I have significant expertise as to allegations of unfair claims practices by personal and commercial property casualty insurers as well as expertise as to related bad faith. Watch the video below on my bad faith expertise, followed by detailed career highlights.

Specific Expertise as to Unfair Claims Practices and Bad Faith

1A. Expertise as to Insurance Personal and Commercial Property Casualty Policies from a Regulatory Perspective. From an educational standpoint, I hold a B.A. in mathematics, a M.Ed. in educational psychology and a J.D. from the University of Illinois and am a member upon examination of The Florida Bar along with other state bars, also by examination.

I have had extensive and substantive experience relating directly to insurance policies. As a regulator for eight years in three positions: ((i) Assistant Attorney General assigned to the Department of Insurance (Iowa); (ii) First Deputy Commissioner of Insurance; and (iii) Commissioner of Insurance, along with my staff, I approved (or disapproved) every word of every phrase of every sentence of every page of every property casualty policy used by each of the 1,000 property casualty insurance companies doing business in the state.

This regulatory action included policy forms like those in regular use in the industry. These regulatory positions also included the responsibility to approve (and disapprove, as necessary) proposed premiums to be used in connection with the particular policy form, including premium levels relating to personal and commercial property polices like those commonly at issue in the industry.

While Commissioner, I also served as a member of the Executive Committee of the National Association of Insurance Commissioners (“NAIC”), the nationwide organization of all state insurance commissioners, including Florida’s Commissioner. That organization has responsibilities for establishing model insurance administrative regulations and model statutes for consideration by all of the states.

One of the reasons insurance can be conducted smoothly on a national basis in the U.S. is the comparability of state-by-state insurance laws, many of which originated from NAIC mode laws. While with the NAIC, I served among others on the: (i) Commercial Lines Committee, with nationwide jurisdiction over policies such as those in common use in the industry; (ii) on the Casualty Actuarial Committee, which had nationwide jurisdiction over pricing principals for related personal and commercial policies; and (iii) finally, I chaired a series of NAIC committees.

1B. Expertise as to Personal and Commercial Property Casualty Insurance Policies from an Insurance Industry Executive and From a Company CEO Perspective. Along these same lines, I served as General Counsel and chief lobbyist to the American Academy of Actuaries, Washington D.C. The Academy is the national professional association for actuaries. These professionals establish premium levels for policies such as policies commonly in use in the industry. In addition, because policy language dictates premium levels, actuaries are also active in determining policy language. While with the profession, I worked with actuaries to establish standards relating to both their work product and professional demeanor.

From 1990 to 1998, I served as President and Chief Executive Officer for the National Council on Compensation Insurance ("NCCI"), New York City and Boca Raton, Florida, a nationwide property casualty industry-owned organization with about 1,500 employees with annual revenues of about $150 million that did (and does) business in about 40 states including Florida, which is also the domiciliary state of NCCI. This means while I served as president and CEO, NCCI was subject to the full authority of the Florida Office of Insurance Regulation ("FL OIR") and subject as well to the Florida Insurance Code as well as the jurisdiction of all Florida courts, state and federal.

Among my responsibilities at NCCI was (together with my staff) to formulate all workers compensation insurance policy forms as used in our states of operation (about 40 such states). This work included drafting all policy language (tailored to the specific state’s Insurance Code) as well as drafting all endorsements and all other policy forms. In addition, my responsibility included gaining state insurance department approval of all such policy forms as a condition precedent to their use as submitted by some 600 property casualty insurance companies.

I am also one of about 400+ certified reinsurance arbitrators (by ARIAS-US) and have sat as an arbitrator on property casualty issues in disputes about policy language between reinsurers and their insurers. I know insurance policies and policy forms.

2A. Expertise as to Claim Adjustment Duties of Personal and Commercial Property Casualty Insurance Companies From a Regulatory Perspective. I have also had significant experience and responsibility in connection with determining and passing judgment on insurers' responsibilities in their adjustment of property casualty claims. In particular, in my three regulatory positions previously described, I had daily responsibility to assure and to hold accountable all of the state’s 1,000 property casualty insurers for their claim adjustment obligations. I did so through a series of action steps and tools. The action steps and tools (all of which are likewise used by every state department of insurance in the U.S.) included the following:

• Unfair Claims Settlement Act: Personal and Commercial Property Casualty. Like most every other state, Iowa enacted the model NAIC Unfair Claims Settlement Practices Act (“UCSA”) which set forth standards against which the Insurance Commissioner could pass judgment on a property insurer’s claims settlement practices. As Commissioner and as First Deputy and earlier as Assistant Attorney General assigned to the Department, I had daily responsibility to enforce this act and assure all insurance companies were in compliance with the act. That was the same act as adopted by every state in the U.S. in substantially similar form and enforced on a regular basis by each such state.


• NAIC Market Regulation Handbook Personal and Commercial Property Casualty Insurers. In addition to the standards set out in the UCSA, as Commissioner, I had as an available tool, the NAIC Market Regulation Handbook (“Examiners Handbook” or “Handbook”). This Handbook sets forth standards to assess insurer claim settlement behavior and is used by every department of insurance in the United States. The standards have been universally agreed to by all of the nation’s Commissioners of Insurance as adopted formally by them through the NAIC. The claim settlement standards of the Handbook are universally recognized as appropriate standards against which to judge insurer claim behavior.


• Market Conduct Examination: Personal and Commercial Property Casualty Insurers. On a regular basis, my agency conducted Market Conduct Examinations of property casualty insurers utilizing the Examiners Handbook to determine whether in fact the target insurer was meeting all of their claim settlement obligations. This action entailed physically going into the insurers claim operations and studying claim files to determine any errant action or inappropriate claim settlement behavior. As further discussed below, errant insurers were warned, disciplined and prosecuted as required.


• Complaints from the Public: Personal and Commercial Property Casualty Insurers. On a daily basis, my department received incoming consumer complaints as to insurance company claim settlement practices. This division was staffed by department lawyers who resolved the individual complaint but equally important, those lawyers also determined whether an insurer evidenced unacceptable claim settlement practices. That is to say, staff lawyers determined whether the incoming consumer complaints in fact constituted a red flag as to the insurance company’s potential behavior across the board.


• Prosecution. To the extent insurer behavior required formal action (whether a result of complaints from the public or a result of Department investigation through a Market Conduct Examination), my Department prosecuted such insurers under the state’s civil Administrative Procedures Act. In connection with such prosecutions, I served in various capacities during my eight years as a regulator as: (i) prosecutor (as Assistant Attorney General); (ii) as the decision maker as to whether to initiate prosecution in the first instance; and (iii) as the Administrative Law Judge (“ALJ”) who presided over the prosecution and defense of the case and entered findings of fact and conclusions of law as to insurer claim settlement practices. I have served as an ALJ in scores of such cases where the insurer’s claim settlement practices in property claim settlement matters were the primary issue and entered final decisions in such matters.

2B. Expertise as to Claim Adjustment Duties of Personal and Commercial Property Casualty Insurance Companies from the Perspective of an Industry Executive. In addition to my experience as a regulator, as reflected above, I have had specific industry experience (in other positions) as to insurer claim settlement practices. Some of those positions included the following:

• CEO of a Major US Insurance Organization, Regulated Throughout the US; Domiciled in Florida; President and Chief Executive Office of the National Council on Compensation Insurance (NCCI), 1990 – 1998. I referenced above, under policy expertise, my experience at NCCI. In addition to exposure as to insurance policy forms, this same NCCI experience also provided significant background as to insurer claim settlement obligations.
  
  
• NCCI: Claim Settlement. In addition and relevant to this case, NCCI had a vested interest in member insurer claim practices in that the industry’s reputation for fair underwriting and claim settlement practices ultimately impacted regulatory attitudes toward NCCI’s premium approval process.
  
  
• NCCI: Industry Standards of Practice. While President and CEO of NCCI, I visited and physically toured and reviewed in excess of 400 insurance companies and gained direct exposure to the procedures and processes and standard industry practices of the U.S. insurance community and its claim settlement practices. I have had extensive exposure to insurer practices and procedures.
  
  
• General Counsel and Director of Government Relations to the American Academy of Actuaries (Washington D.C.), 1980 – 1983. I served as General Counsel and Director of Government Relations for the American Academy of Actuaries, including advising on admissions, discipline, federal antitrust and general corporate law. I represented the 15,000 member professional organization before Congress (e.g., Senate Committees on Banking, Commerce, Finance and Labor, and House committees on Education, Labor, Energy, and Ways and Means) and the various federal regulatory agencies.
  
  The Academy is the professional organization of actuaries and includes qualified actuaries from all disciplines and all forms of insurers. Academy members included affiliation with virtually every commercial property insurance company in America. Such actuaries had duties relating to policy language and policy pricing. The Academy’s Board of Directors was likewise made up of leading insurance company executives from such property companies.
  
  
• Attorney in Private Practice: Personal and Commercial Property Casualty Insurance Issues. Those interests also included intimate involvement with commercial property insurance, as counsel to the:
  

  Professional Insurance Agents of Iowa (property casualty insurance agents);

  Iowa Association of Life Underwriters (life, health and annuity insurance agents); and

  The Property Casualty Insurers Association of America ("PCIAA"; I served as Iowa Counsel to this trade group), the trade association of smaller stock property casualty insurers.

Specific duties as counsel at both the Professional Insurance Agents of Iowa (who sold, among other coverages, personal and commercial property casualty insurance) and the Iowa Association of Life Underwriters (life, health and annuity insurance agents) included in-depth familiarity with commercial property insurers, their agents and their claim settlement practices. Specific duties at the PCIAA included daily counsel to member insurers as to their claim settlement duties.

In sum, I know insurer claim settlement duties of insurers regardless of the venue.

Contact Bill Hager at 561-995-7429 or via email to discuss your case.