Hospitals Shifting Costs to Auto Insurance System, Study Finds

Posted by Benji Riggins on April 23, 2010 under Claims | Be the First to Comment

Low reimbursements from public health insurance programs, such as Medicare and Medicaid, have prompted hospitals to shift costs to automobile insurance companies—raising auto injury claim costs and forcing auto insurers to more closely scrutinize and negotiate hospital bills prior to payment.

A new study from the Insurance Research Council (IRC) estimates that for bodily injury (BI) liability claims in 38 tort and add-on states, cost shifting in 2007 resulted in $1.2 billion in excess hospital charges.

However, the study says, the full impact of hospital cost shifting, including that occurring in other insurance coverages and in other states, is likely much greater.

“The conventional wisdom is that hospitals aggressively seek to shift costs from public insurance programs to private payers such as auto insurance companies,” said Elizabeth Sprinkel, senior vice president of the IRC. “With this study, we now have information on the magnitude of cost shifting and a better understanding of the need for supportive state laws and effective tools that will enable auto insurers to pay hospitals appropriately and help control auto injury claim costs.”

Spronkel said hospital cost shifting to auto injury claims illustrates the complex relationship between property/casualty insurance and the broader healthcare and insurance system.

“Healthcare legislation enacted by Congress last month underscores the complexity of this relationship,” said Sprinkel. “It will take months, if not years, to understand the full impact of the reforms on hospital cost shifting and the auto insurance system.”

To explore the relationship between key health system features and auto injury hospital costs, IRC developed a statistical model of average hospital charges for auto injury claims in different states. Key predictors of average hospital charges confirmed by the model are the percentage of a state’s population without health insurance coverage and the percentage of the population covered by Medicaid.

To estimate excess hospital charges due to hospital cost shifting, IRC compared average hospital charges for BI liability claims in Maryland with average charges in 38 other tort and add-on states. In the 1970s, Maryland received a waiver from the federal government allowing it to regulate hospital reimbursement rates for all purchasers of hospital services. As a result, virtually all hospital cost shifting in the state was eliminated. IRC said that Maryland’s unique approach to hospital reimbursement, while unlikely to be replicated in other states, provided an opportunity to examine costs in an environment with minimal cost shifting.

In all instances, IRC found that average hospital charges for auto injury claims in Maryland were substantially lower than hospital charges in most other states.

IRC also found that the costs of expensive diagnostic procedures performed in Maryland hospitals were much lower than in other states but were more similar to costs in other states when the procedures were performed outside a hospital.

The IRC study, Hospital Cost Shifting and Auto Injury Insurance Claims, is based on data from more than 42,000 auto injury claims closed with payment under the five principal private passenger coverages. Twenty-two insurers, representing 58 percent of the private passenger auto insurance market in the Unites Sates in 2006, participated in the study.

Source: IRC

Study: Dog Bite Claims Up 8.7% in 2008

Posted by Benji Riggins on September 18, 2009 under Claims | Be the First to Comment

Man’s best friend is sinking its teeth into homeowners insurance costs. Dog bites account for one-third of all homeowners insurance liability claims, costing $387.20 million in 2008, up 8.70 percent from 2007, according to the Insurance Information Institute (I.I.I.).

An analysis of homeowners insurance data by the I.I.I. found that the average cost of dog bite claims was $24,461 in 2008 (the most recent figures available) down slightly from $24,511 in 2007. Since 2003, however, the cost of these claims has risen nearly 28 percent. Additionally, the number of claims has increased 8.89 percent to 15,823 in 2008 from 14,531 in 2007.

“The rise in dog bite claims over the course of the past five years can be attributable to the increased medical costs as well as the size of settlements, judgments and jury awards which have risen well above inflation in recent years,” said Loretta Worters, vice president of the I.I.I.

More than 4.5 million people in the U.S. are bitten by dogs annually, and nearly 900,000 of those — half of them children — require medical care, according to the Centers for Disease Control and Prevention (CDC). More than 31,000 Americans needed reconstructive surgery after dogs attacked them in 2006, center figures show. With more than 50 percent of bites occurring on the dog owner’s property, the issue is a major source of concern for insurers.

Dog Owner Liability

There are three kinds of law that impose liability on owners:

• Dog-bite statute: The dog owner is automatically liable for any injury or property damage the dog causes, even without provocation.
• “One-bite” rule: In some states, the owner is not held liable for the first bite the dog inflicts. Once an animal has demonstrated vicious behavior, such as biting or otherwise displaying a “vicious propensity”, the owner can be held liable. Some states have moved away from the one-bite rule and hold owners responsible for any injury, regardless of whether the animal has previously bitten someone.
• Negligence laws: The dog owner is liable if the injury occurred because the dog owner was unreasonably careless (negligent) in controlling the dog.

In most states, dog owners are not liable to trespassers who are injured by a dog. A dog owner who is legally responsible for an injury to a person or property may be responsible for reimbursing the injured person for medical bills, lost wages, pain and suffering and property damage.

“Although some people purchase dogs for the purpose of guarding their homes, deadbolt locks and home security systems are safe burglary deterrents and that will often earn you a discount on your insurance premium,” said Worters.

A single lawsuit — even if won — can end up costing hundreds of thousands of dollars, Worters said.

“Most dogs are friendly, loving members of the family,” said Worters. “But even normally docile dogs may bite when they are frightened or when protecting their puppies, owners or food. Ultimately, the responsibility for properly training and controlling a dog rests with the owner.”