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Q&A: Tim Over, Sedgwick Claims Management Services Inc.

Posted On: Oct. 21, 2015 12:00 AM CST

Tim Over, Chicago-based senior vice president of specialty operations at Sedgwick Claims Management Services Inc., says health care organizations are retaining more risk and making greater use of enterprise risk management. In an interview with Business Insurance Staff Reporter Donna Mahoney, he also said the industry has an ongoing hunt for qualified staff. Edited excerpts follow.

Q: What new trends are you seeing?

A: One of the trends that we continue to see in health care organizations is the acceptance of more risk, with employer practice liability continuing to move into higher retentions.

Of course privacy and security remain the No. 1 growth area in the risk management challenge in health care. I think the market has reacted quickly in what we see as a great amount of uncertainty as far as the correct path to take to address the means to reduce exposures and prevent the losses in both cyber and privacy. I think that if you would probably ask 10 risk managers, “What is your biggest concern?” aside from the obvious of keeping their patients healthy, this would be it.

Slips and falls continue to be major issues. People who aren't monitored fall out of bed or go to the bathroom and slip. That is followed by the traditional misdiagnosis, as well as those relating to inadequate procedures. I think due to so much technology in the industry now, you have physicians and health care providers that aren't adequately trained on new equipment.

Q: What employer issues do you see on the horizon?

A: It's always going to be staffing, staffing, staffing, most definitely.

There is a shortage, and the shortage is going to be even greater. Nothing surprising there — we have an aging workforce in health care whether it be claims specialists or claims adjusters, risk people, patient safety and risk management people, and defense attorneys. The aging workforce is not being replenished at a rate that I think is necessary to continue to be successful.

These positions can't be filled with someone who only has a year or two of experience. There is too much risk for reputation in health professions.

Q: What's your outlook for the next several years?

A: We are seeing a huge amount of surplus in the elder care industry, where every carrier that we talk to is contemplating or wants to get into the elder care space, which is a little bit shocking (considering) how difficult that space is. So that trend … in the bigger picture as it relates to the insurance industry is definitely not going away.

Q: What innovative approaches would you like to see?

A: I do feel like that the health care industry is moving more into accepting enterprise risk management. This may be more due to necessity rather than innovation … Health care to me is unlike other operations in this country. It is very unique in terms of the exposures. You have everything from occupational disease exposure on your work comp side to your traditional chronic and lifting injuries to medical malpractice, reputational risk as it relates to the providing of health care coverage, and services to patients.

Because of economic challenges and pressures, we are seeing more and more people who had been worker compensation risk managers now trying to learn the risk involved in health care, hence the obvious need for the training and education and understanding of what ERM is all about — I think in health care more so than in any other industry.

I feel the big challenge is what looms ahead in security and technology. Reliable research now says health care organizations are definitely underfunded — and underprotected — as far as how easily systems can be breached. It’s a very scary thought that really needs to be addressed by the industry and, if not, the government, because the government had a hand in how we are changing health care delivery. Protecting those resources might have to be a combined effort somehow, because I do believe health care has a very vulnerable system in how easily their networks can be breached.