank you for tuning in and we will see everybody next time.
