For reference, below are the proposals for gross and risk margin

Data based in Active, Completed and Abrogated OP through January 2025

Below is the summary of total price showing that the new margin scheme is revenue neutral over the 2020-2024 period

Total Revenue Before and After
Diagnosis Type Contract Price New Contract Price Count
ABI 892,553,367 896,904,576 602
Amputation 195,188,388 191,483,076 184
Burn Injury 317,621,999 316,708,019 158
Multiple Trauma 588,843,972 571,912,898 539
Other 10,515,637 9,491,852 8
SCI 618,174,460 634,280,561 290
Total 2,622,897,823 2,620,780,984 1,781

The charts below show the statistics on price changes for our largest clients had the changes been in effect for years 2020 to 2024. The 10th to 90th percentile are less than +-10% for all clients. The upper range increases to about +13% for the 95th percentile, while a few cases (mainly SCI), exceed that threshhold due to a higher allowed limit on risk margin, which calculates a margin of between 20 and 30% for some SCI cases. There were 13 such cases for the 4 largest carriers and 30 overall for the 5 year period.

Average Price Changes
Primary Payer Count Mean 5th Percentile 10th Percentile 90th Percentile 95th Percentile
AIG Technical Third Party Oversight 70 -3.11% -8.32% -7.43% 3.37% 4.65%
Chubb 248 0.18% -9.12% -7.84% 9.80% 13.13%
Travelers 145 0.45% -8.49% -6.91% 9.40% 13.37%
Zurich North America 360 0.92% -7.20% -4.95% 8.53% 12.20%

The following charts show the dispersion of price changes about the mean

This table shows the ranges by diagnosis, which indicates the largest potential impact in SCI and ABI cases.

Average Price Changes by Diagnosis
Primary Payer Diagnosis Type Count Mean 5th Percentile 10th Percentile 90th Percentile 95th Percentile
AIG Technical Third Party Oversight ABI 28 -0.79% -7.60% -5.85% 3.85% 7.23%
AIG Technical Third Party Oversight Amputation 4 -1.59% -5.32% -4.90% 1.63% 1.98%
AIG Technical Third Party Oversight Burn Injury 8 -3.40% -8.27% -7.28% 0.00% 0.00%
AIG Technical Third Party Oversight Multiple Trauma 18 -4.29% -8.12% -7.60% -1.05% 0.85%
AIG Technical Third Party Oversight Other 1 3.32% 3.32% 3.32% 3.32% 3.32%
AIG Technical Third Party Oversight SCI 11 -2.70% -10.92% -10.53% 4.39% 4.62%
Chubb ABI 81 1.32% -6.95% -5.09% 9.89% 10.88%
Chubb Amputation 36 -2.54% -6.26% -5.82% 0.76% 2.40%
Chubb Burn Injury 23 1.35% -6.58% -6.06% 13.70% 14.70%
Chubb Multiple Trauma 68 -3.87% -8.12% -8.04% -0.58% 0.00%
Chubb Other 1 -9.13% -9.13% -9.13% -9.13% -9.13%
Chubb SCI 39 0.70% -14.05% -13.62% 17.72% 23.12%
Travelers ABI 75 1.17% -7.10% -5.11% 10.01% 12.95%
Travelers Amputation 4 -4.03% -6.93% -6.48% -1.85% -1.59%
Travelers Burn Injury 12 -1.35% -7.93% -7.27% 2.70% 7.30%
Travelers Multiple Trauma 28 -2.79% -6.87% -5.68% -0.61% 1.14%
Travelers SCI 26 1.17% -10.86% -9.74% 15.58% 17.23%
Zurich North America ABI 93 2.99% -4.98% -4.19% 11.02% 13.86%
Zurich North America Amputation 58 2.64% -5.73% -5.71% 7.60% 10.12%
Zurich North America Burn Injury 33 2.68% -3.37% -1.39% 7.54% 9.91%
Zurich North America Multiple Trauma 131 -0.51% -4.85% -3.69% 3.04% 3.84%
Zurich North America Other 2 -7.81% -13.50% -12.87% -2.75% -2.11%
Zurich North America SCI 43 -0.03% -12.93% -11.31% 17.36% 21.90%

Now we show the average price changes for Zurich if we hold the gross margin constant and only change risk margin, and vice versa

Zurich Price Change due to Risk and Gross
Diagnosis Type Count Risk Change Gross Change Total Change
ABI 93 1.00610 1.0231 1.02997
Amputation 58 0.97643 1.0283 1.00446
Burn Injury 33 0.98433 1.0373 1.02059
Multiple Trauma 131 0.95691 1.0314 0.98564
Other 2 0.86191 1.0373 0.89006
SCI 43 0.97311 1.0412 1.01227
Top 4 Price Change due to Risk and Gross
Diagnosis Type Count Risk Change Gross Change Total Change
ABI 277 0.99897 1.0147 1.01400
Amputation 102 0.97186 1.0173 0.98885
Burn Injury 76 0.96731 1.0324 0.99856
Multiple Trauma 245 0.95811 1.0206 0.97720
Other 4 0.90896 1.0210 0.92228
SCI 119 0.98171 1.0382 1.01822

Below is the price change per year for Zurich

Zurich Effective Year Price Change due to Risk and Gross
Effective Year Count Risk Change Gross Change Total Change
2020 51 0.96826 1.0325 0.99876
2021 66 1.00200 1.0340 1.03605
2022 63 1.00128 1.0369 1.03909
2023 75 0.96527 1.0224 0.98591
2024 105 0.96286 1.0305 0.99095

And for the Top 4

Top 4 Effective Year Price Change due to Risk and Gross
Diagnosis Type Count Risk Change Gross Change Total Change
2020 143 0.98270 1.0184 1.00025
2021 157 0.99503 1.0284 1.02341
2022 138 1.00712 1.0251 1.03368
2023 194 0.96382 1.0190 0.98116
2024 191 0.95778 1.0247 0.98014

The increase of price for Zurich is due to the higher proportion of sub-500K contracts compared to the average. The second table shows an average increase for Zurich of almost 6% in gross margin for sub-500K contracts, with a new gross margin of 30%

Claim Budget Breakdown Top 4 Payers
Budget/Payer AIG Chubb Travelers Zurich Total
A- 0-500K 15 (21.4%) 80 (32.3%) 17 (11.7%) 143 (39.7%) 255 (31.0%)
B- 500-750 12 (17.1%) 42 (16.9%) 24 (16.6%) 58 (16.1%) 136 (16.5%)
C- 750-1M 16 (22.9%) 45 (18.1%) 32 (22.1%) 66 (18.3%) 159 (19.3%)
D- 1M-1.25M 7 (10.0%) 29 (11.7%) 20 (13.8%) 29 (8.1%) 85 (10.3%)
E- 1.25M-1.5M 3 (4.3%) 16 (6.5%) 17 (11.7%) 18 (5.0%) 54 (6.6%)
F- 1.5M-1.75M 8 (11.4%) 10 (4.0%) 19 (13.1%) 25 (6.9%) 62 (7.5%)
G- 1.75M-2M 3 (4.3%) 9 (3.6%) 7 (4.8%) 8 (2.2%) 27 (3.3%)
H- 2M-2.5M 2 (2.9%) 12 (4.8%) 4 (2.8%) 8 (2.2%) 26 (3.2%)
I- 2.5M-3M 2 (2.9%) 3 (1.2%) 1 (0.7%) 1 (0.3%) 7 (0.9%)
J- Over 3M 2 (2.9%) 2 (0.8%) 4 (2.8%) 4 (1.1%) 12 (1.5%)
Total 70 (100.0%) 248 (100.0%) 145 (100.0%) 360 (100.0%) 823 (100.0%)
Zurich Price Change by Claim Budget
Claim Budget Count Risk Change Gross Change
A- 0-500K 143 0.97225 1.0588
B- 500-750 58 0.96632 1.0233
C- 750-1M 66 0.97386 1.0205
D- 1M-1.25M 29 0.97024 1.0063
E- 1.25M-1.5M 18 0.97769 1.0250
F- 1.5M-1.75M 25 1.00131 1.0282
G- 1.75M-2M 8 0.98750 1.0364
H- 2M-2.5M 8 0.97454 1.0405
I- 2.5M-3M 1 1.12195 1.0147
J- Over 3M 4 0.99874 1.0507

Next we show the loss ratio based on the original contract price v the new contract price

Loss Ratio Comaprison
Payer Current Price New Price
AIG Technical Third Party Oversight 71.00% 73.28%
Chubb 74.82% 74.68%
Travelers 74.17% 73.84%
Zurich North America 70.91% 70.26%
Loss Ratio by Effective Year
Payer Effective Year Current Price New Price
AIG Technical Third Party Oversight 2020 66.70% 66.11%
AIG Technical Third Party Oversight 2021 83.88% 86.63%
AIG Technical Third Party Oversight 2022 73.17% 73.13%
AIG Technical Third Party Oversight 2023 71.36% 74.30%
AIG Technical Third Party Oversight 2024 65.41% 69.23%
Chubb 2020 64.99% 65.16%
Chubb 2021 80.41% 78.91%
Chubb 2022 80.27% 77.30%
Chubb 2023 69.45% 71.42%
Chubb 2024 76.13% 77.89%
Travelers 2020 74.39% 74.27%
Travelers 2021 74.12% 72.21%
Travelers 2022 74.83% 73.06%
Travelers 2023 73.31% 73.78%
Travelers 2024 75.03% 76.25%
Zurich North America 2020 66.88% 66.96%
Zurich North America 2021 77.61% 74.91%
Zurich North America 2022 68.44% 65.87%
Zurich North America 2023 65.14% 66.07%
Zurich North America 2024 74.23% 74.91%
Bookends Before and After
Bookend Current New
L 139 132
N 1358 1378
W 284 271