1.1. Summary

A member of the PPO Working Party at a meeting in 2014 asked, “what do we actually mean when we say a PPO?”. The members then challenged themselves to define what a PPO is, in a single sentence. They approached this from the point of view of the inception of an insurance policy, on which a PPO may later arise. After debate and deliberation, they arrived at:

Seemingly exhaustive, even this does not fit all PPOs. For example, some are indexed to the Retail Prices Index (RPI) rather than wage inflation and not all PPOs are for the whole life of the claimant. This definition does, however, set out the main challenges for actuarial professionals working with PPOs.

This paper consolidates the skills and experience of a wide range of actuarial practitioners who, in aggregate, have many years of experience learning about PPOs as they lead thought on this new area. This paper is not professional guidance or advice. Instead, this paper sets out ideas to provoke thoughts on assessing risk, modelling it and communicating it for actuarial professionals working in reserving, capital modelling and pricing.

It starts with a discussion of the background to PPOs and the risks associated with them, before moving on to specific discussions of the issues they present for data gathering and assumptions setting, best estimate valuations, capital modelling, pricing and financial reporting.

The Courts Act 2003 and subsequent court decisions defined the current form of PPOs, igniting a new challenge for general insurance practitioners. Not simply annuities, and certainly not general insurance risks, PPOs still provide a challenge today, especially for those encountering them for the first time and also for more experienced practitioners.

This new settlement method has brought about new risks to consider for actuarial professionals working in motor and casualty insurance, or any other line where a claim for future economic loss may arise in the United Kingdom.

Life contingencies have entered the sphere of general insurance in a new way. PPO claimants, upon whose life the payments are contingent, typically have brain and spinal injuries. The measurement of impairments to life expectancy from these conditions had not been explored extensively by actuarial professionals previously, and, due to lack of data, actuarial research is currently in the early stages of development. This makes it an even greater challenge for general insurance actuaries unfamiliar with longevity risk. There is risk from the level of mortality, projected trends and the inherent volatility of sometimes very small portfolios, where the difference between the life expectancy and the actual survival period can be very different.

As a relatively new settlement method, the propensity of PPOs is highly uncertain and presents a risk in itself.

Other risks, more common to life insurance, are important for PPOs owing to the very long expected duration of typical cases. Actuarial professionals have investment risk to consider, and for PPOs the inflation risk is unusual, significant and not currently fully hedgeable. There are two inflationary pressures acting: the indexation of periodical payments; and the inflation acting on the initial payment amount between the loss date and date of sealing the order, which has additional considerations beyond indexation reference, such as the attitude to which future losses should be included to indemnify the claimant.

Some PPOs also have an unusual risk written into them. They can allow for a change in the annual payment separately to periodical indexing, where a predefined event triggers the right for these amounts to be reassessed. This is often referred to as a variable PPO.

Long durations also pose further risks from the extended time periods: the length of exposure to counterparty default risk is longer; and administration is over longer timescales and may have implications in setting claims handling reserves for expenses.

Being complex and relatively novel, additional operational risk arises from the existence of PPOs. PPOs require additional data to be captured.

General considerations for gathering data and setting assumptions for PPO valuation models highlight that economic assumptions are likely to be linked to each other, and cannot be set in isolation. Other assumptions may also be interlinked. This paper highlights methods that could be considered when setting mortality assumptions, some of which may become more feasible as time progresses and more data becomes available, both internally and from external sources such as industry data and other jurisdictions.

From a reserving perspective, it is important to remember that the nature of the liabilities does not lend itself to triangulation. On top of bespoke general insurance methods, for example, determining propensities for claims to settle as PPOs, it is important to value the PPO amount using cash flow techniques. Cash flows allow for more explicit discounting as well as the timing and value of reinsurance recoveries. Keeping track of what proportion of PPOs is already reserved for in claims system estimates and accompanying projections is also an important challenge that the reserving actuary must overcome.

Models can be constructed with different levels of complexity. Regardless of whether a relatively straightforward deterministic cash flow model or a complex stochastic model is used, it should allow for reinsurance arrangements that are in place, mitigating risk by transferring it. This can be a complex area to understand, as it is common for treaties to have indexation clauses that will interact with the periodical payments.

No estimate would be complete without checking the sensitivity of the calculation and applying real-world scenarios to highlight risks.

Common to chain ladder reserving, but determined very differently, the actual-versus-expected results can be analysed for discount rate unwinding and mortality profit, for example.

The paper also explores the basic considerations for modelling a range of possible outcomes in the Capital Modelling section. Stochastic modelling is considered, with the need to balance parsimony with sophistication. Again, stress and scenario testing is an important consideration for validating models that have been created, especially since PPOs present accumulations of risks, dependencies between them and may need to capture behaviour over relatively long time horizons compared to other general insurance risks.

Pricing is another area in which PPOs should be considered. Large loss loadings may need adapting to allow for PPOs. Estimates of the propensity and uplift can be made to help assess this aspect, not forgetting key interactions such as those between reinsurance and capital. Pricing PPOs is obviously a more significant issue for inwards reinsurers of motor and other casualty business.

Common to all actuarial work, but essential in a growing, fairly new liability, is the importance of clear communication. This includes informing users on the limitations of work. For example, a capital model under a 1-year time horizon may give a much reduced sense of the level of risk to ultimate. The clarity and straightforwardness of communication is essential in gaining buy-in when taking decisions which lead to increased liabilities or acknowledgement of higher risk in a firm. Both of these may be essential for a firm’s long-term financial strength.

Consequently, the paper also touches briefly on reporting requirements. This is to help provide a start for actuaries interacting with those undertaking financial reporting. The main learning is that PPOs can again lead to new requirements. These requirements may differ for different financial statements, with two obvious and common distinct types being statutory and regulatory returns. Furthermore, it is important for those working in reserving, pricing and capital modelling to understand how their work will affect the financial results of their company or client if they are a consultant. Increased communication with financial reporting professionals may be needed to aid understanding on both sides. Requirements will vary depending on each reporting basis and the sanctions and consequences of inaccurate financial statements can be very severe.

This paper is just a starting point for actuarial professionals working with PPOs. With the valuation of PPOs often being highly sensitive to the assumptions, it is important that practitioners continue to build their skills in order to gain a comprehensive understanding of the liabilities. PPOs will evolve as a settlement method over time, so actuarial practitioners will need to stay aware of developments arising and act on them accordingly.

Given the long-term nature of the liabilities, professionalism and ethics are also very important. Most people reading this paper have a strong chance of retiring before the liabilities they model are run-off. The long-term implications for the adequacy of the reserves and the business strategy should be considered when working with PPOs, as the claimants, fellow employees and company shareholders may all be depending on practitioners responsibly innovating to accurately model these relatively new liabilities for many years to come.

1.2. Recommendations

As with any new area, the recommendations for actuarial practitioners working with PPO liabilities revolve around increasing their knowledge of the nature of the liabilities and informing their stakeholders about PPO risks in the context of the firm’s wider business.

This includes the actuarial practitioner:

• ∙ increasing their knowledge on the features and risks of PPOs, and we hope they find this paper useful as a starting point;

• ∙ considering the most appropriate method of modelling PPOs in context of the business model and risk profile of the firm. Depending on materiality, this will normally mean using cash flow models, which are uncommon in general insurance;

• ∙ communicating the risks of PPOs to key stakeholders including the administrative, management or supervisory body of the firm;

• ∙ keeping up to date with developments in the external environment, for example, the impact of legal changes; and

• ∙ proactively working with connected practitioners and in particular life insurance actuaries to support each other, for example, supplying cash flows and risk information to asset management teams, working with accounting practitioners preparing financial statements involving PPOs, or working with claims professionals to understand the nature of the liabilities.

In order to provide future generations with greater mortality data on PPOs, we urge insurers to start classifying large losses and PPOs using the PPO Injury Classification developed by the PPO Working Party and industry partners. The classification is of the severity of claimants’ injuries and the degree of future care they may require. Please see Further Reading section for a link to both further information and the classification system itself.

PPOs also challenge an actuarial practitioner’s professionalism with a requirement to balance stakeholders’ needs against a background of very long duration liabilities which exist to support individuals that have suffered life-changing injuries and need care for the rest of their lives.

Continued professional development in this area is therefore important, in terms of keeping up to date with thought leadership on technical actuarial modelling of PPOs, keeping abreast of changes in the external environment and continuously taking into account the principles of the Actuaries’ Code.

2.1. Document Organisation

All actuarial professionals can benefit from the background covered in section 3 and description of risks in section 4.

Specifically, reserving topics are covered in:

• ∙ section 5 investigating data requirements and assumption setting;

• ∙ section 6 exploring valuation techniques; and

• ∙ section 9 regarding reporting.

For pricing practitioners, on top of the background and risk overview there is a dedicated discussion of pricing issues in section 8. In addition, section 5 covers assumption setting in more detail.

There is also separate discussion of the issues which arise for those working in capital modelling in section 7. In addition, section 5 explores data requirements and assumption setting for PPO models in general in more detail. Section 9 includes regulatory reporting.

To highlight which area is being covered in each section, we have used the following icons at the start of each section:

2.2. Scope

This paper is primarily intended to cover the valuation of PPO liabilities in reserving, capital and pricing modelling. Although assets are commented on in regards to the risks of assets and liabilities moving independently, the paper is not intended to cover considerations on the asset side of the balance sheet such as a detailed exploration of appropriate investment strategies and asset-liability management. Further information on this can be found elsewhere including in a paper written by the PPOs Working Party (2014a).

In addition, the starting point of the paper is to assume that any large loss metrics used to build up PPO reserves have been reserved for adequately. This paper does not seek to discuss methods to project large losses in general.

The paper is specifically focussed on PPO liabilities arising from UK insurance policies, and does not discuss similar liabilities which may arise in other jurisdictions. While there is a bias towards the considerations relevant to direct insurers, the majority of the issues discussed are equally applicable to reinsurers.

3.1. Legislative Background

In the United Kingdom, before PPOs, structured settlements had been in use since 1989 (Periodical Payments and the Courts Act Working Party 2005, page 5). With structured settlements, part of a claim is settled as a lump sum and part as a recurring payment. The Damages Act 1996 (Her Majesty's Stationary Office, 1996) gave the courts the power to order a structured settlement, if both parties agreed. Section 100 of the Courts Act 2003 (Her Majesty's Stationary Office, 2003a) was implemented on 1 April 2005 and permitted courts in England, Wales and Northern Ireland to impose periodical payments as part of a settlement, even if neither party consented to it. The explanatory notes to the Act set out the aim of the legislation: “to promote the widespread use of periodical payments as the means of paying compensation for future financial loss in personal injury cases” (Her Majesty’s Stationary Office, 2003b, page 224).

Whilst Scots law at present differs in regards to the imposition of PPOs from that of England and Wales, the Scottish Government has stated that they intend to: “provide Scottish courts with a power to impose a periodical payment order and to vary such orders in the future” (The Scottish Government, 2013). In practice, the imposition by courts of PPOs has not been extensively exercised, with only about 6% of the cases decided upon by the court being settled by way of a PPO, based on insurance industry data at the end of 2013 (PPOs Working Party, 2015a). This implies that most PPOs are agreed out of court before being sealed.

Since the landmark Thompstone case (Court of Appeal, 2008) and stock market crash in 2008, PPO settlements have become commonplace. The Thompstone judgement allowed index linking of the annual payments to care workers’ wage inflation instead of the historically lower RPI, making PPOs more attractive to claimants. At present it appears that they will remain an important method of settlement in the future. The Ministry of Justice’s second Discount Rate Consultation Paper for use with the Ogden tables issued on 12 February 2013 asks whether there are any issues relating to the “possible encouragement of the use of periodical payments” or whether the present level of usage of PPOs “is appropriate and no change is necessary” (Ministry of Justice, 2013).

Further information on the legal background can be found in earlier papers from the PPO Working Party, including the 2010 General Insurance Research Organising Committee (GIRO) Paper (PPOs Working Party, Reference Orr2010).

The legal framework that defines PPOs has changed over the years. Further changes in the future can clearly have profound effects on the propensity of claims to settle by means of a PPO and their subsequent value.

3.2. Features of a PPO

The description of the features of a PPO that follows is based on the PPO Working Party’s 2010 GIRO Paper (PPOs Working Party, Reference Orr2010).

Although PPOs can be used to settle any claim resulting from future economic loss, most orders awarded to date are for a subset: future care costs, with case management costs frequently included. Large future care costs tend to arise as a result of brain and spinal injuries. Typically, claims settling with PPOs include an initial lump-sum element to cover large upfront expenses, such as setting up appropriate accommodation, as well as future economic losses not settled as a periodical payment. It is quite common for economic loss and loss of earnings to be settled by lump sums rather than periodical payments. This gives flexibility in award levels.

The amount of the periodical payment will reflect the level of the future economic loss covered by the order and the needs of the individual claimant. The initial award is adjusted in future periods in line with changes to a specified index or survey, as detailed below.

The length of time a PPO specifies payments to continue will vary by head of damage. The claimant is generally eligible for future care costs for the remainder of their life. The payments in the order can be structured to reflect the changing needs of the claimant. An example is a stepped PPO: this will include a specified change to the award, at an identified future date. The change in payment amount could be to reflect the ageing of key carers, such as parents or spouses, or a greater need for care in old age. Economic loss or loss of earnings is likely to be paid up until retirement, or death if earlier. In cases where there is a fatality, periodical payments to dependants are likely to be set up until each dependant reaches a particular age.

Where there is uncertainty in the future course of a condition, the PPO may be a variable order, which either allows claimants to seek additional payments if a pre-specified trigger event occurs as a result of the original accident or the potential to reduce the amount if the condition improves in a pre-specified way. This is different to a lump-sum settlement alternative, where such protection is not usually part of the settlement.

The size of the award will take into account any contribution made by the local authorities. Where there are such payments, some insurers decide to pay all of the costs and require monies paid by the local authority to be repaid, whilst others pay the amount net of local authority funding. In the latter scenario, the PPO may include a review clause or indemnity guarantee against the possibility statutory funding is reduced or withdrawn at a later date.

A PPO is typically set up as an annual or semi-annual payment, payable in advance. To receive the payment, the claimant or claimant’s representative must provide proof of life, usually at least annually. On the claimant’s death, overpayment can be returned to the insurer, though due to the sensitive nature of such requests, insurers may need to assume differently.

3.3. Prevalence of PPOs

In the United Kingdom, at the time of writing, there are PPO settlements in payment for motor, public liability, employers’ liability and clinical negligence claims. In theory PPOs can arise on any policy where there is an element of liability cover, including household cover. In practice low liability limits might limit the attractiveness of PPOs compared to lump sums. A lump sum is a discounted value of future payments and once invested may provide a total sum that is greater than the limit of indemnity after the settlement, assuming lump sums are discounted at positive rates of interest. A PPO payment stream is not discounted and so will reach the limit sooner.

There is wide variation in the prevalence of PPOs both by class of business and by insurer. The propensity for a large claim to settle as a PPO has been higher to date on motor than on employers’ liability and public liability products. This may be due to motor cover being unlimited in the United Kingdom and the previously discussed limits of indemnity for employers’ liability and public liability.

The prevalence of PPOs is also highly influenced by the market environment. As PPOs are indexed, if there are concerns that inflation may be higher than is embedded within the Ogden discount rate then a PPO may be preferred, all else being equal. Also, as the claimant receives the payments periodically, rather than a discounted lump sum, PPOs may be preferred if the investment returns embedded within the Ogden discount rate are higher than is achievable on the investment markets for the claimant’s attitude to risk. Consequently, it can be seen that the attractiveness of a PPO to a claimant will also be heavily dependent on the Ogden discount rate, which can be at odds with short-term economic conditions and concerns.

Other jurisdictions outside of the UK settle claims using various forms of periodical payments. The exact nature varies by country and also by product within the country. An annual amount that increases with inflation is paid in some countries and in others the required care costs are reimbursed. The PPO Working Party plans to publish a website providing its understanding of how several different jurisdictions settle claims soon. This will be available on the Working Party’s website, as provided in section 11.

3.4. Initial Actuarial Response

Since the introduction of PPOs, actuaries have continued to develop the sophistication of their models used for reserving, capital modelling and pricing for PPOs.

In reserving, the initial response was to use life techniques to value settled PPOs for the purpose of setting the reserves. Alongside this, models for capital analyses have developed in more recent years as consideration of the impact of these long-term liabilities on capital requirements has increased. Developments in pricing of direct business for PPOs has been slower, as large loss loadings are often very uncertain, as they are from an unknown third party and actual experience is volatile.

Reserving models of PPOs have developed over time. The distortion that PPO claims introduced to claims triangles forced practitioners to separate out these claims and consider them independently. The emerging changes to the regulatory environment, namely Solvency II, crystallises this requirement.

Initial reserving models generally used an annuity certain approach, typically taking into account:

• ∙ life expectancy – based on medical evidence to provide the expected length of payments;

• ∙ future inflationary and stepped increases;

• ∙ future investment returns; and

• ∙ indexation clauses within the reinsurance treaties.

The approach to potential future PPO claims was more varied. Many relied on claims handlers’ or solicitors’ advice to identify future PPOs, based on the severity or type of claim. The approach to calculate reserves for future PPOs used a combination of expected future numbers of large claims, the proportion of large claims expected to settle by way of a PPO, and the uplift to cover the higher PPO costs arising from real discount rates being lower than that prescribed to value lump-sum settlements, namely the discount rate prescribed for use with the Ogden tables, currently at 2.5% p.a. Allowances for Pure Incurred But Not Reported (IBNR) PPOs (those claims that at the point of valuation have not yet been reported) were not common historically, but have become a consideration in more recent years. A loading is often applied either in conjunction with the potential future PPOs currently identified as large claims or separately.

Over time, the models of PPO liabilities have moved from an annuity certain basis, to approaches using probability-weighted mortality, and adjusted life tables. Whilst we can only speculate as to the reasons for this, it is likely that the possibility that over time, if the claimant lived longer than initially expected, the two reserve estimates would materially diverge may have contributed to the trend. When cases do live beyond their life expectancies, probability-weighted mortality would more accurately reflect the reserve required and the expected reinsurance recovery.

3.5. Growth in PPO Reserves

Each year, newly settled PPOs are added to prior years’ PPOs already in payment. At present there have been few deaths amongst PPO claimants since 2008, when PPOs first became a commonly used method of settlement. This is in line with expectations. It will be many decades until the flow of new settlements is balanced by older PPOs ceasing to be paid. This means that the majority of individual insurers should expect that their PPO reserves will grow over time, and this should be reflected in their business plans. As the proportion of reserves held for PPOs grows relative to overall claims reserves, general insurers’ balance sheets may start to look more and more like those of life insurers (PPOs Working Party, 2014a).

4.1. Overview

The risk profile of PPOs has features that are not typically seen in other general insurance liabilities, or that are not seen to the same degree. It is important that this is communicated clearly by actuarial practitioners. A firm’s administrative, management or supervisory body need to understand the risks their firms are exposed to, recognising both the current risk profile and how this might change in the future. This will enable them to make informed decisions about their risk appetite, risk mitigation strategies, and ultimately make a risk and reward assessment of their participation in business lines which can be affected by PPOs.

We consider the risk profile of PPOs below, with a focus on risks that are either not present, or are less significant, for more typical general insurance liabilities. The risks we shall discuss in this section are:

• ∙ longevity risk;

• ∙ propensity risk;

• ∙ inflation risk and indexation risk;

• ∙ interest rate risk and other market risks;

• ∙ variable orders;

• ∙ counterparty credit risk;

• ∙ operational and expense risk; and

• ∙ additional considerations.

This is by no means an exhaustive list of all risks that an insurer with PPO liabilities should consider, but provides a structured way in which to consider the key risks arising from PPOs. Actuarial practitioners working on PPOs may wish to engage with colleagues responsible for an insurers risk identification processes and ensure that PPOs are being appropriately considered.

Furthermore, although discussions of risk often revolve around the downside, there may be material upside risks on PPOs. Claimants may survive for shorter periods than expected, propensities may fall, and inflation may be lower than expected. With such long-tail risks, at a relatively early stage in their emergence as a settlement method, PPO valuations are likely to be materially different from the ultimate result, and this could be in either direction.

4.2. Longevity Risk

Longevity risk is the risk of loss, or of adverse change in the value of insurance liabilities, resulting from changes in the level, trend, or volatility of mortality rates, where a decrease in the mortality rate leads to an increase in the value of insurance liabilities (European Insurance and Occupational Pensions Authority (EIOPA), 2009, page 5).

Once a claim is settled as a PPO, the term of future payments is contingent on the claimant’s survival. The longer the claimant lives, the more the insurer has to pay. This introduces longevity risk, which is not a typical feature of general insurance liabilities. Longevity risk is a common feature of annuity contracts, and consequently data and research on longevity is available. However, PPOs have characteristics that would be considered atypical for conventional annuities and hence have their own longevity considerations. In particular, PPO claimants are typically significantly younger than conventional annuitants. The average PPO claimant is around 35–40, but claimants can be in their teens or younger (PPOs Working Party, 2015a). In addition, the nature of their injuries means that they often have impaired life expectancy.

Impaired lives referred to in the context of life insurance products do not typically involve brain and spinal injuries. The term instead usually refers to people who have chronic conditions, such as heart disease, diabetes or cancer, and usually the products are for older lives than PPOs. This makes PPO longevity risk unusual and uncertain, and consequently risk transfer to a third-party may be significantly more difficult and costly.

Longevity risk can be decomposed in a number of ways. For the purposes of the discussion in this paper, longevity risk has been split into three sub-risks:

• ∙ Level risk: the risk that the base mortality rates have been estimated incorrectly at the outset.

• ∙ Trend risk: the risk that expected future mortality changes have been estimated incorrectly.

• ∙ Volatility risk: the risk that, even when the base mortality rates and mortality trend have been estimated correctly, individual life spans could still deviate from the average life expectancies.

4.3. Propensity Risk

Propensity risk refers to the uncertainty associated with the future propensity for individual claims to settle by way of a PPO, rather than a lump-sum settlement.

Whilst dependent on the assumptions adopted when valuing PPOs, at the time of writing it is typically the case that a PPO settlement has a higher expected cost than a lump-sum settlement on equivalent terms (PPOs Working Party, 2015a). This is a result of the current market-consistent real rates of return being significantly lower than the 2.5% p.a. real discount rate for lump-sum settlements. The risks associated with a lump-sum settlement are also largely extinguished at the point of settlement, whereas the risks associated with a PPO settlement will continue until the death of the claimant. An increase in the propensity for claims to settle as PPOs will therefore tend to have an adverse effect on both a firm’s best estimate liabilities and its capital requirements.

Propensity can be affected by a number of factors. These include, but are not limited to:

• ∙ changes arising from court precedent, for example, the Thompstone case (see section 3.1);

• ∙ changes in the discount rate prescribed for use with the Ogden tables used in valuing lump-sum settlements;

• ∙ changes in the wider economic environment, which may influence the perceived value of a PPO settlement compared to a lump-sum award;

• ∙ changes in social trends influencing claimants’ preferences or changes in the claims handling practices of the insurer.

Figure 1 shows the propensity for a claim above £1 million (in the 2011 settlement year, indexed at 7%) to settle with a PPO, based on data as at the end of 2013. It shows a very approximate chain ladder estimate of a potential expected ultimate position together with the corresponding approximate 10^th and 90^th percentiles using Mack variability and assuming a normal distribution capped at 100% and collared at 0%. (The actual percentiles may be much wider due to the low volume of condensed data used to estimate the percentiles; PPOs Working Party, 2014b.)

Figure 1

Potential accident year Periodical Payment Order (PPO) propensities

For an insurer settling low numbers of large bodily injury claims, the inherent risk of whether or not specific large bodily injury claims do, or do not, settle as PPOs can also be significant, even if the rate could be predicted with certainty.

At the time of writing the discount rate for lump-sum settlement is 2.5% p.a. Compared to a market-consistent valuation a lump-sum valued using a 2.5% p.a. real rate of return would seem to give a lower economic value, all things considered. The table below highlights the impact of different discount rates. Table 2 shows the difference in the Ogden discount factor (7^th edition) for a 35-year-old male. For a negative 1.5% factor, the reserve for cost of care would be 200% higher, and thus a lump sum with this discount rate would change the relative economic attractiveness significantly, thus highlighting the importance of this assumption to PPO propensity.

Table 2

Impact of Different Discount Rates

There is a considerable degree of uncertainty over the value of the discount rate used to value lump sums in the future.

4.4. Inflation and Indexation Risk

Inflation risk refers to the risk that the future indexation of payments under a PPO award differs from that anticipated.

As with many other features of PPOs, it is not the case that actuarial practitioners can rely solely on the experience of annuity providers writing index-linked annuities, as there are significant differences between the indexation arrangements for PPOs compared to typical annuity products.

First and foremost, future payments for PPOs tend to be linked to a percentile of ASHE 6115, although other indices are also used (PPOs Working Party, 2015a). ASHE 6115 is an ONS survey of the wages for care assistants and home carers (ONS, 2013). If we consider traditional index-linked annuities, these tend to be linked in some way to price inflation (RPI, or a function of RPI such as Limited Price Inflation). Whilst there is a deep and liquid market in RPI-linked assets, there are not currently any investment products widely available that provide a return linked to general wage inflation, let alone changes in the wages of a specific percentile of a specific sector of employment. Therefore, there do not appear to be assets at present that can be used to completely match liabilities that are linked to ASHE 6115 (Clarke et al., Reference Clarke, Lee and Jamieson2013).

The consequence of this is that, given the long duration of PPO liabilities, uncertainty in the level of ASHE 6115, or any other indexation method other than RPI, is typically a material risk to an insurer with PPO liabilities, which is very difficult to mitigate.

The levels of RPI and ASHE 6115 depend on the relative supply of and demand for products and services and care assistants’ labour, respectively. Phenomena such as these are impossible to predict accurately over a very long timeframe. Care workers’ wage inflation could be materially different from general wage inflation in the future, especially since it is an area of the economy that has the potential to be distorted by the actions of the state. This gives insurers a challenge in selecting values for ASHE 6115 in valuing PPO liabilities and also in matching those liabilities with suitable assets.

When considering the risk from ASHE 6115 linkage, actuarial practitioners may in some cases choose to deconstruct the indexation into the RPI component and the difference between the ASHE survey and RPI. Where the RPI component of the liabilities is well-matched with RPI-linked assets in the firm’s current asset portfolio and future investment strategy, the RPI inflation risk can be considered in a more traditional way and any mitigation from liability matching considered. When analysing the risks inherent in the difference between ASHE indices and RPI, actuarial practitioners may consider the general level of wages in the economy compared to RPI and the extent to which the trends in care workers’ wages may differ from those of the general population.

ASHE 6115 has historically been the most common survey to which PPOs are linked. As explained in the Background section, in 2012 the ONS stopped publishing ASHE 6115 within the main body of the ASHE data, and reclassified the index in two parts. At some point, the ONS may stop producing the ASHE 6115 data, and although many PPOs have a formula in the order to adjust for previous and future basis changes, there is uncertainty as a result. What is a similar survey or index, when the original is so specific? There is a risk of indexation basis change across the portfolio if ASHE 6115 were to be discontinued.

For PPOs not yet in payment, insurers are also exposed to another source of inflation risk between the valuation date and the date of settlement. Future award levels may differ from those awarded historically, for example, due to changes in the structure of care regimes proposed, or changes in the scope of costs covered by PPOs. For those settling out of court especially, there are also influences from the relative negotiating powers of the claimants’ and defendants’ representatives. This source of inflation is similar to but not the same as typical large claims inflation, and is easy to overlook when so much focus is on the indexation of the periodical payment award once in payment. An example of a source of inflation to the initial amount is allowing for support for carers to assist with holidays, on top of regular home care assuming no support.

Figure 2 shows the interaction of the two types of inflation risk described above on the size of annual PPO payments.

Figure 2

Impact of inflation on Periodical Payment Order awards

4.5. Interest Rate Risk and Other Market Risks

4.6. Variable Orders

PPOs which are variable orders give even greater uncertainty as to the amount of future payment amounts. This is because variable orders allow the annual award to be revalued to reflect changing care needs of the claimant, linked to the development or improvement of specified medical conditions.

There is very little past experience and information available (PPOs Working Party, 2015a, page 37) either to estimate the proportion of variable orders which might be triggered as a consequence of changing medical conditions or to address the average level of award increase, or decrease, resulting from a variable order being triggered. When valuing future PPOs, consideration would also be required of the proportion of future PPOs that might be variable, including whether they could be specified for different conditions or scenarios than currently specified.

Whilst it is generally anticipated that the triggering of variable orders will lead to an increase in award levels, it is possible for a variable order to result in a reduction in the award level. This would be possible in the event of a pre-specified improvement in a claimant’s medical condition, which reduces their care requirement. Furthermore, changes in award levels may indicate that the claimant’s future mortality may have also changed in the opposite direction. For example, a deterioration in a claimant’s condition triggering the variation, may increase annual payments amounts but reduce life expectancy.

4.7. Counterparty Credit Risk

Counterparty credit risk refers to the potential for an insurer to suffer financial loss due to the failure of another party to meet its obligations as they fall due. The most notable exposure is often to reinsurers, but other sources of potential exposure can arise.

4.8. Operational and Expense Risk

Operational risk refers to the risk of failure of people, processes or systems leading to an increased level of cost for an insurer, either through higher direct expenses, or regulatory censure. Expense risk refers to the risk of a firm’s future expenses being different than anticipated.

Whilst general insurers are used to considering operational and expense risk, a liability which requires payment on a regular basis over many decades is different to typical general insurance liabilities.

PPOs are still fairly new, so the chance of errors by people, processes and systems not designed for this settlement method is high. It is important to consider the differences in claims handling requirements, system requirements, data requirements, reporting requirements and actuarial modelling requirements that are introduced by PPOs. Reinsurance wordings may be complex surrounding recoveries on PPOs and therefore, require greater attention by insurers. After taking into account the current control framework, actuarial practitioners should consider any residual operational risks faced by insurers when managing PPO liabilities, and look to continually increase the robustness of the control framework.

The long-term nature of PPO liabilities means that the level of expense provisions which need to be set aside to cover on-going claims handling expenses needs to be carefully considered, alongside the risk that actual expenses differ from those projected.

4.9. Additional Considerations

5.1. Overview

As with any actuarial exercise, it is important to consider the purpose to which the model will be put to ensure its construction and parameterisation are adequate. For PPOs this is particularly important. There are many assumptions that are very uncertain at this point. This does not stop a reasonable model being created, as long as the practitioner remains focussed on the outputs required.

Evaluation of PPOs involves quantifying both settled PPOs in payment, and possible future settlements, known as “PPO IBNR”. For settled PPOs, the identity of the PPO annuitant and the terms of the award are known. Possible future settlements may come from a number of sources, claims which the insurer knows are potential PPOs, claims the insurer is not aware will be large, claims the insurer is not yet aware of and claims that will happen in the future on business the insurer has already written. Consideration will need to be given to all of these. Clearly, the less mature the claim, the less data are available to quantify it, and the more one must rely upon general statistics relevant to the class of business, judgement and the firm’s past experience. For modelling claims that are expected to arise in the future, which will always be the case in pricing, the practitioner would need to consider whether the observed distribution of PPO claimants is a fair representation of what the future claims environment might experience.

As well as making assumptions about the profile of the portfolio of PPOs to be settled, we need to make assumptions about future indexation, investment return and mortality.

Whilst there is often no prescription as to what these assumptions should be, key assumptions should be made explicit, and there should be evidence that these assumptions are reasonable. As the actual future out-turn is uncertain, it is worth flexing the assumptions to see how much this changes the expected pay-out and using these to inform the end users of the modelling. After all, in many cases, risks associated with PPOs will not be overly familiar to stakeholders beyond initial training within general insurance-focussed business, but because of their long durations they may affect the running of the company for many years in the future.

5.2. Claim Data

The quantification of known PPO claims will almost invariably be by a cash flow model. This will require:

• ∙ The payment schedule as set out by the PPO which includes the:

  1. o First annual payment amount.

  2. o Frequency of payment.

  3. o Any planned steps to payments.

• ∙ Where payment amounts, steps and indexation vary by head of damage then these will need to be separated.

• ∙ The future life expectancy, determined by reference to:

  1. o The age of the claimant.

  2. o The sex of the claimant.

  3. o The claimant’s impairment to life (usually from accompanying medical evidence and expressed as an adjusted life expectancy).

• ∙ The indexation method (ASHE, RPI or other referenced index).

• ∙ Any variable orders or other special features of the PPO.

• ∙ The currency payments will be made in.

• ∙ Details of any co-insurance and reinsurance applicable to the claim together with the lump-sum components and property damage elements of the claim to test if a recovery can be made.

The extent of data available will depend on the closeness of the party to the claimant, with the direct insurer handling the claim having the most information, through to reinsurers which may have less information available to them. The terms of reinsurance policies now generally require that insurers provide details of all claims identified as potential PPOs so this issue is becoming less important.

Quantification of future potential PPOs should take account of the following data:

• ∙ An exposure measure to help determine likely future numbers of PPOs.

• ∙ PPO propensity for the class and insurer, linked to that exposure.

• ∙ An indication of whether the claimant population is different to the market claimant population for the class (in order to determine likely claimant characteristics).

• ∙ Details of claims close to settlement which may settle as PPOs.

An assumption of court award inflation may need to be made separately to assumptions on indexing the annual payments if models project PPOs that commence in the future. PPOs are generally linked to indices and surveys once an award has been made, whereas the initial level of awards has other pressures such as changing attitudes of the courts towards the necessary level of care.

5.3. Indexation of Annual Amounts

PPOs are typically inflation linked to provide the required level of protection intended at settlement. Often the reference to index payments is a percentile of the ASHE 6115 sub-code, as this relates specifically to wage inflation of care workers in the United Kingdom. Inflation linking using ASHE 6115 has led to both increases and decreases in the payments over the years since PPOs were introduced from a mixture of inflation and deflation of care workers’ wages. The common use of this index, as opposed to RPI, gives additional complexity. There have been some orders that give periodical payments under more than one head of damages, with the different sections being linked to different indices. There have been investments linked to RPI available for some time, allowing the possibility of using the assets to value the liability directly using economic scenario generators (ESGs). There are no known investments that can be used to obtain a price for ASHE from securities data at the time of writing. It should be noted that orders are indexed at different percentiles and that ASHE 6115 is not the only reference for indexing, reducing the likelihood of there being an asset match in the future.

Therefore, forecasts of the expected future inflation will need to be made, which is not a straightforward exercise. Whilst some forecasts for wage inflation do exist these are not necessarily in line with ASHE 6115. In addition, the link between the indexation and the investment return assumption needs to be considered so the assumptions are consistent and coherent. A failure to treat investment return and inflation consistently will seriously jeopardise the robustness of any model output. A simple example of not being consistent would be excluding a period of unusual inflation but not investment returns over the same period if using historical data to set assumptions.

The indexation assumption is an important variable. Ignoring reinsurance, it defines the future cash flows in nominal terms, which is important for cash flow and general business planning. Considering reinsurance, where treaties are indexed, the inflation will affect the level of coverage provided in nominal terms. Consequently for direct insurers a robust projection is needed for an accurate determination of reassurance assets, and therefore the net of reinsurance balance sheet position. For reinsurers, it is obvious this assumption will materially affect their reserve value.

The purpose of the model may restrict or guide the indexation assumption, because of influences from both external factors, such as Solvency II, and internal factors which may include the company’s accounting policies.

If a term structure-dependant investment assumption is chosen, perhaps because of a portfolio of gilts over varying terms, then a term structure-dependent inflation assumption should also be selected.

A formal assumption linking inflation with investment returns will be needed for any model that is stochastic; however, it is important to note that we are not aware of any investment product available to match this inflationary measure precisely.

Regardless of the basis, the practitioner should test the reasonableness of the assumption used. The reasonableness can be tested by looking at historical inflation levels, current market-consistent expectations of future inflation and future economic reasoning in respect of the projected inflation rate. These are considered below, and along with those for investment returns were published at early stages in the 2015 CIGI presentation (PPOs Working Party, 2015b).

5.4. Investment Return

The purpose of the valuation (and the method used to choose the inflation assumption) will influence the appropriate investment return assumption. It may be prescribed or a natural complement to the indexation assumption. If a rate other than the risk-free rate is used, the latter should also be determined and compared to the rate used. In addition, as with inflation, more generally any assumption needs testing for reasonableness. The practitioner should have a reasonable degree of confidence that the investment return (or at least the margin above inflation) is achievable given the company’s long-term investment objectives and assets purchased.

The assumption should reflect the assets held by the company or expected to be held by the company. The past performance of these assets and their market-implied price should be considered. Whether or not there is a sub-portfolio of assets dedicated to PPO liabilities will affect the ability to identify the assets to use in setting the rate. For example, if only government bonds were held and the strategy was to only hold government bonds until the liabilities are exhausted it would be unfeasible to justify discounting above the rate implied by those bonds for a valuation exercise. This would recognise future investment income that is not expected to be received.

In order to sense check the rate chosen where it exceeds the risk-free rate it is important to consider future investment strategy. For example, a pricing exercise may assume that a proposed portfolio will have a higher return and lower value of PPOs to set the technical premium. However, in reserving for the risk or modelling capital, there will need to be consideration of how likely the company is to move to the proposed portfolio which may affect the level of investment return that can be assumed. For reserving actuaries, it will be important to consider the strategy resulting from asset-liability modelling exercises as well as the company’s risk tolerance to different asset classes.

There should also be consistency between the investment return assumption and future indexation of the payments, as discussed within the inflation section above. Ignoring the impact on indexed reinsurance limits and other indexed cash flows outside the PPOs, it is the reasonableness of the real rate of return that determines how robust the final impact of discounting will be. Reasonableness will depend on the assets that the company holds and their expected returns. Again, sensitivity testing of the investment return assumption is advisable to capture the sensitivity of the model and resulting impact on the reserves and capital requirements to changes in real returns.

Different investment assumptions may be required for different valuation bases and the practitioner should investigate the up-to-date requirements of Solvency II, IFRS or any other reporting bases used, as well as any other regulations or guidance relevant to the reporting basis.

Any stochastic model will most likely require an assumption between the level of inflation and the investment return. Even if an ESG is used, the practitioner should be aware of the level of real return implied by the difference. For any models relying on the reasonableness of the volatility modelled, any limitations as a result of the selected methodology are important to understand and document. The specific limitations will depend on the use and type of model.

Technical considerations are also required for the rate chosen. The rate assumed will not affect the actual amount paid gross of investment returns – it affects the timing of their recognition. However, when evaluating the outputs of models, higher discount rates make cash flows in the distant future increasingly less significant. This may mask long-term risks expected to emerge later on, by devaluing them. However, lower, and especially negative rates, increase the perceived value of risk in the long term.

As for inflation, investment returns can be determined and checked for reasonableness by considering three main viewpoints: historical analysis, current market-consistent rates and future prospects for investment returns over the duration of the liabilities. These are considered in more detail below.

5.5. Mortality

Another key assumption, and one infrequently encountered in general insurance, is mortality.

This is a critical assumption, defining the value of payment, directly affecting the valuation, as well as the assumed timing affecting any discounting performed. As the mortality assumption applies to similar lives, the risk of systematic inaccuracy accumulates across the portfolio of PPOs, as well as the volatility from individual cases living longer or shorter than expected.

There are several modelling options for applying mortality. The simplest approach is to be deterministic and define the expected lifetime of those PPOs already in payment. This information is generally provided by experts but even then it is highly subjective, may not be robust and there is the possibility of bias in the experts’ views.

Most of the readily available expert views are for determining lump-sum settlement amounts. This introduces obvious bias. The claimants’ experts would seek a view to support a long life expectancy for a large lump-sum award, whereas the insurers would have the opposite inclination, so long as the estimate is reasonable. Bearing in mind these contrasting standpoints on mortality, the question becomes what should be the policy in consistently determining the life expectancy?

Beyond the known uncertainty, there is also a risk that medical advances could restore the claimant’s life expectation to near-normal levels, and further that historically observed improvements in mortality persist. There is also the risk that reserves are overstated, if claimants’ morbidity reduces life expectancy compared to experts’ opinions or if general improvements reverse. Please see section 4.2 for more details.

To allow for the possibility of individual claimants dying before or after their life expectancies a life table can be used. This requires basic consideration of which life tables to select, amongst other assumptions.

The base life tables present the first assumption: what population to base the mortality experience on? There are not yet any available tables for the impaired lives of PPO claimants that are known about publically. Life insurance tables are available but unlikely to be suitable as they are presented. They are for insured populations which differ fundamentally to PPO claimants. Insured lives self-select and are subject to health underwriting and tend to be predominantly from the more affluent section of the population. Annuitants and pensioners tables are also likely to be from more affluent lives, as they have had the disposable income to save. Annuitants may also self-select and therefore may be of better-than-average health. Furthermore, as the attitude to saving may be linked to health this could also affect the mortality.

PPO claimants in contrast are generally third parties, injured by the insured, so selection does not apply at inception of the policy. However, the claimant generally decides whether to pursue a PPO or not, so has some choice in the settlement and therefore may have different mortality to those choosing a lump-sum alternative. Additionally, any traditional annuity-based life tables are calibrated to older claimants, the typical annuity purchaser. PPOs are different in that the annuities often apply not only to impaired lives, but to impaired lives who are considerably younger than conventional annuitants. Case law already uses life tables based on the general population for lump-sum settlement using the Ogden tables.

For PPO IBNR, further assumptions could be made on the links between life expectancies at the point of claiming compared to the profile of the exposure. For example, a motor insurer with more than the standard market share of young drivers would be expected to have higher life expectancies (as the claimants would be expected to be younger owing to passenger liability). This may be even more relevant in future pricing models, where life expectancy modelling may be linked to risk and rating factors. For reserving purposes, the profile of the stock of large losses may be an even more powerful indicator of the PPO IBNR as time progresses and cases are updated with more information.

Essentially, to choose a mortality basis, the actuarial practitioner should select the one that most represents the population of PPO claimants they are analysing. Once a table is selected that is similar it is very likely to need adjusting. Also more than one table may be needed, as the same mortality for spinal injuries and brain injuries seems unlikely.

First, any tables that have select mortality, where mortality differs depending on the time between an initial event (usually the purchase of a life insurance policy) and the valuation date need careful consideration. The select mortalities, where the probabilities of death vary depending on the time since an insurance contract commences, are unlikely to be useful: the PPO claimant will have suffered the injury some time before their PPO commences.

Second, to reduce the life expectancy for impairments will need an assumption. The PPO Working Party (PPOs Working Party, Reference Orr2010, page 71) identified three potential mechanisms of doing so. The adjustments can be applied to a life individually or to a collection of lives:

• ∙ A: applying a multiple to the base mortality;

• ∙ B: adjusting the age x of the base table; and

• ∙ C: adding a variable to mortality.

A PPO claimant’s mortality, $$q_{{x,t}}^{\prime} $$ , where x is the age at which the individual PPO was sealed and t the number of years since the date of the order can be linked to base table’s mortality q _x,t . The variables A, B and C represent the represent different ways in which adjustments can be applied to modify the mortality for an impaired PPO claimant’s life:

Figure 4 shows the different q _x rates that are generated under the methods described above. They all represent a claimant aged 18 with an estimated life expectancy of 56 years, a reduction of 5 years relative to the equivalent unimpaired life expectancy (ONS, 2016f).

Figure 4

Estimated q _x rates under different mortality adjustment methods

To increase complexity the three constants (A, B and C) could be made to be dependent on the number of years since the date of the order, and multiple adjustments could be applied simultaneously. In practice, this will be limited by the quantity of data available to parametrise such models.

The significance of the three potential mechanisms are discussed below. Advice from a medical professional may be useful in understanding the appropriateness to mortality projections of using such adjustments.

5.6. Propensity

The frequency of PPO claims is highly uncertain. Catastrophic injury is fortunately not common in the United Kingdom, and so there are not that many PPO claims to analyse compared to other types of losses. This sparseness of data, along with the drivers of propensity being complex and linked to the external environment, makes determining the assumption challenging.

Using a propensity, or transition rate, of a claim to settle as a PPO allows for the exposure to the risk of a PPO to be allowed for. The greater the number of open and expected IBNR large claims, the more PPOs are possible.

For some time, headline rates of PPO propensity have been output by the annual survey on PPOs conducted by the PPO Working Party. However, as always, care is needed when applying market data to a particular book.

First, most of the headline rates are by settlement year, which is an uncommon reporting basis for actuarial analysis. Should an accident year reporting basis be used, the rates will need to be translated to an accident year basis, or the claims to a settlement basis, to be applicable. For an underwriting year reporting basis, again a transformation would be needed. Consider a simple example where for a single underwriting year, four large losses are notified in every 1 of the first 3 settlement years, one of which always settles at the end of the third year from the notification year as a PPO and the remaining three always settle on a lump-sum basis at the end of the first, second and third years from their notification. At outset and at ultimate, the PPO propensity is 25%, but, for example, for future settlements at the close of the third settlement year the PPO propensity would be 40%.

Figure 6 illustrates the distorting impact that different settlement delays for PPOs can have on settlement year metrics when compared with underwriting year metrics using the example in the text above.

Figure 6

Comparison of settlement period and accident period propensity; PPO, Periodical Payment Order; SY, settlement year

Second, PPO propensity is thought to vary by various risk factors. When performing a valuation, the appropriateness of any survey or market benchmark needs to be verified. The further away the profile of the book being valued from the market, the more unreliable the market rate will be. Factors that appear to affect propensity from the PPO Working Party’s survey include, but are not limited to:

• ∙ class of business;

• ∙ size of claim; and

• ∙ age of claimant.

Clearly some factors may be linked to the underwriting profile of the business being valued. For example, both the class of business and any corresponding limits that may affect the PPO propensity will be known. Furthermore, the age of the claimant may be partially determined by the profile of the book. For example, younger drivers tend to travel with other younger drivers, so when there is a crash there is an aggregation of exposure to risk. In this circumstance a higher PPO propensity may be expected.

At the point of claim more will be known about the potential PPO, which could be factored into estimates of the propensity.

More generally there are wider and external factors than can affect propensity assumptions. Those working with PPO liabilities should be aware of the insurer’s stance towards settling PPOs, and its historical propensity rates. It will be important to keep up to date with any changes in claims handling practices that could impact propensity in the future. It is also very important to understand the way that data are recorded both within and outside of the claims handling systems. As a result of the small number of claims involved, it is likely that at least some important information is captured manually.

In the wider economic context Ogden discount rates for traditional lump sums play a big role in the propensity of large claims to settle by PPO. The difference between the Ogden discount rate and the investment returns available to claimants to invest their lumps sums affects the value of PPOs relative to lump sums. Even without factoring in the lower risk to the claimant generally from PPOs, when PPOs are more valuable their propensity can expected to be higher. The Ogden rate is set by the Lord Chancellor and practitioners should be mindful of any consultations to change the rate, as the outcome is likely to change rates and therefore affect the level of the propensity assumption.

This sentiment can be applied to the economic environment more generally. Higher investment returns, all other things being equal, will favour lump sums, and low rates will favour PPOs. Low and negative ASHE index rates may make PPOs seem less attractive, whereas spikes in care costs picked up by the index would make them seem more attractive, even though these changes in the past may have limited relevance to the future changes that will affect the amounts claimants are paid. Rates may also be affected by the advice received by claimants during settlement, which itself may depend on regulation and the attractiveness of PPOs to those providing that advice.

Overall, there is a lot to consider, and the key thing will be to monitor any rates chosen to ensure they continue to remain effective assumptions for the model’s purpose.

6.1. Overview

As with the assumptions, the techniques used to value PPOs need to be appropriate to the purpose to which the model will be put. Models need not be overly complex, but should be able to provide a usable and communicable output.

Straightforward closed-form models producing only a point estimate may be entirely appropriate for reserving and forecasting management accounts. The higher potential transparency of using a point estimate may help with understanding the inherent risks associated with these liabilities, especially if used in conjunction with scenarios and stress testing, which is becoming increasingly necessary as the desire of stakeholders in the insurance industry to understand risk becomes greater. However, such a model may make investigating and communicating uncertainty more challenging.

The model is likely to need to be able to output the cash flows as well as the reserve. This will be useful for asset-liability modelling.

Further choices involve whether or not to apply Ogden factors (annuity multipliers) at an appropriate discount rate to the annual PPO amounts, or whether to index and discount the future cash flows explicitly. If the former is chosen, there are the complexities of how to allow for stepped payments and whether this approach would systematically over- or underestimate the PPOs’ reserve value? One challenge with Ogden factors is that they are unlikely to accurately reflect the difference between gross and net claims, which is important for reserves for bad debt risk.

The practitioner must also be mindful of market practice, the size of their current and potential future PPO stock, as well as to what extent stakeholder expectations should be considered.

6.2. Failure of Standard Triangulation

This section deals with the challenges associated with using a triangle-based approach in the valuation of PPOs (PPOs Working Party, 2015b, pages 10–11). However, there are some areas where a triangle analysis may be useful, and we will discuss these below.

A key assumption of the standard triangle method is that the past development of claims is a good estimate of future development to their ultimate position. To understand why a triangle approach might be challenging, it is important to first consider how PPO claims number development has been impacted by the external environment historically.

Before the Courts Act of 2003, PPOs were in effect allowed in the form of structured settlements. For reasons that we can only speculate on, the use of these was limited, although it is worth noting that both the claimant and insurer had to agree to the structured settlement, and the courts had no ability to override the decision. Hence any projection of future PPO claim numbers based solely on the triangle history would understate the number or proportion of large losses settling as PPOs, as the period prior to 2003 would be included in the development. In addition, depending on the size of the triangle, there are likely to be periods where there are no PPOs, resulting in the need for manual adjustments. This gives evidence to suggest a paid or incurred chain ladder or Bornhuetter Ferguson method would be inappropriate.

Another consideration that has a calendar year effect on the development history is the linking of the PPO annual payments to an earnings index, following the judgement in Thompstone vs Thameside (Court of Appeal, 2008), which resulted in the more widespread use of PPOs. Therefore, the period prior to 2009 would have fewer settled PPOs than recent experience, which may give too low an estimate of prior assumptions whereas the sudden increase in settlement in the diagonal when the change occurred may overstate the development factors from the affected period onwards, if it is not excluded as an outlier, and this may overstate PPO numbers in recent periods. In general, the use of triangle-based methods becomes at least more complicated when there are diagonal effects.

Whilst we have considered how triangulation is likely to result in the frequency of PPO claims being misestimated, it is almost certain that the severity would be incorrect using triangulation rather than cash flow methods.

Even under the assumption that it was possible to construct a 50-year triangle containing a high volume of PPOs, there would still be limitations. First, there are likely to be child claimants who may still survive beyond 50 years, so an assumption as to the size of the tail factor would need to be made, despite future survival being uncertain; this factor could be considerable. Second, over any lengthy period, there are likely to be advances in medical techniques that would increase the future life expectancy of PPO claimants. In addition, changes in vehicle safety and waiting times for medical assistance at the crash site may further increase the proportion of severely injured individuals who survive motor accidents and thereby go on to make claims for lifetime support, invalidating the assumption of historical experience being a guide to future development. Finally, simple triangulation methods assume implicitly that future inflation is consistent with historical inflation, which over a short period may not be inappropriate, but over the length of these liabilities is unlikely to be borne out in practice, therefore requiring the practitioner to make an explicit assumption as to future inflation. Changes in inflation may therefore cause the valuation estimate to be over- or understated.

In addition to the arguments that the past experience may not necessarily provide a good guide to the future experience, using standard triangle methods requires sufficient volume of data on which to project. Whilst the number of settled PPOs across the industry is in the hundreds, at a company level the volume is likely to be significantly smaller, which creates more volatility in the patterns and requires more judgement to be used. As a result standard triangle methods are less appropriate.

Where claims volumes are larger, for example, for reinsurers or large direct insurers, in the future triangulation may be useful for frequency analysis so long as adjustments are made for changes in development discussed in the paper and allowance made for future expected changes. This would, however, require that PPO amounts are frozen at a single point in time by capitalising them with an appropriate set of assumptions. If this is not done any changes to assumptions will be projected forward at the same rate, and change the size of losses evaluated.

6.3. Deterministic: Without Triangulation

A truly deterministic model has many limitations. Trivial situations would be required: for example, where the claimant has a long life expectancy, low reinsurance excess point and limited indexation, so that both the amounts paid and their timings are constrained.

A truly deterministic model does not use a life table. And, having no allowance for stochastic mortality, for example, will lead to the tricky situation of deciding whether or not to re-establish a reserve at the point the payments were expected to cease if the claimant remains alive. Whilst common sense suggests that a reserve should be re-established, it could instead be offset by continuing to hold reserves on death of a claimant ahead of when payments were expected to cease. Recalculating expected future lifetimes each year would get round this problem, though having stochastic mortality simply by using life tables would avoid this completely.

Reinsurance also presents a conundrum with a deterministic model. If the claimant is expected to die just before the PPO reaches the reinsurance threshold the model would give zero recovery, even though there is a chance that they may live longer and a recovery may be made. Again, if the claimant lives longer than expected should a reinsurance asset be established? A deterministic model without a life table applied will tend to understate the reinsurance recoveries.

However, a simple deterministic model capturing the features of the PPO and its reinsurance forms the centre of calculation engines of any stochastic model. Therefore, it will be explained to build up the consideration for PPO models in general.

The basic form of the common deterministic models used involves a starting point of projecting large losses using standard methods. Often large losses are defined as losses greater than £1 million on a lump-sum basis (indexed to a particular point in time). Very few losses below £1 million have historically been settled on a PPO basis, so the losses above £1 million could be considered as a potential exposure to risk.

Often, this projection will be based on incurred chain ladder projections (backed by paid chain ladder projections), or a frequency-severity approach. For these projections, both settled and potential PPOs are normally included within the projections, with all future payments valued on a consistent basis (i.e. discounted at the prevailing Ogden rate of 2.5%, though other rates are sometimes used within claims processes).

A portion of these claims projected have already settled as, or will settle as a PPO.

For claims that settle as PPOs, under current economic conditions and Ogden rates, the present value of future payments based on a PPO valuation basis is likely to be higher than the reserve based on the standard Ogden lump-sum rate, as the net effective discount rate used for valuing PPOs would be lower than the Ogden rate. This means that an uplift will be required.

One of the more subjective areas in which actuaries are involved is in calculating the uplift. The components of the uplift can be estimated by considering claims in each of the three key stages – settled PPOs (but still in payment), notified potential PPOs (which will include notified claims that are currently small and large claims not currently expected to become PPOs) and PPOs arising from true IBNR claims.

A deterministic model could then involve considering each of these elements in turn using a formula of the form of propensity×percentage uplift.

6.4. Understanding the Basis of Projection

Similarly to classic chain ladder reserving, understanding the data being used are vital to having a robust projection. An example in triangle-based chain ladder projections could be as simple as using annual factors mid-year on a growing portfolio without any adjustment and consequently potentially underestimating reserves.

PPO reserves are no different in this regard. It is necessary to understand the data, claims’ case reserving philosophy and any changes. For example, we have described uplifts. What if claims teams had moved all reserves to higher multipliers, say using a real rate on the Ogden tables of −0.5% p.a. to reflect lower investment returns? Then both the PPO and non-PPO reserves would need adjusting, the former to the firms chosen rate for financial accounting purposes, and the latter to the rate for the jurisdiction in which the lump-sum claim is expected to settle.

There may be more subtleties that challenge a simple uplift-propensity approach. Actuarial practitioners must take the time to understand the large losses being projected.

6.5. Moving Beyond a Simple Deterministic Model

First, deterministic models could be made more complex.

6.6. Stochastic Models

As mentioned in the previous section, the most obvious stochastic feature that can be incorporated into models is the use of life tables. Models can be made more complex allowing for probability in other assumptions and when this applies to most variables the model will often move towards Monte Carlo methods.

Section 7 on capital modelling provides more information on stochastic modelling. This does not mean that for other valuation purposes stochastic models should be avoided, they may even be required in some circumstances to allow the model to capture the risk features with enough accuracy to be of value and not be misleading. A good example of this is cost-benefit analysis of reinsurance coverage.

6.7. Other Features of PPOs to Value

Variable orders or PPOs with indemnity or reverse indemnity guarantees have embedded options and guarantees.

Variable orders are highly challenging to estimate as there is little data on progression of medical states of health associated with them or the level of the possible change in periodical payments. It is, however, clear that an estimate may need to be made to satisfy the reporting basis. Under Solvency II, for example, variations following from variable orders may be treated as an Event Not In Data. Either way, an approximate likelihood of triggering a variable order and the potential severity impact would be a starting point. This may require interactions with claims functions to estimate potential levels and likelihoods, until such a time as market data becomes available as a further reference point to benchmark against.

For indemnity and reverse indemnity guarantees, the order may be clearer over the change in level of the PPO, but again on a case-by-case basis, estimations of the potential likelihood of an event at each time period and the associated cost could be used to estimate their impact.

6.8. Reinsurance

It is important to consider outwards reinsurance when PPOs are valued. The net of reinsurance position may be different to the gross position.

If a cash flow model is used to value the gross cost of a PPO then the reinsurance treaty can be applied directly to the gross cash flows to calculate the recoveries due at each payment date. For future payments, this will be the expected recovery, which depends on the inflation assumption.

Most reinsurance contracts for UK insurers have an indexation clause, and this may be specific to PPOs. The indexation of the retentions and limits is generally calculated by using specified indices. It is typical that national wage inflation is applied up until a PPO’s settlement date, and then from settlement onwards, the relevant index is the one to which the PPO is linked.

Figure 7 shows the effect of changing the balance between the size of the lump sum and annual periodical payments on the indexation of treaty limits assuming both inflation of the lump sum and indexation of the periodical payments is at 4% p.a. for an excess of loss treaty with unlimited cover attaching at £5 million, with an indexation clause. The PPO with an accompanying £3 million lump sum has a periodical payment amount of £150,000 in contrast to the PPO with a £1.5 million lump sum and a £167,000 periodical payment, both giving the same paid to date after 40 years.

Figure 7

Reinsurance indexation; PPO, Periodical Payment Order

The indexation clause affects the value of recoveries. Under a typical indexation clause, the split of the claim between the lump-sum element and the regular payments will affect the amount recoverable under the policy. The amount recovered from reinsurers for an individual PPO also depends on both the timings and sizes of the periodical payment, even in the absence of other payments.

The risk of a reinsurer defaulting is greater under the increasing presence of these long-term liabilities, so it is a significant consideration for insurers. The credit default risk of reinsurance bad debt needs to be considered for recommending and setting reserves and allowed for in capital requirement calculations. Several approaches are possible:

• ∙ margin in the credit default swaps market, where available;

• ∙ the rating attributed by one or more rating agencies;

• ∙ regulatory reported solvency position; or

• ∙ a detailed consideration of the reinsurer’s position by the insurer.

Consideration could be given to the historical failure rates of reinsurers of different ratings and sizes, but a sufficiently long period of historical data may not be available.

Capitalisation clauses are becoming increasingly common in reinsurance contracts. These specify that at a certain period of time, typically linked to either the date of the PPO settlement or inception of the treaty, the reinsurer will pay the insurer a lump sum in order to crystallise the reinsurer’s liabilities to the insurer in respect of that PPO. At this point, any risks previously mitigated by the treaty revert to the insurer. The period before capitalisation varies dependant on the nature of the clause and the length of time taken to agree the PPO. The size of the lump sum for capitalisation need not necessarily represent the expected cost of the PPO. Treaties specify calculations using agreed assumptions and methodology, which may be different from economic principles as a commercial consideration in setting treaties’ price levels. Insurers’ demand for capitalisation clauses will depend on the availability of traditional non-capitalised reinsurance, the difference in reinsurance prices between the two options and the risk appetite of the insurer. An insurer taking a capitalisation clause should consider prior to purchase what their strategy is regarding investing the cash they receive. Credit risk will be higher for companies without capitalisation clauses (all else being equal) as these insurers will be dependent on reinsurers over the lifetime of the PPO.

A further complication is that an individual insurer may have part of their reinsurance purchased on a capitalised basis and the rest on a non-capitalised basis. This may create an additional complexity when modelling reinsurance assets.

Also when reserving, insurers will need to take account of the correct treaties for each risk, as excess points may have changed, or the proportion of the reinsurance with capitalisation clause. This will need to be taken into account when the reinsurance recoveries are assessed.

When considering the reinsurance purchase, the insurer should model the capital required at different attachment points. This should then be compared against the price of the various attachment points, to assess the best return on capital, subject to an acceptable amount of risk. Taking PPOs into account may change the optimum attachment point.

6.9. Stress Testing

After any valuation of the neutral estimate of PPOs, similarly to any valuation exercise, stress and scenario tests can be used to:

• ∙ give consideration to alternative base scenarios other than those presented as the best estimate;

• ∙ identify the key sensitivities and assumptions;

• ∙ help communicate the level of risk and uncertainty to a firm’s administrative, management or supervisory body;

• ∙ help validate and provide context to the capital model or any stochastic approach; and

• ∙ link to any risk registers kept.

In addition, consideration of stresses on the key assumptions and alternative scenarios both deterministically and stochastically may enable practitioners to better understand, and where possible, quantify, the level of parameter and model uncertainty and not just the sample error.

Stress and scenario tests should be considered that explore the key assumptions. Key assumptions include, but are not limited to, propensity, inflation and life expectancy. Where PPO valuations are discounted an obvious additional key assumption is the investment return assumption.

6.10. Actual-Versus-Expected Results

Techniques to value PPOs make a number of assumptions about the future, including inflation, investment returns, mortality, and assumptions on the profiles of future settlements and so on. As assumptions for some of these elements will represent events far in the future, they may not be updated as frequently as general insurance reserves, which are often updated multiple times a year.

As the years go by, the assumptions will be replaced with the actual experience and gradually unwind. If the original assumptions start to look questionable and were to remain unchanged, the valuation basis will diverge continually from actual experience and large surpluses or deficits may arise in the future when assumptions are changed.

The more unfamiliar aspects which are likely to be common to most models are described below, but ultimately how PPO reserves unwind depends on the model used to construct them.

In practice it will be up to the model owner to establish a framework to analyse the surplus and deficit from actual experience versus modelled expectations. It is very important that actuarial practitioners monitor the performance of their PPO models wherever possible using actual-versus-expected analysis, as this will often illuminate areas that may need further work either by updating assumptions or the models. Communicating actual-versus-expected analysis effectively will help the firm’s administrative, management or supervisory body understand the issues surrounding PPO valuation and risk, and give more confidence that the liabilities are robustly calculated.

7.1. Stochastic Modelling

This section considers some of the challenges associated with building a simulation-based model for PPOs. In order to model a range of reasonable outcomes for PPO liabilities to measure risk, there are a number of new risk areas to consider and validation issues to overcome, especially for those who have previously exclusively modelled general insurance liabilities.

7.2. Solvency II Standard Formula

An alternative approach to quantifying the range of possible outcomes in relation to PPO liabilities could be to consider estimates arising from the Standard Formula SCR calculation. If considering the use of the Standard Formula SCR for determining regulatory capital requirements, actuarial practitioners should be aware that the Prudential Regulation Authority (PRA) requires firms to demonstrate that the assumptions underpinning the Standard Formula are appropriate for their risk profile (Bank of England, 2016a), and furthermore PPOs have been specifically highlighted by the PRA as an area that non-life insurers need to carefully consider (see Orr, 2015, page 10; PRA, 2015a). In forming an opinion on the appropriateness of the Standard Formula, it is important to understand the assumptions which underpin the Standard Formula modules. These are outlined in EIOPA’s technical guidance (EIOPA, 2014b).

In performing an assessment under the Standard Formula for a non-life insurer, calculations may be required under a wider range of Standard Formula modules than conventional non-life insurance liabilities. In particular, PPOs are considered an example of annuities stemming from non-life insurance obligations and consequently classified as life insurance liabilities and subject to assessment under the life underwriting risk module (EIOPA, 2014a, page 65).

Section 4 considers in detail the extent to which risks associated with PPOs differ from risks associated with conventional non-life liabilities, or from conventional life insurance annuities.

7.3. Stress and Scenario Testing

Stress and scenario testing in a capital modelling context can, amongst other things, be used to:

• ∙ give consideration to alternative assumption sets and the impact these might have on the best estimate valuation or capital requirements;

• ∙ identify the key assumptions to which the valuation of PPO liabilities are most sensitive;

• ∙ help communicate the level of risk and uncertainty to the firm’s administrative, management or supervisory body;

• ∙ help validate and provide context to the outputs of a stochastic model;

• ∙ assist in risk identification processes; and

• ∙ enable practitioners to better understand, and where possible quantify, the level of parameter and model error.

Stress and scenario tests should therefore be designed to help explore the sensitivity of the valuation to uncertainty in the risks associated with PPOs (which are detailed in section 4).

The types of testing that could be undertaken include:

• ∙ Flexing model parameters with reference to the range of reasonable best estimates or the range of possible outcomes for each parameter. This is typically referred to as sensitivity testing.

• ∙ Creating “real-world” scenarios for the external environment, and considering the impact these would have on the valuation of PPO liabilities. This is typically referred to as scenario testing.

• ∙ Reverse stress testing, whereby consideration is given to the outcomes for PPO liabilities that would be required to lead the firm to be unable to meet a key business objective (e.g. the inability to pay planned dividends, or to continue to write new business).

In all cases, it is likely that the exercise will be of most value when there is engagement from areas outside the actuarial department, for example, claim handlers or underwriting professionals.

8.1. Propensity

When deciding on the propensity for cases to settle as PPOs, a company can choose a single assumption across pricing and reserving, or allow each of the teams to derive their own assumptions independently. Where separate assumptions are used, teams should investigate differences between assumptions to strengthen their overall understanding. Either way, it is important to consider historical ratios between the volume of settled lump sums and PPOs in addition to current and projected future trends. It is also worth considering that the PPO settlement propensity varies by size of loss according to historical market data (PPOs Working Party, 2015a, page 8).

8.2. PPO Uplift

Calculating the additional cost of a PPO over a lump-sum claim is crucial in pricing PPOs. This depends on a number of factors discussed below.

9.1. Aligning Valuation Bases

An additional challenge for actuaries reporting on PPOs is to align valuation bases as far as possible.

Aligning valuation bases and techniques across a company can be complex given the number of different requirements needing to be met depending upon the purpose of the reporting. PPO volumes continue to constitute a growing proportion of balance sheets for organisations with exposure to motor and casualty insurance, and the understanding of PPOs by practitioners in these businesses continues to mature.

As reserving teams reflect on these developments, including drawing parallels with life insurance, emerging reporting requirements may increase to better inform stakeholders.

However, the different valuation reporting bases are not mutually exclusive and there is an element of overlap between them.

One simple way to align reporting is to use a single model. In practice, this may be overly complex and instead the challenge may be to align the neutral estimates under different bases. As will become clear from reading about some common bases below, many hurdles can be overcome by the PPO model being explicit and using a cash flow approach. This allows compliance across a multitude of standards, by enabling flexibility and supporting disclosure requirements.

Even where models have been fully rationalised and prepared for multiple assumptions to meet each basis’ requirements, some planning will be useful to meet the financial reporting outputs. This may involve communicating with accounting, financial control and planning teams amongst others. An example is expenses: under common UK accounting practices firms often set up a claims handling reserve, with the aim of provisioning for the run-off of claims over the long term which, as well as matching the long-term reporting of claims costs. However, regulatory reporting may not require separate disclosures and may need expense strain versus lower premium than planned considered instead. Therefore flexibility will be important.

A key difference between reporting bases that can be easy to implement, but difficult to rationalise is the discount rate used to value PPOs. If models are constructed to use yield curves, it is possible to switch in and out a number of bases. However, determining the basis is less simple. In some cases it is either prescribed in value or by a fairly rigid procedure, which is more likely to be the case for regulatory reporting. For accounting returns designed for the current and potential future owners of the business the same rate may not be appropriate. The rate should always be low enough to be reasonably achieved, as discounting recognises future investment income immediately. Choosing a higher than justifiable rate puts the claimants primarily at risk of the company running out of funds, and is also disadvantageous to future shareholders as this understates the value of liabilities and increases the risk of institutional failure.

A lower rate can also be damaging. It may distort the view of the company’s potential for future investors and if translated into pricing raises prices for consumers. Consequently a one-size-fits all approach, whilst simpler, may not be appropriate. If more than one rate is chosen across financial reports, it will be important to be mindful of the rates used and clearly communicate them to the firm’s administrative, management or supervisory body.

Solvency must be considered. If a single discount rate were used, lowering rates for management accounts without considering regulatory accounts, for example, may make the organisation insolvent. If more than one rate is required, it should be clear why. In addition, if the regulatory rate is lower than that used in the general accounts this will still limit business activities as capital constraints will prevent the payment of surplus to the owners regardless of how much earnings are recognised.

9.2. Statutory Reporting Bases

9.3. Regulatory Reporting Bases

Regulatory reporting bases often have a different purpose from statutory accounts, being designed to prove that the insurer can meet the policyholders liabilities as they fall due, whereas statutory bases are often focussed on providing a true and fair view to existing and future potential investors in the company.

9.4. Valuation at Lloyd’s

Lloyd’s valuation principles for discounting are currently aligned to the regulatory reporting basis in force before Solvency II, found in GENPRU 2.2 (Financial Conduct Authority, 2010). The relevant rule is that amongst other exceptions, discounting is permitted only on “annuity liabilities” and PPOs are in Lloyd’s valuations deemed to be annuities at the time of writing.

The deferment period, or time between the valuation date and the point payments are due to commence should not be discounted. This means that reserves for claims due to be paid by way of a PPO in the future can be discounted only from the point payment is due to begin.

Excluding the effects of inflation linking, PPOs can include changes in the payment schedule over time. These can be explicitly set out within the court award in the form of stepped payments, in which case the full payment schedule is known (with each payment contingent on claimant survival).

PPOs can also be variable orders, stating specific conditions within the court award on which the case can return to court for the PPO payments to be renegotiated, for example, a medical deterioration. With variable orders it is not known whether the specified conditions will occur, whether the variable part of the order will come into action, or what the PPO payments will be revised to if the case does return to court.

If the PPO has undefined or uncertain payment changes in the court order, for example, a variable order as explained above, then that contingent part: that is, any part of the annuity over and above the current level, cannot be discounted, as it is a contingent event and may not occur. On the other hand, as the real quantum of step payments are known from the outset, any part of the annuity over and above, or below, the current level can be discounted.

At Lloyd’s, a significant proportion of the PPO reserve relates to inwards reinsurance, and this can cause further complications. Cedants often do not inform their reinsurers explicitly whether they have themselves discounted the reported outstanding amount or not. Lloyd’s Valuation of Liability Rules allow cedants to advise discounted reserves to the market. The Lloyd’s Reinsurance Claims Group issued guidance in early 2013 detailing the information and data that should be obtained from the reinsured for reserving purposes.

At the time of writing, as a result of the combination of both the complexity of the valuation rules and the current low discount rate environment, discounting is of minimal benefit to the market and often does not outweigh the time it would take to do the discounting calculations. Those valuing PPOs will clearly have to be mindful that it is possible that the current environment will revert to historical norms and then the impact of discounting may be of greater financial consequence.

As well as initial valuation, reserves are subject to Statements of Actuarial Opinion which should include information on PPOs.