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Survey Report

Insurance Marketplace Realities 2022 Spring Update – Healthcare professional liability

April 7, 2022

Healthcare professional liability (HPL) and general liability (GL) rates and terms and conditions have stabilized, but the market is closely watching some key global trends.
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Rate predictions: Healthcare professional liability
  Trend Range
Primary Increase (Purple triangle pointing up) +5% to +10%
Excess Increase (Purple triangle pointing up) +15%
Hospital Increase (Purple triangle pointing up) +5% to +25%
Allied health Increase (Purple triangle pointing up) +5% to +15%
Physicians Increase (Purple triangle pointing up) +5% to +15%
(particularly venue dependent)
Loss-affected accounts highly variable rate increases

Key takeaway

Healthcare professional liability (HPL) and general liability (GL) rates and terms and conditions have stabilized, but the market is closely watching some key global trends. Excess layers are still seeing greater rate pressure and more restricted terms and conditions than lead and primary layers — especially in larger towers.

HPL and GL marketplace

  • Despite another market exit, the available HPL capacity has largely stabilized.
  • The reduction in deployed capacity from $25 million to $15 million that we’ve written about in this space increasingly appears to be a permanent feature of the HPL market.
  • Several risk retention groups (RRGs) and alternative markets have entered the healthcare liability segment.
  • The pace and level of rate increases have also steadied, and rate increases sought by insurers have remained fairly consistent over the last few quarters. Yet there are still some negative market forces at play:
    • Insurers have very pessimistic views about social inflation — a major driver of rising loss severity.
    • Excess layers are subject to more rate pressure than primary/lead layers. There are several reasons.
      • Insurers are more likely to deem excess layers as not having reached rate adequacy.
      • More carriers are necessary to construct large towers, especially on towers greater than $75 million, muting the rate depressing power of competition.
      • Severity trends are still rising, and insurers are concerned about obtaining adequate pricing for catastrophic losses.
  • The impact of COVID on claim trends is a much-discussed topic, particularly as courts have been reopening. Dockets are jammed with COVID-delayed cases; this may encourage a rush of settlements to clear caseloads.
  • Another COVID-related topic of discussion is its potential impact on healthcare tail; COVID might result in delayed detection of incidents and lengthen the time it takes to resolve claims.
  • Some carriers have increased their loss assumptions to account for multiple inflationary trends (e.g., social inflation) — a sign that carriers are not expecting the upward severity trend to ease.
  • Carriers are trying to balance the opportunity to grow with their concerns about severity trends, social inflation and unknowns around COVID claims. At times, this has resulted in a degree of market dissonance — a divergence between the rates carriers would like to obtain and what they can obtain in the marketplace — that has been favorable to buyers.
  • Have transparent pre-renewal conversations with incumbent carriers to obtain their guidance on rate, attachment, limit deployment and terms, and be prepared to market programs to achieve the best terms and pricing.

Physician’s professional liability market

  • A few carriers are showing early signs of renewed conservatism due to uncertainty about claim outcomes now that court trials are resuming after the pandemic pause.
  • Physician’s medical malpractice written premium is shifting from the admitted market to E&S markets. This is in large part due to the admitted physicians’ market adopting more conservative underwriting stances, reducing capacity and often seeking greater rate increases.
  • API (application programming interface) security is a growing concern in healthcare as cyberattacks increase. X-rays, charts and test results from our physician’s office are now all available on our phones, leaving this information more vulnerable to attack.

Macro trends directly impacting HPL/GL

  • Global supply chain disruptions can lead to delays in acquiring critical healthcare supplies (medication, PPE and technology), which could directly contribute to an erosion of staff and patient safety. Healthcare entities should prepare to discuss with underwriters the steps they are taking to reduce their exposure to ongoing supply chain vulnerabilities.
  • Medical malpractice insurers are concerned about the disruptive effects of the current healthcare workforce shortage. Healthcare entities should be ready to highlight how they have bolstered safety and quality systems in the face of costly employee turnover.
  • The future impact of inflation on medical expenses and medical malpractice verdicts is a growing concern. Historically, healthcare inflation has typically outpaced consumer prices; yet the current inflationary pressure has not manifested yet in healthcare. This lag between emergence of inflationary pressures (labor shortage and supply chain disruption) and a rise in healthcare pricing has raised many questions about if (and when) medical inflation will follow. Rising inflation in long-tail business may have a compounding negative effect on distressed loss ratios that could impact model assumptions and, ultimately, pricing.

Disclaimer

Willis Towers Watson hopes you found the general information provided in this publication informative and helpful. The information contained herein is not intended to constitute legal or other professional advice and should not be relied upon in lieu of consultation with your own legal advisors. In the event you would like more information regarding your insurance coverage, please do not hesitate to reach out to us. In North America, Willis Towers Watson offers insurance products through licensed entities, including Willis Towers Watson Northeast, Inc. (in the United States) and Willis Canada Inc. (in Canada).

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Contacts

Head of Healthcare Broking, North America,
WTW

Michael Faralli
Senior Broker, Healthcare Broking, North America

Laura Coombs, RPLU, CPLP
National Physicians Broking Leader

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