A few pockets of increasing frequency in medical claims are just that for now, but still have the attention of Chad C. Karls, principal and consulting actuary for Milliman.

Karls said he's noticed a recent upward tick in frequency among some results from separate, individual companies. Should those results become more widespread, it could well signal that frequency hit the bottom of a trough in 2007-08.

"There are some indications that it might be the case, but it's not universal enough to make the call yet," Karls said.

It may develop into the latest vexing issue for medical professional liability writers, who are already contending with what the A.M. Best Co. recently described as a "highly competitive, soft market environment."

There's also the challenge of reconciling how the practice and delivery of medicine will change under national health care reform and what it means for insurance markets. Just how to navigate this changing landscape will provide no shortage of discussion points when the Physicians Insurers Association of America's annual conference begins May 12 in Chicago.

PIAA Chairman Dr. James Carland, who is also the chairman, president and chief executive of Mutual Insurance Company of Arizona, said the need to rapidly bring medical care providers online to supplement the anticipated shortfall in physicians under health care reform may lead to abbreviated training.

"That's going to change primary care dramatically," Carland said. "We've already seen declines in primary care enrollment by physicians over the past five years. I think it's dropped 25%. So we're going to see a huge shift in that regard, and that's going to have an implication for the structures in which they practice."

How quickly and sharp that turn in the road comes for insurers remains to be seen. Despite soft market conditions, an A.M. Best Special Report released May 3, 2010, noted the "distinct dichotomy between insurers' reported results and general state of the market."

The A.M. Best report cited favorable loss cost trends and the release of prior year loss reserves as factors that helped MPLI writers post another solid year in 2009. The report stated last year marked the fourth in a row the medical professional liability sector "bested the property/casualty industry in a wide range of measures, including combined ratio, operating ratio, pretax returns and total return on equity."

Constitutional challenges that have upended tort reforms at the state level have been cited as a trend worth watching.

After the Illinois Supreme Court overturned a $500,000 cap on noneconomic damages for plaintiffs, a subsequent Milliman study projected an 18% increase in physician liability claims costs (BestWire, Feb. 23, 2010). The Milliman study stated while severity of indemnity claims would increase by about 23%, medical professional liability rates in Illinois may not increase because the court decision was anticipated.

Carland said does not expect any federal level activity on tort reform. He also said the plaintiffs' bar can make a strong argument with frequency being down in the recent past.

"I'm not saying it's a valid argument," he said. "I'm saying that's the one they are going to be using."

Tort reform rollback will be the subject of an A.M. Best Co. webcast at 11:30 a.m. May 12, which is entitled "Medical Professional Liability After Tort-Reform Rollback: The New Landscape." This webcast is sponsored by Lexington Insurance Co.

The webcast panelists include:

-- Brad D. Cox, senior vice president and division executive health care, Lexington Insurance

-- Chad C. Karls, principal and consulting actuary, Milliman

-- John W Patton Jr., managing partner, Patton & Ryan, LLC

-- Robert P Hartwig, president, Insurance Information Institute

Registration for this webcast is free online at http://www.ambest.com/healthcare10.

(By Al Slavin, senior associate editor, BestWeek)