Source: http://www.uscaptiveinsurancelaw.com/blog/archives/02-2016
Timestamp: 2019-04-18 19:24:15+00:00

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We formed and operate the first series LLC in Montana (named Aegis) for captive insurers. Several other firms provide key services such as accounting, audit and actuarial work. Please contact us at 832.330.4101 if you'd like to discuss forming a captive for your company.
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The third insurance element is an insurable interest—i.e., the existence of a relationship between the insured and the property that is insured such that any damage to the property will negatively impact the insured’s finances.
The concept of an insurable interest as an element of insurance developed gradually over a significant period and is best illustrated by the business environment of the life insurance business in the 1800s where people, despite having no familial relationship with an insured person, were able to purchase life insurance on celebrities’ lives and thus profit from their eventual death. Courts eventually realized that allowing insurance to be purchased by essentially disinterested parties was nothing more than gambling and was against public policy. Ultimately, the doctrine settled to require that the insured demonstrate a strong enough relationship with the subject of the insurance to justify concluding that damage to that subject would directly hurt the insured.
Risk shifting and risk distribution, were both stated as requirements by the Supreme Court in Helvering v. LeGierse. Risk shifting is a straightforward concept: the insured must transfer some or all of the financial burden of loss to the insurer. This element is accomplished via contract and is rarely in dispute, as attested to by the dearth of case law on point.
Risk distribution requires a more in-depth explanation. Begin with the risk borne by a single homeowner who does not have property insurance. It is highly unlikely he will have sufficient financial resources to replace his home in the event it is destroyed by a fortuitous event. But if that individual pools his risk with other similarly situated homeowners who live across a geographically diverse area, a key development occurs--the possibility that the insured’s funds will return to him as part of the indemnification payment decrease, since all of the insureds are unlikely to suffer a simultaneous loss; while it becomes more likely that one insured’s funds (and any earnings thereon while held by the insurer) will ultimately support a payment to another insured who has indeed lost his home. It is this pooling of premiums in the insurance company, resulting in a distribution of the risk of loss (and potential for indemnification) across the entire pool of insured persons, that prevents insurance from being merely a reserve fund for tax purposes: this is the key difference between a reserve and an insurance company. In effect, the insured has shifted his risk of loss not only to a separate company but to other parties.
A reserve is an accounting entry, whereby a company will designate an amount of its funds in anticipation a particular contingency emerging. For example, a business anticipates it will have to pay $1,000 for a potential loss. To account for this, the business establishes a reserve account in its general ledger which is then placed on its balance sheet as a liability. But most importantly, the person or company establishing the reserve ultimately uses his/its own monies to extinguish the reserve and pay the claim.
The tax code allows a deduction for business expenses, but not for amounts paid into an internally held reserve. This is supported by a strict reading of the statute.
Moving funds internally – from cash to a reserve or from one corporate “pocket” to another – does not shift the risk as required by insurance.
Preventing the manipulation of gross income through the use of “reserves” and “contingency funds” is an important tax principle.
Both accrual and cash accounting methods require the taxpayer to deduct specific “realized” amounts. A taxpayer cannot deduct a speculative amount.
 Helvering v. LeGierse, 312 U.S. 531 (1941) (An insured purchased both an annuity and a life insurance policy very close to her death. After she died, the estate filed an estate tax return and did not include the proceeds of life insurance in the estate. In analyzing the transaction, the court noted: “That life insurance is desirable from an economic and social standpoint as a device to shift and distribute risk of loss from premature death is unquestionable. That these elements of risk-shifting and risk-distributing are essential to a life insurance contract is agreed by courts and commentators.” The court simply used the two terms within the same sentence. Subsequent cases over the next 40-50 years would provide guidance as to the exact definition of each term.).
 Appeal of William J. Ostheimer 1.B.T.A. 18, 21 (“The statute specifies what deductions are allowable and, except in the case of in insurance companies, no provision is made in the 1918 Act for the deduction of a reserve as such.”).
 Spring Canyon Coal Co. v. Comm’r of Internal Revenue, 43 F.2d 78 (10th Cir. 1930). See also Appeal of Consolidated Asphalt, 1 B.T.A. 79, 81 (“When estimating the reserve to set aside for a construction contract, the appellant’s accountant doubled the amount set aside for the years in question.”).
 See Gen. Couns. Mem. 35340, (May 15, 1973) (“However, because anticipated casualty losses are contingent in nature, it is a firmly established principle of tax accounting that even an accrual basis taxpayer may not deduct amounts it adds to a reserve for insuring its own risks.”).
“Life is risk,” or so says King Benny in the movie Sleepers in response to Dustin Hoffman’s character’s attempt to avoid becoming involved in an underworld conspiracy. The point may be a cliché, but it’s true: risk cannot be avoided. Nonetheless, ever since the Renaissance when merchants created insurance to mitigate the damage of lost cargo on voyages to the Far East, business has relied on indemnification from insurance to prevent financial ruin should a risky event occur. Like most common-law concepts, it has taken many individual cases and much time for a settled view to develop of the necessary elements for a valid insurance policy.
Put simply, these elements are the following: (i) a definable risk, (ii) a fortuitous event, (iii) an insurable interest, (iv) risk shifting and (v) risk distribution. Each of these elements must be present for a policy to be valid. In addition, there is a very important legal difference between a reserve and an insurance company.
Furthermore, because the law of contracts applies to the formation and interpretation of insurance policies, the basic elements of contract (i.e., offer, acceptance, and consideration) must be present for a court to uphold an insurance agreement. The insured pays a premium to the insurer, who then offers to indemnify the insured in the event a specific risk occurs. Key to the contract is for the risk to be specifically enumerated and clearly defined. As an example, the standard property policy provides coverage in the event of 11 specifically named perils: fire, lightning, explosion, windstorm or hail, smoke, aircraft or vehicles, riot or civil commotion, vandalism, sprinkler leakage, sinkhole collapse, and volcanic action. All other insurance policies contain similar language for their respective underlying coverage. The occurrence of the risk is a condition to the insurer’s performance, and therefore must be clearly evident from a plain reading of the policy or contract.
But the occurrence of a specifically defined risk gives rise to the second required element of valid insurance policies -- fortuity. Indemnification from insurance only occurs if the happening of the loss cannot be predicted. This is because non-fortuitous risks are foreseeable and either planning can mitigate damages or the foreseen risk can be avoided altogether, thereby eliminating the need for insurance. The unknown or unforeseen element of the fortuity definition is best explained by the three primary fortuity-related defenses offered by insurers to deny a claim – defenses which have a certain amount of conceptual overlap. The first of these is the “known loss” defense in which an insurer argues either that the loss had already occurred or that the insured should have known the loss would occur at the time he purchased the policy. The assumption in the latter case is that the insured could and should have taken appropriate steps to mitigate the foreseeable damage. The second defense is the “known risk” defense where the insurer will assert that some type of advance preparation was warranted because the possibility of loss was so high as to make the event essentially unavoidable. Finally, the insurer arguing the third fortuity related defense will aver the loss was ongoing when the insured purchased insurance. The one common element to all of these defenses is the assumption that the insured knew or should have known that a loss had either occurred or was so likely to occur as to warrant some type of preventative action.
 Id at pg. 320 (“In a broad economic sense, insurance transfers risk from individuals to a larger group, which is better able to pay for losses”). See also 1 Couch on Ins. § 1:9 (“It is characteristic of insurance that a number of risks are accepted, some of which will involve losses, and that such losses are spread over all the risks in a way that enables the insurer to accept each risk at a slight fraction of the possible liability upon it.”). While a reserve is only used by one company, an insurance company pools risks from multiple sources.
 Douglas G. Houser and Thomas W. Rynard, Insuring Real Property, Section 1.06(b) (Mathew Bender 2010).
 Byrne at Section 224 (“A condition is an event, not certain to occur, which must occur, unless its nonoccurrence is excused, before performance under a contract becomes due”).
 1-1 Appleman on Insurance Law & Practice Archive § 1.3 ("Fortuity is another key element in determining what constitutes insurance for purposes of legal classification. It would be foolhardy for insurance companies to sell insurance that would pay for losses strictly within an insured’s control. Obviously, whenever an insured needed money, there would be the temptation to cause the insured event to happen to get the pecuniary insurance benefit. This is the point where the concept of fortuity comes into play. Insurance is designed to cover the unforeseen or at least unintentional damages arising from risks encountered in life and business: injuries and damages caused by negligence and other similar conduct where the insured stands to sustain a real and palpable loss (generally pecuniary) as a result of the event for which the insurance has been purchased.").
 7 Couch on Ins. § 102:10 (“The known risk, known loss, and loss in progress defenses are generally considered to be part of the “fortuity” requirement that runs throughout insurance law.”).
Using A Captive To Underwrite Tornado Risks, Which Impact 2/3 of the U.S.
The maps above show two important data points related to tornadoes. The top map shows the number of tornadoes per 1,000 square mile area. There, Arkansas, Oklahoma, Missouri and NE Texas have the highest concentration. But in reality, the entire country east of New Mexico, Colorado, Wyoming and Montana are exposed to some level of tornado risk.
The bottom map shows the potential wind speed of tornadoes. Again, the center of the country is susceptible to very high tornado speeds. But that’s not to say the rest of the country faces no danger, just lower potential tornado speeds.
If you own commercial real estate (or have a triple net lease) in the eastern 2/3 of the US, you should consider using a captive to underwrite tornado coverage.
The typical organization loses 5% of its revenues to fraud each year.
The median loss in the cases in their study was $140,000. More than one-fifth of these cases caused losses of at least $1 million.
The frauds lasted an average of 18 months before being detected.
Perpetrators with higher levels of authority tend to cause much larger losses. The median loss among frauds committed by owner/ executives was $573,000, the median loss caused by managers was $180,000, and the median loss caused by employees was $60,000.
The longer a perpetrator had worked for an organization, the higher fraud losses tended to be. Perpetrators with more than 10 years of experience at the company caused a median loss of $229,000. By comparison, the median loss caused by perpetrators who committed fraud in their first year on the job was only $25,000.
Most occupational fraudsters are first-time offenders with clean employment histories.
A company loses $50,000 for every million dollars of revenue. That means a company with gross revenue of $10 million could have $500,000 in losses.
It takes more than a fiscal year to find the fraud; for example a fraudulent scheme that begins now (February 2016) probably won’t be detected until August 2017.
Higher ranking and longer tenured employees steal larger amounts of money.
Background screening doesn’t help to prevent this from happening.
​Employee fidelity is a very common captive insurance policy for all the above stated reasons. If you would like to learn more, please contact us at 832.330.4101.
The US Tax Code divides insurance companies into two sub-types: life and “non-life.” The former underwrites risks on people while the latter insure risks associated with property. Historically, the 831(b) market has largely focused on property insurance because it’s easier to create and manage these companies. But with the increasing costs of health care and, in some cases, workers comp, captives that insure the risks associated with people are growing in popularity.
For certain lines of coverage, such as group-term life insurance and long-term disability, the cost savings — compared with buying the coverages in the traditional market — range from 15% to 25%, panelists said.
“The captive earns the underwriting profit and investment income earned” on premiums paid to the captive, said Kathleen Waslov, a senior vice president with Willis Towers Watson P.L.C. in Boston.
Another advantage to the approach — compared with buying coverage in the commercial market — is that the captive sponsor has greater control over the design of the benefits offered to employees, Ms. Waslov said.
One of the most common statements I hear from potential captive owners looking at a workers comp or health care captive is, “I pay “X” in premiums and have rarely filed annual claims above that number. We’d like to earn that profit.” If a company is able to effectively manage its risks, then the savings will build-up in the captive.
Health care liability captive insurers can be a key tool in improving the quality of patient care, captive experts say.
The volume of claims data that can be accessed through a captive, in the right hands, can help health care institutions improve safety practices and ultimately save lives, they say.
And working in partnership with captive reinsurers, captive owners can drill down into even more extensive data and improve medical processes, they said Tuesday during a session of the 2016 World Captive Forum, being held in Boca Raton, Florida.
A key benefit of forming and managing a captive is the ability to obtain a large amount of data. For example, suppose the employee census shows 15% of the workforce regularly purchases cholesterol lowering medication. The company could use this information to tailor various wellness programs such as dietary seminars and sponsored gym memberships. The possibilities are endless.
Free cash flow of at least $300,000-$500,000 for the last few years.
Please call us at 832.330.4101 if you’d like to learn more.

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