Beyond Structured Settlements

Annual Industry Reports

Historical Structured Settlement Industry Reports (2006-2015) which previously appeared on the structured settlement wiki.

Annual Structured Settlement Industry Reports:

• 2015
• Part 1 - Market Metrics
• Part 2 - Issues and Developments
• 2014
• Part 1 - Primary market
• Part 2 - Secondary market
• Part 3 - Settlement planning
• Part 4 - ELNY and Reliance
• 2013
• Part 1 - Primary market
• Part 2 - Settlement planning
• Part 3 - Secondary market
• Part 4 - ELNY and Reliance
• 2012
• Part 1 - Primary market
• Part 2 - Settlement planning
• Part 3 - Secondary market
• Part 4 - Executive Life of New York
• 2011
• Part 1 - Executive Life of New York
• Part 2 - Strategic perspective
• Part 3 - Industry developments
• 2010
• Part 1 - Looking forward
• Part 2 - Year in review
• 2009
• Part 1 - Looking forward
• Part 2 -Strategic analysis
• Part 3 - Mid-year update
• Part 4 - Year in review
• 2008
• Part 1 - Historical perspective
• Part 2 - Industry conferences
• Part 3 - Industry analysis
• 2007
• 2006

Past Reporting - ASNP, NAELA, NAMSAP

Historical S2KM reporting about conferences sponsored by ASNP, NAELA and NAMSAP which previously appeared on the structured settlement wiki.

ASNP

• 2007 ASNP Annual Meeting
• 2008 ASNP Annual Meeting
• 2009 ASNP Annual Meeting
• 2010 ASNP Annual Meeting
• 2011 ASNP Annual Meeting
• 2012 ASNP Annual Meeting
• 2013 ASNP Annual Meeting
• 2014 ASNP Annual Meeting
• 2015 ASNP Annual Meeting
• 2016 ASNP Annual Meeting
• 2017 ASNP Annual Meeting

NAELA

• 2006 NAELA Advanced Institute
• 2007 Advanced Elder Law Institute
• 2008 NAELA Symposium
• Part 1
• Part 2
• 2010 NAELA Special Needs Summit
• Part 1 - summary
• Part 2 - analysis
• Part 3 - web 2.0 webinar
• 2012 Ohio NAELA Unprogram
• 2013 NAELA Annual Meeting
• 2014 NAELA Annual Conference
• 2016 NAELA Summit

NAMSAP

• 2005 NAMSAP Annual Meeting
• 2008 NAMSAP Annual Meeting
• 2010 NAMSAP Annual Meeting
• 2014 NAMSAP Regional Meeting
• Part 1
• Part 2
• 2014 NAMSAP Annual Meeting
• 2015 NAMSAP Winter Regional Conference
• 2015 NAMSAP Annual Conference

Past Reporting - NASP

Historical S2KM reporting about National Association of Settlement Purchaser (NASP) Conferences which previously appeared on the structured settlement wiki.

NASP

• 2006 NASP Conference
• Part 1 - speakers and topics
• Part 2 - structured settlement market overview and how the primary market views factoring
• 2007 NASP Conference
• Part 1 - educational program wiki
• Part 2 - primary market transfer issues
• Part 3 - primary market panel discussion
• 2008 NASP Conference
• Part 1 - primary market panel discussion questions
• Part 2 - primary market panel participants
• Part 3 - how to improve and grow the market
• 2009 NASP Conference
• Part 1 - a listing of educational issues and participants;
• Part 2 - a summary of the educational discussions;
• Part 3 - a closer look at the strategic discussions.
• 2010 NASP Conference
• Part 1 - industry issues
• Part 2 - discussion topics
• Part 3 - "protect and preserve" vs. "improve and grow"
• Part 4 - strategic questions
• 2011 NASP Conference
• Part 1 - summary
• Part 2 - criticism of S2KM reporting
• 2012 NASP Conference
• Part 1 - speakers and topics
• Part 2 - industry issues
• Part 3 - presentation summaries
• 2013 NASP Conference
• Part 1 - speakers and topics
• Part 2 - discussion of issues
• 2014 NASP Conference
• 2015 NASP Conference

Past Reporting - SSP

Historical S2KM Reporting about Society of Settlement Planner (SSP) Conferences which previously appeared on the structured settlement wiki.

SSP

• 2005 SSP Annual Meeting
• 2006 SSP Annual Meeting
• 2007 SSP Annual Meeting
• 2007 SSP Fall Meeting
• 2008 SSP Annual Meeting - 2 posts
• 2009 SSP Annual Meeting
• 2010 SSP Annual Meeting
• Part 1 - topics and speakers.
• Part 2 - S2KM pre-meeting strategic perspective.
• Part 3 - leadership changes.
• Part 4 - awards and recognition.
• Part 5 - NSSTA's lobbying strategy.
• Part 6 - tax panels part 1 - introducing the participants.
• Part 7 - tax panels part 2 - discussing the issues.
• Part 8 - Dan Clark and NSSTA ethics.
• Part 9 - industry leadership and issues.
• 2011 SSP Annual Meeting
• Part 1 - speakers and topics
• Part 2 - strategic perspective
• Part 3 - tax issues
• Part 4 - transition to settlement planning
• Part 5 - transition to multiple, more flexible products
• Part 6 - transition to the internet
• Part 7 - insurer insolvencies and guaranty associations
• 2012 SSP Annual Meeting
• Part 1
• Part 2
• 2013 SSP Annual Meeting
• 2014 SSP Annual Conference
• Part 1
• Part 2
• 2015 SSP Annual Conference
• Part 1
• Part 2
• 2016 SSP Annual Conference
• SSP 2017 Annual Conference

Past Reporting - NSSTA

Historical S2KM Reporting about National Structured Settlement Trade Association (NSSTA) Conferences which previously appeared on the structured settlement wiki.

NSSTA Conferences

• 2005 NSSTA Winter Meeting
• 2005 NSSTA Annual Meeting - 2 posts
• 2005 NSSTA Fall Meeting
• 2006 NSSTA Winter Meeting
• 2006 NSSTA Annual Meeting - 2 posts
• 2006 NSSTA Fall Meeting
• 2007 NSSTA Winter Meeting - 3 posts
• 2007 NSSTA Fall Meeting
• 2008 NSSTA Winter Meeting
• 2008 NSSTA Annual Meeting - 2 posts
• 2008 NSSTA Fall Meeting - 3 posts
• 2009 NSSTA Winter Meeting
• 2009 NSSTA Annual Meeting
• 2009 NSSTA Fall Meeting
• 2010 NSSTA Annual Meeting
• Part 1 - topics and speakers.
• Part 2 - S2KM pre-meeting strategic perspective.
• Part 3 - leadership changes.
• Part 4 - awards and recognition.
• Part 5 - NSSTA's lobbying strategy.
• Part 6 - tax panels part 1 - introducing the participants.
• Part 7 - tax panels part 2 - discussing the issues.
• Part 8 - Dan Clark and NSSTA ethics.
• Part 9 - industry leadership and issues.
• 2010 NSSTA Fall Meeting
• Part 1 - industry issues
• Part 2 - discussion topics
• Part 3 - "protect and preserve" vs. "improve and grow"
• Part 4 - strategic questions
• 2011 NSSTA Annual Meeting
• Part 1 - speakers and topics
• Part 2 - strategic perspective
• Part 3 - tax issues
• Part 4 - transition to settlement planning
• Part 5 - transition to multiple, more flexible products
• Part 6 - transition to the internet
• Part 7 - insurer insolvencies and guaranty associations
• 2011 NSSTA Fall Meeting
• 2014 NSSTA Fall Educational Conference
• 2015 NSSTA Structures 202 Conference
• 2015 NSSTA Annual Meeting
• 2015 NSSTA Fall Conference
• 2016 NSSTA Structures 202 Conference
• 2016 NSSTA Annual Conference

AAJ 2014 Annual Meeting

Increasing use of structured settlements by plaintiff attorneys and their clients requires a more "unified marketing strategy" by stakeholders according to multiple brokers who exhibited at the recent American Association for Justice (AAJ) 2014 Annual Conference in Baltimore.

Seven primary market brokers, one structured settlement annuity provider and two secondary market companies were prominent among the 141 sponsors and exhibitors at the AAJ conference which also included as exhibitors multiple companies offering lien resolution, MSA compliance, life care planning, legal finance and economic consulting services.

Other marketing advice from AAJ structured settlement exhibitors offering insights into how to grow the primary market:

• "Our industry needs more educational marketing.
• "The secondary market has stolen our brand and we need to get it back.
• "Many plaintiff attorneys do not discuss structured settlements with their clients.
• "We need to educate plaintiff attorneys to stop thinking of their clients as 'investors' and to recognize the benefits of structured settlements.
• "Most plaintiff structured settlement brokers are too narrowly focused on product.
• "Future success requires 'full service' not just annuities - financial planning, settlement trusts and lien resolution.
• "Plaintiff brokers need to be more holistic and offer plaintiff attorneys a 'brain trust' of strategic relationships.
• Offering non-structured settlement products and services to plaintiff attorneys 'has taken the lid off' our company's original view of the size of the settlement planning market."

Underperforming Market

Many industry observers view the United States structured settlement primary market as a strategic, underperforming segment of the larger personal injury settlement planning market:

• Primary market structured settlement annuity premium increased approximately seven (7%) percent to $5.134,380,855 in 2013 (compared with $4,819,124,617 in 2012) according to industry estimates compiled by Melissa Evola.
• Total structured settlement cases in 2013 also increased to 26,533 from 25,038 a year earlier for an average case premium of $193,495.
• The 2013 annual premium totals, however, fell substantially short of the historic 12 month industry high ($6,226,578,725 in 2008) after consistently averaging close to $6 billion annually from 2001-2007.
• Evola's 2013 compilation also reported an annual decrease in annuity premium for non-qualified structured settlements (from $170.1 million in 2012 to $164.9 million in 2013) despite earlier industry projections of a large and growing market .
• Non-qualified structured settlements represent transfers of periodic payment obligations that do not meet the requirements of IRC sections 130 and 104(a)(1) or (2) including deferred plaintiff attorney fees.
• Independent industry sources further report a substantial shift in recent structured settlement premium with increasing sales to fund workers compensation Medicare set-aside arrangements (WCMSAs).

For comparison, based upon Towers Watson's 2011 Annual Study of "United States Tort Cost Trends" and utilizing Tower Watson's 2002 "best estimate" of payout percentages, S2KM estimates that more than $170 billion of United States tort costs annually have represented payments to injury victims and their attorneys. The Towers Watson study excluded: 1) no-fault auto insurance; 2) property coverages; 3) workers compensation; 4) certain extraordinary (one time) costs.

Structured Settlement Marketing - to Defendant Insurers

Although primary market structured settlement participants have successfully marketed their products and services to defendants and their insurers, they have been less successful marketing to plaintiff attorneys and their clients.

A 2011 National Litigation Management study, commissioned by the Council on Litigation Management (CLM) and conducted by Revere Advisory, identified structured settlement as the "most penetrated external initiative" among 30 litigation-related service areas analyzed based upon interviews with leading litigation management executives.

The success of structured settlement marketing to defense insurers was further evidenced by a 2014 study of "how senior claims executives perceive the value of structured settlements and the value that structured settlement consultants bring to the table" commissioned by the National Structured Settlement Trade Association (NSSTA) and conducted by CLM Advisors. Among the findings - ninety percent of respondents:

• Indicated their organizations maintain a “formalized structured settlement program”; and
• Reported their belief that, when a structured settlement consultant is involved, claims are “more likely to settle.”

 Structured Settlement Marketing - to Plaintiff Attorneys and Injury Victims

Earlier in 2006 (before interest rates crashed), NSSTA sponsored a survey of plaintiff attorneys involved in structured settlements (43 telephone surveys) and structured settlement recipients (1275 telephone and Internet surveys) titled: "A Study of the Structured Settlement Process Conducted on behalf of the National Structured Settlement Trade Association." Among the results, as reported at NSSTA's 2007 Winter and Annual meetings:

• Structured settlement recipients:
  • 65% said they had not heard about structured settlements prior to settlement.
  • Most were uncertain whether a structured settlement consultant was involved with their case.
  • 34% recalled receiving educational information while 75% of this 34% said the information was helpful.
  • 66% first learned about structured settlements from their trial attorney.
  • 75% said they were very happy their settlement included structured settlement annuities.
  • 75% said they would recommend a structured settlement.
• Plaintiff attorneys involved in structured settlements:
  • 95% said they are proponents of structured settlements.
  • 70% said they retain a structured settlement consultant at least for some cases.
  • When asked: "Whom do you prefer to use for purposes of financial planning for your clients?", the attorneys responded:
    • 30% - Trust company/department.
    • 28% - Financial planner.
    • 23% - Structured settlement consultant.
    • 19% - No response.

Based upon the 2006 survey results, however, NSSTA estimated only 7% of personal injury settlements between $75,000 and $200,000 include structured settlements; and only 30% of personal injury settlements above $1 million include structured settlements.

Growing the Primary Market

What explains the apparent differences in marketing success by the primary structured settlement industry to 1) defense insurers; and 2) plaintiff attorneys and personal injury victims?

Several explanations are possible. They deserve and require greater analysis by the primary market. As one example, while defense brokers essentially sell a singular structured settlement product to their clients without direct competition from other financial/insurance product providers, plaintiff brokers must compete with settlement trustees, financial planners and other providers of asset management services.

As a result, plaintiff structured settlement brokers increasingly are evolving into alternative business models that offer structured settlement annuities as one of multiple products and more fully participate in a larger, more complex business (personal injury settlement planning) than structured settlement defense brokers.

Growing the primary structured settlement market therefore requires its proponents to ask themselves these fundamental questions: "what business are we in?", or, stated somewhat differently, "in what markets do we, or should we, participate?"

Failure to sufficiently address these issues has perpetuated both "inside-the-box" strategic thinking and traditional marketing strategies responsible, in part, for recent sales declines of the structured settlement product - a product which offers multiple, unique advantages and benefits from public policy endorsement, multiple tax preferences and statutory consumer protection.

The Settlement Planning Market

Despite an abundance of related professional associations, participants and conferences, as well as legislative and regulatory developments, personal injury settlement planning remains an evolving concept and market with competing definitions, standards and business models and many unanswered questions.

Many recent and continuing legislative and regulatory developments impact personal injury settlement planning, including:

• Affordable Care Act
• CMS WCMSA Reference Guide
• The SMART Act
• Defense of Marriage Act
• Dodd-Frank Uniform Fiduciary Standard
• Bipartisan Budget Act of 2013

Settlement planners consist, or represent a blend, of several professionals in addition to traditional personal injury litigation participants. These professionals include: tax attorneys, special needs attorneys, trustees, financial planners, structured settlement specialists, life care planners, economists, Medicare set-aside (MSA) specialists and damage allocators.

Professional associations, in addition to AAJ, whose members engage in settlement planning include: NSSTA, SSP, NAELA, ASNP, SNA, NAMSAP, AANLCP - and NASP assuming the definition of settlement planning includes adjustments during an injury victim's lifetime.

To grow the primary market, structured settlement proponents must learn how to better market the benefits and applications of structured settlements to plaintiff attorneys and these other professional groups and associations in the context of evolving settlement planning marketing, work product, business standards and educational priorities.

This educational and marketing challenge requires all structured settlement participants to fundamentally "re-think" structured settlements and their own roles in personal injury settlement planning. One result should be consideration of a more unified marketing strategy to plaintiff attorneys and their clients among heretofore competing professional associations such as NSSTA, SSP and NASP.

Conversations with structured settlement exhibitors at the AAJ 2014 Annual Meeting indicate some primary market plaintiff brokers already understand this message and are transitioning their business models accordingly.

For S2KM's report about the AAJ 2014 Winter Meeting, see this prior blog post.

ACA and Future Medical Expenses - 3

Is the Affordable Care Act (ACA) good or bad for structured settlements? What impact will it have on settlement planning in personal injury cases?

Four years following the ACA's enactment, and two years after the U.S. Supreme Court upheld its primary provisions as constitutional, including the individual mandate and elimination of pre-existing condition restrictions which became effective nationally on January 1, 2014, those questions not only lack definitive unanswers - they have not yet been comprehensively addressed in any public forum.

One primary related issue is what impact the ACA will have upon future medical expenses in personal injury cases. The answer depends, however, not only on the terms and conditions of the ACA, but also on how the ACA interacts with other related laws and legal developments such as Medicaid (including the Bipartisan Budget Act of 2013), Medicare (including WCMSAs , liability MSAs and MMSEA) as well as state specific collateral source and subrogation rules.

To provide a point of reference for future S2KM reporting about the legal interplay involving the ACA, personal injury cases and structured settlements, S2KM is publishing a series of blog posts looking generally at the "ACA and Future Medical Expenses":

• Part 1 reviews an article written by Seth Cardeli, titled "Thwart the Assault on Future Medical Expenses", which appeared in the May 2014 issue of the American Association for Justice (AAJ) Trial Magazine.
• Part 2 summarizes ACA-related analysis by speakers at professional conferences S2KM has previously attended and includes excerpts from prior S2KM reviews of those conferences.
• Part 3 (this post) summarizes similar ACA analysis from articles and papers previously reviewed by S2KM and also features excerpts from those reviews.

Authors of Articles and Papers Addressing ACA Issues

NAELA Journal

NAELA devoted the entire Spring 2011 edition of its "NAELA Journal" to health care reform generally and the ACA more specifically. Available to NAELA members only, this NAELA analysis featured a detailed introduction by NAELA Journal's then Editor-in-Chief William J. Brisk plus eight articles and a supplement of online resources.

• Brisk's introduction addressed why health care reform is "too significant to ignore" and highlighted its most important features. His analysis identified what the ACA actually does and does not accomplish and emphasized the important roles Medicare, Medicaid, private health insurance companies and health maintenance organizations will play in implementing health care reform.
• Additional NAELA Journal topics and authors:
  • Health Care Changes: Challenges to Medicare - Vicki Gottlich, Patricia Nemore, and Alfred J. Chiplin Jr.;
  • The New CLASS Act - Morris Klein;
  • Nursing Home Regulations - Charles Perez Golbert;
  • Health Care Reform’s Impact on Small Businesses and Individuals - Ben A. Neiburger;
  • Health Care Reform and End-of-Life Issues - Fay Blix;
  • The Affordable Care Act’s Changes to Medicaid’s Coverage for Long-Term Services and Supports - Gene Coffey;
  • Health Insurance Reforms: Once In a Lifetime Change or Same as It Ever Was? - Lucinda E. Jesson;
  • Medicaid Expansion Under the 2010 Health Care Reform Legislation: The Continuing Evolution of Medicaid’s Central Role in American Health Care - Renée M. Landers and Patrick A. Leeman;
  • Online Resources Available to Supplement Health Care Reform Discussion - prepared by Claire DeMarco.

Alfred Chiplin, Jr. and Bethany Lilly

In addition to the Spring 2011 edition of the NAELA Journal, NAELA awarded its 2014 John Regan Writing Award, honoring the authors of the best article published in the "NAELA Journal" during the past year, to Alfred Chiplin, Jr. and Bethany Lilly, for their 2013 article titled "Medicare’s Future: Letting the Affordable Care Act Work, While Learning From the Past" analyzing various ACA cost-saving components on Medicare.

Chiplin and Lilly begin their article with an extensive review of the historical debate concerning public health insurance in the United States including a summary of key components of the current Medicare system and current concerns about Medicare solvency.

This historical debate not only defines the current structure of the Medicare program but also, according to Chiplin and Lilly, "the on-going debate ... about the necessary elements of a comprehensive program, including health care financing and accessing the quality of necessary services."

Chiplin and Lilly provide statistical evidence to highlight the negative impact of rising health care costs on Medicare and Medicare beneficiaries as well as the United States economy. Following their historical and statistical summaries, Chiplin and Lilly address the central issue in their article: "how will the ACA reduce health care costs?"

The ACA's cost-containment programs, according to Chiplin and Lilly, are based upon the theory that costs can be reduced by demanding a higher quality of care and greater efficiency from providers and allowing providers to share in the savings. ACA programs the authors highlight include:

• Patient-Centered Medical Home
• Medicare Shared Savings Program
• The Independent Payment Advisory Board
• Quality Review Mechanisms.

Chiplin and Lilly view ACA as "a vast experiment in paying for high-quality health care while preserving the Medicare program and expanding access to health care for other population segments." Implementation will be a tough, but doable challenge so long as we "let the tools of the ACA work".

Among the implementation challenges: the "fiscal cliff", insurance exchanges, and integrating services for "dual-eligibles". Overtime, the authors believe the ACA's spending and cost-containment provisions should at least slow the health care spending curve.

Seth Cardeli

The impact of the ACA on future medical expenses, perhaps the most important ACA-related issue for personal injury stakeholders, including settlement planners and structured settlement professionals, was addressed most recently by plaintiff attorney Seth Cardeli in an article  featured in the May 2014 issue of the AAJ's Trial Magazine, and summarized by S2KM, titled "Thwart the Assault on Future Medical Expenses".

In his article, Cardeli labels as "speculative and misleading" current defense efforts to convince courts the ACA changed how courts should calculate future medical expenses thereby transforming the ACA into "the latest tort 'reform' vehicle." Their efforts should fail, Cardeli maintains, because they wrongly attempt to circumvent states' collateral source and subrogation rules.

Cardeli's article cites cases from several state venues where courts have rejected defendants' attempts to limit plaintiff evidence of future medical expenses or to present their own evidence of ACA-related health care coverage. He urges plaintiff attorneys to aggressively oppose all related motions in limine by arguing:

• The effect of the ACA on a plaintiff's recoverable future medical expenses is speculative.
• Evidence of collateral sources is prejudicial to personal injury plaintiffs.
• Tortfeasors should bear the risk that any future medical expenses will not be covered by medical insurance.

Joshua Congdon-Hohman and Victor Matheson

A 2012 research paper titled "Potential Effects of the Affordable Care Act on the Award of Life Care Expenses" and written by economists Joshua Congdon-Hohman and Victor Matheson provides a notable counter argument to Seth Cardeli's Trial Magazine article. Contrary to Caredi, these economists maintain: "the ACA may well have indirectly resulted in a great deal of tort reform" and, as a result, "awards in personal injury cases could be dramatically impacted".

Their argument:

• When the ACA is fully implemented in 2014, all individuals will be required to purchase health insurance or pay a penalty.
• The ACA provides insurance premium subsidies for low income individuals who do not receive health insurance through the government or from a family member’s employer.
• The ACA prevents price discrimination based on health status and bans annual and lifetime expenditure limits.
• Most individuals will pay the same cost for health insurance before and after an accident.
• The legal maximum out-of-pocket expenses allowable under the ACA is $5,950 per year.
• The goal of tort law is to make the plaintiff "whole".
• Funding of health care through private insurance is a valid methodology for accomplishing this goal now that the ACA makes those markets available to injury victims.
• Therefore, the ACA:
  • Should simplify and reduce calculations of future medical damages;
  • By limiting those costs to "[health insurance] premiums and out-of-pocket limits less any pre-injury expected medical costs and penalties if uninsured."

Similar to Cardeli, and significantly, Congdon-Hohman and Matheson acknowledge a collateral source issue is "at play" and "remains of significant importance". Unlike Cardeli, however, they argue "there is reason to believe the ACA changes the underlying reason of excluding collateral source compensation from inclusion in tort cases."

More specifically, Congdon-Hohman and Matheson maintain: "removing existing health insurance coverage from exclusion under the collateral source rule would not significantly affect health insurance coverage rates reducing the economic rationale for having a collateral source rule in place for health insurance."

As a related result of the ACA, Congdon-Hohman and Matheson believe life care planners will play an increasingly important role in personal injury damage analysis.

• Prior to the ACA, life care planners were tasked with identifying medical and living expenses not otherwise required "but for" the accident.
• Under the ACA, the authors maintain life care planners must also identify which health care and living expenses will, and will not, be covered by the ACA's minimum insurance requirements. And, despite certain minimum federal standards, these requirements may also differ by state.

Rebecca Levenson and Ann Levin

During 2013, S2KM reviewed two law review articles which address whether and how the ACA will impact the collateral source rule (CSR):

• Rebecca Levenson (Levenson), "Allocating the Costs of Harm to Whom They are Due: Modifying the Collateral Source Rule after Health Care Reform" (Levenson article), University of Pennsylvania Law Review, Volume 160.
• Ann S. Levin (Levin), "The Fate of the Collateral Source Rule After Health Care Reform" (Levin article), UCLA Law Review, Volume 60.

Although every state and federal court recognizes the CSR in some form, many states have limited its scope or abolished it completely as a result of tort reform. Plaintiffs in different states and/or different courts therefore can receive widely different damage awards for the same injury because different courts measure medical costs differently.

Levenson and Levin each summarize traditional arguments favoring and opposing the common law CSR. However, neither Levin nor Levenson:

• Directly address whether and/or how the CSR will affect calculations of future medical damages, as opposed to past medical damages.
• Discuss how the ACA's restrictions against pre-existing conditions impact calculations of medical damages.

CSR proponents emphasize the deterrence theory of tort law which seeks to punish tortfeasors and deter them from injuring future plaintiffs:

• Defendants should not be unjustly enriched if a plaintiff purchases medical insurance.
• The CSR incentivizes plaintiffs to purchase medical insurance.
• Collateral sources never fully reimburse plaintiffs.
• Subrogation rights reduce and/or prevent double recoveries.
• The CSR promotes independence of jury determinations.

CSR opponents argue the purpose of tort law is compensation for harm not deterrence. They criticize the CSR for:

• Allowing some plaintiffs to recover twice.
• Generating different damage awards for the same injuries in different cases.
• Adding an unjustified element of punitive damages.
• Inflating awards.
• Encouraging claimants to go to trial.

Both Levenson and Levin agree the ACA's individual mandate weakens the traditional common law CSR rationale and that medical damages should now be calculated differently. However they do so for different reasons and propose different solutions.

• Levin - Levin's primary argument for changing the traditional common law CSR is that it calculates medical damages based on medical provider bills instead of the lower negotiated reimbursement rate paid by most health insurers. To achieve fairness and accuracy post-ACA, Levin maintains courts should calculate medical damages using: 1) the negotiated reimbursement rate; and 2) a portion of the premium payments the plaintiff has paid for medical insurance.
• Levenson - The purpose of changing the CSR after the ACA, according to Levenson, should be to align the CSR's outcome with the underlying goal of the individual mandate. Whether and what changes will occur, however, will vary from jurisdiction to jurisdiction depending upon a number of factors which Levenson identifies including the current status of the CSR in a particular state. Levenson insists any changes in the CSR must account for the different groups affected: insured plaintiffs, willfully uninsured plaintiffs and exempt plaintiffs.

Conclusion

For personal injury and settlement planning professionals who are attempting to understand how the ACA impacts personal injury damage analysis, future medical expenses, negotiation strategy, work product, and funding options, this S2KM blog series hopefully captures some of the complexity of the related laws, issues and perspectives and encourages continuing and more comprehensive analysis.

The impact of the ACA on structured settlements, and settlement planning more generally, depends not only upon the terms and conditions of the ACA itself, but also upon the new and evolving legal construct for future medical expenses in personal injury cases created by the interaction of the ACA with these related laws and legal developments.

For S2KM's continuing coverage of ACA-related issues, see the structured settlement wiki.

Primary Market Update

Structured settlement primary market annuity sales increased approximately seven (7%) percent to $5.134,380,855 in 2013 (compared with $4,819,124,617 in 2012) according to industry estimates compiled and recently published by Melissa Evola. Total 2013 structured settlement cases also increased to 26,533 from 25,038 a year earlier for an average case premium of $193,495.

The 2013 annual premium totals, however, still fall substantially short of the historic 12 month industry high ($6,226,578,725 in 2008) after consistently averaging close to $6 billion annually from 2001-2007.

Adding these 2013 results to historic U.S. structured settlement totals, S2KM estimates the following primary market metrics from 1976 thru 2013:

• Total annuity premium: $139.5 billion.
• Total structured settlement cases: 802,000
• Average annuity premium: $174,000.

Berkshire Hathaway, which re-entered the structured settlement market in 2011 following a multi-year hiatus, assumed primary market leadership by generating $1,424,306,831 of structured settlement annuity premium (28% of the industry total) during 2013.

With announced departures of Allstate and John Hancock during 2013, the U.S. structured settlement market now consists of eight annuity providers. 2013 sales results for other structured settlement annuity providers (per Evola's report) plus the rounded increase (+) or decrease (-) from comparable 2012 results:

• Pacific Life - $848,725,000 (+ $11.7 million)
• MetLife - $726,000,000 (+ $62 million)
• Amgen/USL - $587,367,753 (+ $61.3 million)
• Liberty Life - $558,106,000 (+ $147.3 million)
• Prudential Life - $548,700,000 (- $86.7 million)
• New York Life - $275,253,601 (- $47.5 million)
• Mutual of Omaha - $86,598,027 (+ $29 million)

Evola's 2013 compilation also reports an annual decrease in annuity premium for non-qualified structured settlement assignments (from $170.1 million in 2012 to $164.9 million in 2013) as a portion of the overall structured settlement numbers.

Non-qualified assignments represent transfers of periodic payment obligations that do not meet the requirements of IRC sections 130 and 104(a)(1) or (2) including deferred attorney fees. Despite earlier industry projections of a large and growing market, only two structured settlement annuity providers (AmGen and Liberty) currently offer non-qualified assignments.

Independent industry sources further report a substantial shift in recent structured settlement premium with increasing sales to fund workers compensation Medicare set-aside arrangements (WCMSAs). For S2KM's most recent analysis of structured settlements and WCMSAs, see this prior blog post.

Many industry observers continue to view the United States structured settlement primary market as a strategic, underperforming segment of the larger personal injury settlement planning market. S2KM looked at some of the related issues in a three-part 2013 blog series titled "Growing the Primary Market"

• Part 1 - Daniel Durbin's survey of primary market leaders.
• Part 2 - NSSTA and NASP 2013 Fall Conferences.
• Part 3 - NSSTA's marketing boot camp - "What business are we in?"

Sanders v. JGWPT Holdings

A new Class Action lawsuit has escalated the legal battle in Illinois concerning the impact of "anti-assignment" restrictions on transfers of structured settlement payment rights.

In the lawsuit, Plaintiff Valerio Sanders seeks to represent the following class: "Those individuals who sold part or all of their structured settlement annuities under the provisions of the Illinois [Structured] Settlement Protection Act, where the original structured settlement contract contained a valid and enforceable anti-assignment clause."

Filed February 11, 2014 in the Twentieth Judicial Circuit Court St. Clair County, Illinois, the Class Action Complaint accuses Defendants JGWPT Holdings, Inc., several affiliate companies including J.G. Wentworth and Peachtree Settlement Funding (JGWPT entities), and Illinois attorney Brian P. Mack of violating the Illinois Consumer Fraud and Deceptive Business Practice Act (ICFA).

The Class Action Complaint alleges "the JGWPT entities ... intentionally failed to inform potential sellers that a valid and enforceable anti-assignment clause prohibited the sale of deferred payment annuities because the JGWPT entity intended to defraud the seller and the Illinois courts by filing false pleadings under the Illinois [Structured] Settlement Protection Act in order to obtain large amounts of deferred cash payments for discounted present lump sum amounts and reap the tax benefits of the same in violation of federal law."

Section 2 of the ICFA provides in part: "[U]nfair or deceptive acts or practices, including but not limited to the use or employment of any deception, fraud, false pretense, false promise, misrepresentation, or the concealment, suppression of omission of any material fact .... in the conduct of any trade or commerce are hereby declared unlawful ..."

The Class Action Complaint alleges Defendants used their advertising and solicitations to cause Plaintiff Valerio Sanders and other sellers to believe they could obtain cash for their structured settlement payment rights, "but intentionally failed to inform the potential sellers that if there was a valid and enforceable anti-assignment clause in the settlement contract, no lump sum payment could be received in exchange for the seller assignment the deferred payments because any such "order" issued by an Illinois court approving such a transfer would be void. Moreover, the legal proceeding would violate federal law."

The Class Action Complaint further alleges:

• When a potential seller had a valid and enforceable anti-assignment clause, the JGWPT entities would routinely hire Brian P. Mack to obtain a "Qualified Order" pursuant to the Illinois Structured Settlement Protection Act so that the deferred payments could be purchased at a deeply discounted rate, and without any tax consequences.
• Attorney Mack "would personally counsel the seller ... on how to create Illinois jurisdiction and venue, how to find a 'friendly court', how to avoid appearing in court, how to obtain the services of 'independent counsel', ..... or inform them they could waive the right, and how to finalize the details to obtain the lump sum payment."
• Valerio Sanders' "Settlement Agreement and Release" included an anti-assignment clause which provided: "The periodic payments to be received by the Payee(s) pursuant to paragraphs 2B are not subject in any manner to anticipation, alienation, sale or transfer, assignment, pledge or encumbrance by Payee(s)."
• The Petition filed by Mack claimed: "That the assignment does not contravene any federal or state statutes or the order of any court or responsible administrative authority."
• "Mack knew that this allegation was false and misleading as Plaintiff's settlement contract had a valid and enforceable anti-assignment clause."
• "....[F]ailure to inform Plaintiff that the order obtained from the court was in violation of Illinois and federal law was fraudulent and a material omission under the ICFA and a violation of the ICFA."
• In a subsequent transfer involving Plaintiff Sanders and the Defendants, Mack's representation that jurisdiction and venue were proper was also a fraudulent misrepresentation because the action was filed in Madison County and the Plaintiff never lived in Madison County and the underlying action did not accrue there.
• Plaintiff and putative class members relied on materials misrepresentations made by JGWPT entities and attorney Mack and sold payment rights under circumstances where the sale was contrary to Illinois law as well as the laws of various other states, "thus rendering the alleged transfers void, and were a fraud on the Internal Revenue Service of the United States government under 26 U.S. Code section 130."

The Complaint requests the court for an Order awarding both Plaintiff Sanders and the Class compensatory and punitive damages plus injunctive relief against Defendants to prohibit them from continuing to defraud the Class and the courts of Illinois plus attorney fees and costs.

Brenston Case

To support their legal arguments in the Sanders Class Action, Plaintiff attorneys: Cates Mahoney, LLC and Brad L. Badgley, P.C. cite six Illinois Appellate Court decisions (including Settlement Funding v. Cathy Brenston) upholding the enforceability of an anti-assignment clause in a structured settlement contract. The Complaint alleges Mack was attorney of record in Brenston plus three of the additional cited cases.

In Brenston, an Illinois 5th District panel, sitting for the 4th District Illinois Court of Appeals, held that an Illinois state court, which had previously approved transfers requested by Brenston:

• Had a duty to enforce anti-assignment provisions in Brenston's original structured settlement documentation; and
• Had no authority under the Illinois protection act to approve the transfer petitions - even though all of the relevant parties had waived the anti-assignment provisions.

The Illinois Supreme Court subsequently denied Peachtree's petition for appeal of this decision leaving both primary and secondary structured settlement market participants uncertain about the case's precedential meaning and scope. In an Amicus curiae brief, NASP asserted the Appellate Court decision could render the Illinois transfer statute "a practical nullity"

A companion case involving Peachtree and Brenston remains on appeal in the 3rd District Illinois Court of Appeals and will be argued February 27, 2014. The parties had previously stayed their appeal waiting for the Illinois Supreme Court to rule on the 4th District case.

In a recent Florida case, summarized in this Drinker Biddle Structured Settlement Alert, a Sumter County Circuit Court Judge cited the Brenston case as authority in ruling that an April 2011 transfer order was void ab initio, and that resulting arbitration awards were “impotent and without substance.”

For additional recent developments impacting the structured settlement secondary market, see:

• Structured Settlements 2013 - Secondary Market
• Secondary Market Update

NAMSAP 2014 Regional Conference - 2

WCMSA Market Metrics

The recent National Alliance of Medicare Set-Aside Professionals (NAMSAP) Regional Conference highlighted the strategic importance of workers' compensation Medicare set-aside arrangements (WCMSAs), and their growth potential for structured settlements - as well as the need for more comprehensive and public MSA market metrics.

One logical starting point for determining MSA market metrics [as well as Medicare and Medicare Secondary Payer (MSP) metrics] is the CMS Financial Report for Fiscal Year 2013 which covers the October 1, 2012 to September 30, 2013 time period. Selected highlights:

• Medicare
  • "Medicare processes over one billion fee-for-service (FFS) claims a year, and accounts for approximately 15 percent of the Federal Budget."
  • "Medicare enrollment has increased from 19 million beneficiaries in 1966 to over 52 million beneficiaries."
  • "CMS and its contractors process over one billion Medicare claims annually."
• MSP and WCMSAs
  • "CMS’ efforts in the MSP area saved the Medicare Trust Funds approximately $8.93 billion in FY 2013."
  • "Under MMSEA section 111 requirements, group health plans began limited reporting of data in January 2009 and were fully phased in as of January 2011. Workers' compensation, liability insurance and no-fault insurance began limited reporting of data in June 2010, and reporting thresholds will gradually be implemented through January 1, 2015."
  • "As of October 2013, there were over 1,400 insurers reporting data to CMS under section 111."
  • "The implementation of section 111 is the single largest contributor to growth of Medicare savings of $6.5 billion in FY 2007, to approximately $7 billion per year in FY 2011 and FY 2012 and almost $9 billion in FY 2013."
  • "CMS has calculated WCMSA amounts totaling approximately $1.8 billion in FY 2013." (emphasis added).

S2KM discussions with MSA industry experts following the NAMSAP Regional Conference provided these additional estimates:

• Annual number of WCMSAs - estimates vary between 30,000 and 40,000.
• Average size of WCMSAs (including professionally and self-administered WCMSAs) - estimates vary up to $100,000.
• Professional administration - less than 10 percent of WCMSAs are professionally administered.
• Structured settlements - less than 25 percent of WCMSAs are funded with structured settlements.
• Seed money - seed money for WCMSAs funded with structured settlements averages approximately 10 percent of the total per case cost.
• CMS turn around time - the average CMS turnaround time for WCMSAs is 35 days - and increasing.

Structured Settlements and WCMSAs - Estimates Based Upon Trend Projections

Although final 2013 structured settlement primary market annuity sale totals have not yet been reported, 2013 third quarter results are available for comparison. Note: earlier this week, Berkshire Hathaway reported selling $1.42 billion of structured settlement annuities in 2013 which appears to represent the largest single year company total in the history of the U.S. structured settlement industry.

Correction (1/24/14) - Amgen/AILife exceeded Berkshire Hathaway's 2013 structured settlement annuity sales total in 2006, 2007 and 2008.

Based upon a comparison with 2012 structured settlement primary market production results, projected total 2013 sales can be expected to approximate 26,310 annuities and $5.1 billion of premium (approximately $192,000 average premium). Note: S2KM will report actual 2013 structured settlement primary market sales once they have been compiled by Melissa Evola.

Assuming:

• 26,310 structured settlement annuities were sold during calendar year 2013 producing $5.1 billion of premium; and
• 25 percent of the CMS calculated $1.8 billion of WCMSAs for fiscal year 2013 were funded with structured settlements; and
• The seed money for WCMSAs funded with structured settlements averages 10 percent; and
• The average size of WCMSAs funded with structured settlements is $70,000 ($63,000 annuity and $7,000 seed money);

Then, approximately:

• Eight (8%) percent ($405 million) of projected 2013 structured settlement premium ($5.1 billion) was attributable to WCMSAs; and
• 6429 (24%) of projected 2013 structured settlement annuities (26,310) funded WCMSAs.

Growing the Structured Settlement Market

Based upon the CMS inflation/discount methodology for WCMSAs, as promulgated in the October 15, 2004 CMS WCMSA Policy Memorandum, structured settlements have had an inherent cost advantage over lump sum alternatives for funding WCMSAs.

As explained in this prior S2KM blog post, the CMS Workers' Compensation Reference Guide published in 2013 appears to have retained this structured settlement cost advantage.

Strategic Question: Why, therefore, has the structured settlement industry failed to further penetrate the WCMSA market?

The importance of this strategic question will be magnified if, as suggested in Part 1 of S2KM's NAMSAP Regional Conference Report, the CMS WCMSA primary payer model ultimately is applied to:

• Liability MSAs as a result of HHS/CMS RIN: 0938-AR43;
• Medicaid reimbursements as a result of the Bipartisan Budget Act of 2013; and
• Implementation of the Patients' Protection and Affordable Care Act.

Structured settlement professionals identify multiple reasons "why more WCMSAs are not funded with structured settlement annuities". The most significant reasons appear to be:

• The relatively smaller size of WCMSA structured settlements; and
• The administrative burden created by CMS rules for submitting annuity quotes with rated ages to establish reduced life expectancy.

Conclusion

One strategy for growing the primary structured settlement market: improve administrative rules for determining MSA life expectancies - which should represent a shared priority goal for both structured settlement and MSA stakeholders.

A second and related educational strategy: continue to develop more focused industry study about the respective roles of structured settlements and MSAs within the changing rules of personal injury settlement planning.

S2KM welcomes additional input about market metrics from structured settlement and MSA stakeholders.