insurance assignment risk

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Assigned Risk: What It Is, How It Works

Julia Kagan is a financial/consumer journalist and former senior editor, personal finance, of Investopedia.

What Is Assigned Risk?

Assigned risk is when an insurance company is required, by state insurance law, to provide coverage for risk that may not find coverage in the general insurance marketplace. In order to compensate insurers for the potential losses associated with such mandated coverage, insurers will often pool funds and share the assigned risk.

Common examples include mandating that all drivers obtain car insurance or requiring businesses to purchase workers' compensation insurance.

Key Takeaways

• Assigned risk is when the law mandates that an insurance company offer certain coverages.
• In such cases, regulators will require insurance companies to pool together and accept the assigned risk, even if the insurers individually don’t want to provide a commercial policy.
• Assigned risk allows the state to protect drivers who are able to purchase commercial policies and who may be involved in an accident with a risky driver.

Understanding Assigned Risk

In most cases, insurance companies choose who they underwrite insurance policies for, and this choice to insure is based on the risk profile of the individual or business applying for coverage. These considerations include the likelihood that a claim that results in a loss for the insurance company. The insurer will thus price the cost of the policy it underwrites according to the potential severity of any losses. If a potential insured is deemed too risky, the insurer may not underwrite a new policy.

State insurance regulators recognize that insurers only want to underwrite policies that will be profitable, but also recognize that it is in the interest of the government that coverage is extended to groups that need protection but may not be able to obtain it in the general insurance market. To do this the regulator will require insurance companies that provide a particular line of insurance, such as workers’ compensation or automotive insurance, to participate in a state-sponsored plan that provides coverage.

Example: Motorist Coverage

For example, drivers are required to carry insurance with them in order to legally operate an automobile. This insurance is designed to cover claims made against the driver. In most cases, the driver’s record is in good shape, and insurers are likely to provide coverage.

Some drivers, however, have poor driving records and may not be able to obtain coverage because they present too much of a risk . Insurance regulators will require insurance companies to pool together and accept the assigned risk, even if the insurers don’t want to provide a commercial policy . This allows the state to protect drivers who are able to purchase commercial policies and who may be involved in an accident with a risky driver.

"In some cases, you can apply to an automobile insurance plan or assigned risk plan by directly contacting your state's Department of Insurance," according to the website DMV.org, a private, non-governmental website:

Some states require that you apply to several car insurance companies before you apply for the state's car insurance plan. If each provider has denied you car insurance coverage, you'll be accepted into the plan. Typically, your signature on the application is enough to acknowledge that you have fulfilled this requirement.

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AI and compliance analytics: driving value for insurance carriers

Managing Director, Financial Services, Ernst & Young LLP

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Four key takeaways can help bring an artificial intelligence (AI)-led, analytics-driven approach to insurance compliance risk management.

• An EY survey found that insurers on average are still in the early stages of compliance analytics maturity.
• Challenges include data accessibility, strategic vision, data-fluent compliance talent, buy-in and investment from senior leadership.
• Compliance leaders are exploring ways to embed analytics or use emerging capabilities, such as AI and generative AI (GenAI), in their compliance activities.

T raditionally, regulatory compliance has been a human-centric endeavor, relying on individuals deeply versed in the intricacies of securities and insurance regulations. However, with the increasing complexity of financial solutions and products, technological advances and the expanding market, the approach to compliance risk management has started to evolve through the power of artificial intelligence (AI) and data-driven analytics.

The appeal of leveraging AI and an analytics-driven approach is clear. Insurers are facing internal pressures to maximize efficiency and increase the coverage of risk across the enterprise. Externally, regulators are paying close attention to how firms are leveraging AI and analytics. At the same time, regulators are increasingly using these tools to conduct regulatory oversight.

Leveraging data analytics reduces the manual effort involved while proactively identifying areas of risk. Yet many companies have been reluctant to invest in data and analytics to enable their compliance functions, which are viewed as a nonrevenue-generating function. An EY survey suggests that firms take a closer look, as companies that embrace a comprehensive, AI-led data analytics compliance program can generate substantial value across business activities and risk management.

The survey evaluated compliance analytics maturity among insurance carriers in the following categories:

• Comprehensive strategy and vision, as well as the ability to execute in terms of methodology
• Skilled talent
• Accessibility and quality of data
• Use of technology

Firms then received a rating in the data analytics maturity framework, ranging from Stage 1, which is a reactive approach, to Stage 4, which is an AI-led, real-time, 360-degree view across compliance, operations, technology and other functional areas. The average analytics program maturity score in the survey neared Stage 2 with a point-in-time approach.

Data and analytics transformation journey

• Limited, ad hoc use case development
• Experimentation and proof of concepts with a subject matter advisor model
• Targeted analytics to uncover specific compliance failures, largely rule-based
• Adoption of analytics operating model and fit-for-purpose tooling
• Data-driven risk assessment
• Shift toward 100% population testing, using advanced techniques such as machine learning, natural language, processing and AI
• Forward-looking, KRI-driven continuous monitoring
• Connected view of risks across compliance, operations, technology and other functional areas

How EY can help

The generative AI opportunity for financial services

Harnessing the power of generative AI carries both risk and reward. EY teams are enabling clients to create holistic strategies and operating models.

The EY survey offers four key takeaways:

1. Support from leadership matters. The organizations that scored the highest had buy-in from senior compliance leaders. Leadership support aligned with having a comprehensive vision and strategy and a level of investment that allowed for high-quality data and skilled team members. These served as key accelerators and outweighed other considerations, such as team size and technology stack, in driving success.

2. Analytics programs are evolving toward risk-based, data-driven compliance enablement. Organizations in the early stages of maturity are focused on automating repeatable functions to reduce manual efforts. More advanced programs employ regular monitoring dashboards and data-based risk assessments across a range of areas, including complaints, financial crimes, testing and monitoring, agent risk ranking, licensing and registration. As analytics programs mature, companies are developing more sophisticated use cases, such as leveraging AI and machine learning tools to assess agent behavior. There is also an increasing interest in incorporating analytics into nonfinancial risk management, including operational risk.

3. Proximity of the data and analytics team matters. Organizations reported having compliance analytics teams that ranged in size from three to 13 members and had a mix of experience in technical, compliance and business knowledge. Compliance functions with dedicated data analytics teams accelerated their programs more effectively than those that relied on a shared data service team. More successful compliance functions recognized the importance of cross-training to bridge the knowledge gap in analytics functions.

4. The most common roadblock is access to data. Disparate data sources are an ongoing challenge. Organizations are focusing on standardizing their data-sourcing methods to better operationalize analytics. Establishing data lakes can improve availability and lineage. Digital enablement of business processes through e-applications and electronic deliveries is streamlining the collection of customer data and policy information, reducing the barriers to data sourcing.

By investing in the power of AI and data analytics, risk and compliance leaders can transform compliance and broader risk management, making more efficient use of talent, increasing risk coverage and managing external regulatory pressures. A strategic, analytics-driven approach will allow companies to shift from a reactive mindset to a proactive one that creates value and enables an agile risk response.

Compliance in insurance is shifting from a personnel-driven endeavor to one that harnesses AI and data analytics. Creating a robust, comprehensive, AI-led, data analytics-enabled compliance program can lead to a more strategic risk management approach that adds value.

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Risk management basics

Contributed by James B. Atkins, FAIA, and Grant A. Simpson, FAIA

Chapter 16.01 Risk management strategies

Strategies for architects to manage professional risks and liability claims, including quick-response planning.

Dive into a comprehensive exploration of liability claims within the architecture profession. This classic best practice document—originally adapted from a series of articles that appeared in AIArchitect —navigates the complexities of professional liability insurance, discusses key elements of liability claims, and describes seven steps for creating a quick-response risk management plan. Originally published in 2007, the advice holds true today.

The basis of liability claims

You don’t have to practice architecture long before you encounter challenges to your work. These may come in the form of a simple disagreement over your opinions or the performance of your services, or they may come as a direct demand for compensation for alleged damages caused by your actions. Nevertheless, you will find that you are judged not only by what you do but when, how fast, and why you do it. And the services you provide will be scrutinized by other professionals who almost certainly will disagree with your actions. To understand this challenging process and better defend yourself throughout its duration, it is helpful to understand what a claim is: the vehicle for launching an effort to recover alleged damages. Our professional liability insurance (PLI) policy protects us from claims against our services. These policies typically have deductibles that you must pay upfront to activate coverage; they contain policy limits, which are the monetary amounts that the policy provides; and they have rules for preserving the coverage, to which you must conform to keep your coverage intact. 

What is a liability claim?

PLI policies are known as claims-made policies. That is, policy coverage is triggered when you give notice that a claim has been made against you, and you are protected by the policy that is in effect at the time of the claim. This differs from your automobile insurance policy, which is triggered by the date the injury to a person or property occurs. Injuries ocurring through professional services can be caused by an act or a failure to act. These can be caused by a design that may prove to be defective over an extended period of time. Insurers use the claims-made process because of the potential difficulties in determining the date of origin of the action that precipitated the injury. 

Because the claim triggers the policy coverage, it is important to define a claim to the extent that it can be sufficiently recognized. Accordingly, in most circumstances, an event must include three necessary elements for it to be considered a claim:

• Identifiable injury to a person or property. If injury cannot be proven, legally there is no cause for a claim.
• An allegation of wrongdoing. It must be alleged that you caused the damages by your actions.
• A demand for money or services (sometimes referred to as “damages”) as compensation for the alleged injury.

Under the terms and conditions of the typical insurance policy, however, insurance companies are generally content to acknowledge a claim against you if only the first two elements exist.

It is important that you respond quickly and appropriately when a claim is made. Your insurance company may require you to report claims on “first knowledge,” and you have certain advantages when a claim is first made that may not sustain over time. Therefore, it is advisable to develop a quick-response plan that you can initiate immediately when a claim is made.

Seven steps to a quick-response plan

1. Report the claim to your insurer in accordance with the notice requirements of your PLI policy. Policies have specific claims-reporting procedures, and you should understand your policy requirements and notify your insurer accordingly. Although insurance companies may accept a verbal notice of claim, it is advisable to document your notice in writing to avoid any misunderstanding later.

2. Contact your preferred legal counsel and ask him or her to represent your firm in the claim. If you do not know a lawyer who specializes in architect and engineer errors-and-omissions (E&O) defense, your insurance company will provide you with a “panel” attorney. This is a lawyer whom your insurance company has preselected based on qualifications. If you wish to use counsel that your insurance company has not preapproved, you must get your insurer’s prior consent. Lawyers with experience in architect E&O defense are relatively rare, so it is important to secure your representation early before someone beats you to the punch.

3. Visit the project site, if appropriate. Gather necessary information and document relevant conditions. Conditions that give rise to claims often mysteriously disappear or are corrected within a short time following an incident. It is wise to take photographs, make notes, and gather documents relating to the claim or circumstance while they are available. If necessary, have a third-party expert inspect the conditions and, in some cases, file a report. At a minimum, your own photographs can be beneficial. Wherever possible, coordinate these efforts with your legal counsel or insurer. 

4. Hire an expert. For a claimant to prove that you have breached your professional duty, that party must generally hire an expert witness who has appropriate credentials. Likewise, for you to defend against the expert’s testimony, you will need a similar expert. In some cases, it may be appropriate for you or a member of your firm to serve as an expert in defense of the claim. If you do not know an architect who is qualified to be your expert, your legal counsel or your insurer can help you find one. 

5. Assemble your project team and plan how you will manage the claim within your office. Designate who will serve as the primary contact within your office. If this person did not work on the project, he or she will need project team members to assist with knowledge of facts and to review and manage documents. People who worked on the project and have since left your firm must be contacted to obtain their knowledge of facts. You should maintain a good relationship with them even if you have to pay for their time spent giving testimony or providing information. 

Someone in your office must be in charge of the claims management activities, including

• assembling in-house documents
• reviewing in-house documents
• reviewing documents in other offices (owner, contractor, subcontractors, subconsultants)
• developing a written chronology of events that led up to the claim
• communicating with the insurance claims supervisor, legal counsel, and experts
• attending depositions
• giving depositions
• making your documents available for review by others
• being the “corporate representative” for your firm in legal proceedings

6. Contact subconsultants and advise them of the claim. Your consultants will be required to defend claims made against their portion of the work, and it is important that they follow a response plan as well. You should be certain their insurance carrier is involved early to ensure that they are managing their portion of the claim effectively.

7. Assemble your documents, develop the chronology, and organize your defense effort. One of the greatest expenses in claims management is personnel time. A large, complicated claim can absorb many labor hours that otherwise would be billable, and usually these expenses cannot be counted against your deductible. The more efficient your claims management is, the less it will cost you in time.

A little information and preparation will go a long way toward helping you defend claims, and it is wise to become thoroughly familiar with the claims process.

AIA collects and disseminates best practices as a service to AIA members without endorsement or recommendation. Appropriate use of the information provided is the responsibility of the reader.

This article was originally published in 2007 and is reproduced for reference. The information provided in this article is for general informational and educational purposes only and is not intended to be a substitute for professional advice.  

About the contributors

Jim Atkins is a principal with HKS Architects. He is a contributing editor for AIArchitect, he serves on the AIA Risk Management Committee, and he is chair of the Architect’s Handbook of Professional Practice, 14th edition Revision Task Group. Grant Simpson manages project delivery for RTKL Associates in Dallas and is the 2006 chair of the AIA Practice Management Advisory Group.  

Help build AIA Best Practices by contributing your experience. Contact us with your feedback or ideas for an article.

Nearly half of architecture firm leaders say that length of time for design activities has increased in recent years

Contributed by Peter Piven, FAIA, and Bradford Perkins, FAIA. Excerpted from Architect’s Essentials of Starting a Design Firm

Chapter 7.02 Financial Management Systems

Grasping key financial terms and

Contributed by David B. Richards, FAIA. Excerpted and adapted from The Architect’s Handbook of Professional Practice, 15th edition .

Chapter 15.02 Services and Compensation

Different payment strategies

Assignment of Benefits vs Direction to Pay vs Assignment of Policy

Assignment of Benefits vs. Assignment of Policy

Assignment of Benefits forms, also known as AOBs, play a crucial role in the restoration industry’s contractor-client dynamics. These legal documents empower policyholders to transfer their insurance policy benefits to a third party, effectively connecting their restoration contractor directly to their insurance company. By doing so, policyholders can bypass many of the complications and anxieties typically associated with a restoration project, streamlining the process.

According to Josh Ehmke, Co-owner and General Consult at One Claim Solution , there’s a  common misunderstanding between assignment of benefits and assignment of policy. An assignment of policy refers to the transfer of the benefits and rights of an insurance policy from one party (the policyholder) to another party (the assignee).

“An assignment of policy is never going to be valid. In fact, I haven’t come across a state that allows an assignment of an insurance policy without the insurance company’s prior written consent,” Josh said. “The reason it’s not allowed is because it’s against public policy. It increases the insurance risk substantially.”

For example, a policyholder might have a history of filing numerous claims against their insurance provider, suggesting a pattern that they might be well-versed in exploiting certain loopholes and taking advantage of insurance companies. Additionally, there are concerns that they may not adequately maintain or safeguard their property, leading to an increased risk for the insurance company. 

“That is absolutely different from an assignment of benefits, which grants the rights the policyholder had to the payment under the policy to be transferred to the assignee,” Josh said. ”The only prerequisite for an assignment of benefits other than having a covered claim, is that the loss has already occurred. If you get an assignment of benefits before the loss occurs, that’s essentially a transfer of a policy.”

OCS recently encountered a case where the question arose regarding the scope of an assignment of benefits. Specifically, the issue was whether only the rights of the policyholder are transferred, or if the policyholder’s obligations are also transferred alongside the benefits under the assignment.

“By taking the assignment, the contractor doesn’t assume the policyholder’s obligations under that policy,” Josh said. “It’s very important to word your assignment of benefits appropriately to clearly state that you’re not agreeing to assume any of those policy obligations, and to specify which rights you want.”

Direction to Pay vs. Assignment of Benefits

Direction to pay (DTP) is a financial arrangement where the policyholder, who is entitled to receive an insurance claim payment, instructs the insurance company to pay the claim proceeds directly to a third party. This third party could be a vendor, contractor, service provider, or any other entity to whom the policyholder owes a debt or has entered into an agreement.

“The issue with direction to pay is that the carrier doesn’t have to honor it because it’s not enforceable,” Josh said. “It’s very limited in what it can do, whereas an assignment of benefits is much more powerful because it obligates the insurance company legally to pay you.”

According to Josh, DTP’s are rarely used, except in states like Texas and Florida where AOBs are detrimental to contractors or illegal.

“A DTP is better than nothing and allows you to at least show the carrier that the homeowner granted approval to request payment,” Josh said. “But outside of those situations, the direction to pay in my mind is worthless. When you can have an assignment of benefits, there’s no reason to have a direction to pay at all.”

A Final Word

Understanding the differences between an AOB, Assignment of Policy, and DTP is crucial because each term represents distinct legal and financial arrangements that can significantly impact insurance claims and policyholder rights. To learn more about the value of assignment of benefits in helping you navigate the restoration process, be sure to subscribe to our newsletter .

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Connor Trahan

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Hi there! I’m Connor, the Account Executive for One Claim. My goal is to guide our contractors through the sales process, ensuring you’re equipped with all the information you need to make your decision and hit the ground running once aboard. We view ourselves as an extension of your business and I strive to make the process an enlightening and consultative one. My career has primarily been focused in software sales over a few different industries but the last few years were spent helping general contractors solve similar problems to what we’re doing here at OCS! Outside of work, I love spending time with my family, cooking and boating during the summer months.

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Hello! I’m Nicole, and I’m here to champion for our employees, recruit for new talent, and impact culture at One Claim Solution. I find satisfaction in supporting a memorable employee experience and bring innovation, problem solving, and strategic view to the process. Nothing is more important than our people, and a healthy culture is my top priority! I have had the pleasure of building my career in various sectors, specializing in small to medium size firms focused on high-growth. My experience is centered around driving and implementing change, leading high-performing teams, and driving process improvements. I am excited to make an impact at One Claim. Outside of work, my family and I enjoy getting outdoors as much as possible to explore beautiful Colorado!

Elizabeth McGlone

Demand generation manager.

Great to meet you! I’m Elizabeth, and I’m the one behind all the emails and advertisements you’ve been seeing. As the Demand Generation Manager at One Claim Solution, my mission is to connect with contractors like you who need our services. I’m passionate about having an impact on others and I bring a wealth of experience in demand generation and marketing strategy to create moments of delight, curiosity, and education for you.

Prior to One Claim Solution, I had the privilege of building marketing departments from the ground up at companies in a variety of industries, including IT consulting, first protection, and healthcare. Personally, I love being outdoors, playing Dungeons and Dragons and board games, singing, and traveling.

Alisha Yartzoff

Director of contractor success.

Welcome! I’m Alisha, and I’m here to champion your success as the Director of Contractor Success at One Claim. With a passion for helping contractors thrive, I bring a wealth of experience in onboarding, customer service, and account management to ensure your journey with us is nothing short of exceptional.

Prior to joining One Claim, I had the privilege of scaling SMB and Enterprise Customer Success teams at fast-growing SaaS startups. With over six years of experience at companies like Mavenlink, Teamwork, and ServiceTitan, I honed my expertise in building high-performing teams and fostering proactive, consultative relationships. This background has equipped me with a deep understanding of the challenges faced by businesses like yours, and I’m dedicated to helping you overcome them.

Hi there, my name is Eric! I am the Chief Technology Officer here at OCS, spearheading our technical strategy. I have a background in computer science, graduating cum laude from BYU-Idaho with a Bachelor’s degree in Computer Information Technology.

Before coming to One Claim, I served as the Director of Engineering at Slingshot Technology, Inc., a company later acquired by WorkWave in 2021. My professional journey has spanned both emerging startups and established corporations, with a steadfast focus on cultivating high-trust, low bureaucracy teams and innovating technology using agile methodologies.

In my free time, you can find me flying drones, enjoying the outdoors, and spending time with my family.

Hello, my name is Cam, I’m the COO of One Claim Solution! I come from a management consulting background (Bain & Company) and hold an MBA from the University of Michigan. I have worked at a wide variety of organizations, from Fortune 500 to small-cap, in an equally wide variety of industries. I have over 15 years of experience in operations and strategic growth, and I have spent much of my career focused on developing high-performing tech-enabled service organizations through early stage and high growth phases.

Outside of work, my wife Brittny and I have four kids, ages 13 to 6. As residents of Mesa, Arizona, we love to ski and explore the national parks of the southwest!

Hello, my name is Dan, and I am the CEO of One Claim Solution. I am super excited by everything we are doing at OCS to be the market leading insurance billing specialist that advocates on behalf of our restoration contractors. 

My professional experiences are predominantly corporate in nature. My career started at General Electric in finance and accounting. Immediately prior to joining OCS, I spent time as an investor at Bondcliff Partners and management consultant with Bain & Company. I also hold an MBA from the Kellogg School of Management at Northwestern University and got my BS in finance and accounting from Northeastern University.

Outside of the office, I enjoy spending time with my wife, two young children, and our family dog, Whiskey. We live in Charleston, SC and take advantage of the beautiful weather by spending as much time as possible outside at the beach or adventuring around town

Co-Founder and General Counsel

Hi, I’m Josh! In 2016, I co-founded One Claim Solution with my partner Jeremy Traasdahl, and I serve as General Counsel of One Claim Solution. Working in the restoration industry, Jeremy and I saw contractors struggling to get paid quickly and fairly and we knew there was a need for change. We founded One Claim Solution to be this change and it’s been my privilege to see our company grow and to advocate for our clients as general counsel.

Outside of my passion for helping the restoration industry, I enjoy spending time outdoors, fly-fishing, hunting, skiing, and coaching my kids’ baseball teams. I’ve been married to my amazing wife for 20 years and we have a beautiful family of 5 children.

Jeremy Traasdahl

Hey, I’m Jeremy! In 2016, I co-founded One Claim Solution with my partner Josh Ehmke. Working in the restoration industry, Josh and I saw contractors struggling to get paid quickly and fairly and we knew there was a need for change. We founded One Claim Solution to be this change and it’s been my privilege to lead our amazing team.

Prior to One Claim Solution, I started my career as an inside sales rep for Avnet, then moved to Pepsico as a district sales manager. Outside of work, I love spending time with my wife and four children, two boys and two girls!

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Post-Loss Assignments of Claims Under Insurance Policies

In the settlement of lawsuits involving insured claims, it is not uncommon that one condition of the settlement is that the defendant assign his or her claims under all applicable insurance policies to the party that filed suit.

Indeed, it is frequently the case that the defendant, particularly when the defendant is an individual, has a limited ability to pay a judgment and insurance coverage offers the best opportunity for a recovery by the suing party. Usually, such settlements are made without any serious thought being given to whether the defendant’s claim against its insurer is assignable; the assumption being that it is assignable.

However, insurance policies generally have anti-assignment clauses which prohibit the assignment of the policy, or an interest in the policy, without the insurer’s consent. These clauses come into play in determining the validity or enforceability of the assignment of a claim under an insurance policy and should be considered when such an assignment is part of a settlement.

When considering the enforceability of anti-assignment clauses in insurance policies, the courts generally draw a distinction between an assignment made prior to the occurrence of a covered loss (a “pre-loss” assignment) and an assignment made after the occurrence of a covered loss (a “post-loss” assignment).

In analyzing pre-loss assignments, the courts recognize that requiring an insurer to provide coverage to an assignee of its policy prior to the occurrence of a covered loss would place the insurer in the position of covering a party with whom it had not contracted nor been allowed to properly underwrite to assess the risks posed by that potential insured, and, accordingly, determine the appropriate premium to charge for the risks being undertaken or choose to decline coverage.

Post-loss assignments, on the other hand, take place after the insurer’s obligations under its policy have become fixed by the occurrence of a covered loss, thus the risk factors applicable to the assignee are irrelevant with regard to the covered loss in question. For these reasons, the majority of the courts enforce anti-assignment clauses to prohibit or restrict pre-loss assignments, but refuse to enforce anti-assignment clauses to prohibit or restrict post-loss assignments.

Katrina Cases

The Louisiana Supreme Court, which had not previously addressed the enforceability of anti-assignment clauses for post-loss assignments, was recently confronted with this issue in the In re: Katrina Canal Breaches Litigation, litigation involving consolidated cases arising out of Hurricane Katrina. The issue arose as a result of a lawsuit brought by the State of Louisiana as the assignee of claims under numerous insurance policies as part of the “Road Home” Program. The Road Home Program was set up following Hurricanes Katrina and Rita to distribute federal funds to homeowners suffering damage from the hurricanes. In return for receiving a grant of up to $150,000, homeowners were required to execute a Limited Subrogation/Assignment agreement, which provided in pertinent part:

Pursuant to these Limited Subrogation/Assignments, the State of Louisiana brought suit against more than 200 insurance companies to recover funds dispensed under the Road Home Program. The suit was removed to Federal Court under the Class Action Fairness Act and the insurers filed motions to dismiss, arguing that the assignments to the State of Louisiana were invalid under the anti-assignment clauses in the homeowner policies at issue.

On appeal, the United States Fifth Circuit Court of Appeals certified the following question to the Louisiana Supreme Court: “Does an anti-assignment clause in a homeowner’s insurance policy, which by its plain terms purports to bar any assignment of the policy or an interest therein without the insurer’s consent, bar an insured’s post-loss assignment of the insured’s claims under the policy when such an assignment transfers contractual obligations, not just the right to money due?”

In answering this question, the Louisiana Supreme Court began by noting that, as a general matter, contractual rights are assignable unless the law, the contract terms or the nature of the contract preclude assignment. Specific to the certified question, Louisiana Civil Code article 2653 provides that a right “cannot be assigned when the contract from which it arises prohibits the assignment of that right.” The Louisiana Supreme Court observed that the language of article 2653 is broad and, on its face, applies to all assignments, including post-loss assignments of insurance claims. The Court, therefore, construed the issue confronting it as whether Louisiana public policy would enforce an anti-assignment clause to preclude post-loss assignments of claims under insurance policies.

In addressing the public policy question, the Louisiana Supreme Court recognized the distinction between pre-loss assignments and post-loss assignments discussed by courts from other states and noted that the prevailing view was that anti-assignment clauses were invalid and/or unenforceable when applied to post-loss assignments. Notwithstanding this weight of authority, the Louisiana Supreme Court stated:

“[W]hile the Louisiana legislature has clearly indicated an intent to allow parties freedom to assign contractual rights, by enacting La. C.C. art. 2653, it has also clearly indicated an intent to allow parties freedom to contractually prohibit assignment of rights. We recognize the vast amount of national jurisprudence distinguishing between pre-loss and post-loss assignments and rejecting restrictions on post-loss assignments, however we find no public policy in Louisiana favoring assignability of claims over freedom of contract.”

Thus, Court refused to invalidate the enforceability of the anti-assignment clauses to the post-loss assignments before it based on public policy, adding that public policy determinations are better suited to the legislature.

Nonetheless, after having recognized the general enforceability of anti-assignment clauses to post-loss assignments, the Court immediately placed limits on when those clauses would be applicable, stating that to be applicable, they “must clearly and unambiguously express that the non-assignment clause applies to post-loss assignments.” The Court refused “to formulate a test consisting of specific terms or words,” which would satisfy this condition and remanded the case to the federal courts to determine whether the individual anti-assignment clauses in the various policies were sufficiently clear and explicit to be enforced with respect to post-loss assignments at issue.

A Broad Application

It should be noted that the Court’s opinion appears to apply broadly to all post-loss assignments irrespective of what specific rights are being assigned, despite the fact that the certified question was narrower and asked only about the applicability of a post-loss assignment where the assignment “transfers contractual obligations, not just the right to money due.”

In a footnote at the beginning of its opinion, the Louisiana Supreme Court observed that in certifying the question to it, the Fifth Circuit “disclaimed any intent” that the Court “confine its reply to the precise form or scope of the legal questions certified.” The footnote indicates that the Court’s opinion was not intended to be limited to only those post-loss assignments involving the assignment of contractual obligations.

Louisiana has departed from the majority view in holding that as a matter of general law, anti-assignment clauses are not inherently void with regard to post-loss assignments. However, it may be that in practical application, the results of individual cases may well be consistent with the majority rule of not enforcing anti-assignment clauses with regard to post-loss assignments because Louisiana courts may be reluctant to find that the anti-assignment clauses are sufficiently “clear and explicit” unless they specifically state that they apply to post-loss assignments, notwithstanding the Louisiana Supreme Court’s unwillingness to “formulate a test consisting of specific terms or words.”

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Climate change, disaster risk, and homeowner’s insurance.

CBO analyzes recent changes in property insurance markets and considers alternative insurance products as well as policy approaches to increase the availability and affordability of insurance for homeowners and renters.

Climate change heightens the risks of wildfires and other natural disasters. As insurance payouts for losses sustained in those disasters increase and as uncertainty about future losses grows, people in many high-risk areas have faced difficulty obtaining or affording insurance coverage for their property. As risk and costs increase, premiums will increase as well, which may make insurance less affordable for homeowners. If state regulators do not allow higher premiums, insurers may exit high-risk areas, reducing the availability of insurance.

In this report, the Congressional Budget Office analyzes recent changes in property insurance markets and considers alternative insurance products as well as policy approaches to increase the availability and affordability of insurance for homeowners and renters. The highlights of that analysis include the following:

• Higher land and ocean temperatures, drought, sea level rise, and excessive precipitation are all features of climate change that contribute to increasing the risks of natural disasters, including wildfires, hurricanes, and floods. With increased uncertainty attributable to climate change, insurers may limit coverage for risks that are difficult to quantify or where regulators constrain their ability to set prices reflecting risk.
• Households may underinsure for natural disasters for a variety of reasons, including a lack of information about the risks and the extent of any postdisaster government assistance.
• Means-tested subsidies would make coverage more affordable for low- and moderate-income households. That approach has the advantage of targeting assistance and preserving incentives for other policyholders to mitigate losses, but controlling costs and implementing the program could be difficult.
• Other approaches would expand the availability of insurance. States could lessen regulatory constraints on insurers’ risk-based prices. The federal government could act as a catastrophic risk reinsurer or insurer, as it does for flood insurance, and bear more of the cost of disasters.

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Soaring Insurance Costs Could ‘End’ Affordable Housing, Developers Warn

Developers and landlords of subsidized housing, who cannot raise rents or charge more for starter homes, say property insurance increases could put them out of business.

By Emily Flitter

For the poorest Americans, finding an apartment to rent or a home to buy often means tapping into a vast network of nonprofit groups that use public and charitable funds to rehab or build affordable housing. Over the past year, the skyrocketing cost of property insurance has put that network on shaky ground.

In Houston, hundreds of apartments once protected from rising rents are being sold off to landlords who can charge the full market rate. In Selma, Ala., insurance premiums are keeping even heavily subsidized homes out of buyers’ reach. In Kingsville, Texas, a planned affordable housing development was scrapped entirely.

Costs are rising for homeowners of all types, and in states like Florida, Texas and California, it has become harder to get insurance at all. The industry says bigger, more frequent storms, along with increased home prices and material and labor costs, are forcing them to raise premiums or stop writing policies.

Wealthier homeowners can go without insurance, if they can buy a home without a mortgage. Landlords of market-rate apartments can raise the rent to adjust to the higher costs. But for the 4,000 or so nonprofits and developers that aren’t allowed to raise rents, or are selling homes only to buyers with the most constrained budgets, the soaring cost of insurance is an existential threat.

The problem is most serious in coastal states, hit hard by severe weather. But Frank Woodruff, the executive director of the Community Opportunity Alliance, a trade group representing nonprofit housing developers, warned of a wider crisis.

“If it spreads further, it could threaten to end affordable housing development as we know it,” he said.

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Insurance refused to pay for her abortion, even when her life was at stake.

Sarah Varney

Wisconsin Abortion

Anti-abortion protesters stand outside of the Republican National Convention in Milwaukee in July. Wisconsin reverted to an 1800s abortion ban when Roe was overturned. The courts have since reinstated some abortion access in Wisconsin. Jim Vondruska/Getty Images hide caption

Ashley and Kyle were newlyweds in early 2022 and thrilled to be expecting their first child. But bleeding had plagued Ashley from the beginning of her pregnancy, and in July, at seven weeks, she began miscarrying.

The couple’s heartbreak came a few weeks after the U.S. Supreme Court overturned the federal right to abortion. In Wisconsin, their home state, an 1849 law had sprung back into effect, halting abortion care except when a pregnant woman faced death.

Insurance coverage for abortion care in the U.S. is a hodgepodge. Patients often don’t know when or if a procedure or abortion pills are covered, and the proliferation of abortion bans has exacerbated the confusion. Ashley said she got caught in that tangle of uncertainties.

A prolonged process

Ashley’s life wasn’t in danger during the miscarriage, but the state’s abortion ban meant doctors in Wisconsin could not perform a D&E — dilation and evacuation — even during a miscarriage until the embryo died. She drove back and forth to the hospital, bleeding and taking sick time from work, until doctors could confirm that the pregnancy had ended. Only then did doctors remove the pregnancy tissue.

“The first pregnancy was the first time I had realized that something like that could affect me,” said Ashley, who asked to be identified by her middle name and her husband by his first name only. She works in a government agency alongside conservative co-workers and fears retribution for discussing her abortion care.

'Jane Roe' is anonymous no more. The very public fight against abortion bans in 2023

A year later, the 1849 abortion ban still in place in Wisconsin, Ashley was pregnant again.

“Everything was perfect. I was starting to feel kicking and movement,” she said. “It was the day I turned 20 weeks, which was a Monday. I went to work, and then I picked Kyle up from work, and I got up off the driver’s seat and there was fluid on the seat.”

The amniotic sac had broken, a condition called previable PPROM (preterm premature rupture of membranes). The couple drove straight to the obstetrics triage at UnityPoint Health-Meriter Hospital, billed as the largest birthing hospital in Wisconsin. The fetus was deemed too underdeveloped to survive, and the ruptured membranes posed a serious threat of infection.

Dr. Eliza Bennett is an OB-GYN in Wisconsin. Sarah Varney for KFF Health News hide caption

Obstetrician-gynecologists from across Wisconsin had decided that “in cases of previable PPROM, every patient should be offered termination of pregnancy due to the significant risk of ascending infection and potential sepsis and death,” said Eliza Bennett, the OB-GYN who treated Ashley.

Ashley needed an abortion to save her life.

Documented risks

The couple called their parents; Ashley’s mom arrived at the hospital to console them. Under the 1849 Wisconsin abortion ban, Bennett, an associate clinical professor at the University of Wisconsin School of Medicine, needed two other physicians to attest that Ashley was facing death.

But even with an arsenal of medical documentation, Ashley’s health insurer, the Federal Employees Health Benefits Program, did not cover the abortion procedure. Months later, Ashley logged in to her medical billing portal and was surprised to see that the insurer had paid for her three-night hospital stay but not the abortion.

“Every time I called insurance about my bill, I was sobbing on the phone because it was so frustrating to have to explain the situation and why I think it should be covered,” she said. “It’s making me feel like it was my fault, and I should be ashamed of it.”

Eventually, Ashley talked to a woman in the hospital billing department who relayed what the insurance company had said.

“She told me,” Ashley said, “quote, ‘FEP Blue does not cover any abortions whatsoever. Period. Doesn’t matter what it is. We don’t cover abortions.’”

The Hyde amendment

University of Wisconsin Health, which administers billing for UnityPoint Health-Meriter hospital, confirmed this exchange.

The Federal Employees Health Benefits Program contracts with FEP Blue , or the BlueCross BlueShield Federal Employee Program, to provide health plans to federal employees.

In response to an interview request, FEP Blue emailed a statement saying it “is required to comply with federal legislation which prohibits Federal Employees Health Benefits Plans from covering procedures, services, drugs, and supplies related to abortions except when the life of the mother would be endangered if the fetus were carried to term or when the pregnancy is the result of an act of rape or incest.”

Abortions resume in Wisconsin after 15 months of legal uncertainty

Those restrictions, known as the Hyde Amendment, have been passed each year since 1976 by Congress and prohibit federal funds from covering abortion services. But the Hyde Amendment has exceptions for rape, incest and the life of the mother, as the health insurer noted in response to questions from KFF Health News and NPR.

Insurance kryptonite

In Ashley’s case, physicians had said her life was in danger, and her bill should have immediately been paid, said Alina Salganicoff, director of Women’s Health Policy at KFF, a health information nonprofit that includes KFF Health News.

What tripped up Ashley’s bill was the word “abortion” and a billing code that is insurance kryptonite, said Salganicoff.

“Right now, we’re in a situation where there is really heightened sensitivity about what is a life-threatening emergency, and when is it a life-threatening emergency,” Salganicoff said.

The same chilling effect that has spooked doctors and hospitals from providing legal abortion care, she said, may also be affecting insurance coverage.

In Wisconsin, Bennett said, lack of coverage for abortion care is widespread.

“Many patients I take care of who have a pregnancy complication or, more commonly, a severe fetal anomaly, they don’t have any coverage,” Bennett said.

Settled, and looking forward

Recently, the bill for $1,700 disappeared from Ashley’s online bill portal. The hospital confirmed that eight months later, after multiple appeals, the insurer paid the claim. When contacted again on Aug. 7, FEP Blue responded that it would “not comment on the specifics of the health care received by individual members.”

Ashley said tangling with her insurance company and experiencing the impact of abortion restrictions on her health care, similar to other women around the country, has emboldened her.

“I’m in this now with all these people,” she said. “I feel a lot more connected to them, in a way that I didn’t as much before.”

Ashley is pregnant again, and she and her husband hope that this time their insurance will cover whatever medical care her doctor says she needs.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF .

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USDA Expands Shellfish Insurance Program

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RMA Allows Insurance on Seeds Initially Purchased Smaller than 4 mm

WASHINGTON, Aug. 30, 2024 – The U.S. Department of Agriculture (USDA) is expanding the Shellfish insurance program beginning with the 2025 crop year. USDA’s Risk Management Agency (RMA) is expanding coverage to an additional 27 counties in Delaware, Florida, Louisiana, Maryland, New Hampshire, New Jersey, and North Carolina. Additionally, RMA is modifying the program to allow insurance on seeds initially purchased smaller than 4 mm once they reach the minimum insurable size of 4 mm, allowing producers to use existing records for coverage in adjacent program counties, and allowing alternative yield procedures. RMA worked with stakeholders on these program enhancements.  

“In the shellfish program’s first year as a pilot, the Risk Management Agency listened to shellfish producers to understand what is and isn’t working,” said RMA Administrator Marcia Bunger. “I’m excited to see so many producer-focused changes addressing the challenges they shared because those changes are going to improve the program in its second year.”  

The Shellfish insurance program is an actual production history-price component (APH-PC) coverage policy for container-grown oysters commercially cultivated for the fresh half shell market. RMA first implemented the program for the 2024 crop year in select counties in Alabama, California, Florida, Maine, Maryland, Massachusetts, Mississippi, New York, North Carolina, Rhode Island, South Carolina, and Virginia.   

This Shellfish APH-PC coverage policy insures producers against yield losses due to hurricane, nor’easters, excessive heat during a low tide event, freeze during a low tide event, and low salinity due to excessive rainfall.  

Producers select a percentage of their average yield to insure, from 50 to 75%. The producer also selects a percentage of the crop price to insure, between 55 and 100% of the crop price, as established annually by RMA. If producers purchase additional levels of coverage, with prior sales records, they may also increase their price guarantee up to 125% of RMA’s established price. The program uses county loss triggers combined with producers’ sales records to confirm a loss has occurred. The insurance guarantee is based on the number of oysters expected to be harvested between January 1 and December 31.  

The sales closing date for the 2025 crop year is Nov. 30, 2024.  

RMA also offers crop insurance for certain aquaculture categories through crop insurance programs for Group Risk Plan oysters available in select parishes in Louisiana, cultivated clams available in select counties in Massachusetts, South Carolina, and Virginia, and the nationally available Whole Farm Revenue Protection (WFRP) plan of insurance. WFRP provides a risk management safety net for all commodities in an operation under one insurance policy. View the  Aquaculture Fact Sheet to learn more.     

More Information   

Crop insurance is sold and delivered solely through private crop insurance agents. A list of crop insurance agents is available at all USDA Service Centers and online at the  RMA Agent Locator . Producers can learn more about crop insurance and the modern farm safety net at  rma.usda.gov or by contacting their  RMA Regional Office .   

RMA secures the future of agriculture by providing world class risk management tools to rural America through Federal crop insurance and risk management education programs. RMA provides policies for more than 130 crops and is constantly working to adjust and create new policies based on producer needs and feedback.  

USDA touches the lives of all Americans each day in so many positive ways. Under the Biden-Harris administration, USDA is transforming America’s food system with a greater focus on more resilient local and regional food production, fairer markets for all producers, ensuring access to safe, healthy and nutritious food in all communities, building new markets and streams of income for farmers and producers using climate smart food and forestry practices, making historic investments in infrastructure and clean energy capabilities in rural America, and committing to equity across the Department by removing systemic barriers and building a workforce more representative of America. To learn more, visit usda.gov .

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His campaign took videos of his visit and used them in ads.