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An Audit: | |
Injured Patients and Families Compensation Fund |
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Office of the Commissioner of Insurance |
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March 2010 | |
Report Highlights | |
The Injured Patients and Families Compensation Fund provides
participating physicians and other health care providers in Wisconsin
with secondary medical malpractice insurance to cover claims that
exceed the coverage limits of their primary insurance. Statutes require
most health care providers that operate or have permanent practices in
Wisconsin to maintain primary malpractice coverage of $1.0 million for
each incident and
The Fund has paid more than
Statutes require the Legislative Audit Bureau to perform financial audits
of the Fund at least once every three years. Our audit report contains
our unqualified opinion on the Fund’s financial statements and related
notes as of and for the years ending
Financial Position
Since its creation in 1975, the
Fund has received more provider
assessments and investment income
than it has paid out in claims and
administrative expenses. As a result,
it accumulated However, the Fund’s financial position is also significantly affected by its loss liabilities, which are based on estimates of what it may be required to pay for malpractice incidents that have occurred but may not yet have been settled or even reported. Both the uncertainty and the long-term nature of medical malpractice claims make it difficult to predict the size and timing of claims that will be settled and paid from the Fund. The Board of Governors, which manages the Fund, relies on a consulting actuarial firm to estimate the Fund’s loss liabilities.
For several years, the Fund had
reported a positive financial
position because estimated loss
liabilities were less than the cash
and investments available to pay
them. However, its financial balance
has declined significantly over
the last two years. The net asset
balance declined
In 2007 Wisconsin
The transfer took place in two
stages:
The Wisconsin Medical Society
filed a lawsuit in
The Fund’s financial position also
has been affected by the recent
downturn and instability in the
economy and the investment markets.
The Fund incurred
The Fund has experienced a steady
increase in annual claim payments
over the last four years. The
fiscal year
In
At least part of the increase in claim
payments over the last four years can
be attributed to a 2005 Wisconsin
Supreme Court ruling that a
The Fund’s consulting actuary
projects deterioration in the Fund’s
financial position over the next several
years without fee increases. In
response, the Board increased rates
by
Actuarial Audits
Estimating the Fund’s loss liabilities is challenging because:
Estimates of the Fund’s loss liabilities have been regularly reduced over the last several years as claim experience was more favorable than expected. We recommended in past audits that the Fund obtain regular and comprehensive reviews of its actuaries’ methods and assumptions for estimating loss liabilities. Such actuarial reviews or audits are fairly common for critical and complex actuarial analyses, such as those completed for the Fund. Two actuarial audits completed Two actuarial audits completed by two different actuarial firms—the first in July 2005 and the second in September 2008—concluded that the Fund’s loss liabilities were reasonable, although conservative. Both firms also recommended improvements to the process for estimating the Fund’s loss liabilities. The 2005 actuarial audit recommended that the analysis of the consulting actuary include an explicit loss liability risk margin to represent the risk that actual losses could be higher than predicted, and consider a lower investment return assumption. In 2007, we recommended that the next actuarial audit again evaluate these areas and that the Board of Governors report the results of the audit to the Legislature. However, the 2008 actuarial audit did not evaluate the appropriateness of either the explicit loss liability risk margin or the investment return assumption.
The 2008 actuarial audit recommended
that the actuary use a
second method to estimate losses
for recent years and reevaluate the
effect on its analyses of a 1997
increase in the statutory threshold
for Fund coverage to
Provider System
As discussed in past audit reports, a continuing challenge for the Fund had been the decreasing effectiveness of an aging computer system that maintained the accounts of participating health care providers. The provider system, which was developed in the early 1990s, was not able to accommodate the increasing demands of the Fund’s operations.
In response to the critical nature
of the provider system and the
seriousness of noted concerns,
the Office of the Commissioner of
Insurance (OCI) began to develop
and implement a new provider
system in
The new system was implemented
in As part of our next audit of the Fund, we will assess whether the new provider system adequately addresses past concerns.
Recommendation
Our recommendation again addresses the need for the Fund’s Board of Governors to:
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