The convergence of Wall Street’s meltdown, falling insurance industry surplus, uncertainty over the future of medical care financing and a persistently soft commercial lines market has created a perfect storm of challenges for liability carriers covering long-term-care facilities. To survive and prosper, health care liability underwriters must therefore stay focused on core competencies and use best practices with risk selection and pricing.

This market will not reward cash-flow-conscious or creative but unprincipled underwriters. Such mavericks could be in store for a world of hurt as this market unfolds. Ignoring the simple principle of whether each individual risk placement strengthens the book as a whole might boost the top line in the short run, but the bottom line result could be quite messy.

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