Outsiders are often taken aback at the vitriolic nature of insurance debates. There are a few reasons for this.
First, as insurers know well, an allegation of claims-handling misconduct represents more than a simple contract dispute. It’s illegal. To knowingly deny or underpay a legitimate claim is the equivalent of a bank refusing a withdrawal: it better have a good reason. Hence, even a single allegation is a problem.
Second, insurance is a backwater in the mainstream business press, and its actors are thus unused to serious, arms-length scrutiny. The reasons for this are many, but as this post reminds me, insurance is a difficult beat that requires immersion in an ocean of obscure ratios and facts and long, grinding arguments over their meaning with an adroit research operation headed by Hartwig, a Ph.D. Suffice it to say that from a career point of view, most business reporters find the beat unrewarding.
Third, despite this seeming surfeit of information, insurance lacks a useful metric for—of all things—claims-handling performance. While deeply ironic to anyone who has ever hoisted a phonebook-sized volume of, say, Best’s Aggregates and Averages, the industry fact bible, it is nonetheless true that no aggregate figures exist to document the amount policyholders actually demanded from insurers, a key figure that could then be compared to how much insurers chose to pay. There is no “insurer payout ratio,” which I like to call the “Starkman ratio.” Imagine a discussion about a mutual fund without knowing its past performance.
As a result, arguments over insurer claims performance tend to take on almost a theological tone. News organizations point to harrowing individual cases, statistics that show insurers pay little in claims as percentage of premiums, (as low as 55 percent or 65 percent depending on who’s counting) and the industry’s wild profitability as proof that insurers routinely take advantage of policyholders in their moment of need.
Insurers say the sob-story anecdotes are either anomalous or bogus altogether, that the use of certain ratios out of context is irresponsible and misleading, that policyholders are more likely to game the system than insurers, and that critics do not understand or fail to note the industry’s (supposedly) wildly cyclical nature.
Into this howling maw dropped “The Insurance Hoax.” The two-part, 11,000-word series, written by David Dietz and Darrell Preston, compiles court records, whistleblower accounts, internal documents won in discovery, and financial figures to describe profiteering on a vast scale, driven in part by a claims-handling system engineered by consultants to lowball legitimate claims or deny them outright.
The series (I refer to a series but the main disputes center around the first day’s story on insurer claims conduct; the second day deals with regulatory failings) won recognition in other journalism awards contests as well as high praise from me).
The series’s strength, in my view, is precisely its remorseless assembly of a factual record. It includes testimony from former adjusters (“It’s tough to look at people and know you’re lying”) engineers (“we were working for insurance companies and they wanted certain results”), policyholders (“If they defrauded me, how many more are they going to defraud”), and cases in which juries found insurers had acted in deliberate bad faith. The series makes use of blockbuster discovery material, particularly a sequence of slides prepared by McKinsey & Co. for Allstate Insurance Co. in the early 1990s that characterized claims as a “zero-sum game” and recommended insurers adopt a combative posture toward customers who wanted more than insurers offered.
But where I saw strength, critics saw weakness. They believed the story lacked balance and unfairly used anecdotes, even if true, to tar an entire industry.
Sam Friedman, a Deadline Club member and editor-in-chief of National Underwriter, a trade publication, in an online column called the series a “hatchet job” and asked readers to write to the Deadline Club to deny Bloomberg a prize.
In one of his posts, Friedman said he anticipated being dismissed as an “industry shill” but that he found the piece so one-sided and misleading that even its nomination was a travesty.
In an email to me, Friedman says that if he influenced the club, “so be it.”
This particular article, “The Insurance Hoax,” was a hatchet job, plain and simple. Not only did it have numerous factual errors, but the publication did not grant industry representatives a fair opportunity to refute the central assertions in the article, nor did they publish any corrections or even a letter offering the other side, to my knowledge.