An Ounce of Prevention: What Employers Can Do to Keep Workers’ Compensation Costs Down

As a firm specializing in Workers’ Compensation defense, General Liability defense, and Employment and Labor Law defense, we have a bird’s eye view of the successful (and sometimes unsuccessful) practices of our clients. In this article, we offer preventative measures that can be utilized to minimize or mitigate workplace accidents and their associated monetary exposures.

As a general rule, any policy or procedure should be uniformly applied to all Employees, regardless of race, religion, gender, age, or any other protected factor. Failure to apply these provisions uniformly could result in violation of State, Federal, or Local law. As such, if you choose to adopt any of the following suggestions, it is imperative that they be applied without variation.

Perhaps the least expensive and most beneficial practice that a company can utilize is to conduct routine safety workshops. A safety workshop is an inexpensive method aimed at avoiding accidents. We recommend that you conduct safety workshops frequently, perhaps monthly, at which time you can review techniques for safe lifting, ergonomic workplace solutions, and applicable safety rules. To assist your supervisors and HR personnel, Setnor Byer Insurance & Risk, along with Kelley Kronenberg, can facilitate workers’ compensation workshops at your workplace that will specifically address your unique needs and will guide you toward implementing more aggressive and cost-effective practices that can prevent workplace accidents.

Often, injured workers are more apt to stay home if they perceive that the rewards for being out of work are potentially greater than for returning to work. In light of this trend, a useful suggestion for an employer is to establish a safety program. As a company, you may consider offering an incentive to Employees who are accident-free for a specified time period. This practice may also be used for Employees who have a perfect attendance record, thereby reducing frivolous time off for “sick days.” Feel free to contact Setnor Byer Insurance & Risk for additional support. Please note: To avoid disparate treatment or the appearance of impropriety, absences for workers’ compensation purposes, FMLA leave time, or leave provided to an Employee for accommodation of an ADA disability should not count against one’s attendance record in this incentive program.

Obtaining information (post-hiring) about an Employee’s medical history can also be quite useful. The names and contact information for a worker’s physicians can be obtained on your standard employment documents “to be used in the event of a medical emergency.” This information often provides valuable assistance should a workers’ compensation claim later be filed, as it is more likely that a pre-existing condition would have been revealed to a doctor prior to a work accident than after the work accident.

In this regard, we also encourage gathering information from Employees regarding pre-existing medical conditions. This information will be invaluable and may aid in the defense of a workers’ compensation claim, if provided on a timely basis, to the treating physician after an accident. Please be advised that the use of medical questionnaires is strictly governed by the Americans with Disability Act (ADA), and the failure to comply with the requirements of this law could create additional legal exposure for you as an employer.

Under the ADA, the types of questions asked of the Employee depends on the stage of the hiring process.

  • Stage One: Before a Conditional Job Offer is Made. The ADA permits you to show the prospective Employee a job description that describes the physical demands of the job, or to demonstrate the job and inquire whether the prospective Employee is physically able to perform the job function with or without an accommodation.
  • Stage Two: After the Job Offer but Before Employment Begins. The ADA permits the Employer to ask a prospective Employee to respond to a detailed medical questionnaire and to submit to a medical examination, if practical, as long as these are required of all Employees entering the job force within a particular job category.
  • Stage Three: After the Employee Has Begun Working. Among other things, the ADA allows employers to require a fitness-for-duty examination in situations in which the examination is job-related and consistent with business necessity.

The ADA is a complex set of laws-please seek legal advice prior to instituting procedures.

Obtaining information regarding the Employee’s physicians and prior medical care may prove beneficial should the Employee later have an accident. Thus, it is also imperative to know whether the Employee has sustained prior accidents and/or whether a prior workers’ compensation claim or lawsuit has been filed. To answer these questions, we recommend that an index search, background check, or a simple online search be conducted at the post-offer stage.

An index search typically will list any known accidents that the Claimant has had, including workers’ compensation claims and automobile/personal injury claims. The reports typically list parties with additional information regarding the claim, i.e. an Insurance Carrier, an Employer, or an insured individual. Often, we are able to subpoena records based upon the index search that greatly assist in limiting exposure. In fact, for some clients, we seek this information once an injured worker has an accident but before litigation has commenced. At an Employer’s request, we can open a “ghost file” and guide our clients from the sidelines in an effort to avoid unnecessary and costly litigation.

Consider the value of many of the public record search options that exist. A person’s name can be looked up on local civil and criminal case dockets, and much information can be garnered by looking at personal web pages such as flickr, myspace, and similar social networking sites. Small and seemingly insignificant details found today could save thousands of dollars should the Employee later file a claim seeking medical or indemnity benefits. In fact, in one case in which we served as defense counsel, the adjuster obtained pictures of a claimant riding and performing stunts on his motorcycle. The pictures were posted on the claimant’s myspace page and were taken after his alleged accident.

It is also useful to institute a daily or a weekly checkout system. You may wish to have Employees sign out on a daily basis and indicate whether they were in an accident, whether they witnessed an accident, or whether they were in need of medical treatment prior to or upon leaving. This is an excellent tool for defending against workers’ compensation claims that are reported late. It must be noted, however, that if an Employee feels coerced or threatened to document an accident, any defenses available will be undermined.

It is important to note that, in conjunction with a checkout system, you must designate an Employee to be responsible for reviewing these reports. If an Employee indicates an accident or injury on the report, such documentation will likely suffice as notice under the requirements of Florida Statute Section 440, even if the document has not been actually reviewed by a supervisor or another Employee of your company. In this regard, upon learning of an accident or injury, you must report this information to your Workers’ Compensation Carrier to avoid penalties for late reporting or exposure related to late provision of benefits.

It is strongly recommended that every employer establish a zero tolerance policy for violence, safety violations, and fraud. To complement this policy, we recommend that each Employee sign a form acknowledging that violence, safety violations, and fraud are grounds for immediate termination. Your safety documents should explain that a safety violation is considered a failure to comply with any company safety rules, established standards of safety for the industry, OSHA rules, or any rules promulgated by an applicable regulatory agency. For your protection, safety rules should also be set forth in your Employee Handbook, which should be adhered to and distributed uniformly.

It is also recommended that the Zero Tolerance Policy be posted in a place frequented by all Employees, such as a lunchroom or near the time clock. The policy may also be reiterated at staff meetings or in Company bulletins and newsletters.

Established in 1980, Kelley Kronenberg is one of the largest Insurance & Employer defense firms in the State of Florida. They have been a leader in Florida law since they began their practice and have maintained a strong presence in the legal profession since then. Kelley Kronenberg believes that their experience and stability serve as the basis for their firm’s success. In addition, they know that their high standards are constantly complemented by their long-standing philosophy that every attorney is trained with an eye toward cost-effectiveness on behalf of their clients, along with exemplary customer service.

® 2008, Kelley Kronenberg. Reprinted with permission.

Florida Supreme Court Ruling May Increase Workers’ Compensation Premiums

A recent decision by the Florida Supreme Court may soon have employers paying substantially more for workers’ compensation insurance. In Castellanos v. Next Door Company, the Court ruled that Florida’s mandatory workers’ compensation attorney fee schedule is unconstitutional. In response to this ruling, the National Council on Compensation Insurance (NCCI) proposed increasing Florida’s workers’ compensation rates by 17.1%.

Under Florida Statute 440.34, attorneys who successfully secure workers’ compensation benefits for injured clients may be awarded attorneys’ fees. However, any attorney fee award, which is based on the amount of workers’ compensation benefits secured, must equal:

  • 20 percent of the first $ 5,000;
  • 15 percent of the next $ 5,000;
  • 10 percent of any remaining benefits that will be provided during the first 10 years after the claim is filed; and
  • 5 percent of any benefits secured after 10 years.

In Castellanos, the Florida Supreme Court considered whether this mandatory fee schedule is constitutional.

Marvin Castellanos suffered an injury on the job. The workers’ compensation insurance company refused to authorize the medical treatment recommended by its own designated doctor and raised twelve affirmative defenses to avoid paying compensation. After a final hearing, the Judge of Compensation Claims (JCC) ruled entirely in Mr. Castellanos’ favor.

Mr. Castellanos’ attorney spent 107 hours working on the case and requested an award of attorneys’ fees calculated at $350 per hour. Despite finding this request to be reasonable and warranted, the JCC was required to follow Florida’s mandatory fee schedule. Based on the actual value of the benefits secured, Mr. Castellanos’ attorney was awarded fees in the amount of $164.54, or $1.53 per hour.

The Court noted that the mandatory fee schedule does not consider the reasonableness of a fee and does not permit the review of grossly inadequate or grossly excessive fees. “Without the ability of the attorney to present, and the JCC to determine, the reasonableness of the fee award and to deviate where necessary, the risk is too great that the fee award will be entirely arbitrary, unjust, and grossly inadequate.” Accordingly, the Court ruled that Section 440.34 is unconstitutional.

As a result, the statute’s immediate predecessor, which was construed to provide for a “reasonable” award of attorney’s fees, was essentially revived. Though the statutory fee schedule remains the starting point for calculating fees, claimants must now be allowed to present evidence to show that its application will result in an unreasonable fee.

Though the Court emphasized that its ruling does not mean that claimants’ attorneys will receive a windfall, insurance companies disagreed. On May 27, 2016, NCCI, which is a licensed rating organization authorized to submit workers’ compensation insurance rate filings on behalf of Florida insurance companies, submitted a proposed rate increase to the Office of Insurance Regulation (OIR).

According to NCCI, the first year impact of Castellanos will be a 15% increase in overall Florida workers compensation system costs. (The total proposed rate increase of 17.1% includes factors that are not related to Castellanos.) NCCI proposes applying the increased rates to new and renewal policies that are effective on or after August 1, 2016. NCCI also proposes applying the increased rates to all policies in effect on August 1, 2016 on a pro-rata basis through the remainder of the term of these policies.

If NCCI’s proposal is approved, Florida would have the highest workers’ compensation rates in the Southeast. The OIR plans to hold a public hearing regarding NCCI’s proposed rate increase in the coming months, so stay tuned.

Even if the OIR approves all or part of NCCI’s proposed rate increase, there are ways to lower workers’ compensation insurance costs, such as promoting employee safety and maintaining a safe work environment.

Please contact us if you would like more information about controlling workers’ compensation insurance costs.

Additional information is also available in our weekly Risk Management Newsletters.

Using the Benefits of Representations and Warranties Insurance When Buying or Selling a Business

Deals to buy or sell a business typically include statements of fact by the seller about the business. These representations and warranties are then combined with indemnification provisions to allocate risks and liabilities between the parties. Negotiating representations and warranties can be challenging, and deals often fall apart because the parties cannot reach an agreement. Representations and Warranties Insurance (RWI) can simplify negotiations and possibly save the deal.

RWI protects against unintentional and unknown breaches of a seller’s contractual representations and warranties. Though RWI is not a new insurance product, it’s increasingly being used by both buyers and sellers to shift liability to insurers for a fixed cost.

These policies cover many of a seller’s standard representations and warranties, such as statements about:

  • Capitalization and debt;
  • Accuracy of financial statements;
  • Title to real, personal and intellectual property;
  • Tax matters;
  • Accounts receivable/payable and inventory;
  • Employee benefits and compensation; and
  • Compliance with laws and regulations.

 

In the past, RWI was typically reserved for buyers, but today RWI is used by both buyers and sellers. A ‘buy-side’ policy covers a buyer’s losses, including defense costs, due to the seller’s breach of a representation or warranty. A ‘sell-side’ policy covers the seller for defense costs and losses resulting from claims made by the buyer that the seller breached a representation or warranty.

Sellers can use RWI to:

  • Reduce potential liability for future representation and warranty claims;
  • Lock in their return on investment;
  • Cleanly exit a business or industry;
  • Eliminate the need for purchase price escrows or holdbacks;
  • Retain, use or distribute all or most of the sale proceeds;
  • Protect passive sellers; or
  • Expedite a sale.

 

Buyers can use RWI to:

  • Ensure a source of recovery for the seller’s breach of representations and warranties;
  • Ease concerns created by a sellers’ poor financial condition or other practical considerations that can make it difficult to collect from the seller in the event of a breach, such as sellers that are numerous, geographically dispersed or difficult to locate;
  • Distinguish its bid and appear more attractive to a seller;
  • Provide additional time to detect and report problems by extending the duration of a seller’s representations and warranties; or
  • Protect relationships with sellers who may continue working with buyer after the sale as a key employee or business partner.

 

Unlike standard general liability and property insurance policies, RWI coverages and exclusions can be relatively complex and can also vary depending on the specific policy form and insurance company. You should consult a reputable insurance agent with experience handling RWI applications and policies.

Please contact us if you would like more information about obtaining Representations and Warranties Insurance coverage.

Additional information is also available in our weekly Risk Management Newsletters.

How Can Safety Reduce Workers’ Compensation Insurance Premiums?

Workers’ compensation insurance provides indemnity and medical benefits to employees injured on the job. Many states, including Florida, set the premiums for workers’ compensation insurance, so shopping around isn’t the way to save money. However, employers can reduce their workers’ compensation insurance premiums by maintaining a safe workplace

Insurance companies prefer safe workplaces because there are presumably fewer claims to pay. They encourage employers to maintain a safe workplace by using experience modification ratings to adjust premiums. Employers with fewer claims are rewarded with premium credits, and employers with more claims may face increased premiums.

The experience modification rating, or experience mod, is designed to tailor the final premium to an employer’s actual claims experience. An employer’s actual workers’ compensation claims experience, typically over a three year period, is compared to other employers operating in the same type of business with a similar number of employees.

If an employer’s claims experience is consistent with the industry average, the experience mod is 1.0, which when multiplied by the base premium, will not increase or decrease the premium. If the claims experience is 25% better than the industry average, the experience mod will be .75, which when multiplied by the base premium, will decrease the premium by 25%. Alternatively, if the claims experience is 25% worse, the experience mod will be 1.25, which will increase the premium by 25%.

The experience mod gives more weight to accident frequency than to accident severity. In other words, an employer with one loss totaling $100,000 will have a better experience mod than an employer with 10 losses totaling $100,000. Since any single injury could have astronomical costs, an employer with a higher frequency of small claims is considered a greater risk than an employer with a single, expensive claim.

Medical-only claims do impact the experience modification as much as indemnity claims, so employers are not necessarily penalized when they occur. However, the existence of open or unresolved claims can negatively impact the experience mod, so employers benefit from getting claims resolved and closed.

Insurers may offer dividend payments to employers with few or no claims. Dividends, which are generally reserved for the most attractive risks, are usually based on a sliding scale wherein the amount of the dividend decreases as the number of claims increases. Rather than focus on the most generous dividend percentage, employers should compare dividend percentages that comport with their specific claims history.

Employers can reduce their workers’ compensation insurance premiums by taking advantage of the experience modification rating system. Though it requires a commitment to workplace safety and loss control, the savings could be significant. Given the complexity, employers should work with an insurance agent who knows about the experience modification rating system and available dividend plans, and who can ensure claims are treated appropriately and resolved quickly.

If you would like more information about workers’ compensation insurance or how Setnor Byer Insurance & Risk can help control your workers’ compensation insurance costs, please contact us.

A Contract’s Fine Print: Find the Devil in the Details

Contracts are an essential part of doing business. Regardless of size or industry, contracts with customers, vendors, suppliers, service providers or independent contractors are an important part of a business’s operations. While good contracts can help manage risk and maintain good working relationships, bad contracts can be incredibly harmful. This is why every business must proceed cautiously when negotiating and signing contracts.

Ideally, an attorney will be consulted when negotiating or signing contracts. The reality, however, is that many businesses handle their own contracts. Though it may be easy for some to identify and understand a contract’s main provisions, like cost, volume, part numbers, etc., the devil is in the details, which, in the case of contracts, is the fine print.

Every provision in a contract has a purpose, including those found in the fine print. Despite being underemphasized, they are often important when defining a contractual relationship, particularly when things go wrong. The following provisions, for example, are not only commonly used, but commonly overlooked.

Forum (Jurisdiction) Selection: A contract may require that any lawsuits involving the contract be filed in a specific forum or jurisdiction (county, state, country). This may not be a problem if a business is located in the jurisdiction specified in the contract. However, it may be a huge problem if, for example, a Florida business is required to file a lawsuit in Alaska. Despite having the legal right to enforce the contract, the increased complexity and cost of filing a lawsuit in another jurisdiction makes it practically impossible for many businesses to do so, particularly when relatively small amounts of money are involved.

Choice of Law: Similar to a forum selection clause, a choice of law provision specifies which state’s law will be used to interpret and enforce the contract. These clauses can be significant because laws may vary from state to state. For example, one state may have more favorable consumer protection laws, while another makes it more difficult to recover damages. It is important to know if and how a choice of law provision may affect any contractual rights or remedies.

Integration (Merger) Clause: Contracts typically contain a provision stating that the contract represents the full and final agreement and supersedes any other agreements, oral or written. With an integration clause, any verbal or written conversations, brochures, promises, representations or statements that are not included in the contract are not part of the contract. This may become an issue when a business is not receiving what the salesperson promised before signing the contract. Expectations, obligations and requirements must be included in the contract to be enforceable under the contract.

Assignment: A contract may allow one or both parties to assign their rights, duties or obligations to a third party. This can create a problem if there is an expectation that a specific person or company will be performing under the contract. If, for example, a business wants only a specific vendor to do a job, the contract must state that the vendor cannot assign its obligations under the contract to someone else. Otherwise, a business may find that the person they contracted with isn’t the person they end up working with.

Evergreen Clause: Contracts are typically entered into for a specific period of time (term). A contract with an evergreen clause will automatically renew for a new term unless notice of termination is given by either party, usually within a specific period of time. For example, a one year contract will automatically renew for another year unless written notice of termination is given at least 60 days before the end of the yearly term. Businesses that fail to discover and comply with an evergreen clause may be stuck in a contract they no longer need or want.

Dispute Resolution: Contracts may require that disputes be resolved through arbitration rather than by filing a lawsuit. Depending on the nature of the contract, this requirement can significantly affect the resolution of disputes and the apportionment of damages.

Indemnification Clause: Indemnification clauses are used to allocate risk and responsibility among the parties to a contract by requiring one party to compensate the other for specific liabilities or losses arising out of the contract. Since these clauses commonly require a party to assume liability that would not otherwise exist, they must be reviewed carefully and understood completely. Indemnification clauses often end up being the most significant provision in a contract when something goes wrong.

Insurance Requirements: Many contracts include specific insurance requirements. For example, a contract may require a party to have general liability or workers’ compensation insurance, or it may require that one party be given Additional Insured status under the other party’s insurance policies. Contracts often require proof of insurance before work can begin or payment is made. It is important to identify and comply with any contractual insurance requirements.

Despite the benefits of using an attorney to negotiate and review contracts, particularly complex or high-value contracts, many businesses take a do-it-yourself approach. Nevertheless, given the increased risk of harm caused by bad contracts, businesses should never sign a contract without reading and understanding every provision, including those in fine print.

If you have any questions or would like to discuss how Setnor Byer Insurance & Risk can help identify and protect against various business risks, please contact us.

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Summary Plan Descriptions under ERISA

The Employee Retirement Income Security Act (ERISA) is a federal law that sets minimum standards for most voluntarily established employee pension and welfare plans in the private sector. To protect individuals in these plans, ERISA requires plan administrators, which are oftentimes the employers, to provide plan participants and their beneficiaries with a Summary Plan Description (SPD).

SPDs are used to give plan participants and beneficiaries important information about pension plans, like 401(k) and profit sharing plans, and welfare plans, like group health, disability and pre-paid legal plans. SPDs provide information about the plan, what benefits are available under the plan, the rights of participants and beneficiaries under the plan, and how the plan works.

SPDs must generally be given to each plan participant and each beneficiary receiving benefits under the plan within 90 days after first becoming covered by the plan. Under ERISA, SPDs must generally:

  • Identify the plan name, plan number and employer identification number (EIN)
  • Describe the type of plan (ex. 401(k), profit sharing, group health, disability)
  • Describe the type of plan administration
  • Provide contact information for the plan administrator and service of process
  • Describe the plan’s eligibility requirements
  • Describe circumstances which may result in disqualification, ineligibility, denial, loss, forfeiture, suspension or reduction of benefits
  • State the date of the plan’s fiscal year
  • Describe the procedures governing claims for benefits, applicable time limits and remedies if claims are denied
  • Describe provisions governing termination of the plan
  • A statement of rights available to plan participants under ERISA

SPDs for employee pension plans must include additional information, such as:

  • The plan’s normal retirement age
  • A description of benefits, eligibility, vesting and accrual
  • A statement about whether the plan is covered by termination insurance from the Pension Benefit Guaranty Corporation
  • Source of contributions to the plan and the methods used to calculate contributions amounts

Similarly, SPDs for employee welfare plans must also include additional information, such as information about:

  • Cost-sharing provisions, including costs of premiums, deductibles, coinsurance and copayment requirements
  • Annual or lifetime caps or limits on benefits
  • Coverage for preventive services
  • Coverage for drugs, medical tests, devices and procedures
  • The use of network providers, the composition of provider networks and whether, and under what circumstances, coverage is provided for out-of-network services
  • Conditions or limits on the selection of primary care providers or providers of specialty medical care
  • Conditions or limits applicable to obtaining emergency medical care
  • Preauthorization requirements or utilization review as a condition to obtaining a benefit or service

Since comprehension is the key, SPDs must follow strict style and formatting requirements. For example:

  • SPDs must be written in a manner calculated to be understood by the average plan participant
  • SPDs must be sufficiently comprehensive to apprise the plan’s participants and beneficiaries of their rights and obligations under the plan
  • SPDs must not be formatted in a way that misleads, misinforms or fails to inform participants and beneficiaries
  • Advantages and disadvantages of the plan must be presented without either exaggerating the benefits or minimizing the limitations
  • Exceptions, limitations, reductions, and restrictions of plan benefits cannot be minimized, rendered obscure or otherwise made to appear unimportant (style, caption, printing type and prominence must be the same as that used to describe plan benefits)

In fulfilling these requirements, plan administrators must consider the level of comprehension and education of typical participants in the plan and the complexity of the terms of the plan. In most cases, this will usually require limiting or eliminating technical jargon and long, complex sentences, and using clarifying examples, illustrations, clear cross references and a table of contents.

Unlike the general descriptions provided in this article, the SPD requirements are highly technical and very specific. To avoid violations, employers must confirm strict compliance with ERISA’s SPD requirement. If you have questions about your employee welfare plans, or if you would like to see how Setnor Byer Insurance & Risk can help, contact us.

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Loss of Business Income Caused by Civil Authority Action

Public safety concerns may prompt civil authorities to take action to protect people and property. For example, a governor can issue a mandatory hurricane evacuation, a mayor can close roads during inclement weather, the police can enforce curfews during riots, or a fire department can restrict access to a neighborhood during a gas leak. Though these actions may be good for public safety, they may be bad for business.

In some cases, a Business Interruption policy’s Civil Authority coverage may offset income losses suffered during a civil authority action. Business Interruption, also known as Business Income, is a type of commercial insurance that protects against loss of income when a covered loss causes a business to reduce or suspend its operations. Civil Authority coverage is an additional protection that may be included in a Business Interruption policy.

A typical Civil Authority clause states: We will pay for the actual loss of Business Income you sustain and necessary Extra Expense caused by action of civil authority that prohibits access to the described premises due to direct physical loss of or damage to property, other than at the described premises, caused by or resulting from any Covered Cause of Loss.

Under this framework, the Civil Authority provision will not provide coverage unless all four of the following conditions are met.

  • The loss of business income must be caused by the civil authority action. There must be a direct relation between a civil authority action and a loss of income.
  • The civil authority action must prohibit access to the insured business. Courts have held that access must be completely prohibited in order to satisfy this requirement. A civil authority action that makes travel to an insured’s business difficult or inconvenient is not enough to trigger Civil Authority coverage.
  • The civil authority action must be caused by direct physical loss of or damage to property away from the insured’s premises. Unlike Business Interruption coverage, which requires loss or damage to the insured’s property, Civil Authority coverage requires loss or damage to property somewhere else. For example, an explosion at a nearby warehouse causes the fire department to shut down the area surrounding an insured business for two weeks.
  • It’s worth noting that claims for Civil Authority coverage often fail to meet this requirement because the decision to take civil authority action is not caused by direct property damage, but by the desire to prevent it. Courts have denied coverage for losses caused by civil authority actions that were designed to prevent future damage rather than address existing property damage, such as pre-hurricane evacuation orders and curfews imposed to prevent looting and rioting. According to one court, Civil Authority coverage is designed to address situations involving civil authority action that is taken after damage occurs.
  • The loss or damage to property away from the insured’s premises must be caused by or result from a loss that is covered under the insured’s policy. A business without hurricane insurance, for example, would not be covered if a civil authority action was caused by hurricane wind damage.

Though many aspects of Civil Authority coverage are relatively standard, there are some variations among insurers and policy forms. For example, some policies provide that coverage will not begin until 24 hours after the civil authority action was taken, and others require 72 hours. The duration of Civil Authority coverage may also be different.

Given the complexity of Civil Authority coverage under a Business Interruption policy, an experienced and reputable insurance agent should be consulted to help identify needs and evaluate options.

If you have any questions or would like to speak with one of our Risk Management Professionals, please contact us.

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Florida’s New Data Breach Notice Law

Florida has a new law to combat the recent surge of data security breaches involving sensitive personal information. On July 1, 2014, Florida’s current data breach notification statute will be replaced by the Florida Information Protection Act of 2014 (Act). Though similar to Florida’s current statute, the Act makes some significant changes that businesses must incorporate into their data security practices and procedures.

Under the Act, sole proprietors, partnerships, corporations, trusts, estates, cooperatives, associations and other commercial entities that acquire, maintain, store or use personal information (Covered Entities) are required to take reasonable measures to protect and secure such personal information. The Act broadens the definition of Personal Information to include:

  • An individual’s first name or first initial and last name in combination with that individual’s social security number, driver license or identification card number, passport number, military identification number, or other similar number issued on a government document used to verify identity. (Broader)
  • Financial account, credit and debit card numbers, in combination with any security code, access code or password.
  • Information regarding an individual’s medical history, mental or physical condition, or medical treatment or diagnosis by a health care professional. (New)
  • An individual’s health insurance policy number or subscriber identification number and any unique identifier used by a health insurer to identify the individual. (New)
  • A user name or e-mail address, in combination with a password or security question and answer that would permit access to an online account. (New)

Like the current statute, Personal Information does not include information that is encrypted, secured or modified by any other method or technology that removes personally identifying elements or that otherwise renders the information unusable.

In the event of a breach, Covered Entities must follow one or more of the Act’s various notice requirements. The Act generally defines a breach as unauthorized access of electronic data containing personal information. Covered Entities must notify each individual in Florida whose Personal Information was, or is reasonably believed to have been, breached no later than 30 days after the Covered Entity determines that a breach occurred or has reason to believe a breach occurred. Under the current statute, Covered Entities had 45 days to provide notice.

This notice, which may be sent by mail or e-mail, must include:

  • The date, estimated date or estimated date range of the breach
  • A description of the Personal Information that was or may have been accessed during the breach
  • Contact information that individuals can use to inquire about the breach

If a Covered Entity is required to notify more than 1,000 individuals at a single time, the Covered Entity must also provide notice to all national consumer reporting agencies. If a breach affects 500 or more individuals in Florida, the Department of Legal Affairs must be notified no later than 30 days after the Covered Entity determines that a breach occurred or had reason to believe a breach occurred. This is a new notice requirement.

If a Covered Entity uses a third-party vendor to maintain, store or process Personal Information, then that third-party agent must notify the Covered Entity no later than 10 days after the third-party agent determines that a breach occurred or had reason to believe a breach occurred. Though a third-party agent may provide the required notices, the Covered Entity is ultimately responsible for compliance with the Act.

The Act also requires Covered Entities and their third-party agents to take all reasonable measures to dispose, or arrange for the disposal, of customer records containing Personal Information within its custody or control when they are no longer retained. Disposal shall involve shredding, erasing, or otherwise modifying the records to make Personal Information unreadable or undecipherable through any means.

Unlike the general descriptions provided in this article, the Act is highly technical and very specific. Though the Act does not create a private cause of action, civil penalties of up to $500,000 should be enough motivation for Covered Entities to learn more about Florida’s new law and ways to limit the new risks with insurance.

If you would like to learn more about insuring against data security breaches, contact us.

If you would like to learn more about preventing data security breaches, take our online course Information Risk Management: Strategies for Preventing and Mitigating Information Security Breaches.

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Are You Ready for the 2014 Hurricane Season?

For those living or working in the Atlantic hurricane region, June 1st rarely passes unnoticed. At Setnor Byer Insurance & Risk, we understand that preparing for hurricane season is rarely easy and often stressful. We also understand that a lack of awareness and preparation can lead to disaster, and that the best way to limit the risks posed by hurricanes is to take preventative steps.

The National Oceanic and Atmospheric Administration’s 2014 Atlantic Hurricane Outlook predicts a 50% chance of a below-normal season, a 40% chance of a near-normal season and only a 10% chance of an above-normal season. According to NOAA, the 2014 hurricane season will bring:

  • 8 – 13 Named Storms (winds of 39 mph or higher)
  • 3 – 6 Hurricanes (winds of 74 mph or higher)
  • 1 – 2 Major Hurricanes (winds of 111 mph or higher)

These numbers are near or below the 1981 to 2010 seasonal averages of 12 named storms, six hurricanes and three major hurricanes. “Though we expect El Niño to suppress the number of storms this season,” NOAA administrator, Dr. Kathryn Sullivan, reminds us that, “it’s important to remember it takes only one land falling storm to cause a disaster.”

The 2014 hurricane season will also see changes in the information provided by the National Hurricane Center, including:

  • A smaller tropical cyclone forecast cone
  • The addition of a Potential Storm Surge Flooding Map, which will highlight areas where storm surge inundation could occur and the height above ground level that the water could reach
  • The elimination of the Intensity Probability Table due to misleading estimates of landfall intensity and excessive reliance on these estimates by the public

Though different situations call for different measures, here are some tips that can help you weather a storm.

Before the Storm

  • Monitor the news to allow time to prepare.
  • Identify all tools and equipment that will be needed to secure property before a storm and limit the damage after the storm (flashlights, batteries, caulking, tarpaulins, sandbags, cutting and fastening equipment, etc.).
  • Clear drains and downspouts to minimize the risk of flooding.
  • Move items inside.
  • Unplug electrical equipment and move property away from windows.
  • Check and secure all documents and records.
  • Take or update photographs of real and personal property.
  • Gather insurance policies and agent/insurer contact information.

After the Storm

  • Only after it has been declared safe to do so, take reasonably necessary steps to protect against any further property damage.
  • Report fallen power lines to power company immediately—stay away from them!
  • Check exterior walls and roof for damage from wind, rain, flying objects and rising waters (flood insurance).
  • Check all interior perimeter walls, floors and roof for leaks and water damage.
  • Document all damage with photographs and video.
  • Prepare detailed damage reports.
  • Call your insurer or agent as soon as possible to report damage.

While preparing for Hurricane Season is never easy, our team of experienced and responsive professionals can work with you to make sure that your personal and business property are protected in the event of a hurricane. With over 30 years of experience dealing with tropical storms and hurricanes, Setnor Byer Insurance & Risk has a long history of helping our clients prepare before the storm and, more importantly, providing support through the process of rebuilding after the storm.

If you would like more information about protecting your personal and business property during the 2014 Hurricane Season, please contact us.

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The Affordable Care Act’s Summary of Benefits and Coverage

The complexity of group health insurance makes it difficult for employers to shop for health plans and for employees to choose among several employer-provided options. Unfortunately, helpful consumer information is not typically found in the patchwork of various non-uniform and intricate consumer disclosures, such as the Summary Plan Description required by ERISA. To help consumers make informed decisions about health care coverage, the Affordable Care Act created the Summary of Benefits and Coverage and Uniform Glossary requirement.

Under this requirement, insurers and employers are required to give group health plan participants and beneficiaries, which are generally employees and their dependents, a short, plain-language Summary of Benefits and Coverage (SBC). A Uniform Glossary of terms used in health coverage and medical care must also be made available to plan participants and beneficiaries.

Insurers must provide the SBC to employers:

  • Upon Application (no later than 7 business days following receipt of the application)
  • By 1st Day of Coverage (if any changes to the initial SBC were made)
  • Upon Renewal (if renewal is automatic, no later than 30 days before the new plan year; if renewal applications are required, no later than the date application materials are distributed)
  • Upon Request (no later than 7 business days following receipt the request)

Plan participants and beneficiaries must also receive the SBC:

  • Upon Application (at the same time written application materials are distributed)
  • By 1st Day of Coverage (if any changes to the initial SBC were made)
  • Upon Renewal (if renewal is automatic, no later than 30 days before the new plan year, or within 7 business days after the new policy is issued; if renewal applications are required, no later than the date applications are distributed to participants)
  • Upon Request (no later than 7 business days following receipt the request)

Though insurers and employers are both responsible for providing the SBC to plan participants and beneficiaries, only one SBC is required. Under the regulations, the obligation of one is satisfied if the other provides the required SBC in a timely manner. To avoid violations, employers must confirm, not assume, that the insurer is providing the required SBCs to plan participants and beneficiaries.

The SBC must include the following:

  • Uniform definitions of standard insurance and medical terms
  • Descriptions of coverage, including cost sharing, for each category of benefits
  • Exceptions, reductions and limitations of coverages
  • Cost-sharing provisions, including deductible, coinsurance and copayment obligations
  • Renewability and continuation of coverage
  • Coverage examples
  • A statement about whether the plan or coverage provides minimum essential coverage and whether the share of the total allowed costs meets applicable requirements
  • A statement that the SBC is only a summary of coverage
  • contact information (telephone number, Internet address) for asking questions or requesting copies of plan or policy documents
  • An Internet address (or similar contact information) for obtaining a list of network providers (for plans with one or more networks of providers)
  • An Internet address (or similar contact information) for obtaining coverage information (for plans that use a formulary for prescription drug coverage)

The SBC must also provide an Internet address and phone number that plan participants and beneficiaries can use to obtain the Uniform Glossary, which provides definitions for a number of health-coverage-related and medical terms. Insurers and employers must provide the Uniform Glossary, in either paper or electronic form, no later than 7 business days after receiving a request from a plan participant or beneficiary.

The SBC and Uniform Glossary requirements, which also apply to grandfathered plans, became effective on September 23, 2012. However, the administration extended various safe harbors and enforcement relief through the end of the second year of applicability, so penalties will not be imposed on those working diligently and in good faith to meet the requirements.

Unlike the general descriptions provided in this article, the regulations are highly technical and very specific. For example, the SBC cannot be more than 4 double-sided pages in length and cannot use print smaller than 12-point font. Paying attention to the details is critical. Since a willful failure to provide the required information can result in a $1,000 fine for each plan participant or beneficiary, employers cannot afford a casual approach to SBCs.

At Setnor Byer Insurance & Risk, we are committed to serving as a resource for Affordable Care Act compliance. If you have specific questions about the Act or if you are ready to take action and would like to see how Setnor Byer Insurance & Risk can help, contact us.

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