Archives

The Social Costs of Choice, Free Market Ideology and the Empirical Consequences of the 401(k) Plan Large Menu Defense

Mercer Bullard

Volume 20

Issue 2

PUBLISHED

Spring 2014

Abstract

This article explores the recent “hidden-fee” litigation trend that has consumed the 401(k) world and how recent decisions by these courts will likely result in reduced wealth for workers. The author challenges the “large menu defense” espoused by the Third, Seventh, and Eighth Circuit Courts of Appeals as not fitting within the intent of ERISA’s “safe harbor.” In addition, the author questions the logic of these decisions by suggesting that courts are evaluating employers’ legal responsibilities using free-market ideology rather than the fiduciary duties prescribed by ERISA, and questions the belief that “large menu” pension benefit plans are wealth-maximizing.

Overlooked and Underused: Clinical Practice Guidelines and Malpractice Liability for Independent Physicians

Ronen Avraham

Volume 20

Issue 2

PUBLISHED

Spring 2014

Abstract

This paper discusses how the use of Clinical Practice Guidelines (CPGs) can improve the quality and delivery of healthcare in America. The author states that with the passage of the Patient Protection and Affordable Care Act of 2010, the American healthcare system is in need of realignment, specifically challenging the established norms for promulgating CPGs. The article explores the legal evolution of CPGs and new legal avenues for their promulgation by examining their history and purpose. The author concludes by identifying three accountability models and arguing in favor of a private competitive regime for CPGs.

Risk Classification’s Big Data (R)evolution

Rick Swedloff

Volume 21

Issue 1

PUBLISHED

Fall 2014

Abstract

Insurers can no longer ignore the promise that the algorithms driving big data will offer greater predictive accuracy than traditional statistical analysis alone. Big data represents a natural evolutionary advancement of insurers trying to price their products to increase profits, mitigate additional moral hazard, and better combat adverse selection. But these big data promises are not free. Using big data could lead to inefficient social and private investments, undermine important risk-spreading goals of insurance, and invade policyholder privacy. These dangers are present in any change to risk classification, but using algorithms to classify risk by parsing new and complex data sets raises two additional, unique problems. First, this machine-driven classification may yield unexpected correlations with risk that unintentionally burden suspect or vulnerable groups with higher prices. The higher rates may not reinforce negative stereotypes or cause dignitary harms, because the algorithms obscure who is being charged more for coverage and for what reason. Nonetheless, concerns may arise regarding which groups are burdened by having to pay more for coverage. Second, big data raises novel privacy concerns: insurers classifying risk with big data will harvest and use personal information indirectly, without asking policyholders for permission, potentially causing privacy invasions unanticipated by current regulatory regimes. Further, the predictive power of big data may allow insurers to determine personally identifiable information about policyholders without asking them directly.

Information & Equilibrium in Insurance Markets with Big Data

Peter Siegelman

Volume 21

Issue 1

PUBLISHED

Fall 2014

Abstract

Asymmetric information makes the behavior of insurance markets very difficult to predict. But this Article argues that the increasing use of Big Data by insurers will not result in forecasts of loss that are so accurate that they eliminate uncertainty, and with it, the possibility of insurance. Big Data techniques might lead to a “flip” in informational asymmetry, resulting in a situation in which insurers know more about their customers than the latter know about themselves, but the effects of such a development could actually be benign. Finally, the Article considers the potential for Big (or at least More) Data to create new markets for spreading risks that are currently uninsurable.

Medical Big Data and Big Data Quality Problems

Sharona Hoffman

Volume 21

Issue 1

PUBLISHED

Fall 2014

Abstract

Medical big data has generated much excitement in recent years and for good reason. It can be an invaluable resource for researchers in general and insurers in particular. This Article, however, argues that users of medical big data must proceed with caution and recognize the data’s considerable limitations and shortcomings, including data errors, missing information, lack of standardization, record fragmentation, software problems, and other flaws. This Article analyzes a variety of data quality problems and then formulates recommendations to address these deficiencies, including data audits, workforce and technical solutions, and regulatory approaches.

Payment Protection Insurance (PPI) Misselling: Some Lessons From the UK

Andromachi Georgosouli

Volume 21

Issue 1

PUBLISHED

Fall 2014

Abstract

The misselling of Payment Protection Insurance (“PPI”) is a longstanding problem in the UK. The Treating Customers Fairly (“TCF”) initiative was introduced to tackle this problem but, despite its sophisticated inception, its effectiveness has been limited. This Article canvasses the main features of TCF as a management-based approach to regulation and highlights its initial appeal. Against this backdrop, it draws on recent UK experience with recurring instances of PPI misselling to explain the principal causes of its shortcomings in the retail financial sector. It argues that the perceived failure of this regulatory approach may be attributed to three factors: (i) the rulification of TCF; (ii) several shortcomings of the existing data resource management; and (iii) the absence of a system of credible deterrence to support the Financial Conduct Authority’s attempts to be proactive and infuse cultural change at the regulated firm level. The Article concludes with a summary of key lessons that may be drawn from the UK experience.

Big Data and Insurance Symposium

George Jepsen

Volume 21

Issue 1

PUBLISHED

Fall 2014

Abstract

This Article reproduces the keynote address delivered by Connecticut Attorney General George Jepsen at the University of Connecticut School of Law’s Spring 2014 Big Data and Insurance Symposium. In his address, Attorney General Jepsen describes the opportunities and challenges associated with the use of big data technologies. He stresses the need to consider personal privacy concerns at every step of the data collection and analysis processes. Moreover, he argues that self-policing is not enough and that it is vital for the government to play a role in defining and enforcing individual privacy protections. Attorney General Jepsen concludes by calling for regulators and industry to remember that they share the common goal of achieving an effective balance between protecting personal privacy and promoting the use of big data to create new business opportunities and more efficient service delivery.

Fortuity Victims and the Compensation Gap: Re-Envisioning Liability Insurance Coverage for Intentional and Criminal Conduct

Erik S. Knutsen

Volume 21

Issue 1

PUBLISHED

Fall 2014

Abstract

Insurance is based on the notion that only uncertain, or fortuitous, losses are insurable. There are systemic problems, however, with the consistency in which fortuity clauses are applied in the liability insurance context. Differing interpretive approaches and litigation distortions include the use of at least three interpretive perspectives and two substantive requirements to interpret the intentional act fortuity clause, and four interpretive perspectives to interpret the criminal act fortuity clause. These problems stem from the tension between the two purposes of liability insurance (wealth protection and victim compensation) coupled with a move from explanatory rhetoric about fortuity to explanatory rhetoric about morality. This Article outlines the importance of balancing that tension and examines the problematic effects of these two ubiquitous fortuity clauses that remove coverage for policyholders and simultaneously deny access to compensatory funds for injured victims. The Article argues that intentional and criminal act fortuity clauses need to be more consistently interpreted to avoid a host of inefficient distortion effects that result from the introduction of moral concerns, and it concludes by offering possible solutions for redress for those accident victims who would still be left—though more predictably—in the liability insurance compensation gap.

Towards a European Supervisory Authority

Javier Vercher-Moll

Volume 21

Issue 1

PUBLISHED

Fall 2014

Abstract

Regulation (EU) No. 1094/2010, which established a European Insurance and Occupational Pensions Authority, may involve a major change to the management and supervision of private insurance in Spain and in the European Union. This Article analyzes the evolution from the original Insurance Committee, which had only advisory functions, to this new Authority, which has been given decision-making functions in addition to its advisory role. The Article concludes by suggesting that, in the future, this new Authority will be the sole supervisory body operating in all Member States, demonstrating a progression toward a new conception of supervision and regulation of insurance—or perhaps another step toward Community-wide integration.

The Harmonization of European Contract Law: The Case of Insurance Contracts

Juan Bataller Grau

Volume 21

Issue 1

PUBLISHED

Fall 2014

Abstract

The harmonization of European Contract Law for consumers and businesses continues to progress; however, without some standardization of the insurance contract, it will be difficult to achieve a true single market. This Article chronicles the European Union’s activities toward this goal, including the role of the Principles of European Insurance Contract Law, which provides a set of model rules for European legislators. The Article also analyzes (i) the appropriate legal nature of the instrument of European Contract Law; (ii) the scope of that legal instrument (for example, whether it should cover both cross-border and domestic contracts, and whether it should include contracts between businesses and consumers or only those between businesses); and (iii) the most appropriate scope to answer the needs to be served. The Article argues for the use of optional instruments as a key step toward a harmonized system and suggests that the best way forward is to construct a regulatory system whose ultimate objective is to be globally applicable. Lastly, the Article concludes that the law of insurance contracts is a constituent part of contract law and that, as such, the best legislative practice for the regulation of insurance contracts is to restrict its scope to those issues that differentiate insurance from the general theory of obligation and contract.