1. Paul Ruiz – Claims Executive Gen Re, San Francisco
Current Trends in Medical Malpractice Presentation to the Professional Liability Defense Federation September 29, 2016 Denver, CO
Paul Ruiz – Claims Executive
Gen Re, San Francisco

2. Proprietary Notice
The material contained in this presentation has been prepared solely for informational purposes by Gen Re. The material is based on sources believed to be reliable and/or from proprietary data developed by Gen Re, but we do not represent as to its accuracy or its completeness. The content of this presentation is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.
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3. Welcome to Denver
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5. Welcome to Trends in Medical Malpractice
Industry undercurrents driving change
Developing the next generation of trial attorney talent
Nursing claim developments
Dental claims developments
Impact of the Affordable Care Act
Additional miscellaneous items if time
Frequency/Severity, Telemedicine, Cyber, Electronic Health Records, National Counsel.
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6. Industry Undercurrents in Medical Malpractice
The Market
Trend of physicians becoming employees of hospitals and healthcare systems.
Continuing acquisition of physician practices by healthcare systems.
Demand
Aging Baby Boomers
Affordable Care Act: 20M newly covered patients
Supply
Increased need for primary care and physician extenders
Increased need for MPL (but fewer independent physicians requiring MPL)
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7. Increased hospital insurance purchasing leverage
Impact to MPL
Declining market share for carriers leading to more mergers and acquisitions
Increased hospital insurance purchasing leverage
Downward pressure on rates, decreased profitability
Effects of industry consolidation
Expense tightening
Impact to defense firms
What hasn’t changed…the need for quality claims and risk management
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8. Developing Defense Attorneys
What it was…
Several associates providing assistance.
The partner is the trial attorney
High defense costs
Associates occasionally authorized to try the case
What it is…
Frequency down, less cases for associates to gain experience
Partners will keep the big cases, smaller cases usually get settled
And yet…
Importance of talented and capable trial attorneys.
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9. Identifying those associates with trial capabilities
Developing the Bench
Identifying those associates with trial capabilities
Allowing second chair
Flexible billable hours
Having an associate handle some of the witnesses
Qualities of a capable defense attorney (from an insurance point of view)
New claims talent – where are they coming from?
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10. Nursing Claims Developments
On the rise
$90M over the past 5 years
Foreign trained – more frequency, less severity
85% of nurses with 16+ years of experience had claims
Largest indemnity payments were with those in the 3-5 year range
Causes? (more responsibilities and demands = more claims, deep pockets)
What can be done?
Risk management strategies, training (5 “Rs”), documentation.
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11. Dental Claim Developments – Increased Severity
Old v New Paradigm
Procedures at the upper limits of training.
Why?
Patients, Dentists, the Economy, Plaintiff Attorneys?
Impact on dental carriers?
Premiums
Defense Costs
What to do?
Importance of Risk Management
Claim handling – settlement v trial
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12. Impact of the Affordable Care Act?
Is the ACA going anywhere?
Use of the ACA to mitigate future medical costs
Example of future medical costs
What are carriers and defense attorneys doing?
What does the ACA not cover?
Is the ACA a collateral source?
How jurors may view the ACA
Challenges to defense counsel
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13. Additional Medical Malpractice Items
Less frequency. Causes. Is it here to stay?
More severity. Causes.
Selectivity of cases, creative damage arguments (early and aggressive, negative discount rate, driving a wedge between insurer and insured)
Telemedicine
Cyber
Electronic Medical Records
Efficacy of using national counsel on select cases?
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14. Primary Takeaways
Significant market shifts with employed physicians, soft market, consolidation.
Mutual benefit of developing younger attorneys.
Hospitals and their carriers would do well to emphasize risk management and training of their nurses given the increased responsibilities.
Carriers for dentists would also do well to focus on risk management efforts. Consider case studies for their insureds. “Lessons from losses.”
ACA – Carriers and defense counsel should keep the provisions of the ACA in mind when addressing future medical costs.
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15. Thank You