Coordination of Benefits

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Coordination of benefits cases most often call for insurance expertise as to, among other things, custom and practice as to the following matters: (i) coordination of benefits in connection with health insurance, regardless of how defined, including benefits under auto and workers’ compensation policies by way of further example, in the marketplace and the rules and regulations and rules and construction that come to bear on such matters and (ii) the obligations of the parties as to such matters.[1]

Coordination of benefits Expertise:  State Insurance Regulatory.  My expertise as to these matters can be found as follows. I am a former:

  • Commissioner of Insurance (Iowa); [2]
  • First Deputy Commissioner of Insurance (IA);
  • Administrative Law Judge, (ALJ), f/k/a “Hearing Officer,” to the Department of Insurance (IA);
  • Assistant Attorney General assigned on a full-time basis to the Department of Insurance;

In those capacities, on a regular basis, I had full regulatory oversight and responsibility for and I dealt directly with (i) coordination of benefits in connection with health insurance, regardless of how health insurance is defined, as well as auto and workers’ compensation insurance by way of further example, in the marketplace and the rules and regulations and rules and construction that come to bear on such matters and (ii) the obligations of the parties as to such matters.

Coordination of benefits Expertise:  National Insurance Regulatory.  My expertise as to these matters can be found as follows. I am a former:

  • Member of the National Association of Insurance Commissioners (“NAIC”) and Member of its Executive Committee.
  • Elected Member of the Executive Committee of the NAIC;
  • Authority over the Property Casualty Committee (i.e., the “B” Committee of the NAIC), the Health Insurance Committee, including coordination of benefits issues;

In those capacities, on a regular basis, I had full regulatory oversight and responsibility for and I dealt directly with (i) coordination of benefits in connection with health insurance, regardless of how health insurance is defined, in the marketplace and the rules and regulations and rules and construction that come to bear on such matters and (ii) the obligations of the parties as to such matters.

Coordination of benefits Expertise: Legislative.[3]  In addition to my regulatory background at the state and national levels, I have served or am serving in the following capacities, each of which included working knowledge of and interaction with (i) coordination of benefits in connection with health insurance, regardless of how health insurance is defined, in the marketplace and the rules and regulations and rules and construction that come to bear on such matters and (ii) the obligations of the parties as to such matters.

  • Legal Counsel to the Iowa House of Representatives;
  • Chief of Staff, f/k/a Administrative Assistant, at the U.S. House of Representatives;
  • Elected Member of the Florida House of Representatives (currently – I was first elected in 2010 and re-elected in 2012 and 2014 and 2016) where I serve or have served for each of those years in one of the following insurance capacities: as a Member and Vice Chairman of the Insurance Committee (among other committees) or its upstream parent, the Commerce Committee, which collectively have legislative oversight over all statutory elements of insurance in the state (as administered by the Florida Office of Insurance Regulation) including those relating to coordination of benefits; and
  • In addition, I have sat as Vice Chairman of the Civil Justice Subcommittee of the Florida House, which has responsibilities as to Florida laws that establish (among other things) liability.

Coordination of benefits Expertise: Industry. In addition to my state and national insurance regulatory background and my legislative background as to coordination of benefits matters, I have served or am serving in the following capacities, each of which included regular and significant working knowledge of and interaction with (i) coordination of benefits in connection with health insurance, regardless of how health insurance is defined, in the marketplace and the rules and regulations and rules and construction that come to bear on such matters and (ii) the obligations of the parties as to such matters.

  • President and Chief Executive Officer of the National Council on Compensation Insurance (NCCI), a major U.S. property casualty insurance company doing business throughout the United States;
  • This position included the obligation to promulgate and gain approval of some $100 billion of property casualty premium, during the time I served as CEO. That is to say, I had responsibility, utilizing actuarial methodology, to accurate price and gained Insurance Commissioner approval throughout the U.S. of some $100 billion of property casualty premium; work that parallels pricing in this case;
  • Workers’ compensation insurance, the primary focus of NCCI, raises coordination of benefits issues on a daily basis, i.e., injuries that arise and whether those injuries are covered by other health insurance coverage and/or auto or workers’ compensation coverage.

Coordination of benefits Expertise:  Actuarial. In addition to my regulatory background at both the state and national levels and my legislative background and my industry background as to coordination of benefits matters, I have served or am serving in the following capacities, each of which included regular and significant working knowledge of and interaction with (i) coordination of benefits in connection with health insurance, regardless of how health insurance is defined, in the marketplace and the rules and regulations and rules and construction that come to bear on such matters and (ii) the obligations of the parties as to such matters.

  • American Academy of Actuaries, Washington D.C. I served as general counsel and chief lobbyist to the Academy, whose role to actuaries is parallel to that of the AMA to physicians and the ABA to lawyers.  Academy members determine pricing for coordination of benefits matters.
  • Actuarial Standards Board (ASB). I served as well as counsel to the Interim Actuarial Standards Board, the forerunner to ASB.  ASB, which is to the actuarial profession as to what the Financial Accounting Standards Board (FASB) is to the accounting profession, promulgates and enforces professional standards upon the work product of actuaries.  Those standards include rate making standards that apply to the pricing of the coordination of benefits matters.
  • Commissioner of Insurance; First Deputy Commissioner of Insurance. In these two positions, in which I served for a total of six years, I had full regulatory responsibility over the pricing considerations of all coordination of benefits.
  • As CEO of NCCI, during my tenure, as stated above, I had responsibility for the formation of some $100 billion of premium, which was accomplished through a team of some 150 actuarial professionals; I fully cognizant of the process by which premiums are formulated and the factors that go into premium formulation.

Coordination of benefits Expertise:  Insurance and Reinsurance Arbitrator. In addition to my regulatory and industry background and my legislative background as to coordination of benefits matters, I have served or am serving in the following arbitration capacities, each of which included knowledge of and interaction with (i) coordination of benefits in connection with health insurance, regardless of how health insurance is defined, in the marketplace and the rules and regulations and rules and construction that come to bear on such matters and (ii) the obligations of the parties as to such matters.

  • Nationally certified Insurance Arbitrator (ARIAS-US), where I sit as an arbitrator on disputes between (among others) health insurers (broadly defined) and other insurers;
  • Nationally certified Reinsurance Arbitrator (ARIAS-US), where I sit as an arbitrator on disputes between (among others) health insurers (including COB issues) and their reinsurers;

Coordination of benefits Expertise: Insurance Lawyer.  In addition to my state and national insurance regulatory background and my legislative background and my industry background and my actuarial background and my arbitration background as to coordination of benefits matters, I have served or am serving in the following legal capacities, each of which included knowledge of and interaction with (i) coordination of benefits in connection with health insurance, regardless of how health insurance is defined, in the marketplace and the rules and regulations and rules and construction that come to bear on such matters and (ii) the obligations of the parties as to such matters.

  • As stated, I am an insurance lawyer admitted to practice, all by examination in Iowa, Illinois[4] and Florida;
  • Admitted to practice before the U.S. Supreme Court;
  • Legal Counsel to the Iowa House of Representatives;
  • Iowa Assistant Attorney General;
  • Counsel to the Professional Insurance Agents Association (IA);
  • Counsel of the Iowa Association of Life Underwriters, whose members sold life and health insurance and whose members dealt regularly with COB issues;
  • Counsel to the Property Casualty Insurance Association of America (PCIAA), an insurer trade organization;
  • Insurance lawyer with the firm of Hager and Schachterle;
  • General Counsel to the American Academy of Actuaries (see above), Washington D.C., whose members determine premium impact of coordination of benefits; and
  • Florida insurance lawyer (Hager Law Firm), currently in private practice.

Coordination of benefits Expertise: Formal Education as a Basis for this Expertise.  In addition to the above expertise, my background is bolstered by the following degrees and certifications:

  • Bachelor’s degree in Mathematics (secondary mathematics education);
  • Master’s degree in Education (specifically educational psychology);
  • Juris Doctorate degree from the University of Illinois;

Coordination of benefits Expertise: Licenses and Certifications as a Basis for this Expertise.  In addition to the above expertise, my background is bolstered by the following licenses and certifications:

  • Licensed to practice law in the states listed above, all by examination;
  • Admitted to practice before the U.S. Supreme Court;
  • Certified Insurance Arbitrator by the ARIAS-US.
  • Certified Reinsurance Arbitrator by the ARIAS-US.

Coordination of benefits: Other Expertise. The above expertise should be read together with the balance of my background as set forth:

Contact Bill Hager at 561-306-5072 or via email to discuss your case.

Footnotes

[1] I do not enter legal opinions in an expert report.  My opinions are based on custom and practice in the industry that come to bear on a matter.  At the same time, insurance is one of the most highly regulated areas of commerce in the U.S. and as such, it is not possible to review an insurer’s handling of matters without reference to rules and regulations that apply to the insurer and the transactions at issue.

[2] Because the insurance business is conducted across state lines and more specifically, nationally, the Insurance Codes and Department of Insurance rules and regulations (by whatever name) are substantially similar state over state.  This is so because much of insurance regulation, though conducted primarily at the state level, is a result of adoption of national model statutes and administrative regulations as promulgated by the nation’s Insurance Commissioners through the National Association of Insurance Commissioners so as to assure uniformity state over state.  Furthermore, state by state regulation of coordination of benefits, by whatever formal name, is substantially similar to the equivalent of which I enforced in Iowa.  My point is that my regulatory experience is substantially similar to parallel experience and positions in the 50 states (e.g., the state’s Commissioner of Insurance). This experience is bolstered by my 42 years of direct insurance experience, including that of being a CEO of a major U.S. property casualty insurer doing business throughout much of the U.S. and my seven years of experience as an elected Member of the Florida House of Representatives where I serve or have served as a (1) Member of and (2) Vice Chairman of the Insurance Committee as well as (3) its parent, the Commerce Committee, with statutory oversight over coordination of benefits.

[3] My background at both the U.S. Congress and with the Florida House of Representatives could be construed as regulatory in nature but I include it here under my non-regulatory experience because it seems to be a better fit.  In addition to these legislative positions, I have also served as Deputy Mayor and Member of the City Council of the City of Boca Raton, Florida, where I headed up the Council’s insurance oversight function.

[4] This license is currently in inactive status at my request and is eligible for reactivation at any time upon my request.  This is so because I am in good standing with the Illinois Bar.