By 2002, Randall says, it was clear that the turmoil in the industry was deep and widespread and didn't lend itself to any quick resolution. In addition, insurers' investment income has come down, lawsuits are increasing and reinsurance costs more. Health care providers face a huge challenge now and in the foreseeable future, says Randall.

"Our retail broker clients, and the health care professionals they serve, have watched with serious concern as malpractice insurers have voluntarily departed this business segment, or been forced to close. The markets that remain have issued many nonrenewal notices, major premium increases, new class and state restrictions, and coverage reductions," says the NSU president.

Even when coverage is available, he says, the search through the marketplace can be time consuming, expensive and frustrating. Underwriters now require brokers to provide more information than ever before, including written verification of losses, says Randall. "They reject any incomplete or unsigned forms. On top of this, brokers have frequently been asked to work at reduced commission rates."

As a result, he says, this $8 billion to $10 billion market is in flux. "At NSU, our mission is to bring expertise and reliability to the process. Retail brokers with health care clients are learning they can have positive expectations when they come to us. For targeted segments of the industry, we can meet the need for high-quality medical professional coverage."

Randall points out that NSU has invested in a staff of veterans from the medical professional liability industry. Brokers are eager to work with a wholesaler whose staff has health care experience, market knowledge and carrier relations, he says. "They appreciate that our people dedicate themselves 100% to malpractice insurance. We have further specialized the department by dividing our account executives between allied health care facilities and physicians."

Randall continues: "For brokers needing coverage for medical facilities, we offer a unit focused on dialysis centers, medical labs, imaging centers, surgery centers, therapy centers, home health agencies, hospice care providers, nurse staffing agencies, banks for eyes, organs, tissues and blood, as well as community clinics. For brokers whose concern is physicians, our physicians unit provides a much-needed market for individual doctors and small groups, particularly for nonstandard physicians--those who, for a variety of reasons, can't find placement in the standard marketplace."

Brokers get access to NSU's wholesale negotiating power with about 10 key insurers providing these products, Randall points out. "We work with both admitted and nonadmitted carriers, but in all cases they are well established, highly reputable companies with a long-term commitment to the industry. The insurance companies that write our primary and umbrella health care coverage have earned A.M. Best's ratings that range from A++ (Superior) to A- (Excellent). Brokers can feel very good about the market stability and claims-paying strength of the carriers we present to them. We work with brokers throughout the U.S. with very few restrictions. For qualifying risks, we can make available hard-to-find provisions such as prior acts, defense outside the limits, defense outside the deductible and expanded/extended reporting period options."

The strongest feedback NSU receives from brokers, Randall says, is in the area of customer service. "We do our very best to facilitate ease of doing business. This appears to be paying off in the health care industry. Customers tell us that, everywhere they look, terms are tougher and prices are higher than in the past; but what distinguishes NSU is that we are responsive, friendly and frank. We answer questions quickly and accurately and provide meaningful indications of availability early in the process, so nobody's time is wasted. We return calls and follow through on our commitments. It may not sound like anything extraordinary, but we are finding out that in a hard market, top-notch service is the exception, not the rule."