Current Developments in Tort Claims summarizes key topics in tort liability, including major drivers and areas of liability. It discusses the status of asbestos litigation, noting reforms aimed at prioritizing impaired claims. Securities litigation is increasing globally due to accounting scandals. Medical malpractice severity is rising though reforms like damages caps show promise. Drug and device liability is driven by new technologies and marketing practices, while federal and state tort reform efforts aim to increase predictability and uniformity.
Millions Involved in False Claims Act Cases: Medical Fraud and Recent Court D...Conference Panel
Join our advanced webinar to gain a comprehensive understanding of federal false claims act laws, and learn how to avoid liability and maintain defensible record-keeping in the context of medical waste, fraud, and abuse cases involving millions of dollars.
This webinar provides an in-depth overview of the two types of prosecutions for alleged false claims, and explores the real-world outcomes of federal cases, including landmark rulings from the United States Supreme Court that have changed the landscape of false claims act cases.
Through an analysis of federal court cases, attendees will gain insights into the potential risks and consequences of non-compliance, and learn practical tips and techniques to mitigate risk and ensure compliance with federal false claims act laws. Don't miss this opportunity to stay ahead of the curve in this complex and constantly evolving area of the law.
Register, https://conferencepanel.com/conference/false-claims-act-cases-involving-millions-in-medical-fraud-what-you-need-to-know-about-recent-court-decisions
Chapter 19National Health Insurance& Managed Care.docxwalterl4
Chapter 19
National Health Insurance
& Managed Care
LEARNING OBJECTIVES
• Discuss the purpose and various titles of the
Patient Protection and Affordable Care Act of
2010 (PPACA).
• Discuss the Supreme Court’s ruling on the
constitutionality of the PPACA.
• Describe the common models of managed care
organizations.
• Explain what can happen if a state fails to comply
with the PPACA.
PPACA Purpose
• Increase # of Americans covered by health
insurance
• Decrease cost of insurance
– Make more affordable through shared
responsibility
• Eliminate discriminatory acts
– Exclusion due to pre-existing conditions,
health status, & gender.
PPACA Reforms Health Care – I
• Eliminate lifetime & unreasonable annual limits on
benefits
• Prohibit recessions of health insurance policies
• Assistance for uninsured due to pre-existing
conditions
• Require coverage: preventative services &
immunizations
• Extend dependent coverage up to age 26
PPACA Reforms Health Care - II
• Develop uniform coverage documents so consumers
can make equal insurance comparisons
• Cap insurance company
– nonmedical & administrative expenditures
• Ensure consumers have access to an effective
appeals process
– provide a place to turn for help
• navigating the appeals process & assessing
coverage
Supreme Court 6/28/12
• Agreed that the requirement for nearly all
Americans to buy health insurance.
• Court excised part of law requiring states to
expand their Medicaid coverage in a joint
federal–state effort, to families with incomes
up to 133% of the Federal Poverty Level (FPL).
PPACA Titles
Title I. Quality Affordable Health Care for All
Americans
Title II. The Role of Public Programs
Title III. Improving the Quality and Efficiency of
Health Care
Title IV. Prevention of Chronic Disease and
Improving Public Health
Title V. Health Care Workforce
PPACA Titles – II
Title VI. Transparency and Program Integrity
Title VII. Improving Access to Innovative Medical
Therapies
Title VIII. CLASS Act
Title IX. Revenue Provisions
Title IX. Strengthening Quality, Affordable
Health Care for All Americans
Models of Managed Care
Organizations (MCO’s)
• Health Maintenance Organizations
• Preferred Provider Organizations
• Exclusive Provider Organizations
• Point of Service Plans
• Experience-Rated HMOs
• Specialty HMO’s
• Independent Practice Associations
• Physician Group Practice
Models of MCOs – II
• Group Practice without Walls
• Physician-Hospital Organizations
• Medical Foundations
• Managed Service Organizations
• Vertically Integrated Delivery System
• Horizontal Consolidations
• Federally Qualified
Federally Qualified MCOs
• Strictly Voluntary
• Must Meet Federal Standards
• Less flexibility in
– benefits packages
– setting premium rates
• Must Provide Basic Package of Health Services
State HMO Laws – I
• Specify what types on entities may operate an
MCO.
• Require the provisio.
Forensic and Valuation Issues in HealthcarePYA, P.C.
PYA Principal Carol Carden co-presented “Forensic and Valuation Issues in Healthcare” at the AICPA Forensic & Valuation Services Conference in New Orleans, LA, November 10, 2014.
To hear the recorded version of this webinar, visit http://bit.ly/1JqXkox
Our panel discusses developments in government enforcement of health care anti-fraud laws. This will include recent court decisions, settlements and OIG/DOJ pronouncements and public statements. The focus will be on development in 2015 year to date. The panel will also discuss significant "cases to watch" that are in active litigation and could result in decisions that impact the industry.
On our agenda:
Overview of recent government enforcement efforts
Highlight of significant False Claims Act decisions in 2015
Discussion of pending cases and their implications for the industry
Presenters:
Jeffrey Fitzgerald, Shareholder, Polsinelli
Brian Bewley, Shareholder, Polsinelli
Presentation at the National Bar Association's 92nd Annual Convention at the Health Law Summit on "Canadian vs US Health System: Lessons for Reformers in Protecting the Poor and Promoting Innovation" on August 1, 2017, at the Fairmont York Royal Hotel.
During our D&O conference we held a panel debate on the current trends observed in European D&O claims, the rise in D&O class/representative actions and enforcement of orders in various European jurisdictions. Members of the panel included leading lawyers from Austria, Israel, Spain, the Netherlands and the United Kingdom.
- FIRST EXAM SPRING 20201. Describe how the view of operations.docxgertrudebellgrove
- FIRST EXAM SPRING 2020
1. Describe how the view of operations as a process can be applied to the following:
a. Acquisition of another company
b. Marketing Research for a New Product
c. Design of an Information System
2. An operations manager was heard complaining
“My boss never listens to me ----- all the boss wants from me is to avoid making waves. I rarely get any capital to improve operations. Also, we do not have weekly, biweekly or even monthly meetings with our product managers, supply chain department, customer service or the sales department. We only meet with the accounting and finance departments when there are issues with the monthly budgets. Furthermore, our department has interacted with information service department about four times in past fiscal year”
Please assess the following:
a. Whether this business has a business strategy ?
b. Does it have an operations strategy?
c. What would you recommend?
3. Firm A has recorded the following costs in 2018:
Incoming materials and inspection $20,000
Training of Personnel $40,000
Warranty $45,000
Process Planning $15,000
Scrap $13,000
Quality Laboratory $30,000
Rework $25,000
Allowances $10,000
Complaints $14,000
a. What are the Prevention, Appraisal, Internal Failure and External Failure costs?
b. What inferences can you draw on Quality Measures taken by Firm A?
c. What would you recommend to improve quality programs in Firm A?
d. What initiatives should Firm A implement for 2019 and 2020?
4. Please explain the House of Quality (QFD) as discussed in class.
5. A certain process is under statistical control and has a mean value of 130 and a standard deviation of 8. The specifications for the process are:
a. USL (upper specification limit) = 150
b. LSL(lower specification limit) =100
a. Calculate the cp and cpk
b. Which of these indices is a better measure of process capability and why?
c. Assuminng a normal distribution what percentage of output is expected to fall ourside the specification. Why is it important to know this?
d. What would you recommend?
2
Chapter 7
Government Ethics
and the Law
William A. Myers, Ph.D.
Learning Objectives (1 of 2)
• Describe some of the reasons why there has
been a loss of trust in government.
• Explain the purpose of various government
committees on ethics.
• Discuss how public policy protects the rights of
citizens.
Learning Objectives (2 of 2)
• Describe federal laws designed to protect each
individual’s rights.
• Explain the concept of political malpractice.
• Understand the importance of ethics in public
service.
Let every American, every lover of liberty, every
well wisher to his posterity, swear by the blood
of the Revolution, never to violate in the least
particular, the laws of the country; and never to
tolerate their violation by others.
—Abraham Lincoln
Executive Branch:
U.S. Office of Government Ethics
• Exercises leadership ...
- FIRST EXAM SPRING 20201. Describe how the view of operations.docxgertrudebellgrove
- FIRST EXAM SPRING 2020
1. Describe how the view of operations as a process can be applied to the following:
a. Acquisition of another company
b. Marketing Research for a New Product
c. Design of an Information System
2. An operations manager was heard complaining
“My boss never listens to me ----- all the boss wants from me is to avoid making waves. I rarely get any capital to improve operations. Also, we do not have weekly, biweekly or even monthly meetings with our product managers, supply chain department, customer service or the sales department. We only meet with the accounting and finance departments when there are issues with the monthly budgets. Furthermore, our department has interacted with information service department about four times in past fiscal year”
Please assess the following:
a. Whether this business has a business strategy ?
b. Does it have an operations strategy?
c. What would you recommend?
3. Firm A has recorded the following costs in 2018:
Incoming materials and inspection $20,000
Training of Personnel $40,000
Warranty $45,000
Process Planning $15,000
Scrap $13,000
Quality Laboratory $30,000
Rework $25,000
Allowances $10,000
Complaints $14,000
a. What are the Prevention, Appraisal, Internal Failure and External Failure costs?
b. What inferences can you draw on Quality Measures taken by Firm A?
c. What would you recommend to improve quality programs in Firm A?
d. What initiatives should Firm A implement for 2019 and 2020?
4. Please explain the House of Quality (QFD) as discussed in class.
5. A certain process is under statistical control and has a mean value of 130 and a standard deviation of 8. The specifications for the process are:
a. USL (upper specification limit) = 150
b. LSL(lower specification limit) =100
a. Calculate the cp and cpk
b. Which of these indices is a better measure of process capability and why?
c. Assuminng a normal distribution what percentage of output is expected to fall ourside the specification. Why is it important to know this?
d. What would you recommend?
2
Chapter 7
Government Ethics
and the Law
William A. Myers, Ph.D.
Learning Objectives (1 of 2)
• Describe some of the reasons why there has
been a loss of trust in government.
• Explain the purpose of various government
committees on ethics.
• Discuss how public policy protects the rights of
citizens.
Learning Objectives (2 of 2)
• Describe federal laws designed to protect each
individual’s rights.
• Explain the concept of political malpractice.
• Understand the importance of ethics in public
service.
Let every American, every lover of liberty, every
well wisher to his posterity, swear by the blood
of the Revolution, never to violate in the least
particular, the laws of the country; and never to
tolerate their violation by others.
—Abraham Lincoln
Executive Branch:
U.S. Office of Government Ethics
• Exercises leadership .
Relatively Exclusive: A national overview of employer liability for toxic tortsMichael D. Martinez
Presentation given at The National Forum for Environmental & Toxic Tort Issues (FETTI) 2019 Annual Conference at the Union League Club in Chicago, Illinois on September 26, 2019.
Presentation focuses on the viability of, and challenges to, the exclusive remedy defense in toxic tort and asbestos actions nationwide, including recent legislation enacted by the Pennsylvania and Illinois legislatures to reverse the decisions of each state's supreme court with respect to the viability of the exclusive remedy as a defense to civil actions for asbestos-related injuries.
Millions Involved in False Claims Act Cases: Medical Fraud and Recent Court D...Conference Panel
Join our advanced webinar to gain a comprehensive understanding of federal false claims act laws, and learn how to avoid liability and maintain defensible record-keeping in the context of medical waste, fraud, and abuse cases involving millions of dollars.
This webinar provides an in-depth overview of the two types of prosecutions for alleged false claims, and explores the real-world outcomes of federal cases, including landmark rulings from the United States Supreme Court that have changed the landscape of false claims act cases.
Through an analysis of federal court cases, attendees will gain insights into the potential risks and consequences of non-compliance, and learn practical tips and techniques to mitigate risk and ensure compliance with federal false claims act laws. Don't miss this opportunity to stay ahead of the curve in this complex and constantly evolving area of the law.
Register, https://conferencepanel.com/conference/false-claims-act-cases-involving-millions-in-medical-fraud-what-you-need-to-know-about-recent-court-decisions
Chapter 19National Health Insurance& Managed Care.docxwalterl4
Chapter 19
National Health Insurance
& Managed Care
LEARNING OBJECTIVES
• Discuss the purpose and various titles of the
Patient Protection and Affordable Care Act of
2010 (PPACA).
• Discuss the Supreme Court’s ruling on the
constitutionality of the PPACA.
• Describe the common models of managed care
organizations.
• Explain what can happen if a state fails to comply
with the PPACA.
PPACA Purpose
• Increase # of Americans covered by health
insurance
• Decrease cost of insurance
– Make more affordable through shared
responsibility
• Eliminate discriminatory acts
– Exclusion due to pre-existing conditions,
health status, & gender.
PPACA Reforms Health Care – I
• Eliminate lifetime & unreasonable annual limits on
benefits
• Prohibit recessions of health insurance policies
• Assistance for uninsured due to pre-existing
conditions
• Require coverage: preventative services &
immunizations
• Extend dependent coverage up to age 26
PPACA Reforms Health Care - II
• Develop uniform coverage documents so consumers
can make equal insurance comparisons
• Cap insurance company
– nonmedical & administrative expenditures
• Ensure consumers have access to an effective
appeals process
– provide a place to turn for help
• navigating the appeals process & assessing
coverage
Supreme Court 6/28/12
• Agreed that the requirement for nearly all
Americans to buy health insurance.
• Court excised part of law requiring states to
expand their Medicaid coverage in a joint
federal–state effort, to families with incomes
up to 133% of the Federal Poverty Level (FPL).
PPACA Titles
Title I. Quality Affordable Health Care for All
Americans
Title II. The Role of Public Programs
Title III. Improving the Quality and Efficiency of
Health Care
Title IV. Prevention of Chronic Disease and
Improving Public Health
Title V. Health Care Workforce
PPACA Titles – II
Title VI. Transparency and Program Integrity
Title VII. Improving Access to Innovative Medical
Therapies
Title VIII. CLASS Act
Title IX. Revenue Provisions
Title IX. Strengthening Quality, Affordable
Health Care for All Americans
Models of Managed Care
Organizations (MCO’s)
• Health Maintenance Organizations
• Preferred Provider Organizations
• Exclusive Provider Organizations
• Point of Service Plans
• Experience-Rated HMOs
• Specialty HMO’s
• Independent Practice Associations
• Physician Group Practice
Models of MCOs – II
• Group Practice without Walls
• Physician-Hospital Organizations
• Medical Foundations
• Managed Service Organizations
• Vertically Integrated Delivery System
• Horizontal Consolidations
• Federally Qualified
Federally Qualified MCOs
• Strictly Voluntary
• Must Meet Federal Standards
• Less flexibility in
– benefits packages
– setting premium rates
• Must Provide Basic Package of Health Services
State HMO Laws – I
• Specify what types on entities may operate an
MCO.
• Require the provisio.
Forensic and Valuation Issues in HealthcarePYA, P.C.
PYA Principal Carol Carden co-presented “Forensic and Valuation Issues in Healthcare” at the AICPA Forensic & Valuation Services Conference in New Orleans, LA, November 10, 2014.
To hear the recorded version of this webinar, visit http://bit.ly/1JqXkox
Our panel discusses developments in government enforcement of health care anti-fraud laws. This will include recent court decisions, settlements and OIG/DOJ pronouncements and public statements. The focus will be on development in 2015 year to date. The panel will also discuss significant "cases to watch" that are in active litigation and could result in decisions that impact the industry.
On our agenda:
Overview of recent government enforcement efforts
Highlight of significant False Claims Act decisions in 2015
Discussion of pending cases and their implications for the industry
Presenters:
Jeffrey Fitzgerald, Shareholder, Polsinelli
Brian Bewley, Shareholder, Polsinelli
Presentation at the National Bar Association's 92nd Annual Convention at the Health Law Summit on "Canadian vs US Health System: Lessons for Reformers in Protecting the Poor and Promoting Innovation" on August 1, 2017, at the Fairmont York Royal Hotel.
During our D&O conference we held a panel debate on the current trends observed in European D&O claims, the rise in D&O class/representative actions and enforcement of orders in various European jurisdictions. Members of the panel included leading lawyers from Austria, Israel, Spain, the Netherlands and the United Kingdom.
- FIRST EXAM SPRING 20201. Describe how the view of operations.docxgertrudebellgrove
- FIRST EXAM SPRING 2020
1. Describe how the view of operations as a process can be applied to the following:
a. Acquisition of another company
b. Marketing Research for a New Product
c. Design of an Information System
2. An operations manager was heard complaining
“My boss never listens to me ----- all the boss wants from me is to avoid making waves. I rarely get any capital to improve operations. Also, we do not have weekly, biweekly or even monthly meetings with our product managers, supply chain department, customer service or the sales department. We only meet with the accounting and finance departments when there are issues with the monthly budgets. Furthermore, our department has interacted with information service department about four times in past fiscal year”
Please assess the following:
a. Whether this business has a business strategy ?
b. Does it have an operations strategy?
c. What would you recommend?
3. Firm A has recorded the following costs in 2018:
Incoming materials and inspection $20,000
Training of Personnel $40,000
Warranty $45,000
Process Planning $15,000
Scrap $13,000
Quality Laboratory $30,000
Rework $25,000
Allowances $10,000
Complaints $14,000
a. What are the Prevention, Appraisal, Internal Failure and External Failure costs?
b. What inferences can you draw on Quality Measures taken by Firm A?
c. What would you recommend to improve quality programs in Firm A?
d. What initiatives should Firm A implement for 2019 and 2020?
4. Please explain the House of Quality (QFD) as discussed in class.
5. A certain process is under statistical control and has a mean value of 130 and a standard deviation of 8. The specifications for the process are:
a. USL (upper specification limit) = 150
b. LSL(lower specification limit) =100
a. Calculate the cp and cpk
b. Which of these indices is a better measure of process capability and why?
c. Assuminng a normal distribution what percentage of output is expected to fall ourside the specification. Why is it important to know this?
d. What would you recommend?
2
Chapter 7
Government Ethics
and the Law
William A. Myers, Ph.D.
Learning Objectives (1 of 2)
• Describe some of the reasons why there has
been a loss of trust in government.
• Explain the purpose of various government
committees on ethics.
• Discuss how public policy protects the rights of
citizens.
Learning Objectives (2 of 2)
• Describe federal laws designed to protect each
individual’s rights.
• Explain the concept of political malpractice.
• Understand the importance of ethics in public
service.
Let every American, every lover of liberty, every
well wisher to his posterity, swear by the blood
of the Revolution, never to violate in the least
particular, the laws of the country; and never to
tolerate their violation by others.
—Abraham Lincoln
Executive Branch:
U.S. Office of Government Ethics
• Exercises leadership ...
- FIRST EXAM SPRING 20201. Describe how the view of operations.docxgertrudebellgrove
- FIRST EXAM SPRING 2020
1. Describe how the view of operations as a process can be applied to the following:
a. Acquisition of another company
b. Marketing Research for a New Product
c. Design of an Information System
2. An operations manager was heard complaining
“My boss never listens to me ----- all the boss wants from me is to avoid making waves. I rarely get any capital to improve operations. Also, we do not have weekly, biweekly or even monthly meetings with our product managers, supply chain department, customer service or the sales department. We only meet with the accounting and finance departments when there are issues with the monthly budgets. Furthermore, our department has interacted with information service department about four times in past fiscal year”
Please assess the following:
a. Whether this business has a business strategy ?
b. Does it have an operations strategy?
c. What would you recommend?
3. Firm A has recorded the following costs in 2018:
Incoming materials and inspection $20,000
Training of Personnel $40,000
Warranty $45,000
Process Planning $15,000
Scrap $13,000
Quality Laboratory $30,000
Rework $25,000
Allowances $10,000
Complaints $14,000
a. What are the Prevention, Appraisal, Internal Failure and External Failure costs?
b. What inferences can you draw on Quality Measures taken by Firm A?
c. What would you recommend to improve quality programs in Firm A?
d. What initiatives should Firm A implement for 2019 and 2020?
4. Please explain the House of Quality (QFD) as discussed in class.
5. A certain process is under statistical control and has a mean value of 130 and a standard deviation of 8. The specifications for the process are:
a. USL (upper specification limit) = 150
b. LSL(lower specification limit) =100
a. Calculate the cp and cpk
b. Which of these indices is a better measure of process capability and why?
c. Assuminng a normal distribution what percentage of output is expected to fall ourside the specification. Why is it important to know this?
d. What would you recommend?
2
Chapter 7
Government Ethics
and the Law
William A. Myers, Ph.D.
Learning Objectives (1 of 2)
• Describe some of the reasons why there has
been a loss of trust in government.
• Explain the purpose of various government
committees on ethics.
• Discuss how public policy protects the rights of
citizens.
Learning Objectives (2 of 2)
• Describe federal laws designed to protect each
individual’s rights.
• Explain the concept of political malpractice.
• Understand the importance of ethics in public
service.
Let every American, every lover of liberty, every
well wisher to his posterity, swear by the blood
of the Revolution, never to violate in the least
particular, the laws of the country; and never to
tolerate their violation by others.
—Abraham Lincoln
Executive Branch:
U.S. Office of Government Ethics
• Exercises leadership .
Relatively Exclusive: A national overview of employer liability for toxic tortsMichael D. Martinez
Presentation given at The National Forum for Environmental & Toxic Tort Issues (FETTI) 2019 Annual Conference at the Union League Club in Chicago, Illinois on September 26, 2019.
Presentation focuses on the viability of, and challenges to, the exclusive remedy defense in toxic tort and asbestos actions nationwide, including recent legislation enacted by the Pennsylvania and Illinois legislatures to reverse the decisions of each state's supreme court with respect to the viability of the exclusive remedy as a defense to civil actions for asbestos-related injuries.
Claims Process Improvement And AutomationClaire Louis
Presentation to Casualty Actuarial Society November 2007: presents retrospective on claim process improvement; identifies current change drivers; examines future claims process trends
1. Current Developments in Tort Claims
Claire Louis - PricewaterhouseCoopers LLP
November 14, 2005
Casualty Actuarial Society
Baltimore, Maryland
2. Key Topics
• Tort claim drivers
• Major areas of tort liability
– Asbestos
– Securities litigation
– Medical malpractice
– Drug products and medical devices
• Status of federal and state tort reform
1
3. Key Topics
• Tort claim drivers
• Major areas of tort liability
– Asbestos
– Securities litigation
– Medical malpractice
– Drug products and devices
• Status of federal and state tort reform
2
4. Tort claim drivers
• U.S.
– Culture of blame
– Contingency fees
– Plaintiffs bar and judiciary
– Promotion of attorney services
– Technology
– Expanded bases of liability
– Tort reform erosion
– Media
– Medical advances and medical cost inflation
3
5. Tort claim drivers
• International
– Differences in legal and structural systems
– Loser pays winner’s attorney fees: After the Event insurance
– European social insurance: greater medical and financial benefits
– Traditionally, contingency fees not allowed
• Maintenance and champerty
– England and Wales: “success fee” arrangements
• Courts and Legal Services Act of 1990 and related legislation
• Allowed in all civil proceedings except family cases
• Still exception rather than the rule
• Based on solicitor’s costs, not damages
– EC
• Move to harmonize different legal systems
• Elements of civil and common law system
• Strict liability still new
– New Zealand and Switzerland have abolished tort law system
4
6. Key Topics
• Tort claim drivers
• Major areas of tort liability
– Asbestos
– Securities litigation
– Medical malpractice
– Drug products and medical devices
• Status of federal and state tort reform
5
7. Asbestos
• More than 8,400 businesses affected
• Original projected costs - $8 bn
– Total projected costs - $300 bn
• Original projected claims – 60 mm
– Total claims to date – 770 mm
– Total projected claims – 3.3 bn
6
8. Asbestos
• Since 1981, ten attempts to pass federal
asbestos legislation
• S.852 – Fairness in Asbestos Injury Resolution
Act of 2005
– $140 bn over 30 years
– Would eliminate virtually all existing and future cases
– Lacks support from insurers, certain defendants, and
other interest groups
– Insurance industry concerns include lack of finality,
exigent claim issues, and orphan share funding
7
9. Asbestos
• State asbestos reform
– Legislative
• Ohio Asbestos Reform Bill (Sept 2004)
– Intent is to give priority to the truly sick
– First state to require actual impairment under objective
medical criteria
– Already there are attempts to circumvent
8
10. Asbestos
• State asbestos reform
– Legislative
• Texas (Sept 2005)
– Requires a report from a qualified physician stating a
diagnosis of mesothelioma or other cancer
– Specific X-ray and PFT criteria must be met
– Expedites malignancy cases for trial
– Prohibits reliance on reports or opinions produced by
labs linked with law firms
9
11. Asbestos
• State asbestos reform
– Legislative
• Florida (July 2005)
– Sets minimum medical criteria
– Requires that qualified doctors read X-rays
– Protects the rights of those who become sick in the future
10
12. Asbestos
• State asbestos reform
– Judicial
• Inactive dockets (IL, NY, WA; Baltimore, Boston,
Chicago)
– Favorable experience
– Defer and protect unimpaired claims until individual
develops an impairment
– Must meet medical criteria
– Sick receive priority
– Relieves docket congestion
– Preserves scarce financial resources
11
13. Asbestos
• Federal asbestos reform
– Federal MDL
• Thousands of unimpaired claims dismissed
• 20,000 Jones Act cases dismissed (1996)
– Few claims reinstated
– Evidence of “manifest injury”
• Administrative dismissal of mass screening cases
(2002)
12
14. Asbestos
• International
– Focus is serious disease cases: escalating
mesothelioma rate in the UK (3.8 X higher than U.S)
– Claimants fearful of judicial system
– Burden of proof difficult to satisfy
– Claimants were socially marginalized
– Possible national solution sought in UK
– European Asbestos Conference Sept 2005
– 2005-2006 EU Year of Action on Asbestos
13
15. Asbestos
• U.S. insurance issues
– Dramatic decrease in new filings; increase in severe case filings
– Few surviving matrix agreements
• Battles fought case-by-case
• Stricter proof requirements
• More trials
– Insurers looking for finality:
• Push for buy-outs of Tier Two and Three players
• CSAs for relatively minor defendants
– Bankruptcies: in general, has not caused the acceleration in
insurance pay-outs once feared
– Silica
• Plaintiffs bar repackaging asbestos cases as silica cases
• Rate of filings jumped 2002-2003
• Favorable developments in Texas
14
16. Key Topics
• Tort claim drivers
• Major areas of tort liability
– Asbestos
– Securities litigation
– Medical malpractice
– Drug products and medical devices
• Status of federal and state tort reform
15
17. Securities litigation
• In 2004, securities litigation became global:
securities litigation, securities regulatory
investigations, and enforcement actions
increased substantially around the world
• U.S. private securities actions increased
• More litigation, investigation, enforcement
activity against foreign private issuers than ever
before
• Skyrocketing settlement costs
• Regulation, regulatory enforcement, and
securities litigation
16
18. Globalization of securities litigation
• In 2004, 29 foreign filers listed on foreign
exchanges—the highest number in one year--
were sued in U.S. private securities class
actions: a 90% increase from 2003
• 22 of the cases involved allegations of
accounting irregularities and financial fraud
– Parmalat
– Ahold
– Royal Dutch Shell
• Adoption of IFRS and SOx 404 compliance
17
19. U.S. private securities actions
• 203 private securities actions filed in 2004:
16% increase
• Drivers
– New SEC rules and regulations
– New PCAOB rules
– Effects of private class actions and court
decisions: Enron, WorldCom, HealthSouth
• Effects of SOx still to be felt
18
20. 2004 settlement trends in U.S.
private securities class actions
• Increasing trend in high-dollar settlements
• 104 cases settled for $5.4 bn ($2.8 bn
excluding WorldCom)
• Average settlement value: $27.6 mm (up
18% from 2003)
• Median settlement value: $7mm (up 25%
from 2003)
19
21. Drivers of U.S. private securities
class action settlements
• High level of market capitalization
• Role of retirement fund and pension fund
fiduciaries and institutional investors as
lead plaintiffs in class actions
• Intersection of private securities class
action claims with financial restatements
• Severity of accounting scandals and
financial frauds20
22. Regulation, enforcement, and
securities litigation
• Securities class action litigation not just a U.S.
phenomenon, e.g., France and Netherlands
• Reach of regulatory enforcement crosses borders
• Convergence of generally accepted accounting
principles: IFRS and US GAAP
• Greater coordination among securities regulators
worldwide
• International cooperation agreements to facilitate
enforcement and prosecution
• Joint investigation protocol between U.S. and other
countries
• Adoption of SOx-like regulations and reforms by
international regulators21
23. Future securities litigation trends
• Steady increase in number of private securities
class actions and regulatory enforcement
actions
• Continuing significant increase in dollar values
of private securities class action settlements
• Significant increase in Section 10(a), SEC (and
others) investigations, internal corporate
investigations leading to more restatements,
more regulatory enforcement actions, more
private securities litigation
22
24. Key Topics
• Tort claim drivers
• Major areas of tort liability
– Asbestos
– Securities litigation
– Medical malpractice
– Drug products and medical devices
• Status of federal and state tort reform
23
25. Medical malpractice
• Trend toward higher verdicts and median
awards
• Severity increasing in serious injury cases
• Sharp rise in defense and administration costs
• Nursing home litigation continues strong
– MS, FL, AL still “hot spots”
– Wilkes & McHugh may be moving on
– Fewer trials, more settlements
– Operator financial difficulty increasing insurer risk
24
26. Medical malpractice
• Drivers of med mal claims
– Not just a tort system issue
– Other factors
• Sicker, older population
• Greater expectations for medical care
• Breakdown in doctor-patient relationship
• Incidence of medical error
25
27. Medical malpractice
• Prospects for reducing med mal claims
– Increased diagnostic testing
– Peer review and disciplining
– Improved communications with patients
– Technology
26
28. Medical malpractice
• Reform
– National med mal reform defeated in 2005
– Certain recent reforms appear to be working:
caps on awards appear the most effective
– Not infrequently, medical mal reforms are
challenged and overturned or circumvented
27
29. Medical malpractice
• State approaches to med mal reform
– Advance notice of claim
– Statute of limitations
– Joint and several limitations
– Compulsory ADR
– Expert affidavit
– Limited attorney fees
– Modification of collateral source rules
– Damages caps: pain and suffering, punitive, total
– Periodic payments
28
30. Key Topics
• Tort claim drivers
• Major areas of tort liability
– Asbestos
– Securities litigation
– Medical malpractice
– Drug products and medical devices
• Status of federal and state tort reform
29
31. Drug products and medical devices
• Current claim drivers
– Fast-track FDA approval
– Direct to consumer marketing: erosion of learned
intermediary defense
– Off-label promotion of drugs
– New drug delivery technologies
– Clinical trials
– Product counterfeiting
– Quality control (Ortho-Evra patch)
– Aging of population
30
32. Drug products and medical devices
• Limiting drug and medical devices product
liability
– Proposed federal legislation
• Pre-emption of punitive damages against
manufacturers of FDA-approved drug products
• Healthcare providers shielded from liability
– Federal pre-emption of state tort claims
• FDA intervention in private lawsuits involving drugs
or medical devices
– State tort reform initiatives
31
33. Key Topics
• Tort claim drivers
• Major areas of tort liability
– Asbestos
– Securities litigation
– Medical malpractice
– Drug products and medical devices
• Status of federal and state tort reform
32
34. Tort reform: current efforts
– Federal
• Intent is to address lack of uniformity at the state level
• Class Action Fairness Act of 2005 – Feb 2005
• Lawsuit Abuse Reduction Act
– State
• Extent of reform varies by state
• Current focus is on damages caps, joint and several,
punitive damages, collateral source rule
– Tort reform effectiveness
• No single reform offers the perfect solution
• Damages caps appear to be the most effective means to
reduce the number of lawsuits and the value of awards
• In the end, what matters most for insurers is predictability
33