A Deep Bow

Paul Greve, JD RPLU
Senior Director, Healthcare Risk Solutions, Markel Specialty

Paul has twenty years’ experience as an administrator, risk manager and attorney for major hospitals in Ohio, including Cleveland Clinic, University Hospitals of Cleveland, Columbus Childrens Hospital, and St. Lukes Hospital. Paul also has twenty years’ experience in the health care professional liability industry as a broker and consultant. He worked as a broker and consultant for Willis for 19 years, primarily in the National Health Care Practice. He has also worked for two health care professional liability insurance companies including Medical Protective and Markel Specialty.

I did not come into the insurance industry directly out of college. My initial twenty-year career was in the health care industry in hospital administration, chiefly risk management and inhouse counsel in large teaching hospitals in Cleveland and Columbus. I was an insured and a client of defense firms, actuarial firms, agents, and brokers. Being on the other side of the table has had distinct advantages during my medical professional liability insurance industry career. Having to learn about medicine and patient care while employed by four hospitals was a strong and useful foundation for my second career. Being on the other side of the table has also allowed me to appreciate the incredible talent, professionalism, and kindness of the wonderful colleagues we have in the medical professional liability insurance industry.

When I joined Willis Corroon in downtown Cleveland in early 1993, I had a minimal grasp of property/casualty insurance for hospitals and physicians. I joined Medical Protective towards the end of 1995 and began to attend insurance industry conferences and state ASHRM conferences, particularly in the Midwest, as well as the annual ASHRM Conference each fall. The last twenty years have included such MPL industry conferences as the Cayman Captive Conference beginning in 2004, the Crittenden Medical Insurance Conference, Insurance ExecuSummit, and the PLUS MPL Symposium.

PLUS was my most important professional organization after I changed careers as I was able to further my knowledge of insurance by taking the courses and passing the tests to receive the Registered Professional Liability Underwriter designation. That was a huge help and a confidence-builder. I met many industry colleagues by serving on PLUS committees and attending both the International Conference and the PLUS MPL Symposium. I learned so much from colleagues at conference sessions and socializing. The networking has been invaluable.

In 2020, the coronavirus pandemic has challenged the medical professional liability insurance (MPLI) industry as never before. If one pegs the year 1975 as the beginning of the first malpractice crisis, although there were a number of insurers prior to that date, the industry really has been in existence for about 45 years. It has withstood at least three or more crises with the attendant claims and underwriting challenges, beginning in the mid-1970s, but those were a matter of significant legal and financial hurdles that were eventually and capably overcome with talent, innovation, and strong leadership. New and specialized commercial insurers were created, like the bedpan mutuals for physicians, as were self insurance vehicles like trusts, risk retention groups and captive insurers. New coverages were crafted and creative risk management and claims services developed. Efforts at enacting tort reform laws and claims strategies to reduce frequency and severity improved industry financials for over a decade beginning around the year 2005.

But the pandemic is unprecedented in so many ways and has required a quick pivot as all kinds of companies directly involved in the industry had to leave office settings and continue to provide essential services of all kinds to insureds and to business partners. That this has occurred so smoothly is not only a tribute to the technology of today that allows staff to function efficiently while working remote but chiefly also to the commendable diligence of all our industry colleagues in their many and diverse roles in our varied settings: insurers, agents, brokers, law firms, actuarial firms, accounting firms, risk management services firms. the Medical Professional Liability Association, PLUS, and others.

In an article published in the 2nd Quarter PLUS Journal, my co-authors, Lori Semlies of Wilson Elser and Richard Henderson of TransRe, and I provided some preliminary thoughts on how the pandemic may affect the medical professional liability insurance industry. With the possible exception of nursing home claims, we did not anticipate a wave of claims against other industry segments, especially hospitals, physicians, and miscellaneous facilities. In fact, the industry may well benefit, at least temporarily, from reduced legal and indemnity expenses. Claims severity, perhaps the greatest issue confronting the industry over the last decade, has been abated with the current delay and near-term difficulty in seating juries, a situation not likely to improve in most states and regions for the balance of 2020. 2018 was a record year for exceptionally large ($10M+) MPL verdicts (46 according to TransRe data) and 2019 was only slightly lower with a total of 42. In 2020, it is believed there have been only two such verdicts pre-pandemic and realistically, not much chance for others to occur.

One notable example of how the MPLI industry stepped up to support the radical transformation of health care services needed to address the pandemic is coverage for telehealth and telemedicine, particularly virtual visits that replaced in-person appointments in physician offices, urgent care, and even the emergency department. Many insurers quickly extended existing coverage, particularly for physicians and practices, to enable the immediate use of telemedicine for patient care.

Like many, if not all of us, I have been deeply engrossed in learning as much as possible about the coronavirus and thinking about its effect on medical professional liability and our insureds. Health care industry online news feeds, an ASHRM membership, and a personal subscription to the New England Journal of Medicine have greatly aided my research. It is always important for the staff in this industry like me to understand health care industry trends, but particularly so during this difficult time.

The industry’s raison detre is to support and protect the dedicated providers of patient care and the organizations that employ them. The health care industry has heroically responded to the pandemic. We can be proud of our support for them as we learned to do business in ways never done before.

As was also true during my hospital career, I may not be the person touching the patients but I help those who do. When that interaction occurs now whenever I speak with our insureds on risk management issues, the gratitude is still there. Even if one is in an insurance industry position where a verbal thanks is not often conveyed directly to all staff from an insured for all that we do to assist them in their roles of providing patient care, we should know that it is still there.

Working remote can have its advantages. Th ability to do tasks that require large amounts of uninterrupted time is one. The quiet of the home setting can allow for more reflection on how fortunate we all are to be in this industry, even at this difficult time.

Like many, I especially miss seeing my incredibly gifted and kind industry colleagues at conferences. The fall will be so difficult without the ability to attend many conferences and events that one looks forward to with pleasure.

May I offer a deep bow to all the wonderful colleagues we have in the medical professional liability insurance industry. Your knowledge, your professionalism, your kindness has made a difficult time more than bearable.

The pandemic can bring us hidden blessings. May we not forget the many blessings we have of deep mutual respect and friendship due to our being in such a fine industry.

Paul Greve works for Markel Specialty, a division of Markel Service Incorporated. The opinions in this Blog are that of the author and not his employer.