Robert J. Walling III

Legislative / Regulatory Impacts

A state medical society asked Pinnacle to evaluate the impact of a change in the state’s damage caps for non-economic damages for medical professional liability. Pinnacle worked with the medical society to identify the most appropriate claims databases to assess the legislation’s potential impact. Our detailed analysis not only considered data from that state, but several others to stress test the results and provide a range of reasonable outcomes. In addition, we performed a thorough analysis of how the state compared to other states in terms of the availability and affordability of medical professional liability insurance coverage, insurer operating results for the line, and access to healthcare in the states. Through this industry analysis, we identified differences well beyond a simple loss limitation and provide a more complete review of potential environmental changes that could be expected in the state.

Optimization of Assets and Liabilities

An international insurance and reinsurance company wanted to design an optimization model to be used for both asset and liability decisions. Pinnacle actuaries were able to demonstrate to company management that their initial approach was both practically and theoretically unsound and prevented them from implementing a flawed decision making procedure. We were also able to suggest approaches that were more sound and would allow them to design a model that performed as desired.

U S Domestic Statement of Actuarial Opinion

Domestic U.S. property/casualty insurers and risk retention groups are required to file an Annual Statement with state regulators each year by March 1. Part of that filing includes the submission of a formal Statement of Actuarial Opinion (SAO) by a qualified Appointed Actuary as to the reasonableness of held loss and loss adjustment expense reserves. The SAO must be one of five types:

• Reasonable
• Inadequate/Deficient
• Excessive/Redundant
• Qualified
• No Opinion

In addition to the SAO, most jurisdictions require an Actuarial Opinion Summary (AOS) providing more detail on the Appointed Actuary’s specific findings by March 15. Lastly, a formal report narrative in support of the SAO and AOS is required to be available by May 1.

As the SAO is a compliance document, the primary audience is state regulators but the individual company must arrange for the service to be provided.

A recent SAO for one of our clients touched on many of the required disclosures:

1. The adequacy of held reserves on a net basis were below the low end of our range of reasonable reserves until we took into account anticipated salvage and subrogation recoveries.
2. The unearned premium reserves for long duration contracts were substantial and we conducted a review to determine they were adequate
3. The Company held material loss and loss adjustment expense reserves for pools and associations. In order avoid having to issue a Qualified Opinion, we separately computed indicated reserves for two of the pools/associations, and obtained an SAO from the Appointed Actuary for the National Workers Compensation Reinsurance Pool.
4. Reinsurance recoveries were in doubt for certain carriers as balance were sometimes overdue by more than 90 days. After reviewing the reinsurers’ A. M. Best ratings, we made the required disclosures about reinsurance collectability.